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1

Central sleep apnea  

MedlinePLUS

... central sleep apnea. A condition called Cheyne-Stokes respiration can mimic central sleep apnea. This involves breathing ... bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV). Some types of central sleep apnea are ...

2

Sodium oxybate-induced central sleep apneas.  

PubMed

Sodium oxybate (?-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

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

2013-09-01

3

Sleep Apnea  

MedlinePLUS

NINDS Sleep Apnea Information Page Table of Contents (click to jump to sections) What is Sleep Apnea? Is there ... Trials Organizations Additional resources from MedlinePlus What is Sleep Apnea? Sleep apnea is a common sleep disorder ...

4

Sleep Apnea  

MedlinePLUS

... is sleep apnea? Sleep apnea is a serious sleep disorder. People who have sleep apnea stop breathing for ... doctor may ask you to go to a sleep disorder center for a sleep study. Tests done at ...

5

Reversal of Central Sleep Apnea following Discontinuation of Opioids  

PubMed Central

This case report including polysomnography shows reversal of central sleep apnea after opioid withdrawal. A patient using opioids for pain was diagnosed with central sleep apnea (CSA), but was not compliant with therapy. Five years later he underwent detoxification. Subsequent polysomnography showed no sleep disordered breathing. This is the first report of correction of CSA following opioid withdrawal confirmed by polysomnogram. Citation: Davis MJ; Livingston M; Scharf SM. Reversal of central sleep apnea following discontinuation of opioids. J Clin Sleep Med 2012;8(5):579-580. PMID:23066372

Davis, Matthew J.; Livingston, Marian; Scharf, Steven M.

2012-01-01

6

Sleep Apnea  

MedlinePLUS

... their throats may have obstructive sleep apnea. The animation below shows how obstructive sleep apnea occurs. Click the "start" button to play the animation. Written and spoken explanations are provided with each ...

7

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 ...

8

Alternative approaches to treatment of Central Sleep Apnea.  

PubMed

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

Thomas, Robert Joseph

2014-03-01

9

Alternative approaches to treatment of Central Sleep Apnea  

PubMed Central

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

2013-01-01

10

Central and peripheral factors contributing to obstructive sleep apneas.  

PubMed

Apnea, the cessation of breathing, is a common physiological and pathophysiological phenomenon. Among the different forms of apnea, obstructive sleep apnea (OSA) is clinically the most prominent manifestation. OSA is characterized by repetitive airway occlusions that are typically associated with peripheral airway obstructions. However, it would be an oversimplification to conclude that OSA is caused by peripheral obstructions. OSA is the result of a dynamic interplay between chemo- and mechanosensory reflexes, neuromodulation, behavioral state and the differential activation of the central respiratory network and its motor outputs. This interplay has numerous neuronal and cardiovascular consequences that are initially adaptive but in the long-term become major contributors to morbidity and mortality. Not only OSA, but also central apneas (CA) have multiple, and partly overlapping mechanisms. In OSA and CA the underlying mechanisms are neither "exclusively peripheral" nor "exclusively central" in origin. This review discusses the complex interplay of peripheral and central nervous components that characterizes the cessation of breathing. PMID:23770311

Ramirez, Jan-Marino; Garcia, Alfredo J; Anderson, Tatiana M; Koschnitzky, Jenna E; Peng, Ying-Jie; Kumar, Ganesh K; Prabhakar, Nanduri R

2013-11-01

11

Central and Peripheral factors contributing to Obstructive Sleep Apneas  

PubMed Central

Apnea, the cessation of breathing, is a common physiological and pathophysiological phenomenon with many basic scientific and clinical implications. Among the different forms of apnea, obstructive sleep apnea (OSA) is clinically the most prominent manifestation. OSA is characterized by repetitive airway occlusions that are typically associated with peripheral airway obstructions. However, it would be a gross oversimplification to conclude that OSA is caused by peripheral obstructions. OSA is the result of a dynamic interplay between chemo- and mechanosensory reflexes, neuromodulation, behavioral state and the differential activation of the central respiratory network and its motor outputs. This interplay has numerous neuronal and cardiovascular consequences that are initially adaptive but in the long-term become major contributors to the morbidity and mortality associated with OSA. However, not only OSA, but all forms of apnea have multiple, and partly overlapping mechanisms. In all cases the underlying mechanisms are neither “exclusively peripheral” nor “exclusively central” in origin. While the emphasis has long been on the role of peripheral reflex pathways in the case of OSA, and central mechanisms in the case of central apneas, we are learning that such a separation is inconsistent with the integration of these mechanisms in all cases of apneas. This review discusses the complex interplay of peripheral and central nervous components that characterizes the cessation of breathing. PMID:23770311

Ramirez, Jan-Marino; Garcia, Alfredo J.; Anderson, Tatiana M.; Koschnitzky, Jenna E.; Peng, Ying-Jie; Kumar, Ganesh; Prabhakar, Nanduri

2013-01-01

12

Peripheral and Central Ventilatory Responses in Central Sleep Apnea with and without Congestive Heart Failure  

Microsoft Academic Search

Given that the apnea-ventilation cycle length during central sleep apnea (CSA) with congestive heart failure (CHF) is z 70 s, we hy- pothesized that rapidly responsive peripheral CO 2 ventilatory re- sponses would be raised in CHF-CSA and would correlate with the severity of CSA. Sleep studies and single breath and rebreathe hy- percapnic ventilatory responses (HCVR) were measured as

PETER SOLIN; TEANAU ROEBUCK; DAVID P. JOHNS; E. HAYDN WALTERS; MATTHEW T. NAUGHTON

2000-01-01

13

Tetraplegia is a risk factor for central sleep apnea.  

PubMed

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 ?PetCO2. 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

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

2014-02-01

14

Tetraplegia is a risk factor for central sleep apnea  

PubMed Central

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/m2) 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 ?PetCO2. 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

Bascom, Amy T.; Chowdhuri, Susmita; Badr, M. Safwan

2013-01-01

15

SLEEP APNEA: IS YOUR PATIENT  

E-print Network

............................ 3 Nasal Continuous Positive Airway Pressure .............................................. 4 Oral of sleep apnea: central and obstructive. Central sleep apnea, characterized by a lack of airflow in the absence of ventilatory effort, is rare. Obstructive sleep apnea is much more common and is referred

Bandettini, Peter A.

16

Radiation necrosis causing failure of automatic ventilation during sleep with central sleep apnea  

SciTech Connect

A patient operated upon for a midline cerebellar hemangioblastoma developed failure of automatic respiration during sleep, together with central sleep apnea syndrome, approximately two years after receiving radiation therapy to the brain. Clinical and CT scan findings were compatible with a diagnosis of radiation necrosis as the cause of his abnormal respiratory control.

Udwadia, Z.F.; Athale, S.; Misra, V.P.; Wadia, N.H.

1987-09-01

17

Sleep Apnea (For Parents)  

MedlinePLUS

... kids and teens can develop it, too. About Sleep Apnea Sleep apnea happens when a person stops ... body movements and sleep positions Back Continue Treating Sleep Apnea If enlarged tonsils or adenoids are thought ...

18

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

PubMed Central

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

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

2014-01-01

19

Snoring and Sleep Apnea  

MedlinePLUS

Snoring and Sleep Apnea Snoring and Sleep Apnea Patient Health Information News media interested in covering the latest from AAO-HNS/ ... newsroom@entnet.org . Insight into sleeping disorders and sleep apnea Forty-five percent of normal adults snore ...

20

Sleep Apnea Facts  

MedlinePLUS

... use increase the risk of sleep apnea. Continuous positive airway pressure, or CPAP, is the most common, noninvasive treatment for moderate to severe sleep apnea. © 2015 American Association for Respiratory Care

21

How Is Sleep Apnea Treated?  

MedlinePLUS

... page from the NHLBI on Twitter. How Is Sleep Apnea Treated? Sleep apnea is treated with lifestyle ... children grow. Rate This Content: Next >> Featured Video Sleep Apnea Research: The HeartBeat Study 10/14/2014 ...

22

Adaptive Servoventilation for Treatment of Opioid-Associated Central Sleep Apnea  

PubMed Central

Rationale: Opioids have become part of contemporary treatment in the management of chronic pain. Although severe daytime ventilatory depression is uncommon, chronic use of opioids could be associated with severe central and obstructive sleep apnea. Objectives: To determine the acute efficacy, and prolonged use of adaptive servoventilation (ASV) to treat central sleep apnea in patients on chronic opioids. Methods: Twenty patients on opioid therapy referred for evaluation of obstructive sleep apnea (OSA) were found to have central sleep apnea (CSA). The first 16 patients underwent continuous positive airway pressure (CPAP) titration, which showed persistent CSA. With the notion that CSA will be eliminated with continued use of CPAP, 4 weeks later, 9 of the 16 patients underwent a second CPAP titration which proved equally ineffective. Therefore, therapy with CPAP was abandoned. All patients underwent ASV titration. Main Results: Diagnostic polysomnography showed an average apnea-hypopnea index (AHI) of 61/h and a central-apnea index (CAI) of 32/h. On CPAP 1, AHI was 34/h and CAI was 20/h. Respective indices on CPAP 2 were AHI 33/h and CAI 19/h. During titration with ASV, CAI was 0/h and the average HI was 11/h on final pressures. With a reduction in AHI, oxyhemoglobin saturation nadir increased from 83% to 90%, and arousal index decreased from 29/h of sleep to 12/h on final ASV pressures. Seventeen patients were followed for a minimum of 9 months and up to 6 years. The mean long-term adherence was 5.1 ± 2.5 hours. Conclusions: Chronic use of opioids could be associated with severe CSA which remains resistant to CPAP therapy. ASV device is effective in the treatment of CSA and over the long run, most patients remain compliant with the device. Randomized long-term studies are necessary to determine if treatment of sleep apnea with ASV improves quality of life and the known mortality associated with opioids. Citation: Javaheri S, Harris N, Howard J, Chung E. Adaptive servoventilation for treatment of opioid-associated central sleep apnea. J Clin Sleep Med 2014;10(6):637-643. PMID:24932143

Javaheri, Shahrokh; Harris, Nicholas; Howard, Joseph; Chung, Eugene

2014-01-01

23

Recognizing pediatric sleep apnea.  

PubMed

Obstructive sleep apnea is a common condition in childhood and has a significant impact on health, learning, academic performance, and quality of life. The purpose of this article is to review the epidemiology, etiology, risk factors, clinical presentation, diagnostic procedures, and treatment of obstructive sleep apnea. PMID:25036250

Weiss, Miriam; Owens, Judith

2014-08-16

24

Sleep Apnea and Hypertension  

Microsoft Academic Search

\\u000a Sleep disordered breathing (SDB) encompasses all forms of respiratory disorders specific to sleep (1). There is a spectrum of SDB ranging from mild to severe with the most severe form being obstructive sleep apnea (OSA) (2). In adults, OSA has been linked to cardiovascular disease, specifically hypertension (HTN) (3). The association between systemic HTN and OSA is well documented in

Alisa A. Acosta

25

Obstructive Sleep Apnea  

NSDL National Science Digital Library

Physiology in Medicine review article Obstructive sleep apnea is an increasingly common disorder that is strongly linked to obesity. Neurocognitive sequelae, such as daytime sleepiness and impaired executive function, are important factors in motor vehicle accidents and probably contribute to loss of work-related productivity. Metabolic abnormalities in obstructive sleep apnea appear to be mediated in part by insulin resistance, which may be independent of body weight, and by the dysregulation of leptin.

DDS/DO Sean M. Caples (Mayo Clinic Pulmonary and Critical Care Medicine)

2005-02-01

26

Risk Factors for Central and Obstructive Sleep Apnea in 450 Men And Women with Congestive Heart Failure  

Microsoft Academic Search

In previous analyses of the occurrence of central (CSA) and obstructive sleep apnea (OSA) in patients with congestive heart failure (CHF), only men were studied and risk factors for these disorders were not well characterized. We therefore analyzed risk factors for CSA and OSA in 450 consecutive pa- tients with CHF (382 male, 68 female) referred to our sleep laboratory.

DON D. SIN; FABIA FITZGERALD; JOHN D. PARKER; GARY NEWTON; JOHN S. FLORAS; T. DOUGLAS BRADLEY

1999-01-01

27

Influence of Cerebral Blood Flow on Central Sleep Apnea at High Altitude  

PubMed Central

Study Objectives: To further our understanding of central sleep apnea (CSA) at high altitude during acclimatization, we tested the hypothesis that pharmacologically altering cerebral blood flow (CBF) would alter the severity of CSA at high altitude. Design: The study was a randomized, placebo-controlled single-blind study. Setting: A field study at 5,050 m in Nepal. Patients or Participants: We studied 12 normal volunteers. Interventions: Between days 5 to10 at high altitude, CBF velocity (CBFv) was increased by intravenous (IV) acetazolamide (10 mg/kg) and reduced by oral indomethacin (100 mg). Measurements and Results: Arterial blood gases, hypoxic and hypercapnic ventilatory responses, and CBFv and its reactivity to carbon dioxide were measured awake. Overnight polysomnography was performed. The central apnea-hypopnea index was elevated following administration of indomethacin (89.2 ± 43.7 to 112.5 ± 32.9 events/h; mean ± standard deviation; P < 0.05) and was reduced following IV acetazolamide (89.2 ± 43.7 to 47.1 ± 48.1 events/h; P < 0.001). Intravenous acetazolamide elevated CBFv at high altitude by 28% (95% confidence interval [CI]: 22-34%) but did not affect ventilatory responses. The elevation in CBFv was partly mediated via a selective rise in partial pressure of arterial carbon dioxide (PaCO2) (28 ± 4 to 31 ± 3 mm Hg) and an associated fall in pH (P < 0.01). Oral indomethacin reduced CBFv by 23% (95% CI: 16-30%), blunted CBFv reactivity, and increased the hypercapnic ventilatory response by 66% (95% CI: 30-102%) but had no effect on PaCO2 or pH. Conclusion: Our findings indicate an important role for cerebral blood flow regulation in the pathophysiology of central sleep apnea at high altitude. Citation: Burgess KR, Lucas SJE, Shepherd K, Dawson A, Swart M, Thomas KN, Lucas RAI, Donnelly J, Peebles KC, Basnyat R, Ainslie PN. Influence of cerebral blood flow on central sleep apnea at high altitude. SLEEP 2014;37(10):1679-1687. PMID:25197804

Burgess, Keith R.; Lucas, Samuel J.E.; Shepherd, Kelly; Dawson, Andrew; Swart, Marianne; Thomas, Kate N.; Lucas, Rebekah A.I.; Donnelly, Joseph; Peebles, Karen C.; Basnyat, Rishi; Ainslie, Philip N.

2014-01-01

28

Dreams in Sleep Apnea Patients  

Microsoft Academic Search

The present study was undertaken to investigate the influence of apneas on REM-elicited dream reports, and to examine the influence of clinically successful treatment of the apneas on dreaming. Thirty-three volunteers suffering from sleep apnea syndrome (SAS) slept during two nights in the sleep laboratory. Sixteen were treated with nasal continuous positive air pressure (CPAP) during the first night and

M. Gross; P. Lavie

1994-01-01

29

Mechanisms and Clinical Consequences of Untreated Central Sleep Apnea in Heart Failure  

PubMed Central

Central sleep apnea (CSA) is a highly prevalent, though often unrecognized, comorbidity in patients with heart failure (HF). Data from HF population studies suggest that it may present in 30% to 50% of HF patients. CSA is recognized as an important contributor to the progression of HF and to HF-related morbidity and mortality. Over the past 2 decades, an expanding body of research has begun to shed light on the pathophysiologic mechanisms of CSA. Armed with this growing knowledge base, the sleep, respiratory, and cardiovascular research communities have been working to identify ways to treat CSA in HF with the ultimate goal of improving patient quality of life and clinical outcomes. In this paper, we examine the current state of knowledge about the mechanisms of CSA in HF and review emerging therapies for this disorder. PMID:25572513

Costanzo, Maria Rosa; Khayat, Rami; Ponikowski, Piotr; Augostini, Ralph; Stellbrink, Christoph; Mianulli, Marcus; Abraham, William T.

2015-01-01

30

A novel therapeutic approach for the treatment of central sleep apnea: The remed?® system.  

PubMed

Central sleep apnea (CSA) occurs primarily in cardiovascular patients and is associated with high morbidity and mortality. The disorder often is unrecognized due to the overlap of symptoms with those of the underlying cardiac disease. CSA can be easily diagnosed with a sleep study. Following optimization of all co-morbidities, the therapeutic approach available currently focuses on mask-based therapies which suffer from poor patient adherence. A new therapy, the remed?® System, has been developed; it utilizes a transvenous, fully implantable system providing phrenic nerve stimulation intended to restore a more normal breathing pattern. The therapy demonstrated promising results based on an initial chronic study and a randomized trial is underway to further evaluate safety and efficacy of this novel system in patients with CSA. PMID:24726495

Germany, Robin; Joseph, Susan; James, Kristofer; Kao, Andrew

2014-06-01

31

Relation of Central Fat Mass to Obstructive Sleep Apnea in the Elderly  

PubMed Central

Study Objectives: Obesity is a recognized risk factor for obstructive sleep apnea syndrome (OSAS). We evaluated whether total trunk and central fat mass (CFM) is associated with OSAS in elderly subjects. Design: Cross-sectional. Setting: Body composition assessment by dual-energy X-ray absorbsiometry (DEXA). Participants: 749 volunteers aged 67.2 ± 0.8 years (59.4% women). Intervention: All participants underwent evaluation of their body composition by DEXA in parallel with clinical and polygraphic assessments. The presence of OSAS was defined by an apnea plus hypopnea index (AHI) ? 15. Measurements and Results: A total of 44.8% of the population had an AHI < 15, and 55.2% presented OSAS. OSAS subjects were more frequently overweight and had a higher total trunk fat mass and central fat mass (CFM). Correlation analyses revealed that body mass index (r = 0.27, P < 0.001), neck circumference (r = 0.35, P < 0.001), and CFM (r = 0.23, P < 0.001) were significantly related to AHI. Logistic regression analysis indicated that in mild OSAS cases (> 15AHI < 30), BMI (OR: 1.10; 95% CI: 1.03-1.18; P = 0.008), and male gender (OR: 1.49; 95% CI: 1.05-2.12, P = 0.03) were key factors explaining an AHI between 15 and 30. In severe cases (AHI > 30), male gender (OR: 3.65; 95% CI: 2.40-5.55; P < 0.001) and CFM (OR: 1.10; 95% CI: 1.03-1.19; P = 0.009) were significant independent predictors of OSAS. Clinical Trial Registration: NCT 00759304 and NCT 00766584. Conclusions: Although central fat mass plays a role in the occurrence of severe OSAS in men older than 65 years of age, its low discriminative sensitivity in mild OSAS cases does not warrant systematic use of DEXA for the diagnosis of OSAS. Citation: Degache F; Sforza E; Dauphinot V; Celle S; Garcin A; Collet P; Pichot V; Barthélémy JC; Roche F. Relation of central fat mass to obstructive sleep apnea in the elderly. SLEEP 2013;36(4):501-507. PMID:23564997

Degache, Francis; Sforza, Emilia; Dauphinot, Virginie; Celle, Sébastien; Garcin, Arnauld; Collet, Philippe; Pichot, Vincent; Barthélémy, Jean-Claude; Roche, Frédéric

2013-01-01

32

[Sleep apnea syndrome: SAS].  

PubMed

Obstructive sleep apnea (OSA) is an independent risk factor for hypertension and cardiovascular disease. OSA is the frequent underlying disease of secondary hypertension and resistant hypertension. In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure recognized sleep apnea as a common and identifiable cause of hypertension and suggested blood pressure screening among patients with OSA. OSA increases both daytime and nocturnal ambulatory blood pressures through the activation of various neurohumoral factors including the sympathetic nervous system and the renin-angiotensin-aldosterone system. Randomized, controlled trials have evaluated the use of continuous positive airway pressure (CPAP) to reduce BP among persons with OSA. The benefits of OSA treatment are related to implications for hypertension management. PMID:25167750

Osada, Naohiko

2014-08-01

33

Treatment of complex sleep apnea syndrome.  

PubMed

Patients with complex sleep apnea syndrome (CompSAS) present with features of obstructive sleep apnea syndrome but demonstrate not only instability of upper airway tone (leading to classic obstructive apneas and hypopneas) but also unstable, chemosensitive ventilatory control leading to repetitive central apneas or periodic breathing during sleep. The central apneas often become most apparent after application of continuous positive airway pressure (CPAP) to alleviate upper airway obstruction; patients continue to have fragmented sleep and repetitive desaturations as a result of central apneas and hypopneas. In some patients, central apneas appear to abate over time as a result of some form of adaptation to CPAP. How often this occurs is uncertain, however, and many patients with CompSAS require treatment that combines stabilization of the upper airway obstruction with treatment of respiratory center dysfunction. Adaptive servo-ventilation, which provides both a minimum pressure to hold the airway open and a precisely calculated ventilatory assist to minimize cyclic hypoventilation and hyperventilation, has emerged as a leading treatment. Noninvasive ventilation using bilevel positive airway pressure in the spontaneous-timed mode also may regulate ventilation in some patients with CompSAS. There is anecdotal evidence that CompSAS may be successfully treated using combined PAP therapy with oxygen, carbon dioxide, or the addition of dead space, but data are not sufficient to routinely recommend these methods. PMID:18782506

Ku?niar, Tomasz J; Morgenthaler, Timothy I

2008-09-01

34

Always Tired? You May Have Sleep Apnea  

MedlinePLUS

... Consumers Consumer Updates Always Tired? You May Have Sleep Apnea Search the Consumer Updates Section CPAP machines, ... Stimulation (UAS) System. back to top What is Sleep Apnea? The Greek word "apnea" literally means "without ...

35

Obstructive Sleep Apnea in Children: Implications for the Developing Central Nervous System  

PubMed Central

Recent increases in our awareness to the high prevalence of sleep disorders in general, and of sleep-disordered breathing among children, in particular, has led to concentrated efforts aiming to understand the pathophysiological mechanisms, clinical manifestations and potential consequences of such conditions. In this review, I will briefly elaborate on some of the pathogenetic elements leading to the occurrence of obstructive sleep apnea (OSA) in children, focus on the psycho-behavioral consequences of pediatric OSA, and review the evidence on the potential mechanisms underlying the close association between CNS morbidity and the episodic hypoxia and sleep fragmentation that characterize OSA. PMID:18555196

Gozal, David

2008-01-01

36

What Can You Do About Sleep Apnea?  

MedlinePLUS Videos and Cool Tools

... 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 ...

37

Bilateral and Simultaneous Central Retinal Vein Occlusion in a Patient with Obstructive Sleep Apnea Syndrome  

PubMed Central

Purpose To describe a case of bilateral and simultaneous central retinal vein occlusion (RVO) in a young patient diagnosed with obstructive sleep apnea syndrome (OSAS). Case Report A 38-year-old man with morbid obesity and daytime sleepiness presented with a history of bilateral vision loss. His visual acuity (VA) was hand movements, and fundus examination (FE) revealed bilateral central RVO. General medical examination revealed untreated hypertension and type II respiratory failure. Laboratory tests for thrombophilia showed increased hematocrit (59%) and high levels of fibrinogen and C-reactive protein. Other causes of congenital and acquired hypercoagulability were ruled out. Pathologic polysomnography led to the diagnosis of OSAS. The patient was treated with antihypertensive drugs and continuous positive air pressure. In addition, he received intravitreal ranibizumab. At 10 months after presentation, his VA was no light perception in the right eye and hand movements in the left eye. FE revealed bilateral retinal and optic nerve atrophy, and the occurrence of a nonarteritic anterior ischemic neuropathy in the right eye was considered. PMID:24987364

Govetto, Andrea; Domínguez, Ramón; Rojas, Laura; Pereiro, María; Lorente, Ramón

2014-01-01

38

Thermal Vision for Sleep Apnea Monitoring , Ioannis Pavlidis1  

E-print Network

to metabolic, organic, central nervous system, and endocrine ailments [1]. Therefore, there is a strong need for the detection of sleep apnea syndrome. It is a multi-channel wired signal acquisition system which typically

39

Obstructive sleep apnea  

MedlinePLUS

... Avoid sleeping on your back Lose excess weight Continuous positive airway pressure (CPAP) devices work best to ... McArdle N, Singh B, Murphy M, et al. Continuous positive airway pressure titration for obstructive sleep apnoea: ...

40

Sleep Apnea Detection  

MedlinePLUS

... to Later Sleep Onset in Children Parents Often Need After-Hours Child Sleep Advice HealthyChildren.org Post-it Notes Newborn Intensive Care, 3rd ... Young Adult Privacy Policy Terms of Use Sponsor ...

41

Sleep apnea syndrome after irradiation of the neck  

SciTech Connect

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.

Herlihy, J.P.; Whitlock, W.L.; Dietrich, R.A.; Shaw, T. (Pulmonary Disease Service, Presidio of San Francisco, CA (USA))

1989-12-01

42

nCPAP Treatment of Obstructive Sleep Apnea Increases Slow Wave Sleep in Prefrontal EEG  

Microsoft Academic Search

According to standard sleep stage scoring, sleep EEG is studied from the central area of parietal lobes. However, slow wave sleep (SWS) has been found to be more powerful in frontal areas in healthy subjects. Obstructive sleep apnea syndrome (OSAS) patients often suffer from functional disturbances in prefrontal lobes.We studied the effects of nasal Continuous Positive Airway Pressure (nCPAP) treatment

Veera Eskelinen; Toomas Uibu; Sari-Leena Himanen

2007-01-01

43

Wireless remote monitoring system for sleep apnea  

NASA Astrophysics Data System (ADS)

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.

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

2011-04-01

44

Brainstem Involvement as a Cause of Central Sleep Apnea: Pattern of Microstructural Cerebral Damage in Patients with Cerebral Microangiopathy  

PubMed Central

Background The exact underlying pathomechanism of central sleep apnea with Cheyne-Stokes respiration (CSA-CSR) is still unclear. Recent studies have demonstrated an association between cerebral white matter changes and CSA. A dysfunction of central respiratory control centers in the brainstem was suggested by some authors. Novel MR-imaging analysis tools now allow far more subtle assessment of microstructural cerebral changes. The aim of this study was to investigate whether and what severity of subtle structural cerebral changes could lead to CSA-CSR, and whether there is a specific pattern of neurodegenerative changes that cause CSR. Therefore, we examined patients with Fabry disease (FD), an inherited, lysosomal storage disease. White matter lesions are early and frequent findings in FD. Thus, FD can serve as a "model disease" of cerebral microangiopathy to study in more detail the impact of cerebral lesions on central sleep apnea. Patients and Methods Genetically proven FD patients (n?=?23) and age-matched healthy controls (n?=?44) underwent a cardio-respiratory polysomnography and brain MRI at 3.0 Tesla. We applied different MR-imaging techniques, ranging from semiquantitative measurement of white matter lesion (WML) volumes and automated calculation of brain tissue volumes to VBM of gray matter and voxel-based diffusion tensor imaging (DTI) analysis. Results In 5 of 23 Fabry patients (22%) CSA-CSR was detected. Voxel-based DTI analysis revealed widespread structural changes in FD patients when compared to the healthy controls. When calculated as a separate group, DTI changes of CSA-CSR patients were most prominent in the brainstem. Voxel-based regression analysis revealed a significant association between CSR severity and microstructural DTI changes within the brainstem. Conclusion Subtle microstructural changes in the brainstem might be a neuroanatomical correlate of CSA-CSR in patients at risk of WML. DTI is more sensitive and specific than conventional structural MRI and other advanced MR analyses tools in demonstrating these abnormalities. PMID:23637744

Duning, Thomas; Deppe, Michael; Brand, Eva; Stypmann, Jörg; Becht, Charlotte; Heidbreder, Anna; Young, Peter

2013-01-01

45

Sleep apnea syndrome and cognition.  

PubMed

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by repetitive episodes of airflow cessation resulting in brief arousals and intermittent hypoxemia. Several studies have documented significant daytime cognitive and behavioral dysfunction that seems to extend beyond that associated with simple sleepiness and that persists in some patients after therapeutic intervention. A still unanswered question is whether cognitive symptoms in OSA are primarily a consequence of sleep fragmentation and hypoxemia, or whether they coexist independently from OSA. Moreover, very little is known about OSA effects on cognitive performances in the elderly in whom an increased prevalence of OSA is present. In this review we will consider recent reports in the association between sleep apnea and cognition, with specific interest in elderly subjects, in whom sleep disturbances and age-related cognitive decline naturally occur. This will allow us to elucidate the behavioral and cognitive functions in OSA patients and to gain insight into age differences in the cognitive impairment. Clinically, these outcomes will aid clinicians in the evaluation of diurnal consequences of OSA and the need to propose early treatment. PMID:22661967

Sforza, Emilia; Roche, Frédéric

2012-01-01

46

Sleep Apnea and Dementia  

MedlinePLUS Videos and Cool Tools

... tissue. The researchers conducted sleep tests on 167 men who were 71 to 93 years old, and ... and plaques and tangles associated with Alzheimer’s disease. Men who spent the most time with lower than ...

47

Effects of nocturnal oxygen therapy in patients with chronic heart failure and central sleep apnea: CHF-HOT study.  

PubMed

It was previously reported that nocturnal home oxygen therapy (HOT) significantly improved not only sleep disordered breathing (SDB), but also quality of life (QOL) and left ventricular ejection fraction (LVEF) in two trials. To strengthen the statistical reliability of the above efficacies of HOT and to assess the effects of 12-week nocturnal HOT on suppression of ventricular arrhythmias, we combined the two trials and undertook a post hoc analysis. Ninety-seven patients with chronic heart failure (CHF) and central sleep apnea were assigned to receive HOT (45 patients) or not (52 patients). HOT resulted in greater reduction in the apnea-hypopnea index (AHI) (-11.4 ± 11.0 vs. -0.2 ± 7.6 events/h, p < 0.01), which is associated with greater improvement in the Specific Activity Scale (0.8 ± 1.2 vs. 0.0 ± 0.6, p < 0.01), New York Heart Association (NYHA) functional class (p < 0.01), and LVEF (p = 0.06). Median number of premature ventricular contraction (PVC) at baseline was 17 beats per hour in both the HOT and the control groups. Overall improvements of PVCs were not different either in the HOT group or in the control. However, in 12 patients with NYHA >III and AHI >20 events/h, PVC was significantly improved by HOT with a marked reduction in AHI and a substantial increase in LVEF. In conclusion, among patients with CHF and CSA, HOT improves SDB, QOL, and cardiac function. The effectiveness of HOT for ventricular arrhythmias was not observed in the overall analysis, but only in a limited number of patients with severe CHF and SDB. To clarify the effects of HOT on ventricular arrhythmias in patients with CHF and SDB, a further study is needed. PMID:25348726

Nakao, Yoko M; Ueshima, Kenji; Yasuno, Shinji; Sasayama, Shigetake

2014-10-28

48

Chiari 1 Malformation Presenting as Central Sleep Apnea during Pregnancy: A Case Report, Treatment Considerations, and Review of the Literature  

PubMed Central

Purpose: Chiari malformation (CM) type-1 frequently causes obstructive or central sleep-disordered breathing (SDB) in both adults and children, although SDB is relatively rare as a presenting manifestation in the absence of other neurological symptoms. The definitive treatment of symptomatic CM is surgical decompression. We report a case that is, to our knowledge, a novel manifestation of central sleep apnea (CSA) due to CM type-1 with severe exacerbation and initial clinical presentation during pregnancy. Methods: Case report from tertiary care comprehensive sleep medicine center with literature review of SDB manifestations associated with CM type-1. PubMed search was conducted between January 1982 and October 2013. Results: We report a 25-year-old woman with severe CSA initially presenting during her first pregnancy that eventually proved to be caused by CM type-1. The patient was successfully treated preoperatively by adaptive servoventilation (ASV), with effective resolution of SDB following surgical decompression, and without recurrence in a subsequent pregnancy. Our literature review found that 58% of CM patients with SDB had OSA alone, 28% had CSA alone, 8 (10%) had mixed OSA/CSA, and 6 (8%) had hypoventilation. Of CM patients presenting with SDB, 50% had OSA, 42% had CSA, 8% had mixed OSA/CSA, and 10.4% had hypoventilation. We speculate that CSA may develop in CM patients in whom brainstem compression results in excessive central chemoreflex sensitivity with consequent hypocapnic CSA. Conclusion: Chiari malformation type-1 may present with a diversity of SDB manifestations, and timely recognition and surgical referral are necessary to prevent further neurological deficits. ASV therapy can effectively manage CSA caused by CM type-1, which may initially present during pregnancy. PMID:25386156

St. Louis, Erik K.; Jinnur, Praveen; McCarter, Stuart J.; Duwell, Ethan J.; Benarroch, Eduardo E.; Kantarci, Kejal; Pichelmann, Mark A.; Silber, Michael H.; Boeve, Bradley F.; Olson, Eric J.; Morgenthaler, Timothy I.; Somers, Virend K.

2014-01-01

49

Hypertension and obstructive sleep apnea  

PubMed Central

Obstructive sleep apnea (OSA) is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined. PMID:23750107

Phillips, Craig L; O’Driscoll, Denise M

2013-01-01

50

Epidemiology of obstructive sleep apnea: a population health perspective.  

PubMed

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority. PMID:11991871

Young, Terry; Peppard, Paul E; Gottlieb, Daniel J

2002-05-01

51

Sleep apnea in patients with hemispheric stroke  

Microsoft Academic Search

Sleep pattern and breathing in humans are altered following cerebrovascular accidents involving the brainstem. Sleep apnea is a well-established complication of stroke involving the brainstem. On the other hand, the effect of cerebral stroke on sleep and breathing has not been well defined. The diffuse cerebral symptoms such as cognitive deficits, depression or fatigue, after hemispheric stroke mimic those present

Vahid Mohsenin; Raul Valor

1995-01-01

52

Impaired cerebral autoregulation in obstructive sleep apnea  

NSDL National Science Digital Library

Obstructive sleep apnea (OSA) increases the risk of stroke independent of known vascular and metabolic risk factors. Although patients with OSA have higher prevalence of hypertension and evidence of hypercoagulability, the mechanism of this increased risk is unknown. Obstructive apnea events are associated with surges in blood pressure, hypercapnia, and fluctuations in cerebral blood flow. These perturbations can adversely affect the cerebral circulation.

Fred Urbano (Yale University School of Medicine and Center for Sleep Center)

2008-10-08

53

Dream content of patients with sleep apnea  

Microsoft Academic Search

Summary  Previous research has shown that external stimuli were often incorporated into the dream to some extend. The aim of the present\\u000a study was to investigate whether the internal stimulus sleep apnea is also incorporated into dreams. Findings showed, however,\\u000a that direct incorporation occurs very seldom. On the other hand, arousals accompanying sleep apneas seem to interfere with\\u000a dream formation since

M. Schredl; Beate Kraft-Schneider; H. Kröger; Isabella Heuser

1999-01-01

54

Central Sleep Apnea in Left Ventricular Dysfunction Prevalence and Implications for Arrhythmic Risk  

Microsoft Academic Search

Background—The prevalence and characteristics of sleep-disordered breathing in patients with asymptomatic left ventricular (LV) dysfunction are unknown. Therefore, we evaluated the prevalence of sleep-disordered breathing in patients with LV dysfunction without overt heart failure and tested the hypothesis that sleep-disordered breathing is linked to greater hemodynamic and autonomic impairment. Methods and Results—We studied 47 patients with LV ejection fractions 40%

Paola A. Lanfranchi; Virend K. Somers; Alberto Braghiroli; Ugo Corra; Ermanno Eleuteri; Pantaleo Giannuzzi

55

Obstructive Sleep Apnea Due To Extrathoracic Tracheomalacia  

PubMed Central

We report obstructive sleep apnea in a 3-year-old boy with tracheomalacia secondary to tracheotomy that resolved after placement of a metallic stent in the region of tracheomalacia. The tracheal location of obstruction during sleep in this case contrasts with the usual location in the pharynx or, less often, the larynx. This case also demonstrates the utility of polysomnography in managing decannulation of tracheostomies. Citation: Muzumdar H; Nandalike K; Bent J; Arens R. Obstructive sleep apnea due to extrathoracic tracheomalacia. J Clin Sleep Med 2013;9(2):163–164. PMID:23372471

Muzumdar, Hiren; Nandalike, K.; Bent, J.; Arens, Raanan

2013-01-01

56

Dental treatment of a patient with central sleep apnea and phobic anxiety under sedation: report of a case and clinical considerations.  

PubMed

Central sleep apnea (CSA) results from a reduction in lack of output from the central respiratory generator in the brainstem, manifesting as apneas and hypopneas without discernible efforts. CSA can lead to hypercarbia, arrhythmias, pulmonary hypertension, and heart failure. Indeed, the patient may develop a disturbed breathing during sedation procedures. We report a patient who was diagnosed with CSA and had been on continuous positive airway pressure (CPAP) therapy for 5 years. He was referred for multiple tooth extractions under sedation owing to severe gag reflex and phobic anxiety disorder. The treatment was completed uneventfully under N(2)O and sevoflurane inhalation accompanied by midazolam and ketamine induction. The role of sedative, analgesic, and anesthetic agents as a precipitating factor for CSA is of particular concern. The combined administration of midazolam, ketamine, sevoflurane, and N(2)O/O(2) is a useful and safe option for patients requiring sedation. PMID:23083486

K?l?nç, Yeliz; I??k, Berrin

2012-11-01

57

Study Finds a Connection between Glaucoma and Sleep Apnea  

MedlinePLUS

... Alerts Study Finds a Connection Between Glaucoma and Sleep Apnea Tweet Eye Health Lifestyle Topics Preventing Eye ... Follow Us New research shows that those with sleep apnea are more likely to develop glaucoma Over ...

58

77 FR 25226 - Proposed Recommendations on Obstructive Sleep Apnea  

Federal Register 2010, 2011, 2012, 2013, 2014

...FMCSA-2012-0102] Proposed Recommendations on Obstructive Sleep Apnea AGENCY: Federal Motor Carrier Safety Administration...withdrawing its proposed regulatory guidance for obstructive sleep apnea (OSA) and request for comment as published on...

2012-04-27

59

Asthma Tied to Higher Risk of Sleep Apnea  

MedlinePLUS

... enable JavaScript. Asthma Tied to Higher Risk of Sleep Apnea The longer a person had asthma, the ... Tuesday, January 13, 2015 Related MedlinePlus Pages Asthma Sleep Apnea TUESDAY, Jan. 13, 2015 (HealthDay News) -- Two ...

60

Obesity accentuates circadian variability in breathing during sleep in mice but does not predispose to apnea  

PubMed Central

Obesity is a primary risk factor for the development of obstructive sleep apnea in humans, but the impact of obesity on central sleep apnea is less clear. Given the comorbidities associated with obesity in humans, we developed techniques for long-term recording of diaphragmatic EMG activity and polysomnography in obese mice to assess breathing patterns during sleep and to determine the effect of obesity on apnea generation. We hypothesized that genetically obese ob/ob mice would exhibit less variability in breathing across the 24-h circadian cycle, be more prone to central apneas, and be more likely to exhibit patterns of increased diaphragm muscle activity consistent with obstructive apneas compared with lean mice. Unexpectedly, we found that obese mice exhibited a greater circadian impact on respiratory rate and diaphragmatic burst amplitude than lean mice, particularly during rapid eye movement (REM) sleep. Central apneas were more common in REM sleep (42 ± 17 h?1) than non-REM (NREM) sleep (14 ± 5 h?1) in obese mice (P < 0.05), but rates were not different between lean and obese mice in either sleep state. Even after experimentally enhancing central apnea generation by acute withdrawal of hypoxic chemoreceptor activation during sleep, central apnea rates remained comparable between lean and obese mice. Last, we were unable to detect patterns of diaphragmatic burst activity suggestive of obstructive apnea events in obese mice. In summary, obesity does not predispose mice to increased occurrence of central or obstructive apneas during sleep, but does lead to a more pronounced circadian variability in respiration. PMID:23722707

Locke, Landon W.; McDowell, Angela L.; Strollo, Patrick J.; O'Donnell, Christopher P.

2013-01-01

61

Intermittent hypoxia from obstructive sleep apnea may cause neuronal impairment and dysfunction in central nervous system: the potential roles played by microglia  

PubMed Central

Obstructive sleep apnea (OSA) is a common condition characterized by repetitive episodes of complete (apnea) or partial (hypopnea) obstruction of the upper airway during sleep, resulting in oxygen desaturation and arousal from sleep. Intermittent hypoxia (IH) resulting from OSA may cause structural neuron damage and dysfunction in the central nervous system (CNS). Clinically, it manifests as neurocognitive and behavioral deficits with oxidative stress and inflammatory impairment as its pathophysiological basis, which are mediated by microglia at the cellular level. Microglia are dominant proinflammatory cells in the CNS. They induce CNS oxidative stress and inflammation, mainly through mitochondria, reduced nicotinamide adenine dinucleotide phosphate oxidase, and the release of excitatory toxic neurotransmitters. The balance between neurotoxic versus protective and anti- versus proinflammatory microglial factors might determine the final roles of microglia after IH exposure from OSA. Microglia inflammatory impairments will continue and cascade persistently upon activation, ultimately resulting in clinically significant neuron damage and dysfunction in the CNS. In this review article, we summarize the mechanisms of structural neuron damage in the CNS and its concomitant dysfunction due to IH from OSA, and the potential roles played by microglia in this process. PMID:23950649

Yang, Qingchan; Wang, Yan; Feng, Jing; Cao, Jie; Chen, Baoyuan

2013-01-01

62

Intact implicit probabilistic sequence learning in obstructive sleep apnea  

E-print Network

is characterized by repeated episodes of upper airway obstruction during sleep, resulting in hypoxia which leadsIntact implicit probabilistic sequence learning in obstructive sleep apnea D E Z S O N E M E T H 1, obstructive sleep apnea, sequence learning, sleep Correspondence Dezso Nemeth, PhD, Institute of Psychology

Nemeth, Dezso

63

Obstructive sleep apnea due to extrathoracic tracheomalacia.  

PubMed

We report obstructive sleep apnea in a 3-year-old boy with tracheomalacia secondary to tracheotomy that resolved after placement of a metallic stent in the region of tracheomalacia. The tracheal location of obstruction during sleep in this case contrasts with the usual location in the pharynx or, less often, the larynx. This case also demonstrates the utility of polysomnography in managing decannulation of tracheostomies. PMID:23372471

Muzumdar, Hiren; Nandalike, K; Bent, J; Arens, Raanan

2013-02-01

64

Epidemiology of Pediatric Obstructive Sleep Apnea  

Microsoft Academic Search

Pediatric obstructive sleep apnea (OSA) has become widely recog- nized only in the last few decades as a likely cause of significant morbidity among children. Many of the clinical characteristics of pediatricOSA,andthedeterminantsofitsepidemiology,differfrom those of adult OSA. We systematically reviewed studies on the epidemiology of conditions considered part of a pediatric sleep- disordered breathing (SDB) continuum, ranging from primary snoringtoOSA.Wehighlightanumberofmethodologicchallenges, including

Julie C. Lumeng; Ronald D. Chervin

2008-01-01

65

Obstructive sleep apnea: awakening the hidden truth.  

PubMed

Obstructive sleep apnea (OSA) is a common type of sleep apnea and is caused by obstruction of upper airway. Sleep apnea is clinically defined as frequent episodes of apnea, hypopnea and symptoms of functional impairment, which could be life-threatening and associated with extreme daytime hyper somnolence, dysfunction, discrements in health-related quality of life, automobile accidents, and cardiovascular morbidity and mortality. Etiopathogenic factors that contribute to OSA include reduced upper-airway dilator muscle activity during sleep, upper-airway anatomical features, ventilatory control insufficiency, lung volume, and rostral fluid shifts. The presence of risk factors such as age, gender and obesity increases the incidence of OSA. The repetitive nocturnal hypoxemia experienced by patients with OSA is associated with activation of a number of neural, humoral, thrombotic, metabolic, and inflammatory disease mechanisms, all of which have also been implicated in the pathophysiology of various systemic diseases. This article summarizes the etiopathogenesis, epidemiology, associated systemic diseases such as cardiovascular diseases, diabetes, and dental diseases with OSA and the influence of tongue on oropharyngeal airway in OSA patients. PMID:25511335

Viswanath, A; Ramamurthy, J; Dinesh, S P S; Srinivas, A

2015-01-01

66

Sleep Apnea and Heart Disease, Stroke  

MedlinePLUS

Sleep Apnea and Heart Disease, Stroke Updated:Jan 6,2015 Plain old snoring can get a little annoying, especially for someone listening to it. ... high blood pressure , arrhythmia , stroke and heart failure . Heart disease is the leading cause of death in America, ...

67

On the Use of Smartphones for Detecting Obstructive Sleep Apnea Abstract--Obstructive Sleep Apnea (OSA) is a common  

E-print Network

(OSA) is a common sleep disorder which is characterized by recurrent blockage of the upper airway sleeping disorder. In most cases, the patient is unaware of the breath stoppages because the body doesOn the Use of Smartphones for Detecting Obstructive Sleep Apnea Abstract--Obstructive Sleep Apnea

Aloul, Fadi

68

Obstructive Sleep Apnea, Immuno-Inflammation and Atherosclerosis  

E-print Network

Obstructive Sleep Apnea, Immuno-Inflammation and Atherosclerosis Claire Arnaud1,2 , Maurice;31(1):113-25" DOI : 10.1007/s00281-009-0148-5 #12;2 ABSTRACT Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder leading to cardiovascular and metabolic complications. OSA is also a multicomponent

Paris-Sud XI, Université de

69

The linkage of allergic rhinitis and obstructive sleep apnea.  

PubMed

Rhinitis can be divided into allergic and non-allergic rhinitis. Rhinitis, particularly allergic rhinitis, has been shown to be associated with obstructive sleep apnea; a condition characterized by repetitive upper airway obstruction during sleep. Allergic rhinitis increases the risk of developing obstructive sleep apnea by two major mechanisms: 1) increase in airway resistance due to higher nasal resistance and 2) reduction in pharyngeal diameter from mouth breathing that moves the mandible inferiorly. Other inflammatory mediators including histamine, CysLTs, IL 1? and IL-4 found in high levels in allergic rhinitis, have also been shown to worsen sleep quality in obstructive sleep apnea. Prior studies have shown that treatment of allergic rhinitis, particularly when intranasal steroid are used, improved obstructive sleep apnea. Leukotriene receptor antagonists were also associated with positive results on obstructive sleep apnea in adult patients with concomitant allergic rhinitis but current data are limited in the case of children. PMID:25543037

Chirakalwasan, Naricha; Ruxrungtham, Kiat

2014-12-01

70

CPAP versus Oxygen in Obstructive Sleep Apnea  

PubMed Central

Background Obstructive sleep apnea is associated with hypertension, inflammation, and increased cardiovascular risk. Continuous positive airway pressure (CPAP) reduces blood pressure, but adherence is often suboptimal, and the benefit beyond management of conventional risk factors is uncertain. Since intermittent hypoxemia may underlie cardiovascular sequelae of sleep apnea, we evaluated the effects of nocturnal supplemental oxygen and CPAP on markers of cardiovascular risk. Methods We conducted a randomized, controlled trial in which patients with cardiovascular disease or multiple cardiovascular risk factors were recruited from cardiology practices. Patients were screened for obstructive sleep apnea with the use of the Berlin questionnaire, and home sleep testing was used to establish the diagnosis. Participants with an apnea–hypopnea index of 15 to 50 events per hour were randomly assigned to receive education on sleep hygiene and healthy lifestyle alone (the control group) or, in addition to education, either CPAP or nocturnal supplemental oxygen. Cardiovascular risk was assessed at baseline and after 12 weeks of the study treatment. The primary outcome was 24-hour mean arterial pressure. Results Of 318 patients who underwent randomization, 281 (88%) could be evaluated for ambulatory blood pressure at both baseline and follow-up. On average, the 24-hour mean arterial pressure at 12 weeks was lower in the group receiving CPAP than in the control group (?2.4 mm Hg; 95% confidence interval [CI], ?4.7 to ?0.1; P = 0.04) or the group receiving supplemental oxygen (?2.8 mm Hg; 95% CI, ?5.1 to ?0.5; P = 0.02). There was no significant difference in the 24-hour mean arterial pressure between the control group and the group receiving oxygen. A sensitivity analysis performed with the use of multiple imputation approaches to assess the effect of missing data did not change the results of the primary analysis. Conclusions In patients with cardiovascular disease or multiple cardiovascular risk factors, the treatment of obstructive sleep apnea with CPAP, but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure. (Funded by the National Heart, Lung, and Blood Institute and others; HeartBEAT ClinicalTrials.gov number, NCT01086800.) PMID:24918372

Gottlieb, Daniel J.; Punjabi, Naresh M.; Mehra, Reena; Patel, Sanjay R.; Quan, Stuart F.; Babineau, Denise C.; Tracy, Russell P.; Rueschman, Michael; Blumenthal, Roger S.; Lewis, Eldrin F.; Bhatt, Deepak L.; Redline, Susan

2014-01-01

71

Analog and Mixed Signal Design towards a Miniaturized Sleep Apnea Monitoring Device  

E-print Network

and Related Procedures”, using polysomnography for the evaluation of sleep apnea requires the following signals as a min- imum set of data channels: electroencephalography (EEG), electrooculography (EOG), chin electromyogram (EMG), breathing airflow, arterial... data help judge the specific type or nature of each apnea event, i.e. obstructive, central, or mixed. When EEG and EMG signals are si- multaneously recorded, sleep staging tasks can be performed to provide a denominator for the AHI scoring. Other...

Jin, Jiayi

2014-07-23

72

Sleep Endoscopy in the Evaluation of Pediatric Obstructive Sleep Apnea  

PubMed Central

Pediatric obstructive sleep apnea (OSA) is not always resolved or improved with adenotonsillectomy. Persistent or complex cases of pediatric OSA may be due to sites of obstruction in the airway other than the tonsils and adenoids. Identifying these areas in the past has been problematic, and therefore, therapy for OSA in children who have failed adenotonsillectomy has often been unsatisfactory. Sleep endoscopy is a technique that can enable the surgeon to determine the level of obstruction in a sleeping child with OSA. With this knowledge, site-specific surgical therapy for persistent and complex pediatric OSA may be possible. PMID:22518178

Lin, Aaron C.; Koltai, Peter J.

2012-01-01

73

Mallampati Score and Pediatric Obstructive Sleep Apnea  

PubMed Central

Rationale: Pediatric obstructive sleep apnea (OSA) is common, and a delay in diagnosis can lead to significant morbidity. Polysomnography (PSG) is the gold standard for the diagnosis of OSA. However, difficulty accessing PSG due to the relative shortage of sleep centers with pediatric expertise can lead to a delay in the diagnosis and management of OSA. Objectives: To assess the utility of Mallampati score (sitting and supine) in predicting the presence and severity of OSA in children. Methods: A retrospective study of 158 children from a single pediatric sleep center. All patients had a PSG and a physical examination documenting Mallampati score. The Mallampati score, tonsillar size, age, sex, and apnea hypopnea index (AHI) were analyzed. Odds ratio of having pediatric OSA (AHI > 1) with increase in Mallampati score and tonsillar size were calculated. Measurements and Main Results: A significant correlation was found between Mallampati score, tonsillar size, and AHI. For every point increase in the Mallampati score, the odds ratio of having OSA increased by more than 6-fold. For every point increase in tonsillar size, the odds ratio of having OSA increased by more than 2-fold. Conclusions: Mallampati score and tonsillar size are independent predictors of OSA. Oral examination including Mallampati score and tonsillar size should be considered when evaluating a patient for OSA. They can be used to prioritize children who may need PSG. Citation: Kumar HVM, Schroeder JW Jr, Gang Z, Sheldon SH. Mallampati score and pediatric obstructive sleep apnea. J Clin Sleep Med 2014;10(9):985-990. PMID:25142764

Kumar, Harsha Vardhan Madan; Schroeder, James W.; Gang, Zhang; Sheldon, Stephen H.

2014-01-01

74

Obstructive Sleep Apnea Syndrome (OSAS). Review of the literature  

PubMed Central

Obstructive sleep apnea and hypopnea syndrome is characterized by repeated airway collapse during sleep. The li-terature describes multiple causes of the disease. The main cause is a reduction of the expansion forces of the pharyngeal dilator muscles, as in situations of genioglossal muscle dysfunction, and discoordination between the inspiratory activity of the muscle and respiratory effort, which play an important role in progression of the disease. Other described causes are soft tissue disorders, such as macroglossia or tonsillar hypertrophy, and skeletal structural alterations such as micrognathia and retrognathia. The syndrome is also more frequent in obese people, where the accumulation of fat in the neck region produces narrowing of the pharyngeal airway, thereby diminishing the passage of air. This review focuses on the pathogenesis, epidemiology, main features and diagnosis of the disease, and on its main forms of treatment. Key words:Sleep apnea, obstructive sleep apnea, sleep apnea syndrome, obstructive sleep apnea syndrome. PMID:22549673

Azagra-Calero, Eva; Barrera-Mora, José M.; Llamas-Carreras, José M.; Solano-Reina, Enrique

2012-01-01

75

Diagnostic performance of single airflow channel recording (ApneaLink) in home diagnosis of sleep apnea  

Microsoft Academic Search

Background  ApneaLink is a novel single-channel screening device for sleep apnea detection which is based on pressure-transduced measurement\\u000a of oronasal airflow, summarised as respiratory disturbance index per hour of recording time (RDIApneaLink). We tested ApneaLink's diagnostic performance in a patient population with high prevalence of sleep apnea.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  ApneaLink was applied simultaneously with in-laboratory polysomnography (PSG) (n?=?102, 24 female, age 54.7 years) and

Regine Ragette; Yi Wang; Gerhard Weinreich; Helmut Teschler

2010-01-01

76

Obstructive sleep apnea and type 2 diabetes  

PubMed Central

Type 2 diabetes and obstructive sleep apnea (OSA) are diseases with high prevalence and major public health impact. There is evidence that regular snoring and OSA are independently associated with alterations in glucose metabolism. Thus, OSA might be a risk factor for the development of type 2 diabetes. Possible causes might be intermittent hypoxia and sleep fragmentation, which are typical features of OSA. OSA might also be a reason of ineffective treatment of type 2 diabetes. There is further evidence that the treatment of OSA by continuous positive airway pressure (CPAP) therapy might correct metabolic abnormalities in glucose metabolism. It is assumed that this depends on therapy compliance to CPAP. On the other hand, there are also hints in the literature that type 2 diabetes per se might induce sleep apnea, especially in patients with autonomic neuropathy. Pathophysiological considerations open up new insights into that problem. Based on the current scientific data, clinicians have to be aware of the relations between the two diseases, both from the sleep medical and the diabetological point of view. The paper summarizes the most important issues concerning the different associations of OSA and type 2 diabetes. PMID:21147644

2010-01-01

77

The Relationship between High Risk for Obstructive Sleep Apnea and General and Central Obesity: Findings from a Sample of Chilean College Students.  

PubMed

This cross-sectional study evaluates the prevalence and extent to which high risk for obstructive sleep apnea (OSA) is associated with general obesity and central obesity among college students in Punta Arenas, Chile. Risk for OSA was assessed using the Berlin Questionnaire and trained research nurses measured anthropometric indices. Overweight was defined as body mass index (BMI) of 25-29.9?kg/m(2) and general obesity was defined as BMI ? 30?kg/m(2). Central obesity was defined as waist circumference ?90 centimeters (cm) for males and ?80?cm for females. Multivariate logistic regression models were fit to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI). Prevalence of high risk for OSA, general obesity, and central obesity were 7.8%, 12.8%, and 42.7%, respectively. Students at high risk for OSA had greater odds of general obesity (OR 9.96; 95% CI: 4.42-22.45) and central obesity (OR 2.78; 95% CI 1.43-5.40). Findings support a strong positive association of high risk for OSA with obesity. PMID:24944841

Wosu, Adaeze C; Vélez, Juan Carlos; Barbosa, Clarita; Andrade, Asterio; Frye, Megan; Chen, Xiaoli; Gelaye, Bizu; Williams, Michelle A

2014-01-01

78

Nasal Involvement in Obstructive Sleep Apnea Syndrome  

PubMed Central

Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected. PMID:25548569

Michels, Daniel de Sousa; Rodrigues, Amanda da Mota Silveira; Nakanishi, Márcio; Sampaio, André Luiz Lopes; Venosa, Alessandra Ramos

2014-01-01

79

Childhood Obesity and Obstructive Sleep Apnea  

PubMed Central

The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA), occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG), is characterised by snoring, recurrent partial (hypopneas) or complete (apneas) obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA. PMID:22957216

Narang, Indra; Mathew, Joseph L.

2012-01-01

80

Contemporary surgery for obstructive sleep apnea syndrome.  

PubMed

Surgical treatment of obstructive sleep apnea syndrome (OSAS) has been available in some form for greater than three decades. Early management for airway obstruction during sleep relied on tracheotomy which although life saving was not well accepted by patients. In the early eighties two new forms of treatment for OSAS were developed. Surgically a technique described as a uvulopalatopharyngoplasty (UPPP) was used to treat the retropalatal region for snoring and sleep apnea. Concurrently sleep medicine developed a nasal continuous positive airway pressure (CPAP) device to manage nocturnal airway obstruction. Both of these measures were used to expand and stabilize the pharyngeal airway space during sleep. The goal for each technique was to limit or alleviate OSAS. Almost 30 yr later these two treatment modalities continue to be the mainstay of contemporary treatment. As expected, CPAP device technology improved over time along with durable goods. Surgery followed suit and additional techniques were developed to treat soft and bony structures of the entire upper airway (nose, palate and tongue base). This review will only focus on the contemporary surgical methods that have demonstrated relatively consistent positive clinical outcomes. Not all surgical and medical treatment modalities are successful or even partially successful for every patient. Advances in the treatment of OSAS are hindered by the fact that the primary etiology is still unknown. However, both medicine and surgery continue to improve diagnostic and treatment methods. Methods of diagnosis as well as treatment regimens should always include both medical and surgical collaborations so the health and quality of life of our patients can best be served. PMID:19784401

Powell, Nelson B

2009-09-01

81

Automated sleep scoring and sleep apnea detection in children  

NASA Astrophysics Data System (ADS)

This paper investigates the automated detection of a patient's breathing rate and heart rate from their skin conductivity as well as sleep stage scoring and breathing event detection from their EEG. The software developed for these tasks is tested on data sets obtained from the sleep disorders unit at the Adelaide Women's and Children's Hospital. The sleep scoring and breathing event detection tasks used neural networks to achieve signal classification. The Fourier transform and the Higuchi fractal dimension were used to extract features for input to the neural network. The filtered skin conductivity appeared visually to bear a similarity to the breathing and heart rate signal, but a more detailed evaluation showed the relation was not consistent. Sleep stage classification was achieved with and accuracy of around 65% with some stages being accurately scored and others poorly scored. The two breathing events hypopnea and apnea were scored with varying degrees of accuracy with the highest scores being around 75% and 30%.

Baraglia, David P.; Berryman, Matthew J.; Coussens, Scott W.; Pamula, Yvonne; Kennedy, Declan; Martin, A. James; Abbott, Derek

2005-12-01

82

Inflammation in sleep apnea: An update.  

PubMed

Obstructive sleep apnea (OSA) is a common disorder associated with cardiovascular disease (CVD). One theory to explain this relationship proposes that OSA can induce systemic inflammation, thereby inducing CVD. This theory is based on the premise that obesity is a pro-inflammatory state, and that physiological derangements during sleep in subjects with OSA further aggravate inflammation. In support of this theory, some clinical studies have shown elevated inflammatory biomarkers in OSA subjects, or improvement in these markers following treatment of OSA. However, the data are inconsistent and often confounded by the effects of comorbid obesity. Animal models of OSA have been developed, which involve exposure of rodents or cells to intermittent hypoxia, a hallmark feature of OSA. Several of these experiments demonstrate that intermittent hypoxia can stimulate inflammatory pathways and lead to cardiovascular or metabolic pathology. In this review, we review relationships between OSA and inflammation, with particular attention to studies published within the last year. PMID:25502450

Unnikrishnan, Dileep; Jun, Jonathan; Polotsky, Vsevolod

2015-03-01

83

A Respiratory Movement Monitoring System Using Fiber-Grating Vision Sensor for Diagnosing Sleep Apnea Syndrome  

NASA Astrophysics Data System (ADS)

A non-restrictive and non-contact respiratory movement monitoring system that finds the boundary between chest and abdomen automatically and detects the vertical movement of each part of the body separately is proposed. The system uses a fiber-grating vision sensor technique and the boundary position detection is carried out by calculating the centers of gravity of upward moving and downward moving sampling points, respectively. In the experiment to evaluate the ability to detect the respiratory movement signals of each part and to discriminate between obstructive and central apneas, detected signals of the two parts and their total clearly showed the peculiarities of obstructive and central apnea. The cross talk between the two categories classified automatically according to several rules that reflect the peculiarities was ? 15%. This result is sufficient for discriminating central sleep apnea syndrome from obstructive sleep apnea syndrome and indicates that the system is promising as screening equipment. Society of Japan

Takemura, Yasuhiro; Sato, Jun-Ya; Nakajima, Masato

2005-01-01

84

Automatic quantification of light sleep shows differences between apnea patients and healthy subjects  

Microsoft Academic Search

A fully automatic method to quantify sleep depth during the night was developed in the present work. The method was tested using 20 all-night recordings from 10 healthy control subjects and 10 sleep apnea patients. The results showed statistically significant differences in sleep depth between control subjects and sleep apnea patients. The overall sleep was lighter in apnea patients than

Eero Huupponen; Sari-Leena Himanen; Joel Hasan; Alpo Värri

2004-01-01

85

Obstructive sleep apnea syndrome: a literature review.  

PubMed

Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that can cause significant physiologic disturbance with various clinical impacts. The etiology is multifactorial and its clinical manifestations are night snoring, headache when patient wakes up, day-time sleepiness and degrease of cognitive performance. Some recent international studies suggest that the OSAS prevalence is 2-4% in men and 1-2% in women of average age. The aim of this work was presenting a literature review in Medline concerning Obstructive sleep apnea syndrome. A review of the articles ranging from 1980 to 2014 has been done. Over 2000 articles were found and those which give useful information about etiology, diagnosis, therapy and found results after the study were selected and evaluated. In literature there is no unanimous opinion on the treatment of OSAS. According to the majority of the authors it should be multidisciplinary. The choice of therapy is predicated on the etiology, severity and natural history of the increased upper airway resistance. The importance of a praecox diagnosis and orthodontic therapy in order to re-establish normal function is underlined, since OSAS is linked with high risk of hypertension, cardiovascular diseases, daytime sleepiness, home and work-related accidents, with consequent worsening of life quality. PMID:25747430

Maspero, C; Giannini, L; Galbiati, G; Rosso, G; Farronato, G

2015-04-01

86

Semin Immunopathol . Author manuscript Obstructive sleep apnea, immuno-inflammation, and atherosclerosis  

E-print Network

sleep disorder leading to cardiovascular and metabolic complications. OSA is also a multicomponentSemin Immunopathol . Author manuscript Page /1 11 Obstructive sleep apnea, immuno Arnaud Abstract Obstructive sleep apnea (OSA) is a highly prevalent

Boyer, Edmond

87

Respiratory sound recordings for detection of sleep apnea  

NASA Astrophysics Data System (ADS)

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.

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

1999-03-01

88

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study  

PubMed Central

Background The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample. PMID:25252161

Cintra, Fatima Dumas; Leite, Renata Pimentel; Storti, Luciana Julio; Bittencourt, Lia Azeredo; Poyares, Dalva; Castro, Laura de Siqueira; Tufik, Sergio; de Paola, Angelo

2014-01-01

89

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study.  

PubMed

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample. PMID:25252161

Cintra, Fatima Dumas; Leite, Renata Pimentel; Storti, Luciana Julio; Bittencourt, Lia Azeredo; Poyares, Dalva; Castro, Laura de Siqueira; Tufik, Sergio; Paola, Angelo de

2014-11-01

90

Impaired Performance in Commercial Drivers Role of Sleep Apnea and Short Sleep Duration  

E-print Network

Impaired Performance in Commercial Drivers Role of Sleep Apnea and Short Sleep Duration Allan I, and David F. Dinges Center for Sleep and Respiratory Neurobiology; Division of Sleep Medicine; Division of Pulmonary Allergy and Critical Care, Department of Medicine; Division of Sleep and Chronobiology, Department

Pennsylvania, University of

91

Treatment options for obstructive sleep apnea.  

PubMed

Sleep apnea is a major public health problem that afflicts 9% of women and 24% of men 30 to 60 years of age. It is highly treatable, but when untreated, it has been associated with (but not necessarily linked to) increased probability of cerebral and coronary vascular disease, congestive heart failure, metabolic dysfunction, cognitive dysfunction, excessive daytime sleepiness, motor vehicle accidents, reduced productivity, and decreased quality of life. The gold standard for treatment in adults is positive airway pressure (PAP) therapy: continuous PAP (CPAP), bilevel PAP, autotitrating CPAP, or autotitrating bilevel PAP. Measures to increase compliance with PAP therapy include medical or surgical treatment of any underlying nasal obstruction, setting appropriate pressure level and airflow, mask selection and fitting, heated humidification, desensitization for claustrophobia, patient and partner education, regular follow-up with monitoring of compliance software, and attendance of support groups (eg, AWAKE). Adjunctive treatment modalities include lifestyle or behavioral measures and pharmacologic therapy. Patients with significant upper airway obstruction who are unwilling or unable to tolerate PAP therapy may benefit from surgery. Multilevel surgery of the upper airway addresses obstruction of the nose, oropharynx, and hypopharynx. A systematic approach may combine surgery of the nose, pharynx, and hypopharynx in phase 1, whereas skeletal midface advancement or tracheotomy constitutes phase 2. Clinical outcomes are reassessed through attended diagnostic polysomnogram performed 3 to 6 months after surgery. Oral appliances can be used for patients with symptomatic mild or moderate sleep apnea who prefer them to PAP therapy or for whom PAP therapy has failed or cannot be tolerated. Oral appliances also may be used for patients with severe obstructive sleep apnea who are unable or unwilling to undertake PAP therapy or surgery. For children, the main treatment modality is tonsillectomy and adenoidectomy, with or without turbinate surgery. Children with craniofacial abnormalities resulting in maxillary or mandibular insufficiency may benefit from palatal expansion or maxillary/mandibular surgery. PAP therapy may be used for children who are not surgical candidates or if surgery fails. PMID:19744402

Abad, Vivien C; Guilleminault, Christian

2009-09-01

92

Obstructive apnea during sleep is associated with peripheral vasoconstriction  

NASA Technical Reports Server (NTRS)

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.

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

2002-01-01

93

21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.  

Code of Federal Regulations, 2012 CFR

...intraoral devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570...intraoral devices for snoring and obstructive sleep apnea. (a) Identification. Intraoral...intraoral devices for snoring and obstructive sleep apnea are devices that are worn...

2012-04-01

94

21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.  

Code of Federal Regulations, 2014 CFR

...intraoral devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570...intraoral devices for snoring and obstructive sleep apnea. (a) Identification. Intraoral...intraoral devices for snoring and obstructive sleep apnea are devices that are worn...

2014-04-01

95

21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.  

Code of Federal Regulations, 2011 CFR

...intraoral devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570...intraoral devices for snoring and obstructive sleep apnea. (a) Identification. Intraoral...intraoral devices for snoring and obstructive sleep apnea are devices that are worn...

2011-04-01

96

21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.  

Code of Federal Regulations, 2013 CFR

...intraoral devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570...intraoral devices for snoring and obstructive sleep apnea. (a) Identification. Intraoral...intraoral devices for snoring and obstructive sleep apnea are devices that are worn...

2013-04-01

97

21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.  

Code of Federal Regulations, 2010 CFR

...intraoral devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570...intraoral devices for snoring and obstructive sleep apnea. (a) Identification. Intraoral...intraoral devices for snoring and obstructive sleep apnea are devices that are worn...

2010-04-01

98

CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea  

SciTech Connect

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.

Bohlman, M.E. (Johns Hopkins Univ. School of Medicine, Baltimore, MD); Haponik, E.F.; Smith, P.L.; Allen, R.P.; Bleecker, E.R.; Goldman, S.M.

1983-03-01

99

Study Helps Explain Connection Between Sleep Apnea, Stroke And Death  

NSDL National Science Digital Library

Press release covers study that finds obstructive sleep apnea decreases blood flow to the brain, elevates blood pressure within the brain and eventually harms the brainÂ?s ability to modulate these changes and prevent damage to itself.

APS Communications Office (American Physiological Society Communications Office)

2009-01-06

100

416 IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 15, NO. 3, MAY 2011 Apnea MedAssist: Real-time Sleep Apnea Monitor  

E-print Network

APNEA is a sleep related breathing disorder--commonly known as obstructive sleep apnea (OSA) is a common disorder that affects about 4% of the general population. People with sleep apnea literally stop breathingAssist: Real-time Sleep Apnea Monitor Using Single-Lead ECG Majdi Bsoul, Member, IEEE, Hlaing Minn, Senior

Minn, Hlaing

101

Effects of treatment of obstructive sleep apnea on circadian hemodynamics  

Microsoft Academic Search

Introduction: The role of obstructive sleep apnea syndrome (OSAS) in the etiology of daytime hypertension is still an issue of debate, which is fed by the high prevalence of the syndrome in hypertensive patients. In this study the anti-hypertensive effect of short-term treatment of obstructive sleep apnea with nasal continuous positive airway pressure (nCPAP) was assessed. Patients and methods: In

Albertus J Voogel; Reindert P van Steenwijk; John M Karemaker; Gert A van Montfrans

1999-01-01

102

Resistant Hypertension and Sleep Apnea: Pathophysiologic Insights and Strategic Management  

Microsoft Academic Search

Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant\\u000a hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A\\u000a frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep\\u000a apnea–associated hypertension is characterized by sustained adrenergic activation and

Stephen K. Williams; Joseph Ravenell; Girardin Jean-Louis; Ferdinand Zizi; James A. Underberg; Samy I. McFarlane; Gbenga Ogedegbe

2011-01-01

103

Clinical presentations of obstructive sleep apnea syndrome.  

PubMed

Obstructive sleep apnea syndrome (OSAS) is a common but still underrecognized disorder. It affects 2% to 4% of middle-aged adults, a significant proportion of whom are female. The spectrum of clinical presentations of OSAS and their severity is variable, ranging from neurocognitive complaints to cardiorespiratory failure. OSAS has a significant impact on quality of life, cardiovascular morbidity, and mortality. Its major sequelae include daytime somnolence and its consequences (motor vehicle accidents, poor work performance, disrupted social interactions), systemic and pulmonary hypertension, and ischemic heart disease. Treatment of OSAS results in improvement in symptoms, quality of life, and blood pressure control, and may improve mortality. An expansion of our understanding of this condition has resulted in increased awareness of its consequences, but the recognition of OSAS in clinical practice is still delayed. Identification of these patients in clinical practice requires attention to risk factors (history of snoring and witnessed apneas, obesity, increased neck circumference, hypertension, family history) and careful examination of the upper airway. Clinical impression alone, however, has poor (50% to 60%) sensitivity and specificity (63% to 70%) and the diagnosis is usually obtained on polysomnography. Physicians and other health care professionals need to be aware of the progress made in this area and recognize the necessity for prompt evaluation and treatment of these patients. PMID:10406327

Skomro, R P; Kryger, M H

1999-01-01

104

Brain circuitry mediating arousal from obstructive sleep apnea.  

PubMed Central

Obstructive sleep apnea (OSA) is a disorder of repetitive sleep disruption caused by reduced or blocked respiratory airflow. Although an anatomically compromised airway accounts for the major predisposition to OSA, a patient's arousal threshold and factors related to the central control of breathing (ventilatory control stability) are also important. Arousal from sleep (defined by EEG desynchronization) may be the only mechanism that allows airway re-opening following an obstructive event. However, in many cases arousal is unnecessary and even worsens the severity of OSA. Mechanisms for arousal are poorly understood. However, accumulating data are elucidating the relevant neural pathways and neurotransmitters. For example, serotonin is critically required, but its site of action is unknown. Important neural substrates for arousal have been recently identified in the parabrachial complex (PB), a visceral sensory nucleus in the rostral pons. Moreover, glutamatergic signaling from the PB contributes to arousal caused by hypercapnia, one of the arousal-promoting stimuli in OSA. A major current focus of OSA research is to find means to maintain airway patency during sleep, without sleep interruption. PMID:23810448

Chamberlin, Nancy L.

2013-01-01

105

Respiration Physiology (2000) Detection of obstructive sleep apnea by analysis phase  

E-print Network

collapsibility and that #(t) might potentially useful parameter for detection impending upper airway obstruction. 2000 Elsevier Science rights reserved. Keywords: Mammals, humans; Muscle, upper airways, obstructions; Sleep, obstructive apnea; Upper airways, obstructive sleep apnea; Ventilation, forced oscilation www

Timmer, Jens

106

Dynamic changes in brain bioenergetics during obstructive sleep apnea  

Microsoft Academic Search

Repetitive collapse of the upper airway during obstructive sleep apnea\\/hypopnea (OSA) exposes the brain of sufferers to frequent, transient, hypoxic episodes. The loss of cerebrovascular reactivity in sleep, and particularly in OSA, means that physiologic compensatory mechanisms may not ensure adequate brain oxygen levels. This 31P magnetic resonance spectroscopy study, of 13 males with severe, untreated OSA undertaken after overnight

Caroline Rae; Delwyn J Bartlett; Qiao Yang; David Walton; Angela Denotti; Toos Sachinwalla; Ronald R Grunstein

2009-01-01

107

Topography-specific spindle frequency changes in Obstructive Sleep Apnea  

PubMed Central

Background Sleep spindles, as detected on scalp electroencephalography (EEG), are considered to be markers of thalamo-cortical network integrity. Since obstructive sleep apnea (OSA) is a known cause of brain dysfunction, the aim of this study was to investigate sleep spindle frequency distribution in OSA. Seven non-OSA subjects and 21 patients with OSA (11 mild and 10 moderate) were studied. A matching pursuit procedure was used for automatic detection of fast (?13Hz) and slow (<13Hz) spindles obtained from 30min samples of NREM sleep stage 2 taken from initial, middle and final night thirds (sections I, II and III) of frontal, central and parietal scalp regions. Results Compared to non-OSA subjects, Moderate OSA patients had higher central and parietal slow spindle percentage (SSP) in all night sections studied, and higher frontal SSP in sections II and III. As the night progressed, there was a reduction in central and parietal SSP, while frontal SSP remained high. Frontal slow spindle percentage in night section III predicted OSA with good accuracy, with OSA likelihood increased by 12.1%for every SSP unit increase (OR 1.121, 95% CI 1.013 - 1.239, p=0.027). Conclusions These results are consistent with diffuse, predominantly frontal thalamo-cortical dysfunction during sleep in OSA, as more posterior brain regions appear to maintain some physiological spindle frequency modulation across the night. Displaying changes in an opposite direction to what is expected from the aging process itself, spindle frequency appears to be informative in OSA even with small sample sizes, and to represent a sensitive electrophysiological marker of brain dysfunction in OSA. PMID:22985414

2012-01-01

108

Baroreflex Sensitivity after Adenotonsillectomy in Children with Obstructive Sleep Apnea during Wakefulness and Sleep  

PubMed Central

Study Objectives: Children with obstructive sleep apnea have blunted baroreflex sensitivity and increased blood pressure variability. The aim of the study was to test the hypothesis that treatment of sleep apnea by adenotonsillectomy results in significant improvement of baroreflex sensitivity, lowering of blood pressure and blood pressure variability and increase vagal heart rate modulation. Study Design: One hundred ninety-four children aged 9.6 ± 2.3 years were enrolled; 133 had obstructive sleep apnea and 61 were healthy controls. For children with sleep apnea, polysomnography with 3-lead electrocardiography and continuous blood pressure was performed before adenotonsillectomy, then 6 weeks and 6 months postoperatively. Controls underwent the same assessment at study entry and 6 months later. Spontaneous baroreflex sensitivity was measured in the time and frequency domains. Data analyses were performed for available and complete cases. Results: Children with sleep apnea experienced postoperatively an increase in baroreflex sensitivity and decrease in blood pressure variability during wakefulness and sleep. A decrease in blood pressure during sleep and in heart rate during wakefulness was also measured. The improvement in baroreflex sensitivity was predicted by the change in the apnea-hypopnea and arousal indices. A normal pattern of rising baroreflex sensitivity during the night was restored in children with severe apnea after surgery. However, baroreceptor sensitivity did not completely normalize after treatment. Conclusion: Treatment of obstructive sleep apnea in children by adenotonsillectomy is associated with gradual improvement in known risk factors for cardiovascular disease. Complete normalization of baroreceptor sensitivity was not achieved 6 months postoperatively. Citation: Crisalli JA; McConnell K; VanDyke RD; Fenchel MC; Somers VK; Shamszumann A; Chini B; Daniels SR; Amin RS. Baroreflex sensitivity after adenotonsillectomy in children with obstructive sleep apnea during wakefulness and sleep. SLEEP 2012;35(10):1335-1343. PMID:23024431

Crisalli, Joseph A.; McConnell, Keith; VanDyke, Rhonda D.; Fenchel, Matthew C.; Somers, Virend K.; Shamszumann, A.; Chini, Barbara; Daniels, Stephen R.; Amin, Raouf S.

2012-01-01

109

Classification algorithms for predicting sleepiness and sleep apnea severity  

PubMed Central

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

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

2013-01-01

110

Interhemispheric Asynchrony Correlates With Severity of Respiratory Disturbance Index in Patients With Sleep Apnea  

Microsoft Academic Search

Obstructive sleep apnea (OSA) hypopnea syndrome is a disorder characterized by airway obstructions during sleep; full obstructions are known as apnea and partial obstructions are called hypopnea. Sleep in OSA patients is significantly disturbed with frequent apnea\\/hypopnea and arousal events. We illustrate that these events lead to functional asymmetry of the brain as manifested by the interhemispheric asynchrony (IHA) computed

Udantha R. Abeyratne; Vinayak Swarnkar; Craig Hukins; B. Duce

2010-01-01

111

A Wireless Sensor System for Biopotential Recording in the Treatment of Sleep Apnea  

E-print Network

A Wireless Sensor System for Biopotential Recording in the Treatment of Sleep Apnea Disorder Lei Integrated Sensor Networks [3]. Sleep apnea is very common disorder that affects millions of Americans, which) to diagnose the disorders of sleep apnea. This research focuses on: (1) developing application program

Tang, Wendy

112

Physical Modeling of Airflow-Walls Interactions to Understand the Sleep Apnea Syndrome  

E-print Network

Introduction Sleep apnea is a disorder in which a person stops breathing during the night, usually for periodsPhysical Modeling of Airflow-Walls Interactions to Understand the Sleep Apnea Syndrome Yohan Payan1, France {pelorson,perrier}@icp.inpg.fr Abstract. Sleep Apnea Syndrome (SAS) is defined as a partial

Payan, Yohan

113

When a fluid-structure interaction keeps you awake: a physical approach to Obstructive Sleep Apnea  

E-print Network

When a fluid-structure interaction keeps you awake: a physical approach to Obstructive Sleep Apnea, Paris, France 4 CHU Purpan, Toulouse, France Abstract The Sleep Apnea Syndrome is known to be related). The characteristic recurrent collapse causes about 3 % of the adult population to suffer from Obstructive Sleep Apnea

Boyer, Edmond

114

Sleep apnea classification using least-squares support vector machines on single lead ECG*  

E-print Network

Sleep apnea classification using least-squares support vector machines on single lead ECG* Carolina Van Huffel, Fellow, IEEE Abstract-- In this paper a methodology to identify sleep apnea events. I. INTRODUCTION Sleep apnea is considered an important factor for morbid- ity and mortality due

115

Sleep Apnea and Daytime Sleepiness and Fatigue: Relation to Visceral Obesity, Insulin Resistance, and Hypercytokinemia  

Microsoft Academic Search

Sleep apnea and associated daytime sleepiness and fatigue are common manifestations of mainly obese middle-aged men. The onset of sleep apnea peaks in middle age, and its morbid and mortal se- quelae include complications from accidents and cardiovascular events. The pathophysiology of sleep apnea remains obscure. The purpose of this study was to test three separate, albeit closely related, hypotheses.

ALEXANDROS N. VGONTZAS; DIMITRIS A. PAPANICOLAOU; EDWARD O. BIXLER; KENNETH HOPPER; ANGELA LOTSIKAS; HUONG-MO LIN; ANTHONY KALES; GEORGE P. CHROUSOS

116

Pathogenic Roles of the Carotid Body Inflammation in Sleep Apnea  

PubMed Central

Breathing difficulties in sleep are a hallmark of sleep-disordered breathing commonly observed in patients with sleep disorders. The pathophysiology of sleep apnea is in part due to an augmented activity of the carotid body chemoreflex. Arterial chemoreceptors in the carotid body are sensitive to inflammatory cytokines and immunogenic molecules in the circulation, because cytokine receptors are expressed in the carotid body in experimental animals and human. Intriguingly, proinflammatory cytokines are also locally produced and released in the carotid body. Also, there are significant increases in the expression of proinflammatory cytokines, cytokine receptors, and inflammatory mediators in the carotid body under hypoxic conditions, suggesting an inflammatory response of the carotid body. These upregulated cytokine signaling pathways could enhance the carotid chemoreceptor activity, leading to an overactivity of the chemoreflex adversely effecting breathing instability and autonomic imbalance. This review aims to summarize findings of the literature relevant to inflammation in the carotid body, with highlights on the pathophysiological impact in sleep apnea. It is concluded that local inflammation in the carotid body plays a pathogenic role in sleep apnea, which could potentially be a therapeutic target for the treatment of the pathophysiological consequence of sleep apnea. PMID:25276055

2014-01-01

117

Treatment of obstructive sleep apnea in children  

PubMed Central

Obstructive sleep apnea (OSA) in children is a frequent disease for which optimal diagnostic methods are still being defined. Treatment of OSA in children should include providing space, improving craniofacial growth, resolving all symptoms, and preventing the development of the disease in the adult years. Adenotonsillectomy (T&A) has been the treatment of choice and thought to solve young patient's OSA problem, which is not the case for most adults. Recent reports showed success rates that vary from 27.2% to 82.9%. Children snoring regularly generally have a narrow maxilla compared to children who do not snore. The impairment of nasal breathing with increased nasal resistance has a well-documented negative impact on early childhood maxilla-mandibular development, making the upper airway smaller and might lead to adult OSA. Surgery in young children should be performed as early as possible to prevent the resulting morphologic changes and neurobehavioral, cardiovascular, endocrine, and metabolic complications. Close postoperative follow-up to monitor for residual disease is equally important. As the proportion of obese children has been increasing recently, parents should be informed about the weight gain after T&A. Multidisciplinary evaluation of the anatomic abnormalities in children with OSA leads to better overall treatment outcome. PMID:21189957

2010-01-01

118

Cardiac autonomic control in the obstructive sleep apnea  

PubMed Central

Introduction The sympathetic activation is considered to be the main mechanism involved in the development of cardiovascular diseases in obstructive sleep apnea (OSA). The heart rate variability (HRV) analysis represents a non-invasive tool allowing the study of the autonomic nervous system. The impairment of HRV parameters in OSA has been documented. However, only a few studies tackled the dynamics of the autonomic nervous system during sleep in patients having OSA. Aims To analyze the HRV over sleep stages and across sleep periods in order to clarify the impact of OSA on cardiac autonomic modulation. The second objective is to examine the nocturnal HRV of OSA patients to find out which HRV parameter is the best to reflect the symptoms severity. Methods The study was retrospective. We have included 30 patients undergoing overnight polysomnography. Subjects were categorized into two groups according to apnea–hypopnea index (AHI): mild-to-moderate OSAS group (AHI: 5–30) and severe OSAS group (AHI>30). The HRV measures for participants with low apnea–hypopnea indices were compared to those of patients with high rates of apnea–hypopnea across the sleep period and sleep stages. Results HRV measures during sleep stages for the group with low rates of apnea–hypopnea have indicated a parasympathetic activation during non-rapid eye movement (NREM) sleep. However, no significant difference has been observed in the high AHI group except for the mean of RR intervals (mean RR). The parasympathetic activity tended to increase across the night but without a statistical difference. After control of age and body mass index, the most significant correlation found was for the mean RR (p=0.0001, r=?0.248). Conclusion OSA affects sympathovagal modulation during sleep, and this impact has been correlated to the severity of the disease. The mean RR seemed to be a better index allowing the sympathovagal balance appreciation during the night in OSA. PMID:25861821

Gammoudi, Nouha; Ben Cheikh, Ridha; Saafi, Mohamed Ali; Sakly, Ghazi; Dogui, Mohamed

2015-01-01

119

Mandibular Advancement for Obstructive Sleep Apnea: Dose Effect on Apnea, Long-Term Use and Tolerance  

Microsoft Academic Search

Background: Previous studies have documented an effect of mandibular advancement (MA) on pharyngeal airway size and collapsibility. Objectives: We aimed to describe the course of the apnea-hypopnea index (AHI) and the snoring index (SI) during progressive MA and to evaluate the long-term efficacy, tolerance and usage of MA therapy after progressive MA titration in sleep apnea patients. Methods: Sixty-six patients

Louise Gindre; Frédéric Gagnadoux; Nicole Meslier; Jean-Marie Gustin; Jean-Louis Racineux

2008-01-01

120

What is the importance of radiology in obstructive sleep apnea?  

PubMed

Lipomas are rare, and they rarely arise in deep soft tissue. Only few cases associated with obstructive sleep apnea (OSA) have been reported. Because of radiologic examinations (computed tomography and magnetic resonance imaging) in a case with OSA, a rarely observed large lipoma was encountered in the retropharyngeal region. In the case that was followed, the apnea-hypopnea index was measured. The radiologic examination of the upper airway of the case with OSA symptoms was presented. PMID:21959486

Tuncyurek, Ozum; Eyigor, Hulya; Ozkul, Ayca

2011-09-01

121

Endothelial Function in Obstructive Sleep Apnea and Response to Treatment  

Microsoft Academic Search

Impaired endothelium-dependent vascular relaxation is a prognos- tic marker of atherosclerosis and cardiovascular disease. We evalu- ated endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin (NTG)-induced dilation of the brachial artery with Doppler ultrasound in 28 men with obstruc- tive sleep apnea (OSA) and 12 men without OSA. Subjects with OSA (apnea-hypopnea index; mean SD, 46.0 14.5) had lower FMD compared

Mary S. M. Ip; Hung-Fat Tse; Bing Lam; Kenneth W. T. Tsang; Wah-Kit Lam

122

Reliability and accuracy of sleep apnea scans in novel cardiac resynchronization therapy devices: an independent report of two cases.  

PubMed

Pacemaker apnea scan algorithms are able to screen for sleep apnea. We investigated whether these systems were able to accurately detect sleep-disordered breathing (SDB) in two patients from an outpatient clinic. The first patient suffered from ischemic heart failure and severe central sleep apnea (CSA) and underwent adaptive servoventilation therapy (ASV). The second patient suffered from dilated cardiomyopathy and moderate obstructive sleep apnea (OSA). Pacemaker read-outs did not match polysomnography (PSG) recordings well and overestimated the apnea-hypopnea index. However, ASV therapy-induced SDB improvements were adequately recognized by the apnea scan of the Boston Scientific INVIVE® cardiac resynchronization therapy pacemaker. Detection of obstructive respiratory events using impedance-based technology may underestimate the number of events, as frustrane breathing efforts induce impedance changes without significant airflow. By contrast, in the second case, apnea scan overestimated the number of total events and of obstructive events, perhaps owing to a very sensitive but less specific hypopnea definition and detection within the diagnostic algorithm of the device. These two cases show that a pacemaker apnea scan is able to reflect SDB, but PSG precision is not met by far. The device scan revealed the decline of SDB through ASV therapy for CSA in one patient, but not for OSA in the second case. To achieve reliable monitoring of SDB, further technical developments and clinical studies are necessary. PMID:24519661

Fox, Henrik; Nölker, Georg; Gutleben, Klaus-Jürgen; Bitter, Thomas; Horstkotte, Dieter; Oldenburg, Olaf

2014-03-01

123

Sodium oxybate and sleep apnea: a clinical case.  

PubMed

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

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

2011-12-15

124

Sleep Apnea in Early Childhood Associated with Preterm Birth but Not Small for Gestational Age: A Population-Based Record Linkage Study  

PubMed Central

Study Objectives: Investigate the relationship between gestational age and weight for gestational age and sleep apnea diagnosis in a cohort of children aged up to 6 years old. Design: A cohort study, using record linked population health data. Setting: New South Wales, Australia. Participants: 398,961 children, born between 2000 and 2004, aged 2.5 to 6 years. Measurements: The primary outcome was sleep apnea diagnosis in childhood, first diagnosed between 1 and 6 years of age. Children with sleep apnea were identified from hospital records with the ICD-10 code G47.3: sleep apnea, central or obstructive. Results: A total of 4,145 (1.0%) children with a first diagnosis of sleep apnea were identified. Mean age at first diagnosis was 44.2 months (SD 13.9). Adenoidectomy, tonsillectomy, or both were common among the children diagnosed with sleep apnea (85.6%). Children born preterm compared to term were significantly more likely to be diagnosed with sleep apnea (< 32 weeks versus term hazard ratio 2.74 [95% CI: 2.16, 3.49]) this remained even after adjustment for known confounding variables. Children born small for gestational age were not at increased risk of sleep apnea compared to children born appropriate for gestational age, hazard ratio 0.95 (95% CI 0.86-1.06). Conclusions: This is the largest study investigating preterm birth and sleep apnea diagnosis and suggests that diagnosis of sleep disordered breathing is more prevalent in children born preterm, but not those who are small for gestational age. Citation: Raynes-Greenow CH; Hadfield RM; Cistulli PA; Bowen J; Allen H; Roberts CL. Sleep apnea in early childhood associated with preterm birth but not small for gestational age: a population-based record linkage study. SLEEP 2012;35(11):1475-1480. PMID:23115396

Raynes-Greenow, Camille H.; Hadfield, Ruth M.; Cistulli, Peter A.; Bowen, Jenny; Allen, Hugh; Roberts, Christine L.

2012-01-01

125

A rare cause of obstructive sleep apnea syndrome: lingual thyroid  

Microsoft Academic Search

Obstructive sleep apnea syndrome (OSAS) is an important clinical condition resulting from anatomical narrowings developing in the upper respiratory tract during sleep, affecting the quality of life substantially, leading to serious complications. Herein, we present a 24-year-old male patient with OSAS causedby lingual thyroid,and along with this rare case, we discuss the clinical features of lingual thyroid, imaging methods, and

Mehmet Ali Babademez; Emre Günbey; Baran Acar; Hediye P?nar Günbey

126

A review of 50 children with obstructive sleep apnea syndrome  

Microsoft Academic Search

Fifty children and adolescents with obstructive sleep apnea syndrome and related breathing disorders during sleep are reviewed.\\u000a Subjects were subdivided according to whether their breathing irregularity was secondary to a medical problem (group I) or\\u000a was the primary complaint (group II). The most common presenting complaint was excessive daytime somnolence; hyperactivity\\u000a and antisocial behavior also were cited frequently. In 20%

C. Guilleminault; R. Korobkin; R. Winkle

1981-01-01

127

IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 16, NO. 3, MAY 2012 469 Real-Time Sleep Apnea Detection  

E-print Network

sleep-disordered-breathing suspects' full overnight recordings. Index Terms--Classifier combination ), sleep apnea. I. INTRODUCTION SLEEP apnea and hypopnea syndrome (SAHS) is a com- mon sleep disorder which-Time Sleep Apnea Detection by Classifier Combination Baile Xie, Student Member, IEEE, and Hlaing Minn, Senior

Minn, Hlaing

128

Acoustic rhinometry findings in patients with mild sleep apnea  

Microsoft Academic Search

Background: Nasal obstruction may contribute to the development of obstructive sleep apnea (OSA). Acoustic rhinometry (AR) measures nasal patency and congestion, which are useful parameters in objectively evaluating nasal obstruction. The nasal obstruction produced by allergic rhinitis may contribute to the development of OSA and can be easily assessed with AR. Objective: This study was undertaken to assess the degree

Steven M. Houser; Bulent Mamikoglu; Benjamin F. Aquino; Rizwan Moinuddin; Jacquelynne P. Corey

2002-01-01

129

Effect of improved nasal breathing on obstructive sleep apnea  

Microsoft Academic Search

Objectives: The goal was to compare the effect of an improved nasal airway on obstructive sleep apnea (OSA) by use of subjective and objective measures. Methods: A prospective study of 50 consecutive patients with nasal airway obstruction and OSA was carried out. Results: Subjectively, nasal breathing improved in 49 (98%) patients, whereas snoring decreased or disappeared in 17 (34%); the

MICHAEL FRIEDMAN; HASAN TANYERI; JESSICA W. LIM; ROY LANDSBERG; KRISHNA VAIDYANATHAN; DAVID CALDARELLI

2000-01-01

130

Compliance with nasal CPAP in obstructive sleep apnea patients  

Microsoft Academic Search

Continuous positive airway pressure (CPAP) is currently the treatment of choice for the majority of patients with obstructive sleep apnea (OSA). After a CPAP trial, the initial acceptance rate is 70–80%. Patients who derive no subjective benefit from such a trial are poor candidates for home treatment with CPAP because they are likely to exhibit lower adherence and compliance rates.

Ph. Collard; Th. Pieters; G. Aubert; P. Delguste; D. O. Rodenstein

1997-01-01

131

Automatic Detection of Obstructive Sleep Apnea Using Speech Signals  

Microsoft Academic Search

Obstructive sleep apnea (OSA) is a common disorder associated with anatomical abnormalities of the upper airways that affects 5% of the population. Acoustic parameters may be influenced by the vocal tract structure and soft tissue properties. We hypothesize that speech signal properties of OSA patients will be different than those of control subjects not having OSA. Using speech signal processing

Evgenia Goldshtein; Ariel Tarasiuk; Yaniv Zigel

2011-01-01

132

Selective Potentiation of Peripheral Chemoreflex Sensitivity in Obstructive Sleep Apnea  

Microsoft Academic Search

Background—The chemoreflexes are an important mechanism for regulation of both breathing and autonomic cardiovascular function. Abnormalities in chemoreflex mechanisms may be implicated in increased cardiovascular stress in patients with obstructive sleep apnea (OSA). We tested the hypothesis that chemoreflex function is altered in patients with OSA. Methods and Results—We compared ventilatory, sympathetic, heart rate, and blood pressure responses to hypoxia,

Krzysztof Narkiewicz; Philippe J. H. van de Borne; Catherine A. Pesek; Mark E. Dyken; Nicola Montano; Virend K. Somers

133

Dead space mask eliminates central apnea at altitude.  

PubMed

Travelers to high altitude may have disturbed sleep due to periodic breathing with frequent central apneas. We tested whether a mask with added dead space could reduce the central apneas of altitude. 16 subjects were recruited, age 18-35, residing at 4600?ft (1400?m). They each slept one night with full polysomnographic monitoring, including end tidal CO2, in a normobaric hypoxia tent simulating 12,000?ft. (3658?m) altitude. Those who had a central apnea index (CAI) >20/h returned for a night in the tent for dead space titration, during which they slept with increasing amounts of dead space, aiming for a CAI <5/h or <10% of baseline. Then each subject slept another night with the titrated amount of dead space. Of the 16 subjects, 5 had a central apnea index >20/h mean 49.1, range 21.4-131.5/hr. In each of the 5, the dead space mask reduced the CAI by at least 88% to a mean of 3.1, range 0.9-7.1/h, (p=0.04). Hypopnea index was unchanged. Three subjects required 500?cc of dead space or less. One subject required 860?cc, and one required 2.1?L. Morning symptoms and arousal index were not significantly affected by the dead space mask. Dead space did not appear to increase the CO2 reserve. At 12,000?ft., central apneas can be effectively reduced with a dead space mask, but clinical utility will require further evaluation. PMID:23795738

Patz, David S; Patz, Michael D; Hackett, Peter H

2013-06-01

134

COMPARISON OF TWO METHODS FOR DEMODULATION OF PULSE SIGNALS APPLICATION IN CASE OF CENTRAL  

E-print Network

monitoring for elderly persons and sleep apnea detection. Central sleep apnea is a sleep disorder in whichCOMPARISON OF TWO METHODS FOR DEMODULATION OF PULSE SIGNALS ­ APPLICATION IN CASE OF CENTRAL SLEEP). With the aim to monitor sleep apnea, two simulated central sleep apnea were performed and recorded with Biopac

Boyer, Edmond

135

Online Supplement for: DIAGNOSIS OF SLEEP APNEA BY AUTOMATIC ANALYSIS OF NASAL  

E-print Network

Online Supplement for: DIAGNOSIS OF SLEEP APNEA BY AUTOMATIC ANALYSIS OF NASAL PRESSURE AND FORCED and as obstructive apneas by the other (weight 0.25). The weighted observed proportional agreement between the two

Timmer, Jens

136

Maxillomandibular Advancement in the Management of Obstructive Sleep Apnea  

PubMed Central

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

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

2012-01-01

137

Update on obstructive sleep apnea and its relation to COPD  

PubMed Central

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

Mieczkowski, Brian; Ezzie, Michael E

2014-01-01

138

Prevalence of Sleep Disordered Breathing and Sleep Apnea in 50- to 70YearOld Individuals  

Microsoft Academic Search

Purpose: To determine the prevalence of sleep disordered breathing (SDB) and sleep apnea syndrome (SAS) in a general population aged from 50 to 70 years. Subjects and Methods: We recruited 76 individuals aged between 50 and 70 years, chosen at random from the electoral census. They were invited to the clinic where a detailed medical history was taken and physical

C. Zamarrón; F. Gude; Y. Otero; J. M. Alvarez; A. Golpe; J. R. Rodriguez

1999-01-01

139

MRI sleep studies: use of positive airway pressure support in patients with severe obstructive sleep apnea.  

PubMed

Maintaining the patency of the upper airway during MRI sleep studies, without an artificial airway placement in sedated or anesthetized patients with severe obstructive sleep apnea (OSA) is a major challenge. We report two cases in which a continuous positive airway pressure (CPAP) was used instead of artificial airway to allow interpretation of the dynamic component of the study. PMID:24845266

Fleck, Robert J; Amin, Raouf S; Shott, Sally R; Mahmoud, Mohamed A

2014-07-01

140

Obstructive sleep apnea and neurocognitive performance: the role of cortisol  

PubMed Central

Background Obstructive sleep apnea (OSA) is a prevalent disorder with multiple consequences including negative effects on neurocognitive function. Several domains of cognitive function are impaired in OSA patients, but the mechanisms through which this sleep disorder results in impairment are not clear. Given the well-known effects of cortisol on cognitive function, in particular memory, the dysregulating effects of OSA on cortisol levels is hypothesized as a potential pathway leading to cognitive impairment. Methods Fifty-five participants with OSA (mean apnea-hypopnea index [AHI], 30.3) were assessed over 2 days. Over a 24-hour period, blood was collected every 2 hours to examine cortisol levels. The following night, sleep was monitored with polysomnography (PSG). Participants were given a battery of neurocognitive tests, which assessed 7 cognitive domains. Results OSA severity assessed by oxygen desaturation index (ODI) was associated with 24-hour cortisol levels. AHI, ODI, and nighttime cortisol levels were associated with global deficit scores (GDS) in cognitive functioning, particularly in domains of learning, memory, and working memory (P<.05 for all). Hierarchical linear regression analysis revealed that nighttime cortisol accounted for 9% to 16% of variance in learning (P=.018), memory (P=.003), and working memory (P=.016) domains, though apnea severity did not significantly predict any additional variance. Conclusions In our sample of patients with OSA, nocturnal cortisol levels were associated with neuropsychologic functioning above and beyond the influence of covariates and apnea severity. These findings suggest that OSA-related alterations in cortisol activity may partially explain the pathophysiology of neuropsychologic impairments in sleep apnea. PMID:24269133

Edwards, Kate M.; Kamat, Rujvi; Tomfohr, Lianne M.; Ancoli-Israel, Sonia; Dimsdale, Joel E.

2013-01-01

141

Application of Dual Mask for Postoperative Respiratory Support in Obstructive Sleep Apnea Patient  

PubMed Central

In some conditions continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) therapy alone fails to provide satisfactory oxygenation. In these situations oxygen (O2) is often being added to CPAP/BIPAP mask or hose. Central sleep apnea and obstructive sleep apnea (OSA) are often present along with other chronic conditions, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, pulmonary fibrosis, neuromuscular disorders, chronic narcotic use, or central hypoventilation syndrome. Any of these conditions may lead to the need for supplemental O2 administration during the titration process. Maximization of comfort, by delivering O2 directly via a nasal cannula through the mask, will provide better oxygenation and ultimately treat the patient with lower CPAP/BIPAP pressure. PMID:23662212

Porhomayon, Jahan; Zadeii, Gino; Nader, Nader D.; Bancroft, George R.; Yarahamadi, Alireza

2013-01-01

142

AN IMPROVED APPROACH FOR REAL-TIME DETECTION OF SLEEP APNEA  

E-print Network

AN IMPROVED APPROACH FOR REAL-TIME DETECTION OF SLEEP APNEA Baile Xie, Wenxun Qiu Department {hlaing.minn, tamil, nourani}@utdallas.edu Keywords: Sleep anpea, SpO2, Real-time detection, Feature selection, Cost-sensitive Abstract: The traditional diagnosis of sleep apnea and hypopnea syndrome (SAHS

Minn, Hlaing

143

Obstructive sleep apnea in a referral population in India.  

PubMed

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 +/- 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 +/- 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 +/- 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 +/- 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% +/- 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 +/- 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 +/- 427 mm2 compared with normal controls at 561.1 +/- 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 +/- 10.5 in OSA and 16 +/- 16.7 in controls; uvula area was 452.5 +/- 145.8 mm2 in OSA and 221.4 +/- 49.85 mm2 in controls; uvula diameter was 13.8 +/- 2.74 mm in OSA and 10.1 +/- 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 +/- 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA. PMID:14710337

Vigg, Ajit; Vigg, Avanti; Vigg, Arul

2003-12-01

144

Physiological Effects of Obstructive Sleep Apnea Syndrome in Childhood  

PubMed Central

Sleep disordered breathing in children refers to a group of respiratory disorders that occur or are exacerbated during sleep. Obstructive sleep apnea syndrome (OSAS) is one of the most significant disorders in this group. OSAS can present in all age groups from early infancy to adolescent years. The cardinal feature of OSAS is limitation of inspiratory flow and volume during sleep resulting in abnormal gas exchange and/or alteration of sleep patterns. When OSAS is a chronic condition it often results in adverse physiological effects that impact on health and development. The present review discusses genesis of OSAS in children and consequent end organ injury with special emphasis on behavior and cognition, cardiovascular function, autonomic regulation, inflammation, endothelial function and metabolic syndrome. PMID:23707879

Muzumdar, Hiren; Arens, Raanan

2013-01-01

145

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

PubMed

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

2015-01-15

146

Assessing severity of obstructive sleep apnea by fractal dimension sequence analysis of sleep EEG  

NASA Astrophysics Data System (ADS)

Different sleep stages are associated with distinct dynamical patterns in EEG signals. In this article, we explored the relationship between the sleep architecture and fractal dimension (FD) of sleep EEG. In particular, we applied the FD analysis to the sleep EEG of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), which is characterized by recurrent oxyhemoglobin desaturation and arousals from sleep, a disease which received increasing public attention due to its significant potential impact on health. We showed that the variation of FD reflects the macrostructure of sleep. Furthermore, the fast fluctuation of FD, as measured by the zero-crossing rate of detrended FD (zDFD), is a useful indicator of sleep disturbance, and therefore, correlates with apnea-hypopnea index (AHI), and hourly number of blood oxygen saturation (SpO 2) decreases greater than 4%, as obstructive apnea/hypopnea disturbs sleep architecture. For practical purpose, a modified index combining zDFD of EEG and body mass index (BMI) may be useful for evaluating the severity of OSAHS symptoms.

Zhang, J.; Yang, X. C.; Luo, L.; Shao, J.; Zhang, C.; Ma, J.; Wang, G. F.; Liu, Y.; Peng, C.-K.; Fang, J.

2009-10-01

147

Sleep Apnea - Multiple Languages: MedlinePlus  

MedlinePLUS

... Arabic (???????) Chinese - Simplified (????) Chinese - Traditional (????) French (français) Hindi (??????) Japanese (???) Korean (???) ... Chinese Community Health Resource Center Return to top French (français) Common Sleep Problem Problèmes de sommeil courants - ...

148

Effect of Isolated Uvulopalatopharyngoplasty on Subjective Obstructive Sleep Apnea Symptoms  

PubMed Central

Objectives The aims of this study were 1) to evaluate the effect of isolated uvulopalatopharyngoplasty (UPPP) on subjective obstructive sleep apnea (OSA) symptoms in adult patients regardless of the response to surgery, and ultimately 2) to investigate the differences in changes in subjective OSA symptoms between successful and unsuccessful surgery groups. Methods Twenty consecutive adult patients who underwent isolated UPPP were enrolled. Pre- and postoperative subjective OSA symptoms (snoring, witnessed apnea, daytime sleepiness, morning headache, daytime fatigue, restless sleep, difficulty with morning arousal) and polysomnographic data were evaluated in all subjects. Changes in subjective OSA symptoms before and after surgery were investigated in the successful (n=11) and unsuccessful (n=9) groups. Surgical success was defined as a reduction of at least 50% in the preoperative apnea-hypopnea index (AHI) and a postoperative AHI less than 20 per hour. Results After isolated UPPP, all subjective OSA symptoms changed significantly in the patients, especially in the successful group. In the unsuccessful group, snoring, witnessed apnea and daytime fatigue changed significantly, while other symptoms did not change significantly after surgery. Conclusion Isolated UPPP may improve subjective OSA symptoms in adult patients whom surgery was successful or unsuccessful. However, after isolated UPPP, the improvements in subjective OSA symptoms in the unsuccessful group may be different from those in the successful group. PMID:24069519

Choi, Ji Ho; Jun, Young Joon; Kim, Tae Hoon; Lee, Heung Man; Lee, Sang Hag; Kwon, Soon Young; Choi, Hyuk

2013-01-01

149

Impact of obstructive sleep apnea on sleep-wake stage ratio.  

PubMed

Patients with obstructive sleep apnea (OSA) experience fragmented sleep and exhibit different sleep architectures. While polysomnographic metrics for quantifying sleep architecture are studied, there is little information about the impact of OSA on the ratio of different sleep-wake stages (wake, W; rapid eye movement, REM; non-REM stages 1 to 3, N1 to N3). This study, therefore, aims to investigate the relationship between apnea-hypopnea index (AHI, a measure of OSA severity) and all possible ratios of sleep-wake stages. Sleep architectures of 24 adult subjects with suspected OSA were constructed according to the American Academy of Sleep Medicine scoring manual, and subsequently analyzed through various correlation (Pearson, Spearman, and Kendall) and regression (linear, logarithmic, exponential, and power-law) approaches. Results show a statistically significant positive, linear and monotonic correlation between AHI and REM/N3, as well as between AHI and N1/W (p-values < 0.05). These findings imply that patients with increased severity of OSA may spend more time in REM than deep sleep, and in light sleep than wake (or less time in deep sleep than REM, and in wake than light sleep). A power-law regression model may possibly explain the relationships of AHI-REM/N3 and AHI-N1/W, and predict the value of AHI using REM/N3 or N1/W. PMID:23366967

Ng, Andrew Keong; Guan, Cuntai

2012-01-01

150

Quantitative Effects of Trunk and Head Position on the Apnea Hypopnea Index in Obstructive Sleep Apnea  

PubMed Central

Study Objectives: To test the hypothesis that head position, separately from trunk position, is an additionally important factor for the occurrence of apnea in obstructive sleep apnea (OSA) patients. Design: Prospective cohort study. Setting: St. Lucas Andreas Hospital, Amsterdam, the Netherlands. Patients and Participants: Three hundred patients referred to our department because of clinically suspected OSA. Interventions: N/A Measurements and Results: Patients underwent overnight polysomnography with 2 position sensors: one on the trunk, and one in the mid-forehead. Of the 300 subjects, 241 were diagnosed with OSA, based on an AHI > 5. Of these patients, 199 could be analyzed for position-dependent OSA based on head and trunk position sensors (AHI in supine position twice as high as AHI in non-supine positions): 41.2% of the cases were not position dependent, 52.3% were supine position dependent based on the trunk sensor, 6.5% were supine position dependent based on the head sensor alone. In 46.2% of the trunk supine position-dependent group, head position was of considerable influence on the AHI (AHI was > 5 higher when the head was also in supine position compared to when the head was turned to the side). Conclusions: The results of this study confirm our hypothesis that the occurrence of OSA may also be dependent on the position of the head. Therefore in patients with a suspicion of position-dependent OSA, sleep recording with dual position sensors placed on both trunk and head should be considered. Citation: van Kesteren ER; van Maanen JP; Hilgevoord AAJ; Laman DM; de Vries N. Quantitative effects of trunk and head position on the apnea hypopnea index in obstructive sleep apnea. SLEEP 2011;34(8):1075-1081. PMID:21804669

van Kesteren, Ellen R.; van Maanen, J. Peter; Hilgevoord, Anthony A.J.; Laman, D. Martin; de Vries, Nico

2011-01-01

151

Obstructive sleep apnea and psychomotor vigilance task performance  

PubMed Central

Background Obstructive sleep apnea (OSA) is a highly prevalent disorder with considerable morbidity and mortality. Vigilance and attentiveness are often impaired in OSA patients. In occupational medicine settings, subjective reports of sleepiness are notoriously inaccurate, making the identification of objective measures of vigilance potentially important for risk assessments of fitness for duty. In order to evaluate the effects of OSA on attentiveness and vigilance, we conducted a cross-sectional study to examine the association between OSA and psychomotor vigilance task (PVT) performance. Methods Patients attending sleep clinics for evaluation of possible sleep apnea were recruited. The subjects underwent either a standard overnight laboratory polysomnography or home sleep study. Subjective daytime sleepiness was assessed by Epworth sleepiness scale, and vigilance was tested using a portable device. The participants were asked to respond to the PVT signals using their dominant hand. Each PVT administration lasted 10 minutes, with stimuli signals appearing randomly at variable intervals of 2–10 seconds. Results Mean age of the participants was 46±15 years, and mean body mass index was 34.3±9.8 kg/m2. Participants with higher Epworth scores had worse PVT performance (P<0.05). In multivariate analyses, age, body mass index, and poor sleep efficiency (measured by Pittsburgh sleep quality index score) were associated with worse PVT performance (P<0.05). In contrast, PVT performance did not differ significantly across categories of apnea hypopnea index severity. Subgroup analysis demonstrated that women had worse performance on all PVT measures (P<0.05). Conclusion PVT performance can be utilized for risk assessments of sleepiness and may be particularly useful among populations where subjective reports are unreliable. PMID:24920941

Batool-Anwar, Salma; Kales, Stefanos N; Patel, Sanjay R; Varvarigou, Vasileia; DeYoung, Pamela N; Malhotra, Atul

2014-01-01

152

Metabolic correlates with obstructive sleep apnea in obese subjects  

Microsoft Academic Search

Objective: To examine links between obstructive sleep apnea (OSA), insulin resistance, and dyslipidemia. Study design: Obese (body mass index [BMI] >95th percentile for age and gender) children who snored (n = 62, 46 males, age 10.89 [5-16 years] underwent polysomnography and metabolic studies. Results: Respiratory disturbance index (RDI) was 9.23 (0-95), with 23 children (39%) recommended for treatment. Fasting insulin

Roland C. de la Eva; Louise A. Baur; Kim C. Donaghue; Karen A. Waters

2002-01-01

153

Cardio-Respiratory Coordination Increases during Sleep Apnea  

PubMed Central

Cardiovascular diseases are the main source of morbidity and mortality in the United States with costs of more than $170 billion. Repetitive respiratory disorders during sleep are assumed to be a major cause of these diseases. Therefore, the understanding of the cardio-respiratory regulation during these events is of high public interest. One of the governing mechanisms is the mutual influence of the cardiac and respiratory oscillations on their respective onsets, the cardio-respiratory coordination (CRC). We analyze this mechanism based on nocturnal measurements of 27 males suffering from obstructive sleep apnea syndrome. Here we find, by using an advanced analysis technique, the coordigram, not only that the occurrence of CRC is significantly more frequent during respiratory sleep disturbances than in normal respiration (p-value<10?51) but also more frequent after these events (p-value<10?15). Especially, the latter finding contradicts the common assumption that spontaneous CRC can only be observed in epochs of relaxed conditions, while our newly discovered epochs of CRC after disturbances are characterized by high autonomic stress. Our findings on the connection between CRC and the appearance of sleep-disordered events require a substantial extension of the current understanding of obstructive sleep apneas and hypopneas. PMID:24718564

Riedl, Maik; Müller, Andreas; Kraemer, Jan F.; Penzel, Thomas; Kurths, Juergen; Wessel, Niels

2014-01-01

154

Original Article HHT based cardiopulmonary coupling analysis for sleep apnea detection  

E-print Network

fast wave sleep (stages 1 and 2), decreased slow wave sleep (stages 3) [2], sleep fragmentation of OSAHS in clinical practice. However, PSG is expensive and encumbering. Sleep stage 3, especially, showsOriginal Article HHT based cardiopulmonary coupling analysis for sleep apnea detection Dongdong Liu

155

Sleep Apnea in Adults (Beyond the Basics)  

MedlinePLUS

... and that is acceptable for long term use. Continuous positive airway pressure (CPAP) — The most effective treatment ... the upper airway open during sleep. A CPAP (continuous positive airway pressure) ( figure 3 ) device uses an ...

156

Sleep Apnea Is Related to the Atherogenic Phenotype, Lipoprotein Subclass B  

PubMed Central

Study Objectives: Sleep apnea has been implicated as an independent risk factor for atherosclerotic coronary artery disease (CAD). An association between the severity of sleep apnea and total cholesterol levels has previously been reported. However, the association with small dense low density lipoprotein (LDL) cholesterol concentration (subclass B), one of the strongest predictors of atherosclerosis, is unknown. We examined the relationship between sleep apnea and LDL subclass B, considering body size. Methods: This is a cross-sectional observational cohort of participants enrolled in a cardiovascular health study. Sleep apnea was assessed with a validated portable monitor. Lipid panels included total cholesterol, triglycerides, high density lipoprotein cholesterol, LDL cholesterol, and LDL subclasses A, B, and A/B. Sleep apnea was analyzed categorically using the apnea hypopnea index (AHI). Results: A total of 519 participants were evaluated. Mean age was 58.7 ± 7.4 years; BMI was 29.6 ± 5.7; 65% were female; 59% were Caucasian, and 37% were African American. Among participants with abnormal waist circumference by ATP III criteria, moderate to severe sleep apnea (AHI ? 25) was not independently associated with LDL subclass B. In contrast, among participants with normal waist circumference, moderate to severe sleep apnea was associated with 4.5-fold odds of having LDL subclass B. Conclusions: Sleep apnea is independently associated with an atherogenic phenotype (LDL subclass B) in non-obese individuals. The association between sleep apnea and LDL subclass B in those with normal waist circumference may account, in part, for the increased risk of atherosclerosis and subsequent vascular events. Citation: Luyster FS; Kip KE; Drumheller OJ; Rice TB; Edmundowicz D; Matthews K; Reis SE; Strollo PJ. Sleep apnea is related to the atherogenic phenotype, lipoprotein subclass B. J Clin Sleep Med 2012;8(2):155-161. PMID:22505860

Luyster, Faith S.; Kip, Kevin E.; Drumheller, Oliver J.; Rice, Thomas B.; Edmundowicz, Daniel; Matthews, Karen; Reis, Steven E.; Strollo, Patrick J.

2012-01-01

157

Cortical Processing of Respiratory Afferent Stimuli during Sleep in Children with the Obstructive Sleep Apnea Syndrome  

PubMed Central

Study Objectives: Children with the obstructive sleep apnea syndrome (OSAS) have blunted upper airway responses to negative pressure, but the underlying cause remains unknown. Cortical processing of respiratory afferent information can be tested by measuring respiratory-related evoked potentials (RREPs). We hypothesized that children with OSAS have blunted RREP responses compared to normal children during sleep. Design: During sleep, RREPs were obtained from EEG electrodes Fz, Cz, Pz during stage 2 sleep, slow wave sleep (SWS), and REM sleep. RREPs were produced with multiple short occlusions of the upper airway. Setting: Sleep laboratory. Participants: 9 children with OSAS and 12 normal controls. Measurements and Results: Children with OSAS had significantly decreased evoked K-complex production in stage 2 sleep and slow wave sleep and significantly reduced RREP N350 and P900 components in slow wave sleep. There were no significant differences in any of the measured RREP components in stage 2 sleep, and the only REM difference was decreased P2 amplitude. Conclusions: Results indicate that in children with OSAS, cortical processing of respiratory-related information measured with RREPs persists throughout sleep; however, RREPs during SWS are blunted compared to those seen in control children. Possible causes for this difference include a congenital deficit in neural processing reflective of a predisposition to develop OSAS, or changes in the upper airway rendering the airway less capable of transducing pressure changes following occlusion. Further research is required to evaluate RREPs after effective surgical treatment of OSAS in children, in order to distinguish between these alternatives. Citation: Huang J; Colrain IM; Melendres MC; Karamessinis LR; Pepe ME; Samuel JM; Abi-Raad RF; Trescher WH; Marcus CL. Cortical processing of respiratory afferent stimuli during sleep in children with the obstructive sleep apnea syndrome. SLEEP 2007;31(3):403-410. PMID:18363317

Huang, Jingtao; Colrain, Ian M.; Melendres, M. Cecilia; Karamessinis, Laurie R.; Pepe, Michelle E.; Samuel, John M.; Abi-Raad, Ronald F.; Trescher, William H.; Marcus, Carole L.

2008-01-01

158

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

PubMed Central

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

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

159

When a fluid-structure interaction keeps you awake: a physical approach to Obstructive Sleep Apnea  

E-print Network

When a fluid-structure interaction keeps you awake: a physical approach to Obstructive Sleep Apnea is dictated by a combination of passive mechanical properties and active neural mechanisms. From a physical, Paris, France 4 CHU Purpan, Toulouse, France Abstract The Sleep Apnea Syndrome is known to be related

Payan, Yohan

160

Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea  

Microsoft Academic Search

background Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adre- nergic loads and may thereby contribute to the progression of heart failure. We hypoth- esized that treatment of obstructive sleep apnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function. methods Twenty-four patients with a depressed left ventricular ejection fraction

Yasuyuki Kaneko; John S. Floras; Kengo Usui; Julie Plante; Ruzena Tkacova; Toshihiko Kubo; Shin-ichi Ando; T. Douglas Bradley

2003-01-01

161

In-vitro study of pharyngeal pressure losses at the origin of obstructive sleep apnea  

E-print Network

are very limited. In [9] a polynomial function is proposed to predict the upper- airway pressureIn-vitro study of pharyngeal pressure losses at the origin of obstructive sleep apnea A. Van Hirtum of pharyngeal airflow at the origin of obstructive sleep apnea. The air flow rate and pressure along

Payan, Yohan

162

Respiration Physiology 123 (2000) 8799 Detection of obstructive sleep apnea by analysis of phase  

E-print Network

and that f(t) might be a potentially useful parameter for detection of impending upper airway obstruction, obstructions; Sleep, obstructive apnea; Upper airways, obstructive sleep apnea; Ventilation, forced oscilation) is linked to decreased upper airway muscle activity. We hypothesised that decreased muscle activity causes

Timmer, Jens

163

Sleep Apnea: Traffic and Occupational Accidents – Individual Risks, Socioeconomic and Legal Implications  

Microsoft Academic Search

Obstructive sleep apnea has been associated with a high risk for motor vehicle accidents, probably the highest of all risks due to medical conditions. Treatment of sleep apnea with nasal continuous positive airway pressure appears to reduce the risk of traffic accidents to the one of the general population. The risk for accidents may also be increased in untreated patients

Daniel Rodenstein

2009-01-01

164

Simulation of the Retroglossal Fluid-Structure Interaction During Obstructive Sleep Apnea  

E-print Network

Simulation of the Retroglossal Fluid-Structure Interaction During Obstructive Sleep Apnea Franz are in agreement with the effects of the surgery. 1 Introduction The Obstructive Sleep Apnea Syndrome is now countries [1]. At least, 2 % of the women and 4 % of the men suffer from this disorder [2]. Its main

Lagrée, Pierre-Yves

165

Treatment with Nasal CPAP Decreases Automobile Accidents in Patients with Sleep Apnea  

Microsoft Academic Search

We studied 50 consecutive patients to test the hypothesis that successful treatment of obstructive sleep apnea with nasal continuous positive airway pressure (nasal CPAP) will decrease automobile ac- cidents in patients with sleep apnea. Thirty-six (72%) of the patients reported using nasal CPAP reg- ularly during 2 yr. Fourteen patients reported they had not used CPAP during 2 yr. The

LARRY FINDLEY; CAROL SMITH; JOANNA HOOPER; MICHAEL DINEEN; PAUL M. SURATT

166

Marinobufagenin in hypertensive patients with obstructive sleep apnea.  

PubMed

Although obstructive sleep apnea (OSA) is an independent risk factor for hypertension, the underlying mechanisms are not clearly understood. Apnea and hypopnea episodes during sleep lead to sympathoactivation, decrease plasma pH, and predispose to sodium and volume retention. We hypothesized that, the latter could stimulate digitalis-like natriuretic/vasopressor hormones, endogenous ouabain (EO) and marinobufagenin (MBG). Overnight polysomnography (Embletta) and 24 hrs blood pressure monitoring (SpaceLab 90207) was conducted in 52 consecutive patients with OSA (51 +/- 8 years; 40 males, 12 females) and in 48 age-matched hypertensive subjects without OSA. According to the polysomnography data, 17 patients had a mild degree of OSA (apnea/hypopnea index (AHI) 5-15), 17 patients-moderate (AHI 15-30) and 18 -severe OSA (AHI >30). Levels of MBG excretion co-varied with OSA severity (0.5 +/- 0.1, 0.9 +/- 0.04 and 1.2 +/- 0.06 nmoles per 24 hrs, respectively), while excretion of EO did not differ in patients with different degrees of OSA severity. Our observations suggest that MBG may be involved in the pathogenesis of hypertension in OSA, and may be a marker of OSA severity. PMID:17535732

Zvartau, N E; Conrady, A O; Sviryaev, Y V; Rotari, O P; Merkulova, N K; Kalinkin, A L; Shlyakhto, E V; Bagrov, A Y

2006-01-01

167

Do patients with obstructive sleep apnea have thick necks?  

PubMed

During physical examination of patients with suspected obstructive sleep apnea (OSA), a comment is frequently made that they appear to have a short and fat neck. To confirm this subjective impression by objective measurements, we studied a group of 123 patients referred to us because of snoring and suspected OSA, all of whom had nocturnal polysomnography and measurements of external and internal neck circumference. The external neck circumference was measured at the level of the superior border of the cricothyroid cartilage. Internal neck circumferences were calculated from the measurements of pharyngeal, glottic, and tracheal areas obtained by the acoustic reflection technique. Internal pharyngeal circumference was further subdivided into the proximal, middle, and distal thirds. The acoustic technique also permitted us to measure the distance between the teeth and the glottic minimum, which reflects the length of the upper airway. Stepwise multiple linear regression analysis revealed that the apnea/hypopnea index (AHI) correlated only with the external neck circumference, the body mass index, and the internal circumference of the distal pharynx; these three variables accounted for 39% of the variability in AHI. We conclude that the external and internal neck circumferences and the degree of obesity are important predictors of sleep apnea; it is possible that obesity produces its effect via fat in the neck. We speculate that the static pharyngeal size modulated by the dynamic loading of the airway due to the weight of fatty tissue of the neck may contribute to the pathogenesis of OSA. PMID:2339843

Katz, I; Stradling, J; Slutsky, A S; Zamel, N; Hoffstein, V

1990-05-01

168

Obstructive sleep apnea in loudly snoring army conscripts.  

PubMed

One of the hallmarks of obstructive sleep apnea (OSA) is loud snoring. Army conscripts sleep in barracks, and loud snorers are easily detected. We made polygraphic recordings from these snorers during one night spent in the hospital, to find the ones suffering from OSA. Forty-nine conscripts (all male; mean age, 21 +/- 2 years; body mass index, 25 +/- 3 kg/m2) were studied; 32 (65%) complained about daytime sleepiness, and one had caused a shipwreck during an episode of fatigue. Oxygen levels decreased 4 to 9% >20 times per hour (4-9% oxygen desaturation index [ODI4] of >20 hours) for three subjects (6%). Eleven additional subjects (22%) had ODI4 values of >10 hours. Four (8%) of them did not complain about daytime sleepiness. The mean apnea index (AI) was 11 +/- 13 hours; 20 patients (41%) had AI values exceeding 10 hours. ODI4 and AI were significantly correlated (r = 0.67; p < 0.001). Body mass index did not correlate significantly with ODI4 or apnea index. Approximately one-fifth of loudly snoring conscripts suffer from OSA. Loud snorers should be examined before being selected for duties requiring maintenance of high alertness. PMID:17803083

Mäkelä, Jyrki P; Savolainen, Seppo

2007-08-01

169

Prevalence of Sleep-disordered Breathing and Sleep Apnea in Middle-aged Urban Indian Men  

Microsoft Academic Search

No data are available on the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea-hypopnea syndrome (OSAHS) in Indians. We conducted a two-phase cross-sectional prevalence study for the same in healthy urban Indian males (35-65 years) coming to our hospital in Bombay for a routine health check. We also investigated its risk factors and evaluated the significance of the most

Zarir F. Udwadia; Amita V. Doshi; Sharmila G. Lonkar; Chandrajeet I. Singh

2003-01-01

170

Getting a Diagnosis for Sleep Apnea  

MedlinePLUS

... step is to discuss your suspicions with your primary care physician. If you don't have a primary care physician, you can go directly to a clinician ... first. Some policies require you to see a primary care physician first, and some policies limit the sleep ...

171

Figure 1. A result from a 14-year old subject with sleep related breathing disorder. (a,b) Axial MR image frames representing that there is (a) no apneic event and (b) central apnea. A marked reduction of the airway cross-sectional area is observed in (b)  

E-print Network

information of the nasal and pharyngeal airway [1]. MRI has the potential to visualize sites of airway collapse in patients with obstructive sleep apnea during natural sleep, but it is difficult to obtain.I. Pack, "Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric

Southern California, University of

172

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

PubMed Central

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

2014-01-01

173

Daytime Sleepiness in Obesity: Mechanisms Beyond Obstructive Sleep Apnea—A Review  

PubMed Central

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. Citation: Panossian LA; Veasey SC. Daytime sleepiness in obesity: mechanisms beyond obstructive sleep apnea—a review. SLEEP 2012;35(5):605-615. PMID:22547886

Panossian, Lori A.; Veasey, Sigrid C.

2012-01-01

174

The Consolidation of Implicit Sequence Memory in Obstructive Sleep Apnea  

PubMed Central

Obstructive Sleep Apnea (OSA) Syndrome is a relatively frequent sleep disorder characterized by disrupted sleep patterns. It is a well-established fact that sleep has beneficial effect on memory consolidation by enhancing neural plasticity. Implicit sequence learning is a prominent component of skill learning. However, the formation and consolidation of this fundamental learning mechanism remains poorly understood in OSA. In the present study we examined the consolidation of different aspects of implicit sequence learning in patients with OSA. We used the Alternating Serial Reaction Time task to measure general skill learning and sequence-specific learning. There were two sessions: a learning phase and a testing phase, separated by a 10-hour offline period with sleep. Our data showed differences in offline changes of general skill learning between the OSA and control group. The control group demonstrated offline improvement from evening to morning, while the OSA group did not. In contrast, we did not observe differences between the groups in offline changes in sequence-specific learning. Our findings suggest that disrupted sleep in OSA differently affects neural circuits involved in the consolidation of sequence learning. PMID:25329462

Malecek, Nick

2014-01-01

175

Insomnia Subtypes and Their Relationships to Daytime Sleepiness in Patients with Obstructive Sleep Apnea  

Microsoft Academic Search

Background: Insomnia and obstructive sleep apnea syndrome (OSA) are the two most common sleep disorders. Studies showed that insomnia complaints were prevalent in OSA. Relatively little is known about the causes of insomnia in OSA and whether etiological factors differ for insomnia subtypes. We hypothesized that sleep onset problem was mainly due to hyperarousal and sleep maintenance difficulty was primarily

Ka Fai Chung

2005-01-01

176

Obstructive sleep apnea and driving: A Canadian Thoracic Society and Canadian Sleep Society position paper.  

PubMed

Untreated patients with obstructive sleep apnea (OSA) are at increased risk for motor vehicle collisions; however, it is unclear how this should be translated into fitness-to-drive recommendations. Accordingly, the Canadian Thoracic Society (CTS) Sleep Disordered Breathing Clinical Assembly and the Canadian Sleep Society (CSS) assembled a CTS-CSS working group to propose recommendations with regard to driving in patients with OSA. Recommendations for assessing fitness to drive in noncommercial drivers: 1. Severity of OSA alone is not a reliable predictor of collision risk and, therefore, should not be used in isolation to assess fitness to drive; 2. The severity of sleep apnea should be considered in the context of other factors to assess fitness to drive; 3. The decision to restrict driving is ultimately made by the motor vehicle licensing authority; however, they should take into account the information and recommendations provided by the sleep medicine physician and should follow provincial guidelines; 4. For patients prescribed continuous positive airway pressure (CPAP) therapy, objective CPAP compliance should be documented. Efficacy should also be documented in terms of reversing the symptoms and improvement in sleep apnea based on physiological monitoring; 5. For patients treated with surgery or an oral appliance, verification of adequate sleep apnea treatment should be obtained; and 6. A driver diagnosed with OSA may be recertified as fit to drive based on assessment of symptoms and demonstrating compliance with treatment. The assessment should be aligned with the provincial driver's license renewal period. Commercial vehicles: Assessment of fitness to drive should be more stringent for patients operating commercial vehicles. In general, the CTS-CSS working group was in agreement with the Medical Expert Panel recommendations to the Federal Motor Carrier Safety Administration in the United States; these recommendations were adapted for Canadian practitioners. PMID:24724150

Ayas, Najib; Skomro, Robert; Blackman, Adam; Curren, Kristen; Fitzpatrick, Michael; Fleetham, John; George, Charles; Hakemi, Tom; Hanly, Patrick; Li, Christopher; Morrison, Debra; Series, Frédéric

2014-01-01

177

Innovative treatments for adults with obstructive sleep apnea  

PubMed Central

Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone. PMID:25429246

Weaver, Terri E; Calik, Michael W; Farabi, Sarah S; Fink, Anne M; Galang-Boquiren, Maria T; Kapella, Mary C; Prasad, Bharati; Carley, David W

2014-01-01

178

Cognition and biomarkers of oxidative stress in obstructive sleep apnea  

PubMed Central

OBJECTIVES: The aim of this study was to investigate neuropsychological performance and biomarkers of oxidative stress in patients with obstructive sleep apnea and the relationships between these factors. METHODS: This was an observational, cross-sectional study of 14 patients (36.0±6.5 years old) with obstructive sleep apnea and 13 controls (37.3±6.9 years old). All of the participants were clinically evaluated and underwent full-night polysomnography as well as neuropsychological tests. Blood samples were used to assay superoxide dismutase, catalase, glutathione and homocysteine, as well as vitamins E, C, B11 and B12. RESULTS: The patients performed poorly relative to the controls on several neuropsychological tests, such as the attention test and tests of long-term memory and working memory/executive function. They also had lower levels of vitamin E (p<0.006), superoxide dismutase (p<0.001) and vitamin B11 (p<0.001), as well as higher concentrations of homocysteine (p<0.02). Serum concentrations of vitamin C, catalase, glutathione and vitamin B12 were unaltered. Vitamin E levels were related to performance in the backward digit span task (F?=?15.9; p?=?0.002) and this correlation remained after controlling for age and body mass index (F?=?6.3, p?=?0.01). A relationship between superoxide dismutase concentrations and executive non-perseveration errors in the Wisconsin Card Sorting Test (F?=?7.9; p?=?0.01) was also observed. CONCLUSIONS: Decreased levels of antioxidants and lower performance on the neuropsychological tasks were observed in patients with obstructive sleep apnea. This study suggests that an imbalance between antioxidants and pro-oxidants may contribute to neuropsychological alterations in this patient population. PMID:23778335

Sales, Leticia Viana; de Bruin, Veralice Meireles Sales; D'Almeida, Vania; Pompéia, Sabine; Bueno, Orlando Francisco Amodeo; Tufik, Sérgio; Bittencourt, Lia

2013-01-01

179

Driving impairment in patients with obstructive sleep apnea syndrome.  

PubMed

Drivers with obstructive sleep apnea syndrome (OSAS) have an increased risk of motor vehicle crashes. Unfortunately, neither clinical nor polysomnographic features allow clinicians to reliably identify high-risk drivers. One potential means of identifying these drivers is with the use of driving simulators. Several investigators have shown that OSAS patients perform worse than healthy control drivers and results from our studies have demonstrated declines in driving performance during EEG-defined "microsleeps." The use of simulators, and in-vehicle detection and alerting devices may mitigate some of the suffering caused by these crashes. PMID:17679579

Tippin, Jon

2007-06-01

180

APAP impact on metabolic syndrome in obstructive sleep apnea patients  

Microsoft Academic Search

Purpose  Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effect of autoadjusting positive\\u000a airway pressure (APAP) on MS remains unclear. This study aimed to determine the prevalence of MS in OSA patients before and\\u000a 6 months after APAP, and to identify potential determinants of metabolic status change.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Seventy-four male patients with moderate to severe OSA were

Patrícia Caetano Mota; Marta Drummond; João Carlos Winck; Ana Cristina Santos; João Almeida; José Agostinho Marques

181

A Thyroglossal Duct Cyst Causing Obstructive Sleep Apnea in Adult  

PubMed Central

Obstructive sleep apnea (OSA) is a common disorder. It usually results from the structural compromise of the upper airway. In patients with OSA, the obstruction predominantly occurs along the pharyngeal airway, and also a variety of tumors have been reported to cause such a condition. We present here the case of a thyroglossal duct cyst causing OSA in adult. This case demonstrates that thyroglossal duct cyst or some kind of mass lesions in the airway lesions should be considered in the differential diagnosis of OSA patients. PMID:24069524

Jung, Hahn Jin; Kim, Jeong-Whun; Lee, Chul Hee; Chung, Young Jun

2013-01-01

182

Chemoreceptors, Baroreceptors, and Autonomic Deregulation in Children with Obstructive Sleep Apnea  

PubMed Central

Obstructive sleep apnea (OSA) is highly prevalent sleep disorder of breathing in both adults and children that is fraught with substantial cardiovascular morbidities, the latter being attributable to a complex interplay between intermittent hypoxia (IH), episodic hypercapnia, recurrent large intra-thoracic pressure swings, and sleep disruption. Alterations in autonomic nervous system function could underlie the perturbations in cardiovascular, neurocognitive, immune, endocrine and metabolic functions that affect many of the patients suffering from OSA. Although these issues have received substantial attention in adults, the same has thus far failed to occur in children, creating a quasi misperception that children are protected. Here, we provide a critical overview of the evidence supporting the presence of autonomic nervous system (ANS) perturbations in children with OSA, draw some parallel assessments to known mechanisms in rodents and adult humans, particularly, peripheral and central chemoreceptor and baroreceptor pathways, and suggest future research directions. PMID:22954503

Gozal, David; Hakim, Fahed; Kheirandish-Gozal, Leila

2012-01-01

183

Apnea D.E.S.I.R. 17/03/2010 1/17 High baseline insulin levels associated with 6year incident observed sleep apnea.  

E-print Network

was the strongest predictor of incident apnea: standardized odds ratio (OR) (95% Confidence Interval), adjusted hypoxia, recurrent arousals, changes in intrathoracic pressure, changes in sleep architecture (reduction

Paris-Sud XI, Université de

184

Dynamics of Snoring Sounds and Its Connection with Obstructive Sleep Apnea  

E-print Network

Snoring is extremely common in the general population and when irregular may indicate the presence of obstructive sleep apnea. We analyze the overnight sequence of wave packets --- the snore sound --- recorded during full polysomnography in patients referred to the sleep laboratory due to suspected obstructive sleep apnea. We hypothesize that irregular snore, with duration in the range between 10 and 100 seconds, correlates with respiratory obstructive events. We find that the number of irregular snores --- easily accessible, and quantified by what we call the snore time interval index (STII) --- is in good agreement with the well-known apnea-hypopnea index, which expresses the severity of obstructive sleep apnea and is extracted only from polysomnography. In addition, the Hurst analysis of the snore sound itself, which calculates the fluctuations in the signal as a function of time interval, is used to build a classifier that is able to distinguish between patients with no or mild apnea and patients with mod...

Alencar, Adriano M; Oliveira, Carolina Beatriz; Vieira, Andre P; Moriya, Henrique T; Lorenzi-Filho, Geraldo

2012-01-01

185

Feasibility of Portable Sleep Monitors to Detect Obstructive Sleep Apnea (OSA) in a Vulnerable Urban Population  

PubMed Central

Purpose Portable sleep monitors may offer a convenient method to expand detection of obstructive sleep apnea (OSA), yet few studies have evaluated this technology in vulnerable populations. We therefore aimed to assess the feasibility and acceptability of portable sleep monitors for detection of OSA in a prediabetic, urban minority population. Methods We recruited a convenience sample of participants at their 12-month follow-up for a community-partnered, peer-led lifestyle intervention aimed to prevent diabetes in prediabetic and overweight patients in this prospective mixed-methods pilot study. All participants wore portable sleep monitors overnight at home. We qualitatively explored perceptions about OSA and portable monitors in a subset of participants. Results We tested 72 people, predominantly non-White, female, Spanish speaking, uninsured, and of low income. Use of portable sleep monitors was feasible: 100% of the monitors were returned and all participants received results. We detected OSA in 49% (defined as an Apnea-Hypopnea Index [AHI] >5) and moderate-severe OSA in 14% (AHI >15) requiring treatment in 14%. In 21 qualitative interviews, participants supported increased use of portable sleep monitors in their community, were appropriately concerned that OSA could cause progression to diabetes, and thought weight loss could prevent or improve OSA. Conclusions Portable sleep monitors may represent a feasible method for detecting OSA in high-risk urban minority populations. PMID:25748767

Nickerson, Jillian; Lee, Euny; Nedelman, Michael; Aurora, R. Nisha; Krieger, Ana; Horowitz, Carol R.

2015-01-01

186

Sleep Apnea Monitoring Using Mobile Phones Shamma Alqassim, Madhumeta Ganesh, Shaheen Khoja, Meher Zaidi, Fadi Aloul, Assim Sagahyroon  

E-print Network

Sleep Apnea Monitoring Using Mobile Phones Shamma Alqassim, Madhumeta Ganesh, Shaheen Khoja, Meher of Sharjah, UAE Abstract--Obstructive Sleep Apnea (OSA) is a sleeping disorder characterized by the repetitive reduction of airflow during sleep. In this paper, we discuss the design and implementation

Aloul, Fadi

187

Obstructive sleep apnea in children: a critical update  

PubMed Central

Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment. PMID:24109201

Tan, Hui-Leng; Gozal, David; Kheirandish-Gozal, Leila

2013-01-01

188

Obstructive sleep apnea in children: a critical update.  

PubMed

Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment. PMID:24109201

Tan, Hui-Leng; Gozal, David; Kheirandish-Gozal, Leila

2013-01-01

189

The Impact of Obstructive Sleep Apnea on Chronic Kidney Disease  

PubMed Central

Obstructive sleep apnea (OSA) is an important clinical problem in the chronic kidney disease (CKD) population. OSA is associated with hypoxemia and sleep fragmentation, which activates the sympathetic nervous system, the renin-angiotensin-aldosterone system, alters cardiovascular hemodynamics, and results in free radical generation. In turn, a variety of deleterious processes such as endothelial dysfunction, inflammation, platelet aggregation, atherosclerosis, and fibrosis are triggered, predisposing individuals to adverse cardiovascular events and likely renal damage. Independent of obesity, OSA is associated with glomerular hyperfiltration and may be an independent predictor of proteinuria, a risk factor for CKD progression. OSA is also associated with hypertension, another important risk factor for CKD progression, particularly proteinuric CKD. OSA may mediate renal damage via several mechanisms, and there is a need to better elucidate the impact of OSA on incident renal disease and CKD progression. PMID:20676805

Adeseun, Gbemisola A.

2010-01-01

190

Real-time sleep apnea detection by classifier combination.  

PubMed

To find an efficient and valid alternative of polysomnography (PSG), this paper investigates real-time sleep apnea and hypopnea syndrome (SAHS) detection based on electrocardiograph (ECG) and saturation of peripheral oxygen (SpO(2)) signals, individually and in combination. We include ten machine-learning algorithms in our classification experiment. It is shown that our proposed SpO (2) features outperform the ECG features in terms of diagnostic ability. More importantly, we propose classifier combination to further enhance the classification performance by harnessing the complementary information provided by individual classifiers. With our selected SpO(2) and ECG features, the classifier combination using AdaBoost with Decision Stump, Bagging with REPTree, and either kNN or Decision Table achieves sensitivity, specificity, and accuracy all around 82% for a minute-based real-time SAHS detection over 25 sleep-disordered-breathing suspects' full overnight recordings. PMID:22353404

Xie, Baile; Minn, Hlaing

2012-05-01

191

Reliability of SleepStrip as a screening test in obstructive sleep apnea patients.  

PubMed

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder and related to multiple conditions that cause mortality in adults. In the present study, reliability of SleepStrip, a disposable screening device for detection of OSAS, is tested. In this prospective, nonrandomized double-blinded single cohort study at an academic health center, the performance of the SleepStrip in detecting respiratory events and establishing an SleepStrip score (Sscore) in domestic use were compared to the apnea-hypopnea index (AHI) obtained by the standard polysomnography (PSG) recordings in the sleep laboratory. Forty-one patients who have the PSG results participated the study and wore the SleepStrips at home. Test efficiency rate was 75% and there was a positive correlation between PSG-AHI scores and Sscores (r = 0.71, p < 0.001). However, diagnostic accuracy analysis showed that the correlation between Sscores and PSG-AHI scores were significant only at AHI > 30 levels. The SleepStrip has 100% specificity and positive predictive values, but it also has low negative predictive and sensitivity values. The SleepStrip is not a reliable screening test in differential diagnosis among simple snorers, mild, moderate and severe OSAS patients. However, high Sscores highly indicate the presence of moderate-severe OSAS. We can safely send these patients to split-night PSG and continuous, automatic, bi-level positive airway pressure (CPAP/BPAP/APAP) titration at the same night. The SleepStrip may increase the effective use of the sleep laboratories. PMID:24861563

Dinç, Aykut Erdem; Y?lmaz, Metin; Tutar, Hakan; Aydil, Utku; K?z?l, Yusuf; Damar, Murat; Kemalo?lu, Yusuf K

2014-10-01

192

Sleep apnea and risk of pneumonia: a nationwide population-based study  

PubMed Central

Background: Evidence evaluating the risk of pneumonia in patients with obstructive sleep apnea is limited and mostly focuses on patients who receive continuous positive airway pressure (CPAP) therapy or on pediatric patients. We aimed to explore the risk of incident pneumonia among adults with sleep apnea, either with or without the need of CPAP therapy. Methods: From Jan. 1, 2000, we identified adult patients with sleep apnea from the Taiwan National Health Insurance Research Database. A control cohort without sleep apnea, matched for age, sex and comorbidities, was selected for comparison. The 2 cohorts were followed until Dec. 31, 2010, and observed for occurrence of pneumonia. Results: Of the 34 100 patients (6816 study patients and 27 284 matched controls), 2757 (8.09%) had pneumonia during a mean follow-up period of 4.50 years, including 638 (9.36%) study patients and 2119 (7.77%) controls. Kaplan–Meier analysis showed a higher incidence of pneumonia among patients with sleep apnea (log rank test, p < 0.001). After multivariate adjustment, patients with sleep apnea experienced a 1.20-fold (95% confidence interval 1.10–1.31) increase in incident pneumonia. The risk was even higher among patients who received CPAP therapy. Interpretation: Sleep apnea appeared to confer a higher risk for future pneumonia, possibly in a severity-dependent manner. PMID:24591276

Su, Vincent Yi-Fong; Liu, Chia-Jen; Wang, Hsin-Kai; Wu, Li-An; Chang, Shi-Chuan; Perng, Diahn-Warng; Su, Wei-Juin; Chen, Yuh-Min; Lin, Elizabeth Ya-Hsuan; Chen, Tzeng-Ji; Chou, Kun-Ta

2014-01-01

193

Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment  

SciTech Connect

Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.

Tal, A.; Leiberman, A.; Margulis, G.; Sofer, S.

1988-01-01

194

Copeptin: a new predictor for severe obstructive sleep apnea  

PubMed Central

Introduction Copeptin which is the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker that has been reported to be increased in various cardiovascular disorders, cerebrovascular diseases and associated with prognosis. Patients with obstructive sleep apnea syndrome (OSAS) have a tendency to develop coronary and cerebral atherosclerotic diseases. Objectives The aim of the present study was to study copeptin levels in patients with obstructive sleep apnea and in a control group in order to determine whether copeptin could be used as a biomarker predicting the severity of OSAS and possible complications in this group. Methods A total of 116 patients with OSAS, diagnosed by polysomnography, and 27 controls were included in the study. Blood samples were collected after overnight fasting, and copeptin levels were measured with enzyme-linked immunosorbent assay. Results Copeptin levels were significantly higher in the OSAS group compared to control group (2,156±502; 1,845±500 pg/mL, respectively, P=0.004). Mean copeptin level of the patients having apnea-hypopnea index (AHI) ?30 was significantly higher than that of the patients having AHI <30 (2,392±415; 2,017±500 pg/mL, respectively, P<0.001). A multivariate regression analysis showed that copeptin level, (hazard ratio: 1.58; 95% confidence interval: 1.09–2.30) was a predictor of severe OSAS (P=0.016). Copeptin levels showed significant positive correlation with AHI (r=0.32; P<0.001), desaturation index (r=0.23; P=0.012), arousal index (r=0.24; P=0.010) and CRP (r=0.26; P=0.011) respectively. Conclusion Copeptin levels are high in OSAS patients and copeptin is a potential marker for identifying patients with a high risk of early cardiovascular complications of OSAS. Copeptin has modest sensitivity (84%) for discriminating severe OSAS patients who are candidates for severe cardiovascular complications.

Ç?narka, Halit; Kayhan, Servet; Karata?, Mevlüt; Yavuz, Asiye; Gümü?, Aziz; Özyurt, Songül; Cüre, Medine Cumhur; ?ahin, Ünal

2015-01-01

195

Childhood obstructive sleep apnea syndrome: a review of the 2012 American Academy of Pediatrics guidelines.  

PubMed

On a busy day at the pediatric office, child health care practitioners may see children of different ages present with symptoms such as inattentiveness, hyperactivity, aggression, behavioral problems, excessive sleepiness, difficulty waking up in the morning, learning problems, frequent awakening at night, restless sleep, morning headaches, and nocturnal enuresis. Children with these symptoms may be underweight or morbidly obese; healthy; or suffering from asthma, seasonal allergies, or other ailments. What they will likely have in common is a fairly well-known and yet under-recognized condition - obstructive sleep apnea syndrome (OSA). The American Academy of Pediatrics first published "Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome" in 2002. However, with the increase in obstructive sleep apnea syndrome research, they revised these guidelines in 2012. These new guidelines evaluate obstructive sleep apnea syndrome diagnostic techniques, describe available treatment options, and provide follow-up recommendations. This article explores those revisions. PMID:24126981

Trosman, Irina

2013-10-01

196

Classi cation of Sleep Apnea Events by Means of Radial Basis Function Networks  

E-print Network

of the upper airway, sigh (SI) - a deep inspiration followed by an ap- nea (only considered in the case: Central apnea (CA) - due to missing nervous stimulus, obstructive apnea (OA) - due to obstruction

Zemen, Thomas

197

Persistence of Obstructive Sleep Apnea After Surgical Weight Loss  

PubMed Central

Study Objectives: Weight loss may reduce the severity of obstructive sleep apnea (OSA), but persistence of OSA following surgical weight loss has not been defined. We sought to clarify the impact of bariatric surgery on OSA. We hypothesized that, despite substantial weight loss and reductions in the apnea-hypopnea index (AHI), many will have persistent disease. Methods: Consecutive patients referred for preoperative sleep evaluation underwent polysomnography before and 1 year following bariatric surgery. We compared the effects of weight loss on body mass, OSA, and continuous positive airway pressure requirements. We defined OSA severity using the AHI (normal < 5 events per hour, mild 5 to 14 events per hour, moderate 15 to 29 events per hour, and severe 30 or more events per hour). We identified predictors of OSA severity following weight loss and assessed compliance with therapy. Results: Twenty-four patients (aged 47.9 ± 9.3 years; 75% women) were enrolled. At baseline, all subjects had OSA, the majority of which was severe. Weight loss reduced body mass index from 51.0 ± 10.4 kg/m2 to 32.1 ± 5.5 kg/m2 (p < 0.001) and the AHI from 47.9 ± 33.8 to 24.5 ± 18.1 events per hour (p < 0.001). At follow-up, only 1 patient (4%) experienced resolution of OSA. The majority (71%) had moderate or severe disease. The most important predictor of the follow-up AHI was the baseline AHI (R2 = 0.603). All patients with residual OSA required continuous positive airway pressure to ablate apneic events, but the required pressures decreased from 11.5 ± 3.6 cm H2O to 8.4 ± 2.1 cm H2O (p = 0.001). Only 6 patients were compliant with continuous positive airway pressure therapy at the follow-up visit. Conclusions: Surgical weight loss reduces the AHI, but many patients have residual OSA one year after bariatric surgery. Citation: Lettieri CJ; Eliasson AH; Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med 2008;4(4):333–338. PMID:18763424

Lettieri, Christopher J.; Eliasson, Arn H.; Greenburg, David L.

2008-01-01

198

The subjective-objective mismatch in sleep perception among those with insomnia and sleep apnea.  

PubMed

The diagnosis and management of insomnia relies primarily on clinical history. However, patient self-report of sleep-wake times may not agree with objective measurements. We hypothesized that those with shallow or fragmented sleep would under-report sleep quantity, and that this might account for some of the mismatch. We compared objective and subjective sleep-wake times for 277 patients who underwent diagnostic polysomnography. The group included those with insomnia symptoms (n = 92), obstructive sleep apnea (n = 66) or both (n = 119). Mismatch of wake duration was context dependent: all three groups overestimated sleep latency but underestimated wakefulness after sleep onset. The insomnia group underestimated total sleep time by a median of 81 min. However, contrary to our hypothesis, measures of fragmentation (N1, arousal index, sleep efficiency, etc.) did not correlate with the subjective sleep duration estimates. To unmask a potential relationship between sleep architecture and subjective duration, we tested three hypotheses: N1 is perceived as wake; sleep bouts under 10 min are perceived as wake; or N1 and N2 are perceived in a weighted fashion. None of these hypotheses exposed a match between subjective and objective sleep duration. We show only modest performance of a Naïve Bayes Classifier algorithm for predicting mismatch using clinical and polysomnographic variables. Subjective-objective mismatch is common in patients reporting insomnia symptoms. We conclude that mismatch was not attributable to commonly measured polysomnographic measures of fragmentation. Further insight is needed into the complex relationships between subjective perception of sleep and conventional, objective measurements. PMID:23521019

Bianchi, Matt T; Williams, Kathryn L; McKinney, Scott; Ellenbogen, Jeffrey M

2013-10-01

199

Recent developments in the treatment of obstructive sleep apnea.  

PubMed

Modern sleep medicine has been in existence for only 20 years and therefore has to be regarded as a comparatively recent field of specialization. For this reason it is not surprising that there are numerous new trends and developments concerning the treatment of sleep-related breathing disorders. This review focuses on developments in the treatment of obstructive sleep apnea (OSA) over the last 5 years.The review is based on a Medline bibliographic search using the key words 'treatment', 'obstructive sleep apnea' and 'sleep-related breathing disorders' and covers papers published since 1997, including references in these articles. In respect to conservative treatments the following important developments were found. Oral devices were shown to be effective in about 50-70% of patients with OSA, but at this stage it is not possible to predict in which patients successful treatment can be expected. As subjective compliance averages only about 50%, thermoplastic devices used as trial devices provide a reasonable alternative to reduce costs. Automatic continuous positive airway pressure (CPAP) units have been shown to cut costs when used for pressure titration in severe sleep apneics during the day or when used in so-called split-night procedures in appropriate cases. Nasal CPAP has proven to be effective in children, showing higher compliance rates than in adults. The development of mouth-pieces provides the possibility of using CPAP orally, e.g. after nasal surgery. Electrical stimulation of the tongue muscles shows promising preliminary results. Nevertheless, further research in this field is necessary. In the field of surgery, the most valuable development has been tissue reduction using radiofrequency energy, which has been shown to be effective and minimally invasive. Other fundamentally new surgical techniques have not been attempted within the last 5 years; instead, development in this area appears to be defined by a combination of previously known methods (so-called multilevel surgery) and optimized methods of patient selection. Such combined surgical procedures has achieved success rates of about 70%. Taking all these developments into account, CPAP therapy remains the gold standard for treatment of patients with OSA; yet the low long-term compliance rates of 60-70% have to be regarded as a major challenge warranting further effort. PMID:14720014

Verse, Thomas; Pirsig, Wolfgang; Stuck, Boris A; Hörmann, Karl; Maurer, Joachim T

2003-01-01

200

Oral Appliance Treatment for Obstructive Sleep Apnea: An Update  

PubMed Central

Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA. Citation: Sutherland K; Vanderveken OM; Tsuda H; Marklund M; Gagnadoux F; Kushida CA; Cistulli PA; on behalf of the ORANGE-Registry. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 2014;10(2):215-227. PMID:24533007

Sutherland, Kate; Vanderveken, Olivier M.; Tsuda, Hiroko; Marklund, Marie; Gagnadoux, Frederic; Kushida, Clete A.; Cistulli, Peter A.

2014-01-01

201

Real-Time 3D Magnetic Resonance Imaging of the Pharyngeal Airway in Sleep Apnea  

E-print Network

:1501­1510, 2014. VC 2013 Wiley Periodicals, Inc. Key words: MRI; upper airway; airway obstruction; sleep apnea of physio- logical signals for identifying sites of airway obstruction during natural sleep in pediatric with sleep-disordered breathing. External airway occlusion was used to induce partial collapse of the upper

Southern California, University of

202

Using the Pathophysiology of Obstructive Sleep Apnea to Teach Cardiopulmonary Integration  

ERIC Educational Resources Information Center

Obstructive sleep apnea (OSA) is a common disorder of upper airway obstruction during sleep. The effects of intermittent upper airway obstruction include alveolar hypoventilation, altered arterial blood gases and acid-base status, and stimulation of the arterial chemoreceptors, which leads to frequent arousals. These arousals disturb sleep

Levitzky, Michael G.

2008-01-01

203

Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea  

Microsoft Academic Search

Objective: To determine the safety and efficacy of nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) during childhood and the effects of growth and maturation on CPAP requirements. Design: Retrospective study with use of a written questionnaire administered to pediatric practitioners treating sleep disorders. Setting: Nine academic pediatric sleep disorders centers. Results: Data were obtained for 94

Carole L. Marcus; Sally L. Davidson Ward; George B. Mallory; Carol L. Rosen; Robert C. Beckerman; Debra E. Weese-Mayer; Robert T. Brouillette; Ha T. Trang; Lee J. Brooks

1995-01-01

204

Sleep Apnea and Inflammation – Getting a Good Night’s Sleep with Omega-3 Supplementation  

PubMed Central

Obstructive sleep apnea (OSA) is a multifactorial sleep disorder associated with an increased risk of cardiovascular mortality and morbidity. Several mechanisms have been proposed to explain the association between OSA and cardiovascular dysfunction. One of the proposed mechanisms is an inflammatory response to OSA mediated by tumor necrosis factor (TNF-?). Patients with OSA have higher plasma, serum, and intracellular levels of TNF-?, which may be reduced after apnea treatment with continuous positive airway pressure (CPAP). Because TNF-? plays an important role in OSA related cardiovascular morbidity, the present review aims to identify other preventive measures, in addition to CPAP, that may minimize the inflammatory process in OSA and consequently the risk of premature death due to cardiovascular dysfunction. Thus, we hypothesized that a nutritional immunology profile, i.e., supplementation with omega-3 fatty acids, may be valuable for individuals with OSA. PMID:24348457

Scorza, Fulvio A.; Cavalheiro, Esper A.; Scorza, Carla A.; Galduróz, José C. F.; Tufik, Sergio; Andersen, Monica L.

2013-01-01

205

The Effect of Exercise Training on Obstructive Sleep Apnea and Sleep Quality: A Randomized Controlled Trial  

PubMed Central

Study Objectives: To evaluate the efficacy of a 12-week exercise training program for reducing obstructive sleep apnea (OSA) severity and improving sleep quality, and to explore possible mechanisms by which exercise may reduce OSA severity. Design: Randomized controlled trial. Setting: Clinical exercise physiology center, sleep laboratory. Participants: Forty-three sedentary and overweight/obese adults aged 18-55 years with at least moderate-severity untreated OSA (screening apnea-hypopnea index [AHI] ? 15). Interventions: Participants randomized to exercise training (n = 27) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity, followed by resistance training twice/week. Participants randomized to a stretching control (n = 16) met twice weekly for 12 weeks to perform low-intensity exercises designed to increase whole-body flexibility. Measurements and Results: OSA severity was assessed with one night of laboratory polysomnography (PSG) before and following the 12-week intervention. Measures of sleep quality included PSG, actigraphy (7-10 days), and the Pittsburgh Sleep Quality Index. Compared with stretching, exercise resulted in a significant AHI reduction (exercise: 32.2 ± 5.6 to 24.6 ± 4.4, stretching: 24.4 ± 5.6 to 28.9 ± 6.4; P < 0.01) as well as significant changes in oxygen desaturation index (ODI; P = 0.03) and stage N3 sleep (P = 0.03). Reductions in AHI and ODI were achieved without a significant decrease in body weight. Improvements in actigraphic sleep and subjective sleep quality were also noted following exercise compared with stretching. Conclusions: Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults, which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss. Trial Registration: Clinicaltrials.gov identification number NCT00956423. Citation: Kline CE; Crowley EP; Ewing GB; Burch JB; Blair SN; Durstine JL; Davis JM; Youngstedt SD. The effect of exercise training on obstructive sleep apnea and sleep quality:a randomized controlled trial. SLEEP 2011;34(12):1631-1640. PMID:22131599

Kline, Christopher E.; Crowley, E. Patrick; Ewing, Gary B.; Burch, James B.; Blair, Steven N.; Durstine, J. Larry; Davis, J. Mark; Youngstedt, Shawn D.

2011-01-01

206

Poor Sleep Quality and Obstructive Sleep Apnea in Patients with GERD and Barrett’s Esophagus  

PubMed Central

Background Gastroesophageal reflux disease (GERD) reduces sleep quality. Whether Barrett’s esophagus (BE) affects sleep differently is unknown. Obstructive sleep apnea (OSA) often coexists with GERD and may disrupt sleep; whether GERD reduces sleep quality independently of OSA is unknown. Our aims were to compare the effect of GERD and BE on sleep quality, and assess the impact of OSA on this association. Methods Validated questionnaires for GERD symptoms, sleep quality, and OSA risk were prospectively administered to subjects undergoing upper endoscopy. GERD was defined by erosive esophagitis and/or reflux symptoms >1/week. BE was defined histologically. Controls had normal endoscopy and were asymptomatic. Poor sleep quality was defined by a Pittsburgh Sleep Quality Index score >5. Risk of OSA was defined by a positive Berlin Questionnaire. The risk poor sleep quality in GERD, BE, and controls was evaluated in multivariate models. Key Results 83 GERD, 63 BE, and 75 controls were included. OSA and poor sleep quality were significantly more frequent in GERD (65% and 60%) but not BE (52% and 46%) compared with controls (48% and 39%). Controlling for age, race, gender, smoking, BMI, and hypertension, the risk of poor sleep quality was significantly increased in GERD compared with controls (odds ratio [OR] = 2.79, 95% confidence interval [CI]: 1.08 – 6.80), significance was lost after adding OSA to the model (OR = 2.27, 95% CI: 0.87 – 5.85). Conclusions and Inferences GERD but not BE increases the risk of poor sleep quality. This association is not independent of OSA. PMID:24460751

Vela, Marcelo F.; Kramer, Jennifer R.; Richardson, Peter A.; Dodge, Rhiannon; El-Serag, Hashem B.

2014-01-01

207

Transoral robotic sleep surgery: the obstructive sleep apnea-hypopnea syndrome.  

PubMed

Nocturnal upper airway collapse is often multi-level in nature but typically will involve some degree of obstruction at the level of the tongue-base. Several surgical procedures have been developed in recent years to address this area in patients resistant to continuous positive airway pressure. This article outlines a novel way to treat obstructive sleep apnea lingual obstruction using the da Vinci robotic surgical system. This technique offers significant potential advantages over other established approaches and it should be included in the surgical armamentarium of sleep surgeons. PMID:24882797

Crawford, Julia A; Montevechi, Filippo; Vicini, Claudio; Magnuson, J Scott

2014-06-01

208

Obstructive sleep apnea and metabolic bone disease: insights into the relationship between bone and sleep.  

PubMed

Obstructive sleep apnea (OSA) and low bone mass are two prevalent conditions, particularly among older adults-a section of the U.S. population that is expected to grow dramatically over the coming years. OSA, the most common form of sleep-disordered breathing, has been linked to multiple cardiovascular, metabolic, hormonal, and inflammatory derangements and may have adverse effects on bone. However, little is known about how OSA (including the associated hypoxia and sleep loss) affects bone metabolism. In order to gain insight into the relationship between sleep and bone, we review the growing information on OSA and metabolic bone disease and discuss the pathophysiological mechanisms by which OSA may affect bone metabolism/architecture. © 2015 American Society for Bone and Mineral Research. PMID:25639209

Swanson, Christine M; Shea, Steven A; Stone, Katie L; Cauley, Jane A; Rosen, Clifford J; Redline, Susan; Karsenty, Gerard; Orwoll, Eric S

2015-02-01

209

CPAP, Weight Loss, or Both for Obstructive Sleep Apnea  

PubMed Central

BACKGROUND Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear. METHODS We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-reactive protein (CRP) greater than 1.0 mg per liter to receive treatment with continuous positive airway pressure (CPAP), a weight-loss intervention, or CPAP plus a weight-loss intervention for 24 weeks. We assessed the incremental effect of the combined interventions over each one alone on the CRP level (the primary end point), insulin sensitivity, lipid levels, and blood pressure. RESULTS Among the 146 participants for whom there were follow-up data, those assigned to weight loss only and those assigned to the combined interventions had reductions in CRP levels, insulin resistance, and serum triglyceride levels. None of these changes were observed in the group receiving CPAP alone. Blood pressure was reduced in all three groups. No significant incremental effect on CRP levels was found for the combined interventions as compared with either weight loss or CPAP alone. Reductions in insulin resistance and serum triglyceride levels were greater in the combined-intervention group than in the group receiving CPAP only, but there were no significant differences in these values between the combined-intervention group and the weight-loss group. In per-protocol analyses, which included 90 participants who met prespecified criteria for adherence, the combined interventions resulted in a larger reduction in systolic blood pressure and mean arterial pressure than did either CPAP or weight loss alone. CONCLUSIONS In adults with obesity and obstructive sleep apnea, CPAP combined with a weight-loss intervention did not reduce CRP levels more than either intervention alone. In secondary analyses, weight loss provided an incremental reduction in insulin resistance and serum triglyceride levels when combined with CPAP. In addition, adherence to a regimen of weight loss and CPAP may result in incremental reductions in blood pressure as compared with either intervention alone. PMID:24918371

Chirinos, Julio A.; Gurubhagavatula, Indira; Teff, Karen; Rader, Daniel J.; Wadden, Thomas A.; Townsend, Raymond; Foster, Gary D.; Maislin, Greg; Saif, Hassam; Broderick, Preston; Chittams, Jesse; Hanlon, Alexandra L.; Pack, Allan I.

2014-01-01

210

Factors Influencing Daytime Sleepiness in Chinese Patients With Obstructive Sleep Apnea  

Microsoft Academic Search

This study examined clinically significant physiological and psychological factors contributing to the complaint of daytime sleepiness in 108 Chinese patients with newly diagnosed obstructive sleep apnea (OSA). A higher degree of obesity and greater anxiety, in addition to a higher Apnea–Hypopnea Index, were associated with more daytime sleepiness. The results of this study suggest that the experience of daytime sleepiness

Lichuan Ye

2011-01-01

211

How, what, and why of sleep apnea Perspectives for primary care physicians  

Microsoft Academic Search

OBJECTIVE To review the need for primary care physicians to screen for patients with obstructive sleep apnea (OSA). QUALITY OF EVIDENCE Literature was reviewed via MEDLINE from 1993 to 2000, inclusive, using the search term \\

Sharon A. Chung; Shani Jairam; Mohamed R. G. Hussain; Colin M. Shapiro

212

Metabolic consequences of intermittent hypoxia: relevance to obstructive sleep apnea.  

PubMed

Obstructive sleep apnea (OSA) is recurrent obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia (IH) during sleep. There is growing evidence from animal models of OSA that IH is independently associated with metabolic dysfunction, including dyslipidemia and insulin resistance. The precise mechanisms by which IH induces metabolic disturbances are not fully understood. Over the last decade, several groups of investigators developed a rodent model of IH, which emulates the oxyhemoglobin profile in human OSA. In the mouse model, IH induces dyslipidemia, insulin resistance and pancreatic endocrine dysfunction, similar to those observed in human OSA. Recent reports provided new insights in possible mechanisms by which IH affects lipid and glucose metabolism. IH may induce dyslipidemia by up-regulating lipid biosynthesis in the liver, increasing adipose tissue lipolysis with subsequent free fatty acid flux to the liver, and inhibiting lipoprotein clearance. IH may affect glucose metabolism by inducing sympathetic activation, increasing systemic inflammation, increasing counter-regulatory hormones and fatty acids, and causing direct pancreatic beta-cell injury. IH models of OSA have improved our understanding of the metabolic impact of OSA, but further studies are needed before we can translate recent basic research findings to clinical practice. PMID:21112030

Drager, Luciano F; Jun, Jonathan C; Polotsky, Vsevolod Y

2010-10-01

213

In: Progress in Sleep Apnea Research Editor: Robert T. Ferber, pp. 41-76  

E-print Network

: A PHYSICAL APPROACH TO OBSTRUCTIVE SLEEP APNEA A. Van Hirtum1 , F. Chouly1,2 , P.Y. Lagr´ee3 , J.R. Paoli4 neural mechanisms. From a physical point of view, neglecting active neural control mechanisms, the airwayIn: Progress in Sleep Apnea Research Editor: Robert T. Ferber, pp. 41-76 ISBN 978-1-60021-652-7 c

Lagrée, Pierre-Yves

214

Taste disturbance after palatopharyngeal surgery for obstructive sleep apnea.  

PubMed

Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51-year-old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three-drop-method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2-year follow-up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function. PMID:17395567

Hsiao, Han-Ren; Li, Hsueh-Yu

2007-04-01

215

IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 13, NO. 6, NOVEMBER 2009 1057 Automated Scoring of Obstructive Sleep Apnea  

E-print Network

Automated Scoring of Obstructive Sleep Apnea and Hypopnea Events Using Short-Term Electrocardiogram, Senior Member, IEEE Abstract--Obstructive sleep apnea or hypopnea causes a pause or reduction in airflow duration) from normal breathing dur- ing sleep, 1638 ECG epochs from 689 hypopnea events, and 3151 ECG

Khandoker, Ahsan

216

Obstructive sleep apnea among commercial motor vehicle drivers: using evidence-based practice to identify risk factors.  

PubMed

Commercial motor vehicle driving is a hazardous occupation, having the third highest fatality rate among common U.S. jobs. Among the estimated 14 million U.S. commercial motor vehicle drivers, the prevalence of obstructive sleep apnea is reported to be 17% to 28%. Despite the identified increased prevalence of obstructive sleep apnea among commercial motor vehicle drivers, federal law does not require that they be screened for obstructive sleep apnea. This article presents an evidence-based practice change project; the authors developed, implemented, and evaluated a screening program to identify commercial motor vehicle drivers' risk for obstructive sleep apnea during commercial driver medical examinations. The results of this practice change indicated screening for obstructive sleep apnea during the commercial driver medical examination led to improved identification of obstructive sleep apnea risk among commercial motor vehicle drivers and should be a clinical standard in occupational health clinics. PMID:24144003

Olszewski, Kimberly; Wolf, Debra

2013-11-01

217

Effects of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease on Asthma Control in Obesity  

PubMed Central

Background Obesity is a risk factor for asthma. Obese asthmatics often have poor asthma control and respond poorly to therapy. It has been suggested that co-morbidities associated with obesity, such as reflux and obstructive sleep apnea, could be important factors contributing to poor asthma control in obese patients. Objectives The purpose of this study was to determine if (i) reflux and/or (ii) symptoms of sleep apnea contribute to poor asthma control in obesity. Methods We studied asthmatic subjects participating in a trial of reflux treatment. Participants underwent baseline evaluation of asthma symptoms and lung function. 304 participants underwent esophageal pH probe testing. 246 participants were evaluated for obstructive sleep apnea symptoms. Results Of 402 participants in this trial, 51% were obese. Role of reflux in asthma control Those with higher body mass index reported a higher prevalence of reflux symptoms, but the prevalence of pH probe acid reflux was similar in all groups. Reflux was not associated with measures of asthma control in obese patients. Role of obstructive sleep apnea in asthma control Symptoms and self-report of obstructive sleep apnea were more common with increasing body mass index and associated with worse asthma control as measured by the Juniper Asthma Control Questionnaire and Asthma Symptom Utility Index. Conclusions Our data suggest that obstructive sleep apnea, but not gastroesophageal reflux disease may contribute significantly to poor asthma control in obese patients. PMID:21819338

Dixon, Anne E.; Clerisme-Beaty, Emmanuelle M.; Sugar, Elizabeth A.; Cohen, Rubin I.; Lang, Jason E.; Brown, Ellen D.; Richter, Joel E.; Irvin, Charles G.; Mastronarde, John G.

2011-01-01

218

SLEEP, Vol. 33, No. 5, 2010 643 Heritability of Abnormalities in Cardiopulmonary Coupling--Ibrahim et al OBSTRUCTIVE SLEEP APNEA (OSA) IS A COMPLEX DIS-  

E-print Network

SLEEP, Vol. 33, No. 5, 2010 643 Heritability of Abnormalities in Cardiopulmonary Coupling--Ibrahim et al OBSTRUCTIVE SLEEP APNEA (OSA) IS A COMPLEX DIS- EASE WITH A STRONG GENETIC COMPONENT1 . A NUM genetic variants that increase risk of sleep apnea. Of particular interest are intermediate traits

219

Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea  

Microsoft Academic Search

Purpose  Isolated sleep paralysis (ISP) is a rapid eye movement (REM) sleep parasomnia and has a special meaning in Chinese population.\\u000a Worsening of obstructive sleep apnea (OSA) occurs especially during REM sleep. The relationship between ISP and OSA is unclear.\\u000a The aim of this study was to investigate the impact of ISP on sleep and life quality in Chinese-Taiwanese OSA patients.

Sun-Wung Hsieh; Chiou-Lian Lai; Ching-Kuan Liu; Sheng-Hsing Lan; Chung-Yao Hsu

2010-01-01

220

Continuous Positive Airway Pressure Improves Sleep and Daytime Sleepiness in Patients with Parkinson Disease and Sleep Apnea  

PubMed Central

Study Objectives: Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. Design: This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. Setting: Sleep laboratory. Participants: Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). Intervention: Continuous positive airway pressure. Measurements: PSG outcome measures: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). Results: There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). Conclusions: Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease. Citation: Neikrug AB; Liu L; Avanzino JA; Maglione JE; Natarajan L; Bradley L; Maugeri A; Corey-Bloom J; Palmer BW; Loredo JS; Ancoli-Israel S. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. SLEEP 2014;37(1):177-185. PMID:24470706

Neikrug, Ariel B.; Liu, Lianqi; Avanzino, Julie A.; Maglione, Jeanne E.; Natarajan, Loki; Bradley, Lenette; Maugeri, Alex; Corey-Bloom, Jody; Palmer, Barton W.; Loredo, Jose S.; Ancoli-Israel, Sonia

2014-01-01

221

Obstructive sleep apnea, immuno-inflammation, and atherosclerosis  

PubMed Central

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder leading to cardiovascular and metabolic complications. OSA is also a multicomponent disorder, with intermittent hypoxia (IH) as the main trigger for the associated cardiovascular and metabolic alterations. Indeed, recurrent pharyngeal collapses during sleep lead to repetitive sequences of hypoxia-reoxygenation. This IH induces several consequences such as hemodynamic, hormono-metabolic, oxidative and immuno-inflammatory alterations that may interact and aggravate each other, resulting in artery changes, from adaptive to degenerative atherosclerotic remodeling. Atherosclerosis has been found in OSA patients free of other cardiovascular risk factors, and is related to the severity of nocturnal hypoxia. Early stages of artery alteration, including functional and structural changes, have been evidenced in both OSA patients and rodents experimentally exposed to IH. Impaired vasoreactivity with endothelial dysfunction and/or increased vasoconstrictive responses due to sympathetic, endothelin and renin-angiotensin systems have been reported and also contribute to vascular remodeling and inflammation. Oxidative stress, inflammation and vascular remodeling can be directly triggered by IH, further aggravated by the OSA-associated hormono-metabolic alterations, such as insulin resistance, dyslipidemia and adipokine imbalance. As shown in OSA patients and in the animal model, genetic susceptibility, comorbidities (obesity) and life habits (high fat diet) may aggravate atherosclerosis development or progression. The intimate molecular mechanisms are still largely unknown, and their understanding may contribute to delineate new targets for prevention strategies and/or development of new treatment of OSA-related atherosclerosis, especially in patients at risk for cardiovascular disease. PMID:19404644

Arnaud, Claire; Dematteis, Maurice; Pepin, Jean-Louis; Baguet, Jean-Philippe; Lévy, Patrick

2009-01-01

222

Epidemiological and Pathogenic Relationship between Sleep Apnea and Ischemic Heart Disease  

PubMed Central

Obstructive sleep apnea is recognized as having high prevalence and causing remarkable cardiovascular risk. Coronary artery disease has been associated with obstructive sleep apnea in many reports. The pathophysiology of coronary artery disease in obstructive sleep apnea patients probably includes the activation of multiple mechanisms, as the sympathetic activity, endothelial dysfunction, atherosclerosis, and systemic hypertension. Moreover, chronic intermittent hypoxia and oxidative stress have an important role in the pathogenesis of coronary disease and are also fundamental to the development of atherosclerosis and other comorbidities present in coronary artery diseases such as lipid metabolic disorders. Interestingly, the prognosis of patients with coronary artery disease has been associated with obstructive sleep apnea and the severity of sleep disordered breathing may have a direct relationship with the morbidity and mortality of patients with coronary diseases. Nevertheless, treatment with CPAP may have important effects, and recent reports have described the benefits of obstructive sleep apnea treatment on the recurrence of acute heart ischaemic events in patients with coronary artery disease. PMID:23862060

Carpio, Carlos; Álvarez-Sala, Rodolfo; García-Río, Francisco

2013-01-01

223

Some Suggestions for Sleep Apnea Self-Experimentation May 6, 2010  

E-print Network

that depression sufferers have tried, along with the perceived effectiveness. [5] A graph like this can help you that I had sleep apnea and suggested that I just exercise more to get a proper night's sleep. The exercise didn't seem to help, so I decided to try to figure out if anything was related to my good nights

Miller, Ethan L.

224

Excessive daytime sleepiness in obstructive sleep apnea: prevalence, severity, and predictors  

Microsoft Academic Search

Objectives: To assess prevalence, severity, and predictive factors of excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) in an Asian population.Methods: A retrospective, cross-sectional study of data from patients diagnosed with OSA over a period of three years and having had overnight polysomnography (PSG) followed by daytime multiple sleep latency test (MSLT). Respiratory disturbance index (RDI) was used for

Udaya Seneviratne; Kathiravelu Puvanendran

2004-01-01

225

Daytime Functioning in Obstructive Sleep Apnea Patients: Exercise Tolerance, Subjective Fatigue, and Sleepiness  

Microsoft Academic Search

A sample of 32 obstructive sleep apnea patients (27 males, 5 females) was assessed with overnight polysomnography and the Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Patients also participated in a maximal exercise test, which served as an objective indicator of physical fatigue. The Fatigue Severity Scale (FSS) was used as a subjective measure of fatigue.

Robert Neal Aguillard; Brant W. Riedel; Kenneth L. Lichstein; Frederick G. Grieve; Christopher T. Johnson; Sharon L. Noe

1998-01-01

226

Clinical predictors of nocturia in the sleep apnea population  

PubMed Central

Objectives: This study aims to evaluate clinical predictors of nocturia in patients with obstructive sleep apnea (OSA). Materials and Methods: In retrospective manner, a total of 200 patients with OSA were randomly included. Group I contained 100 patients with OSA and no nocturia, and Group II included 100 patients with OSA and nocturia. Bivariate logistic analyses were used to identify variables most likely to contribute to nocturia. Multivariate logistic regression of age, waist circumference, STOP score (Snore, Tired, Obstruction and Pressure), and Apnea–Hypopnea Index (AHI) was performed to evaluate predictors of nocturia. Statistical significance was defined as P < 0.05. Results: Median nocturia episodes were 2.2 in Group II. Patients were younger in Group I, with a mean age of 45 vs 50 years (P = 0.008). Mean BMI of 30 was similar in both groups, but there were more overweight patients in Group II (28% vs 18%). AHI approached significance between groups—18 vs 23 in group I and II, respectively (P = 0.071). In multivariate analysis, age over 70 years and moderate AHI were statistically significant predictors of nocturia (coefficients 0.6 and –0.2 with P = 0.003 and 0.03, respectively). Conclusions: This study identifies age and AHI score as predictors of nocturia in patients with OSA. This may indicate the usefulness of incorporating nocturia in the screening of patients with OSA. Future studies are needed to further evaluate mechanism of action, clinical significance, and effect of treatment for nocturia in patients with OSA. PMID:24669119

Raheem, Omer A; Orosco, Ryan K; Davidson, Terence M; Lakin, Charles

2014-01-01

227

Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea.  

PubMed

A study was conducted to assess oxygenation and respiratory changes on the first and second postoperative nights after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). Twelve patients were postoperatively evaluated with 8-hour nocturnal polysomnography on four occasions: (1) PREOP--night before UPPP, (2) POPN1--first postoperative night, (3) POPN2--second postoperative night, and (4) 3MOS--3-month follow-up study. Results demonstrate that apnea index (AI) and respiratory disturbance index (RDI) were significantly improved at 3MOS from PREOP levels: AI (p less than 0.01) and RDI (p less than 0.05). There were no statistical differences from PREOP to POPN1 or POPN2 for AI, RDI, lowest oxyhemoglobin saturation (LSAT), or number of desaturations (#DESAT). One of twelve patients dropped LSAT greater than 10% from PREOP to POPN1 or POPN2 (82% PREOP to 71% POPN2). Patients were grouped by PREOP LSAT greater than or equal to 80% or less than 80%, and the postoperative change in LSAT was evaluated by comparing PREOP to a value averaging POPN1 and POPN2. Patients with LSAT greater than or equal to 80% decreased by 2.6%; patients with LSAT less than 80% improved by 6.2%. This change in LSAT between groups was statistically different (p = 0.02). These data suggest that in the majority of patients, preoperative indices remain unchanged for at least 2 days after surgery, even for patients who demonstrated improvement at 3 months. However, worsening does occur in some patients. On the basis of the results of this study and clinical experience with the postoperative course, a selective management protocol is outlined. PMID:1734375

Burgess, L P; Derderian, S S; Morin, G V; Gonzalez, C; Zajtchuk, J T

1992-01-01

228

Driving Simulation with EEG Monitoring in Normals and Obstructive Sleep Apnea Patients  

PubMed Central

We hypothesized that impaired performance on driving simulation and EEG defined attention lapses are greater in obstructive sleep apnea patients than in the normal population. Participants completed a 60-minute driving simulation with continuous EEG monitoring. Sleep apnea patients demonstrated increased lane position variability, crashes, and attention lapses throughout the task. Attention lapses appeared to underlie the poorer driving performance. Because sleepiness can occur in other populations, e.g. shift workers and on call physicians, these results support the need for the development of countermeasures, highway safety education programs, and the recognition and treatment of sleep disorders.

Risser, M.R.; Ware, J.C.

1999-01-01

229

Association of Elevated Levels of Vascular Endothelial Growth Factor in Obstructive Sleep Apnea Syndrome with Patient Age rather than with Obstructive Sleep Apnea Syndrome Severity  

Microsoft Academic Search

Background: Although certain studies report high levels of vascular endothelial growth factor (VEGF) in obstructive sleep apnea syndrome (OSAS), the effect of systemic hypoxia on circulating VEGF remains controversial. Objectives: To study the association of serum VEGF and OSAS in a large group of patients. Methods: One hundred patients with OSAS (mean age 58.1 ± 12.4 years, mean body mass

Nir Peled; David Shitrit; Daniele Bendayan; Eli Peled; Mordechai R. Kramer

2007-01-01

230

Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features.  

PubMed

Since sleep apnea is a risk factor for high mortality of rheumatoid arthritis (RA) patients, this study examined the prevalence in RA patients with occipitocervical lesions, and the associated radiographic features. Twenty-nine RA patients requiring surgery for progressive myelopathy due to occipitocervical lesions (3 males, 26 females, average age 65 years) were preoperatively evaluated. Twenty-three (79%) had sleep apnea defined as apnea-hypopnea index >5 events per hour measured by a portable monitoring device, and all of them were classified as the obstructive type. Among gender, age, bone mass index (BMI), and radiographic parameters related to occipitocervical lesions: atlantodental interval (ADI), cervical angles (O/C1, C1/2, and C2/6), and cervical lengths (O-C2 and O-C6), the ADI and cervical lengths were shown to be significantly associated with the presence of sleep apnea by parametric statistical analysis. Since there were positive correlations between the ADI and cervical lengths by Pearson's test, we performed a multivariate logistic regression analysis after adjustment for confounding factors and found that small ADI was the principle parameter associated with sleep apnea. We therefore conclude that the prevalence of sleep apnea is higher than that in a general RA population that was reported previously, and believe that occipitocervical lesions are an independent risk factor for this condition. Small ADI and short neck, secondary to the vertical translocation by RA, may cause obstructive sleep apnea, probably through mechanical or neurological collapse of the upper airway. PMID:19365641

Shoda, Naoki; Seichi, Atsushi; Takeshita, Katsushi; Chikuda, Hirotaka; Ono, Takashi; Oka, Hiroyuki; Kawaguchi, Hiroshi; Nakamura, Kozo

2009-06-01

231

Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features  

PubMed Central

Since sleep apnea is a risk factor for high mortality of rheumatoid arthritis (RA) patients, this study examined the prevalence in RA patients with occipitocervical lesions, and the associated radiographic features. Twenty-nine RA patients requiring surgery for progressive myelopathy due to occipitocervical lesions (3 males, 26 females, average age 65 years) were preoperatively evaluated. Twenty-three (79%) had sleep apnea defined as apnea–hypopnea index >5 events per hour measured by a portable monitoring device, and all of them were classified as the obstructive type. Among gender, age, bone mass index (BMI), and radiographic parameters related to occipitocervical lesions: atlantodental interval (ADI), cervical angles (O/C1, C1/2, and C2/6), and cervical lengths (O–C2 and O–C6), the ADI and cervical lengths were shown to be significantly associated with the presence of sleep apnea by parametric statistical analysis. Since there were positive correlations between the ADI and cervical lengths by Pearson’s test, we performed a multivariate logistic regression analysis after adjustment for confounding factors and found that small ADI was the principle parameter associated with sleep apnea. We therefore conclude that the prevalence of sleep apnea is higher than that in a general RA population that was reported previously, and believe that occipitocervical lesions are an independent risk factor for this condition. Small ADI and short neck, secondary to the vertical translocation by RA, may cause obstructive sleep apnea, probably through mechanical or neurological collapse of the upper airway. PMID:19365641

Shoda, Naoki; Seichi, Atsushi; Takeshita, Katsushi; Chikuda, Hirotaka; Ono, Takashi; Oka, Hiroyuki; Nakamura, Kozo

2009-01-01

232

[Psychological burden of patients diagnosed with obstructive sleep apnea].  

PubMed

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated episodes of upper airway obstruction during sleep, which leads to the presence of excessive daytime drowsiness. Regarding the psychological comorbidity in patients diagnosed with OSAS, previous studies focused mainly on depressive and secondarily on anxiety symptoms. Due to the lack of research data regarding the prevalence of anxiety and depressive symptoms as well as of alexithymic characteristics in patients with OSAS in Greece, the aim of the study was to record the above symptomatology in a sample of Greek OSAS patients and to investigate its relation to the respiratory parameter (Apnea-Hypopnea Index, AHI) of polysomnography. The study was conducted in a certified sleep laboratory. Thirty five randomly selected patients who attended the laboratory with symptoms of daytime drowsiness, fatigue, disrupted sleep and snoring, were examined for anxiety, depression and alexithymia using the Spielberger Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI) and the Toronto Alexithymia Scale (TAS-20), respectively, 24 hours prior to being submitted to polysomnography. All 35 patients met the inclusion criteria of the study (age?75 years, no other chronic diseases and no history of major psychiatric disorders). Six patients did not meet the diagnostic criteria for OSAS and were thus used as the control group of the study. A high prevalence of anxiety (41.4%) and depressive (55.2%) symptoms and of alexithymic characteristics (41.4%) was observed in OSAS patients. Although the control group showed a higher prevalence of anxiety (66.7%) and depressive (83.3%) symptoms, there were no differences between the two groups (STAI: t=-0.927, p=0.360, BDI: t=-1.537, p=0.134, TAS-20: t=0.196, p=0.846). With regard to severity, no differences were observed between control, mild, moderate and severe OSAS subgroups (STAI: F=0.583, p=0.660, BDI: F=0.829, p=0.488, TAS-20: F=0.987, p=0.412). Females scored higher on the BDI and on the STAI compared to males (STAI: t=-2.38, p=0.039, BDI: t=-3.59, p=0.01). Finally, no correlation was observed between psychometric scores and AHI (Pearson correlation p>0.05). The study confirms the high prevalence of anxiety and depressive symptoms which has been found in previous studies. Furthermore, we found a high prevalence of alexithymic characteristics, a factor that has not been investigated previously and which is positively correlated with anxiety symptoms. The coexistence of alexithymic characteristics may further complicate the clinical manifestations of OSAS due to the fact that patients with alexithymia typically have difficulty in indentifying and describing their underlying psychological symptomatology and, moreover, tend to exhibit more, and often atypical, physical symptoms. In conclusion, the study supports the presence of a high degree of psychological burden in patients diagnosed with OSAS, regardless of the severity of their symptoms, as determined by the AHI. This comorbidity should be taken into consideration during the clinical assessment of OSAS and for the treatment planning. PMID:25035178

Bratis, D; Tselebis, A; Zafeiropoulos, G; Tsaraklis, A; Dumitru, S; Moussas, G; Kosmas, E; Koutsilieris, M

2014-01-01

233

Sleep apnea and occupational accidents: Are oral appliances the solution?  

PubMed Central

Background: Dental practitioners have a key role in the quality of life and prevention of occupational accidents of workers with Obstructive Sleep Apnea Syndrome (OSAS). Aim: The aim of this study was to review the impact of OSAS, the Continuous Positive Airway Pressure (CPAP) therapy, and the evidence regarding the use of oral appliances (OA) on the health and safety of workers. Materials and Methods: Searches were conducted in MEDLINE (PubMed), Lilacs and Sci ELO. Articles published from January 1980 to June 2014 were included. Results: The research retrieved 2188 articles and 99 met the inclusion criteria. An increase in occupational accidents due to reduced vigilance and attention in snorers and patients with OSAS was observed. Such involvements were related to excessive daytime sleepiness and neurocognitive function impairments. The use of OA are less effective when compared with CPAP, but the results related to excessive sleepiness and cognitive performance showed improvements similar to CPAP. Treatments with OA showed greater patient compliance than the CPAP therapy. Conclusion: OSAS is a prevalent disorder among workers, leads to increased risk of occupational accidents, and has a significant impact on the economy. The CPAP therapy reduces the risk of occupational accidents. The OA can improve the work performance; but there is no scientific evidence associating its use with occupational accidents reduction. Future research should focus on determining the cost-effectiveness of OA as well as its influence and efficacy in preventing occupational accidents. PMID:25568596

Rabelo Guimarães, Maria De Lourdes; Hermont, Ana Paula

2014-01-01

234

Cognitive profile and brain morphological changes in obstructive sleep apnea  

PubMed Central

Obstructive sleep apnea (OSA) is accompanied by neurocognitive impairment, likely mediated by injury to various brain regions. We evaluated brain morphological changes in patients with OSA and their relationship to neuropsychological and oximetric data. Sixteen patients affected by moderate-severe OSA (age: 55.8±6.7 years, 13 males) and fourteen control subjects (age: 57.6±5.1 years, 9 males) underwent 3.0 Tesla brain magnetic resonance imaging (MRI) and neuropsychological testing evaluating short and long-term memory, executive functions, language, attention, praxia and non-verbal learning. Volumetric segmentation of cortical and subcortical structures and voxel-based morphometry (VBM) were performed. Patients and controls differed significantly in Rey Auditory- Verbal Learning test (immediate and delayed recall), Stroop test and Digit span backward scores. Volumes of cortical gray matter (GM), right hippocampus, right and left caudate were smaller in patients compared to controls, with also brain parenchymal fraction (a normalized measure of cerebral atrophy) approaching statistical significance. Differences remained significant after controlling for comorbidities (hypertension, diabetes, smoking, hypercholesterolemia). VBM analysis showed regions of decreased GM volume in right and left hippocampus and within more lateral temporal areas in patients with OSA. Our findings indicate that the significant cognitive impairment seen in patients with moderate-severe OSA is associated with brain tissue damage in regions involved in several cognitive tasks. We conclude that OSA can increase brain susceptibility to the effects of aging and other clinical and pathological occurrences. PMID:20888921

Torelli, Federico; Moscufo, Nicola; Garreffa, Girolamo; Placidi, Fabio; Romigi, Andrea; Zannino, Silvana; Bozzali, Marco; Fasano, Fabrizio; Giulietti, Giovanni; Djonlagic, Ina; Malhotra, Atul; Marciani, Maria Grazia; Guttmann, Charles RG

2014-01-01

235

Association of Systematic Head and Neck Physical Examination With Severity of Obstructive Sleep Apnea???Hypopnea Syndrome  

Microsoft Academic Search

Objectives\\/Hypothesis: To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI). Study Design: Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evalu- ated in

Adriane I. Zonato; Lia Rita Bittencourt; Fernanda Louise Martinho; Sergio Tufik

2003-01-01

236

Treatment of sleep apnea in congestive heart failure with a dental device  

Microsoft Academic Search

The aim of the present study was to investigate the effect of a mandibular advancement device (MAD) for the treatment of sleep\\u000a apnea (SA) on plasma brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and health-related qualify\\u000a of life (HRQL) in patients with mild to moderate stable congestive heart failure (CHF). Seventeen male patients aged 68.4±5.5\\u000a with an apnea–hypopnea

Mahmoud Eskafi; Charles Cline; Maria Nilner; Bo Israelsson

2006-01-01

237

Severe Obstructive Sleep Apnea Alleviated by Oral Appliance in a Three-Year-Old Boy  

Microsoft Academic Search

This clinical report describes a 3.5-year-old boy suffering from chronic daytime fatigue, accumulated snoring and dramatically appearing apnea during sleep. Oxycardiorespirography revealed a breathing pattern similar to repetitive obstructive apnea and an oxygen saturation periodically dropping to 80%. During tidal breathing, fiberoptic bronchoscopy showed aspiration of the aryepiglottic folds and the epiglottis during inspiration. Adenotonsillar hypertrophy was excluded. Due to

Joachim Schessl; Edmund Rose; Rudolf Korinthenberg; Matthias Henschen

2008-01-01

238

Gender-Specific Impacts of Apnea, Age, and BMI on Parasympathetic Nerve Dysfunction during Sleep in Patients with Obstructive Sleep Apnea  

PubMed Central

Background The gender-specific influences of various confounding factors, including apnea, age, BMI, and cigarette consumption, on the function of the parasympathetic nerve system (PNS) during sleep in OSA patients has never been investigated. Methods One hundred ninety-seven males and 63 females with OSA were subjected to full PSG examinations including assessment of R-R intervals (RRIs) during an overnight ECG. The PNS-derived modulatory effect on the RRIs and the variability of this effect were quantified during REM and NREM using instantaneous time-frequency analysis with complex demodulation. The spectral domain with the maximum instantaneous amplitude in the high-frequency band between 0.15 and 0.4 Hz was defined as the main HF peak and used as a surrogate marker of PNS discharge. Based on density-spectrum-array maps of the main HF peaks (HF-DSA map), shifts in the central frequency of the main HF peak over time were continuously observed. When the main HF peaks on the HF-DSA maps maintained the same central frequency for more than 20 sec or 5 min, the PNS functions were considered to be “stable” or “very stable”, respectively. Results Apneas enhanced PNS-derived cardiac-modulation during REM in males, but more importantly, they made PNS-function unstable during both REM and NREM in males and during NREM in females. Aging blunted the PNS-derived cardiac-modulation during both REM and NREM regardless of gender, but aging had no impact on the stability of PNS-function. BMI blunted PNS-eliciting cardiac-modulation during REM in males and during NREM in both males and females. BMI made the PNS unstable during REM in females. Neither height nor cigarette consumption influenced any PNS-related parameter. Conclusions The PNS-derived cardiac-modulation was generally inhibited by aging and obesity, in which the effect of obesity was gender-specific. The PNS instability at nighttime was mainly induced by apneas but by obesity particularly during REM in females. PMID:24667894

Yamaguchi, Kazuhiro; Inoue, Yuji; Ohki, Noboru; Satoya, Natsumi; Inoue, Fukumi; Maeda, Yoshiko; Sekiguchi, Haruki; Suzuki, Mayumi; Tsuji, Takao; Aoshiba, Kazutetsu; Nagai, Atsushi

2014-01-01

239

Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature.  

PubMed

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. PMID:22505868

Vasu, Tajender S; Grewal, Ritu; Doghramji, Karl

2012-04-15

240

Shared governance in building community capacity: A case study of sleep apnea  

PubMed Central

East Harlem has the highest diabetes mortality rate in New York City, NY. Using Community Based Participatory Research principles, the East Harlem Partnership for Diabetes Prevention—a community- academic partnership—formed to build community capacity with a goal to address health disparities in East Harlem. As part of prevention efforts, community partners chose to study the prevalence of obstructive sleep apnea and its relationship to pre-diabetes and progression to diabetes. However, community partners insisted any study of sleep apnea go beyond simple assessment to ensure the largely uninsured, minority population enrolled also have access to state of the art diagnosis and treatment. Through compromise and collaboration, the partnership developed a culturally appropriate and scientifically rigorous method to diagnose and treat sleep apnea as part of a novel research program. PMID:25621099

Lee, Euny C; Simon, Ellen P.; Nickerson, Jillian; Brenner, Barbara; Talavera, Sandra; Goytia, Crispin; Arniella, Guedy; Horowitz, Carol R.

2015-01-01

241

Intracranial hypertension associated with obstructive sleep apnea: a discussion of potential etiologic factors.  

PubMed

Obstructive sleep apnea has been shown to increase intracranial pressure, and to be a secondary cause of intracranial hypertension. There are a few theories that attempt to explain this relationship, however there is little data, and even less recognition among physicians that this actually occurs. This paper discusses multiple pieces of data, from anatomical correlates to biochemical information involving neuro-excitotoxicity, as well as hematologic factors and issues surrounding brain edema and blood-brain barrier dysfunction. A complex paradigm for how obstructive sleep apnea may lead to increased intracranial pressure is thus proposed. In addition, suggestions are made for how obstructive sleep apnea must as a result be managed differently in the setting of idiopathic intracranial hypertension. PMID:25456788

Wardly, D E

2014-12-01

242

Real-time MRI can differentiate sleep-related breathing disorders in children Yoon-Chul Kim1  

E-print Network

) in children have five phenotypes: primary snoring, hypoventilation, high arousal frequency, obstructive sleep apnea, and central sleep apnea [1]. Obstructive sleep apnea is defined by an obstructive apnea hypopnea phenotype and its severity, but it does not provide direct information of the upper airway anatomy. Nasal

Southern California, University of

243

029. Comorbidities’ burden in newly diagnosed obstructive sleep apnea patients  

PubMed Central

Background Obstructive sleep apnea (OSA) is frequently associated with several comorbidities. Objective The study was to examine the characteristics and to evaluate gender differences in comorbidities in OSA patients. Methods The characteristics of 689 consecutive individuals (511 males and 178 females) evaluated with polysomnography due to suspected OSA were analyzed. Patients were divided according to OSA severity into three groups and comparisons were made between male and female patients. Results Mild OSA was diagnosed in 142, moderate in 105 and severe OSA in 303 patients according to their Apnea Hypopnea Index (AHI). In 139 individuals, AHI was <5/h and they were served as control group. Mean number of comorbidities increased with OSA severity (1.5±1.3 in mild, 1.7±1.4 in moderate, and 1.8±1.6 in severe OSA; P=0.048). Among OSA patients, female patients were older (56.2±10.9 vs. 52.8±13.3 years, P=0.001) and more obese [body mass index (BMI) 36±8.7 vs. 32.9±5.9 kg/m2, P<0.001]. A significantly higher total number of comorbidities (2.3±1.6 vs. 1.6±1.4; P<0.001) was observed in female patients in comparison with men. This difference was not observed in controls. Smoking prevalence (current or ex-smokers) was significantly higher in men (75% vs. 46.2%, chi-squared: 35.107, P<0.001). Females with OSA had a higher prevalence of comorbidities such as hypothyroidism (21.4% vs. 2.9%, chi-squared: 48.145, P<0.001), depression (13.7% vs. 1.9%; chi-squared: 29.239; P<0.001), arterial hypertension (58.1% vs. 45.7%; chi-squared: 5.677; P=0.021) and heart failure (6% vs. 1.7%; chi-squared: 6.490; P=0.019) in comparison with male patients. Conclusions Women with newly diagnosed OSA are older and more obese, with higher burden of comorbidities than men. Hypothyroidism, depression, arterial hypertension and heart failure are more prevalent in women with OSA than in men.

Xanthoudaki, Maria; Nena, Evangelia; Kotakidou, Despoina; Markou, Markos; Mpikou, Sofia; Papadopoulou, Marina; Ntolios, Paschalis; Konstantinidis, Theodoros C.; Froudarakis, Marios; Bouros, Demosthenes; Steiropoulos, Paschalis

2015-01-01

244

Driving habits and risk factors for traffic accidents among sleep apnea patients--a European multi-centre cohort study.  

PubMed

Obstructive sleep apnea is associated with increased motor vehicle accident risk, and improved detection of patients at risk is of importance. The present study addresses potential risk factors in the European Sleep Apnea Database and includes patients with suspected obstructive sleep apnea [n = 8476, age 51.5 (12.5) years, body mass index 31.0 (6.6) kg m(-2) , 82.4% driver's licence holders]. Driving distance (km year(-1) ), driver's licence type, sleep apnea severity, sleepiness and comorbidities were assessed. Previously validated risk factors for accident history: Epworth Sleepiness Scale ?16; habitual sleep time ?5 h; use of hypnotics; and driving ?15 000 km year(-1) were analysed across European regions. At least one risk factor was identified in male and female drivers, 68.75 and 51.3%, respectively. The occurrence of the risk factors was similar across Europe, with only a lower rate in the eastern region (P = 0.001). The mean number of risk factors increased across classes of sleep apnea severity. Frequent driving was prevalent [14.0 (interquartile range 8.0-20.0) × 10(3)  km year(-1) ] and 32.7% of drivers had severe obstructive sleep apnea [apnea-hypopnea index 50.3 (38.8-66.0) n h(-1) ]. Obesity, shorter sleep time and younger age were associated with increased traffic exposure (P ? 0.03). In conclusion, the risk factors associated with accident history were common among European patients with suspected obstructive sleep apnea, but varied between geographical regions. There was a weak covariation between occurrence of risk factors and clinically determined apnea severity but frequent driving, a strong risk factor for accidents, was over-represented. Systematic evaluation of accident-related risk factors is important to detect sleep apnea patients at risk for motor vehicle accidents. PMID:25040185

Karimi, Mahssa; Hedner, Jan; Lombardi, Carolina; Mcnicholas, Walter T; Penzel, Thomas; Riha, Renata L; Rodenstein, Daniel; Grote, Ludger

2014-12-01

245

Are the adverse effects of body position in patients with obstructive sleep apnea dependent on sleep stage?  

Microsoft Academic Search

Purpose  The purpose of the study was to determine if the adverse effect of body position on obstructive sleep apnea (OSA) is worsened\\u000a during rapid eye movement (REM) sleep and if patients with OSA decrease the time spent supine during REM sleep.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Overnight polysomnography from 80 sequential patients referred to Buffalo VA Sleep Lab for suspected OSA were analyzed with\\u000a 20

M. Jeffery Mador; Youngmi Choi; Abid Bhat; Jacek Dmochowski; Mark Braun; V. A. Gottumukkala; Brydon J. Grant

2010-01-01

246

Gender Differences in Obstructive Sleep Apnea and Treatment Response to Continuous Positive Airway Pressure  

PubMed Central

Objectives: Whether gender differences exist in clinical manifestations of obstructive sleep apnea (OSA) and whether women's responses to continuous positive airway pressure (CPAP) are similar to those of men are critical areas of exploration in sleep disordered breathing. This exploratory analysis addressed these questions by examining gender differences over a wide range of clinical outcomes at baseline and in response to CPAP in participants with severe OSA. Methods: Data from 152 men and 24 women who participated in a multicenter CPAP effectiveness study were analyzed. Gender differences in functional status (functional outcomes of sleep questionnaire, sickness impact profile), daytime sleepiness (epworth sleepiness scale, multiple sleep latency test), mood disturbance (profile of mood states), apnea symptoms (multivariable apnea prediction index), and neurobehavioral performance (psychomotor vigilance task) were examined. Treatment response was examined by the change in each outcome from baseline to 3 months after treatment. Results: Despite similar age, body mass index, and apnea-hypopnea index, women reported significantly lower functional status, more subjective daytime sleepiness, higher frequency of apnea symptoms, more mood disturbance, and poorer neurobehavioral performance compared to men at baseline. CPAP treatment significantly improved functional status and relieved symptoms for both genders. The magnitude of improvement in each clinical outcome did not vary by gender. Conclusions: Women with OSA showed greater impairment in daytime functioning and symptoms than men. Both genders benefit from CPAP treatment. Adequately powered studies considering possible referral and response bias are necessary to examine gender differences in OSA clinical manifestations and response to CPAP treatment. Citation: Ye L; Pien GW; Ratcliffe SJ; Weaver TE. Gender Differences in Obstructive Sleep Apnea and Treatment Response to Continuous Positive Airway Pressure. J Clin Sleep Med 2009;5(6):512-518. PMID:20465016

Ye, Lichuan; Pien, Grace W.; Ratcliffe, Sarah J.; Weaver, Terri E.

2009-01-01

247

Assessment of a Neck-Based Treatment and Monitoring Device for Positional Obstructive Sleep Apnea  

PubMed Central

Study Objectives: A majority of patients diagnosed with obstructive sleep apnea are position dependent whereby they are at least twice as severe when sleeping supine (POSA). This study evaluated the accuracy and efficacy of a neck-worn device designed to limit supine sleep. The study included nightly measurements of snoring, sleep/wake, time supine, and the frequency and duration of feedback to monitor compliance. Methods: Thirty patients between ages 18 and 75 years, BMI ? 35 with an overall apnea-hypopnea index (AHI) ? 5 and an overall AHI ? 1.5 times the non-supine AHI, and an Epworth score ? 5 were prospectively studied. Subjective reports and polysomnography were used to assess efficacy resulting from 4 weeks of in-home supine-avoidance therapy and to measure device accuracy. From 363 polysomnography reports, 209 provided sufficient positional data to estimate one site's prevalence of positional OSA. Results: In 83% of participants exhibiting > 50% reduction in overall AHI, the mean and median reductions were 69% and 79%. Significant reductions in the overall and supine AHI, apnea index, percent time SpO2 < 90%, and snoring contributed to significant improvements in stage N1 and N2 sleep, reductions in cortical arousals and awakenings, and improved depression scores. Supine position was under-detected by > 5% in 3% of cases. Sleep efficiency by neck actigraphy was within 10% of polysomnography in 87% of the studies when position feedback was delivered. The prevalence of POSA was consistently > 70% when the overall AHI was < 60. Conclusions: The neck position therapy device is accurate and effective in restricting supine sleep, improving AHI, sleep architecture and continuity, and monitoring treatment outcomes. Citation: Levendowski DJ, Seagraves S, Popovic D, Westbrook PR. Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. J Clin Sleep Med 2014;10(8):863-871. PMID:25126032

Levendowski, Daniel J.; Seagraves, Sean; Popovic, Djordje; Westbrook, Philip R.

2014-01-01

248

University of Wisconsin study finds sleep apnea associated with higher mortality from cancer  

Cancer.gov

Sleep-disordered breathing (SDB), commonly known as sleep apnea, is associated with an increased risk of cancer mortality, according to a new study. While previous studies have associated SDB with increased risks of hypertension, cardiovascular disease, depression, and early death, this is the first human study to link apnea with higher rate of cancer mortality, showing a nearly five times higher incidence of cancer deaths in patients with severe SDB compared to those without the disorder, a result that echoes previous findings in animal studies.

249

Pattern of upper airway obstruction during sleep before and after uvulopalatopharyngoplasty in patients with obstructive sleep apnea  

Microsoft Academic Search

Objective: To investigate the pre-and postoperative pattern of upper airway obstruction in obstructive sleep apnea (OSA) patients treated by uvulopalatopharyngoplasty (UPPP).Background: The response rate to UPPP in unselected OSA patients is generally about 50%.Methods: Intraluminal pressure measurements during sleep were employed to analyze the pattern of upper airway obstruction before and after surgery.Results: Ten patients with mild to moderate OSA

A. N. Boudewyns; W. A. De Backer; P. H. Van de Heyning

2001-01-01

250

Obstructive Sleep Apnea is Associated with Preserved Bone Mineral Density in Healthy Elderly Subjects  

PubMed Central

Study Objectives: Chronic intermittent hypoxia (IH) acts as a stimulator of mesenchymal stem cell (MSC) mobilization, intensifying osteoblast formation in animal models. The recurrence of apnea and oxygen desaturation in obstructive sleep apnea (OSA) may mimic experimental models of IH. We hypothesized that in elderly with OSA, apnea-related IH may mobilize MSCs and thereby prevent the age-related decline in osteogenesis. This study explored the relationship between OSA and bone mineral density (BMD), and the effect of IH on BMD, in a large sample of elderly subjects. Participants: There were 833 volunteers age 68.6 ± 0.8 y (59% women). Intervention: Each participant underwent evaluation of BMD at lumbar spine and femoral sites by dual-energy x-ray absorptiometry (DEXA) as well as clinical and polygraphic examinations. OSA was diagnosed on the basis of an apnea-hypopnea index (AHI) ? 15. Measurements and Results: There were 55% of the participants who presented with OSA, and these subjects were predominantly male and overweight. Compared with subjects without OSA, those with OSA had a higher femoral and spinal BMD (P < 0.001). Body mass index (BMI), AHI, and oxygen desaturation index (ODI) (P < 0.01) were significantly related to BMD. After adjustment for sex, BMI, metabolic values, and hypertension, multiple regression analysis showed a significant association between femoral and lumbar T scores and both daily energy expenditure (P < 0.001) and ODI (P = 0.007). Conclusions: In elderly subjects, the presence of obstructive sleep apnea is associated with higher bone mineral density, with oxygen desaturation index being a significant determinant of bone metabolism. These results suggest that apnea-related intermittent hypoxia may stimulate the bone remodeling process in older population. Clinical Trial Registration: NCT 00759304 and NCT 00766584. Citation: Sforza E; Thomas T; Barthélémy JC; Collet P; Roche F. Obstructive sleep apnea is associated with preserved bone mineral density in healthy elderly subjects. SLEEP 2013;36(10):1509-1515. PMID:24082310

Sforza, Emilia; Thomas, Thierry; Barthélémy, Jean-Claude; Collet, Philippe; Roche, Frédéric

2013-01-01

251

Cognitive function and treatment of obstructive sleep apnea syndrome.  

PubMed

Among patients with obstructive sleep apnea syndrome (OSAS), impairment of cognitive function, i.e. deficits in memory, attention, and visuconstructive abilities are common. We applied different forms of treatment for patients with newly diagnosed OSAS in a randomized study with a one-year follow-up. Patients with BMI > 40 kg/m2 were excluded. After the initial diagnostic work-up, male patients were considered to be candidates for either nasal continuous airway pressure (nCPAP) (27 patients) or surgical treatment (uvulopalatopharyngoplasty with or without mandibular osteotomy) (23 patients). Within the groups, the patients were then randomized to active treatment (nCPAP/surgery) or to conservative management. Cognitive function and severity of OSAS were assessed prior to treatment and 3 and 12 months later. At 12 months, all patients on nCPAP had a normal ODI4 index (< 10), and were significantly less somnolent than their controls; 3/11 of the surgically treated patients had a normal ODI4 index. Daytime somnolence was significantly less severe in the surgically treated patients than in their controls. Cognitive function did not correlate importantly with daytime sleepiness or severity of OSAS; the best Pearson pairwise correlation coefficient was between ODI4 and the Bourdon-Wiersma (r = 0.36). Success in treatment of OSAS did not affect neuropsychological outcome. We concluded that the standard cognitive test battery is insufficiently sensitive to identify positive changes in patients with OSAS, especially among those with a high level of overall mental functioning. PMID:10188139

Lojander, J; Kajaste, S; Maasilta, P; Partinen, M

1999-03-01

252

Molecular Biomarkers of Vascular Dysfunction in Obstructive Sleep Apnea  

PubMed Central

Untreated and long-lasting obstructive sleep apnea (OSA) may lead to important vascular abnormalities, including endothelial cell (EC) dysfunction, hypertension, and atherosclerosis. We observed a correlation between microcirculatory reactivity and endothelium-dependent release of nitric oxide in OSA patients. Therefore, we hypothesized that OSA affects (micro)vasculature and we aimed to identify vascular gene targets of OSA that could possibly serve as reliable biomarkers of severity of the disease and possibly of vascular risk. Using quantitative RT-PCR, we evaluated gene expression in skin biopsies of OSA patients, mouse aortas from animals exposed to 4-week intermittent hypoxia (IH; rapid oscillations in oxygen desaturation and reoxygenation), and human dermal microvascular (HMVEC) and coronary artery endothelial cells (HCAEC) cultured under IH. We demonstrate a significant upregulation of endothelial nitric oxide synthase (eNOS), tumor necrosis factor-alpha-induced protein 3 (TNFAIP3; A20), hypoxia-inducible factor 1 alpha (HIF-1??? and vascular endothelial growth factor (VEGF) expression in skin biopsies obtained from OSA patients with severe nocturnal hypoxemia (nadir saturated oxygen levels [SaO2]<75%) compared to mildly hypoxemic OSA patients (SaO2 75%–90%) and a significant upregulation of vascular cell adhesion molecule 1 (VCAM-1) expression compared to control subjects. Gene expression profile in aortas of mice exposed to IH demonstrated a significant upregulation of eNOS and VEGF. In an in vitro model of OSA, IH increased expression of A20 and decreased eNOS and HIF-1? expression in HMVEC, while increased A20, VCAM-1 and HIF-1?expression in HCAEC, indicating that EC in culture originating from distinct vascular beds respond differently to IH stress. We conclude that gene expression profiles in skin of OSA patients may correlate with disease severity and, if validated by further studies, could possibly predict vascular risk in OSA patients. PMID:23923005

Kaczmarek, Elzbieta; Bakker, Jessie P.; Clarke, Douglas N.; Csizmadia, Eva; Kocher, Olivier; Veves, Aristidis; Tecilazich, Francesco; O'Donnell, Christopher P.; Ferran, Christiane; Malhotra, Atul

2013-01-01

253

[The clinical and polysomnographic characteristics of obstructive sleep apnea syndrome in the children].  

PubMed

The objective of the present work was to study peculiarities of the neurological, ororhinolaryngological status of the children presenting with obstructive sleep apnea syndrome (OSAS) as well as their clinical and polysomnographic (PSG) sleep characteristics. A total of 15 children at the age from 6 to 9 years with OSAS confirmed by the PSG study were included in the investigation. All the children suffered nasal obstruction of different etiology and non-specific neurological complaints of transient headache, emotional lability, impaired memory, enhanced fatigue, and poor attention; these conditions were responsible for school desadaptation. All the patients underwent dyssomnic events. The polysomnographic study revealed the disordered sleep structure manifested as the shortened drowsiness phase, lengthened latent period of the rapid eye movement (REM) sleep and its reduced representation in the overall sleep cycle, enhanced duration of delta-sleep. The sleep alertness time also increased alongside with a rise in the number of activations on the sleep electroencephalograms by virtue of increased respiratory efforts. A characteristic feature of the children presenting with obstructive sleep apnea syndrome was vegetative disorder during sleep associated with a rise in the number of tachycardia episodes. The results of this study facilitate the understanding of certain pathogenetic aspects of neurological problems in the children suffering respiratory tract obstruction and OSAS and outline the problems awaiting further investigations. PMID:25377677

Kalashnikova, T P; Anisimov, G V; Tervo, S O; Skurikhin, A V

2014-01-01

254

Sleep apnea termination decreases cerebral blood volume: a near-infrared spectroscopy case study  

NASA Astrophysics Data System (ADS)

Medical near-infrared spectroscopy (NIRS) can be used to estimate cerebral haemodynamic changes non-invasively. Sleep apnea is a common sleep disorder where repetitive pauses in breathing decrease the quality of sleep and exposes the individual to various health problems. We have measured oxygenated and deoxygenated haemoglobin concentration changes during apneic events in sleep from the forehead of one subject using NIRS and used principal component analysis to extract extracerebral and cortical haemodynamic changes from NIRS signals. Comparison of NIRS signals with EEG, bioimpedance, and pulse oximetry data suggests that termination of apnea leads to decreases in cerebral blood volume and flow that may be related to neurological arousal via neurovascular coupling.

Virtanen, Jaakko; Noponen, Tommi; Salmi, Tapani; Toppila, Jussi; Meriläinen, Pekka

2009-07-01

255

Management of Obstructive Sleep Apnea in an Edentulous Lower Jaw Patient with a Mandibular Advancement Device  

PubMed Central

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed. PMID:24551463

Keyf, Filiz; Çiftci, Bülent; F?rat Güven, Selma

2014-01-01

256

Effects of obesity on the association between long-term sleep apnea treatment and changes in interleukin-6 levels: the Icelandic Sleep Apnea Cohort.  

PubMed

The aim of this study was to evaluate changes in interleukin (IL)-6 and soluble IL-6 receptor levels in obstructive sleep apnea patients and assess the role of positive airway pressure treatment and obesity on these changes. A total of 309 newly diagnosed subjects with sleep apnea from the Icelandic Sleep Apnea Cohort were referred for treatment and reassessed at a 2-year follow-up. Full treatment was defined objectively as use ?4 h day(-1) and ?20 days month(-1) . At the 2-year follow-up, there were 177 full users, 44 partial users and 88 non-users. The mean change in biomarker levels from baseline to the 2-year follow-up was assessed in a primary model that included adjustment for baseline biomarker levels, baseline body mass index and change in body mass index, as well as after adjustment for numerous relevant covariates. No significant overall difference in IL-6 level change was found among full, partial and non-users. However, in severely obese patients (body mass index ?35), a significant increase in IL-6 levels during the 2-year period was found in partial and non-users, compared to no change in full users. Results were attenuated in a smaller propensity score matched subsample, although similar trends were observed. No differences were found in soluble IL-6 receptor levels between full users and non-users, after adjustment for confounders. In conclusion, among untreated obese sleep apnea patients, IL-6 levels increase substantially during 2 years, while adherence to positive airway pressure treatment may prevent further increases in this inflammatory biomarker. PMID:25359691

Arnardottir, Erna S; Lim, Diane C; Keenan, Brendan T; Maislin, Greg; Benediktsdottir, Bryndis; Juliusson, Sigurdur; Pack, Allan I; Gislason, Thorarinn

2015-04-01

257

An obstructive sleep apnea detection approach using kernel density classification based on single-lead electrocardiogram.  

PubMed

Obstructive sleep apnea (OSA) is a common sleep disorder that often remains undiagnosed, leading to an increased risk of developing cardiovascular diseases. Polysomnogram (PSG) is currently used as a golden standard for screening OSA. However, because it is time consuming, expensive and causes discomfort, alternative techniques based on a reduced set of physiological signals are proposed to solve this problem. This study proposes a convenient non-parametric kernel density-based approach for detection of OSA using single-lead electrocardiogram (ECG) recordings. Selected physiologically interpretable features are extracted from segmented RR intervals, which are obtained from ECG signals. These features are fed into the kernel density classifier to detect apnea event and bandwidths for density of each class (normal or apnea) are automatically chosen through an iterative bandwidth selection algorithm. To validate the proposed approach, RR intervals are extracted from ECG signals of 35 subjects obtained from a sleep apnea database ( http://physionet.org/cgi-bin/atm/ATM ). The results indicate that the kernel density classifier, with two features for apnea event detection, achieves a mean accuracy of 82.07 %, with mean sensitivity of 83.23 % and mean specificity of 80.24 %. Compared with other existing methods, the proposed kernel density approach achieves a comparably good performance but by using fewer features without significantly losing discriminant power, which indicates that it could be widely used for home-based screening or diagnosis of OSA. PMID:25732075

Chen, Lili; Zhang, Xi; Wang, Hui

2015-05-01

258

The Face of Sleepiness: Improvement in Appearance after Treatment of Sleep Apnea  

PubMed Central

Study Objectives: Anecdote but no formal evidence suggests that facial appearance improves after hypersomnolent patients with obstructive sleep apnea are treated. We investigated whether masked volunteer raters can identify post- rather than pre-treatment images as looking more alert, and whether impressions are predicted by any objective changes on highly precise 3-dimensional digital photogrammetry. Methods: Participants included 20 adults with obstructive sleep apnea on polysomnography and excessive sleepiness on Epworth Sleepiness Scales. Photogrammetry was performed before and after ? 2 months of adherent use of positive airway pressure. Twenty-two raters then assessed pre- and post-treatment facial images, paired side-by-side in random order. Results: Subjects included 14 men and 6 women, with mean age 45 ± 11 (SD) years and mean baseline apnea/hypopnea index of 26 ± 21. The 22 raters twice as often identified post-treatment rather than pre-treatment images to look more alert (p = 0.0053), more youthful (p = 0.026), more attractive (p = 0.0068), and more likely to reflect the treated state (p = 0.015). Photogrammetry documented post-treatment decreases in forehead surface volume and decreased infraorbital and cheek redness, but no narrowing of the interpalpebral fissure. Decreased deep NREM sleep at baseline, and pre- to post-treatment decrements in facial redness showed promise as predictors of improved subjective ratings for alertness. Conclusions: Patients with obstructive sleep apnea are perceived to appear more alert, more youthful, and more attractive after adherent use of positive airway pressure. Objective changes in facial surface volume and color were identified. Post-treatment decrements in redness may inform subjective impressions of improved alertness. Citation: Chervin RD; Ruzicka DL; Vahabzadeh A; Burns MC; Burns JW; Buchman SR. The face of sleepiness: improvement in appearance after treatment of sleep apnea. J Clin Sleep Med 2013;9(9):845-852. PMID:23997695

Chervin, Ronald D.; Ruzicka, Deborah L.; Vahabzadeh, Arshia; Burns, Margaret C.; Burns, Joseph W.; Buchman, Steven R.

2013-01-01

259

A Model of Obstructive Sleep Apnea in Normal Humans Role of the Upper Airway  

Microsoft Academic Search

tive pressure nights. We found that the application of negative pressure was associated with the development of recurrent ob- structive apneas (non-REM-disordered breathing rate, 32.6 6 34.8 and 37.8 6 29.1 events\\/h during each of two negative pressure nights; p , 0.001) that were associated with oxyhemoglobin de- saturation, arousals from sleep, and alterations in sleep stage dis- tribution. Moreover,

EARL D. KING; PHILIP L. SMITH; ALAN R. SCHWARTZ

260

Positive Airway Pressure Therapy for Obstructive Sleep Apnea\\/Hypopnea Syndrome  

Microsoft Academic Search

Continuous positive airway therapy (CPAP) remains the mainstay of therapy for obstructive sleep apnea syndrome (OSAS). CPAP\\u000a therapy has been demonstrated to resolve sleep-disordered breathing events and improve several clinical outcomes. The first\\u000a part of this review will concentrate on conventional fixed-pressure CPAP therapy with the second portion of this chapter focussing\\u000a on newer technological advancements in the delivery of

Neil S. Freedman

261

A fuzzy logic approach to modeling physical activity levels of obstructive sleep apnea patients  

Microsoft Academic Search

This paper introduces a fuzzy logic approach to classifying the physical activity levels of obstructive sleep apnea (OSA) patients. Obesity is one of the risk factors of OSA, and the strong link between physical activity levels and obesity suggests that a method of assessing the physical activity levels of OSA patients is critical. We studied various objective and subjective instruments,

M. Broadway; L. Matthews; M. Kwiatkowska

2008-01-01

262

Physical activity in sleep apnea and obesity - personal incentives, challenges, and facilitators for success  

Microsoft Academic Search

The purpose of this study was to explore aspects of engagement in physical activity in persons with obstructive sleep apnea (OSA) and overweight. Seven women and eight men were interviewed, and transcribed data were analyzed according to qualitative content analysis.Two themes evolved reflecting influences on engagement in physical activity: 1) Incentives strong enough, and 2) Facilitators for success and challenges

Helena Igelström; Cathrin Martin; Margareta Emtner; Eva Lindberg; Pernilla Åsenlöf

2011-01-01

263

Physical Activity in Sleep Apnea and Obesity—Personal Incentives, Challenges, and Facilitators for Success  

Microsoft Academic Search

The purpose of this study was to explore aspects of engagement in physical activity in persons with obstructive sleep apnea and overweight. Seven women and 8 men were interviewed, and transcribed data were analyzed according to qualitative content analysis. Two themes evolved reflecting influences on engagement in physical activity: (a) incentives strong enough and (b) facilitators for success and challenges

Helena Igelström; Cathrin Martin; Margareta Emtner; Eva Lindberg; Pernilla Åsenlöf

2012-01-01

264

Oral appliances for the treatment of snoring and obstructive sleep apnea  

Microsoft Academic Search

Oral appliances have been used by dentists for several decades to treat snoring and obstructive sleep apnea. Although these devices are regulated by the Food and Drug Administration, most have undergone only sparse clinical testing for efficacy and safety. Most otolaryngologists are not well-versed in their applicability as treatment options. This review summarizes the historical development of oral appliances, the

SCOTT R. SCHOEM

2000-01-01

265

Lingual tonsillectomy in a child with obstructive sleep apnea: a novel technique.  

PubMed

We report on a case of lingual tonsillar hyperplasia contributing to refractory obstructive sleep apnea in a 5-year-old patient. We describe a novel technique utilizing suspension laryngoscopy and a laryngeal angled shaver to remove obstructive lingual tonsillar tissue. We review the available techniques for lingual tonsillectomy and propose theoretical advantages to the novel approach. PMID:16585879

Kluszynski, Brendan A; Matt, Bruce H

2006-04-01

266

Does Acute Exercise Improve Driving Performance in Patients with Untreated Obstructive Sleep Apnea?  

E-print Network

of moderate-intensity exercise (e.g. walking briskly). Measures of interest during the driving simulationDoes Acute Exercise Improve Driving Performance in Patients with Untreated Obstructive Sleep Apnea problematic. The primary objective of this study is to determine if a brief bout of moderate-intensity

Zhou, Yaoqi

267

The Effect of Upper Airway Obstruction and Arousal on Peripheral Arterial Tonometry in Obstructive Sleep Apnea  

Microsoft Academic Search

We evaluated the effects of airflow limitation and arousal on digital from the autonomic nervous system in response to the physio- vascular tone in 10 patients with obstructive sleep apnea (OSA) logic disturbances that characterize periods of upper airway using the recently developed, noninvasive technique of peripheral obstruction. Hypoxia, acting through the carotid body, can arterial tonometry (PAT). Subjects were

Christopher P. O'Donnell; Lawrence Allan; Paul Atkinson; Alan R. Schwartz

268

Adult ADHD and\\/or Sleep Apnea? Differential Diagnostic Considerations with Six Case Studies  

Microsoft Academic Search

An increased interest in the persistence of attention-deficit hyperactivity disorder (ADHD) into adulthood brings concern that adult ADHD may become overdiagnosed. As with ADHD in childhood, various other adult psychological and medical disorders may be associated with ADHD in adulthood, and these related disorders may be mislabeled and mistreated as simple ADHD. One such medical condition is sleep apnea. This

J. D. Ball; Virgil Wooten; Timothy A. Crowell

1999-01-01

269

No Evidence of Sleep Apnea in Children with Attention Deficit Hyperactivity Disorder  

Microsoft Academic Search

Children with attention deficit hyperactivity disorder (ADHD) may have a component of sleep apnea causing arousal and contributing to ADHD behavior during the day. Twenty non-ADHD children between 4 and 16 years of age were compared with 18 children with ADHD with use of nocturnal polysomnography (PSG) and psychometric tests. The psychometric testing confirmed that the control group were normal

Jacky Cooper; Louise Tyler; I. Wallace; Keith R. Burgess

2004-01-01

270

Obstructive Sleep Apnea as a Risk Factor for Stroke and Death  

Microsoft Academic Search

background Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syn- drome is independently related to the risk of stroke or death from any cause after adjust- ment for other risk factors, including hypertension. methods In this observational cohort study, consecutive patients underwent

H. Klar Yaggi; John Concato; Walter N. Kernan; Judith H. Lichtman; Lawrence M. Brass; Vahid Mohsenin

2005-01-01

271

The effect of adding gender item to Berlin Questionnaire in determining obstructive sleep apnea in sleep clinics  

PubMed Central

BACKGROUND AND AIM: We aimed to validate the Turkish version of Berlin Questionnaire (BQ) and developped a BQ-gender (BQ-G) form by adding gender component. We aimed to compare the two forms in defining patients with moderate to severe obstructive sleep apnea (OSA) in sleep clinics. METHODS: Four hundred and eighty five consecutive patients, refered to our sleep clinic for snoring, witnessed apnea and/or excessive daytime sleepiness were enrolled to the study. All patients underwent in-laboratory polysomnography (PSG). Patients with sleep efficiency less than 40% and total sleep time less than 4 hours, chronic anxiolitic/sedative drug usage, respiratory tract infection within past two weeks were excluded from the study. All the patients fulfilled BQ. The test and retest for BQ were applied in 15-day interval in 30 patients. RESULTS: Totally 433 patients were enrolled to the study (285 male, 148 female). The mean age of the patients was 47,5 ± 10.5 (21-79). 180 patients (41.6%) had apnea-hypopnea index (AHI) ? 15, while 253 patients (58,4%) had AHI > 15. The ? value was 48–94 and the the truth value was 69-94% for the test-retest procedure. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve AUC were 84.2%, 31.7%, 48.7%, 63.4%, and 0.579 in order for BQ and 79.9 %, 51.7%, 63.2% , 69.6%, and 0.652 for BQ-G. CONCLUSION: The results showed that BQ-G is relatively better than BQ in determining moderate to severe OSA in sleep clinics where most of the patients are sleep apneic but both of the tests were found to have insufficient validities in defining moderate to severe OSA in sleep clinics. PMID:25593603

Yüceege, Melike; F?rat, Hikmet; Sever, Özlem; Demir, Ahmet; Ard?ç, Sad?k

2015-01-01

272

Response of Genioglossus Muscle to Increasing Chemical Drive in Sleeping Obstructive Apnea Patients  

PubMed Central

Study Objectives: Subjects with a collapsible upper airway must activate their pharyngeal dilators sufficiently in response to increasing chemical drive if they are to maintain airway patency without arousal from sleep. Little is known about the response of pharyngeal dilators to increasing chemical drive in these subjects. We wished to determine, in obstructive apnea patients, the response of the genioglossus to increasing chemical drive and the contribution of mechanoreceptor feedback to this response. Design: Physiological study. Setting: University-based sleep laboratory. Patients: 20 patients with obstructive apnea. Interventions: Genioglossus activity was monitored during overnight polysomnography on optimal continuous positive airway pressure (CPAP). Intermittently, inspired gases were altered to produce different levels of ventilatory stimulation. CPAP was then briefly reduced to 1.0 cm H2O (dial-down), inducing an obstruction. Measurements and Results: Without mechanoreceptor feedback (i.e., on CPAP) the increase in genioglossus activity as ventilation increased from 6.1 ± 1.4 to 16.1 ± 4.8 L/min was modest (?Tonic activity 0.3% ± 0.5%maximum; ?Phasic activity 1.7% ± 3.4%maximum). Genioglossus activity increased immediately upon dial-down, reflecting mechanoreceptor feedback, but only when ventilation before dial-down exceeded a threshold value. This threshold varied among patients and, once surpassed, genioglossus activity increased briskly with further increases in chemical drive (1.1% ± 0.84%GGMAX per L/min increase in VE). Conclusions: In sleeping obstructive apnea patients: (1) Mechanoreceptor feedback is responsible for most of the genioglossus response to chemical drive. (2) Mechanoreceptor feedback is effective only above a threshold chemical drive, which varies greatly among patients. These findings account in part for the highly variable relation between pharyngeal mechanical abnormalities and apnea severity. Citation: Loewen AHS; Ostrowski M; Laprairie J; Maturino F; Hanly PJ; Younes M. Response of genioglossus muscle to increasing chemical drive in sleeping obstructive apnea patients. SLEEP 2011;34(8):1061-1073. PMID:21804668

Loewen, Andrea H.S.; Ostrowski, Michele; Laprairie, John; Maturino, Frances; Hanly, Patrick J.; Younes, Magdy

2011-01-01

273

Automatic screening of obstructive sleep apnea from the ECG based on empirical mode decomposition and wavelet analysis  

E-print Network

. OSA is a common sleep disorder caused by repetitive occlusions of the upper airways, which producesAutomatic screening of obstructive sleep apnea from the ECG based on empirical mode decomposition Physiol. Meas. 31 (2010) 273­289 doi:10.1088/0967-3334/31/3/001 Automatic screening of obstructive sleep

274

Evaluation of a Single-Channel Nasal Pressure Device to Assess Obstructive Sleep Apnea Risk in Laboratory and Home Environments  

PubMed Central

Study Objectives: To evaluate the sensitivity and specificity of a portable single-channel (intra-nasal pressure) sleep apnea device (ApneaLink) in both the laboratory and at home for assessment of sleep apnea risk in comparison with standard polysomnography (PSG). Methods: Fifty-five participants underwent simultaneous recordings of standard PSG and ApneaLink in the laboratory. Of these, 38 participants also used the ApneaLink device in their own homes for one night. PSG respiratory events were scored using standard criteria. Intra-nasal pressure signals were analyzed using the ApneaLink automated computerized algorithm provided to yield estimates of airflow for detection of apneas and hypopneas. Apnea-hypopnea indices (AHI) were compared. Results: There was high sensitivity and specificity for the ApneaLink AHI when compared to simultaneous PSG at comparable AHI levels (AHI ? 15 events/h; sensitivity 100%, specificity 92%; positive and negative predictive values 70% and 100%, respectively). Home-measured ApneaLink AHI sensitivity and specificity were also reliable when compared with PSG (AHI ? 5, 81% and 77%, respectively; AHI ? 15, 67% and 91%), and improved slightly when two nights' data were used (AHI ? 5, 88% and 85%; AHI ? 15, 67% and 93%). Conclusions: The ApneaLink demonstrated good sensitivity and specificity in quantifying AHI when compared to PSG in a population with and without confirmed OSA. This simple, easy-to-use device may be useful in de novo large-scale occupational or underserved community OSA diagnostic programs to identify those with unambiguous disease who need immediate treatment or indicate those who may be at increased risk of OSA. Citation: Crowley KE; Rajaratnam SMW; Shea SA; Epstein LJ; Czeisler CA; Lockley SW. Evaluation of a single-channel nasal pressure device to assess obstructive sleep apnea risk in laboratory and home environments. J Clin Sleep Med 2013;9(2):109–116. PMID:23372462

Crowley, Kate E.; Rajaratnam, Shantha M.W.; Shea, Steven A.; Epstein, Lawrence J.; Czeisler, Charles A.; Lockley, Steven W.

2013-01-01

275

Intermittent hypoxia, respiratory plasticity and sleep apnea in humans; present knowledge and future investigations  

PubMed Central

This review examines the role that respiratory plasticity has in the maintenance of breathing stability during sleep in individuals with sleep apnea. The initial portion of the review considers the manner in which repetitive breathing events may be initiated in individuals with sleep apnea. Thereafter, the role that two forms of respiratory plasticity, progressive augmentation of the hypoxic ventilatory response and long-term facilitation of upper airway and respiratory muscle activity, might have in modifying breathing events in humans is examined. In this context, present knowledge regarding the initiation of respiratory plasticity in humans during wakefulness and sleep is addressed. Also, published findings which reveal that exposure to intermittent hypoxia promotes breathing instability, at least in part, because of progressive augmentation of the hypoxic ventilatory response and the absence of long-term facilitation, are considered. Next, future directions are presented and are focused on the manner in which forms of plasticity that stabilize breathing might be promoted while diminishing destabilizing forms, concurrently. These future directions will consider the potential role of circadian rhythms in the promotion of respiratory plasticity and the role of respiratory plasticity in enhancing established treatments for sleep apnea. PMID:23587570

Mateika, Jason H.; Syed, Ziauddin

2013-01-01

276

Respiratory Sound Analysis for Flow Estimation During Wakefulness and Sleep, and its Applications for Sleep Apnea Detection and Monitoring  

NASA Astrophysics Data System (ADS)

Tracheal respiratory sounds analysis has been investigated as a non--invasive method to estimate respiratory flow and upper airway obstruction. However, the flow--sound relationship is highly variable among subjects which makes it challenging to estimate flow in general applications. Therefore, a robust model for acoustical flow estimation in a large group of individuals did not exist before. On the other hand, a major application of acoustical flow estimation is to detect flow limitations in patients with obstructive sleep apnea (OSA) during sleep. However, previously the flow--sound relationship was only investigated during wakefulness among healthy individuals. Therefore, it was necessary to examine the flow--sound relationship during sleep in OSA patients. This thesis takes the above challenges and offers innovative solutions. First, a modified linear flow--sound model was proposed to estimate respiratory flow from tracheal sounds. To remove the individual based calibration process, the statistical correlation between the model parameters and anthropometric features of 93 healthy volunteers was investigated. The results show that gender, height and smoking are the most significant factors that affect the model parameters. Hence, a general acoustical flow estimation model was proposed for people with similar height and gender. Second, flow--sound relationship during sleep and wakefulness was studied among 13 OSA patients. The results show that during sleep and wakefulness, flow--sound relation- ship follows a power law, but with different parameters. Therefore, for acoustical flow estimation during sleep, the model parameters should be extracted from sleep data to have small errors. The results confirm reliability of the acoustical flow estimation for investigating flow variations during both sleep and wakefulness. Finally, a new method for sleep apnea detection and monitoring was developed, which only requires recording the tracheal sounds and the blood's oxygen saturation level (SaO2) data. It automatically classifies the sound segments into breath, snore and noise. A weighted average of features extracted from sound segments and SaO2 signal was used to detect apnea and hypopnea events. The performance of the proposed approach was evaluated on the data of 66 patients. The results show high correlation (0.96, p < 0.0001) between the outcomes of our system and those of the polysomnography. Also, sensitivity and specificity of the proposed method in differentiating simple snorers from OSA patients were found to be more than 91%. These results are superior or comparable with the existing commercialized sleep apnea portable monitors.

Yadollahi, Azadeh

277

Beliefs and Attitudes Toward Obstructive Sleep Apnea Evaluation and Treatment Among Blacks  

PubMed Central

Objective Although blacks are at higher risk for obstructive sleep apnea (OSA), they are not as likely as their white counterparts to receive OSA evaluation and treatment. This study assessed knowledge, beliefs, and attitudes towards OSA evaluation and treatment among blacks residing in Brooklyn, New York. Methods Five focus groups involving 39 black men and women (aged ?18 years) were conducted at the State University of New York (SUNY) Downstate Medical Center in Brooklyn to ascertain barriers preventing or delaying OSA evaluation and treatment. Results Misconceptions about sleep apnea were a common theme that emerged from participants’ responses. Obstructive sleep apnea was often viewed as a type of insomnia, an age-related phenomenon, and as being caused by certain bedtime activities. The major theme that emerged about barriers to OSA evaluation was unfamiliarity with the study environment. Barriers were categorized as: problems sleeping in a strange and unfamiliar environment, unfamiliarity with the study protocol, and fear of being watched while sleeping. Barriers to continuous positive airway pressure (CPAP) treatment adoption were related to the confining nature of the device, discomfort wearing a mask while they slept, and concerns about their partner’s perceptions of treatment. Conclusion Results of this study suggest potential avenues for interventions to increase adherence to recommended evaluation and treatment of OSA. Potential strategies include reducing misconceptions about OSA, increasing awareness of OSA in vulnerable communities, familiarizing patients and their partners with laboratory procedures used to diagnose and treat OSA. We propose that these strategies should be used to inform the development of culturally and linguistically tailored sleep apnea interventions to increase awareness of OSA among blacks who are at risk for OSA and associated comorbidities. PMID:23560353

Shaw, Raphael; McKenzie, Sharon; Taylor, Tonya; Olafiranye, Oladipupo; Boutin-Foster, Carla; Ogedegbe, Gbenga; Jean-Louis, Girardin

2013-01-01

278

The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial  

PubMed Central

Background Obstructive sleep apnea (OSA) and hypertension are well-known cardiovascular risk factors. Their control could reduce the burden of heart disease across populations. Several drugs are used to control hypertension, but the only consistently effective treatment of OSA is continuous positive airway pressure. The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases. Methods/Design This is a randomized double-blind clinical trial, comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than 40 years of age with stage I hypertension (140 to 159/90 to 99 mmHg) and moderate OSA (15 to 30 apneas/hour of sleep). The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes are adverse events, somnolence scale (Epworth), ventilatory parameters and C reactive protein levels. The follow-up will last 8 weeks. There will be 29 participants per group. The project has been approved by the ethics committee of our institution. Discussion The role of fluid retention in OSA has been known for several decades. The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea. As well as testing the efficacy of these drugs, this study will help to understand the mechanisms that link hypertension and sleep apnea and their treatment. Trial registration ClinicalTrials.gov: NCT01896661 PMID:24382030

2014-01-01

279

Combined bipolar radiofrequency surgery of the tongue base and uvulopalatopharyngoplasty for obstructive sleep apnea  

PubMed Central

Introduction The aim of the study was to investigate the effectiveness of combined bipolar radiofrequency surgery of the tongue base (RFBT) and uvulopalatopharyngoplasty (UPPP) in a single session for obstructive sleep apnea and whether this combination is safe and well tolerated. Material and methods Seventy-nine patients with obstructive sleep apnea and both palatal and retroglossal obstruction underwent UPPP with bipolar RFBT. The control group consisted of 35 patients treated by UPPP alone. Results The apnea-hypopnea index significantly decreased from 28.7 to 14.1. The oxygen desaturation index decreased from 15.1 to 10.3. Mean oxygen saturation was unchanged. Subjectively, the Epworth Sleepiness Scale was significantly improved from 10.6 to 7.3, and the snoring level decreased from 8.4 to 6.0. The overall treatment success rate increased from 41.9% for UPPP alone to 51.7% for UPPP + RFBT. No serious adverse events occurred. Two patients had postoperative bleeding from the tonsillar bed after UPPP. Four patients had ulceration of the base of the tongue after RFBT with spontaneous cure. One patient had a taste change in half of the tongue that resolved within two months. Conclusions Combined bipolar RFBT and UPPP in a single session is well tolerated and safe surgery in the treatment of obstructive sleep apnea. It is effective in reducing respiratory parameters and subjective symptoms of obstructive sleep apnea. Further advantages are a single session, simple feasibility, bipolar technique and short time of the procedure. PMID:24482656

Zabrodsky, Michal; Kastner, Jan; Betka, Jaroslav; Klozar, Jan

2013-01-01

280

A Robust Apnea Period Detection Method in Changing Sleep Posture by Average Mutual Information of Heartbeat and Respiration  

NASA Astrophysics Data System (ADS)

Sleep disorders disturb the recovery from mental and physical fatigues, one of the functions of the sleep. The majority of those who with the disorders are suffering from Sleep Apnea Syndrome (SAS). Continuous Hypoxia during sleep due to SAS cause Circulatory Disturbances, such as hypertension and ischemic heart disease, and Malfunction of Autonomic Nervous System, and other severe complications, often times bringing the suffers to death. In order to prevent these from happening, it is important to detect the SAS in its early stage by monitoring the daily respirations during sleep, and to provide appropriate treatments at medical institutions. In this paper, the Pneumatic Method to detect the Apnea period during sleep is proposed. Pneumatic method can measure heartbeat and respiration signal. Respiration signal can be considered as noise against heartbeat signal, and the decrease in the respiration signal due to Apnea increases the Average Mutual Information of heartbeat. The result of scaling analysis of the average mutual information is defined as threshold to detect the apnea period. The root mean square error between the lengths of Apnea measured by Strain Gauge using for reference and those measured by using the proposed method was 3.1 seconds. And, error of the number of apnea times judged by doctor and proposal method in OSAS patients was 3.3 times.

Kurihara, Yosuke; Watanabe, Kajiro; Kobayashi, Kazuyuki; Tanaka, Tanaka

281

Continuous Positive Airway Pressure Treatment of Sleepy Patients with Milder Obstructive Sleep Apnea  

PubMed Central

Rationale: Twenty-eight percent of people with mild to moderate obstructive sleep apnea experience daytime sleepiness, which interferes with daily functioning. It remains unclear whether treatment with continuous positive airway pressure improves daytime function in these patients. Objectives: To evaluate the efficacy of continuous positive airway pressure treatment to improve functional status in sleepy patients with mild and moderate obstructive sleep apnea. Methods: Patients with self-reported daytime sleepiness (Epworth Sleepiness Scale score >10) and an apnea-hypopnea index with 3% desaturation and from 5 to 30 events per hour were randomized to 8 weeks of active or sham continuous positive airway pressure treatment. After the 8-week intervention, participants in the sham arm received 8 weeks of active continuous positive airway pressure treatment. Measurements and Main Results: The Total score on the Functional Outcomes of Sleep Questionnaire was the primary outcome measure. The adjusted mean change in the Total score after the first 8-week intervention was 0.89 for the active group (n = 113) and ?0.06 for the placebo group (n = 110) (P = 0.006). The group difference in mean change corresponded to an effect size of 0.41 (95% confidence interval, 0.14–0.67). The mean (SD) improvement in Functional Outcomes of Sleep Questionnaire Total score from the beginning to the end of the crossover phase (n = 91) was 1.73 ± 2.50 (t[90] = 6.59; P < 0.00001) with an effect size of 0.69. Conclusions: Continuous positive airway pressure treatment improves the functional outcome of sleepy patients with mild and moderate obstructive sleep apnea. Clinical trial registered with www.clinicaltrials.gov (NCT 00127348). PMID:22837377

Mancini, Cristina; Maislin, Greg; Cater, Jacqueline; Staley, Bethany; Landis, J. Richard; Ferguson, Kathleen A.; George, Charles F. P.; Schulman, David A.; Greenberg, Harly; Rapoport, David M.; Walsleben, Joyce A.; Lee-Chiong, Teofilo; Gurubhagavatula, Indira; Kuna, Samuel T.

2012-01-01

282

Monocarboxylate Transporter 2 and Stroke Severity in a Rodent Model of Sleep Apnea  

PubMed Central

Stroke is not only more prevalent but is also associated with more severe adverse functional outcomes among patients with sleep apnea. Monocarboxylate transporters (MCT) are important regulators of cellular bioenergetics, have been implicated in brain susceptibility to acute severe hypoxia (ASH), and could underlie the unfavorable prognosis of cerebrovascular accidents in sleep apnea patients. Rodents were exposed to either intermittent hypoxia (IH) during sleep, a characteristic feature of sleep apnea, or to sustained hypoxia (SH), and expression of MCT1 and MCT2 was assessed. In addition, the functional recovery to MCAO in rats and hMCT2 transgenic mice and of hippocampal slices subjected to ASH was assessed, as well as the effects of MCT blocker and MCT2 antisense oligonucleotides and siRNAs. IH, but not SH, induced significant reductions in MCT2 expression over time at both the mRNA and protein levels, and in the functional recovery of hippocampal slices subjected to ASH. Similarly, MCAO-induced infarcts were significantly greater in IH-exposed rats and mice, and over-expression of hMCT2 in mice markedly attenuated the adverse effects of IH. Exogenous pyruvate treatment reduced infarct volumes in normoxic rats but not in IH-exposed rats. Administration of he MCT2 blocker 4CN, but not the MCT1 antagonist pCMBS, increased infarct size. Thus, prolonged exposures to IH mimicking sleep apnea are associated with increased CNS vulnerability to ischemia that is mediated, at least in part, by concomitant decreases in the expression and function of MCT2. Efforts to develop agonists of MCT2 should provide opportunities to ameliorate the overall outcome of stroke. PMID:21753001

Wang, Yang; Guo, Shang-Z; Bonen, Arend; Li, Richard C.; Kheirandish-Gozal, Leila; Zhang, Shelley X.L.; Brittian, Kenneth R.; Gozal, David

2011-01-01

283

Effect of Obstructive Sleep Apnea Hypopnea Syndrome on Lipid Profile: A Meta-Regression Analysis  

PubMed Central

Background: Obstructive sleep apnea (OSA) is associated with obesity, metabolic syndrome, and dyslipidemia, which may be related to decrease androgen levels found in OSA patients. Dyslipidemia may contribute to atherosclerosis leading to increasing risk of heart disease. Methods: Systematic review was conducted using PubMed and Cochrane library by utilizing different combinations of key words; sleep apnea, obstructive sleep apnea, serum lipids, dyslipidemia, cholesterol, total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and triglyceride (TG). Inclusion criteria were: English articles, and studies with adult population in 2 groups of patients (patients with OSA and without OSA). A total 96 studies were reviewed for inclusion, with 25 studies pooled for analysis. Results: Sixty-four studies were pooled for analysis; since some studies have more than one dataset, there were 107 datasets with 18,116 patients pooled for meta-analysis. All studies measured serum lipids. Total cholesterol pooled standardized difference in means was 0.267 (p = 0.001). LDL cholesterol pooled standardized difference in means was 0.296 (p = 0.001). HDL cholesterol pooled standardized difference in means was -0.433 (p = 0.001). Triglyceride pooled standardized difference in means was 0.603 (p = 0.001). Meta-regression for age, BMI, and AHI showed that age has significant effect for TC, LDL, and HDL. BMI had significant effect for LDL and HDL, while AHI had significant effect for LDL and TG. Conclusion: Patients with OSA appear to have increased dyslipidemia (high total cholesterol, LDL, TG, and low HDL). Citation: Nadeem R, Singh M, Nida M, Waheed I, Khan A, Ahmed S, Naseem J, Champeau D. Effect of obstructive sleep apnea hypopnea syndrome on lipid profile: a meta-regression analysis. J Clin Sleep Med 2014;10(5):475-489. PMID:24910548

Nadeem, Rashid; Singh, Mukesh; Nida, Mahwish; Waheed, Irfan; Khan, Adnan; Ahmed, Saeed; Naseem, Jawed; Champeau, Daniel

2014-01-01

284

[Obstructive sleep apnea syndrome in bus drivers: clinical and polysomnographic study].  

PubMed

A Questionnaire on sleep and vigilance disorders has been developed by the Italian Association of Sleep Medicine to help the occupational health physicians in screening for sleep disorders. Aim of this study was to compare the Questionnaire with standardized questionnaires for sleepiness and sleep apnea and with a polysomnographic evaluation. Four hundred sixty-three (463#) commercial bus drivers (454M, 9F; mean age +/- S.D. 41.6 +/- 8.1 yrs; mean body mass index 26.2 +/- 3.6 kg/m2) underwent clinical evaluation that included the Italian Association of Sleep Medicine Questionnaire on sleep and vigilance disorders and two standardized questionnaires (Berlin Questionnaire and Epworth Sleepiness Scale). According to the Italian Association of Sleep Medicine Questionnaire on sleep and vigilance disorders 40 subjects presented an high risk for sleep disturbance and in 28 subject the questionnaires were concordant. Preliminary results (16 patients) showed an high rate of concordance between questionnaire and PSG. These data strongly suggest that sleep disorders and symptoms, that are frequent in a population of professional bus drivers, should be better evaluated during occupational health visit. PMID:23405667

Maestri, M; Cosentino, F; Di Coscio, E; Iacopini, E; Carnicelli, L; Buselli, R; Garbarino, S; Cristaudo, A; Bonanni, E

2012-01-01

285

Outcome of CPAP Treatment on Intimate and Sexual Relationships in Men with Obstructive Sleep Apnea  

PubMed Central

Study Objectives: To examine intimate and sexual relationships in patients with obstructive sleep apnea (OSA), the association with daytime sleepiness, and the change in these outcomes with continuous positive airway pressure treatment (CPAP). Design: Pre-post test, quasi-experimental study Setting: Seven sleep disorders centers in the US and Canada Participants: 123 males with OSA (AHI ? 20), aged 21 to 60 years Interventions: Nasal CPAP for ? 3 months Measurements and Results: Compared to normal values, at baseline patients were significantly sleepier, as measured by the Multiple Sleep Latency Test and Epworth Sleepiness Scale. They were also more impaired in intimate and sexual relationships, as measured by the Intimate and Sexual Relationships subscale of the Functional Outcomes of Sleep Questionnaire. Neither race nor marital status was significantly associated with impaired intimate and sexual relationships. Following treatment, patients were significantly more alert and had reported improved intimate and sexual relationships, with the greatest change occurring in those with the most disease severity. Conclusions: OSA has an adverse impact on intimate and sexual relationships that is related to subjective sleepiness and improved with CPAP treatment. Citation: Reishtein JL; Maislin G; Weaver TE. Outcome of CPAP treatment on intimate and sexual relationships in men with obstructive sleep apnea. J Clin Sleep Med 2010;6(3):221-226 PMID:20572413

Reishtein, Judith L.; Maislin, Greg; Weaver, Terri E.

2010-01-01

286

Maxillomandibular Advancement in Obstructive Sleep Apnea Syndrome Patients: a Restrospective Study on the Sagittal Cephalometric Variables  

PubMed Central

ABSTRACT Objectives The present retrospective study analyzes sagittal cephalometric changes in patients affected by obstructive sleep apnea syndrome submitted to maxillomandubular advancement. Material and Methods 15 adult sleep apnea syndrome (OSAS) patients diagnosed by polysomnography (PSG) and treated with maxillomandubular advancement (MMA) were included in this study. Pre- (T1) and postsurgical (T2) PSG studies assessing the apnea/hypopnea index (AHI) and the lowest oxygen saturation (LSAT) level were compared. Lateral cephalometric radiographs at T1 and T2 measuring sagittal cephalometric variables (SNA, SNB, and ANB) were analyzed, as were the amount of maxillary and mandibular advancement (Co-A and Co-Pog), the distance from the mandibular plane to the most anterior point of the hyoid bone (Mp-H), and the posterior airway space (PAS). Results Postoperatively, the overall mean AHI dropped from 58.7 ± 16 to 8.1 ± 7.8 events per hour (P < 0.001). The mean preoperative LSAT increased from 71% preoperatively to 90% after surgery (P < 0.001). All the patients in our study were successfully treated (AHI < 20 or reduced by 50%). Cephalometric analysis performed after surgery showed a statistically significant correlation between the mean SNA variation and the decrease in the AHI (P = 0.01). The overall mean SNA increase was 6°. Conclusions Our findings suggest that the improvement observed in the respiratory symptoms, namely the apnea/hypopnea episodes, is correlated with the SNA increase after surgery. This finding may help maxillofacial surgeons to establish selective criteria for the surgical approach to sleep apnea syndrome patients. PMID:24422033

Ronchi, Paolo; Ambrosoli, Alessandro; Caprioglio, Alberto

2013-01-01

287

Characterization of primary symptoms leading to Chinese patients presenting at hospital with suspected obstructive sleep apnea  

PubMed Central

Objectives We identified the primary symptoms leading to Chinese patients presenting at hospital with suspected obstructive sleep apnea (OSA) and studied the prevalence and characteristics of OSA in confirmed cases. Methods We collected data on 350 consecutive patients (302 males and 43±11 years old) with suspected OSA who underwent overnight polysomnography (PSG). Results Among all patients, rankings of primary symptoms that led to the patients presenting at hospital for PSG were observed apnea (33%), snoring alone (29%), choking/gasping (13%), daytime sleepiness (5%) and other (20%). For severe OSA, prevalence rate was 61%, apnea hypopnea index (AHI) was 64±18, age was 44±10 years old, body mass index (BMI) was 28±3.5 kg/m2, and hypertension rate was 28%. Conclusions Self-awareness of symptoms led a majority of the patients to present at hospital in China. Compared to currently available case series studies, our results suggest that OSA patients in East Asian countries are characterized by higher prevalence and more severe apnea, younger age, poorer sleep quality, but less obesity and less comorbidity with hypertension, relative to countries in North America, South America and Europe. PMID:24822101

Li, Zhe; Du, Lina; Li, Yun; Huang, Lili; Lei, Fei; Yang, Linghui; Li, Tao

2014-01-01

288

Obesity and perceived severity of obstructive sleep apnea-related conditions.  

PubMed

This study examined risk factors and perceived severity of obstructive sleep apnea-related conditions among college students based on weight categories. Data collected from 1399 college students were analyzed using multinomial and binary logistic regressions. Overweight and obese participants were more likely to snore and report familial risk for cardiovascular disease compared with their normal weight counterparts. Relative to normal weight participants, obese participants perceived snoring (odds ratio [OR] = 1.10), irritability (OR = 1.16), and high blood pressure (OR = 1.21) as more severe; they perceived erectile dysfunction (OR = 0.89) and cardiovascular disease (OR = 0.71) as less severe. Efforts are needed to identify obstructive sleep apnea risk and create systems for weight loss interventions, screening, and diagnosis. PMID:25167066

Smith, Matthew Lee; Smith, Harold A; Wilson, Kelly L; Ahn, SangNam; Pulczinski, Jairus C; Ory, Marcia G

2014-01-01

289

High Priority Future Research Needs for Obstructive Sleep Apnea Diagnosis and Treatment  

PubMed Central

Study Objectives: To identify and prioritize future research needs (FRN) topics for diagnosis and treatment of obstructive sleep apnea (OSA). Methods: Twenty-one panel members represented six stake-holder categories: patients and the public, providers; purchasers of health care, payers, policymakers, and principal investigators. Building on a recently completed comparative effectiveness review, stakeholders nominated and discussed potential FRN topics. Stakeholders then nominated their top priority FRN topics based on the Agency for Healthcare Research and Quality Effective Health Care Program Selection Criteria. From these nominations, the highest priority FRN topics were determined and were elaborated upon to include possible study designs to address the topics. Results: Thirty-seven topics were discussed and prioritized. The nine highest priority FRN topics included: cost-effectiveness of management strategies, defining age- and sex-specific criteria for OSA, evaluating routine preoperative screening for OSA, evaluating involvement of a sleep medicine specialist in diagnosis of OSA, evaluating clinical prediction rules, assessing the effect of treating sleep disordered breathing and long-term clinical outcomes, comparing treatments for patients who do not tolerate positive airway pressure, evaluating strategies to improve treatment compliance, and evaluating the association between sleep apnea severity and long-term clinical outcomes. Conclusions: While there are numerous specific research questions with low or insufficient strength of evidence for OSA management, OSA patients, their healthcare providers, and society at large would benefit from refocusing research efforts into the prioritized research questions and away from simple comparisons of short-term outcomes between specific interventions. Citation: Patel K; Moorthy D; Chan JA; Concannon TW. High priority future research needs for obstructive sleep apnea diagnosis and treatment. J Clin Sleep Med 2013;9(4):395-402. PMID:23585757

Patel, Kamal; Moorthy, Denish; Chan, Jeffrey A.; Concannon, Thomas W.; Ratichek, Sara J.; Chung, Mei; Balk, Ethan M.

2013-01-01

290

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

PubMed Central

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

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

2009-01-01

291

Endothelial mechanisms of endothelial dysfunction in patients with obstructive sleep apnea  

Microsoft Academic Search

Background  Obstructive sleep apnea (OSA) occurs in 2% of middle-aged women and 4% of middle-aged men in the general population and the\\u000a prevalence is much higher in specific patient groups. Intermittent hypoxia (IH, oxygen desaturation and re-oxygenation) cycle,\\u000a a major pathophysiologic character of OSA, and the physiological responses this evokes are thought to be responsible for its\\u000a association with increased cardiovascular

Jing Feng; Dan Zhang; Baoyuan Chen

292

Cardiorespiratory complications of neuraxial opioids in patients with obstructive sleep apnea: a systematic review.  

PubMed

We sought to determine the rate of cardiorespiratory complications following neuraxial opioid administration in the setting of obstructive sleep apnea (OSA). This systematic review of the leading biomedical databases originated from a university-affiliated, tertiary-care teaching hospital. A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the International Pharmaceutical Abstracts Database (1970 - September 2011) was undertaken. Cardiorespiratory complications were stratified into minor and major based on existing OSA literature. Five studies, including a total of 121 patients, were selected for analysis. All studies comprised low-quality evidence. Six major cardiorespiratory complications were reported among 5 (4.1%) patients and included three deaths, one cardiorespiratory arrest, and two episodes of severe respiratory depression. Five of these complications occurred during continuous fentanyl-containing epidural infusions and without concurrent positive airway pressure treatment. The rate of cardiorespiratory complications following the administration of neuraxial opioids to surgical patients with OSA is difficult to determine. PMID:23994284

Orlov, David; Ankichetty, Saravanan; Chung, Frances; Brull, Richard

2013-11-01

293

Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor?  

Microsoft Academic Search

Introduction  Erectile dysfunction (ED) is a well-known entity with determined risk factors, which generally has a negative impact on quality\\u000a of life. Obstructive sleep-disordered breathing (SDB), often referred to as obstructive sleep apnea, stands among the possible\\u000a risk factors for ED.\\u000a \\u000a \\u000a \\u000a \\u000a Discussion  Literature review suggests that SDB induces a spectrum of abnormalities in neural, hormonal, and vascular regulation that\\u000a may contribute to

Nikolaos Zias; Vishnu Bezwada; Sean Gilman; Alexandra Chroneou

2009-01-01

294

Upper airway function in the pathogenesis of obstructive sleep apnea: a review of the current literature  

PubMed Central

Purpose of review Obstructive sleep apnea is an increasingly prevalent disease, with a considerable societal burden. The disease is defined by recurrent intermittent collapse of the upper airway. Understanding of and treatment for the disease is largely confined to relief of the mechanical obstruction of the upper airway by application of continuous positive airway pressure, and less commonly weight loss or surgery. However, recent work has focused on the function, rather than structure alone, of the upper airway. Recent findings The following contributors to upper airway structure and function have been studied: traditional fixed anatomical abnormalities, dynamic anatomical changes, upper airway dilator muscle dysfunction, lung volumes, and instability in control of breathing. In each patient with obstructive sleep apnea, the relative contribution of each of these components may be quite variable. The studies reviewed here describe methods to evaluate these factors, and some attempts at treatment. Summary Ongoing studies are attempting to classify patients on the basis of the underlying pathophysiology. This work suggests that obstructive sleep apnea is a heterogeneous disease with multiple root causes. Ultimately, such a classification may allow more individualized treatment, not only relying on mechanical relief of the upper airway obstruction. PMID:18812828

Owens, Robert L.; Eckert, Danny J.; Yeh, Susie Yim; Malhotra, Atul

2009-01-01

295

Impediment in upper airway stabilizing forces assessed by phrenic nerve stimulation in sleep apnea patients  

PubMed Central

Background The forces developed during inspiration play a key role in determining upper airway stability and the occurrence of nocturnal breathing disorders. Phrenic nerve stimulation applied during wakefulness is a unique tool to assess Upper airway dynamic properties and to measure the overall mechanical effects of the inspiratory process on UA stability. Objectives To compare the flow/pressure responses to inspiratory and expiratory twitches between sleep apnea subjects and normal subjects. Methods Inspiratory and expiratory twitches using magnetic nerve stimulation completed in eleven untreated sleep apnea subjects and ten normal subjects. Results In both groups, higher flow and pressure were reached during inspiratory twitches. The two groups showed no differences in expiratory twitch parameters. During inspiration, the pressure at which flow-limitation occurred was more negative in normals than in apneic subjects, but not reaching significance (p = 0.07). The relationship between pharyngeal pressure and flow adequately fitted with a polynomial regression model providing a measurement of upper airway critical pressure during twitch. This pressure significantly decreased in normals from expiratory to inspiratory twitches (-11.1 ± 1.6 and -15.7 ± 1.0 cm H2O respectively, 95% CI 1.6–7.6, p < 0.01), with no significant difference between the two measurements in apneic subjects. The inspiratory/expiratory difference in critical pressure was significantly correlated with the frequency of nocturnal breathing disorders. Conclusion Inspiratory-related upper airway dilating forces are impeded in sleep apnea patients. PMID:16146572

Sériès, F; Vérin, E; Similowski, T

2005-01-01

296

High Altitude, Continuous Positive Airway Pressure, and Obstructive Sleep Apnea: Subjective Observations and Objective Data  

PubMed Central

Abstract Ginosar, Yehuda, Atul Malhotra, and Eli Schwartz. High altitude, continuous positive airway pressure, and obstructive sleep apnea: Subjective observations and objective data. High Alt Med Biol 14:186–189, 2013.—We report observations made by one of the authors who ascended to the Thorang La pass (5416?m) in the Nepal Himalaya in October 2010, despite moderate-severe obstructive sleep apnea. We report the first recorded use of nasal CPAP to treat high altitude pulmonary edema (progressively severe dyspnea at rest and severe orthopnea, with tachycardia and tachypnea) that occurred at 4400 meters, when snow and darkness made safe evacuation difficult. We also present objective longitudinal data of the effects of altitude on auto-adjusting CPAP delivered via a portable nasal CPAP device, and on the apnea hypopnea index measured during sleep while using the device. OSA may be a risk factor for the development of high altitude pulmonary edema and we suggest that a nasal CPAP device located in high altitude trekking stations may provide an additional or alternative treatment option for managing high altitude pulmonary edema until evacuation is possible. PMID:23795742

Malhotra, Atul; Schwartz, Eli

2013-01-01

297

Effect of nasal dilation on snoring and apneas during different stages of sleep.  

PubMed

This study was designed to test the hypothesis that nasal dilation reduces snoring. To achieve this we performed nocturnal polysomnography, including measurement of snoring, in 15 patients without nasal pathology before and after insertion of a nasal dilator (NOZOVENT). Snoring was quantified for each sleep stage by recording the number of snores per minute of sleep, number of snores per minute of snoring time and nocturnal sound intensities (maximum, average and minimum). We found that nasal dilation had no effect on the number of apneas, hypopneas or oxygen saturation. Snoring parameters were unaffected by NOZOVENT during stages I, II and REM sleep, but were all significantly reduced during slow wave sleep. We conclude that dilation of the anterior nares in patients without nasal pathology has a relatively weak effect on snoring, and routine use of nasal dilating appliances is not recommended for treatment of snoring. PMID:8141871

Hoffstein, V; Mateika, S; Metes, A

1993-06-01

298

On using the pathophysiology of obstructive sleep apnea as a teaching tool  

NSDL National Science Digital Library

I read with interest the recent article by Dr. Michael Levitzky on using the pathophysiology of obstructive sleep apnea (OSA) to teach cardiopulmonary integration . With 10 years of experience of teaching courses in both respiratory physiology and sleep at the University of Toronto, I also find that sleep-related breathing disorders, including OSA, provide a rich resource of material to integrate fundamental physiological principles. Importantly, these disorders also provide a focus for interesting case presentations to illustrate these integrative concepts. Indeed, in a previous issue of Advances in Physiology Education, we first introduced the use of sleep as a teaching tool for integrative respiratory physiology, and a major focus of that article was OSA.

Richard L. Horner (University of Toronto Medicine and Physiology)

2009-06-01

299

Molecular Signatures of Obstructive Sleep Apnea in Adults: A Review and Perspective  

PubMed Central

The consequences of obstructive sleep apnea (OSA) are largely mediated by chronic intermittent hypoxia and sleep fragmentation. The primary molecular domains affected are sympathetic activity, oxidative stress and inflammation. Other affected domains include adipokines, adhesion molecules and molecules that respond to endoplasmic reticulum stress. Changes in molecular domains affected by OSA, assessed in blood and/or urine, can provide a molecular signature for OSA that could potentially be used diagnostically and to predict who is likely to develop different OSA-related comorbidities. High-throughput discovery strategies such as microarrays, assessing changes in gene expression in circulating blood cells, have the potential to find new candidates and pathways thereby expanding the molecular signatures for OSA. More research is needed to fully understand the pathophysiological significance of these molecular signatures and their relationship with OSA comorbidities. Many OSA subjects are obese, and obesity is an independent risk factor for many comorbidities associated with OSA. Moreover, obesity affects the same molecular pathways as OSA. Thus, a challenge to establishing a molecular signature for OSA is to separate the effects of OSA from obesity. We propose that the optimal strategy is to evaluate the temporal changes in relevant molecular pathways during sleep and, in particular, the alterations from before to after sleep when assessed in blood and/or urine. Such changes will be at least partly a consequence of chronic intermittent hypoxia and sleep fragmentation that occurs during sleep. Citation: Arnardottir ES; Mackiewicz M; Gislason T; Teff KL; Pack AI. Molecular signatures of obstructive sleep apnea in adults: A review and perspective. SLEEP 2009;32(4):447–470. PMID:19413140

Arnardottir, Erna S.; Mackiewicz, Miroslaw; Gislason, Thorarinn; Teff, Karen L.; Pack, Allan I.

2009-01-01

300

Obstructive Sleep Apnea in Obese Community-Dwelling Children: The NANOS Study  

PubMed Central

Introduction: Obesity in children is assumed to serve as a major risk factor in pediatric obstructive sleep apnea syndrome (OSAS). However, the prevalence of OSAS in otherwise healthy obese children from the community is unknown. Aim: To determine the prevalence of OSAS in obese children identified and recruited from primary care centers. Methods: A cross-sectional, prospective, multicenter study. Spanish children ages 3–14 y with a body mass index (BMI) greater than or equal to the 95th percentile for age and sex were randomly selected, and underwent medical history, snoring, and Pediatric Sleep Questionnaire (PSQ) assessments, as well as physical examination, nasopharyngoscopy, and nocturnal polysomnography (NPSG) recordings. Results: Two hundred forty-eight children (54.4% males) with mean age of 10.8 ± 2.6 y were studied with a BMI of 28.0 ± 4.7 kg/m2 corresponding to 96.8 ± 0.6 percentile when adjusted for age and sex. The mean respiratory disturbance index (RDI), obstructive RDI (ORDI), and obstructive apnea-hypopnea index (OAHI) were 5.58 ± 9.90, 5.06 ± 9.57, and 3.39 ± 8.78/h total sleep time (TST), respectively. Using ? 3/h TST as the cutoff for the presence of OSAS, the prevalence of OSAS ranged from 21.5% to 39.5% depending on whether OAHI, ORDI, or RDI were used. Conclusions: The prevalence of obstructive sleep apnea syndrome (OSAS) in obese children from the general population is high. Obese children should be screened for the presence of OSAS. ClinicalTrials.gov Identifier: NCT01322763. Citation: Alonso-Álvarez ML, Cordero-Guevara JA, Terán-Santos J, Gonzalez-Martinez M, Jurado-Luque MJ, Corral-Peñafiel J, Duran-Cantolla J, Kheirandish-Gozal L, Gozal D, for the Spanish Sleep Network. Obstructive sleep apnea in obese community-dwelling children: the NANOS study. SLEEP 2014;37(5):943-949. PMID:24790273

Alonso-Álvarez, María Luz; Cordero-Guevara, José Aurelio; Terán-Santos, Joaquin; Gonzalez-Martinez, Mónica; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Kheirandish-Gozal, Leila; Gozal, David

2014-01-01

301

Effects of Obstructive Sleep Apnea and Obesity on Exercise Function in Children  

PubMed Central

Study Objectives: Evaluate the relative contributions of weight status and obstructive sleep apnea (OSA) to cardiopulmonary exercise responses in children. Design: Prospective, cross-sectional study. Participants underwent anthropometric measurements, overnight polysomnography, spirometry, cardiopulmonary exercise function testing on a cycle ergometer, and cardiac doppler imaging. OSA was defined as ? 1 obstructive apnea or hypopnea per hour of sleep (OAHI). The effect of OSA on exercise function was evaluated after the parameters were corrected for body mass index (BMI) z-scores. Similarly, the effect of obesity on exercise function was examined when the variables were adjusted for OAHI. Setting: Tertiary pediatric hospital. Participants: Healthy weight and obese children, aged 7–12 y. Interventions: N/A. Measurements and Results: Seventy-one children were studied. In comparison with weight-matched children without OSA, children with OSA had a lower cardiac output, stroke volume index, heart rate, and oxygen consumption (VO2 peak) at peak exercise capacity. After adjusting for BMI z-score, children with OSA had 1.5 L/min (95% confidence interval -2.3 to -0.6 L/min; P = 0.001) lower cardiac output at peak exercise capacity, but minute ventilation and ventilatory responses to exercise were not affected. Obesity was only associated with physical deconditioning. Cardiac dysfunction was associated with the frequency of respiratory-related arousals, the severity of hypoxia, and heart rate during sleep. Conclusions: Children with OSA are exercise limited due to a reduced cardiac output and VO2 peak at peak exercise capacity, independent of their weight status. Comorbid OSA can further decrease exercise performance in obese children. Citation: Evans CA, Selvadurai H, Baur LA, Waters KA. Effects of obstructive sleep apnea and obesity on exercise function in children. SLEEP 2014;37(6):1103-1110. PMID:24882905

Evans, Carla A.; Selvadurai, Hiran; Baur, Louise A.; Waters, Karen A.

2014-01-01

302

Validation of the Apnea Risk Evaluation System (ARES) Device Against Laboratory Polysomnography in Pregnant Women at Risk for Obstructive Sleep Apnea Syndrome  

PubMed Central

Study Objective: To assess the validity of using the Apnea Risk Evaluation System (ARES) Unicorder for detecting obstructive sleep apnea (OSA) in pregnant women. Methods: Sixteen pregnant women, mean age (SD) = 29.8 (5.4) years, average gestational age (SD) = 28.6 (6.3) weeks, mean body mass index (SD) = 44.7 (6.9) kg/m2 with signs and symptoms of OSA wore the ARES Unicorder during one night of laboratory polysomnography (PSG). PSG was scored according to AASM 2007 criteria, and PSG AHI and RDI were compared to the ARES 1%, 3%, and 4% AHIs calculated with the ARES propriety software. Results: Median PSG AHI and PSG RDI were 3.1 and 10.3 events/h of sleep, respectively. Six women had a PSG AHI ? 5 events/h of sleep and 11 had a PSG RDI ? 5 events/h of sleep. PSG AHI and RDI were strongly correlated with the ARES AHI measures. When compared with polysomnographic diagnosis of OSA, the ARES 3% algorithm provided the best balance between sensitivity (1.0 for PSG AHI, 0.91 for PSG RDI) and specificity (0.5 for PSG AHI, 0.8 for PSG RDI) for detecting sleep disordered breathing in our sample. Conclusions: The ARES Unicorder demonstrated reasonable consistency with PSG for diagnosing OSA in this small, heterogeneous sample of obese pregnant women. Citation: Sharkey KM, Waters K, Millman RP, Moore R, Martin SM, Bourjeily G. Validation of the Apnea Risk Evaluation System (ARES) device against laboratory polysomnography in pregnant women at risk for obstructive sleep apnea syndrome. J Clin Sleep Med 2014;10(5):497-502. PMID:24910550

Sharkey, Katherine M.; Waters, Kelly; Millman, Richard P.; Moore, Robin; Martin, Susan M.; Bourjeily, Ghada

2014-01-01

303

Impact of Dronabinol on Quantitative Electroencephalogram (qEEG) Measures of Sleep in Obstructive Sleep Apnea Syndrome  

PubMed Central

Study Objectives: To determine the effects of dronabinol on quantitative electroencephalogram (EEG) markers of the sleep process, including power distribution and ultradian cycling in 15 patients with obstructive sleep apnea (OSA). Methods: EEG (C4-A1) relative power (% total) in the delta, theta, alpha, and sigma bands was quantified by fast Fourier transformation (FFT) over 28-second intervals. An activation ratio (AR = [alpha + sigma] / [delta + theta]) also was computed for each interval. To assess ultradian rhythms, the best-fitting cosine wave was determined for AR and each frequency band in each polysomnogram (PSG). Results: Fifteen subjects were included in the analysis. Dronabinol was associated with significantly increased theta power (p = 0.002). During the first half of the night, dronabinol decreased sigma power (p = 0.03) and AR (p = 0.03), and increased theta power (p = 0.0006). At increasing dronabinol doses, ultradian rhythms accounted for a greater fraction of EEG power variance in the delta band (p = 0.04) and AR (p = 0.03). Females had higher amplitude ultradian rhythms than males (theta: p = 0.01; sigma: p = 0.01). Decreasing AHI was associated with increasing ultradian rhythm amplitudes (sigma: p < 0.001; AR: p = 0.02). At the end of treatment, lower relative power in the theta band (p = 0.02) and lower AHI (p = 0.05) correlated with a greater decrease in sleepiness from baseline. Conclusions: This exploratory study demonstrates that in individuals with OSA, dronabinol treatment may yield a shift in EEG power toward delta and theta frequencies and a strengthening of ultradian rhythms in the sleep EEG. Citation: Farabi SS; Prasad B; Quinn L; Carley DW. Impact of dronabinol on quantitative electroencephalogram (qEEG) measures of sleep in obstructive sleep apnea syndrome. J Clin Sleep Med 2014;10(1):49-56. PMID:24426820

Farabi, Sarah S.; Prasad, Bharati; Quinn, Lauretta; Carley, David W.

2014-01-01

304

Individual Variability and Predictors of Driving Simulator Impairment in Patients with Obstructive Sleep Apnea  

PubMed Central

Study Objectives: Obstructive sleep apnea (OSA) is associated with driving impairment and road crashes. However, daytime function varies widely between patients presenting a clinical challenge when assessing crash risk. This study aimed to determine the proportion of patients showing “normal” versus “abnormal” driving simulator performance and examine whether anthropometric, clinical, and neurobehavioral measures predict abnormal driving. Methods: Thirty-eight OSA patients performed a 90-min simulated driving task under 3 conditions: normal sleep, restricted sleep (4 h in bed), and normal sleep + alcohol (BAC?0.05 g/dL). Patients were classified as “resilient” drivers if, under all 3 experimental conditions their mean steering deviation fell within 2 standard deviations of the mean steering deviation of 20 controls driving under baseline normal sleep conditions, or a “vulnerable” driver if mean steering deviation was outside this range in at least one experimental condition. Potentially predictive baseline anthropometric, clinical, neurocognitive, and cortical activation measures were examined. Results: Of the 38 OSA patients examined, 23 (61%) and 15 (39%) were classified as resilient and vulnerable drivers, respectively. There were no differences in baseline measures between the groups, although the proportion of females was greater and self-reported weekly driving exposure was less among vulnerable drivers (p < 0.05). On univariate analysis gender, weekly driving hours, and auditory event related potential P2 amplitude were weakly associated with group status. Multivariate analysis showed weekly driving hours (OR 0.69, 95%CI, 0.51-0.94, p = 0.02) and P2 amplitude (OR 1.34, 95%CI 1.02-1.76, p = 0.035) independently predicted vulnerable drivers. Conclusions: Most OSA patients demonstrated normal simulated driving performance despite exposure to further sleep loss or alcohol. Most baseline measures did not differentiate between resilient and vulnerable drivers, although prior driving experience and cortical function were predictive. Novel measures to assist identification of OSA patients at risk of driving impairment and possibly accidents are needed. Trial Registration: Data presented in this manuscript was collected as part of a clinical trial “Experimental Investigations of Driving Impairment in Obstructive Sleep Apnea.” Trial ID: ACTRN12610000009011, URL: http://www.anzctr.org.au/trial_view.aspx?ID=334979. Citation: Vakulin A, Catcheside PG, Baulk SD, Antic NA, Banks S, Dorrian J, McEvoy RD. Individual variability and predictors of driving simulator impairment in patients with obstructive sleep apnea. J Clin Sleep Med 2014;10(6):647-655. PMID:24932145

Vakulin, Andrew; Catcheside, Peter G.; Baulk, Stuart D.; Antic, Nick A.; Banks, Siobhan; Dorrian, Jillian; McEvoy, R. Doug

2014-01-01

305

Impact of Treatment with Continuous Positive Airway Pressure (CPAP) on Weight in Obstructive Sleep Apnea  

PubMed Central

Study Objective: To determine the impact of continuous positive airway pressure (CPAP) on weight change in persons with obstructive sleep apnea (OSA). Design, Setting, and Participants: The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blinded sham-controlled multicenter clinical trial conducted at 5 sites in the United States. Of 1,105 participants with an apnea hypopnea index ? 10 events/ hour initially randomized, 812 had body weight measured at baseline and after 6 months of study. Intervention: CPAP or Sham CPAP. Measurements: Body weight, height, hours of CPAP or Sham CPAP use, Epworth Sleepiness Scale score. Results: Participants randomized to CPAP gained 0.35 ± 5.01 kg, whereas those on Sham CPAP lost 0.70 ± 4.03 kg (mean ± SD, p = 0.001). Amount of weight gain with CPAP was related to hours of device adherence, with each hour per night of use predicting a 0.42 kg increase in weight. This association was not noted in the Sham CPAP group. CPAP participants who used their device ? 4 h per night on ? 70% of nights gained the most weight over 6 months in comparison to non-adherent CPAP participants (1.0 ± 5.3 vs. -0.3 ± 5.0 kg, p = 0.014). Conclusions: OSA patients using CPAP may gain a modest amount of weight with the greatest weight gain found in those most compliant with CPAP. Commentary: A commentary on this article appears in this issue on page 995. Citation: Quan SF; Budhiraja R; Clarke DP; Goodwin JL; Gottlieb DJ; Nichols DA; Simon RD; Smith TW; Walsh JK; Kushida CA. Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea. J Clin Sleep Med 2013;9(10):989-993. PMID:24127141

Quan, Stuart F.; Budhiraja, Rohit; Clarke, Denise P.; Goodwin, James L.; Gottlieb, Daniel J.; Nichols, Deborah A.; Simon, Richard D.; Smith, Terry W.; Walsh, James K.; Kushida, Clete A.

2013-01-01

306

Actigraphy combined with EEG compared to polysomnography in sleep apnea patients.  

PubMed

An actigraph extended with electroencephalography (EEG), electroocculography (EOG) and electromyography (EMG) was compared to polysomnography in two studies on patients suffering from sleep disordered breathing. Study A with 30 subjects used a single lead EEG, and study B with 20 subjects used EOG and EMG in addition. Sleep was scored according to Rechtschaffen and Kales rules. Total sleep time (TST), sleep period time (SPT), sleep efficiency (SE), sustained sleep efficiency (SSE), sleep-onset latency (SL), and sleep stages were compared. For study A an epoch-by-epoch comparison of sleep stages revealed an overall agreement of 74.2%. Correlations were high for SE (0.98, p < 0.001), SSE (0.98, p < 0.001), TST (0.99, p < 0.001), SPT (0.99, p < 0.001), and SL (0.98, p < 0.001). Regarding the sleep stages, correlations were high for rapid eye movement (REM) (0.83, p < 0.001), light-sleep (0.78, p < 0.001), and deep sleep (0.73, p < 0.001). For study B, results of an epoch-by-epoch comparison of sleep stages showed an overall agreement of 75.5%. Correlations were high for SE (0.98, p < 0.001), SSE (0.98, p < 0.001), TST (0.87, p < 0.001), SL (0.98, p < 0.001), SPT (0.94, p < 0.001), and for rapid eye movement (REM) (0.91, p < 0.001), light-sleep (0.74, p < 0.001), and deep sleep (0.89, p < 0.001). In summary the study revealed high agreement between polysomnography and single lead EEG in sleep apnea patients. Deviations for REM were slightly higher for the single lead EEG compared to single lead EEG plus EOG/EMG. Both simplified systems proved to be reliable for comfortable out-patient sleep recording. PMID:25651914

Fietze, Ingo; Penzel, Thomas; Partinen, Markku; Sauter, Jochen; Küchler, Gert; Suvoro, Alexander; Hein, Holger

2015-03-01

307

Using the pathophysiology of obstructive sleep apnea to teach cardiopulmonary integration  

NSDL National Science Digital Library

Obstructive sleep apnea (OSA) is a common disorder of upper airway obstruction during sleep. The effects of intermittent upper airway obstruction include alveolar hypoventilation, altered arterial blood gases and acid-base status, and stimulation of the arterial chemoreceptors, which leads to frequent arousals. These arousals disturb sleep architecture and cause hypersomnolence. Chronic intermittent alveolar and systemic arterial hypoxia-hypercapnia can cause pulmonary and systemic hypertension, with effects on the right and left ventricles, and even the renal system. The pathophysiology of OSA can therefore be used to review and integrate many topics in pulmonary and cardiovascular physiology in the context of problem-based learning, a guided discussion, or a formal lecture. The discussion begins with a case scenario, followed by a definition of the disorder, the common symptoms and signs of OSA, and a description of an apneic event. These are related to the physiology of the upper airway in OSA, normal alterations in the respiratory system during sleep, the effects of apnea on gas exchange and arterial blood gases, and the cardiovascular consequences of alterations in alveolar and systemic arterial PO2 and PCO2. The treatment of OSA, particularly how the use of continuous positive airway pressure relates to the pathophysiology of the disorder, is discussed briefly.

PhD Michael G. Levitzky (Louisiana State Univ. Health Sciences Ctr. Dept. Of Physiology)

2008-06-10

308

The Impact of Obstructive Sleep Apnea on Metabolic and Inflammatory Markers in Consecutive Patients with Metabolic Syndrome  

Microsoft Academic Search

BackgroundObstructive Sleep Apnea (OSA) is tightly linked to some components of Metabolic Syndrome (MetS). However, most of the evidence evaluated individual components of the MetS or patients with a diagnosis of OSA that were referred for sleep studies due to sleep complaints. Therefore, it is not clear whether OSA exacerbates the metabolic abnormalities in a representative sample of patients with

Luciano F. Drager; Heno F. Lopes; Cristiane Maki-Nunes; Ivani C. Trombetta; Edgar Toschi-Dias; Maria Janieire N. N. Alves; Raffael F. Fraga; Jonathan C. Jun; Carlos E. Negrão; Eduardo M. Krieger; Vsevolod Y. Polotsky; Geraldo Lorenzi-Filho; Adrian V. Hernandez

2010-01-01

309

Ambulatory treatment of sleep apnea syndrome with CO2 laser: laser-assisted UPPP (LAUP), results on 70 patients  

NASA Astrophysics Data System (ADS)

The pharyngeal airway obstruction during sleep in the Obstructive Sleep Apnea Syndrome (OSAS) can be improved after treatment by LAUP (Laser Assisted Uvulopalatoplasty). This new technique, performed under local anesthesia, permits the snoring treatment without any hospitalization, or general anesthetic; like an ordinary dental visit. This is done by reducing the amount of tissue in the uvula, the velum, and the upper part of the posterior pillars. Our experience with the LAUP in Sleep Apnea Syndrome is described, from December 1988 to May 1994, in 70 patients. Among 62 patients classified as successful `responders', the respiratory disturbance index was reduced more than 50%. Among all the 70 patients: in 51.4 % of cases (36 patients), there's a healing of snoring and Sleep Apnea Syndrome. In 37.2% of cases (26 patients), there's an improvement reduction of length and number of apneas and a significant improvement in nocturnal oxygen saturation. 11.4% (8 patients), are relative failures, with always decrease of snoring, but still Sleep Apnea Syndrome, (with a higher B.M.I.). There were no important complications reported. Patients withstand it well and there's had a better tolerance of the C.P.A.P. in the cases of OSAS LRPP failures. Popularization of LAUP will require serious training of surgeon and further long-term studies.

Kamami, Yves-Victor

1995-05-01

310

Telephone-delivered behavioral intervention among blacks with sleep apnea and metabolic syndrome: study protocol for a randomized controlled trial  

PubMed Central

Background Lack of adherence to recommended treatment for obstructive sleep apnea remains an ongoing public health challenge. Despite evidence that continuous positive airway pressure (CPAP) is effective and improves overall quality of life, adherence with the use of CPAP in certain racial/ethnic groups, especially blacks, is suboptimal. Evidence indicates that the incidence and prevalence of obstructive sleep apnea are higher among blacks, relative to whites, and blacks are less likely to adhere to recommended treatment compared with other racial/ethnic groups. Methods Using a two-arm randomized controlled design, this study will evaluate the effectiveness of a culturally and linguistically tailored telephone-delivered intervention to promote adherence to physician-recommended sleep apnea assessment and treatment among blacks with metabolic syndrome, versus an attention-control arm. The intervention is designed to foster adherence to recommended sleep apnea care using the stages-of-change model. The intervention will be delivered entirely over the telephone. Participants in the intervention arm will receive 10 phone calls to address challenges and barriers to recommended care. Outcomes will be assessed at baseline, and at 6- and 12-months post-randomization. Discussion This tailored behavioral intervention will improve adherence to sleep apnea assessment and treatment among blacks with metabolic syndrome. We expect to demonstrate that this intervention modality is feasible in terms of time and cost and can be replicated in populations with similar racial/ethnic backgrounds. Trial registration The study is registered at clinicaltrials.gov NCT01946659 (February 2013) PMID:24925227

2014-01-01

311

Comparison of different classifier algorithms on the automated detection of obstructive sleep apnea syndrome.  

PubMed

In this paper, we have compared the classifier algorithms including C4.5 decision tree, le artificial neural network (ANN), artificial immune recognition system (AIRS), and adaptive neuro-fuzzy inference system (ANFIS) in the diagnosis of obstructive sleep apnea syndrome (OSAS), which is an important disease that affects both the right and the left cardiac ventricle. The goal of this study was to find the best classifier model on the diagnosis of OSAS. The clinical features were obtained from Polysomnography device as a diagnostic tool for obstructive sleep apnea in patients clinically suspected of suffering this disease in this study. The clinical features are arousals index, apneahypopnea index (AHI), SaO2 minimum value in stage of rapid eye movement, and percent sleep time in stage of SaO2 intervals bigger than 89%. In our experiments, a total of 83 patients (58 with a positive OSAS (AHI>5) and 25 with a negative OSAS such that normal subjects) were examined. The decision support systems can help to physicians in the diagnosing of any disorder or disease using clues obtained from signal or images taken from subject having any disorder. In order to compare the used classifier algorithms, the mean square error, classification accuracy, area under the receiver operating characteristics curve (AUC), and sensitivity and specificity analysis have been used. The obtained AUC values of C4.5 decision tree, ANN, AIRS, and ANFIS classifiers are 0.971, 0.96, 0.96, and 0.922, respectively. These results have shown that the best classifier system is C4.5 decision tree classifier on the diagnosis of obstructive sleep apnea syndrome. PMID:18444362

Polat, Kemal; Yosunkaya, Sebnem; Güne?, Salih

2008-06-01

312

Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening  

NASA Astrophysics Data System (ADS)

Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10-3), neck circumference (p < 10-3), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10-3), and intensity of snoring (p < 10-3). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.

Ravelo-García, A. G.; Saavedra-Santana, P.; Juliá-Serdá, G.; Navarro-Mesa, J. L.; Navarro-Esteva, J.; Álvarez-López, X.; Gapelyuk, A.; Penzel, T.; Wessel, N.

2014-06-01

313

Prevalence of Obstructive Sleep Apnea Syndrome and CPAP Adherence in the Elderly Chinese Population  

PubMed Central

Background This study assessed the prevalence of obstructive sleep apnea syndrome (OSAS) and CPAP adherence in the elderly Chinese in Hong Kong. Methods We conducted a sleep questionnaire survey among the elders aged ?60 years in the community centres followed by level 3 home sleep study (Embletta). Subjects with an apnea hypopnea index (AHI) ? 15/hr alone and those with AHI ? 5/hr plus either cardiovascular risk factors or Epworth Sleepiness Score (ESS) ? 10 were offered CPAP treatment. Results Altogether 819 subjects were interviewed with mean (SD) age of 73.9 (7.5) years, BMI 24.2 (3.6) kg/m2, neck circumference 34.9 (3.4) cm and ESS 6.6 (5.2). Daytime sleepiness was reported by 72.4%, snoring loudly 5.1% and witnessed apnea 4%. Among 234 subjects who underwent home sleep study, 156 (66.7%), 102 (43.6%), 70 (29.9%) and 45 (19.2%) had AHI ? 5, ? 10, ? 15 and ? 20/hr respectively, with the prevalence increasing with age and BMI. In the sample, 149 subjects (63.7%) were classified as having OSAS, as defined by an AHI ? 5/hr with associated symptoms, involving 81 men (74.3%) and 68 women (54.4%). Neck circumference and snoring frequency were the only positive independent factors associated with the AHI and the diagnosis of OSAS. Among 141 subjects who were offered CPAP treatment, 30 accepted CPAP prescription with improvement of ESS and cognitive function over 12 months with CPAP usage of 4.2 (2.2) h/night. Conclusion This study showed a high prevalence of OSAS among the community elders in Hong Kong. Home CPAP acceptance was low but there was significant improvement of subjective sleepiness and cognitive function among those on CPAP treatment. PMID:25774657

To, Kin-Wang; Chan, Ken K. P.; Ngai, Jenny; Tung, Alvin; Ko, Fanny W. S.

2015-01-01

314

Obstructive sleep apnea: novel trigger and potential therapeutic target for cardiac arrhythmias.  

PubMed

Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is prevalent and frequently underdiagnosed in our community. Although presenting with predominantly respiratory symptoms, the most serious complications from OSA are cardiovascular, including arrhythmias, disease of the sinus node and conducting system, and sudden cardiac death. The acute and chronic effects of OSA on the cardiovascular system, which include major effects on autonomic function during sleep and wakefulness, are potent contributors to the development and persistence of cardiac arrhythmias. Although large randomized studies are currently lacking, treatment of OSA may be an important primary or additional therapy to supplement the use of drugs or devices in the treatment of cardiac arrhythmias. PMID:20602559

Chan, Kim H; Wilcox, Ian

2010-07-01

315

Biomarkers to Improve Diagnosis and Monitoring of Obstructive Sleep Apnea Syndrome: Current Status and Future Perspectives  

PubMed Central

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper airway collapse associated with oxygen desaturation and sleep disruption. It is proposed that these periodic changes lead to molecular variations that can be detected by assessing serum biomarkers. Studies have identified inflammatory, oxidative, and metabolic perturbations attributable to sleep-disordered breathing. Given that OSAS is associated with increased cardiovascular and cerebrovascular morbidity, the ideal biomarker should enable timely recognition with the possibility of intervention. There is accumulating data on the utility of serum biomarkers for the evaluation of disease severity, prognosis, and response to treatment. However, current knowledge is limited by data collection techniques, disease complexity, and potential confounding factors. The current paper reviews the literature on the use of serum biomarkers in OSAS. It is concluded that the ideal serum biomarker still needs to be discovered, while caution is needed in the interpretation of hitherto available results. PMID:25538852

Archontogeorgis, Konstantinos; Nena, Evangelia; Papanas, Nikolaos; Steiropoulos, Paschalis

2014-01-01

316

Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight.  

PubMed

The relation between snoring and obstructive sleep apnea as well as hypothyroidism is the object of interest of many authors. The respiratory disturbances during sleep are often observed in patients suffering from hypothyroidism. The relation of snoring to overweight in those patients has not been taken into account. The aim of the study was to evaluate the relations between hypothyroidism and quantitative and qualitative respiratory disturbances during sleep. Additional aim was to establish the relations of sleep apnea syndrome, snoring, hypothyroidism and overweight. The subjects included 15 patients (11 females and 4 males) aged from 28 to 73 (mean 50.3) suffering from hypothyroidism. All of them underwent thyroid testing before and after the hormonal treatment. TSH and fT4 concentrations were determined. At the same time the sleep assessment (PolyMESAM) was performed twice. Data were obtained from sleep studies and questionnaires (Epworth sleepiness scale). After the thyroid hormones stabilization significant decrease of snoring severity was observed. On the contrary, the respiratory disturbance index (RDI), desaturation index (DI), the lowest saturation (LSAT) did not change significantly, however, the Epworth scale score showed significant improvement. The correlations showed the strong relation between loud snoring and TSH (r=0.73, p<0.01) and fT4 (r=-0.66, p<0.003) concentrations before the treatment. The analysis showed no correlation between body mass (BMI) and snoring. The hormonal stabilization in patients suffering from hypothyroidism causes improvement in snoring severity. Based on our investigation the relationship between hypothyroidism and severity of snoring and excessive daytime somnolence was confirmed. It indicates a possible connection between hypothyroidism and upper airway resistance syndrome. PMID:17443029

Misiolek, M; Marek, B; Namyslowski, G; Scierski, W; Zwirska-Korczala, K; Kazmierczak-Zagorska, Z; Kajdaniuk, D; Misiolek, H

2007-03-01

317

Overnight Polysomnography versus Respiratory Polygraphy in the Diagnosis of Pediatric Obstructive Sleep Apnea  

PubMed Central

Background: Substantial discrepancies exist in the type of sleep studies performed to diagnose pediatric obstructive sleep apnea (OSA) in different countries. Respiratory polygraphic (RP) recordings are primarily performed in sleep laboratories in Europe, whereas polysomnography (PSG) constitutes the majority in the US and Australia. Home RP show consistent apnea-hypopnea index (AHI) underscoring, primarily because the total recording time is used as the denominator when calculating the AHI compared to total sleep time (TST). However, laboratory-based RP are less likely affected, since the presence of sleep technicians and video monitoring may enable more accurate TST estimates. We therefore examined differences in AHI in PSG and in-lab RP, and whether RP-based AHI may impact clinical decision making. Methods: Of all the children assessed for possible OSA who underwent PSG evaluation, 100 were identified and divided into 4 groups: (A) those with AHI < 1/h TST (n = 20), (B) 1 ? AHI < 5/h TST (n = 40), (C) 5 ? AHI < 10/h TST (n = 20), and (D) AHI ? 10/h TST (n = 20). Electroencephalography, electrooculography, and electromyography channels were deleted from the original unscored recordings to transform them into RP, and then rescored in random sequence. AHI-RP were compared to AHI-PSG, and therapeutic decisions based on AHI-RP and AHI-PSG were formulated and analyzed using clinical details derived from the patient's clinic letter. Results: Bland Altman analysis showed that in lab RP underestimated the AHI despite more accurate estimates of TST. This underestimation was due to missed hypopneas causing arousals without desaturation. Basing the therapeutic management decision on RP instead of PSG results changed the clinical management in 23% of all patients. The clinical management for patients in groups A and D was unaffected. However, 27.5% of patients in group B would have been given no treatment, as they would be diagnosed as having no OSA (AHI < 1/h TST) when they should have received a trial of anti-inflammatory therapy or been referred for ear, nose, and throat (ENT) review. Sixty percent of patients in group C would have received either a trial of medical treatment to treat mild OSA or no treatment, instead of referral to ENT services or commencement of continuous positive airway pressure. Conclusion: Apnea-hypopnea index (AHI) is underestimated in respiratory polygraphy (RP), and the disparity in AHI-RP and AHI-polysomnography can significantly affect clinical management decisions, particularly in children with mild and moderate obstructive sleep apnea (1 < AHI < 10/h total sleep time). Citation: Tan HL; Gozal D; Ramirez HM; Bandla HPR; Kheirandish-Gozal L. Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. SLEEP 2014;37(2):255-260. PMID:24497654

Tan, Hui-Leng; Gozal, David; Ramirez, Helena Molero; Bandla, Hari P. R.; Kheirandish-Gozal, Leila

2014-01-01

318

[Tongue base reduction with hyoid-epiglottoplasty. A surgical alternative in severe sleep apnea syndromes].  

PubMed

We present preliminary results and indications of tongue base reduction with hyo-epiglottoplasty for the treatment of severe obstructive sleep apnea syndrome (OSAS) due to isolated hyolingual abnormalities. The procedure consists in a subtotal resection of the tongue base after identification and derouting of the lingual neurovascular bundle. Hypopharyngeal enlargement, epiglottis verticalization, floor of the mouth tension and hyoid bone repositioning are also performed during the procedure. 14 severe OSAS male patients (mean apnea-hypopnea index of 71) were treated in our institution from November 1992 to February 1996. Indications were determined after a cephalometric analysis and a magnetic resonance imaging evaluation. Results were evaluated on clinical and polysomnographic criteria. No neurovascular complications occurred. Clinical results were excellent but success rate based on polysomnography was 50%. These preliminary results led us to change some of the steps in the technique. We also identified a predictive factor of success on the cephalometrics: an oropharyngeal area greater than 25 cm2. PMID:9922828

Chabolle, F; Wagner, I; Séquert, C; Lachiver, X; Coquille, F; Fleury, B; Blumen, M

1998-12-01

319

Lack of Impact of Mild Obstructive Sleep Apnea on Sleepiness, Mood and Quality of Life  

PubMed Central

Background and Objectives Obstructive sleep apnea (OSA) is associated with sleepiness, depression and reduced quality of life. However, it is unclear whether mild OSA has these negative impacts. Using data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), this study determined whether participants with mild OSA had greater sleepiness, more depressive symptoms and poorer quality of life in comparison to those without OSA. Methods 239 individuals evaluated for participation in APPLES with a baseline apnea hypopnea index (AHI) < 15 /hour were assigned to 1 of 2 groups: No OSA (N=40, AHI < 5 /hour) or Mild OSA (N=199, 5 to <15 /hour) based on their screening polysomnogram. Scores on their Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS), Hamilton Rating Scale for Depression (HAM-D), Profile of Mood States (POMS) and Sleep Apnea Quality of Life Index (SAQLI) were compared between groups. Results There were no significant differences between the No OSA and Mild OSA groups on any of the 5 measures: ESS (No OSA, 9.8 ± 3.5 vs Mild OSA, 10.6 ± 4.3, p=0.26), SSS,(2.8 ± 0.9 vs. 2.9 ± 1.0, p=0.52), HAM-D (4.6 ± 3.0 vs. 4.9 ± 4.7, p=0.27), POMS (33.5 ± 22.3 vs. 28.7 ± 22.0, p=0.70), SAQLI (4.5 ± 0.8 vs. 4.7 ± 0.7, p=0.39). Conclusion Individuals with mild OSA in this cohort do not have worse sleepiness, mood or quality of life in comparison to those without OSA. PMID:25232509

Quan, Stuart F.; Budhiraja, Rohit; Batool-Anwar, Salma; Gottlieb, Daniel J.; Eichling, Phillip; Patel, Sanjay; Shen, Wei; Walsh, James K.; Kushida, Clete A.

2014-01-01

320

Changes in dreaming induced by CPAP in severe obstructive sleep apnea syndrome patients.  

PubMed

To study dream content in patients with severe obstructive sleep apnea syndrome (OSAS) and its modification with Continuous Positive Airway Pressure (CPAP) therapy. We assessed twenty consecutive patients with severe OSAS and 17 healthy controls. Polysomnograms were recorded at baseline in patients and controls and during the CPAP titration night, 3 months after effective treatment and 2 years later in patients. Subjects were awakened 5-10 min after the beginning of the first and last rapid eye movement (REM) sleep periods and we measured percentage of dream recall, emotional content of the dream, word count, thematic units, sleep architecture and REM density. Dream recall in REM sleep was similar in patients at baseline and controls (51.5% versus 44.4% respectively; P = .421), decreased to 20% and 24.3% the first and third month CPAP nights, and increased to 39% 2 years later (P = 0.004). Violent/highly anxious dreams were only seen in patients at baseline. Word count was higher in patients than in controls. REM density was highest the first CPAP night. Severe OSAS patients recall dreams in REM sleep as often as controls, but their dreams have an increased emotional tone and are longer. Despite an increase in REM density, dream recall decreased the first months of CPAP and recovered 2 years later. Violent/highly anxious dreams disappeared with treatment. A dream recall decrease with CPAP is associated with normalization of sleep in OSAS patients. PMID:17118100

Carrasco, Eva; Santamaria, Joan; Iranzo, Alex; Pintor, Luis; De Pablo, Joan; Solanas, Antonio; Kumru, Hatice; Martínez-Rodríguez, José Enrique; Boget, Teresa

2006-12-01

321

Age Differences in the Association of Obstructive Sleep Apnea Risk with Cognition and Quality of Life  

PubMed Central

Summary Using a sample of 2925 stroke-free participants drawn from a national population-based study, we examined cross-sectional associations of obstructive sleep apnea risk (OSA) with cognition and quality of life and whether these vary with age, while controlling for demographics and co-morbidities. Included participants from the REasons for Geographic And Racial Differences in Stroke Study were aged 47-93. OSA risk was categorized as high or low based on responses to the Berlin Sleep Questionnaire. Cognitive function was assessed with standardized fluency and recall measures. Depressive symptoms were assessed with the four-item Center for Epidemiologic Studies Depression Scale. Health-related Quality of Life (HRQoL) was assessed with the Medical Outcomes Study Short Form-12 (SF-12). MANCOVA statistics were applied separately to the cognitive and quality of life dependent variables while accounting for potential confounders (demographics, co-morbidities). In fully adjusted models, those at high risk for OSA had significantly lower cognitive scores (Wilks’ Lambda = 0.996, F(3, 2786) = 3.31, p < .05) and lower quality of life (depressive symptoms and HRQoL) (Wilks’ Lambda = 0.989, F(3, 2786) = 10.02, p < .0001). However, some of the associations were age-dependent. Differences in cognition and quality of life between those at high and low obstructive sleep apnea risk were most pronounced during middle age, with attenuated effects after age 70. PMID:24033751

Addison-Brown, Kristin J.; Letter, Abraham J.; Yaggi, Klar; McClure, Leslie A.; Unverzagt, Frederick W.; Howard, Virginia J.; Lichtman, Judith H.; Wadley, Virginia G.

2013-01-01

322

The effect of uvulopalatopharyngoplasty with tonsillectomy in patients with obstructive sleep apnea.  

PubMed

In the current study, we evaluated the effectiveness of uvulopalatopharyngoplasty (UPPP) in treatment of patients with obstructive sleep apnea (OSA) syndrome. All patients were previously received medical treatment but their symptoms did not resolve. A prospective study was conducted in Shahid Sadoughi Hospital in Yazd, Iran. Several sleep indices were evaluated using polysomnography (PSG) in all patients before performing UPPP and tonsillectomy. All patients were visited 6 months after surgery and PSG was repeated to assess the efficacy of surgical intervention. A total of 48 patients were enrolled and underwent UPPP and tonsillectomy. Six months after surgery, significant improvements were observed in all indices of sleep (apnea-hypopnea index, respiratory distress index, arterial oxygen saturation, and snoring index). The score of daytime sleepiness (assessed by Epworth score) was also improved. According to the result of this study, using UPPP surgery in patients with OSA can cause symptoms improvement in 64 % of cases. It seems that Muller's maneuver test has assisted in briefly increasing success rate after surgery, though to prove this claim; other studies should be designed and performed in a randomized clinical trial. PMID:25621250

Baradaranfar, Mohammad Hossein; Edalatkhah, Mohsen; Dadgarnia, Mohammad Hossein; Atighechi, Saeid; Behniafard, Nasim; Mirvakili, Abbas; Halvani, Abolhassan; Baradaranfar, Amin; Emami Meybodi, Touhid

2015-03-01

323

Effects of Adenotonsillectomy on Neurocognitive Function in Pediatric Obstructive Sleep Apnea Syndrome  

PubMed Central

Obstructive sleep apnea syndrome (OSAS) in children does not only present with symptoms of sleep disturbances but also with associated symptoms such as growth failure, enuresis, academic learning difficulties, and behavioral problems, including attention deficit/hyperactivity disorder- (ADHD-) like symptoms. We evaluated neurocognitive functions before and after adenotonsillectomy in a patient with OSAS. An 11-year-old boy suspected of having ADHD with nocturnal enuresis was referred for evaluation. He was found to have adenotonsillar hypertrophy. Presence of snoring was evident only after detailed medical interview. Polysomnography confirmed the diagnosis of OSAS, which was subsequently treated by adenotonsillectomy. The apnea/hypopnea index decreased from 21.9 at baseline to 1.8 after surgery, and the frequency of enuresis fell from almost nightly to 2-3 times per month. Neurocognitive and behavioral assessment after the treatment of OSAS showed significant improvement in cognitive functions, especially attention capacity and considerable amelioration of behavioral problems including ADHD-like symptoms. As the most common cause of pediatric OSAS is adenotonsillar hypertrophy, medical interview and oropharyngeal examination should always be performed in children suspected of having ADHD. The necessity of sleep evaluation for children with ADHD-like symptoms was also emphasized. PMID:24971187

Horiuchi, Fumie; Oka, Yasunori; Komori, Kenjiro; Tokui, Yasumasa; Matsumoto, Teruhisa; Ueno, Shu-ichi

2014-01-01

324

Age differences in the association of obstructive sleep apnea risk with cognition and quality of life.  

PubMed

Using a sample of 2925 stroke-free participants drawn from a national population-based study, we examined cross-sectional associations of obstructive sleep apnea (OSA) risk with cognition and quality of life and whether these vary with age, while controlling for demographics and comorbidities. Included participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were aged 47-93 years. OSA risk was categorized as high or low based on responses to the Berlin Sleep Questionnaire. Cognitive function was assessed with standardized fluency and recall measures. Depressive symptoms were assessed with the four-item Center for Epidemiologic Studies Depression Scale. Health-related quality of life (HRQoL) was assessed with the Medical Outcomes Study Short Form-12 (SF-12). Multivariate analyses of covariance (mancova) statistics were applied separately to the cognitive and quality of life dependent variables while accounting for potential confounders (demographics, comorbidities). In fully adjusted models, those at high risk for OSA had significantly lower cognitive scores (Wilks' lambda = 0.996, F3,2786  = 3.31, P < 0.05) and lower quality of life [depressive symptoms and HRQoL] (Wilks' lambda = 0.989, F3,2786  = 10.02, P < 0.0001). However, some of the associations were age-dependent. Differences in cognition and quality of life between those at high and low obstructive sleep apnea risk were most pronounced during middle age, with attenuated effects after age 70 years. PMID:24033751

Addison-Brown, Kristin J; Letter, Abraham J; Yaggi, Klar; McClure, Leslie A; Unverzagt, Frederick W; Howard, Virginia J; Lichtman, Judith H; Wadley, Virginia G

2014-02-01

325

Obstructive Sleep Apnea Severity Is Associated with Left Ventricular Mass Independent of Other Cardiovascular Risk Factors in Morbid Obesity  

PubMed Central

Objective: To evaluate the relation between obstructive sleep apnea (OSA) and left ventricular mass (LVM) in morbid obesity and the influence of gender, menopausal status, anthropometry, body composition, hypertension, and other cardiovascular risk factors in this relationship. Design: Cross-sectional descriptive study. Methods: Polysomnographic and echocardiographic studies were performed in a cohort of 242 patients (86 men, 100 premenopausal (PreM) and 56 postmenopausal (PostM) women), with grade II obesity and above (BMI: 43.7 ± 0.4 kg/m2) to investigate OSA and LVM respectively. Anthropometry, body composition, glucose tolerance, and blood pressure were also recorded. Results: OSA to different degrees was diagnosed in 76.2% of the patients (n: 166), its prevalence being 90.9% (n: 70) for men, and 76% (n: 38) and 63.8% (n: 58) for PostM and PreM women, respectively (p < 0.01). LVM excess was greatest for PostM women (90.2%), followed by men (81.9%) and PreM females (69.6%) (p < 0.01). LVM values increased in accordance to OSA severity (absence, 193.7 ± 6.9 g; mild, 192.6 ± 7.8 g; moderate, 240.5 ± 12.5 g; severe, 273.6 ± 14.6 g; p < 0.01). LVM magnitude correlated with the menopausal state, age, central adiposity, hypertension (HT), type 2 diabetes (DM), desaturation index (DI), and apnea-hypopnea index (AHI) (r = 0.41; p < 0.01). The relationship between LVM and AHI persisted in the multivariate analysis (? = 0.25; p < 0.05) after adjusting for age, gender, menopausal state, BMI, waist circumference, neck circumference, DI, fasting plasma glucose, DM, and HT. But if tobacco habits are included, the statistical difference disappears (? = 0.22; p = 0.06). Conclusions: Morbid obesity is frequently associated with abnormal LVM, particularly in patients with OSA; this association is independent of HT, BMI, body composition, and other clinical factors, supporting a direct role of OSA on LVM in morbid obesity. This suggests that OSA and LVM might be taken as predictors of the cardiovascular risk in these patients. Citation: Pujante P; Abreu C; Moreno J; Barrero EA; Azcarate P; Campo A; Urrestarazu E; Silva C; Maria JG; Tebar J; Frühbeck G; Salvador J. Obstructive sleep apnea severity is associated with left ventricular mass independent of other cardiovascular risk factors in morbid obesity. J Clin Sleep Med 2013;9(11):1165-1171. PMID:24235898

Pujante, Pedro; Abreu, Cristina; Moreno, Jose; Barrero, Eduardo Alegria; Azcarate, Pedro; Campo, Arantxa; Urrestarazu, Elena; Silva, Camilo; Maria, Jesus Gil; Tebar, Javier; Frühbeck, Gema; Salvador, Javier

2013-01-01

326

A Systematic Review of the Association between Obstructive Sleep Apnea and Ventricular Arrhythmias  

PubMed Central

Introduction: Obstructive sleep apnea (OSA) is an independent risk factor for sudden cardiac death. The aim of this review was to study the relationship between OSA and ventricular arrhythmias. Methods: PubMed, Medline, and Cochrane databases were searched with MESH headings to find studies linking OSA and ventricular arrhythmias including ventricular ectopy, ventricular tachycardia (VT), and ventricular fibrillation (VF). Studies were graded by a scoring system, and an attempt was made to pool data. Results: There were no matched cohort or case control studies to study the association between OSA and ventricular arrhythmias. Given data heterogeneity, pooling and meta-analysis of data were not possible. An attempt was made to judge the quality of evidence and present a systematic review. Patients with OSA were noted to have higher odds of ventricular ectopy, and were at a higher risk for ventricular arrhythmias. Associations included higher QTc dispersion and HR variability. We did not, however, find any clear evidence for a direct correlation between increased apnea hypopnea index and increased VT or VF. Conclusions: Pooling and meta-analysis of studies linking OSA and ventricular arrhythmias were not possible due to heterogeneity of data. In a systemic review of studies, patients with OSA were noted to have higher odds of ventricular ectopy and arrhythmias. A single study showed that CPAP may help lower arrhythmogenicity; however, it was unclear if CPAP lowered the risk of VT. Further research should focus on studying the association of OSA and causes of sudden cardiac death, including ventricular arrhythmias. Citation: Raghuram A, Clay R, Kumbam A, Tereshchenko LG, Khan A. A systematic review of the association between obstructive sleep apnea and ventricular arrhythmias. J Clin Sleep Med 2014;10(10):1155-1160. PMID:25317099

Raghuram, Akhil; Clay, Ryan; Kumbam, Anusha; Tereshchenko, Larisa G.; Khan, Akram

2014-01-01

327

Catecholamines, Adiponectin, and Insulin Resistance as Measured by HOMA in Children with Obstructive Sleep Apnea  

PubMed Central

Introduction: Obstructive sleep apnea (OSA) has been implicated in the pathophysiology of metabolic syndrome. Its contribution to insulin resistance is complicated by obesity and puberty. We hypothesized that OSA is associated with worse insulin resistance and lower adiponectin after adjustment for obesity and puberty and that catecholamines might mediate these changes. Methods: Normal controls and children with suspected OSA were recruited and categorized as pubertal or prepubertal. Overnight polysomnography (PSG) was performed. Subjects were categorized as OSA for total apnea hypopnea index (Total-AHI) ? 1.5 events/h. Fasting blood glucose, insulin, adiponectin, and 24-hour urinary catecholamines were obtained. Homeostatic model assessment of insulin resistance (HOMA) was calculated. The independent effects of OSA upon HOMA, adiponectin, and urinary catecholamines following adjustment for body mass index (BMI) were determined. Results (median; min, max): Subjects (n = 98, 42F; 11 ± 4 years, 37 prepubertal) were generally overweight (BMI-Z = 2.1; ?3, 4.1) and had wide-ranging insulin sensitivities (HOMA = 2.7; 0.5, 27) and PSG parameters (Total-AHI = 1.6; 0, 185). The risks of elevated insulin (P = 0.04) and HOMA (P = 0.05) were higher in OSA vs non OSA obese pubertal children. Polysomnographic markers of OSA, including Total-AHI (P = 0.001, R2 = 0.32), were negatively associated with adiponectin in pubertal children. Total-AHI and oxygen desaturation were associated with higher urinary normetanephrine and norepinephrine. Conclusions: In obese pubertal children, OSA was associated with worse insulin resistance. Worsening OSA was associated with lower adiponectin and increasing urinary catecholamines. Whether OSA directly lowers adiponectin and aggravates a predisposition to insulin resistance is unknown, but these preliminary findings highlight the importance of further studying pediatric OSA. Citation: Kelly A; Dougherty S; Cucchiara A; Marcus CL; Brooks LJ. Catecholamines, adiponectin, and insulin resistance as measured by HOMA in children with obstructive sleep apnea. SLEEP 2010;33(9):1185-1191. PMID:20857865

Kelly, Andrea; Dougherty, Shayne; Cucchiara, Andrew; Marcus, Carole L.; Brooks, Lee J.

2010-01-01

328

Effects of obstructive sleep apnea on serum brain-derived neurotrophic factor protein, cortisol, and lipid levels  

Microsoft Academic Search

Objectives  Obstructive sleep apnea (OSA) is a sleep-disordered breathing leading to vascular endothelial cells dysfunction, cognitive\\u000a impairment, and abnormal lipid metabolism. serum brain-derived neurotrophic factor (BDNF) protein, cortisol, and lipid levels\\u000a in OSA were investigated.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  All middle-aged subjects including healthy individuals without signs and symptoms of apnea-hypopnea and ear nose throat (ENT)\\u000a outpatients were randomly recruited and screened by

Busarakumtragul Panaree; Mekseepralard Chantana; Sukhumsirichart Wasana; Neruntarat Chairat

329

A Pilot Study of CPAP Adherence Promotion by Peer Buddies with Sleep Apnea  

PubMed Central

Study Objectives: To evaluate patient ratings of the acceptability of a peer buddy system (PBS). To promote continuous positive airway pressure (CPAP) therapy adherence in patients with obstructive sleep apnea (OSA). To obtain preliminary data on the effectiveness of PBS on sleep-specific health-related quality of life and CPAP adherence. Design: Prospective, randomized, and controlled study. Setting: Academic Center. Participants: Thirty-nine patients with OSA and 13 patients with OSA who were experienced CPAP users. Interventions: Recently diagnosed patients with OSA were randomly assigned to either the PBS to promote CPAP adherence (intervention group) or usual care (control group). Measurements: Patient satisfaction, Functional Outcomes of Sleep Questionnaire (FOSQ), CPAP adherence, vigilance, self-efficacy, and patient activation were measured. Results: Ninety-one percent of the subjects rated the PBS as very satisfactory (68%) or satisfactory (23%). During the 90 days of therapy, weekly CPAP adherence was greater in the intervention than the usual care group (MANOVA; F = 2.29; p = 0.04). Patient satisfaction was positively correlated with CPAP adherence (R2 = 0.14; p = 0.02). We did not find any group differences for FOSQ, vigilance, self-efficacy, or patient activation in this pilot study. Conclusion: Our pilot study suggests that the PBS intervention is feasible and received high patient satisfaction ratings. CPAP adherence may be improved by peer-driven intervention, but a larger, adequately powered study is needed. Clinical Trial Information: ClinicalTrials.gov identifier: NCT01164683. Commentary: A commentary on this article appears in this issue on page 551. Citation: Parthasarathy S; Wendel C; Haynes PL; Atwood C; Kuna S. A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. J Clin Sleep Med 2013;9(6):543-550. PMID:23772186

Parthasarathy, Sairam; Wendel, Christopher; Haynes, Patricia L.; Atwood, Charles; Kuna, Samuel

2013-01-01

330

Determinants of Ventilatory Instability in Obstructive Sleep Apnea: Inherent or Acquired?  

PubMed Central

Study Objectives: Certain respiratory control characteristics determine whether patients with collapsible upper airway develop stable or unstable breathing during sleep, thereby influencing the severity of obstructive apnea (OSA). These include arousal threshold (TA), response to transient hypoxia and hypercapnia (Dynamic Response) and the increase in respiratory drive required for arousal-free airway opening (TER). We wished to determine whether these characteristics are inherent or are acquired during untreated OSA. Design: TA, Dynamic Response, and TER were measured in patients with severe OSA before and after treatment with continuous positive airway pressure (CPAP). Changes observed after treatment were deemed to have been acquired during untreated OSA. Setting: University-based sleep laboratory. Patients: 15 patients with severe OSA. Interventions: (1) 30-sec alterations in inspired gases during sleep on CPAP. (2) Brief dial-downs of CPAP (dial-downs) both during air breathing and when ventilation was increased to different levels. Measurements and Results: TA: the increase in ventilation associated with a 50% probability of arousal (TA50). Dynamic Response: the increase in ventilation on the 5th breath following breathing 3% CO2 in 11% to 15% O2. TER: the increase in ventilation prior to dial-downs that was associated with an arousal-free airway opening during dial-down. CPAP therapy (10.5 ± 4.3 months) resulted in marked reduction in Dynamic Response (131% ± 95% to 52% ± 34% baseline ventilation, P < 0.005), a decrease in TA50 (134% ± 78% to 86% ± 47% baseline ventilation, P < 0.05), and no change in TER. Conclusions: TER may be an inherent characteristic. Untreated OSA results in an increase in dynamic response to asphyxia and an increase in arousal threshold. Citation: Loewen A; Ostrowski M; Laprairie J; Atkar R; Gnitecki J; Hanly P; Younes M. Determinants of Ventilatory Instability in Obstructive Sleep Apnea: Inherent or Acquired? SLEEP 2009;32(10):1355-1365. PMID:19848364

Loewen, Andrea; Ostrowski, Michele; Laprairie, John; Atkar, Raj; Gnitecki, January; Hanly, Patrick; Younes, Magdy

2009-01-01

331

Effects of obstructive sleep apnea severity on serum lipid levels in Greek children with snoring  

Microsoft Academic Search

Background  Although obstructive sleep apnea (OSA) is related to dyslipidemia in adults, limited data are available regarding its effects\\u000a on serum lipids during childhood. Aim of this study was to assess the potential relationships between severity of OSA and\\u000a cholesterol or triglyceride levels in a cohort of Greek children.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Data from children with snoring who underwent polysomnography and complete serum lipids

Emmanouel I. Alexopoulos; Eleftheria Gletsou; Eleni Kostadima; Dimitrios Kaditis; Epameinondas Zakynthinos; Konstantinos Gourgoulianis; Athanasios Kaditis

332

Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea  

Microsoft Academic Search

Purpose  The interaction between moderate-to-severe obstructive sleep apnea (OSA) and cardiac arrhythmias, especially atrial fibrillation\\u000a (AF), is well known. We aimed to determine whether atrial electromechanical parameters assessed by tissue Doppler imaging\\u000a (TDI) would be affected in moderate-to-severe OSA, and detect the influential factors of atrial electromechanical parameters\\u000a in these patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods and results  Interatrial and intra-atrial electromechanical delay was measured by

Julide Yagmur; Ozkan Yetkin; Mehmet Cansel; Nusret Acikgoz; Necip Ermis; Yasin Karakus; Hakan Tasolar

333

Management of severe obstructive sleep apnea using mandibular advancement devices with auto continuous positive airway pressures  

PubMed Central

The use of continuous positive airway pressures (CPAP) is considered standard treatment of moderate to severe obstructive sleep apnea (OSA). Treatment of the disease poses a great challenge not only for its diagnostic purpose but also for its treatment part. In about 29-83% of the patients, treatment is difficult because of non-compliance resulting due to high pressures, air leaks and other related issues. In such situations, alternative methods of treatment need to be looked for so as to ascertain better management. Mandibular advancement devices along with CPAP may show better treatment outcome in specific situations.

Upadhyay, Rashmi; Dubey, Abhishek; Kant, Surya; Singh, Balendra Pratap

2015-01-01

334

Role of preoperative screening for adult patients for obstructive sleep apnea.  

PubMed

Obstructive sleep apnea (OSA) is a chronic disease with increasing prevalence. Underdiagnosed in the surgical population, OSA can reach a prevalence of up to 70% in bariatric surgery, and be associated with difficult airways and postoperative cardiopulmonary adverse events. Despite its association with escalation of care, increased health care resource utilization, and length of hospital stay, < 25% of health care institutions in the United States have OSA perioperative protocols to improve patient safety. This is explained in part by a lack of studies that support a widely accepted systematic approach to preoperative screening and risk stratification. This review evaluates the role of preoperative screening tools for adult patients with suspected OSA. PMID:25485922

Selim, Bernardo J; Surani, Salim R; Ramar, Kannan

2014-12-01

335

USING FEEDBACK FROM NATURALISTIC DRIVING TO IMPROVE TREATMENT ADHERENCE IN DRIVERS WITH OBSTRUCTIVE SLEEP APNEA  

PubMed Central

Summary: We are studying the effects of individualized feedback upon adherence with therapy (CPAP) in ongoing research aimed at improving driving safety in at-risk individuals with obstructive sleep apnea (OSA). The feedback includes specific samples of the individual’s own naturalistic driving record, both alert and drowsy, and record of CPAP adherence. We report on this methodology, provide data examples of CPAP usage, and show preliminary data on the results in the first eleven drivers who received this intervention. PMID:24525915

Krone, J. Tucker; Dawson, Jeffrey D.; Anderson, Steven W.; Aksan, Nazan S.; Tippin, Jon; Rizzo, Matthew

2014-01-01

336

[Obstructive sleep apnea syndrome in the setting of Gorlin-Goltz syndrome].  

PubMed

Goltz-Gorlin syndrome is a rare autosomal dominant hereditary disease associated with a high rate of spontaneous mutation. Diagnosis is based on clinically defined major and minor criteria. The disease is caused by a gene mutation locating to chromosome 9q22-31. We report on a young Goltz-Gorlin syndrome patient with obstructive sleep apnea syndrome. Due to intolerance to continuous positive airway pressure (CPAP) therapy and in order to avoid a tracheotomy, we opted for an alternative therapy comprising interdisciplinary multi-level surgery. PMID:23463414

Grundig, H; Sinikovic, B; Günther, J; Jungehülsing, M

2013-09-01

337

Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae.  

PubMed

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions. PMID:21189956

Chang, Sun Jung; Chae, Kyu Young

2010-10-01

338

A wearable, mobile phone-based respiration monitoring system for sleep apnea syndrome detection.  

PubMed

A new wearable respiration monitoring system has been developed for non-invasive detection of sleep apnea syndrome. The system, which is attached to a shirt, consists of a piezoelectric sensor, a low-power 8-bit single chip microcontroller, EEPROM and a 2.4 GHz low-power transmitting mobile phone (PHS). The piezoelectric sensor, whose electrical polarization voltage is produced by body movements, is installed inside the shirt and closely contacts the patient's chest. The low frequency components of body movements recorded by the sensor are mainly generated by respiration. The microcontroller sequentially stores the movement signal to the EEPROM for 5 minutes and detects, by time-frequency analysis, whether the patient has breathed during that time. When the patient is apneic for 10 sseconds, the microcontroller sends the recorded respiration waveform during and one minute before and after the apnea directly to the hospital server computer via the mobile phone. The server computer then creates apnea "filings" automatically for every patient. The system can be used at home and be self-applied by patients. Moreover, the system does not require any extra equipment such as a personal computer, PDA, or Internet connection. PMID:15850120

Ishida, Ryoichi; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Ninomiya, Ishio; Sada, Kouji; Hamada, Shingo; Hahn, Allen W; Caldwell, W Morton

2005-01-01

339

Obstructive Sleep Apnea and Obesity are Associated With Reduced GPR 120 Plasma Levels in Children  

PubMed Central

Background: Obstructive sleep apnea (OSA) is a common health problem, particularly in obese children, in whom a vicious cycle of obesity and OSA interdependencies promotes increased food intake. G protein-coupled receptor 120 (GPR 120) is a long-chain free fatty acid (FFA) receptor that plays an important role in energy homeostasis, and protects against insulin resistance and systemic inflammation. We hypothesized that GPR 120 levels would be reduced in children with OSA, particularly among obese children. Study Design: Cross-sectional prospectively recruited cohort. Setting: Academic pediatric sleep program. Methods: Two hundred twenty-six children (mean age: 7.0 ± 2.1 y) underwent overnight polysomnographic evaluation and a fasting blood draw the morning after the sleep study. In addition to lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hsCRP) assays, monocyte GPR 120 expression, and plasma GPR 120 levels were assessed using quantitative polymerase chain reaction and enzyme-linked immunosorbent assay kits. Results: Obese children and those with OSA had significantly lower GPR 120 monocyte expression and plasma GPR 120 levels. Furthermore, when both obesity and OSA were present, GPR 120 levels were lowest. Linear associations emerged between GPR 120 plasma levels and body mass index (BMI) z score, as well as with apnea-hypopnea index (AHI), saturation of peripheral oxygen (SpO2) nadir, and respiratory arousal index (RAI), with RAI remaining statistically significant when controlling for age, ethnicity, sex, and BMI z score (P < 0.001). Similarly, HOMA-IR was significantly associated with GPR 120 levels, but neither low density lipoprotein nor high density lipoprotein cholesterol or hsCRP levels exhibited significant correlations. Conclusions: G protein-coupled receptor 120 (GPR 120) levels are reduced in pediatric OSA and obesity (particularly when both are present) and may play a role in modulating the degree of insulin resistance. The short- and long-term significance of reduced GPR 120 relative to food intake and glycemic deregulation remains undefined. Citation: Gozal D, Kheirandish-Gozal L, Carreras A, Khalyfa A, Peris E. Obstructive sleep apnea and obesity are associated with reduced GPR 120 plasma levels in children. SLEEP 2014;37(5):935-941. PMID:24790272

Gozal, David; Kheirandish-Gozal, Leila; Carreras, Alba; Khalyfa, Abdelnaby; Peris, Eduard

2014-01-01

340

A simplified method for determining phenotypic traits in patients with obstructive sleep apnea  

PubMed Central

We previously published a method for measuring several physiological traits causing obstructive sleep apnea (OSA). The method, however, had a relatively low success rate (76%) and required mathematical modeling, potentially limiting its application. This paper presents a substantial revision of that technique. To make the measurements, continuous positive airway pressure (CPAP) was manipulated during sleep to quantify 1) eupneic ventilatory demand, 2) the level of ventilation at which arousals begin to occur, 3) ventilation off CPAP (nasal pressure = 0 cmH2O) when the pharyngeal muscles are activated during sleep, and 4) ventilation off CPAP when the pharyngeal muscles are relatively passive. These traits could be determined in all 13 participants (100% success rate). There was substantial intersubject variability in the reduction in ventilation that individuals could tolerate before having arousals (difference between ventilations #1 and #2 ranged from 0.7 to 2.9 liters/min) and in the amount of ventilatory compensation that individuals could generate (difference between ventilations #3 and #4 ranged from ?0.5 to 5.5 liters/min). Importantly, the measurements accurately reflected clinical metrics; the difference between ventilations #2 and #3, a measure of the gap that must be overcome to achieve stable breathing during sleep, correlated with the apnea-hypopnea index (r = 0.9, P < 0.001). An additional procedure was added to the technique to measure loop gain (sensitivity of the ventilatory control system), which allowed arousal threshold and upper airway gain (response of the upper airway to increasing ventilatory drive) to be quantified as well. Of note, the traits were generally repeatable when measured on a second night in 5 individuals. This technique is a relatively simple way of defining mechanisms underlying OSA and could potentially be used in a clinical setting to individualize therapy. PMID:23349453

Edwards, Bradley A.; Sands, Scott A.; Owens, Robert L.; Nemati, Shamim; Butler, James; Passaglia, Chris L.; Jackson, Andrew C.; Malhotra, Atul; White, David P.

2013-01-01

341

Treatment of Obstructive Sleep Apnea Syndrome with Nasal Positive Airway Pressure Improves Golf Performance  

PubMed Central

Study Objectives: Obstructive sleep apnea syndrome (OSAS) is associated with impairment of cognitive function, and improvement is often noted with treatment. Golf is a sport that requires a range of cognitive skills. We evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS. Methods: Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). Twelve subjects with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry. After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated. Results: The control subjects demonstrated no significant change in HI, ESS, or SQ during this study, while the OSAS group demonstrated a significant drop in average HI (11.3%, p = 0.01), ESS, (p = 0.01), and SQ (p = 0.003). Among the more skilled golfers (defined as HI ? 12), the average HI dropped by an even greater degree (31.5%). Average utilization of PAP was 91.4% based on data card reporting. Conclusions: Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence. Commentary: A commentary on this article appears in this issue on page 1243. Citation: Benton ML; Friedman NS. Treatment of obstructive sleep apnea syndrome with nasal positive airway pressure improves golf performance. J Clin Sleep Med 2013;9(12):1237-1242. PMID:24340283

Benton, Marc L.; Friedman, Neil S.

2013-01-01

342

Serum Angiotensin Converting Enzyme and the Obstructive Sleep Apnea Hypopnea Syndrome  

PubMed Central

Study Objectives: We wanted to see if the obstructive sleep apnea hypopnea syndrome (OSAHS) causes hypertension and endothelial dysfunction through activation of the angiotensin-converting enzyme (ACE). Methods: A cross-sectional followed by a prospective, interventional study in a sleep disordered breathing clinic in a UK Hospital. We measured baseline serum ACE activity and ACE allele frequencies in 26 consecutive (untreated) OSAHS patients, 26 consecutive Sleepy Snorers, and 26 healthy (non-sleepy) controls. The OSAHS and Sleepy Snorers had serum ACE repeated after 6 months, with the OSAHS group receiving CPAP in the interim. Results: There was no difference in baseline mean serum ACE among OSAHS (33 IU/L), sleepy snorers (36 IU/L), and healthy controls (32 IU/L), p = 0.63. There was no difference in serum ACE activity between OSAHS and sleepy snorers after 6 months (p = 0.9) and no change in serum ACE from baseline in either group. In particular, there was no change in ACE activity in the OSAHS group on an intention to treat basis or when limiting analysis was limited to only “good” CPAP users (n = 16, p = 0.68), despite significant improvements in their Epworth scores and blood pressure and normalization of the 4% dip-rate. Conclusions: Changes in serum ACE activity do not occur in OSAHS; therefore it is unlikely to be associated with the hypertension and other cardiovascular dysfunction often reported in OSAHS. Citation: Benjamin JA; Moller M; Ebden P; Bartle I; Lewis KE. Serum angiotensin converting enzyme and the obstructive sleep apnea hypopnea syndrome. J Clin Sleep Med 2008;4(4):325–331. PMID:18763423

Benjamin, John Amit; Moller, Maria; Ebden, Philip; Bartle, Ionah; Lewis, Keir E.

2008-01-01

343

Time-on-task decrements in "steer clear" performance of patients with sleep apnea and narcolepsy  

NASA Technical Reports Server (NTRS)

Loss of attention with time-on-task reflects the increasing instability of the waking state during performance in experimentally induced sleepiness. To determine whether patients with disorders of excessive sleepiness also displayed time-on-task decrements indicative of wake state instability, visual sustained attention performance on "Steer Clear," a computerized simple RT driving simulation task, was compared among 31 patients with untreated sleep apnea, 16 patients with narcolepsy, and 14 healthy control subjects. Vigilance decrement functions were generated by analyzing the number of collisions in each of six four-minute periods of Steer Clear task performance in a mixed-model analysis of variance and linear regression equations. As expected, patients had more Steer Clear collisions than control subjects (p=0.006). However, the inter-subject variability in errors among the narcoleptic patients was four-fold that of the apnea patients, and 100-fold that of the controls volunteers; the variance in errors among untreated apnea patients was 27-times that of controls. The results of transformed collision data revealed main effects for group (p=0.006), time-on-task (p=0.001), and a significant interaction (p=0.022). Control subjects showed no clear evidence of increasing collision errors with time-on-task (adjusted R2=0.22), while apnea patients showed a trend toward vigilance decrement (adjusted R2=0.42, p=0.097), and narcolepsy patients evidenced a robust linear vigilance decrement (adjusted R2=0.87, p=0.004). The association of disorders of excessive somnolence with escalating time-on-task decrements makes it imperative that when assessment of neurobehavioral performance is conducted in patients, it involves task durations and analyses that will evaluate the underlying vulnerability of potentially sleepy patients to decrements over time in tasks that require sustained attention and timely responses, both of which are key components in safe driving performance.

Findley, L. J.; Suratt, P. M.; Dinges, D. F.

1999-01-01

344

Relationship between growth of facial morphology and chronologic age in preschool children with obstructive sleep apnea  

PubMed Central

Background The purpose of this study was to evaluate the relationship between facial morphology using cephalometry and chronologic age in preschool children with obstructive sleep apnea (OSA). Materials and Methods From a group of lateral cephalometric radiographs taken of 35 children with OSA for diagnostic purposes, 15 were selected for the present investigation based on head position. The subjects consisted of preschool children with both OSA and primary dentition, all of them with a lowest documented SpO2 <90% and a lowest 0 sleep apnea in children may be associated with growth disturbances of the nasal floor and corpus length.

Kawashima, Shigeto; Ueda, Koichiro; Shinohara, Mitsuyo; Mano, Mikiko; Kanegae, Haruhide; Namaki, Shunsuke

2012-01-01

345

Simulating obstructive sleep apnea patients' oxygenation characteristics into a mouse model of cyclical intermittent hypoxia.  

PubMed

Mouse models of cyclical intermittent hypoxia (CIH) are used to study the consequences of both hypoxia and oxidative stress in obstructive sleep apnea (OSA). Whether or not a mouse model of CIH that simulates OSA patients' oxygenation characteristics would translate into improved patient care remains unanswered. First we identified oxygenation characteristics using the desaturation and resaturation time in 47 OSA subjects from the Molecular Signatures of Obstructive Sleep Apnea Cohort (MSOSA). We observe that a cycle of intermittent hypoxia is not sinusoidal; specifically, desaturation time increases in an almost linear relationship to the degree of hypoxia (nadir), whereas resaturation time is somewhat constant (?15 s), irrespective of the nadir. Second, we modified the Hycon mouse model of CIH to accommodate a 15-s resaturation time. Using this modified CIH model, we explored whether a short resaturation schedule (15 s), which includes the characteristics of OSA patients, had a different effect on levels of oxidative stress (i.e., urinary 8,12-iso-iPF2?-VI levels) compared with sham and a long resaturation schedule (90 s), a schedule that is not uncommon in rodent models of CIH. Results suggest that shorter resaturation time may result in a higher level of 8,12-iso-iPF2?-VI compared with long resaturation or sham conditions. Therefore, simulating the rodent model of CIH to reflect this and other OSA patients' oxygenation characteristics may be worthy of consideration to better understand the effects of hypoxia, oxidative stress, and their interactions. PMID:25429097

Lim, Diane C; Brady, Daniel C; Po, Pengse; Chuang, Li Pang; Marcondes, Laise; Kim, Emily Y; Keenan, Brendan T; Guo, Xiaofeng; Maislin, Greg; Galante, Raymond J; Pack, Allan I

2015-03-01

346

Nitric oxide metabolites and erythrocyte deformability in a group of subjects with obstructive sleep apnea syndrome.  

PubMed

Our aim was to evaluate nitric oxide metabolites (nitrite and nitrate), expressed as NOx, and erythrocyte deformability, expressed as elongation index, in a group of subjects with obstructive sleep apnea syndrome (OSAS). We enrolled 48 subjects (36 men and 12 women; mean age 50.3 ± 14.68 yrs) with OSAS diagnosed after a 1-night cardiorespiratory sleep study. OSAS severity was assessed evaluating the apnea/hypopnea index (AHI) and subjects were subdivided in two subgroups: Low (L = AHI <30) and High (H = AHI >30). NOx was examined converting nitrate into nitrite with a nitrate reductase and then assessing nitrite with spectrophotometry after the addition of Griess reagent. The elongation index was obtained using the diffractometer Rheodyn SSD of Myrenne at shear stresses of 30 and 60 Pa and it was expressed as elongation index (EI). We found no difference in NOx among the entire group of OSAS subjects and normal controls, while we observed a NOx decrease in the H subgroup in comparison with L subgroup, but not in comparison with normal controls. We noted a significant decrease in EI at each shear stress in the entire group and also in the two subgroups in comparison with controls. The decrease in NO bioavailability and in erythrocyte deformability might contribute to explain the increased cardiovascular risk in OSAS subjects. PMID:24509541

Canino, Baldassare; Hopps, Eugenia; Calandrino, Vincenzo; Montana, Maria; Lo Presti, Rosalia; Caimi, Gregorio

2015-01-01

347

Severe nocturnal cardiac arrhythmias caused by sleep apnea-induced hypoxemia in males  

PubMed Central

Nocturnal cardiac arrhythmias (NCA) were analyzed in patients with sleep apnea/hypopnea syndrome (SAHS) and controls. Occurrence and severity of NCA were compared in 33 SAHS patients and 16 control subjects, matched for cardiovascular risk factors. Continuous overnight polysomnography provided ECG, respiratory and sleep parameters for a comparative analysis. Various types and severity of NCA were detected already in moderate SAHS (apnea/hypopnea index = 26 ± 15.6/h), reflecting the respiratory and atherosclerotic changes. Moderately severe arrhythmias, represented with benign and 2 complex types were caused by hypoxemia characterized by AHI, minimal SaO2, and lower values after desaturation. Three-time higher prevalence of complex arrhythmias in SAHS patients was not significantly different by usual statistical comparison, likely due to a low number of controls and a joint occurrence of various types and complex severity of arrhythmias in some patients. Therefore, a complex assessment of different types and varying severity of arrhythmias would require a scale specifically constructed for their evaluation. PMID:21147650

2010-01-01

348

Hypomyelination, memory impairment, and blood-brain barrier permeability in a model of sleep apnea.  

PubMed

We investigated the effect of intermittent hypoxia, mimicking sleep apnea, on axonal integrity, blood-brain barrier permeability, and cognitive function of mice. Forty-seven C57BL mice were exposed to intermittent or sham hypoxia, alternating 30s of progressive hypoxia and 30s of reoxigenation, during 8h/day. The axonal integrity in cerebellum was evaluated by transmission electron microscopy. Short- and long-term memories were assessed by novel object recognition test. The levels of endothelin-1 were measured by ELISA. Blood-brain barrier permeability was quantified by Evans Blue dye. After 14 days, animals exposed to intermittent hypoxia showed hypomyelination in cerebellum white matter and higher serum levels of endothelin-1. The short and long-term memories in novel object recognition test was impaired in the group exposed to intermittent hypoxia as compared to controls. Blood-brain barrier permeability was similar between the groups. These results indicated that hypomyelination and impairment of short- and long-term working memories occurred in C57BL mice after 14 days of intermittent hypoxia mimicking sleep apnea. PMID:25482664

Kim, Lenise Jihe; Martinez, Denis; Fiori, Cintia Zappe; Baronio, Diego; Kretzmann, Nélson Alexandre; Barros, Helena Maria Tannhauser

2015-02-01

349

Short-Term Memory Performances during Sustained Wakefulness in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome  

ERIC Educational Resources Information Center

Both working and immediate memories were assessed every 4 h by specific short-term memory tasks over sustained wakefulness in 12 patients with obstructive sleep apnea and hypopnea syndrome (OSAHS) and 10 healthy controls. Results indicated that OSAHS patients exhibited lower working memory performances than controls on both backward digit span and…

Greneche, Jerome; Krieger, Jean; Bertrand, Frederic; Erhardt, Christine; Maumy, Myriam; Tassi, Patricia

2011-01-01

350

Sleep apnea predicts distinct alterations in glucose homeostasis and biomarkers in obese adults with normal and impaired glucose metabolism  

Microsoft Academic Search

BACKGROUND: Notwithstanding previous studies supporting independent associations between obstructive sleep apnea (OSA) and prevalence of diabetes, the underlying pathogenesis of impaired glucose regulation in OSA remains unclear. We explored mechanisms linking OSA with prediabetes\\/diabetes and associated biomarker profiles. We hypothesized that OSA is associated with distinct alterations in glucose homeostasis and biomarker profiles in subjects with normal (NGM) and impaired

Maria Pallayova; Kimberley E Steele; Thomas H Magnuson; Michael A Schweitzer; Nathan R Hill; Shannon Bevans-Fonti; Alan R Schwartz

2010-01-01

351

Obstructive Sleep Apnea Is Frequent in Patients with Hypertensive Intracerebral Hemorrhage and Is Related to Perihematoma Edema  

Microsoft Academic Search

Background: Obstructive sleep apnea (OSA) is related to increased systemic inflammation and arterial hypertension. We hypothesize that OSA is frequent in patients with acute hypertensive intracerebral hemorrhage (ICH) and is related to the perihematoma edema. Methods: Thirty-two non-comatose patients with a hypertensive ICH underwent polysomnography in the acute phase. Perihematoma edema volume was measured on CT scans at admission, after

Octavio M. Pontes-Neto; Regina M. F. Fernandes; Heidi H. Sander; Larissa A. T. da Silva; Débora C. Mariano; Fernando Nobre; Gustavo Simão; Draulio B. de Araujo; Antonio C. dos Santos; João P. Leite

2010-01-01

352

A new algorithm for detecting central apnea in neonates.  

PubMed

Apnea of prematurity is an important and common clinical problem, and is often the rate-limiting process in NICU discharge. Accurate detection of episodes of clinically important neonatal apnea using existing chest impedance (CI) monitoring is a clinical imperative. The technique relies on changes in impedance as the lungs fill with air, a high impedance substance. A potential confounder, however, is blood coursing through the heart. Thus, the cardiac signal during apnea might be mistaken for breathing. We report here a new filter to remove the cardiac signal from the CI that employs a novel resampling technique optimally suited to remove the heart rate signal, allowing improved apnea detection. We also develop an apnea detection method that employs the CI after cardiac filtering. The method has been applied to a large database of physiological signals, and we prove that, compared to the presently used monitors, the new method gives substantial improvement in apnea detection. PMID:22156193

Lee, Hoshik; Rusin, Craig G; Lake, Douglas E; Clark, Matthew T; Guin, Lauren; Smoot, Terri J; Paget-Brown, Alix O; Vergales, Brooke D; Kattwinkel, John; Moorman, J Randall; Delos, John B

2012-01-01

353

Trends in Outpatient Visits for Insomnia, Sleep Apnea, and Prescriptions for Sleep Medications among US Adults: Findings from the National Ambulatory Medical Care Survey 1999-2010  

PubMed Central

Study Objective: To examine recent national trends in outpatient visits for sleep related difficulties in the United States and prescriptions for sleep medications. Design: Trend analysis. Setting: Data from the National Ambulatory Medical Care Survey from 1999 to 2010. Participants: Patients age 20 y or older. Measurements and Results: The number of office visits with insomnia as the stated reason for visit increased from 4.9 million visits in 1999 to 5.5 million visits in 2010 (13% increase), whereas the number with any sleep disturbance ranged from 6,394,000 visits in 1999 to 8,237,000 visits in 2010 (29% increase). The number of office visits for which a diagnosis of sleep apnea was recorded increased from 1.1 million visits in 1999 to 5.8 million visits in 2010 (442% increase), whereas the number of office visits for which any sleep related diagnosis was recorded ranged from 3.3 million visits in 1999 to 12.1 million visits in 2010 (266% increase). The number of prescriptions for any sleep medication ranged from 5.3 in 1999 to 20.8 million in 2010 (293% increase). Strong increases in the percentage of office visits resulting in a prescription for nonbenzodiazepine sleep medications (?350%), benzodiazepine receptor agonists (?430%), and any sleep medication (?200%) were noted. Conclusions: Striking increases in the number and percentage of office visits for sleep related problems and in the number and percentage of office visits accompanied by a prescription for a sleep medication occurred from 1999-2010. Citation: Ford ES, Wheaton AG, Cunningham TJ, Giles WH, Chapman DP, Croft JB. Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care Survey 1999-2010. SLEEP 2014;37(8):1283-1293. PMID:25083008

Ford, Earl S.; Wheaton, Anne G.; Cunningham, Timothy J.; Giles, Wayne H.; Chapman, Daniel P.; Croft, Janet B.

2014-01-01

354

A prospective photographic study of the ocular fundus in obstructive sleep apnea  

PubMed Central

Background The prevalence of optic nerve and retinal vascular changes within the obstructive sleep apnea (OSA) population are not well known, although it has been postulated that optic nerve ischemic changes and findings related to elevated intracranial pressure may be more common in OSA patients. We prospectively evaluated the ocular fundus in unselected patients undergoing overnight diagnostic polysomnography (PSG). Methods Demographic data, past medical/ocular history and non-mydriatic fundus photographs were prospectively collected in patients undergoing polysomnography at our institution and reviewed for the presence of optic disc edema for which our study was appropriately powered a priori. Retinal vascular changes were also evaluated. OSA was defined using measures of both sleep disordered breathing and hypoxia. Results Of 250 patients evaluated in the sleep center, fundus photographs were performed on 215 patients, among whom 127 patients (59%) had an apnea/hypopnea index (AHI) ?15 events per hour, including 36 with severe OSA. Those with AHI<15 served as the comparison group. None of the patients had optic disc edema (95%CI:0-3%). There was no difference in rates of glaucomatous appearance or pallor of the optic disc among the groups. Retinal arteriolar changes were more common in severe OSA patients (OR: 1.09 per 5 unit increase in AHI, 95%CI: 1.02-1.16; p=0.01), even after controlling for mean arterial blood pressure. Conclusions We did not find an increased prevalence of optic disc edema or other optic neuropathies in our OSA population. However, retinal vascular changes were more common in patients with severe OSA, independent of blood pressure. PMID:23736744

Fraser, Clare L.; Bliwise, Donald L.; Newman, Nancy J.; Lamirel, Cédric; Collop, Nancy A.; Rye, David B.; Trotti, Lynn M.; Biousse, Valérie; Bruce, Beau B.

2013-01-01

355

Prader Willi Syndrome and Obstructive Sleep Apnea: Co-occurrence in the Pediatric Population  

PubMed Central

Background: A high prevalence of obstructive sleep apnea (OSA) occurs in children with Prader-Willi syndrome (PWS). Yet, due in part to the relatively small samples previously used, the prevalence of OSA has varied greatly across studies. It is also unclear if factors such as age, gender, body mass index (BMI), or type of genetic imprinting are associated with increased risk for OSA among children with PWS. Objectives: To evaluate the (a) prevalence of OSA, as well as narcolepsy, in pediatric populations diagnosed with PWS; (b) effects of age, gender, body mass index, and genetic imprinting on OSA severity; and (c) efficacy of adenotonsillectomy (AT) for decreasing OSA severity in this population. Methods: All studies assessing OSA among children with PWS through August 2013 were identified using the PubMed/Medline, Psych Info, Cochrane library, and Google Scholar data bases. Results: Fourteen studies of children diagnosed with PWS and who were assessed for OSA using polysomnography (PSG) met inclusion criteria (n = 224 children). The prevalence of OSA across studies was 79.91% (n = 179/224). Among youths with OSA, 53.07% had mild OSA, 22.35% moderate OSA, and 24.58% severe OSA. Narcolepsy was found to occur in 35.71% of children with PWS. Adenotonsillectomy was associated with improvement in OSA for most children with PWS. However, residual OSA was present in the majority of cases post-surgery. Conclusion: This study confirms the high prevalence of OSA and narcolepsy among children with PWS. Screening for OSA and narcolepsy among children with PWS is recommended. In addition, while adenotonsillectomy was effective in reducing OSA for some children, alternative treatments may need to be considered, given the only moderate response rate. Citation: Sedky K; Bennett DS; Pumariega A. Prader Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. J Clin Sleep Med 2014;10(4):403-409. PMID:24733986

Sedky, Karim; Bennett, David S.; Pumariega, Andres

2014-01-01

356

Obstructive Sleep Apnea, Obesity, and the Development of Acute Respiratory Distress Syndrome  

PubMed Central

Background: Obstructive sleep apnea (OSA) may increase the risk of respiratory complications and acute respiratory distress syndrome (ARDS) among surgical patients. OSA is more prevalent among obese individuals; obesity can predispose to ARDS. Hypothesis: It is unclear whether OSA independently contributes towards the risk of ARDS among hospitalized patients. Methods: This is a pre-planned retrospective subgroup analysis of the prospectively identified cohort of 5,584 patients across 22 hospitals with at least one risk factor for ARDS at the time of hospitalization from a trial by the US Critical Illness and Injury Trials Group designed to validate the Lung Injury Prediction Score. A total of 252 patients (4.5%) had a diagnosis of OSA at the time of hospitalization; of those, 66% were obese. Following multivariate adjustment in the logistic regression model, there was no significant relationship between OSA and development of ARDS (OR = 0.65, 95%CI = 0.32-1.22). However, body mass index (BMI) was associated with subsequent ARDS development (OR = 1.02, 95%CI = 1.00-1.04, p = 0.03). Neither OSA nor BMI affected mechanical ventilation requirement or mortality. Conclusions: Prior diagnosis of OSA did not independently affect development of ARDS among patients with at least one predisposing condition, nor the need for mechanical ventilation or hospital mortality. Obesity appeared to independently increase the risk of ARDS. Citation: Karnatovskaia LV, Lee AS, Bender SP, Talmor D, Festic E. Obstructive sleep apnea, obesity, and the development of acute respiratory distress syndrome. J Clin Sleep Med 2014;10(6):657-662. PMID:24932146

Karnatovskaia, Lioudmila V.; Lee, Augustine S.; Bender, S. Patrick; Talmor, Daniel; Festic, Emir

2014-01-01

357

A systematic review of the effects of sedatives and anesthetics in patients with obstructive sleep apnea  

PubMed Central

The objective of this review is to determine the effects of perioperative sedatives and anesthetics in surgical patients with obstructive sleep apnea (OSA) on respiratory events, medication requirements, hemodynamics, pain, emergence, and hospital stay. We searched The Cochrane CENTRAL Register of Controlled Trials, Medline, Embase, and Cochrane Database of Systematic Reviews from 1950 to June 2010 for relevant articles. All prospective and retrospective studies were eligible for inclusion if the effects of perioperative administration of sedation and anesthetics on medication requirements, pain, emergence, hemodynamics, respiratory events, and length of hospital stay in OSA patients were reported. The search strategy yielded 18 studies of 1467 patients. Of these, 456 patients were documented as having OSA. Few adverse respiratory effects were reported. Eight out of 700 (1.14%) patients undergoing middle ear surgery with midazolam and fentanyl had impaired upper airway patency and were retrospectively diagnosed as having OSA by polysomnography. Also, intraoperative snoring causing uvular edema in the postoperative period was described in an OSA patient undergoing upper limb surgery when propofol was administered with midazolam and fentanyl for sedation. A decrease in oxygen saturation in the postoperative period was described with propofol and isoflurane in 21 OSA patients undergoing uvulo-palato-pharyngoplasty and tonsillectomy surgery (P<0.05). Perioperative alpha 2 agonists were shown to decrease the use of anesthetics (P<0.05), analgesics (P=0.008) and anti-hypertensives (P<0.001) in OSA patients. Contradictory reports regarding emergence occurred with intraoperative dexmedetomidine. Intraoperative opioids decreased the analgesic consumption (P=0.03) and pain scores (P<0.05) in the postoperative period. There was limited data on the length of hospital stay. There were few adverse effects reported when patients with known OSA underwent elective surgery with the currently available sedatives and anesthetics. Adverse events were reported with midazolam. However, the quality and number of patients in the studies were limited. There is a need for further trials with large numbers and uniform reporting of outcomes. PMID:22096275

Ankichetty, Saravanan; Wong, Jean; Chung, Frances

2011-01-01

358

Effect of Treatment of Obstructive Sleep Apnea on Depressive Symptoms: Systematic Review and Meta-Analysis  

PubMed Central

Background Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and decreased quality of life. Treatment with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is effective for many symptoms of OSA. However, it remains controversial whether treatment with CPAP or MAD also improves depressive symptoms. Methods and Findings We performed a systematic review and meta-analysis of randomized controlled trials that examined the effect of CPAP or MADs on depressive symptoms in patients with OSA. We searched Medline, EMBASE, the Cochrane Central Registry of Controlled Trials, and PsycINFO from the inception of the databases until August 15, 2014, for relevant articles. In a random effects meta-analysis of 19 identified trials, CPAP treatment resulted in an improvement in depressive symptoms compared to control, but with significant heterogeneity between trials (Q statistic, p<0.001; I2?=?71.3%, 95% CI: 54%, 82%). CPAP treatment resulted in significantly greater improvement in depressive symptoms in the two trials with a higher burden of depression at baseline (meta-regression, p<0.001). The pooled standardized mean difference (SMD) in depressive symptoms with CPAP treatment in these two trial populations with baseline depression was 2.004 (95% CI: 1.387, 2.621), compared to 0.197 (95% CI: 0.059, 0.334) for 15 trials of populations without depression at baseline. Pooled estimates of the treatment effect of CPAP were greater in parallel arm trials than in crossover trials (meta-regression, p?=?0.076). Random effects meta-analysis of five trials of MADs showed a significant improvement in depressive symptoms with MADs versus controls: SMD?=?0.214 (95% CI: 0.026, 0.401) without significant heterogeneity (I2?=?0%, 95% CI: 0%, 79%). Studies were limited by the use of depressive symptom scales that have not been validated specifically in people with OSA. Conclusions CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression. The efficacy of CPAP and MADs compared to standard therapies for depression is unknown. Please see later in the article for the Editors' Summary PMID:25423175

Heitman, Steven J.; Tsai, Willis H.; Wang, JianLi; James, Matthew T.

2014-01-01

359

The cerebellum and sleep.  

PubMed

The importance of the cerebellum in sleep disorders, and vice versa, is only beginning to be understood. Advanced neuroimaging modalities have revealed cerebellar changes in both common and rare sleep disorders. Sleep disorders in those with genetic cerebellar disease, such as spinocerebellar ataxia, Friedreich ataxia, Joubert syndrome, and ataxia-telangiectasia, include excessive daytime sleepiness, restless legs syndrome, periodic limb movements of sleep, obstructive apnea, central apnea, and rapid eye movement behavior disorder. Sleep medicine is an important and under-recognized part of the neurologic evaluation in those with cerebellar disease. PMID:25439287

DelRosso, Lourdes M; Hoque, Romy

2014-11-01

360

The role of obesity and obstructive sleep apnea in the pathogenesis and treatment of resistant hypertension.  

PubMed

The incidence of resistant hypertension, obesity, and obstructive sleep apnea (OSA), three highly prevalent conditions in the United States, is rising. Approximately one in three adults in the US has hypertension, and a significant proportion of these individuals have hypertension that is difficult to treat, or resistant. Obesity and OSA are well-established risk factors for resistant hypertension, a condition that portends significant cardiovascular risk. Awareness of the various mechanisms by which obesity and OSA impact systemic blood pressure is essential to better understand how best to effectively care for patients with resistant hypertension. In this review, we discuss the clinical and pathophysiologic associations between obesity, OSA, and resistant hypertension. Furthermore, we will explore the effect of continuous positive airway pressure therapy (CPAP) and other therapeutic interventions on blood pressure control in patients with resistant hypertension.Key Points• Obesity, obstructive sleep apnea, and resistant hypertension are highly prevalent conditions, with increasing overall incidence [1-3].• Both obesity and obstructive sleep apnea are independent risk factors for the development of resistant hypertension.• OSA is characterized by a physiologic cascade of collapse of the upper airway, which can lead to intermittent hypoxia, hypercapnia, significant negative intra-thoracic pressure, and increased SNS output.• Intermittent hypoxia leads to activation of the endothelin system [17, 18, 19•], which can lead to the development of resistant hypertension.• Intermittent hypoxia can lead to the over activation of the SNS, which can also contribute to the development of resistant hypertension [20, 21].• OSA leads to state of elevated adrenergic tone, which in turn may contribute to resistant hypertension [25-27].• OSA patients have a higher incidence of "non-dipping" of nocturnal systolic blood pressure, a marker of increased adrenergic tone. This potentially represents a risk factor for hypertensive end organ disease [31, 32].• The prevalence of OSA is significantly higher in patients predisposed to fluid accumulation: including kidney disease, heart failure and resistant hypertension [33].• Interventions (such as the daytime use of compression stocking) which reduce daytime lower extremity fluid accumulation can significantly reduce the severity of OSA, particularly in patients with comorbid resistant hypertension [35, 36].• CPAP therapy can significantly reduce blood pressure in patients with comorbid hypertension and OSA. The treatment effect is most pronounced in those with resistant hypertension and OSA [16••, 38-42]. PMID:24346827

Marcus, Jonathan A; Pothineni, Aravind; Marcus, Carolina Z; Bisognano, John D

2014-01-01

361

Endothelial Function in Normotensive Men with Obstructive Sleep Apnea Before and 6 Months After CPAP Treatment  

PubMed Central

Study Objectives: To evaluate endothelium-dependent flow-mediated dilation (FMD) and endothelium–independent nitroglycerin (NTG)-induced dilation of the brachial artery with Doppler ultrasound in patients with obstructive sleep apnea (OSA) and impact of six months of continuous positive airway pressure (CPAP) treatment. Design: A prospective, controlled, observational study. Setting: Single-site, clinic-based. Patients: Twenty-nine normotensive men with OSA (apnea-hypopnea index [AHI], mean ± SD, 60.4 ± 22.1-h), and 17 men without OSA (AHI 2.5 ± 0.6-h). Interventions: Six months of CPAP therapy in OSA patients. Measurements and Results: FMD was lower in patients with OSA compared with in controls (7.19 ± 1.78 % vs 10.93 ± 2.59 %; P < 0.001) while NTG-induced vasodilation was similar in both groups (13.75 ± 1.01 % vs 14.25 ± 1.83 %; n.s.). An inverse relationship was found between FMD and AHI adjusted for age and body mass index (BMI) (? = ? 0.05, P < 0.001). Following 6 months of CPAP treatment in the OSA group, FMD was increased from 7.38 ± 2.06 % to 10.45 ± 1.68; P = 0.001) in 20 patients compliant with the device whereas the corresponding values did not change in the non-user group (7.08 ± 1.50% vs 7.26 ± 1.01%). No significant changes were observed regarding the NTG–induced vasodilation after CPAP compared with the baseline values. Conclusion: Our results confirm the previous reports suggesting impaired endothelium-dependent FMD in OSA, and additionally document the sustained improvement in endothelial function after 6 months of CPAP treatment in complaint patients. Citation: Bayram NA; Ciftci B; Keles T; Durmaz T; Turhan S; Bozkurt E; Peker Y. Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment. SLEEP 2009;32(10):1257-1263. PMID:19848355

Bayram, Nihal Akar; Ciftci, Bülent; Keles, Telat; Durmaz, Tahir; Turhan, Sibel; Bozkurt, Engin; Peker, Yüksel

2009-01-01

362

Consequences of Comorbid Sleep Apnea in the Metabolic Syndrome—Implications for Cardiovascular Risk  

PubMed Central

Study Objectives: Metabolic syndrome (MetSyn) increases overall cardiovascular risk. MetSyn is also strongly associated with obstructive sleep apnea (OSA), and these 2 conditions share similar comorbidities. Whether OSA increases cardiovascular risk in patients with the MetSyn has not been investigated. We examined how the presence of OSA in patients with MetSyn affected hemodynamic and autonomic variables associated with poor cardiovascular outcome. Design: Prospective clinical study. Participants: We studied 36 patients with MetSyn (ATP-III) divided into 2 groups matched for age and sex: (1) MetSyn+OSA (n = 18) and (2) MetSyn-OSA (n = 18). Measurements: OSA was defined by an apnea-hypopnea index (AHI) > 15 events/hour by polysomnography. We recorded muscle sympathetic nerve activity (MSNA - microneurography), heart rate (HR), and blood pressure (BP - Finapres). Baroreflex sensitivity (BRS) was analyzed by spontaneous BP and HR fluctuations. Results: MSNA (34 ± 2 vs 28 ± 1 bursts/min, P = 0.02) and mean BP (111 ± 3 vs. 99 ± 2 mm Hg, P = 0.003) were higher in patients with MetSyn+OSA versus patients with MetSyn-OSA. Patients with MetSyn+OSA had lower spontaneous BRS for increases (7.6 ± 0.6 vs 12.2 ± 1.2 msec/mm Hg, P = 0.003) and decreases (7.2 ± 0.6 vs 11.9 ± 1.6 msec/mm Hg, P = 0.01) in BP. MSNA was correlated with AHI (r = 0.48; P = 0.009) and minimum nocturnal oxygen saturation (r = ?0.38, P = 0.04). Conclusion: Patients with MetSyn and comorbid OSA have higher BP, higher sympathetic drive, and diminished BRS, compared with patients with MetSyn without OSA. These adverse cardiovascular and autonomic consequences of OSA may be associated with poorer outcomes in these patients. Moreover, increased BP and sympathetic drive in patients with MetSyn+OSA may be linked, in part, to impairment of baroreflex gain. Citation: Trombetta IC; Somers VK; Maki-Nunes C; Drager LF; Toschi-Dias E; Alves MJNN; Fraga RF; Rondon MUPB; Bechara MG; Lorenzi-Filho G; Negrão CE. Consequences of comorbid sleep apnea in the metabolic syndrome—implications for cardiovascular risk. SLEEP 2010;33(9):1193-1199. PMID:20857866

Trombetta, Ivani C.; Somers, Virend K.; Maki-Nunes, Cristiane; Drager, Luciano F.; Toschi-Dias, Edgar; Alves, Maria Janieire N. N.; Fraga, Raffael F.; Rondon, Maria Urbana P. B.; Bechara, Maíta G.; Lorenzi-Filho, Geraldo; Negrão, Carlos E.

2010-01-01

363

Association of Genetic Loci with Sleep Apnea in European Americans and African-Americans: The Candidate Gene Association Resource (CARe)  

PubMed Central

Although obstructive sleep apnea (OSA) is known to have a strong familial basis, no genetic polymorphisms influencing apnea risk have been identified in cross-cohort analyses. We utilized the National Heart, Lung, and Blood Institute (NHLBI) Candidate Gene Association Resource (CARe) to identify sleep apnea susceptibility loci. Using a panel of 46,449 polymorphisms from roughly 2,100 candidate genes on a customized Illumina iSelect chip, we tested for association with the apnea hypopnea index (AHI) as well as moderate to severe OSA (AHI?15) in 3,551 participants of the Cleveland Family Study and two cohorts participating in the Sleep Heart Health Study. Among 647 African-Americans, rs11126184 in the pleckstrin (PLEK) gene was associated with OSA while rs7030789 in the lysophosphatidic acid receptor 1 (LPAR1) gene was associated with AHI using a chip-wide significance threshold of p-value<2×10?6. Among 2,904 individuals of European ancestry, rs1409986 in the prostaglandin E2 receptor (PTGER3) gene was significantly associated with OSA. Consistency of effects between rs7030789 and rs1409986 in LPAR1 and PTGER3 and apnea phenotypes were observed in independent clinic-based cohorts. Novel genetic loci for apnea phenotypes were identified through the use of customized gene chips and meta-analyses of cohort data with replication in clinic-based samples. The identified SNPs all lie in genes associated with inflammation suggesting inflammation may play a role in OSA pathogenesis. PMID:23155414

Patel, Sanjay R.; Goodloe, Robert; De, Gourab; Kowgier, Matthew; Weng, Jia; Buxbaum, Sarah G.; Cade, Brian; Fulop, Tibor; Gharib, Sina A.; Gottlieb, Daniel J.; Hillman, David; Larkin, Emma K.; Lauderdale, Diane S.; Li, Li; Mukherjee, Sutapa; Palmer, Lyle; Zee, Phyllis; Zhu, Xiaofeng; Redline, Susan

2012-01-01

364

Inflammatory Markers and Obstructive Sleep Apnea in Obese Children: The NANOS Study  

PubMed Central

Introduction. Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). Conclusion. IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763. PMID:24991089

Gileles-Hillel, Alex; Alonso-Álvarez, María Luz; Kheirandish-Gozal, Leila; Peris, Eduard; Cordero-Guevara, José Aurelio; Terán-Santos, Joaquin; Martinez, Mónica Gonzalez; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Gozal, David

2014-01-01

365

Pediatric Obstructive Sleep Apnea and the Critical Role of Oral-Facial Growth: Evidences  

PubMed Central

Aims: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children. Method: Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep-disordered-breathing (SDB) in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often be treated in order for the resolution of OSA. Review of data of long-term recurrence of OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA. Results: Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children. Conclusion: Pediatric OSA in non-obese children is a disorder of oral-facial growth. PMID:23346072

Huang, Yu-Shu; Guilleminault, Christian

2013-01-01

366

Associated bone mineral density and obstructive sleep apnea in chronic obstructive pulmonary disease  

PubMed Central

Background Osteoporosis is an important issue for patients with chronic obstructive pulmonary disease (COPD). Worse systemic inflammation and reduced exercise capacity have been reported in COPD patients with obstructive sleep apnea (OSA), implying that OSA may be an independent factor for osteoporosis in COPD patients. Methods A total of 66 patients with bone mineral density (BMD) and polysomnography results from a previous COPD cohort (January 2008 to January 2013) were retrospectively enrolled. Clinical characteristics such as medication, pulmonary function, BMD, and results of polysomnography were analyzed. Results The BMD in those with OSA was significantly lower than in those without OSA (?1.99±1.63 versus ?1.27±1.14, P=0.045). In univariate analysis, body mass index, forced expiratory volume in 1 second, percentage of predicted value, incremental shuttle walk test, apnea–hypopnea index, and oxygen desaturation index (ODI) were significantly associated with BMD. After multivariate linear regression analysis, the ODI was still an independent factor for BMD. In addition, smaller total lung capacity is significantly associated with higher ODI and lower BMD, which implies that lower BMD might cause severer OSA via decreased total lung capacity. Conclusion OSA may be an independent factor for BMD in patients with COPD, which implies a possible vicious cycle takes place in these patients. PMID:25673983

Wang, Tsai-Yu; Lo, Yu-Lun; Chou, Pai-Chien; Chung, Fu-Tsai; Lin, Shu-Min; Lin, Ting-Yu; Lin, Horng-Chyuan; Wang, Chun-Hua; Yu, Chih-Teng; Kuo, Han-Pin

2015-01-01

367

Spectral analysis of single-channel airflow and oxygen saturation recordings in obstructive sleep apnea detection.  

PubMed

This study investigated the usefulness of the very low spectral content of single-channel airflow recordings to help in the diagnosis of the obstructive sleep apnea (OSA) syndrome. Additionally, we evaluated whether airflow frequency components in the 0.01 - 0.10 Hz band are linked with desaturations in blood oxygen saturation (SaO(2)) recordings due to apnea events. The relationship between changes in airflow and SaO(2) was analyzed by means of the magnitude squared coherence (MSC) function. Power spectral density (PSD) was used to obtain the power spectrum of single airflow and SaO(2) signals. Peak amplitude (PA) and relative power (P(R)) were used to parameterize the power spectrum in the very low frequency band. 148 subjects suspected of suffering from OSA were studied. Significant differences (p-value ? 0.01) between OSA positive and OSA negative subjects were obtained from PSD and MSC features. We found a power increase in the very low frequency band of single-channel airflow linked with the periodic desaturations of OSA. Diagnostic sensitivity, specificity and accuracy of 84.0%, 85.4% and 84.5%, respectively, were reached with the peak amplitude of the airflow PSD. Thus, spectral features from the very low frequency components of single-channel airflow recordings could provide useful information to help in OSA diagnosis. PMID:21096316

Alvarez, Daniel; Gutierrez, G C; Marcos, J Victor; Del Campo, Felix; Hornero, Roberto

2010-01-01

368

Long-Term Effectiveness and Compliance of Positional Therapy with the Sleep Position Trainer in the Treatment of Positional Obstructive Sleep Apnea Syndrome  

PubMed Central

Study Objectives: To investigate effectiveness, long-term compliance, and effects on subjective sleep of the Sleep Position Trainer (SPT) in patients with position-dependent obstructive sleep apnea syndrome (POSAS). Design: Prospective, multicenter cohort study. Patients or Participants: Adult patients with mild and moderate POSAS were included. Interventions: Patients asked to use the SPT for 6 mo. At baseline and after 1, 3, and 6 mo, questionnaires would be completed: Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and questions related to SPT use. Measurements and Results: One hundred forty-five patients were included. SPT use and SPT data could not be retrieved in 39 patients. In the remaining 106 patients, median percentage of supine sleep decreased rapidly during SPT's training phase (day 3 to 9) to near-total avoidance of supine sleep. This decrease was maintained during the following months of treatment (21% at baseline versus 3% at 6 mo). SPT compliance, defined as more than 4 h of nightly use, was 64.4%. Regular use, defined as more than 4 h of usage over 5 nights/w, was 71.2%. Subjective compliance and regular use were 59.8% and 74.4%, respectively. Median ESS (11 to 8), PSQI (8 to 6), and FOSQ (87 to 103) values significantly improved compared with baseline. Conclusions: Positional therapy using the Sleep Position Trainer (SPT) effectively diminished the percentage of supine sleep and subjective sleepiness and improved sleep related quality of life in patients with mild to moderate position-dependent obstructive sleep apnea syndrome. SPT treatment appeared to have sustained effects over 6 months. SPT compliance and regular use rate were relatively good. Subjective and objective compliance data corresponded well. The lack of a placebo-controlled group limited the efficacy of conclusions. Citation: van Maamen JP, de Vries N. Long-term effectiveness and compliance of positional therapy with the Sleep Position Trainer in the treatment of positional obstructive sleep apnea syndrome. SLEEP 2014;37(7):1209-1215. PMID:25061249

van Maanen, J. Peter; de Vries, Nico

2014-01-01

369

Improvements in current treatments and emerging therapies for adult obstructive sleep apnea  

PubMed Central

Obstructive sleep apnea (OSA) is common and is associated with a number of adverse outcomes, including an increased risk for cardiovascular disease. Typical treatment approaches, including positive airway pressure, oral appliances, various upper airway surgeries, and/or weight loss, can improve symptoms and reduce the severity of disease in select patient groups. However, these approaches have several potential limitations, including suboptimal adherence, lack of suitability for all patient groups, and/or absence of adequate outcomes data. Emerging potential therapeutic options, including nasal expiratory positive airway pressure (PAP), oral negative pressure, upper airway muscle stimulation, and bariatric surgery, as well as improvements in existing treatments and the utilization of improving technologies are moving the field forward and should offer effective therapies to a wider group of patients with OSA. PMID:24860658

2014-01-01

370

[Efficiency of intraoral applicator UPLH-01 in snore and obstructive sleep apnea].  

PubMed

Tolerance, subjective and objective effectiveness of domestic intraoral applicator UPLH-01 were studied in the treatment of snoring and obstructive sleep apnea (OSA). In 44 patients with uncomplicated snoring the above parameters were assessed using questionnaire, in 20 patients with uncomplicated snoring and OSA paired polysomnographic investigations were made. Tolerance of the treatment was 50%. Subjective positive effect was registered in 65% of the patients. The applicator was found effective in the majority of patients with uncomplicated snoring. In mild and moderate OSA the applicator was effective only in a few cases. In severe OSA no effect was found. Patients with chronic disorders of nasal breathing exhibited deterioration of respiration and blood saturation with oxygen. Thus nasal obstruction is a contraindication to applicator use. PMID:11496740

Eroshina, V A; Gasilin, V S; Buzunov, R V; Kalinkin, A L

2001-01-01

371

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea  

PubMed Central

Study Objectives: To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA. Methods: Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success. Results: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ? 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. Conclusions: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance. Citation: Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med 2011;7(5):439-445. PMID:22003337

Lettieri, Christopher J.; Paolino, Nathalie; Eliasson, Arn H.; Shah, Anita A.; Holley, Aaron B.

2011-01-01

372

External versus Internal Distraction Devices in Treatment of Obstructive Sleep Apnea in Craniofacial Anomalies  

PubMed Central

Background: Obstructive sleep apnea is often associated with congenital craniofacial malformations due to hypoplastic mandible and decreased pharyngeal airway. In this study, we will compare external and internal distraction devices for mandibular lengthening in terms of effectiveness, results, patient comfort, and complications. Methods: Thirty-seven patients were treated by bilateral mandibular distraction osteogenesis for obstructive sleep apnea: 20 with external and 17 with internal distraction devices. Results: Lengthening of the mandible and increase of the pharyngeal airway were obtained in all patients. Using the external devices, the average mandibular elongation was 30 mm versus 22 mm with the internal devices; however, after 1 year, the results were more stable with internal devices. External devices carried greater risk for pin tract infection than the internal devices (27.5% vs 5.88%). In addition, pin loosening in 22.5% required pin replacement or led to reduced retention period. Internal devices had a precise and predictable vector of lengthening and left less visible scars at the submandibular area but carried the disadvantage of requiring a second operation for device removal. In very young children with severe micrognathia, it was impossible to place internal devices, and external devices were used. Conclusions: Internal devices should be the first choice because they are more comfortable to the patients, more predictable vector of lengthening, are less vulnerable to dislodgement, and leave reduced scarring, with the great disadvantage of second operation for removal. However, external devices still should be considered mainly in severely hypoplastic cases, and the surgeon should be prepared for both options. PMID:25426371

Nseir, Saleh; Emodi, Omri; Aizenbud, Dror

2014-01-01

373

Validity and reliability of the Malay version of sleep apnea quality of life index – preliminary results  

PubMed Central

Background The objective of this study was to determine the validity and reliability of the Malay translated Sleep Apnea Quality of Life Index (SAQLI) in patients with obstructive sleep apnea (OSA). Methods In this cross sectional study, the Malay version of SAQLI was administered to 82 OSA patients seen at the OSA Clinic, Hospital Universiti Sains Malaysia prior to their treatment. Additionally, the patients were asked to complete the Malay version of Medical Outcomes Study Short Form (SF-36). Twenty-three patients completed the Malay version of SAQLI again after 1–2 weeks to assess its reliability. Results Initial factor analysis of the 40-item Malay version of SAQLI resulted in four factors with eigenvalues >1. All items had factor loadings >0.5 but one of the factors was unstable with only two items. However, both items were maintained due to their high communalities and the analysis was repeated with a forced three factor solution. Variance accounted by the three factors was 78.17% with 9–18 items per factor. All items had primary loadings over 0.5 although the loadings were inconsistent with the proposed construct. The Cronbach’s alpha values were very high for all domains, >0.90. The instrument was able to discriminate between patients with mild or moderate and severe OSA. The Malay version of SAQLI correlated positively with the SF-36. The intraclass correlation coefficients for all domains were >0.90. Conclusions In light of these preliminary observations, we concluded that the Malay version of SAQLI has a high degree of internal consistency and concurrent validity albeit demonstrating a slightly different construct than the original version. The responsiveness of the questionnaire to changes in health-related quality of life following OSA treatment is yet to be determined. PMID:23786866

2013-01-01

374

Obstructive sleep apnea in young infants with Down syndrome evaluated in a Down syndrome specialty clinic.  

PubMed

Children with Down syndrome (DS) experience congenital and functional medical issues that predispose them to obstructive sleep apnea (OSA). Research utilizing stringent age criteria among samples of infants with DS and OSA is limited. This study examines clinical correlates of OSA among infants with DS. A retrospective chart review was conducted of infants ?6 months of age referred to a DS clinic at a tertiary children's hospital over five-years (n?=?177). Chi-square tests and binary logistic regression models were utilized to analyze the data. Fifty-nine infants underwent polysomnography, based on clinical concerns. Of these, 95% (56/59) had studies consistent with OSA. Among infants with OSA, 71% were identified as having severe OSA (40/56). The minimum overall prevalence of OSA among the larger group of infants was 31% (56/177). Significant relationships were found between OSA and dysphagia, congenital heart disease (CHD), prematurity, gastroesophageal reflux disease (GERD), and other functional and anatomic gastrointestinal (GI) conditions. Results indicate that odds of OSA in this group are higher among infants with GI conditions in comparison to those without. Co-occurring dysphagia and CHD predicted the occurrence of OSA in 36% of cases with an overall predictive accuracy rate of 71%. Obstructive sleep apnea is relatively common in young infants with DS and often severe. Medical factors including GI conditions, dysphagia and CHD may help to identify infants who are at greater risk and may warrant evaluation. Further studies are needed to assess the impact of OSA in infants with DS. PMID:25604659

Goffinski, Alida; Stanley, Maria A; Shepherd, Nicole; Duvall, Nichole; Jenkinson, Sandra B; Davis, Charlene; Bull, Marilyn J; Roper, Randall J

2015-02-01

375

Obstructive sleep apnea syndrome: the effect of diabetes and autonomic neuropathy.  

PubMed

Several studies indicate an association between obstructive sleep apnea syndrome (OSAS) and diabetic autonomic neuropathy (DAN). Observed frequency of OSAS in diabetic patients with DAN varies between 26% and 30%. Excessive daytime sleepiness is one of the major clinical symptoms of sleep disordered breathing. Diabetics with autonomic neuropathy might have abnormal control of respiration during sleep, probably resulting in a reduced daytime sleepiness. We investigated the impact of autonomic diabetic neuropathy on clinical symptoms (e.g., daytime sleepiness, measured by Epworth Sleepiness Scale, ESS) in patients with suspected OSAS. We examined 196 patients suspected of sleep apnea (52 female, 144 male, mean age 58.7 yrs, mean BMI 30.57 kg/m2). All patients underwent overnight polysomnography and were tested for autonomic neuropathy by a method of measuring heart rate variabilty and heart rate response to the Valsalva maneuver, standing and deep breathing using a computerized data analysis system. Eighty diabetic subjects: 52 DAN-, 28 DAN+; 116 subjects without diabetes: 101 without autonomic neuropathy (AN), 15 AN+. The group of diabetics with DAN+ had a mean apnoea/hypopnea index (AHI) of 38.6/h, mean oxygen desaturation: 77.5%, mean ESS-Score: 9.86. Diabetic patients DAN-: mean AHI:30.4/h, mean oxygen desaturation: 79.3%, mean ESS-Score 9.73. Defining OSAS as AHI>5/h and ESS-Score>9, 46% of the diabetic patients DAN+ were positive, whereas in the DAN- group 61% met the criteria (non-diabetic patients without AN 50.5%; with AN: 60%). Although the group of diabetic patients with autonomic neuropathy had the lowest percentage of OSAS, statistical analysis showed no significance in comparisons between DAN-/DAN+ or diabetic/non-diabetic. In conclusion, although this study did not give statistical evidence, there is reason to assume that patients with diabetic autonomic neuropathy show fewer clinical symptoms of OSAS than those without it. The examination for OSAS might be indicated even without excessive daytime sleepiness because of elevated cardiovascular risk. PMID:18204141

Keller, T; Hader, C; De Zeeuw, J; Rasche, K

2007-11-01

376

An official ATS/AASM/ACCP/ERS workshop report: Research priorities in ambulatory management of adults with obstructive sleep apnea.  

PubMed

An international workshop was held to determine the research priorities for incorporating ambulatory management of adults with obstructive sleep apnea into healthcare systems. The workshop identified the barriers preventing incorporation of portable monitor testing into clinical management pathways and determined the research and development needed to address those barriers. The workshop promoted interaction and collaboration among diverse stakeholders who have interest and expertise in the development and evaluation of portable monitor technology and its clinical application. The consensus of the workshop participants was that outcomes-based research studies are needed to demonstrate the efficacy and cost effectiveness of portable monitor testing. Closely related to this objective is the need to develop clinical sleep research networks capable of performing adequately powered studies. Recommendations were developed regarding research study design and methodology that includes the need to standardize technology, identify the patients most appropriate for ambulatory management of obstructive sleep apnea, ensure patient safety, and identify sources of research funding. The evidence resulting from high-quality comparative effectiveness studies that include cost effectiveness as an outcome will allow decision makers to develop healthcare policies regarding the clinical application of portable monitor testing for the ambulatory management of patients with obstructive sleep apnea. PMID:21364215

Kuna, Samuel T; Badr, M Safwan; Kimoff, R John; Kushida, Clete; Lee-Chiong, Teofilo; Levy, Patrick; McNicholas, Walter T; Strollo, Patrick J

2011-03-01

377

Long-Term Effect of Weight Loss on Obstructive Sleep Apnea Severity in Obese Patients with Type 2 Diabetes  

PubMed Central

Study Objectives: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. Design: Randomized controlled trial with follow-up at 1, 2, and 4 years. Setting: 4 Look AHEAD clinical centers. Participants: Two hundred sixty-four obese adults with type 2 diabetes and OSA. Interventions: Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. Measurements: Change in apnea-hypopnea index on polysomnogram. Results: The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). Conclusions: Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss. Citation: Kuna ST; Reboussin DM; Borradaile KE; Sanders MH; Millman RP; Zammit G; Newman AB; Wadden TA; Jakicic JM; Wing RR; Pi-Sunyer FX; Foster GD; Sleep AHEAD Research Group. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. SLEEP 2013;36(5):641-649. PMID:23633746

Kuna, Samuel T.; Reboussin, David M.; Borradaile, Kelley E.; Sanders, Mark H.; Millman, Richard P.; Zammit, Gary; Newman, Anne B.; Wadden, Thomas A.; Jakicic, John M.; Wing, Rena R.; Pi-Sunyer, F. Xavier; Foster, Gary D.

2013-01-01

378

Trazodone Increases the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea and a Low Arousal Threshold  

PubMed Central

Study Objectives: The effect of common sedatives on upper airway physiology and breathing during sleep in obstructive sleep apnea (OSA) has been minimally studied. Conceptually, certain sedatives may worsen OSA in some patients. However, sleep and breathing could improve with certain sedatives in patients with OSA with a low respiratory arousal threshold. This study aimed to test the hypothesis that trazodone increases the respiratory arousal threshold in patients with OSA and a low arousal threshold. Secondary aims were to examine the effects of trazodone on upper airway dilator muscle activity, upper airway collapsibility, and breathing during sleep. Design: Patients were studied on 4 separate nights according to a within-subjects cross-over design. Setting: Sleep physiology laboratory. Patients: Seven patients with OSA and a low respiratory arousal threshold. Interventions: In-laboratory polysomnograms were obtained at baseline and after 100 mg of trazodone was administered, followed by detailed overnight physiology experiments under the same conditions. During physiology studies, continuous positive airway pressure was transiently lowered to measure arousal threshold (negative epiglottic pressure prior to arousal), dilator muscle activity (genioglossus and tensor palatini), and upper airway collapsibility (Pcrit). Measurements and Results: Trazodone increased the respiratory arousal threshold by 32 ± 6% (-11.5 ± 1.4 versus -15.3 ± 2.2 cmH2O, P < 0.01) but did not alter the apnea-hypopnea index (39 ± 12 versus 39 ± 11 events/h sleep, P = 0.94). Dilator muscle activity and Pcrit also did not systematically change with trazodone. Conclusions: Trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold without major impairment in dilator muscle activity or upper airway collapsibility. However, the magnitude of change in arousal threshold was insufficient to overcome the compromised upper airway anatomy in these patients. Citation: Eckert DJ; Malhotra A; Wellman A; White DP. Trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold. SLEEP 2014;37(4):811-819. PMID:24899767

Eckert, Danny J.; Malhotra, Atul; Wellman, Andrew; White, David P.

2014-01-01

379

Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure.  

PubMed

Obstructive sleep apnea leads to recurrent arousals from sleep, oxygen desaturations, daytime sleepiness and fatigue. This can have an adverse impact on quality of life. The aims of this study were to compare: (i) quality of life between the general population and untreated patients with obstructive sleep apnea; and (ii) changes of quality of life among patients with obstructive sleep apnea after 2 years of positive airway pressure treatment between adherent patients and non-users. Propensity score methodologies were used in order to minimize selection bias and strengthen causal inferences. The enrolled obstructive sleep apnea subjects (n = 822) were newly diagnosed with moderate to severe obstructive sleep apnea who were starting positive airway pressure treatment, and the general population subjects (n = 742) were randomly selected Icelanders. The Short Form 12 was used to measure quality of life. Untreated patients with obstructive sleep apnea had a worse quality of life when compared with the general population. This effect remained significant after using propensity scores to select samples, balanced with regard to age, body mass index, gender, smoking, diabetes, hypertension and cardiovascular disease. We did not find significant overall differences between full and non-users of positive airway pressure in improvement of quality of life from baseline to follow-up. However, there was a trend towards more improvement in physical quality of life for positive airway pressure-adherent patients, and the most obese subjects improved their physical quality of life more. The results suggest that co-morbidities of obstructive sleep apnea, such as obesity, insomnia and daytime sleepiness, have a great effect on life qualities and need to be taken into account and addressed with additional interventions. PMID:25431105

Bjornsdottir, Erla; Keenan, Brendan T; Eysteinsdottir, Bjorg; Arnardottir, Erna Sif; Janson, Christer; Gislason, Thorarinn; Sigurdsson, Jon Fridrik; Kuna, Samuel T; Pack, Allan I; Benediktsdottir, Bryndis

2014-11-27

380

Predicting compliance for mandible advancement splint therapy in 96 obstructive sleep apnea patients.  

PubMed

The treatment of choice in obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). Mandible advancement splint (MAS) offers an option for patients with mild or moderate OSA, who refuse or are unable to tolerate CPAP. The aim of the study was to find predictive factors in OSA for MAS therapy. The study group comprised 96 consecutive OSA patients who were sent for MAS therapy during 2008. Data were collected on the patients' general and dental condition, diagnosis, and treatment for OSA. Panoramic and cephalometric radiographs were analysed. The treatment compliance rate and problems with the use of the MAS were recorded. This rate was 57% and the significant affecting factors were protrusion of the mandible with MAS during the adaptation to the appliance as well as shorter maxillary and mandible lengths. The compliance of the MAS therapy was best in patients with short maxilla and mandible, which should be taken into consideration when planning MAS therapy for OSA patients. Finally, a sleep study should be part of the follow-up in this patient population. PMID:23159421

Ingman, Tuula; Arte, Sirpa; Bachour, Adel; Bäck, Leif; Mäkitie, Antti

2013-12-01

381

Is Mean Platelet Volume Really a Severity Marker for Obstructive Sleep Apnea Syndrome without Comorbidities?  

PubMed Central

Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to significant cardiovascular complications. Several studies have reported increased platelet activation and aggregation in patients with OSAS. In this study we aimed to show a correlation between mean platelet volume (MPV) and severity of OSAS in patients with OSAS without any overt cardiac disease or diabetes. The polysomnography recordings of 556 consecutive patients admitted to the sleep laboratory between January 2012 and July 2012 were retrospectively evaluated. The relationship between polysomnographic parameters and biochemical parameters was assessed. Polysomnographic results of 200 patients (154 males [77%]; mean age, 44.5?±?11.4 years) were included. No correlation was observed between MPV and the average oxygen saturation index, the minimum desaturation index, or the oxygen desaturation index in the study population as well as in severe OSAS group (AHI?>?30). The only correlation was found between MPV and AHI in the severe OSAS group (P = 0.010). MPV was not correlated with OSAS severity in patients without any overt cardiac disease or diabetes. These findings raise doubts about the suggestion that MPV might be a marker for OSAS severity, as recommended in earlier studies. Thus, further prospective data are needed. PMID:25309752

Sökücü, Sinem Nedime; Özdemir, Cengiz; Dalar, Levent; Karasulu, Levent; Ayd?n, ?enay; Alt?n, Sedat

2014-01-01

382

[Automatic positive airway pressure in titration and treatment of the obstructive sleep apnea syndrome].  

PubMed

Although continuous airway pressure therapy (CPAP) represents the standard treatment for obstructive sleep apnea syndrome (OSAS) auto-adjusting CPAP (APAP) devices were developed which adapt the treatment pressure to the actual requirement of the patients. The aim of automatic CPAP therapy is to improve the patients' acceptance of positive pressure treatment. The devices react to respiratory flow, flattening of the inspiratory flow contour, snoring, generator speed or the upper airway impedance. In recent years several studies showed that auto CPAP effectively treats respiratory disturbances, improves sleep profile and the self-assessment of the patients equally as good as the gold standard constant CPAP. Moreover, APAP reduces the treatment pressure substantially. Although an improvement of the patient's compliance has not consistently been proven, most patients prefer APAP versus constant CPAP. APAP devices use different algorithms depending on the primary purpose of the application. Therefore, a clear distinction between automatic titration and treatment is of major relevance. While titration devices aim at the finding of one single pressure which is fixed to a constant CPAP device, automatic treatment means the chronic use of APAP at home for optimal adaptation of the treatment pressure to the actual requirements of the patient. A high constant CPAP level, huge pressure variability, insufficient compliance with constant CPAP may be indications for APAP treatment. The main reason for automatic titration is the standardisation of the initiation process. PMID:17455137

Randerath, W J

2007-04-01

383

Obstructive sleep apnea in non-dialysis chronic kidney disease patients.  

PubMed

Abstract There is an enormous increase in the burden of chronic kidney disease both in developing and developed countries. There is a paucity of data on obstructive sleep apnea (OSA) in chronic kidney disease (CKD) patients in India. We used a cross-sectional prospective observational study to determine the prevalence of OSA in non-dialysis CKD patients. Of the 647 CKD patients 302 patients were in stage II, III and IV. The study population was screened using the Berlin questionnaire and 87 patients were positive for OSA (28%). Among the 87, 37 patients were excluded based on the exclusion criteria. Fifty patients underwent a split night sleep study. Stage II, III CKD patients were clubbed as early CKD or group one and stage IV CKD patients were clubbed as late CKD or group two. The spilt night study revealed an 88% incidence of OSA of varying severity. A sub group analysis was done to assess the severity of OSA. A statistical significance (p?

Shanmugam, G Vijay; Abraham, Georgi; Mathew, Milly; Ilangovan, V; Mohapatra, Madhusmita; Singh, Tripat

2015-03-01

384

Obstructive sleep apnea, polysomnography, and split-night studies: consensus statement of the Connecticut Thoracic Society and the Connecticut Neurological Society.  

PubMed

Obstructive sleep apnea is a state-dependent syndrome. It is characterized by repeated collapse of the upper airway as the result of the loss of waking neuromuscular drive as the brain changes from wakefulness to sleep. This produces a state-dependent decrease in muscle tone, which, together with other predisposing factors such as obesity and anatomical narrowing of the upper airway, results in the spectrum of sleep disordered breathing. Sleep-disordered breathing describes the continuum from simple snoring (pharyngeal vibration), to flow limitation (hypopnea), to complete cessation of breathing (apnea). Obstructive sleep apnea (OSA) is the common description of what is now appreciated as the sleep apnea/hypopnea syndrome. The cardinal symptoms are snoring, observed apneas, and excessive daytime sleepiness. The immediate physical consequences are hypoxia, repeated sympathetic discharges, increased cardiac load, and repeated brain arousals. The repetitive arousals are required to restore airway patency, resulting in severely fragmented sleep and consequent sleep deprivation. The syndrome, untreated, produces significant cognitive and cardiorespiratory morbidity, and potential mortality. Compared to matched controls, patients with undiagnosed sleep apnea use twice the health resources and spend double the health-care dollars in the 10 years prior to diagnosis. Both trends are reversed by successful treatment. It is by definition a sleep-related illness and can be observed and evaluated only when the patient is asleep. Polysomnography is the laboratory procedure to study sleep and its protean dysfunctions. Multiple physiologic parameters are required to document the various types of sleep disorders as well as to establish the origin of pathologic sleep fragmentation. Complete polysomnography includes (but is not limited to) electroencephalogram (EEG), electrooculogram ((EOG), electromyogram (EMG), electrocardiogram (ECG), respiratory effort, air flow, and oxygen saturation. Treatment options for obstructive sleep apnea include continuous positive airway pressure (CPAP), oral appliances, uvulopalatal and/or maxillomandibular surgery, positional control, and weight loss. The efficacy of each depends on the individual anatomy and the severity of the sleep-disordered breathing. CPAP is accepted as the most reliable treatment regardless of anatomy and severity. It is currently the only treatment modality which can be titrated during sleep and requires simultaneous polysomnography. PMID:10984971

2000-08-01

385

Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)  

PubMed Central

Study Objectives: Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Methods: Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ? 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Results: Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m2, and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. Conclusion: Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. Commentary: A commentary on this article appears in this issue on page 473. Citation: Batool-Anwar S, Goodwin JL, Drescher AA, Baldwin CM, Simon RD, Smith TW, Quan SF. Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA). J Clin Sleep Med 2014;10(5):465-472. PMID:24910546

Batool-Anwar, Salma; Goodwin, James L.; Drescher, Amy A.; Baldwin, Carol M.; Simon, Richard D.; Smith, Terry W.; Quan, Stuart F.

2014-01-01

386

Modified Uvulopalatopharyngoplasty and Coblation Channeling of the Tongue for Obstructive Sleep Apnea: A Multi-Centre Australian Trial  

PubMed Central

Study Objectives: To investigate the surgical outcomes and efficacy of modified uvulopalatopharyngoplasty (mod UPPP) and Coblation channelling of the tongue (CCT) as a treatment for obstructive sleep apnea (OSA). Methods: Adult patients with simple snoring or obstructive sleep apnea were treated with combined modified UPPP, bilateral tonsillectomy, and CCT (N = 48). Full polysomnography was performed preoperatively and 3 months postoperatively. Postoperative clinical assessment, sleep questionnaires, and patient demographics including body mass index were compared to preoperative data. All polysomnograms were re-scored to AASM recommended criteria by 2 sleep professionals. Results: The preoperative AHI (median and interquartile range) of 23.1 (10.4 to 36.6) was lowered to a postoperative AHI of 5.6 (1.9 to 10.4) (p < 0.05). The Epworth Sleepiness Scale score fell from 10.5 (5.5 to 13.5) to 5.0 (3.09 to 9.5) (p < 0.05). Morbidity of the surgery was low, with no long-term complications recorded. Conclusions: Modified UPPP combined with CCT is a highly efficacious intervention for OSA with minimal morbidity. It should be considered for individuals who fail or are intolerant of CPAP or other medical devices. Citation: MacKay SG; Carney AS; Woods C; Antic N; McEvoy RD; Chia M; Sands T; Jones A; Hobson J; Robinson S. Modified uvulopalatopharyngoplasty and coblation channeling of the tongue for obstructive sleep apnea: a multi-centre australian trial. J Clin Sleep Med 2013;9(2):117–124. PMID:23372463

MacKay, Stuart G.; Carney, A. Simon; Woods, Charmaine; Antic, Nick; McEvoy, R. Doug; Chia, Michael; Sands, Terry; Jones, Andrew; Hobson, Jonathan; Robinson, Samuel

2013-01-01

387

Symptoms of Insomnia among Patients with Obstructive Sleep Apnea Before and After Two Years of Positive Airway Pressure Treatment  

PubMed Central

Study Objectives: To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up. Design: Longitudinal cohort study. Setting: Landspitali—The National University Hospital of Iceland. Participants: There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment. Intervention: PAP treatment for OSA. Measurements and Results: All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved significantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively). Conclusion: Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure. Citation: Björnsdóttir E; Janson C; Sigurdsson JF; Gehrman P; Perlis M; Juliusson S; Arnardottir ES; Kuna ST; Pack AI; Gislason T; Benediktsdóttir B. Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment. SLEEP 2013;36(12):1901-1909. PMID:24293765

Björnsdóttir, Erla; Janson, Christer; Sigurdsson, Jón F.; Gehrman, Philip; Perlis, Michael; Juliusson, Sigurdur; Arnardottir, Erna S.; Kuna, Samuel T.; Pack, Allan I.; Gislason, Thorarinn; Benediktsdóttir, Bryndis

2013-01-01

388

Low-Temperature Bipolar Radiofrequency Ablation (Coblation) of the Tongue Base for Supine-Position-Associated Obstructive Sleep Apnea  

Microsoft Academic Search

Objective: To assess the effectiveness of low-temperature bipolar radiofrequency ablation for Coblation of the tongue base in the multilevel management of supine-position-associated obstructive sleep apnea syndrome (OSAS). Study Design and Setting: A retrospective analysis of the data of 16 subjects undergoing uvulopalatopharyngoplasty and tongue base Coblation. The efficacy of the procedure was investigated on the basis of polysomnographic results. Results:

Mehmet Ali Babademez; Bulent Ciftci; Baran Acar; Muge Fethiye Yurekli; Hayriye Karabulut; Aydin Yilmaz

2010-01-01

389

Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects.  

PubMed

Obstructive sleep apnea is a chronic disease whose treatment may require long-term nightly use of relatively cumbersome and expensive breathing equipment that provides continuous positive airway pressure (CPAP) via nasal mask. Compliance with this treatment may be influenced not only by the objective improvement in sleep apnea but also by the patient's subjective perception of the benefit, bed mate or family support, side effects, and cost. The last factor may not be important in Ontario, where 75% of the cost is paid by the Ministry of Health. The goal of this study was to analyze the factors that may influence patient acceptance of nasal CPAP. This was done by tabulating the responses to a detailed questionnaire mailed to 148 patients with obstructive sleep apnea (OSA). There were 96 replies. We were able to contact by telephone an additional 42 patients. The results showed that 105 patients continued to use CPAP at a mean follow-up time of 17 +/- 11 months, some for as long as 6 yr. The majority of patients (81%) perceived CPAP as an effective treatment of the disorder, 5% were unsure, and 14% believed that CPAP was ineffective, despite the resolution of sleep apnea on polysomnography. Subjective improvement reported by the patients was also observed by the family members in 83% of the patients. The most common complaint, voiced by 46% of the patients, was nocturnal awakenings. Nasal problems, such as dryness, congestion, and sneezing, were the second most frequent complaint present in 44% of the responders.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1554212

Hoffstein, V; Viner, S; Mateika, S; Conway, J

1992-04-01

390

Endothelial dysfunction and inflammatory reactions of elderly and middle-aged men with obstructive sleep apnea syndrome  

Microsoft Academic Search

Introduction  Obstructive sleep apnea syndrome (OSAS) is considered to be associated with cardiovascular complications, and atherosclerosis\\u000a could mediate this relationship. Cardiovascular risk factors of OSAS still need to be elucidated in elderly patients, since\\u000a studies about the association between OSAS and cardiovascular diseases have been done mainly in middle-aged adults. To investigate\\u000a whether endothelial dysfunction, as an early marker of atherosclerosis,

Seockhoon Chung; In-Young Yoon; Yoon-Kyung Shin; Chul Hee Lee; Jeong-Whun Kim; Hee Jeong Ahn

2009-01-01

391

Effects of Continuous Positive Airway Pressure on Neurocognitive Function in Obstructive Sleep Apnea Patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES)  

PubMed Central

Study Objective: To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA). Design, Setting, and Participants: The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures. Intervention: Active or sham CPAP Measurements: Three neurocognitive variables, each representing a neurocognitive domain: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F]) Results: The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test. Conclusions: CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship. Clinical Trial Information: Registered at clinicaltrials.gov. Identifier: NCT00051363. Citation: Kushida CA; Nichols DA; Holmes TH; Quan SF; Walsh JK; Gottlieb DJ; Simon RD; Guilleminault C; White DP; Goodwin JL; Schweitzer PK; Leary EB; Hyde PR; Hirshkowitz M; Green S; McEvoy LK; Chan C; Gevins A; Kay GG; Bloch DA; Crabtree T; Demen WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2012;35(12):1593-1602. PMID:23204602

Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Quan, Stuart F.; Walsh, James K.; Gottlieb, Daniel J.; Simon, Richard D.; Guilleminault, Christian; White, David P.; Goodwin, James L.; Schweitzer, Paula K.; Leary, Eileen B.; Hyde, Pamela R.; Hirshkowitz, Max; Green, Sylvan; McEvoy, Linda K.; Chan, Cynthia; Gevins, Alan; Kay, Gary G.; Bloch, Daniel A.; Crabtree, Tami; Dement, William C.

2012-01-01

392

Adverse Cognitive Effects of High-Fat Diet in a Murine Model of Sleep Apnea Are Mediated by NADPH Oxidase Activity  

PubMed Central

Intermittent hypoxia (IH) during sleep, such as occurs in sleep apnea (SA), induces increased nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation and deficits in hippocampal learning and memory. Similar to IH, high fat-refined carbohydrate diet (HFD), a frequent occurrence in patients with SA, can also induce similar oxidative stress and cognitive deficits under normoxic conditions, suggesting that excessive NADPH oxidase activity may underlie central nervous system (CNS) dysfunction in both conditions. The effect of HFD and IH during the light period on two forms of spatial learning in the water maze as well as on markers of oxidative stress was assessed in male mice lacking NADPH oxidase activity (gp91phox-/Y) and wild-type littermates fed HFD. On a standard place training task, gp91phox_/Y displayed normal learning, and was protected from the spatial learning deficits observed in wild-type littermates exposed to IH. Moreover, anxiety levels were increased in wild-type mice exposed to HFD and IH as compared to controls, while no changes emerged in gp91phox_/Y mice. Additionally, wild-type mice, but not gp91phox_/Y mice, had significantly elevated levels of malondialdehyde (MDA) and 8-hydroxydeoxyguanosine (8-OHdG) in hippocampal lysates following IH-HFD exposures. The cognitive deficits of obesity and westernized diets and those of sleep disorders that are characterized by IH during sleep are both mediated, at least in part, by excessive NADPH oxidase activity. PMID:23064009

Nair, D.; Ramesh, V.; Gozal, D.

2012-01-01

393

Distinct Associations between Hypertension and Obstructive Sleep Apnea in Male and Female Patients  

PubMed Central

Obstructive sleep apnea (OSA) is highly associated with hypertension. However, the correlation between hypertension and OSA at different levels of severity and the influence of gender on that correlation are unclear. A total of 996 patients (776 males and 190 females) with OSA were recruited. The influence of gender on the correlation between hypertension and OSA at different stratifications of severity, based on the apnea-hypopnea index (AHI), was fully evaluated together with the major health risk factors obesity, age, and diabetes. Females with OSA were significantly older on average than males with OSA. Moreover, females had milder degrees of OSA on average than the extent of severity seen in males. The proportion of females with diabetes or hypertension was higher than that of males. The proportion of males with hypertension and obesity increased significantly with OSA, and age also increased with OSA. The percentage of females with hypertension at different degrees of OSA severity was stable at about 26% in the mild, moderate, and severe OSA groups. Among females, age was increased significantly in the moderate relative to the mild OSA group. Moreover, the proportion of obese subjects was increased significantly in the severe compared with the moderate OSA group. The proportions of males and females with diabetes were not significantly different among all OSA severity groups. An ordinal multivariate logistic regression analysis confirmed that hypertension, age, and obesity were associated with OSA severity in males, whereas only age and obesity were associated with OSA severity in females. Although the proportion of subjects with hypertension was higher in females with OSA than in males with OSA, the proportion of subjects with hypertension increased as the severity of OSA increased in males but not in females. PMID:25402499

Yu, Qiang; Yin, Guizhi; Zhang, Peng; Song, Zhiping; Chen, Yueguang; Zhang, Dadong; Hu, Wei

2014-01-01

394

Clinical assessment and polysomnographic study of sleep apnea in a Chinese population of snorers*  

PubMed Central

Background and objectives: While an increasing number of people who snore are seeking medical consultations, the clinical characteristics of snorers are rarely reported. The aim of this study is to characterize the clinical and polysomnographic features in a population of snorers. Methods: A total of 490 subjects were examined retrospectively. The clinical history, Epworth Sleepiness Scale (ESS) scores, physical examination, and full-night polysomnography (PSG) data were obtained for all the subjects. The correlations between the neck circumference, waist circumference, ESS scores, body mass index (BMI), and apnea-hypopnea index (AHI) of obstructive sleep apnea (OSA) patients were explored. The gender and age differences in OSA patients were analyzed. Results: OSA was diagnosed in 84.7% of the sample, with 21.2% of the patients having a mild form, 15.4% having a moderate form, and 63.4% having a severe form of OSA. The ESS scores, neck circumference, waist circumference, and BMI were positively correlated with AHI in OSA patients. The ESS scores and BMI were negatively correlated with nadir oxygen saturation (SaO2). A greater number of men than women exhibited moderate to severe forms of the disease. OSA affects the work of males more commonly compared with females. Nocturia was a more common complaint in elderly OSA patients. Heart diseases coexisted more frequently with OSA in elderly patients. Conclusions: In a population of snorers, OSA is the most common condition identified. The ESS scores and BMI were well correlated with the severity of the disease. Men had a more severe form of OSA than women. Nocturia frequently occurred in elderly OSA patients, as did the coexistence of heart disease. PMID:25743123

Shao, Chuan; Jiang, Jing-bo; Wu, Hong-cheng; Wu, Shi-bo; Yu, Bi-yun; Tang, Yao-dong

2015-01-01

395

Computational fluid dynamics endpoints to characterize obstructive sleep apnea syndrome in children  

PubMed Central

Computational fluid dynamics (CFD) analysis may quantify the severity of anatomical airway restriction in obstructive sleep apnea syndrome (OSAS) better than anatomical measurements alone. However, optimal CFD model endpoints to characterize or assess OSAS have not been determined. To model upper airway fluid dynamics using CFD and investigate the strength of correlation between various CFD endpoints, anatomical endpoints, and OSAS severity, in obese children with OSAS and controls. CFD models derived from magnetic resonance images were solved at subject-specific peak tidal inspiratory flow; pressure at the choanae was set by nasal resistance. Model endpoints included airway wall minimum pressure (Pmin), flow resistance in the pharynx (Rpharynx), and pressure drop from choanae to a minimum cross section where tonsils and adenoids constrict the pharynx (dPTAmax). Significance of endpoints was analyzed using paired comparisons (t-test or Wilcoxon signed rank test) and Spearman correlation. Fifteen subject pairs were analyzed. Rpharynx and dPTAmax were higher in OSAS than control and most significantly correlated to obstructive apnea-hypopnea index (oAHI), r = 0.48 and r = 0.49, respectively (P < 0.01). Airway minimum cross-sectional correlation to oAHI was weaker (r = ?0.39); Pmin was not significantly correlated. CFD model endpoints based on pressure drops in the pharynx were more closely associated with the presence and severity of OSAS than pressures including nasal resistance, or anatomical endpoints. This study supports the usefulness of CFD to characterize anatomical restriction of the pharynx and as an additional tool to evaluate subjects with OSAS. PMID:24265282

Luo, Haiyan; Persak, Steven C.; Sin, Sanghun; McDonough, Joseph M.; Isasi, Carmen R.; Arens, Raanan

2013-01-01

396

Nocturnal apnea in Chiari type I malformation  

Microsoft Academic Search

A 4-year-old girl presented with sleep-disordered breathing. Her parents described breathing pauses of up to 20 s and progressive\\u000a tiredness during the day. Obstructive apneas from an enlarged adenoid were thought to be the most probable cause. However,\\u000a an adenotomy did not resolve the problem. Polysomnography demonstrated central apneas, and cerebral magnetic resonance imaging\\u000a revealed a Chiari type I malformation. We

Lonneke A. M. Aarts; Michèl A. A. P. Willemsen; Nele L. E. VandenBussche; René van Gent

2011-01-01

397

Polymorphisms in nitric oxide synthase and endothelin genes among children with obstructive sleep apnea  

PubMed Central

Background Obstructive sleep apnea (OSA) is associated with adverse and interdependent cognitive and cardiovascular consequences. Increasing evidence suggests that nitric oxide synthase (NOS) and endothelin family (EDN) genes underlie mechanistic aspects of OSA-associated morbidities. We aimed to identify single nucleotide polymorphisms (SNPs) in the NOS family (3 isoforms), and EDN family (3 isoforms) to identify potential associations of these SNPs in children with OSA. Methods A pediatric community cohort (ages 5–10 years) enriched for snoring underwent overnight polysomnographic (NPSG) and a fasting morning blood draw. The diagnostic criteria for OSA were an obstructive apnea-hypopnea Index (AHI) >2/h total sleep time (TST), snoring during the night, and a nadir oxyhemoglobin saturation <92%. Control children were defined as non-snoring children with AHI <2/h TST (NOSA). Endothelial function was assessed using a modified post-occlusive hyperemic test. The time to peak reperfusion (Tmax) was considered as the indicator for normal endothelial function (NEF; Tmax<45 sec), or ED (Tmax?45 sec). Genomic DNA from peripheral blood was extracted and allelic frequencies were assessed for, NOS1 (209 SNPs), NOS2 (122 SNPs), NOS3 (50 SNPs), EDN1 (43 SNPs), EDN2 (48 SNPs), EDN3 (14 SNPs), endothelin receptor A, EDNRA, (27 SNPs), and endothelin receptor B, EDNRB (23 SNPs) using a custom SNPs array. The relative frequencies of NOS-1,-2, and ?3, and EDN-1,-2,-3,-EDNRA, and-EDNRB genotypes were evaluated in 608 subjects [128 with OSA, and 480 without OSA (NOSA)]. Furthermore, subjects with OSA were divided into 2 subgroups: OSA with normal endothelial function (OSA-NEF), and OSA with endothelial dysfunction (OSA-ED). Linkage disequilibrium was analyzed using Haploview version 4.2 software. Results For NOSA vs. OSA groups, 15 differentially distributed SNPs for NOS1 gene, and 1 SNP for NOS3 emerged, while 4 SNPs for EDN1 and 1 SNP for both EDN2 and EDN3 were identified. However, in the smaller sub-group for whom endothelial function was available, none of the significant SNPs was retained due to lack of statistical power. Conclusions Differences in the distribution of polymorphisms among NOS and EDN gene families suggest that these SNPs could play a contributory role in the pathophysiology and risk of OSA-induced cardiovascular morbidity. Thus, analysis of genotype-phenotype interactions in children with OSA may assist in the formulation of categorical risk estimates. PMID:24010499

2013-01-01

398

A Novel Nasal Expiratory Positive Airway Pressure (EPAP) Device for the Treatment of Obstructive Sleep Apnea: A Randomized Controlled Trial  

PubMed Central

Study Objectives: Investigate the efficacy of a novel nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA). Design: A prospective, multicenter, sham-controlled, parallel-group, randomized, double-blind clinical trial. Setting: 19 sites including both academic and private sleep disorder centers Patients: Obstructive sleep apnea with a pre-study AHI ? 10/hour Interventions: Treatment with a nasal EPAP device (N = 127) or similar appearing sham device (N = 123) for 3 months. Polysomnography (PSG) was performed on 2 non-consecutive nights (random order: device-on, device-off) at week 1 and after 3 months of treatment. Analysis of an intention to treat group (ITT) (patients completing week 1 PSGs) (EPAP N = 119, sham N = 110) was performed. Measurements and Results: At week 1, the median AHI value (device-on versus device-off) was significantly lower with EPAP (5.0 versus 13.8 events/h, P < 0.0001) but not sham (11.6 versus 11.1 events/h, P = NS); the decrease in the AHI (median) was greater (?52.7% vs. ?7.3%, P < 0.0001) for the ITT group. At month 3, the percentage decrease in the AHI was 42.7% (EPAP) and 10.1% (sham), P < 0.0001. Over 3 months of EPAP treatment the Epworth Sleepiness Scale decreased (9.9 ± 4.7 to 7.2 ± 4.2, P < 0.0001), and the median percentage of reported nights used (entire night) was 88.2%. Conclusions: The nasal EPAP device significantly reduced the AHI and improved subjective daytime sleepiness compared to the sham treatment in patients with mild to severe OSA with excellent adherence. Clinical Trial Information: Registrations: ClinicalTrials.gov. Trial name: Randomized Study of Provent Versus Sham Device to Treat Obstructive Sleep Apnea (AERO). URL: http://www.clinicaltrials.gov/ct2/show/NCT00772044?term=Ventus&rank=1. Registration Number: NCT00772044. Citation: Berry RB; Kryger MH; Massie CA. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. SLEEP 2011;34(4):479-485. PMID:21461326

Berry, Richard B.; Kryger, Meir H.; Massie, Clifford A.

2011-01-01

399

Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients.  

PubMed

Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two-phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy-suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary-mandibular advancement osteotomy. One hundred twenty-one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and <