Sample records for central sleep apnea

  1. Central Sleep Apnea

    PubMed Central

    Garcia-Touchard, Arturo; Somers, Virend K.; Olson, Lyle J.; Caples, Sean M.

    2009-01-01

    Congestive heart failure (HF), an exceedingly common and costly disease, is frequently seen in association with central sleep apnea (CSA), which often manifests as a periodic breathing rhythm referred to as Cheyne-Stokes respiration. CSA has historically been considered to be a marker of heart disease, since improvement in cardiac status is often associated with the attenuation of CSA. However, this mirroring of HF and CSA may suggest bidirectional importance to their relationship. In fact, observational data suggest that CSA, associated with repetitive oxyhemoglobin desaturations and surges in sympathetic neural activity, may be of pathophysiologic significance in HF outcomes. In light of the disappointing results from the first large trial assessing therapy with continuous positive airway pressure in patients with CSA and HF, further large-scale interventional trials will be needed to assess the role, if any, of CSA treatment on the outcomes of patients with HF. This review will discuss epidemiologic, pathophysiologic, diagnostic, and therapeutic considerations of CSA in the setting of HF. PMID:18574295

  2. Central sleep apnea in patients with congestive heart failure

    Microsoft Academic Search

    Safwan Badr

    2009-01-01

    Central apnea during sleep represents a manifestation of breathing instability in many clinical conditions of varied etiologies.\\u000a Central apnea is the result of transient cessation of ventilatory motor output, which represents that inhibitory influences\\u000a favoring instability predominate over excitatory influence favoring stable breathing. This article will review the determinants\\u000a of central apnea, the specific features of CHF-related central apnea, and

  3. Alternative approaches to treatment of Central Sleep Apnea

    PubMed Central

    2013-01-01

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

  4. Alternative approaches to treatment of Central Sleep Apnea.

    PubMed

    Thomas, Robert Joseph

    2014-03-01

    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

  5. Sleep Apnea

    MedlinePLUS

    ... that people who are experiencing even a few of these symptoms visit their doctor for evaluation. Sleep apnea is more likely to occur in men than women, and in people who are overweight or obese. ...

  6. Tetraplegia is a risk factor for central sleep apnea

    PubMed Central

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

    2013-01-01

    Sleep-disordered breathing (SDB) is highly prevalent in patients with spinal cord injury (SCI); the exact mechanism(s) or the predictors of disease are unknown. We hypothesized that patients with cervical SCI (C-SCI) are more susceptible to central apnea than patients with thoracic SCI (T-SCI) or able-bodied controls. Sixteen patients with chronic SCI, level T6 or above (8 C-SCI, 8 T-SCI; age 42.5 ± 15.5 years; body mass index 25.9 ± 4.9 kg/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

  7. [Central sleep apnea (Ondine's curse syndrome) in medullary infarction].

    PubMed

    Planjar-Prvan, Miljenka; Krmpoti?, Pavao; Jergovi?, Ilija; Bielen, Ivan

    2010-10-01

    Ondine's curse syndrome primarily refers to cases with congenital central alveolar hypoventilation, but the term can also be used for acquired cases and implies central sleep apnea that occurs as a manifestation or complication of focal lesion in the area of the dorsolateral segment of medulla oblongata. It occurs rarely, but can lead to fatal outcome. Based on our own case report, the aim of this article is to review its clinical symptoms, and appropriate diagnostic and therapeutic procedures. We present a patient who had symptoms of vascular lesion of the dorsolateral segment of the medulla, which was verified by magnetic resonance imaging. On day 12 of his hospital stay, in the early morning, rapid development of coma was observed, which was an expression of serious respiratory failure with dominant hypercapnia. In the beginning, urgent intubation and mechanical ventilation were necessary, while in the later course of the disease breathing was assisted by noninvasive methods of Bilevel Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP). Throughout the night, polygraph recording confirmed the diagnosis of the central sleep apnea syndrome. The course of the disease was favorable, with a very slow but constant improvement of respiratory function. According to literature data, the disease course is not always favorable. There are published cases where it was concluded that ventilatory support was no longer needed but after a long period of normal breathing hypoventilation and death occurred suddenly during sleep. The treatment of central hypoventilation consists of ventilatory support, but there were also attempts of medicamentous treatment with the common aim of raising alertness and reactibility of the automatic breathing center. It is important to emphasize that patients with the risk of central sleep apnea should not be supplied with oxygen without arterial blood gas monitoring because of the possibility of delaying the right diagnosis. The use of oxygen in patients who already have hypercapnia due to hypoventilation could further intensify hyporeactivity of the breathing center and lead to respiratory arrest. PMID:21688613

  8. Epidemiology of obstructive sleep apnea.

    PubMed

    Bresnitz, E A; Goldberg, R; Kosinski, R M

    1994-01-01

    Sleep-disturbed breathing, which includes apneas, hypopneas, and oxygen desaturations, occurs in asymptomatic individuals and increases with age. Obstructive apnea is the most frequent type of respiratory disturbance documented by polysomonography, the gold standard test for assessing sleep-disturbed breathing. Many of the prevalence studies done to date have had one or more methodological weaknesses, including selection biases, varying definitions of obstructive sleep apnea, failure to distinguish types of apneas, failure to control for confounding variables, and small sample size. Although there is consensus on the definitions of sleep-disturbed breathing, the appropriate number of apneas and hypopneas for diagnosing clinically significant obstructive sleep apnea is uncertain. While the cutoff of five or more apneas and hypopneas per hour is historically considered abnormal, the origins of this number are vague, and the longevity of those who have this value on polysomnography is not necessarily reduced. This is particularly true among those without symptoms of obstructive sleep apnea syndrome, which include excessive daytime sleepiness, snoring, nocturnal awakenings, and morning headaches. Investigators should be careful to distinguish symptomatic study subjects from asymptomatic subjects, and to exclude central apneas in calculating their estimates. In addition, various studies have used different definitions of sleep apnea syndrome, making comparisons of point estimates difficult. It would be more appropriate for researchers to estimate morbidity and mortality indices with confidence intervals, using several different cutoff points. Subject selection in all studies should follow a two-stage sampling procedure. All subjects with symptoms compatible with obstructive sleep apnea syndrome and a subsample of asymptomatic individuals should be studied with all-night polysomnography. If portable monitoring is used, the validity and reproducibility of this diagnostic method should be assessed. Subjects with significant comorbidity should be excluded from prevalence studies. Factors that clearly increase the risk of sleep-disturbed breathing and obstructive sleep apnea and its related symptoms include age, structural abnormalities of the upper airway, sedatives and alcohol, and probably family history. Although endocrine changes such as growth hormone, thyroid hormone, and progesterone deficiency also have been suggested as risk factors for exacerbating obstructive sleep apnea syndrome, there is minimal epidemiologic evidence to support this. Case-control studies are recommended to assess the relation of endocrine factors to obstructive sleep apnea syndrome in a rigorous fashion. A limited number of mortality studies have suggested decreased survival in persons with the obstructive sleep apnea syndrome, possibly primarily due to vascular-related disease.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7713177

  9. Sleep apnea and cardiovascular risk.

    PubMed

    Floras, John S

    2014-01-01

    Sleep apnea is evident in approximately 10% of adults in the general population, but in certain cardiovascular diseases, and in particular those characterized by sodium and water retention, its prevalence can exceed 50%. Although sleep apnea is not as yet integrated into formal cardiovascular risk assessment algorithms, there is increasing awareness of its importance in the causation or promotion of hypertension, coronary artery disease, heart failure, atrial arrhythmias, and stroke, and thus, not surprisingly, as a predictor of premature cardiovascular death. Sleep apnea manifests as two principal phenotypes, both characterized by respiratory instability: obstructive (OSA), which arises when sleep-related withdrawal of respiratory drive to the upper airway dilator muscles is superimposed upon a narrow and highly compliant airway predisposed to collapse, and central (CSA), which occurs when the partial pressure of arterial carbon dioxide falls below the apnea threshold, resulting in withdrawal of central drive to respiratory muscles. The present objectives are to: (1) review the epidemiology and patho-physiology of OSA and CSA, with particular emphasis on the role of renal sodium retention in initiating and promoting these processes, and on population studies that reveal the long-term consequences of untreated OSA and CSA; (2) illustrate mechanical, autonomic, chemical, and inflammatory mechanisms by which OSA and CSA can increase cardiovascular risk and event rates by initiating or promoting hypertension, atherosclerosis, coronary artery disease, heart failure, arrhythmias, and stroke; (3) highlight insights from randomized trials in which treating sleep apnea was the specific target of therapy; (4) emphasize the present lack of evidence that treating sleep apnea reduces cardiovascular risk and the current clinical equipoise concerning treatment of asymptomatic patients with sleep apnea; and (5) consider clinical implications and future directions of clinical research and practice. PMID:24084492

  10. Obstructive Sleep Apnea

    NSDL National Science Digital Library

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

    2005-02-01

    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.

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

    Microsoft Academic Search

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

    1999-01-01

    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.

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

    PubMed Central

    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

    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

  13. Contemporary Insights and Novel Treatment Approaches to Central Sleep Apnea Syndrome in Heart Failure

    PubMed Central

    Grayburn, Ryan L.; Kaka, Yaquta; Wilson Tang, W. H.

    2014-01-01

    Opinion Statement Central sleep apnea (CSA) is a common and under-diagnosed condition commonly associated with Cheyne-Stokes respiration. It is particularly prevalent in the heart failure population affecting up to 40% of all patients with heart failure. The pathophysiology associated with CSA is based on the underlying effects of hypoventilation and hyperventilation, with neurologic dysregulation of respiratory control as the primary defect. However, therapeutic options are limited due to the prevailing perception that CSA is a consequence, rather than cause of morbidity and mortality. At present, the main focus remains treating the underlying problem (ie intensifying heart failure therapeutics, decongestion), while additional suggestions of using acetazolamide, progesterone, nocturnal oxygen, and theophylline have not been validated with contemporary clinical trials. Positive pressure ventilation is currently the primary recommendation for all patients with sleep-disordered breathing (CSA included), and in some patients may effectively reduce the apnea-hypopnea index. However, significant research is ongoing to determine how to treat this complex patient population. PMID:24874028

  14. Leptin Deficiency Promotes Central Sleep Apnea in Patients With Heart Failure

    PubMed Central

    Cundrle, Ivan; Somers, Virend K.; Singh, Prachi; Johnson, Bruce D.; Scott, Christopher G.; van der Walt, Christelle

    2014-01-01

    Background: Leptin-deficient animals hyperventilate. Leptin expression by adipocytes is attenuated by atrial natriuretic peptide (ANP). Increased circulating natriuretic peptides (NPs) are associated with an increased risk of central sleep apnea (CSA). This study tested whether serum leptin concentration is inversely correlated to NP concentration and decreased in patients with heart failure (HF) and CSA. Methods: Subjects with HF (N = 29) were studied by measuring leptin, NPs, CO2 chemosensitivity (?minute ventilation [V.e]/?partial pressure of end-tidal CO2 [Petco2]), and ventilatory efficiency (V.e/CO2 output [V.co2]) and were classified as CSA or no sleep-disordered breathing by polysomnography. CSA was defined as a central apnea-hypopnea index ? 15. The Student t test, Mann-Whitney U test, and logistic regression were used for analysis, and data were summarized as mean ± SD; P < .05 was considered significant. Results: Subjects with CSA had higher ANP and brain natriuretic peptide (BNP) concentrations (P < .05), ?V.e/?Petco2 (2.39 ± 1.03 L/min/mm Hg vs 1.54 ± 0.35 L/min/mm Hg, P = .01), and V.e/V.co2 (43 ± 9 vs 34 ± 7, P < .01) and lower leptin concentrations (8 ± 10.7 ng/mL vs 17.1 ± 8.8 ng/mL, P < .01). Logistic regression analysis (adjusted for age, sex, and BMI) demonstrated leptin (OR = 0.07; 95% CI, 0.01-0.71; P = .04) and BNP (OR = 4.45; 95% CI, 1.1-17.9; P = .05) to be independently associated with CSA. Conclusions: In patients with HF and CSA, leptin concentration is low and is inversely related to NP concentration. Counterregulatory interactions of leptin and NP may be important in ventilatory control in HF. PMID:24030529

  15. Sleep apnea and stroke.

    PubMed

    Culebras, Antonio

    2005-01-01

    The concept of sleep apnea as a risk factor for primary stroke derives mainly from evidence implicating sleep-disordered breathing (SDB) in the causation or aggravation of systemic hypertension and heart disease. Evidence of an association between SDB and sustained systemic hypertension is available from several large studies, though the exact mechanism involved is unknown. Another study found a 37% increase in risk of developing cardiovascular disease among middle-aged men attending a sleep clinic. The same study also found that treatment of SDB reduced the cardiovascular risk. Other mechanisms less well studied linking SDB with cerebrovascular risk include reduction in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, and accelerated proinflammatory states. PMID:16400298

  16. Pathophysiology of Sleep Apnea

    PubMed Central

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

    2010-01-01

    Sleep-induced apnea and disordered breathing refers to intermittent, cyclical cessations or reductions of airflow, with or without obstructions of the upper airway (OSA). In the presence of an anatomically compromised, collapsible airway, the sleep-induced loss of compensatory tonic input to the upper airway dilator muscle motor neurons leads to collapse of the pharyngeal airway. In turn, the ability of the sleeping subject to compensate for this airway obstruction will determine the degree of cycling of these events. Several of the classic neurotransmitters and a growing list of neuromodulators have now been identified that contribute to neurochemical regulation of pharyngeal motor neuron activity and airway patency. Limited progress has been made in developing pharmacotherapies with acceptable specificity for the treatment of sleep-induced airway obstruction. We review three types of major long-term sequelae to severe OSA that have been assessed in humans through use of continuous positive airway pressure (CPAP) treatment and in animal models via long-term intermittent hypoxemia (IH): 1) cardiovascular. The evidence is strongest to support daytime systemic hypertension as a consequence of severe OSA, with less conclusive effects on pulmonary hypertension, stroke, coronary artery disease, and cardiac arrhythmias. The underlying mechanisms mediating hypertension include enhanced chemoreceptor sensitivity causing excessive daytime sympathetic vasoconstrictor activity, combined with overproduction of superoxide ion and inflammatory effects on resistance vessels. 2) Insulin sensitivity and homeostasis of glucose regulation are negatively impacted by both intermittent hypoxemia and sleep disruption, but whether these influences of OSA are sufficient, independent of obesity, to contribute significantly to the “metabolic syndrome” remains unsettled. 3) Neurocognitive effects include daytime sleepiness and impaired memory and concentration. These effects reflect hypoxic-induced “neural injury.” We discuss future research into understanding the pathophysiology of sleep apnea as a basis for uncovering newer forms of treatment of both the ventilatory disorder and its multiple sequelae. PMID:20086074

  17. RODENT MODELS OF SLEEP APNEA

    PubMed Central

    Davis, Eric M.; O’Donnell, Christopher P.

    2014-01-01

    Rodent models of sleep apnea have long been used to provide novel insight into the generation and predisposition to apneas as well as to characterize the impact of sleep apnea on cardiovascular, metabolic, and psychological health in humans. Given the significant body of work utilizing rodent models in the field of sleep apnea, the aims of this review are three-fold: first, to review the use of rodents as natural models of sleep apnea; second, to provide an overview of the experimental interventions employed in rodents to simulate sleep apnea; third, to discuss the refinement of rodent models to further our understanding of breathing abnormalities that occur during sleep. Given mounting evidence that sleep apnea impairs cognitive function, reduces quality of life, and exacerbates the course of multiple chronic diseases, rodent models will remain a high priority as a tool to interrogate both the pathophysiology and sequelae of breathing related abnormalities during sleep and to improve approaches to diagnosis and therapy. PMID:23722067

  18. Cardiovascular consequences of sleep apnea.

    PubMed

    Golbidi, Saeid; Badran, Mohammad; Ayas, Najib; Laher, Ismail

    2012-04-01

    Sleep apnea is a common health concern that is characterized by repetitive episodes of asphyxia. This condition has been linked to serious long-term adverse effects such as hypertension, metabolic dysregulation, and cardiovascular disease. Although the mechanism for the initiation and aggravation of cardiovascular disease has not been fully elucidated, oxidative stress and subsequent endothelial dysfunction play major roles. Animal models, which have the advantage of being free of comorbidities and/or behavioral variables (that commonly occur in humans), allow invasive measurements under well-controlled experimental conditions, and as such are useful tools in the study of the pathophysiological mechanisms of sleep apnea. This review summarizes currently available information on the cardiovascular consequences of sleep apnea and briefly describes common experimental approaches useful to sleep apnea in different animal models. PMID:22048845

  19. Cardiopulmonary consequences of obstructive sleep apnea.

    PubMed

    Shepard, J W

    1990-09-01

    During sleep, oxygen consumption and systemic blood pressure decrease in normal subjects; during rapid eye movement sleep, irregular ventilation can be accompanied by brief periods of apnea. In patients with obstructive sleep apnea, alveolar ventilation during an apneic episode is immediately reduced to zero, and the metabolic demands for oxygen must be met from oxygen stores within the body. As the stores of oxygen within the lung are diminished, the rate of arterial oxyhemoglobin desaturation increases. The development of alveolar hypoventilation during wakefulness seems to be based on a balance between central ventilatory drives to breathe and mechanical loads placed on the respiratory system. Coexistent cardiopulmonary or neuromuscular disease in patients with obstructive sleep apnea contributes to the development of alveolar hypoventilation. During apneic episodes, the systemic blood pressure increases while the heart rate and cardiac output decrease. Both bradycardias and increased ventricular ectopic activity have been associated with these disordered breathing episodes. Because of the possibility of apnea-associated arrhythmias, patients with obstructive sleep apnea may be at increased risk for cardiovascular mortality. The influence of these recurrent nocturnal episodes of asphyxia on cardiovascular longevity needs further investigation. PMID:2205763

  20. Treating Sleep Apnea: A Review of the Research for Adults

    MedlinePLUS

    ... Adults" /> Consumer Summary – Aug. 8, 2011 Treating Sleep Apnea: A Review of the Research for Adults ... gov/apnea.cfm . Understanding Your Condition What is sleep apnea? Obstructive sleep apnea (pronounced AP-nee-ah), ...

  1. Diagnosis of Obstructive Sleep Apnea in Adults

    MedlinePLUS

    Diagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians The full report is titled “Diagnosis of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From ...

  2. Pediatric Sleep Apnea

    PubMed Central

    Ievers-Landis, Carolyn E.; Redline, Susan

    2007-01-01

    Over the last 30 years, the prevalence of overweight across all pediatric age groups and ethnicities has increased substantially, with the current prevalence of overweight among adolescents estimated to be approximately 30%. Current evidence suggests that overweight is modestly associated with obstructive sleep apnea syndrome (OSAS) among young children, but strongly associated with OSAS in older children and adolescents. The rising incidence of pediatric overweight likely will impact the prevalence, presentation, and treatment of childhood OSAS. The subgroup of children who may be especially susceptible include ethnic minorities and those from households with caregivers from low socioeconomic groups. OSAS, by exposing children to recurrent intermittent hypoxemia or oxidative stress, may amplify the adverse effects of adiposity on systemic inflammation and metabolic perturbations associated with vascular disease and diabetes. When these conditions manifest early in life, they have the potential to alter physiology at critical developmental stages, or, if persistent, provide cumulative exposures that may powerfully alter long-term health profiles. An increased prevalence of overweight also may impact the response to adenotonsillectomy as a primary treatment for childhood OSAS. The high and anticipated increased prevalence of pediatric OSAS mandates assessment of optimal approaches for preventing and treating both OSAS and overweight across the pediatric age range. In this Pulmonary Perspective, the interrelationships between pediatric OSAS and overweight are reviewed, and the implications of the overweight epidemic on childhood OSAS are discussed. PMID:17158283

  3. A Novel Adaptive Servoventilation (ASVAuto) for the Treatment of Central Sleep Apnea Associated with Chronic Use of Opioids

    PubMed Central

    Cao, Michelle; Cardell, Chia-Yu; Willes, Leslee; Mendoza, June; Benjafield, Adam; Kushida, Clete

    2014-01-01

    Study Objectives: To compare the efficacy and patient comfort of a new mode of minute ventilation-targeted adaptive servoventilation (ASVAuto) with auto-titrating expiratory positive airway pressure (EPAP) versus bilevel with back-up respiratory rate (bilevel-ST) in patients with central sleep apnea (CSA) associated with chronic use of opioid medications. Methods: Prospective, randomized, crossover polysomnography (PSG) study. Eighteen consecutive patients (age ? 18 years) who had been receiving opioid therapy (? 6 months), and had sleep disordered breathing with CSA (central apnea index [CAI] ? 5) diagnosed during an overnight sleep study or positive airway pressure (PAP) titration were enrolled to undergo 2 PSG studies—one with ASVAuto and one with bilevel-ST. Patients completed 2 questionnaires after each PSG; Morning After Patient Satisfaction Questionnaire and PAP Comfort Questionnaire. Results: Patients had a mean age of 52.9 ± 15.3 years. PSG prior to randomization showed an apnea hypopnea index (AHI) of 50.3 ± 22.2 and CAI of 13.0 ± 18.7. Titration with ASVAuto versus bilevel-ST showed that there were significant differences with respect to AHI and CAI. The AHI and CAI were significantly lower on ASVAuto than bilevel-ST (2.5 ± 3.5 versus 16.3 ± 20.9 [p = 0.0005], and 0.4 ± 0.8 versus 9.4 ± 18.8 [p = 0.0002], respectively). Respiratory parameters were normalized in 83.3% of patients on ASVAuto versus 33.3% on bilevel-ST. Patients felt more awake and alert on ASVAuto than bilevel-ST based on scores from Morning After Patient Satisfaction Questionnaire (p = 0.0337). Conclusions: The ASVAuto was significantly more effective than bilevel-ST for the treatment of CSA associated with chronic opioid use. Citation: Cao M, Cardell CY, Willes L, Mendoza J, Benjafield A, Kushida C. A novel adaptive servoventilation (ASVAuto) for the treatment of central sleep apnea associated with chronic use of opioids. J Clin Sleep Med 2014;10(8):855-861. PMID:25126031

  4. Comorbidities in Infants with Obstructive Sleep Apnea

    PubMed Central

    Qubty, William F.; Mrelashvili, Anna; Kotagal, Suresh; Lloyd, Robin M.

    2014-01-01

    Study Objective: The clinical characteristics of obstructive sleep apnea (OSA) in infants have been insufficiently characterized. Our aim was to describe identifiable comorbidities in infants with obstructive sleep apnea, which may assist in recognizing these patients earlier in their disease course and help improve management. Methods: This was a single-center, retrospective study involving infants 0-17 months of age with a diagnosis of OSA on the basis of clinical features and nocturnal polysomnography (PSG) at the Mayo Clinic Center for Sleep Medicine between 2000 and 2011. Patients were excluded if they had central apnea accounting for greater than 50% of respiratory events. OSA severity was determined by the apnea-hypopnea index (AHI). Results: One hundred thirty-nine patients were included. Based upon the AHI, they were subdivided into mild (AHI < 5; 30%), moderate (AHI 5-9; 30%), or severe (AHI > 10; 40%) categories. Comorbidities included gastroesophageal reflux in 95/139 (68%), periodic limb movements in sleep in 59/139 (42%), craniofacial abnormalities in 52/139 (37%), neuromuscular abnormalities in 47/139 (34%), prematurity in 41/139 (29%), genetic syndromes in 41/139 (29%), laryngomalacia/tracheomalacia in 38/139 (27%), and epilepsy in 23/139 (17%) of subjects. Severity of OSA correlated with prematurity, having a genetic syndrome, or neuromuscular abnormality. Multispecialty evaluation was needed for 119/139 (86%). Conclusion: Comorbidities in infants with OSA differ from those of older children. Based upon the comorbidities identified in our study population, it appears that appropriate management of infants with OSA requires a multidisciplinary approach involving genetics, gastroenterology, pulmonology, otolaryngology, neurology, and general pediatrics. Citation: Qubty WF, Mrelashvili A, Kotagal S, Lloyd RM. Comorbidities in infants with obstructive sleep apnea. J Clin Sleep Med 2014;10(11):1213-1216. PMID:25325583

  5. Oral Appliance Therapy for Obstructive Sleep Apnea

    MedlinePLUS

    ... Also, criteria developed by the American Academy of Sleep Medicine (AASM) de ne obstructive sleep apnea as a ... dental professionals who have advanced training in dental sleep medicine. Patients are referred for this treatment by their ...

  6. 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

  7. Sleep apnea syndrome after irradiation of the neck

    SciTech Connect

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

    1989-12-01

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

  8. Sleep Related Expiratory Obstructive Apnea in Children

    PubMed Central

    Haupt, Mark E.; Goodman, Denise M.; Sheldon, Stephen H.

    2012-01-01

    Study Objectives: We describe the respiratory, cardiac, and sleep-related characteristics of two types of sleep-related respiratory pauses in children that can fulfill current criteria of pathological apnea, but often seem to be benign: prolonged expiratory apnea (PEA) and post-sigh central apnea (PSCA). Methods: All outpatient comprehensive overnight polysomnography completed on children without significant underlying medical conditions completed during an 18-month period were retrospectively reviewed for the presence of augmented breaths followed by a respiratory pause. Events were identified as a PEA or PSCA based on characteristic features. Physiologic parameters associated with the respiratory events were recorded and compared. Results: Fifty-seven (29 PEA and 28 PEA) events were identified in 17 patients (8.5 ± 3.5 years old). Median durations of PEA and PSCA were not significantly different. For both PEA and PSCA, average heart rate (HR) during the augmented breath before the respiratory pause differed from lowest instantaneous HR during the first half of the pause. When compared to each other, the lowest instantaneous HR recorded in the first half of PEA was lower than that for PSCA (63.9 [59.41–68.3] vs 66.75 [61.7–80.75]) beats per min, p = 0.03. No PEA or PSCA event was associated with an oxygen desaturation more than 3% from baseline. Conclusion: PEA and PSCA have stereotypic HR changes and resemble pathologic apneas but appear to be benign. Clinical significance of PEA and PSCA is yet to be determined. Consistent recognition of the events is required, given their frequency of occurrence and potential for misclassification. Citation: Haupt ME; Goodman DM; Sheldon SH. Sleep related expiratory obstructive apnea in children. J Clin Sleep Med 2012;8(6):673-679. PMID:23243401

  9. Problems in automatic sleep scoring applied to sleep apnea

    Microsoft Academic Search

    T. Penzel; K. Kesper; V. Gross; H. F. Becker; C. Vogelmeier

    2003-01-01

    Automatic sleep analysis is used in the daily work of sleep centers working with digital polysomnography. Automatic sleep analysis has a limited accuracy in the sleep of healthy volunteers with approximately 80% conformance depending on definition. The problem of limited accuracy is even more severe in sleep disorders. Sleep apnea is a sleep disorder with a high prevalence which requires

  10. Baroreflex modulation during sleep and in obstructive sleep apnea syndrome.

    PubMed

    Cortelli, P; Lombardi, C; Montagna, P; Parati, G

    2012-07-01

    This review focuses on the complex integration between cardiovascular reflexes and central autonomic influences controlling physiological sleep-dependent changes in arterial blood pressure and heart rate. A brief introduction on the anatomic and functional organization of the arterial baroreflex and the methods available to assess its function in humans is followed by an analysis of the functional interaction between autonomic nervous system and sleep mechanisms at the highest levels of brain organization. An insight into these interactions is important to shed light on the physiopathology of the most frequent complications of obstructive sleep apnea syndrome, such as sustained arterial hypertension, and excessive daytime sleepiness. PMID:22465134

  11. [Glaucoma and sleep apnea syndrome].

    PubMed

    Blumen-Ohana, E; Blumen, M; Aptel, F; Nordmann, J P

    2011-06-01

    Glaucomatous optic neuropathy is multifactorial, with currently one known and modifiable risk factor, with good results on the prognosis and intraocular pressure. Nevertheless, some patients may experience progression of their neuropathy even though their intraocular pressure seems appropriately controlled. Vascular risk factors are hypothesized and researched. Obstructive sleep apnea syndrome (OSAS) could be considered one of these risk factors. Screening for this cardiovascular risk factor in glaucomatous patients presenting evocative signs, should be proposed. PMID:21507510

  12. Sleep Apnea and Cardiovascular Disease

    Microsoft Academic Search

    Alexander G. Logan; T. Douglas Bradley

    2010-01-01

    Cardiovascular disease is still the leading cause of death in North America. To improve outcomes, it will likely be necessary\\u000a to identify new potentially treatable conditions. Sleep apnea affects approximately 50% of patients with cardiovascular disease\\u000a and is associated with increased cardiovascular risk. Continuous positive airway pressure is currently the treatment of choice\\u000a and has many short-term favorable effects. The

  13. Complex sleep apnea unmasked by the use of a mandibular advancement device

    Microsoft Academic Search

    Tomasz J. Ku?niar; Ružica Kova?evi?-Ristanovi?; Thomas Freedom

    2011-01-01

    According to most accepted definitions, complex sleep apnea syndrome (CompSAS) is described as an emergence of central apneas\\u000a in a patient with obstructive sleep apnea (OSA) upon introduction of continuous positive airway pressure therapy (CPAP). We\\u000a present two patients who developed comparable central apnea activity when treated with either a CPAP device or a mandibular\\u000a advancement device. As similar findings

  14. Perianesthesia implications of obstructive sleep apnea.

    PubMed

    Strauss, Penelope Z

    2015-01-01

    Obstructive sleep apnea (OSA) is a complex medical condition that affects not only the airway but also the cardiopulmonary, endocrine, and central nervous systems. Obstructive sleep apnea can usually be identified with a focused history and physical examination and is commonly associated with obese, middle-aged men with hypertension and glucose intolerance. A high index of suspicion for OSA should arise when reports of loud snoring, nighttime arousal, and acid reflux accompanied by a history of stroke, atrial fibrillation, or congestive heart failure are elicited during a perianesthesia evaluation. Perianesthesia risk in OSA patients includes the potential for difficult airway management, cardiovascular instability, and abnormal sensitivity to sedation and analgesia. Typical doses of respiratory depressants may cause profound hypoventilation, apnea, or cardiopulmonary arrest in OSA patients. Central axial opioids and continuous intravenous opioid infusions should be avoided while nonopioid and non-centrally acting analgesics are recommended. Careful postoperative monitoring is important to preventing serious morbidity. Early identification of OSA and its comorbidities is key to developing a safe anesthesia and postoperative treatment plan. PMID:25463010

  15. Pathophysiology of Pediatric Obstructive Sleep Apnea

    Microsoft Academic Search

    Eliot S. Katz; Carolyn M. D'Ambrosio

    2008-01-01

    The essential feature of obstructive sleep apnea (OSA) in chil- dren is increased upper airway resistance during sleep. Airway narrowing may be due to craniofacial abnormalities and\\/or soft tissue hypertrophy. The resultant breathing patterns during sleep are highly variable, but include obstructive cycling, in- creased respiratory effort, flow limitation, tachypnea, and\\/or gas exchange abnormalities. Consequently, sleep disruption occurs, ranging from

  16. Upper Airway Imaging in Sleep Apnea Syndrome

    Microsoft Academic Search

    R. Basto; D. Rodenstein

    2006-01-01

    Obstructive sleep apnea is due to repetitive obstructions of the collapsible pharyngeal airway during sleep. It is therefore natural to search for local anatomical abnormalities to unveil the possible causes of the disease, and to look for potential curative interventions. Up to now, imaging of the upper airway has contributed more to the understanding of the pathophysiology of obstructive sleep

  17. Sleep apnea in patients with hemispheric stroke

    Microsoft Academic Search

    Vahid Mohsenin; Raul Valor

    1995-01-01

    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

  18. Impaired cerebral autoregulation in obstructive sleep apnea

    NSDL National Science Digital Library

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

    2008-10-08

    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.

  19. Sleep and breathing disorders: the genesis of obstructive sleep apnea.

    PubMed

    Foresman, B H

    2000-08-01

    Sleep encompasses approximately a third of our lives; however, sleep and the disorders of sleep are not widely understood. Data suggest that sleep plays a restorative role in physiologic mechanisms and that long-term disruption of sleep may contribute to the development of disease. Nearly a third of the adult population is chronically afflicted by sleep disorders, and substantial economic loss is attributable to these disorders in terms of lost time, inefficiency, and accidents. Of the sleep disorders, obstructive sleep apnea (OSA) is one of the more common, clinically affecting up to 5% of the adult population. Obstructive sleep apnea contributes to the development of disease and has an adverse impact on daytime functioning in those affected by the disease. This article reviews basic sleep physiology, how these physiologic mechanisms are disrupted by OSA, and some of the techniques for treating patients with this disorder. PMID:11002613

  20. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses.

    PubMed

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

    2012-01-01

    The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. The preponderance of evidence on the treatment of CSAS supports the use of continuous positive airway pressure (CPAP). Much of the evidence comes from investigations on CSAS related to congestive heart failure (CHF), but other subtypes of CSAS appear to respond to CPAP as well. Limited evidence is available to support alternative therapies in CSAS subtypes. The recommendations for treatment of CSAS are summarized as follows: CPAP therapy targeted to normalize the apnea-hypopnea index (AHI) is indicated for the initial treatment of CSAS related to CHF. (STANDARD)Nocturnal oxygen therapy is indicated for the treatment of CSAS related to CHF. (STANDARD)Adaptive Servo-Ventilation (ASV) targeted to normalize the apnea-hypopnea index (AHI) is indicated for the treatment of CSAS related to CHF. (STANDARD)BPAP therapy in a spontaneous timed (ST) mode targeted to normalize the apnea-hypopnea index (AHI) may be considered for the treatment of CSAS related to CHF only if there is no response to adequate trials of CPAP, ASV, and oxygen therapies. (OPTION)The following therapies have limited supporting evidence but may be considered for the treatment of CSAS related to CHF after optimization of standard medical therapy, if PAP therapy is not tolerated, and if accompanied by close clinical follow-up: acetazolamide and theophylline. (OPTION)Positive airway pressure therapy may be considered for the treatment of primary CSAS. (OPTION)Acetazolamide has limited supporting evidence but may be considered for the treatment of primary CSAS. (OPTION)The use of zolpidem and triazolam may be considered for the treatment of primary CSAS only if the patient does not have underlying risk factors for respiratory depression. (OPTION)The following possible treatment options for CSAS related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (OPTION) . PMID:22215916

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

    PubMed Central

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

    2013-01-01

    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

  2. Making Sense of Oxidative Stress in Obstructive Sleep Apnea: Mediator or Distracter?

    PubMed Central

    Zhang, Jing; Veasey, Sigrid

    2012-01-01

    Obstructive sleep apnea is increasingly recognized as an important contributor to cognitive impairment, metabolic derangements, and cardiovascular disease and mortality. Identifying the mechanisms by which this prevalent disorder influences health outcomes is now of utmost importance. As the prevalence of this disorder steadily increases, therapies are needed to prevent or reverse sleep apnea morbidities now more than ever before. Oxidative stress is implicated in cardiovascular morbidities of sleep apnea. What role oxidative stress plays in neural injury and cognitive impairments has been difficult to understand without readily accessible tissue to biopsy in persons with and without sleep apnea. An improved understanding of the role oxidative stress plays in neural injury in sleep apnea may be developed by integrating information gained examining neural tissue in animal models of sleep apnea with key features of redox biochemistry and clinical sleep apnea studies where extra-neuronal oxidative stress characterizations have been performed. Collectively, this information sets the stage for developing and testing novel therapeutic approaches to treat and prevent, not only central nervous system injury and dysfunction in sleep apnea, but also the cardiovascular and potentially metabolic conditions associated with this prevalent, disabling disorder. PMID:23293626

  3. Epidemiology of Pediatric Obstructive Sleep Apnea

    Microsoft Academic Search

    Julie C. Lumeng; Ronald D. Chervin

    2008-01-01

    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

  4. Association of Hypothyroidism and Obstructive Sleep Apnea

    Microsoft Academic Search

    VISHESH K. KAPUR; THOMAS D. KOEPSELL; RICHARD HERT; ROBERT E. SANDBLOM; BRUCE M. PSATY

    1998-01-01

    Obstructive sleep apnea (OSA) and hypothyroidism are relatively common disorders that have similar clinical features and are thought to be causally linked. We sought to determine the prevalence of pre- viously unrecognized hypothyroidism in a series of patients evaluated for OSA and whether an associ- ation between hypothyroidism and OSA was present. Chart review was used to obtain information on

  5. Does nasal decongestion improve obstructive sleep apnea?

    PubMed

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

    2008-12-01

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

  6. Does obstructive sleep apnea worsen during REM sleep?

    PubMed

    Peregrim, I; Grešová, S; Pallayová, M; Fulton, B L; Štimmelová, J; Ba?ová, I; Miku?aková, A; Tomori, Z; Doni?, V

    2013-01-01

    Although it is thought that obstructive sleep apnea (OSA) is worse during rapid eye movement (REM) sleep than in non-REM (NREM) sleep there are some uncertainties, especially about apnoe-hypopnoe-index (AHI). Several studies found no significant difference in AHI between both sleep stages. However, REM sleep is associated more with side sleeping compared to NREM sleep, which suggests that body position is a possible confounding factor. The main purpose of this study was to compare the AHI in REM and NREM sleep in both supine and lateral body position. A retrospective study was performed on 422 consecutive patients who underwent an overnight polysomnography. Women had higher AHI in REM sleep than NREM sleep in both supine (46.05+/-26.26 vs. 23.91+/-30.96, P<0.01) and lateral (18.16+/-27.68 vs. 11.30+/-21.09, P<0.01) body position. Men had higher AHI in REM sleep than NREM sleep in lateral body position (28.94+/-28.44 vs. 23.58+/-27.31, P<0.01), however, they did not reach statistical significance in supine position (49.12+/-32.03 in REM sleep vs. 45.78+/-34.02 in NREM sleep, P=0.50). In conclusion, our data suggest that REM sleep is a contributing factor for OSA in women as well as in men, at least in lateral position. PMID:24020811

  7. Obstructive Sleep Apnea, Immuno-Inflammation and Atherosclerosis

    E-print Network

    Paris-Sud XI, Université de

    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

  8. [Obstructive sleep apnea syndrome in children].

    PubMed

    Aubertin, G

    2013-08-01

    Obstructive sleep apnea (OSA) is highly prevalent in school-aged children. Tonsillar and/or adenoids hypertrophy is the most common etiology of OSA in children. OSA has been associated with sleep quality disturbance (frequent arousals) and nocturnal gas-exchange abnormalities (hypoxemia and sometimes hypercapnia), complicated with a large array of negative health outcomes. The clinical symptoms are not able to distinguish primary snoring from OSA. Polysomnography remains the gold standard for the diagnosis of sleep disordered breathing, but the demand is increasing for this highly technical sleep test. So, some other simpler diagnostic methods are available, as respiratory polygraphy, but need to be validated in children. Treatment of OSA in children must be based on a mutlidisciplinary approach with pediatricians, ENT surgeons and orthodontists. PMID:23870386

  9. Mallampati Score and Pediatric Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

    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

  10. Sleep Architecture and Respiratory Disturbances in Children with Obstructive Sleep Apnea

    Microsoft Academic Search

    DANIEL Y. T. GOH; PATRICIA GALSTER; CAROLE L. MARCUS

    Little is known regarding sleep architecture in children with the obstructive sleep apnea syndrome (OSAS). We hypothesized that sleep architecture was normal, and that apnea increased over the course of the night, in children with OSAS. We analyzed polysom- nographic studies from 20 children with OSAS and 10 control sub- jects. Sleep architecture was similar between the groups. Of ob-

  11. Gender Differences in the Polysomnographic Features of Obstructive Sleep Apnea

    Microsoft Academic Search

    KRISTINE S. THORNLEY; PATRICK J. HANLY

    We examined the influence of gender on the polysomnographic features of obstructive sleep apnea (OSA) in a retrospective study of 830 patients with OSA diagnosed by overnight polysomnogra- phy (PSG). The severity of OSA was determined from the apnea- hypopnea index (AHI) for total sleep time (AHI TST ), and was clas- sified as mild (5 to 25 events\\/h), moderate

  12. Emerging therapies for obstructive sleep apnea.

    PubMed

    Akinnusi, Morohunfolu; Saliba, Ranime; El-Solh, Ali A

    2012-08-01

    Obstructive sleep apnea (OSA) is a prevalent disorder often associated with daytime sleepiness, cognitive dysfunction, and adverse cardiovascular consequences. Available therapies are limited by either lack of long-term adherence or low response rates. Two emerging therapies hold promise in providing alternatives to patients with OSA. The first stems from the importance of the upper-airway dilator muscles in maintaining pharyngeal stability. Electrical stimulation of the genioglossus muscle improves both upper-airway diameter and ameliorates pharyngeal obstruction. The results of phase I and II clinical trials hold promise, but the reported improvements in the apnea-hypopnea index vary between subjects and concerns about long-term safety await long-term studies. The second technology relies on creating an increased expiratory nasal resistance via a bidirectional valve designed to be worn just inside the nostrils. Initial findings of clinical trials suggest reduction in severity of sleep apnea and subjective daytime sleepiness. Considerable heterogeneity in response to the nasal device was noted despite the high adherence rates. It remains unclear which patients will likely benefit a priori from these devices. PMID:22366855

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

    PubMed

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

    2014-01-01

    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

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

    E-print Network

    Boyer, Edmond

    Sleep Apnea Syndrome is defined as repeated episodes of obstructive hypopnea and apnea during sleepWhen 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

  15. Nasal Involvement in Obstructive Sleep Apnea Syndrome

    PubMed Central

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

    2014-01-01

    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

  16. Childhood obesity and obstructive sleep apnea.

    PubMed

    Narang, Indra; Mathew, Joseph L

    2012-01-01

    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

  17. Sleep apnea syndrome in endocrine clinics.

    PubMed

    Ceccato, F; Bernkopf, E; Scaroni, C

    2015-08-01

    Obstructive sleep apnea syndrome (OSAS) is a chronic condition with a high prevalence (up to 7 % of the general population) characterized by frequent episodes of upper airway collapse while sleeping. Left untreated, OSAS can cause severe complications, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. This review aims to summarize the close links between OSAS, endocrinology, and metabolism. In patients with metabolic syndrome, OSAS is an independent risk factor for the onset of type 2 diabetes and a worsening glycemic control. The accumulation of adipose tissue in the neck and limited chest wall dynamics, hypoxia, and local micro-inflammation link visceral obesity closely with OSAS. There is now an abundance of convincing data indicating that promoting lifestyle changes, improving sleep hygiene, and adjusting diet can ameliorate both metabolic syndrome and OSAS, especially in obese patients. The incidence of OSAS in acromegaly is high, though GH treatments seem to be unrelated to the onset of apnea in GH-deficient individuals. Prospective studies have suggested an association between hypertension and OSAS because intermittent nocturnal hypoxia prompts an increase in sympathetic tone, endothelial dysfunction, and vascular inflammation: aldosterone excess may have a pathophysiological role, and some authors have reported that treating OSAS leads to a modest, but significant, reduction in blood pressure. PMID:26122486

  18. Sleep in women: Normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension

    Microsoft Academic Search

    Carin Sahlin; Karl A. Franklin; Hans Stenlund; Eva Lindberg

    2009-01-01

    ObjectivesTo define normal values for total sleep time, sleep latency, sleep efficiency, sleep stages and sleeping positions in women and to investigate how sleep is affected by age, obesity, sleep apnea, smoking, alcohol dependency and hypertension.

  19. Obstructive sleep apnea and sedation in the endoscopy suite.

    PubMed

    Moos, Daniel D

    2006-01-01

    Patients with obstructive sleep apnea are at risk of mortality and morbidity related to the administration of sedatives, anesthetics, and opioids. Commonly employed sedatives and analgesics promote pharyngeal collapse and alter normal respiratory responses to obstruction and apnea. Literature concerning patients with obstructive sleep apnea undergoing moderate and deep sedation in the endoscopy suite is lacking. The purpose of this article is to provide the reader with a review of normal airway patency, the effects of obstructive sleep apnea on airway patency, and the impact that analgesics and sedatives may impart on the airway of patients with obstructive sleep apnea. The goal of this article is to increase awareness, stimulate discussions within the gastroenterological community, and encourage research regarding sedation in this at-risk population. PMID:17273012

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

    NASA Astrophysics Data System (ADS)

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

    2005-01-01

    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

  1. Obstructive sleep apnea syndrome: a literature review.

    PubMed

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

    2015-04-01

    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

  2. Delirium after cardiac surgery: have we overlooked obstructive sleep apnea?

    PubMed Central

    Mirrakhimov, Aibek E.; Yen, Timothy; Kwatra, Madan M.

    2013-01-01

    Obstructive sleep apnea is common in patients with cardiovascular disease. It is well known that cardiac surgery is a risk factor for delirium. Researchers have shown that obstructive sleep apnea is an independent risk factor for the occurrence of delirium. In this manuscript we speculate on how obstructive sleep apnea may increase the risk of delirium in patients with cardiac surgery. If this is found to be confirmed, we would have another target through which we can decrease the risk of delirium in this population. PMID:23618612

  3. Respiratory sound recordings for detection of sleep apnea

    NASA Astrophysics Data System (ADS)

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

    1999-03-01

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

  4. Detection of post apnea sounds and apnea periods from sleep sounds

    Microsoft Academic Search

    Ersin Karci; Yesim Serinagaoglu Dogrusoz; Tolga Ciloglu

    2011-01-01

    Obstructive Sleep Apnea Syndrome (OSAS) is defined as a sleep related breathing disorder that causes the body to stop breathing for about 10 seconds and mostly ends with a loud sound due to the opening of the airway. OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital, with multiple electrodes

  5. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study.

    PubMed

    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

    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

  6. Obstructive sleep apnea and cardiovascular disease: evidence and underlying mechanisms

    PubMed Central

    JEAN-LOUIS, G; ZIZI, F; BROWN, DB; OGEDEGBE, G; BORER, JS; McFARLANE, SI

    2011-01-01

    A body of epidemiologic and clinical evidence dating back to the early 1960s establishes the relationships between sleep apnea and cardiovascular disease (CVD). Individuals with obstructive sleep apnea, the most common type of sleep-disordered breathing, are at increased risk for coronary artery disease, congestive heart failure, and stroke. Evidence that treatment of sleep apnea with continuous positive airway pressure reduces blood pressure, improves left ventricular systolic function, and diminishes platelet activation further supports linkage between obstructive sleep apnea and CVD. Notwithstanding, complex associations between these two conditions remain largely unexplained due to dearth of systematic experimental studies. Arguably, several intermediary mechanisms including sustained sympathetic activation, intrathoracic pressure changes, and oxidative stress might be involved. Other abnormalities such as dysfunctions in coagulation factors, endothelial damage, platelet activation, and increased systemic inflammation might also play a fundamental role. This review examines evidence for the associations between obstructive sleep apnea and CVD and suggested underlying anatomical and physiological mechanisms. Specific issues pertaining to definition, prevalence, diagnosis, and treatment of sleep apnea are also discussed. Consistent with rising interest in the potential role of the metabolic syndrome, this review explores the hypothesized mediating effects of each of the components of the metabolic syndrome. PMID:21643544

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

    E-print Network

    Pennsylvania, University of

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

  8. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...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...

  9. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...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...

  10. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...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...

  11. Obstructive apnea during sleep is associated with peripheral vasoconstriction

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

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

    SciTech Connect

    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

    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.

  13. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration.

    PubMed

    Al Lawati, Nabil M; Patel, Sanjay R; Ayas, Najib T

    2009-01-01

    We will review the epidemiology, risk factors, and consequences of obstructive sleep apnea (OSA) and short/long sleep duration. Obstructive sleep apnea is a disease characterized by recurrent upper airway obstruction during sleep. Obstructive sleep apnea is common, with moderate to severe disease present in approximately 9% of middle aged men and 4% of women. The prevalence of OSA in certain patient populations (such as elderly patients, hypertensive patients, patients with coronary disease, and prebariatric surgery patients) is even greater. There are a number or risk factors for disease including obesity, male sex, and family history. Obstructive sleep apnea negatively impacts quality of life and is also associated with a number of adverse safety and health consequences including cardiovascular disease and motor vehicle crashes. Short habitual sleep duration can result in excessive daytime sleepiness and reduced neurocognitive function. Sleep loss may have long-term health consequences and may lead to premature death, cardiovascular disease, and the development of diabetes. PMID:19110130

  14. Epidemiological aspects of obstructive sleep apnea

    PubMed Central

    Garvey, John F.; Pengo, Martino F.; Drakatos, Panagis

    2015-01-01

    Obstructive sleep apnea (OSA) is probably the most common respiratory disorder, with recent data from the United States and Europe suggesting that between 14% and 49% of middle-aged men have clinically significant OSA. The intimate relationship between OSA and obesity means that its prevalence will only increase as the global obesity epidemic evolves. At an individual level, OSA leads to a significant decrease in quality of life (QOL) and functional capacity, alongside a markedly increased risk of cardiovascular disease and death. Emerging data also suggest that the presence and severity of OSA and associated nocturnal hypoxemia are associated with an increased risk of diabetes and cancer. At a societal level, OSA not only leads to reduced economic productivity, but also constitutes a major treatable risk factor for hypertension, coronary artery disease (CAD) and stroke. This article addresses OSA from an epidemiological perspective, from prevalence studies to economic aspects to co-morbidity.

  15. Hypoglossal nerve stimulation improves obstructive sleep apnea: 12-month outcomes.

    PubMed

    Kezirian, Eric J; Goding, George S; Malhotra, Atul; O'Donoghue, Fergal J; Zammit, Gary; Wheatley, John R; Catcheside, Peter G; Smith, Philip L; Schwartz, Alan R; Walsh, Jennifer H; Maddison, Kathleen J; Claman, David M; Huntley, Tod; Park, Steven Y; Campbell, Matthew C; Palme, Carsten E; Iber, Conrad; Eastwood, Peter R; Hillman, David R; Barnes, Maree

    2014-02-01

    Reduced upper airway muscle activity during sleep is a key contributor to obstructive sleep apnea pathogenesis. Hypoglossal nerve stimulation activates upper airway dilator muscles, including the genioglossus, and has the potential to reduce obstructive sleep apnea severity. The objective of this study was to examine the safety, feasibility and efficacy of a novel hypoglossal nerve stimulation system (HGNS; Apnex Medical, St Paul, MN, USA) in treating obstructive sleep apnea at 12 months following implantation. Thirty-one subjects (35% female, age 52.4 ± 9.4 years) with moderate to severe obstructive sleep apnea and unable to tolerate positive airway pressure underwent surgical implantation and activation of the hypoglossal nerve stimulation system in a prospective single-arm interventional trial. Primary outcomes were changes in obstructive sleep apnea severity (apnea-hypopnea index, from in-laboratory polysomnogram) and sleep-related quality of life [Functional Outcomes of Sleep Questionnaire (FOSQ)]. Hypoglossal nerve stimulation was used on 86 ± 16% of nights for 5.4 ± 1.4 h per night. There was a significant improvement (P < 0.001) from baseline to 12 months in apnea-hypopnea index (45.4 ± 17.5 to 25.3 ± 20.6 events h(-1) ) and Functional Outcomes of Sleep Questionnaire score (14.2 ± 2.0 to 17.0 ± 2.4), as well as other polysomnogram and symptom measures. Outcomes were stable compared with 6 months following implantation. Three serious device-related adverse events occurred: an infection requiring device removal; and two stimulation lead cuff dislodgements requiring replacement. There were no significant adverse events with onset later than 6 months following implantation. Hypoglossal nerve stimulation demonstrated favourable safety, feasibility and efficacy. PMID:24033656

  16. Characteristics of sleep apnea syndrome in tetraplegic patients

    Microsoft Academic Search

    E Stockhammer; A Tobon; F Michel; P Eser; W Scheuler; W Bauer; M Baumberger; W Müller; TH Kakebeeke; H Knecht; GA Zäch

    2002-01-01

    Objective: To include a larger number of tetraplegics than in previous studies, in order to more reliably characterize the pathogenesis and predisposing factors of sleep apnea in tetraplegia.Methods: Sleep breathing data and oxymetric values were investigated in 50 randomly selected tetraplegic patients and discussed in context with age, gender, BMI, neck circumference, type and height of lesion, time after injury,

  17. Defining association between sleep apnea syndrome and erectile dysfunction

    Microsoft Academic Search

    Patrick E. Teloken; Eric B. Smith; Chris Lodowsky; Thomas Freedom; John P. Mulhall

    2006-01-01

    ObjectivesTo conduct a study using validated sexual function and sleepiness inventories to define whether sleep apnea syndrome (SAS) is associated with erectile dysfunction and whether any correlation exists between the severity of SAS and the severity of erectile dysfunction. Previous work has suggested that sleep disorders are associated with erectile dysfunction.

  18. Pediatric Obstructive Sleep Apnea Syndrome: Time to Wake Up

    PubMed Central

    Namineni, Srinivas; Sampath, Ch

    2012-01-01

    ABSTRACT Pediatric patients with well-controlled OSA present few difficulties for routine dental treatment. However, patients with untreated or undiagnosed OSA can present the dental practitioner with multiple issues and challenges. Dental professionals have a unique doctor-patient relationship that affords them a role in recognizing sleep disorders by exploring the history of patients who are sleepy. Aim: This paper is aimed at providing comprehensive review of pediatric obstructive sleep apnea. How to cite this article: Arali V, Namineni S, Sampath Ch, Pediatric Obstructive Sleep Apnea Syndrome: Time to Wake Up. Int J Clin Pediatr Dent 2012;5(1):54-60. PMID:25206135

  19. Obstructive sleep apnea and the prevalence and incidence of cancer

    PubMed Central

    Kendzerska, Tetyana; Leung, Richard S.; Hawker, Gillian; Tomlinson, George; Gershon, Andrea S.

    2014-01-01

    Background: A link between obstructive sleep apnea and cancer development or progression has been suggested, possibly through chronic hypoxemia, but supporting evidence is limited. We examined the association between the severity of obstructive sleep apnea and prevalent and incident cancer, controlling for known risk factors for cancer development. Methods: We included all adults referred with possible obstructive sleep apnea who underwent a first diagnostic sleep study at a single large academic hospital between 1994 and 2010. We linked patient data with data from Ontario health administrative databases from 1991 to 2013. Cancer diagnosis was derived from the Ontario Cancer Registry. We assessed the cross-sectional association between obstructive sleep apnea and prevalent cancer at the time of the sleep study (baseline) using logistic regression analysis. Cox regression models were used to investigate the association between obstructive sleep apnea and incident cancer among patients free of cancer at baseline. Results: Of 10 149 patients who underwent a sleep study, 520 (5.1%) had a cancer diagnosis at baseline. Over a median follow-up of 7.8 years, 627 (6.5%) of the 9629 patients who were free of cancer at baseline had incident cancer. In multivariable regression models, the severity of sleep apnea was not significantly associated with either prevalent or incident cancer after adjustment for age, sex, body mass index and smoking status at baseline (apnea–hypopnea index > 30 v. < 5: adjusted odds ratio [OR] 0.96, 95% confidence interval [CI] 0.71–1.30, for prevalent cancer, and adjusted hazard ratio [HR] 1.02, 95% CI 0.80–1.31, for incident cancer; sleep time spent with oxygen saturation < 90%, per 10-minute increase: adjusted OR 1.01, 95% CI 1.00–1.03, for prevalent cancer, and adjusted HR 1.00, 95% CI 0.99–1.02, for incident cancer). Interpretation: In a large cohort, the severity of obstructive sleep apnea was not independently associated with either prevalent or incident cancer. Additional studies are needed to elucidate whether there is an independent association with specific types of cancer. PMID:25096668

  20. Three Sudden Postoperative Respiratory Arrests Associated with Epidural Opioids in Patients with Sleep Apnea

    Microsoft Academic Search

    Andreas M. Ostermeier; Michael F. Roizen; Martin Hautkappe; P. Allan Klock; Jerome M. Klafta

    1997-01-01

    urrent prominent textbooks on anesthesiology mention sleep apnea syndrome (SAS) only briefly. However, three patients in Illinois (two at one hospital) had sudden postoperative arrests as- sociated with epidural opioids and sleep apnea. We therefore reevaluated the literature, which suggests that epidural opioids are the therapy of choice for patients with sleep apnea (1). Of the 15 patients with SAS

  1. 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

  2. Definition of Sleep Apnea Event by One Minute HRV Spectrum Analysis

    Microsoft Academic Search

    Wenlong Xu; Zhijie Pan

    2008-01-01

    Obstructive sleep apnea (OSA) is accompanied by a characteristic cyclic variation in heart rate in the waveform of the electrocardiogram (ECG). If sleep apnea could be diagnosed using ECG only, it could be possible to diagnose sleep apnea inexpensively from ECG recordings acquired in the patient's home. The most informative feature is low frequency oscillation at about 0.02 Hz in

  3. Classification algorithms for predicting sleepiness and sleep apnea severity.

    PubMed

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

    2012-02-01

    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

  4. Obstructive sleep apnea and endothelial progenitor cells

    PubMed Central

    Wang, Qing; Wu, Qi; Feng, Jing; Sun, Xin

    2013-01-01

    Background Obstructive sleep apnea (OSA) occurs in 4% of middle-aged men and 2% of middle-aged women in the general population, and the prevalence is even higher in specific patient groups. OSA is an independent risk factor for a variety of cardiovascular diseases. Endothelial injury could be the pivotal determinant in the development of cardiovascular pathology in OSA. Endothelial damage ultimately represents a dynamic balance between the magnitude of injury and the capacity for repair. Bone marrow–derived endothelial progenitor cells (EPCs) within adult peripheral blood present a possible means of vascular maintenance that could home to sites of injury and restore endothelial integrity and normal function. Methods We summarized pathogenetic mechanisms of OSA and searched for available studies on numbers and functions of EPCs in patients with OSA to explore the potential links between the numbers and functions of EPCs and OSA. In particular, we tried to elucidate the molecular mechanisms of the effects of OSA on EPCs. Conclusion Intermittent hypoxia cycles and sleep fragmentation are major pathophysiologic characters of OSA. Intermittent hypoxia acts as a trigger of oxidative stress, systemic inflammation, and sympathetic activation. Sleep fragmentation is associated with a burst of sympathetic activation and systemic inflammation. In most studies, a reduction in circulating EPCs has emerged. The possible mechanisms underlying the decrease in the number or function of EPCs include prolonged inflammation response, oxidative stress, increased sympathetic activation, physiological adaptive responses of tissue to hypoxia, reduced EPC mobilization, EPC apoptosis, and functional impairment in untreated OSA. Continuous positive airway pressure (CPAP) therapy for OSA affects the mobilization, apoptosis, and function of EPCs through preventing intermittent hypoxia episodes, improving sleep quality, and reducing systemic inflammation, oxidative stress levels, and sympathetic overactivation. To improve CPAP adherence, the medical staff should pay attention to making the titration trial a comfortable first CPAP experience for the patients; for example, using the most appropriate ventilators or proper humidification. It is also important to give the patients education and support about CPAP use in the follow-up, especially in the early stage of the treatment. PMID:24204127

  5. Insomnia complaints in patients evaluated for obstructive sleep apnea

    Microsoft Academic Search

    Suzanne B. Krell; Vishesh K. Kapur

    2005-01-01

    Obstructive sleep apnea (OSA) and insomnia are among the most common sleep diagnoses encountered in the sleep clinic population,\\u000a however little is known about potential interactions or associations between the two disorders. This retrospective, cross-sectional\\u000a study was designed to determine the prevalence of insomnia complaints in patients undergoing evaluation for OSA and to ascertain\\u000a which clinical and polysomnographic features are

  6. [Psychiatric and psychological complications in obstructive sleep apnea syndrome].

    PubMed

    Ga?ecki, Piotr; Florkowski, Antoni; Zboralski, Krzysztof; Pietras, Tadeusz; Szemraj, Janusz; Talarowska, Monika

    2011-01-01

    It is estimated, that symptoms of obstructive sleep apnea syndrome (OSAS) affect 2 to 4% of the middle-aged population and their prevalence increases with age (over 50% people aged 65 and older suffer from OSAS). Among risk factors of OSAS we can distinguish: the male sex, race, overweight and obesity, thyroid hypofunction, age and alcohol abuse. Obstructive sleep apnea results in the absence (apnea) or reduction (hypopnea) of airflow lasting at least 10 s despite normal respiratory exertion. The apnea and hypopnea result in decreased oxygen saturation levels in the blood (hypoxemia). A number of consequences of OSAS can appear including: disruption of the sleep cycle, fragmentation of the sleep cycle, sleepiness, fatigue, headaches, cognitive impairments, irritability and mood disturbance, the higher risk of accidents at work and car accidents, the decrease of the quality of life and the higher risk of cardiovascular diseases. Besides various psychiatric and psychological complications presented in this review can occur in obstructive sleep apnea syndrome. PMID:21190150

  7. Sleep Apnea-Hypopnea Syndrome Without Excessive Daytime Sleepiness

    Microsoft Academic Search

    Concepción Hernández García

    2009-01-01

    Nowadays, sleepiness in patients with sleep apnea-hypopnea syndrome (SAHS) is understandable. It is somewhat more difficult to explain why most patients with SAHS enrolled in epidemiologic studies, even those with a high apnea-hypopnea index, do not experience excessive daytime sleepiness. The reasons for this discrepancy lie beyond mere polysomnographic events.This review examines data from the literature that may help us

  8. Obstructive Sleep Apnea and Diabetic Nephropathy

    PubMed Central

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

    2013-01-01

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

  9. Tongue Fat and its Relationship to Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

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

  10. Lack of Regular Exercise, Depression, and Degree of Apnea are Predictors of Excessive Daytime Sleepiness in Patients with Sleep Apnea: Sex Differences

    PubMed Central

    Basta, Maria; Lin, Hung-Mo; Pejovic, Slobodanka; Sarrigiannidis, Alexios; Bixler, Edward O.; Vgontzas, Alexandros N.

    2008-01-01

    Background: Apnea, depression, and metabolic abnormalities are independent predictors of excessive daytime sleepiness (EDS) in patients with sleep apnea. Exercise is beneficial for apnea, depression, and metabolic abnormalities; however, its association with EDS is not known. Study Objectives: To evaluate the contribution of lack of regular exercise, depression, and apnea severity on daytime sleepiness in patients with sleep apnea. Participants and Design: One thousand one hundred six consecutive patients (741 men and 365 women) referred to the sleep disorders clinic for symptoms consistent with sleep apnea. Daytime sleepiness was assessed with the Epworth Sleepiness Scale and activity was evaluated with a quantifiable Physical Activity Questionnaire. Results: Compared with women, men had a higher apnea hypopnea index (AHI) (40.4 ± 1.2 vs 31.0 ± 1.8), lower body mass index (BMI) (35.3 ± 0.3 kg/m2 vs 39.6 ± 0.5 kg/m2), and higher rate of regular exercise (39.1% vs 28.8%) (p < 0.05). Linear regression analysis of the total sample after adjusting for age, BMI, sex, central nervous system medication, and diabetes showed that logAHI, depression, and lack of regular exercise were significant predictors of sleepiness. Predictors of mild or moderate sleepiness for both sexes were depression and logAHI, whereas predictors of severe sleepiness for men were lack of regular exercise, depression, and minimum SaO2 and, for women, logAHI. Conclusions: In obese apneic patients, lack of regular exercise (only in men), depression, and degree of apnea are significant predictors of EDS. This association is modified by sex and degree of sleepiness. Assessment and management of depression and physical exercise should be part of a thorough evaluation of patients with sleep apnea. Citation: Basta M; Lin HM; Pejovic S; Sarrigiannidis A; Bixler EO; Vgontzas AN. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med 2008;4(1):19–25. PMID:18350958

  11. CPAP treats muscle cramps in patients with obstructive sleep apnea.

    PubMed

    Westwood, Andrew J; Spector, Andrew R; Auerbach, Sanford H

    2014-01-01

    We describe a case series of 4 patients with varying degrees of obstructive sleep apnea who incidentally had a history of nocturnal leg cramps. None of the patients had periodic limb movements during the study and denied symptoms consistent with restless legs syndrome. In 3 of the 4 patients, nocturnal leg cramps resolved with CPAP treatment for OSA, while the fourth patient noted near-resolution of cramping after starting CPAP. In patients presenting with muscle cramps, obstructive sleep apnea should be considered. PMID:24932152

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

    PubMed Central

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

    2012-01-01

    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

  13. Neurocognitive impairment in obstructive sleep apnea.

    PubMed

    Lal, Chitra; Strange, Charlie; Bachman, David

    2012-06-01

    Obstructive sleep apnea syndrome (OSAS) is a common disorder with far-reaching health implications. One of the major consequences of OSAS is an impact on neurocognitive functioning. Several studies have shown that OSAS has an adverse effect on inductive and deductive reasoning, attention, vigilance, learning, and memory. Neurocognitive impairment can be measured objectively with tests such as the Wechsler Adult Intelligence Scale-Revised, the Psychomotor Vigilance Task, the Steer Clear Performance Test, and tests of repetitive finger tapping. In children, OSAS may cause attention-deficit hyperactivity disorder in addition to behavioral problems and learning disabilities. Risk factors for cognitive impairment include increasing age, male sex, apolipoprotein E ?4 allele positivity, current cigarette smoking, obesity, hypertension, diabetes mellitus, metabolic syndrome, Down syndrome, hypothyroidism, significant alcohol consumption, stroke, and the use of psychoactive medications. At a cellular level, OSAS likely causes cognitive impairment through intermittent hypoxia, hormonal imbalance, and/or systemic inflammation, either independently or via the resultant endothelial dysfunction that occurs. Excessive daytime sleepiness should be measured and minimized in all studies of neurocognitive impairment. Recent studies have used functional and structural neuroimaging to delineate the brain areas affected in patients with OSAS with neurocognitive dysfunction. A common finding in several of these studies is decreased hippocampal volume. Other affected brain areas include the frontal and parietal lobes of the brain, which show focal reductions in gray matter. These changes can be reversed at least partially with the use of CPAP, which highlights the importance of early recognition and treatment of OSAS. The currently available data in this field are quite limited, and more research is needed. PMID:22670023

  14. Obstructive sleep apnea syndrome in patient with Creutzfeldt-Jakob disease. Clinical and morphological report.

    PubMed

    Jamrozik, Z; Przyby?owski, T; Zakrzewska-Pniewska, B; Rafa?owska, J

    1997-01-01

    We report a case of Creutzfeldt-Jakob disease (CJD) which at the beginning of the disease presented clinical syndrome of progressive supranuclear palsy. Rapid intellectual deterioration, supranuclear palsy, postural instability and myoclonic jerks suggested clinical diagnosis of CJD. After five months suffering from the disease patient developed obstructive sleep apnea syndrome (OSAS) confirmed by serial polysomnograms. OSAS is discussed in the context of the localization of histopathological findings and possible involvement of central autonomic structures. The main structures affected by spongiosis and astrogliosis were cortex, thalamus, basal ganglia and midbrain. OSAS was found as another sleep disturbance in CJD apart from insomnia and sleep-wake cycle abnormalities. PMID:9595849

  15. Sleep Apnea in Adults (Beyond the Basics)

    MedlinePLUS

    ... Collop, MD Nancy Collop, MD Editor-in-Chief — Sleep Medicine Section Editor — Sleep Related Breathing Disorders Professor of ... F Eichler, MD, MPH Deputy Editor — Neurology and Sleep Medicine Assistant Professor of Neurology Harvard Medical School Find ...

  16. Patient selection and surgical results in obstructive sleep apnea

    Microsoft Academic Search

    A. Dündar; M. Gerek; A. Özünlü; S. Yeti?er

    1997-01-01

    In recent years, therapeutic methods have been effective in the management of snoring and sleep apnea. Successful results\\u000a have been possible through conservative and surgical approaches when the nature and site of obstruction is ascertained by\\u000a careful investigation. Sagittal magnetic resonance imaging (MRI) of the upper respiratory tract has been the most valuable\\u000a diagnostic tool in patients with obstructive sleep

  17. A review of 50 children with obstructive sleep apnea syndrome

    Microsoft Academic Search

    C. Guilleminault; R. Korobkin; R. Winkle

    1981-01-01

    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%

  18. Degeneration in Arousal Neurons in Chronic Sleep Disruption Modeling Sleep Apnea

    PubMed Central

    Zhu, Yan; Fenik, Polina; Zhan, Guanxia; Xin, Ryan; Veasey, Sigrid C.

    2015-01-01

    Chronic sleep disruption (CSD) is a cardinal feature of sleep apnea that predicts impaired wakefulness. Despite effective treatment of apneas and sleep disruption, patients with sleep apnea may have persistent somnolence. Lasting wake disturbances in treated sleep apnea raise the possibility that CSD may induce sufficient degeneration in wake-activated neurons (WAN) to cause irreversible wake impairments. Implementing a stereological approach in a murine model of CSD, we found reduced neuronal counts in representative WAN groups, locus coeruleus (LC) and orexinergic neurons, reduced by 50 and 25%, respectively. Mice exposed to CSD showed shortened sleep latencies lasting at least 4 weeks into recovery from CSD. As CSD results in frequent activation of WAN, we hypothesized that CSD promotes mitochondrial metabolic stress in WAN. In support, CSD increased lipofuscin within select WAN. Further, examining the LC as a representative WAN nucleus, we observed increased mitochondrial protein acetylation and down-regulation of anti-oxidant enzyme and brain-derived neurotrophic factor mRNA. Remarkably, CSD markedly increased tumor necrosis factor-alpha within WAN, and not in adjacent neurons or glia. Thus, CSD, as observed in sleep apnea, results in a composite of lasting wake impairments, loss of select neurons, a pro-inflammatory, pro-oxidative mitochondrial stress response in WAN, consistent with a degenerative process with behavioral consequences. PMID:26074865

  19. Active glottal closure during central apneas limits oxygen desaturation in premature lambs.

    PubMed

    Reix, Philippe; Arsenault, Julie; Dome, Valerie; Fortier, Pierre-Hugues; Lafond, Joelle Rouillard; Moreau-Bussiere, Francois; Dorion, Dominique; Praud, Jean-Paul

    2003-05-01

    Our laboratory previously reported that active glottal closure was present in 90% of spontaneous central apneas in premature lambs while maintaining a high-apneic lung volume (Renolleau S, Letourneau P, Niyonsenga T, and Praud JP. Am J Respir Crit Care Med 159: 1396-1404, 1999.) The present study aimed at testing whether this mechanism limits postapnea oxygen desaturation. Four premature lambs were instrumented for recording states of alertness, thyroarytenoid muscle and diaphragm electromyographic (EMG) activity, nasal airflow, lung volume changes, and pulse oximetry. One thousand four hundred fifty-two spontaneous central apneas (isolated or during periodic breathing) were analyzed in nonsedated lambs. Apneas, with high lung volume maintained by active glottal closure, were compared with apneas, with a tracheostomy opened at apnea onset. Oxygen desaturation slopes were lower when high-apneic lung volume was actively maintained during both wakefulness and quiet sleep. Furthermore, oxygen desaturation slopes were lower after isolated apneas with continuous thyroarytenoid EMG during wakefulness, compared with apneas with noncontinuous thyroarytenoid EMG (= glottis opened shortly after apnea onset). These results highlight the importance of maintaining high-alveolar oxygen stores during central apneas by active glottal closure to limit desaturation in newborns. PMID:12524377

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

    PubMed

    Ra?cu, Agripina; Moise, Laura; Naghi, Eugenia; Handra, Claudia; O?elea, Marina; Ra?cu, Alexandra; L?c?tu?u, Lavinia

    2015-01-01

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

  1. The Influence of a Mandibular Advancement Plate on Polysomnography in Different Grades of Obstructive Sleep Apnea

    PubMed Central

    Mattila, Pauli; Huuskonen, Usko; Oikarinen, Kyösti; Sándor, George K.

    2015-01-01

    ABSTRACT Objectives The purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective. Material and Methods A total of 68 patients with obstructive sleep apnea syndrome (OSAS) including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD) and monitored with polysomnography. Results 25 of the 31 mild, 15 of the 23 moderate and 2 of the 14 severe OSAS patients were cured of their OSAS if a post treatment apnea-hypopnea index of less than 5 is regarded as cured. The odds ratios for success with MAD therapy are 3 for women over men, 14.9 for mild obstructive sleep apnea, 5.42 for moderate obstructive sleep apnea if severe obstructive sleep apnea is assigned an odds ratio of 1. Conclusions The use of the apnea-hypopnea index alone is useful in mild and moderate disease to predict the effectiveness of mandibular advancement device. Treatment with a mandibular advancement device is very effective in treating mild and moderate obstructive sleep apnea. Conservative treatment with a mandibular advancement device can be successful in less severe grades of sleep apnea and may be an alternative for non-surgical patients with severe obstructive sleep apnea intolerant of Continuous Positive Airway Pressure management. PMID:25937875

  2. Gender differences in the association of sleep apnea and inflammation.

    PubMed

    Gaines, Jordan; Vgontzas, Alexandros N; Fernandez-Mendoza, Julio; Kritikou, Ilia; Basta, Maria; Bixler, Edward O

    2015-07-01

    Over the last 15years, many studies have established an association of sleep apnea with inflammation and metabolic aberrations. However, no controlled studies have examined potential gender effects in this association. We recruited 120 middle-aged, predominantly non-obese mild-to-moderate sleep apneics and controls (62 males, 58 females). All participants underwent a clinical history, physical examination, and 1-night 8-h polysomnography recording and provided a single fasting blood sample for assessment of interleukin-6 (IL-6), tumor necrosis factor receptor 1 (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels. Among non-sleep apneics, females had higher levels of TNFR1 (p=0.01), CRP (p=0.005), leptin (p<0.001), and adiponectin (p<0.001) compared to males, independent of age and body mass index. When analyzed separately by gender, sleep apneic men had elevated TNFR1 (p=0.04), CRP (p=0.06) and IL-6 (p=0.11) relative to control men; in sleep apneic females, only CRP was elevated (p=0.04). Furthermore, CRP was associated with apnea severity in a dose-response manner (p-linear=0.04 in both genders) and was independently associated with comorbid hypertension in apnea (p-linear=0.005 for women; p-linear=0.09 for men). In conclusion, although women have naturally higher levels of inflammatory and metabolic markers than men, sleep apneic men appear to have a more severe inflammatory profile compared to women. Our findings suggest that these markers should be analyzed and interpreted separately in men and women, and that a single measure of plasma CRP appears to be a clinically-useful marker of apnea severity and comorbid cardiovascular morbidity. PMID:25535861

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

    PubMed Central

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

    2013-01-01

    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

  4. Getting a Diagnosis for Sleep Apnea

    MedlinePLUS

    ... of Internal Medicine and the American Board of Sleep Medicine . You should feel free to ask any doctor ... centers are accredited by the American Academy of Sleep Medicine and you can find them listed here . Others ...

  5. Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome.

    PubMed

    Mutlu, Murad; Bay?r, Omer; Yüceege, Melike B; Karagöz, Tu?ba; F?rat, Hikmet; Ozdek, Ali; Ak?n, Istemihan; Korkmaz, Hakan

    2014-10-01

    Obstructive sleep apnea syndrome (OSAS) provokes oxidative stress and ischemia, which affects the central nervous system. The degeneration of neurons in the brainstem due to periodic hypoxia can be evaluated by vestibular and audiologic tests. The objective of this study is to determine brainstem damage in severe OSAS patients with the help of vestibular evoked myogenic potential (VEMP) responses. Prospective, randomize, double-blind. Research-training hospital. We compared cervical vestibular evoked myogenic potential (cVEMP) responses between severe OSAS patients and a control group. 54 patients were included and divided into the OSAS group, with severe OSAS (apnea-hypopnea index, AHI >70), and a control group with snoring without OSAS (AHI <5). Both groups underwent cVEMP. Bilateral recordings with simultaneous binaural logon stimulations were used during VEMP recordings. The existing p1n1 and n2p2 responses, p1, n1, n2, and p2 latencies and amplitudes, and p1n1 and n2p2 intervals were measured. Statistically significant differences were revealed between patients and controls for the response rate of the p1n1, n2p2 and p1n1, n2p2 amplitudes. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, or the p1n1 and n2p2 intervals. The VEMP response rate was lower in severe OSAS patients, and all amplitudes were shorter than in healthy subjects. VEMP recordings in severe OSAS subjects demonstrates abnormalities in brainstem pathways. It appears that brainstem damage in severe OSAS can be detected by cVEMP recordings. PMID:25288372

  6. Detection and screening of sleep apnea using spectral and time domain analysis of heart rate variability

    Microsoft Academic Search

    Abed Elhamid Lawabni; Ahmed H. Tewfik

    2003-01-01

    Sleep apnea syndrome (SAS) is one of the most common breathing related sleep disorders. Sleep apnea (SA) may be of particular concern in chronic heart failure patients due to its high levels of cardiovascular morbidity and mortality. Our aim was to assess the diagnostic potential of SA using spectral analysis of nocturnal heart rate, and to introduce new simple time

  7. AN IMPROVED APPROACH FOR REAL-TIME DETECTION OF SLEEP APNEA

    E-print Network

    Minn, Hlaing

    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

  8. PHYSICAL MODELING OF AIRFLOW-WALLS INTERACTIONS TO UNDERSTAND THE SLEEP APNEA SYNDROME

    E-print Network

    Boyer, Edmond

    Cedex, France. 1. ABSTRACT Sleep Apnea Syndrome (SAS) is defined as a partial or total closurePHYSICAL MODELING OF AIRFLOW-WALLS INTERACTIONS TO UNDERSTAND THE SLEEP APNEA SYNDROME Y. Payan1 of the patient upper airways during sleep. The term "collapsus" (or collapse) is used to describe this closure

  9. FINITE ELEMENT MODELS OF THE TONGUE AND VELUM FOR A PHYSICAL UNDERSTANDING OF SLEEP APNEA SYNDROME

    E-print Network

    Payan, Yohan

    ) is defined as a partial or total closure (collapse) of the patient's upper airways during sleep. From a fluidFINITE ELEMENT MODELS OF THE TONGUE AND VELUM FOR A PHYSICAL UNDERSTANDING OF SLEEP APNEA SYNDROME Y. Payan 1 , P. Perrier 2 , C. Vilain2 and X. Pelorson2 1. ABSTRACT Sleep Apnea Syndrome (SAS

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

    E-print Network

    Payan, Yohan

    , France {pelorson,perrier}@icp.inpg.fr Abstract. Sleep Apnea Syndrome (SAS) is defined as a partialPhysical Modeling of Airflow-Walls Interactions to Understand the Sleep Apnea Syndrome Yohan Payan1 or total closure of the patient upper airways during sleep. The term "collapsus" (or collapse) is used

  11. Physiological Effects of Obstructive Sleep Apnea Syndrome in Childhood

    PubMed Central

    Muzumdar, Hiren; Arens, Raanan

    2013-01-01

    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

  12. When to Suspect Sleep Apnea and What to Do About It.

    PubMed

    Kimoff, R John

    2015-07-01

    Obstructive sleep apnea (OSA), which is characterized by recurrent upper airway obstruction during sleep with resultant hypoxia-reoxygenation and sleep fragmentation, is prevalent among patients with cardiovascular disease. Refractory hypertension, nocturnal angina or arrhythmias, and stroke in particular should prompt consideration of OSA. The symptoms of OSA include snoring and excessive daytime sleepiness; risk factors include obesity and reduced upper airway dimensions. Up to 50% of patients with congestive heart failure (CHF) may manifest OSA, central sleep apnea-Cheyne-Stokes respiration (CSA-CSR), or both. Patients with CSA-CSR may present with fatigue, disrupted sleep, and paroxysmal nocturnal dyspnea. Objective sleep recording is required to document the nature and severity of sleep apnea. The gold standard is in-laboratory overnight polysomnography (PSG), including monitoring of electroencephalography and other signals to determine sleep-wake state, and recording of body position, airflow, respiratory effort, and pulse oximetry. Portable cardiorespiratory recorders are now approved for diagnosis in patients without comorbidities. Full PSG is recommended for diagnosis in all other cases, although OSA and CSA-CSR can be identified from portable recorders in some patients with CHF and other conditions. The objectives of treatment are to improve symptoms, quality of life, and cardiovascular outcomes. The mainstay of treatment for moderate-to-severe OSA is positive airway pressure (PAP). Automated PAP devices may be used in uncomplicated OSA, whereas continuous fixed PAP is the treatment of choice for other patients with OSA, and may also treat a proportion of patients with CSA-CSR. A form of bi-level PAP known as adaptive servoventilation is effective in treating a majority of patients with CSA-CSR. PMID:26112305

  13. Localized Cortical Thinning in Patients with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Joo, Eun Yeon; Jeon, Seun; Kim, Sung Tae; Lee, Jong-Min; Hong, Seung Bong

    2013-01-01

    Study Objectives: To investigate differences in cortical thickness in patients with obstructive sleep apnea (OSA) syndrome and healthy controls. Design: Cortical thickness was measured using a three-dimensional surface-based method that enabled more accurate measurement in deep sulci and localized regional mapping. Setting: University hospital. Patients: Thirty-eight male patients with severe OSA (mean apnea-hypopnea index > 30/h) and 36 age-matched male healthy controls were enrolled. Interventions: Cortical thickness was obtained at 81,924 vertices across the entire brain by reconstructing inner and outer cortical surfaces using an automated anatomical pipeline. Measurements: Group difference in cortical thickness and correlation between patients' data and thickness were analyzed by a general linear model. Results: Localized cortical thinning in patients was found in the orbitorectal gyri, dorsolateral/ventromedial prefrontal regions, pericentral gyri, anterior cingulate, insula, inferior parietal lobule, uncus, and basolateral temporal regions at corrected P < 0.05. Patients with OSA showed impaired attention and learning difficulty in memory tests compared to healthy controls. Higher number of respiratory arousals was related to cortical thinning of the anterior cingulate and inferior parietal lobule. A significant correlation was observed between the longer apnea maximum duration and the cortical thinning of the dorsolateral prefrontal regions, pericentral gyri, and insula. Retention scores in visual memory tests were associated with cortical thickness of parahippocampal gyrus and uncus. Conclusions: Brain regions with cortical thinning may provide elucidations for prefrontal cognitive dysfunction, upper airway sensorimotor dysregulation, and cardiovascular disturbances in OSA patients, that experience sleep disruption including sleep fragmentation and oxygen desaturation. Citation: Joo EY; Jeon S; Kim ST; Lee JM; Hong SB. Localized cortical thinning in patients with obstructive sleep apnea syndrome. SLEEP 2013;36(8):1153-1162. PMID:23904675

  14. Comparison of detrended fluctuation analysis and spectral analysis for heart rate variability in sleep and sleep apnea

    Microsoft Academic Search

    Thomas Penzel; Jan W. Kantelhardt; Ludger Grote; Jörg-Hermann Peter; Armin Bunde

    2003-01-01

    Sleep has been regarded as a testing situation for the autonomic nervous system, because its activity is modulated by sleep stages. Sleep-related breathing disorders also influence the autonomic nervous system and can cause heart rate changes known as cyclical variation. We investigated the effect of sleep stages and sleep apnea on autonomic activity by analyzing heart rate variability (HRV). Since

  15. Comparison of Detrended Fluctuation Analysis and Spectral Analysis for Heart Rate Variability in Sleep and Sleep Apnea

    Microsoft Academic Search

    Thomas Penzel; Jan W. Kantelhardt; Ludger Grote; Jörg-Hermann Peter; Armin Bunde

    2003-01-01

    Sleep has been regarded as a testing situation for the autonomic nervous system, because its activity is modulated by sleep stages. Sleep-related breathing disorders also influence the autonomic nervous system and can cause heart rate changes known as cyclical variation. We investigated the effect of sleep stages and sleep apnea on autonomic activity by analyzing heart rate variability (HRV). Since

  16. Obstructive Sleep Apnea Alters Sleep Stage Transition Dynamics

    Microsoft Academic Search

    Matt T. Bianchi; Sydney S. Cash; Joseph Mietus; Chung-Kang Peng; Robert Thomas; Pedro Antonio Valdes-Sosa

    2010-01-01

    IntroductionEnhanced characterization of sleep architecture, compared with routine polysomnographic metrics such as stage percentages and sleep efficiency, may improve the predictive phenotyping of fragmented sleep. One approach involves using stage transition analysis to characterize sleep continuity.Methods and Principal FindingsWe analyzed hypnograms from Sleep Heart Health Study (SHHS) participants using the following stage designations: wake after sleep onset (WASO), non-rapid eye

  17. Is excessive daytime sleepiness a predictor of carotid atherosclerosis in sleep apnea?

    Microsoft Academic Search

    Michael Saletu; Cornelia Sauter; Wolfgang Lalouschek; Bernd Saletu; Georg Kapfhammer; Thomas Benesch; Josef Zeitlhofer

    2008-01-01

    ObjectiveTo elucidate the relationship between excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) and carotid atherosclerosis determined by ultrasonography and serum surrogate markers.

  18. Role of Sensory Stimulation in Amelioration of Obstructive Sleep Apnea

    PubMed Central

    Daulatzai, Mak Adam

    2011-01-01

    Obstructive sleep apnea (OSA), characterized by recurrent upper airway (UA) collapse during sleep, is associated with significant morbidity and disorders. Polysomnogram is employed in the evaluation of OSA and apnea-hypopnea number per hour reflects severity. For normal breathing, it is essential that the collapsible UA is patent. However, obstruction of the UA is quite common in adults and infants. Normally, important reflex mechanisms defend against the UA collapse. The muscle activity of UA dilators, including the genioglossus, tensor palatini (TP), and pharyngeal constrictors, is due to the integrated mechanism of afferent sensory input ? to motor function. Snoring is harsh breathing to prevent UA obstruction. Unfortunately, snoring vibrations, pharyngeal suction collapse, negative pressure, and hypoxia cause pathological perturbations including dysfunctional UA afferent sensory activity. The current paper posits that peripheral sensory stimulation paradigm, which has been shown to be efficacious in improving several neurological conditions, could be an important therapeutic strategy in OSA also. PMID:23470957

  19. Asynchrony of lingual muscle recruitment during sleep in obstructive sleep apnea.

    PubMed

    Dotan, Yaniv; Pillar, Giora; Schwartz, Alan R; Oliven, Arie

    2015-06-15

    Pharyngeal collapsibility during sleep increases primarily due to decline in dilator muscle activity. However, genioglossus EMG is known to increase during apneas and hypopneas, usually without reversing upper airway obstruction or inspiratory flow limitation. The present study was undertaken to test the hypothesis that intense activation of the genioglossus fails to prevent pharyngeal obstruction during sleep, and to evaluate if sleep-induced changes in tongue muscle coordination may be responsible for this phenomenon. We compared genioglossus and tongue retractors EMG activity in 13 obstructive sleep apnea (OSA) patients during wakefulness, while breathing through inspiratory resistors, to the activity observed at the end of apneas and hypopneas after 25 mg of brotizolam, before arousal, at equal esophageal pressure. During wakefulness, resistive breathing triggered increases in both genioglossus and retractor EMG. Activation of agonist tongue muscles differed considerably from that of the arm, as both genioglossus and retractors were activated similarly during all tongue movements. During sleep, flow limitation triggered increases in genioglossal EMG that could reach more than twofold the level observed while awake. In contrast, EMGs of the retractors reached less than half the wakefulness level. In sleeping OSA patients, genioglossal activity may increase during obstructed breathing to levels that exceed substantially those required to prevent pharyngeal collapse during wakefulness. In contrast, coactivation of retractors is deficient during sleep. These findings suggest that sleep-induced alteration in tongue muscle coordination may be responsible for the failure of high genioglossal EMG activity to alleviate flow limitation. PMID:25814639

  20. Cardio-Respiratory Coordination Increases during Sleep Apnea

    PubMed Central

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

    2014-01-01

    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

  1. Risk of Sleep Apnea in Hospitalized Older Patients

    PubMed Central

    Shear, Talia C.; Balachandran, Jay S.; Mokhlesi, Babak; Spampinato, Lisa M.; Knutson, Kristen L.; Meltzer, David O.; Arora, Vineet M.

    2014-01-01

    Background/Objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. Design: Prospective cohort study. Setting: General medicine ward in academic medical center Participants: 424 hospitalized adult patients ? 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American). Main Measures: The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and efficiency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI). Key Results: Two of every 5 inpatients ? 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ? 5 h and mean sleep efficiency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ? 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These findings remained significant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ? 5.5% less sleep efficiency per night (-5.50 [-9.96, -1.05], p = 0.015). In multivariate analysis, patients at high risk for OSA also had lower self-reported sleep quality on KSQI (-0.101 [-0.164, -0.037], p = 0.002). Conclusion: Two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality. Commentary: A commentary on this article appears in this issue on page 1067. Citation: Shear TC, Balachandran JS, Mokhlesi B, Spampinato LM, Knutson KL, Meltzer DO, Arora VM. Risk of sleep apnea in hospitalized older patients. J Clin Sleep Med 2014;10(10):1061-1066. PMID:25317085

  2. Sleep apnea-hypopnea syndrome and type 2 diabetes. A reciprocal relationship?

    PubMed

    Martínez Cerón, Elisabet; Casitas Mateos, Raquel; García-Río, Francisco

    2015-03-01

    Epidemiological data suggest that sleep apnea-hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of SAHS in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate-severe SAHS is associated with an increased risk of DM2 (relative risk=1.63 [1.09 to 2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea-hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic-pituitary-adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant SAHS seems to increase DM2 severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, SAHS may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas. PMID:25145320

  3. Neuropsychological changes and treatment compliance in older adults with sleep apnea

    Microsoft Academic Search

    Mark S Aloia; Nora Ilniczky; Pasquelina Di Dio; Michael L Perlis; Donald W Greenblatt; Donna E Giles

    2003-01-01

    Introduction: Apnea is a common disorder in older adults and has been shown to affect cognition. Some studies suggest that treatment for apnea improves certain cognitive deficits, but few studies have examined the relationship between compliance and cognitive improvement. We designed a study to answer the following questions about sleep apnea, cognition and treatment in older adults: (1) Which neuropsychological

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

    PubMed Central

    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

    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

  5. Obstructive Sleep Apnea: A Risk Factor for Work Disability

    PubMed Central

    Omachi, Theodore A.; Claman, David M.; Blanc, Paul D.; Eisner, Mark D.

    2009-01-01

    Study Objective: To examine obstructive sleep apnea (OSA) as a risk factor for work disability. Patients and Setting: Consecutive patients referred to the University of California San Francisco Sleep Disorders Center with suspected OSA (n = 183). Design: All patients underwent overnight polysomnography after completing a written survey which assessed work disability due to sleep problems, occupational characteristics and excessive daytime sleepiness (EDS) defined as an Epworth Sleepiness Scale score > 10. Results: Among 150 currently employed patients, 83 had OSA on polysomnography (apnea-hypopnea index ? 5). Compared with patients in whom both OSA and EDS were absent, patients with the combination of OSA and EDS were at higher risk of both recent work disability (adjusted odds ratio [OR], 13.7; 95% confidence interval [CI], 3.9–48) and longer-term work duty modification (OR, 3.6; CI, 1.1–12). When either OSA or EDS were absent, the strength of the association with work disability was less than when both OSA and EDS were present. When OSA was examined without respect to EDS, patients with OSA were at increased risk of recent work disability relative to patients without OSA (OR 2.6; 95% CI 1.2–5.8), but the association of OSA with longer-term work duty modification did not meet standard criteria for statistical significance (OR = 2.0, 95% CI 0.8–5.0). Conclusions: The combination of OSA and EDS contributes to work disability, and OSA by itself contributes to recent work disability. These findings should highlight to employers and clinicians the importance of OSA in the workplace to encourage patients to be screened for OSA, particularly in situations of decreased productivity associated with EDS. Citation: Omachi TA; Claman DM; Blanc PD; Eisner MD. Obstructive sleep apnea: a risk factor for work disability. SLEEP 2009;32(6):791-798. PMID:19544756

  6. Obstructive Sleep Apnea and Fatigue in Patients with Multiple Sclerosis

    PubMed Central

    Braley, Tiffany J.; Segal, Benjamin M.; Chervin, Ronald D.

    2014-01-01

    Study Objectives: The prevalence of obstructive sleep apnea (OSA) in persons with multiple sclerosis (MS) remains unknown, and little information exists regarding the relative contributions of OSA to symptoms of MS-related fatigue in the presence of other clinical and sleep-related confounders. The objectives of this study were to investigate the prevalence of diagnosed OSA and OSA risk among MS patients, and to assess relationships between fatigue severity, OSA, OSA risk, and sleep quality among persons with MS. Methods: N = 195 MS patients completed a questionnaire comprised of items regarding OSA diagnosis, sleep quality and quantity, daytime symptoms, and 4 validated scales: the Epworth Sleepiness Scale, Fatigue Severity Scale, Insomnia Severity Index, and STOP-Bang questionnaire. Medical records were also accessed to examine clinical characteristics that may predict fatigue or OSA risk. Results: N = 41 patients (21%) carried a formal diagnosis of OSA. N = 110 (56%) of all patients, and 38 (93%) of those with diagnosed OSA had STOP-Bang scores ? 3, indicating an elevated OSA risk. In regression models, the most significant predictors of higher FSS scores were higher STOP-Bang scores (p = 0.01), higher number of nocturnal symptoms (p < 0.0001), and higher disability level (p < 0.0001). Conclusions: Sleep disturbances, and OSA in particular, may be highly prevalent yet underrecognized contributors to fatigue in persons with MS. Citation: Braley TJ; Segal BM; Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med 2014;10(2):155-162. PMID:24532998

  7. Insular Cortex Metabolite Changes in Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

    Study Objective: Adults with obstructive sleep apnea (OSA) show significant autonomic and neuropsychologic deficits, which may derive from damage to insular regions that serve those functions. The aim was to assess glial and neuronal status from anterior insular metabolites in OSA versus controls, using proton magnetic resonance spectroscopy (PMRS), and thus to provide insights for neuroprotection against tissue changes, and to reduce injury consequences. Design: Cross-sectional study. Setting: University-based medical center. Participants: Thirty-six patients with OSA, 53 controls. Interventions: None. Measurements and Results: We performed PMRS in bilateral anterior insulae using a 3.0-Tesla magnetic resonance imaging scanner, calculated N-acetylaspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), myo-inositol/creatine (MI/Cr), and MI/NAA metabolite ratios, and examined daytime sleepiness (Epworth Sleepiness Scale, ESS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and neuropsychologic status (Beck Depression Inventory II [BDI-II] and Beck Anxiety Inventory [BAI]). Body mass index, BAI, BDI-II, PSQI, and ESS significantly differed between groups. NAA/ Cr ratios were significantly reduced bilaterally, and left-sided MI/Cr and MI/NAA ratios were increased in OSA over controls. Significant positive correlations emerged between left insular MI/Cr ratios and apnea-hypopnea index values, right insular Cho/Cr ratios and BDI-II and BAI scores, and negative correlations appeared between left insular NAA/Cr ratios and PSQI scores and between right-side MI/Cr ratios and baseline and nadir change in O2 saturation. Conclusions: Adults with obstructive sleep apnea showed bilaterally reduced N-acetylaspartate and left-side increased myo-inositol anterior insular metabolites, indicating neuronal damage and increased glial activation, respectively, which may contribute to abnormal autonomic and neuropsychologic functions in the condition. The activated glial status likely indicates increased inflammatory action that may induce more neuronal injury, and suggests separate approaches for glial and neuronal protection. Citation: Yadav SK, Kumar R, Macey PM, Woo MA, Yan-Go FL, Harper RM. Insular cortex metabolite changes in obstructive sleep apnea. SLEEP 2014;37(5):951-958. PMID:24790274

  8. Vocal cord adduction causing obstructive sleep apnea from vagal nerve stimulation: case report.

    PubMed

    Aron, Margaret; Vlachos-Mayer, Helen; Dorion, Dominique

    2012-05-01

    A recognized complication of vagal nerve stimulation is new or worsening sleep apnea. Its pathophysiology is not clearly understood. We report a patient with obstructive sleep apnea that was directly associated with vagal nerve stimulation causing recurring vocal cord adduction. Adjusting the stimulator settings resolved the problem. PMID:22364850

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

    Microsoft Academic Search

    Daniel Rodenstein

    2009-01-01

    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

  10. Endothelial Cell Apoptosis in Obstructive Sleep Apnea A Link to Endothelial Dysfunction

    Microsoft Academic Search

    Ali A. El Solh; Morohunfolu E. Akinnusi; Fadi H. Baddoura; Corey R. Mankowski

    Rationale: Patients with obstructive sleep apnea (OSA) are at in- creased risk for cardiovascular diseases. Injury of endothelial cells has been advanced as an initial trigger to atherosclerosis. Objectives: To study the association between circulating apoptotic endothelial cells and vasomotor dysfunction as a function of sleep apnea. Methods: Brachial artery flow-mediated dilation was determined in 14 subjects with documented OSA

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

    Microsoft Academic Search

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

    2003-01-01

    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

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

    Microsoft Academic Search

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

    2003-01-01

    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

  13. Upper airway imaging in pediatric obstructive sleep apnea syndrome.

    PubMed

    Slaats, Monique A; Van Hoorenbeeck, Kim; Van Eyck, Annelies; Vos, Wim G; De Backer, Jan W; Boudewyns, An; De Backer, Wilfried; Verhulst, Stijn L

    2015-06-01

    Obstructive sleep apnea syndrome in children is a manifestation of sleep-disordered breathing and associated with a number of complications. Structural narrowing of the upper airway in combination with inadequate compensation for a decrease in neuromuscular tone is an important factor in the pathogenesis. Adenotonsillar hypertrophy is the most important predisposing factor. However, many other causes of craniofacial defects may coexist. Additionally, the pathogenesis of narrowing is more complex in certain subgroups such as children with obesity, craniofacial malformations, Down syndrome or neuromuscular disorders. The diagnosis of obstructive sleep apnea is based on an overnight polysomnography. This investigation is expensive, time consuming and not widely available. In view of the major role of structural narrowing, upper airway imaging could be a useful tool for investigating obstructive sleep apnea and in establishing the site(s) of obstruction. Several radiological techniques (lateral neck radiography, cephalometry, computerized tomography, magnetic resonance imaging and post-processing of these images using computational fluid dynamics) have been used to investigate the role of structural alterations in the pathogenesis. We reviewed the literature to examine if upper airway imaging could replace polysomnography in making the diagnosis and if imaging could predict the effect of treatment with a focus on adenotonsillectomy. There is a limited number of high quality studies of imaging predicting the effect of treatment. To avoid unnecessary risks and ineffective surgeries, it seems crucial to couple the exact individual anatomical risk factor with the most appropriate treatment. We conclude that imaging could be a non-invasive tool that could assist in selection of treatment. PMID:25438733

  14. Reduced innervation in the human pharynx in patients with obstructive sleep apnea.

    PubMed

    de Carlos, Félix; Cobo, Juan; Macías, Emilio; Feito, Jorge; González, Mónica; Cobo, Teresa; Fernández-Mondragón, María P; García-Suárez, Olivia; Vega, José A

    2015-07-01

    Obstructive sleep apnea is a disease characterized by repetitive breathing during sleep that lead to reduced oxygen saturation and sleep disturbance among other symptoms. Obstructive sleep apnea is caused by blockade of the upper respiratory airway, although the pathogenic mechanism underlying this occlusion remains unknown. In these studies we explored the hypothesis that alterations in the innervation, especially mechanosensory innervation, of the pharynx may contribute to obstructive sleep apnea. We tested this hypothesis by analyzing the innervation of the human pharynx in normal individuals and in subjects clinically diagnosed with obstructive sleep apnea. Using immunohistochemistry for axon and Schwann cells, as well as for two putative mechanoproteins (ASIC2 and TRPV4), we observed a significant reduction in the density of nerve fibers in the submucosa of patients with obstructive sleep apnea as well as morphological abnormalities in mechanosensory corpuscles. Importantly, while ASIC2 and TRPV4 expression was regularly found in the axons of mechanosensory corpuscles distributed throughout the muscular layer in the control subjects, it was absent in patients with obstructive sleep apnea. These findings support that neurological alterations are important contributors to the pathogenesis of obstructive sleep apnea. PMID:25663466

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

    PubMed Central

    Abboud, François; Kumar, Ravinder

    2014-01-01

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

  16. [Atrial fibrillation and obstructive sleep apnea: a fortuitous association?].

    PubMed

    Leszek, A; Perrier, A; Carballo, S

    2014-10-15

    Atrial fibrillation (AF) is a frequent arrhythmia and is associated with important morbidity and mortality. It is particularly frequent in patients with obstructive sleep apnea (OSA), occurring in 3 to 5% of these patients. Numerous studies show an association of these two pathologies, independently of classical cardiovascular risk factors and otherconfounders. A pathophysiological link between repeated apnea and cardiac modifications, inflammation and autonomic nervous system disequilibrium has also been demonstrated. The severity of OSA influences development of AF, and appears to make management more complicated. Success of catheter ablation of AF appears to be inferior in patients with OSA. Whilst more robust studies are required to better define the role of OSA in AF, the existing literature establishes a link between these two entities. PMID:25507891

  17. [Atrial fibrillation and obstructive sleep apnea: a fortuitous association?].

    PubMed

    Leszek, A; Perrier, A; Carballo, S

    2014-10-15

    Atrial fibrillation (AF) is a frequent arrhythmia and is associated with important morbidity and mortality. It is particularly frequent in patients with obstructive sleep apnea (OSA), occurring in 3 to 5% of these patients. Numerous studies show an association of these two pathologies, independently of classical cardiovascular risk factors and otherconfounders. A pathophysiological link between repeated apnea and cardiac modifications, inflammation and autonomic nervous system disequilibrium has also been demonstrated. The severity of OSA influences development of AF, and appears to make management more complicated. Success of catheter ablation of AF appears to be inferior in patients with OSA. Whilst more robust studies are required to better define the role of OSA in AF, the existing literature establishes a link between these two entities. PMID:25438374

  18. The Consolidation of Implicit Sequence Memory in Obstructive Sleep Apnea

    PubMed Central

    Malecek, Nick

    2014-01-01

    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

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

    PubMed

    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

    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

  20. Sleep apnea in adult myotonic dystrophy patients who have no excessive daytime sleepiness

    Microsoft Academic Search

    Esen Kiyan; Gulfer Okumus; Caglar Cuhadaroglu; Feza Deymeer

    2010-01-01

    Purpose  Sleep apnea is common in myotonic dystrophy (MD) and may cause respiratory failure. Most of the sleep studies have been performed\\u000a in patients with excessive daytime sleepiness (EDS), which is a characteristic and strong predictor of sleep apnea. Therefore,\\u000a we investigated the prevalence of sleep apnea in adult MD patients who have no EDS.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Epworth Sleepiness Scale was

  1. Major factors affecting severity of obstructive sleep apnea.

    PubMed

    Kim, Sung Won; Kim, Boo-Young; Han, Jung Ju; Hwang, Jae Hyung; Jung, Kihwan; Kim, Min; Kim, Soo Whan

    2015-03-01

    Computed tomography (CT) has become a common method for evaluating obstructive sleep apnea (OSA). The aim of this study was to analyze the relationships between CT parameters and clinical parameters in OSA patients to determine major factors affecting the severity of OSA. The records of 128 consecutive snoring patients (98 males, 30 females) diagnosed with OSA were retrospectively reviewed. Polysomnography was performed for each patient. On CT scans, airway areas were measured at the level of the hard palate, the soft palate, and the base of the tongue. Polysomnographic parameters were compared by gender and age using the Mann-Whitney U test. Pearson's correlation coefficient was used to analyze relationships between variables and the AHI in each age group. The women were significantly older than the men (p < 0.01). The AHI and apnea index were significantly higher in men than in women. Stage 1 sleep and rapid eye movement sleep were more frequent in men than in women. The area at the base of the tongue was significantly smaller in women than in men (p = 0.027). In the 50-60 age group, the AHI was significantly higher in men (41.47 ± 19.67) than in women (17.14 ± 15.63) (p = 0.001). OSA severity varies with age, gender, and upper airway area. The OSA prognosis could be improved by evaluating the major factors and treating OSA patients according to epidemiological characteristics and anatomical structures. PMID:25621265

  2. Sleep estimation using BodyMedia's SenseWear™ armband in patients with obstructive sleep apnea

    PubMed Central

    Sharif, Munir M.; BaHammam, Ahmed S.

    2013-01-01

    OBJECTIVES: We aimed to evaluate the validity of the BodyMedia's SenseWear™ Armband (BSA) device in estimating total sleep time (TST) in patients with obstructive sleep apnea (OSA). METHODS: Simultaneous overnight recordings of in-laboratory polysomnography (PSG) and BSA were performed on (1) 107 OSA patients (mean age of 45.2 ± 14.3 years, mean apnea hypopnea index of 43 ± 35.7/hr and (2) 30 controls matched with OSA patients for age and body mass index. An agreement analysis between the PSG and BSA scoring results was performed using the Bland and Altman method. RESULTS: There was no significant difference in OSA patients between BSA and PSG with regard to TST, total wake time, and sleep efficiency. There was also no significant difference in the controls between BSA and PSG with regard to TST, total wake time, and sleep efficiency. Bland Altman plots showed strong agreement between TST, wake time, and sleep efficiency for both OSA and the controls. The intraclass correlation coefficients revealed perfect agreement between BSA and PSG in different levels of OSA severity and both genders. CONCLUSION: The current data suggest that BSA is a reliable method for determining sleep in patients with OSA when compared against the gold standard test (PSG). BSA can be a useful tool in determining sleep in patients with OSA and can be combined with portable sleep studies to determine TST. PMID:23440703

  3. Respiratory Movement of Upper Airway Tissue in Obstructive Sleep Apnea

    PubMed Central

    Brown, Elizabeth C.; Cheng, Shaokoon; McKenzie, David K.; Butler, Jane E.; Gandevia, Simon C.; Bilston, Lynne E.

    2013-01-01

    Study Objectives: To measure real-time movement of the tongue and lateral upper airway tissues in obstructive sleep apnea (OSA) subjects during wakefulness using tagged magnetic resonance imaging. Design: Comparison of the dynamic imaging of three groups of increasing severity OSA and a control group approximately matched for age and body mass index (BMI). Setting: Not-for-profit research institute Participants: 24 subjects (apnea hypopnea index [AHI] range 2-84 events/h, 6 with AHI < 5 events/h) Methods: The upper airway was imaged awake in two planes using SPAtial Modulation of Magnetization (SPAMM). Tissue displacements were quantified with harmonic phase analysis. Measurements and Results: All subjects had dynamic airway opening in the sagittal plane associated with inspiration. In the nasopharynx, the increase in airway cross-sectional area during inspiration correlated with minimal cross-sectional area of the airway (R = 0.900, P < 0.001). AHI correlated negatively with movement of the nasopharyngeal lateral walls (R = - 0.542, P = 0.006). Four movement patterns were observed during inspiration: “en bloc” anterior movement of the whole posterior tongue; movement of only the oropharyngeal posterior tongue; bidirectional movement; or minimal movement. Some subjects showed different inspiratory movement patterns with different breaths. A low AHI (< 5) was associated with en bloc movement (P = 0.002). Conclusions: Inspiratory movement of the tongue varied between and within subjects, likely as a result of local and neural factors. However, in severe OSA inspiratory movement was minimal. Citation: Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Respiratory movement of upper airway tissue in obstructive sleep apnea. SLEEP 2013;36(7):1069-1076. PMID:23814344

  4. Sexual dysfunction in women with obstructive sleep apnea

    Microsoft Academic Search

    Shyam Subramanian; Swetha Bopparaju; Ashesh Desai; Tammy Wiggins; Cheryl Rambaud; Salim Surani

    2010-01-01

    Background  Female sexual dysfunction is vastly under-recognized but has been previously described in chronic disease states. Sexual dysfunction\\u000a in male patients with obstructive sleep apnea (OSA) is well described, but not in females.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  The objective of this study was to assess the prevalence of sexual dysfunction in women with OSA.\\u000a \\u000a \\u000a \\u000a Methods  We studied 21 consecutive pre-menopausal women with OSA, referred to our

  5. Overview of proteomics studies in obstructive sleep apnea.

    PubMed

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

    2015-04-01

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

  6. Comorbidity of diabetes and obstructive sleep apnea in hospitalized patients.

    PubMed

    Sudhakaran, Sivakumar; Surani, Salim R

    2015-04-01

    Obstructive sleep apnea (OSA) and type 2 diabetes are two morbidities commonly encountered in the hospitalized setting. Both diseases will present with an array of complications if not managed in a timely, competent manner. However, a growing body of evidence suggests a link between these two pathologies. It is our hope that through careful review of the literature, we may generate heightened awareness of the OSA/diabetes comorbidity. Through better understanding of these conditions and their interactions, we may insure efficient management in the clinical setting and prevent exacerbation of common complications. PMID:25599880

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

    E-print Network

    Aloul, Fadi

    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

  8. Probabilistic sleep architecture models in patients with and without sleep apnea

    PubMed Central

    Bianchi, Matt T.; Eiseman, Nathaniel A.; Cash, Sydney S.; Mietus, Joseph; Peng, Chung-Kang; Thomas, Robert J.

    2015-01-01

    Summary Sleep fragmentation of any cause is disruptive to the rejuvenating value of sleep. However, methods to quantify sleep architecture remain limited. We have previously shown that human sleep–wake stage distributions exhibit multi-exponential dynamics, which are fragmented by obstructive sleep apnea (OSA), suggesting that Markov models may be a useful method to quantify architecture in health and disease. Sleep stage data were obtained from two subsets of the Sleep Heart Health Study database: control subjects with no medications, no OSA, no medical co-morbidities and no sleepiness (n = 374); and subjects with severe OSA (n = 338). Sleep architecture was simplified into three stages: wake after sleep onset (WASO); non-rapid eye movement (NREM) sleep; and rapid eye movement (REM) sleep. The connectivity and transition rates among eight ‘generator’ states of a first-order continuous-time Markov model were inferred from the observed (‘phenotypic’) distributions: three exponentials each of NREM sleep and WASO; and two exponentials of REM sleep. Ultradian REM cycling was accomplished by imposing time-variation to REM state entry rates. Fragmentation in subjects with severe OSA involved faster transition probabilities as well as additional state transition paths within the model. The Markov models exhibit two important features of human sleep architecture: multi-exponential stage dynamics (accounting for observed bout distributions); and probabilistic transitions (an inherent source of variability). In addition, the model quantifies the fragmentation associated with severe OSA. Markov sleep models may prove important for quantifying sleep disruption to provide objective metrics to correlate with endpoints ranging from sleepiness to cardiovascular morbidity. PMID:21955148

  9. Clinical foundation for efficient treatment of obstructive sleep apnea.

    PubMed

    Dasheiff, Richard M; Finn, Richard

    2009-10-01

    Only a few decades ago, the entity known as obstructive sleep apnea (OSA) was unknown and untreated. Now, there is a rush to put literally millions of Americans on continuous positive airway pressure devices. Community practice standards are changing yearly under pressure from strong forces based on economic incentives for industry, government, and physicians, independent of the actual medical evidence supporting treatment and efficacy. Medicare has lowered the diagnostic threshold for diagnosis and reimbursement; the International Classification of Sleep Disorders, Revision 2 (2005) has allowed OSA to be diagnosed exclusively by a laboratory test without the patient having clinical symptoms of excessive daytime sleepiness; and industry is poised to have the public buy computer-assisted continuous positive airway pressure machines without need of a physician prescription. Because of this paradigm shift away from physician-directed diagnosis and treatment, this article will critically evaluate the present state of medical evidence regarding the clinical foundation for treatment of OSA. PMID:19761911

  10. Prediagnosis of obstructive sleep apnea via multiclass MTS.

    PubMed

    Su, Chao-Ton; Chen, Kun-Huang; Chen, Li-Fei; Wang, Pa-Chun; Hsiao, Yu-Hsiang

    2012-01-01

    Obstructive sleep apnea (OSA) has become an important public health concern. Polysomnography (PSG) is traditionally considered an established and effective diagnostic tool providing information on the severity of OSA and the degree of sleep fragmentation. However, the numerous steps in the PSG test to diagnose OSA are costly and time consuming. This study aimed to apply the multiclass Mahalanobis-Taguchi system (MMTS) based on anthropometric information and questionnaire data to predict OSA. Implementation results showed that MMTS had an accuracy of 84.38% on the OSA prediction and achieved better performance compared to other approaches such as logistic regression, neural networks, support vector machine, C4.5 decision tree, and rough set. Therefore, MMTS can assist doctors in prediagnosis of OSA before running the PSG test, thereby enabling the more effective use of medical resources. PMID:22545062

  11. Obstructive sleep apnea syndrome in obese Singapore children.

    PubMed

    Chay, O M; Goh, A; Abisheganaden, J; Tang, J; Lim, W H; Chan, Y H; Wee, M K; Johan, A; John, A B; Cheng, H K; Lin, M; Chee, T; Rajan, U; Wang, S; Machin, D

    2000-04-01

    We set out to determine the prevalence of obstructive sleep apnea syndrome (OSAS) among obese Singapore school children and identify risk factors for OSAS. This study was designed as a prospective study in three phases. Parents completed a questionnaire with regards to sleep and daytime symptoms in Phase 1. Children suspected to have OSAS based on the questionnaire and all with a percent ideal body weight (IBW) >/=180 were called for clinic visits in Phase 2. All whose percent IBW >/=180 and those in whom the physicians strongly suspected OSAS were subjected to a polysomnogram in phase 3. The children were recruited from the School Health Nutritional Clinic for obese children. The investigations were carried out at Tan Tock Seng Hospital. In all, 3,671 children were screened with the questionnaire. Of these, 146 were selected to undergo polysomnography. Twenty-six had abnormal sleep studies with apnea/hypoxia indices (AHIs) >5/hr. The significant clinical feature which correlated with OSAS was sleep sitting up (P = 0.005). The risk is higher in morbidly obese (IBW >/=180), with a prevalence of 13.3% (8/60), than in less obese children (IBW <180). One in eight (12.5%) of these children was asymptomatic and would have been missed based on the questionnaire. Presence of adenotonsillar hypertrophy led to increased risk of OSAS. The prevalence of OSAS was 0.7% (26/3,671) among the obese schoolchildren in Singapore, which is similar to the prevalence reported by others. Using discriminant analysis, the estimated prevalence increased to 5.7%. In the morbidly obese (IBW >/=180), the prevalence rate is higher at 13.3%. PMID:10738016

  12. Physiology in Medicine: Obstructive sleep apnea pathogenesis and treatment—considerations beyond airway anatomy

    PubMed Central

    Xie, Ailiang; Patz, David S.; Wang, David

    2013-01-01

    We review evidence in support of significant contributions to the pathogenesis of obstructive sleep apnea (OSA) from pathophysiological factors beyond the well-accepted importance of airway anatomy. Emphasis is placed on contributions from neurochemical control of central respiratory motor output through its effects on output stability, upper airway dilator muscle activation, and arousability. In turn, we consider the evidence demonstrating effective treatment of OSA via approaches that address each of these pathophysiologic risk factors. Finally, a case is made for combining treatments aimed at both anatomical and ventilatory control system deficiencies and for individualizing treatment to address a patient's own specific risk factors. PMID:24201709

  13. Relationship between obstructive sleep apnea syndrome and thyroid diseases.

    PubMed

    Mete, Turkan; Yalcin, Yavuz; Berker, Dilek; Ciftci, Bulent; Guven Firat, Selma; Topaloglu, Oya; Cinar Yavuz, Halise; Guler, Serdar

    2013-12-01

    Obstructive sleep apnea syndrome (OSAS) is a widespread disorder characterized by recurrent, partial, or complete episodes of apnea due to upper airway tract obstruction during sleep. OSAS frequency is likely to increase in hypothyroidism because of obesity, macroglossia, dysfunctional upper respiratory tractus (URT) musculature, deposition of mucopolysaccharides in URT tissues, and decreased ventilatory control. This study examines the relationship between OSAS and thyroid disease in OSAS subjects. This study includes 150 polysomnographically diagnosed OSAS patients (50 mild, 50 moderate, 50 severe OSAS cases) treated at Endocrinology and Metabolism Department of Ankara Numune Training and Research Hospital between January 2010 and May 2011 and 32 non-OSAS control subjects. All patients were given serum TSH, free T3 (fT3), free T4 (fT4), anti thyroid peroxidase (Anti-TPO), and anti-thyroglobulin (anti-TG) tests, as well as thyroid ultrasounds. We did not find any difference in prevalence of hypothyroidism, numbers of nodules and parenchyma heterogenicity determined by ultrasound, between OSAS subgroups and controls (p > 0,05). In this study, functional and ultrasonographic examination of the thyroid gland did not reveal any relationship between OSAS and thyroid disease. We believe hence that long-term follow-up studies can establish the possible significance of routine evaluation of OSAS patients for thyroid disease. PMID:23564558

  14. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment

    SciTech Connect

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

    1988-01-01

    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.

  15. Copeptin: a new predictor for severe obstructive sleep apnea

    PubMed Central

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

    2015-01-01

    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. PMID:25914540

  16. The genetics of sleep disorders in humans: narcolepsy, restless legs syndrome, and obstructive sleep apnea syndrome.

    PubMed

    Caylak, Emrah

    2009-11-01

    Sleep disorders are a group of neurological disorders known to cause public health problems associated with interference with daily activities including cognitive problems, poor job performance and reduced productivity. There is strong evidence emerging for the presence of genes influencing sleep disorders, such as narcolepsy (NRCLP), restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). NRCLP is typically characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hallucinations. RLS is manifested by compelling need to move the legs and usually experienced when trying to sleep. OSAS is major sleep problem characterized by recurrent episodes of upper airway collapse and obstruction during sleep. In the recent years, many research groups have attempted to identify the susceptibility and candidate genes for NRCLP, RLS, and OSAS through the sequential analyses of genetic linkage and association. The purpose of this review is to summarize some of remarkable molecular advances in sleep and sleep disorders, thereby providing a greater understanding of the complex sleep processes, and a platform for future therapeutic interventions. PMID:19876894

  17. The Utility of Three Screening Questionnaires for Obstructive Sleep Apnea in a Sleep Clinic Setting

    PubMed Central

    Kim, Bomi; Lee, Eun Mi; Chung, Yoo-Sam; Kim, Woo-Sung

    2015-01-01

    Purpose The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea. Materials and Methods Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire. Results The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) ?5/h and 58.4% for an AHI ?15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI ?5/h, 98% for AHI ?15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI ?5/h, 74% for AHI ?15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ. Conclusion The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting. PMID:25837173

  18. Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms.

    PubMed

    Jordan, Amy S; McEvoy, R Doug

    2003-10-01

    Sleep apnea syndromes are a common cause of sleepiness and neurocognitive impairment and have been implicated as an independent risk factor for cardiovascular disease. While both epidemiological and sleep clinic-based studies indicate that sleep apnea syndromes are more common in men than in women, the gender difference in prevalence is more marked within the sleep clinic. Reasons for the relative failure of women to attend sleep clinics and the pathophysiologic differences that give rise to the male predominance of sleep apnea syndromes are unknown. The purpose of this review was to examine the literature with regard to these aspects, to provide clinical guidance to improve the reduced attendance of women to sleep laboratories and to stimulate research interest into the causes of these differences. PMID:14573374

  19. Pathophysiologic Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome

    PubMed Central

    Zamarrón, Carlos; Valdés Cuadrado, Luis; Álvarez-Sala, Rodolfo

    2013-01-01

    Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation). It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients. PMID:23936649

  20. Usefulness of cephalometry in sparing polysomnography of patients with suspected obstructive sleep apnea

    Microsoft Academic Search

    Gabriel Julià-Serdà; Gregorio Pérez-Peñate; Pedro Saavedra-Santana; Miguel Ponce-González; José Manuel Valencia-Gallardo; Raquel Rodríguez-Delgado; Pedro Cabrera-Navarro

    2006-01-01

    The aim of this investigation was to evaluate the contribution of cephalometry to a statistical model integrating clinical, physical, and oximetric variables, to reduce demands for polysomnographies. Two hundred and twenty-five consecutive patients that had been referred to the sleep clinic for suspected obstructive sleep apnea (OSA) were studied. The clinical assessment of all patients consisted of a sleep related

  1. Using the Pathophysiology of Obstructive Sleep Apnea to Teach Cardiopulmonary Integration

    ERIC Educational Resources Information Center

    Levitzky, Michael G.

    2008-01-01

    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

  2. Obstructive Sleep Apnea in Sleepy Pediatric Psychiatry Clinic Patients: Polysomnographic and Clinical Correlates

    Microsoft Academic Search

    J. F. Pagel; Steve Snyder; Dawn Dawson

    2004-01-01

    Study Objectives: To assess the incidence of polysomnographically defined obstructive sleep apnea (OSA) in pediatric psychiatric clinic patients reporting daytime sleepiness on questionnaire, and to identify diagnostic correlates for OSA in this grouping. Design: Prospective and observational. Setting: Outpatient pediatric psychiatry clinic, outpatient sleep medicine clinic, AASM-accredited hospital-based sleep laboratory. Subjects: Children aged 3 to 16 years, reporting daytime sleepiness

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

    PubMed Central

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

    2013-01-01

    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

  4. Identification of Upper Airway Anatomic Risk Factors for Obstructive Sleep Apnea with Volumetric Magnetic Resonance Imaging

    Microsoft Academic Search

    Richard J. Schwab; Michael Pasirstein; Robert Pierson; Adonna Mackley; Robert Hachadoorian; Raanan Arens; Greg Maislin; Allan I. Pack

    2003-01-01

    We used sophisticated volumetric analysis techniques with mag- netic resonance imaging in a case-control design to study the upper airway soft tissue structures in 48 control subjects (apnea-hypopnea index, 2.0 1.6 events\\/hour) and 48 patients with sleep apnea (apnea-hypopnea index, 43.8 25.4 events\\/hour). Our design used exact matching on sex and ethnicity, frequency matching on age, and statistical control for

  5. Comparison of entropy measures for estimating severity of obstructive sleep apnea from overnight pulse oximetry data

    Microsoft Academic Search

    Spyretta Golemati; Veronika Zourou; Konstantina S. Nikita

    2010-01-01

    Regularity of overnight pulse oximetry data, which can be quantified using entropy, may be used to characterize severity of obstructive sleep apnea syndrome (OSAS). In this paper three entropy measures, namely Shannon-, approximate-and sample entropy, were compared in terms of their ability to discriminate between mild and severe OSAS. In a group of 5 mild OSAS subjects, with apnea hypopnea

  6. Control of the Pharyngeal Musculature During Wakefulness and Sleep: Implications in Normal Controls and Sleep Apnea

    PubMed Central

    Edwards, Bradley A.; White, David P

    2011-01-01

    Respiration involves the complex coordination of several pump and upper airway/pharyngeal muscles. From a respiratory perspective, the major function of the pharyngeal muscles is to keep the airway patent allowing for airflow in and out of the lung with minimal work by the respiratory pump muscles. The activity of each of the pharyngeal muscles varies depending on its function, but many reduce their activity during sleep. In healthy individuals, these muscles can respond to respiratory stimuli during sleep in order to prevent airway collapse. However, in individuals with an anatomically small airway, the muscles cannot always compensate for the increased mechanical load. Thus, a vulnerable situation in which the airway is prone to collapse may occur with the development of obstructive sleep apnea (OSA). The present article describes the current understanding regarding the control of the pharyngeal musculature during wakefulness and sleep, as well as the implications for OSA. PMID:21901775

  7. Association of sleep apnea severity and obesity with insulin resistance, C-reactive protein, and leptin levels in male patients with obstructive sleep apnea.

    PubMed

    Kapsimalis, Fotis; Varouchakis, George; Manousaki, Asimina; Daskas, Spiros; Nikita, Dimitra; Kryger, Meir; Gourgoulianis, Konstantinos

    2008-01-01

    Obesity is the major confounding factor in the relationship between obstructive sleep apnea and increased risk for cardiovascular disease. The aim of the study was to investigate the association of sleep apnea severity with insulin resistance, leptin, and CRP levels in a cohort of male patients. Sixty-seven men referred to our sleep laboratory for evaluation of suspected obstructive sleep apnea syndrome (OSAS) were divided into three groups according to apnea severity: non-OSAS group (n=15), mild to moderate OSAS group (n=26), and severe OSAS (n=26). Insulin resistance was estimated by the homeostasis model assessment method. HOMA values were similar in the three groups: (3.2+/-2.2 vs. 3.3+/-1.8 vs. 3.6+/-1.5, respectively, p=0.71). Leptin levels were higher in the mild to moderate OSAS group (23.1+/-21.8 ng/ml, p<0.05) and in the severe OSAS group (20.2+/-17.5 ng/ml, p<0.05) than in the non-OSAS group (9.4+/-6.4 ng/ml). CRP levels were significantly higher in severe sleep apnea (0.35+/-0.3 vs. 0.19+/-0.1 mg/dl, p<0.05). In multiple regression analyses, waist-to-hip ratio (WHR) was the most significant determinant of HOMA estimation for insulin resistance. WHR and the percentage of total sleep time spent with hypoxemia (%TST with SaO2 <90%) were significant predictors for leptin levels, while body mass index (BMI) and the %TST with SaO2 <90% were the best predicting parameters for CRP levels. Insulin resistance estimated by the HOMA method in male patients with OSAS was not associated with sleep apnea severity independent of obesity. The severity of nocturnal hypoxemia was associated with leptin and CRP levels independent of obesity. PMID:18365276

  8. [Sleep apnea-hypopnea syndrome in the elderly].

    PubMed

    Martínez-García, Miguel Angel; Durán-Cantolla, Joaquín; Montserrat, José María

    2010-09-01

    The population pyramid is changing due to the increasing longevity of the population, making it a priority to have better knowledge of those diseases that have an increasingly major impact in advanced age. Sleep apnea-hypopnea syndrome (SAHS) affects 15-20% of individuals over 65 years. However, despite this high prevalence and that one in four sleep studies are conducted on the elderly in this country and that more 60% of these were treated with CPAP, there are few specific studies in this age group on the diagnosis and management of this syndrome. The physiological increase of the number of sleep respiratory disorders with the passing of time may be the biggest obstacle when defining, diagnosing and treating SAHS in the elderly. In any case and while more solid scientific evidence is obtained, the National SAHS Consensus, as well as the Guidelines on the diagnosis and treatment of SAHS, recommend that, within logical limits, age itself should not be an obstacle to offering the elderly diagnostic help and treatment similar to that offered to the rest of the population. PMID:20580480

  9. Apneas During Sleep in Infants: Possible Relationship with Sudden Infant Death Syndrome

    Microsoft Academic Search

    Christian Guilleminault; Rosa Peraita; Marianne Souquet; William C. Dement

    1975-01-01

    Several types of apnea are described in premature infants and in infants who have survived breathing-stoppage episodes which may be related to the sudden infant death syndrome. Upper airway apnea appears to induce the greatest changes: oxygen desaturation is more pronounced than in a central apnea of similar duration, and secondary cardiac changes are observed earlier and are more severe.

  10. Sleep apnea symptoms and accident risk factors in Persian commercial vehicle drivers

    Microsoft Academic Search

    Babak Amra; Reza Dorali; Salehe Mortazavi; Mohammad Golshan; Ziba Farajzadegan; Ingo Fietze; Thomas Penzel

    Background  Motor vehicle accidents are the second highest cause of mortality in Iran. Sleep apnea symptoms have been associated with\\u000a increased risk of motor vehicle accidents in other countries. However, we have limited data in Iran. We conducted a study\\u000a to evaluate sleep apnea symptoms and sleepiness in professional drivers and to assess the predictors of motor vehicle accidents\\u000a in Iran.

  11. Leukotriene B4 pathway activation and atherosclerosis in obstructive sleep apnea[S

    PubMed Central

    Stanke-Labesque, Françoise; Pépin, Jean-Louis; de Jouvencel, Tiphaine; Arnaud, Claire; Baguet, Jean-Philippe; Petri, Marcelo H.; Tamisier, Renaud; Jourdil, Jean François; Lévy, Patrick; Bäck, Magnus

    2012-01-01

    Leukotriene B4 (LTB4) production increases in obstructive sleep apnea syndrome (OSA) and is linked to early vascular remodeling, the mechanism of which is unknown. The objective of this study was to to determine the molecular mechanisms of LTB4 pathway activation in polymorphonuclear cells (PMNs) and early vascular remodeling in OSA and the specific contribution of intermittent hypoxia (IH). PMNs were isolated from 120 OSA patients and 33 healthy subjects and used for measurements of LTB4 production, determination of mRNA and protein expression levels, or exposed for four cycles of in vitro IH. PMNs derived from OSA patients exhibited increased LTB4 production, for which apnea-hypopnea index was an independent predictor (P=0.042). 5-Lipoxygenase-activating protein (FLAP) mRNA and protein increased significantly in PMNs from OSA patients versus controls and were associated with carotid luminal diameter and intima-media thickness. LTB4 (10 ng/ml) increased IL-6 (P=0.006) and MCP-1 (P=0.002) production in OSA patient monocytes. In vitro exposure of PMNs from controls to IH enhanced FLAP mRNA levels (P= 0.027) and induced a 2.7-fold increase (P=0.028) in LTB4 secretion compared with PMNs exposed to normoxia. In conclusion, upregulation of FLAP in PMNs in response to IH may participate in early vascular remodeling in OSA patients, suggesting FLAP as a potential therapeutic target for the cardiovascular morbidity associated with OSA. PMID:22761257

  12. Characteristics of obstructive sleep apnea in patients with Parkinson's disease.

    PubMed

    Nomura, Takashi; Inoue, Yuichi; Kobayashi, Mina; Namba, Kazuyoshi; Nakashima, Kenji

    2013-04-15

    Parkinson's disease (PD) patients frequently develop obstructive sleep apnea (OSA). In order to clarify the clinical significance of OSA in PD, we compared descriptive variables between PD patients with OSA (PD+OSA) and without (PD-OSA), and between the PD+OSA group and a group of OSA patients without PD (control OSA). The apnea hypopnea index (AHI) cutoff of 15 episodes/hour on polysomnogram (PSG) was used to assign 107 PD patients to groups; OSA-related symptoms and PSG findings were then compared. Demographic and PSG variables were compared between PD+OSA patients and 31 OSA controls. Twenty-four patients with PD (22.4%) were classified as PD+OSA. There were no significant differences in descriptive variables between the PD+OSA and PD-OSA groups. The PD+OSA group had a higher arousal index on PSG than the PD-OSA group, although the two groups had similar ESS scores. The PD+OSA patients had a lower respiratory arousal index and a smaller decrease in oxygen saturation than the control OSA group, despite having a similar AHI. The prevalence of OSA in PD did not differ from that in the general elderly population, indicating that the clinical significance of OSA as a contributor to daytime sleepiness in PD is low. PMID:23462516

  13. Functional Role of Neural Injury in Obstructive Sleep Apnea

    PubMed Central

    Saboisky, Julian P.; Butler, Jane E.; Gandevia, Simon C.; Eckert, Danny J.

    2012-01-01

    The causes of obstructive sleep apnea (OSA) are multifactorial. Neural injury affecting the upper airway muscles due to repetitive exposure to intermittent hypoxia and/or mechanical strain resulting from snoring and recurrent upper airway closure have been proposed to contribute to OSA disease progression. Multiple studies have demonstrated altered sensory and motor function in patients with OSA using a variety of neurophysiological and histological approaches. However, the extent to which the alterations contribute to impairments in upper airway muscle function, and thus OSA disease progression, remains uncertain. This brief review, primarily focused on data in humans, summarizes: (1) the evidence for upper airway sensorimotor injury in OSA and (2) current understanding of how these changes affect upper airway function and their potential to change OSA progression. Some unresolved questions including possible treatment targets are noted. PMID:22715333

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

    E-print Network

    Jin, Jiayi

    2014-07-23

    ). . . . . . . . . . . . . 16 2.1 Portable monitoring decision tree recommended by the Portable Monitor- ing Task Force of the American Academy of Sleep Medicine [1]. . . . . . 21 2.2 Wearable patch bearing a miniaturized sleep apnea detection device. . . . 29 2.3 System level... entities were built in large quantities in the United States and other countries in the western world. Today, sleep medicine has grown into a clinical as well as research specialty due to the high prevalence of sleep apnea and its pathological and social...

  15. Contribution of Arousal from Sleep to Postevent Tachycardia in Patients with Obstructive Sleep Apnea

    PubMed Central

    Azarbarzin, Ali; Ostrowski, Michele; Moussavi, Zahra; Hanly, Patrick; Younes, Magdy

    2013-01-01

    Study Objectives: Heart rate increases after obstructive events in patients with obstructive sleep apnea (OSA). This response is generally attributed to arousal from sleep. Opening of the obstructed airway, however, is associated with ventilatory and hemodynamic changes that could result in physiologic responses unrelated to arousal. Our objective was to determine the contribution of these physiologic responses to postevent tachycardia. Design: Analysis of data obtained during previous research protocols. Setting: Academic sleep laboratory. Participants: Twenty patients with severe OSA. Interventions: Patients were placed on a continuous positive airway pressure (CPAP) device. CPAP was reduced during sleep to different levels (dial-downs), producing obstructive events of varying severity. Some dial-downs with severe obstruction were maintained until spontaneous airway opening. In others, CPAP was increased after three obstructed breaths, terminating the events approximately 10 sec before spontaneous termination in long dial-downs. Measurement and Results: Beat-by-beat heart rate (HR) was measured for 20 sec following airway opening. Spontaneous opening during sustained dial-downs occurred 21.9 ± 8.4 sec after dial-down, was associated with arousal, and resulted in the greatest postevent tachycardia (7.8 ± 4.0 min-1). However, deliberate termination of events (12.2 ± 2.6 sec after dial-down) was also followed by tachycardia that, in the absence of cortical arousal, showed a dose-response behavior, increasing with severity of obstruction and without apparent threshold. ?HR following deliberately brief, severe obstruction (3.8 ± 3.0 min-1) was approximately half the ?HR that followed spontaneous opening of equally severe obstructions despite the shorter duration and absence of cortical arousal. Conclusions: Postevent tachycardia is due in large part to physiologic (arousal-unrelated) responses that occur upon relief of obstruction. Citation: Azarbarzin A; Ostrowski M; Moussavi Z; Hanly P; Younes M. Contribution of arousal from sleep to postevent tachycardia in patients with obstructive sleep apnea. SLEEP 2013;36(6):881-889. PMID:23729931

  16. Pharmacologic approaches for the management of symptoms and cardiovascular consequences of obstructive sleep apnea in adults

    Microsoft Academic Search

    John M. Dopp; Barbara J. Morgan

    2010-01-01

    Introduction  Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, arousals from sleep, and daytime sleepiness. Accumulating\\u000a evidence indicates that hypoxemia and sleep disruption contribute to the development of cardiovascular abnormalities in OSA.\\u000a OSA is effectively treated with continuous positive airway pressure (CPAP) therapy that splints open the airway during sleep.\\u000a Studies have shown that CPAP therapy improves daytime sleepiness and

  17. [Paradoxical respiratory response, changes in heart rate and skin circulation in progressive isocapnic hypoxia in sleep apnea patients].

    PubMed

    Mende, M; Raschke, F; Fischer, J

    1995-03-01

    In 73 patients with sleep apnea syndrome, lung function tests, night-time polysomnography for determining the apnea index (AI), hyperoxic progressive hypercapnia tests under rebreathing conditions, and, after a short pause, isocapnic progressive hypoxia tests were carried out. The objective of these examinations was to study peripheral and central chemosensitivity, changes in heart rate and capillary cutaneous circulation under isocapnic hypoxia in patients with sleep apnea syndrome (SAS). The following linear relationships were presupposed for the evaluation: for peripheral chemosensitivity between SaO2 decrease and the increase in respiratory minute volume (VE) and for central chemosensitivity between PETCO2 rise and VE increase. Of the SAS patients with an AI > or = 10, 22.5% did not react to the hypoxia test with and increase in VE but rather with a decrease in the respiratory minute volume. This patient group exhibited a positive correlation between an increase in capillary cutaneous circulation and an increase in heart rate during the hypoxia test. The hypoxic respiratory response behavior is independent of the hypercapnic respiratory response, age, Broca index, initial heart rate, blood pressure, pulmonary function values, and the size of the apnea index. The results are discussed in the context of a reduced peripheral chemosensitivity and an associated reduced sympathetic activation. PMID:7617594

  18. Two-Year-Old with Post-Surgical Hypoglossal Nerve Injury and Obstructive Sleep Apnea

    PubMed Central

    DelRosso, Lourdes M.; Hoque, Romy; Gonzalez-Toledo, Eduardo

    2014-01-01

    Background: Airway patency in both children and adults depends on the tonic and phasic activation of muscles of the tongue and pharynx supplied by the hypoglossal nerve arising at the medullary level Methods/Patient: We report a case of a 2-year-old who after resection of fourth ventricle anaplastic ependymoma developed severe sleep disordered breathing and tongue fasciculation. Results: Polysomnography showed severe obstructive sleep apnea with oxygen desaturation to 33%. Magnetic resonance imaging of the brain showed post-surgical effacement of the dorsal lateral medulla. Conclusions: We postulate that damage to the hypoglossal nerve at the level of the medulla contributed to the patient's severe obstructive sleep apnea. Patient was treated with tracheostomy. Citation: DelRosso LM; Hoque R; Gonzalez-Toledo E. Two-year-old with post-surgical hypoglossal nerve injury and obstructive sleep apnea. J Clin Sleep Med 2014;10(1):97-98. PMID:24426827

  19. Analysis of Sleep Fragmentation and Sleep Structure in Patients With Sleep Apnea and Normal Volunteers

    Microsoft Academic Search

    T. Penzel; C.-C. Lo; P. C. Ivanov; K. Kesper; H. F. Becker; C. Vogelmeier

    2005-01-01

    Sleep disorders have a high prevalence. Sleep disorders are recognized first by the complaint of non-restorative sleep. A quantification of the disorder is done by the investigation in a sleep laboratory. The investigation in the sleep laboratory examines the EEG, EOG and EMG to derive sleep stages. This is a labor intensive sleep scoring after the polysomnography investigation. Usually the

  20. Abdominal fat and sleep apnea: the chicken or the egg?

    PubMed

    Pillar, Giora; Shehadeh, Naim

    2008-02-01

    Obstructive sleep apnea (OSA) syndrome is a disorder characterized by repetitive episodes of upper airway obstruction that occur during sleep. Associated features include loud snoring, fragmented sleep, repetitive hypoxemia/hypercapnia, daytime sleepiness, and cardiovascular complications. The prevalence of OSA is 2-3% and 4-5% in middle-aged women and men, respectively. The prevalence of OSA among obese patients exceeds 30%, reaching as high as 50-98% in the morbidly obese population. Obesity is probably the most important risk factor for the development of OSA. Some 60-90% of adults with OSA are overweight, and the relative risk of OSA in obesity (BMI >29 kg/m(2)) is >or=10. Numerous studies have shown the development or worsening of OSA with increasing weight, as opposed to substantial improvement with weight reduction. There are several mechanisms responsible for the increased risk of OSA with obesity. These include reduced pharyngeal lumen size due to fatty tissue within the airway or in its lateral walls, decreased upper airway muscle protective force due to fatty deposits in the muscle, and reduced upper airway size secondary to mass effect of the large abdomen on the chest wall and tracheal traction. These mechanisms emphasize the great importance of fat accumulated in the abdomen and neck regions compared with the peripheral one. It is the abdomen much more than the thighs that affect the upper airway size and function. Hence, obesity is associated with increased upper airway collapsibility (even in nonapneic subjects), with dramatic improvement after weight reduction. Conversely, OSA may itself predispose individuals to worsening obesity because of sleep deprivation, daytime somnolence, and disrupted metabolism. OSA is associated with increased sympathetic activation, sleep fragmentation, ineffective sleep, and insulin resistance, potentially leading to diabetes and aggravation of obesity. Furthermore, OSA may be associated with changes in leptin, ghrelin, and orexin levels; increased appetite and caloric intake; and again exacerbating obesity. Thus, it appears that obesity and OSA form a vicious cycle where each results in worsening of the other. PMID:18227501

  1. Sleep apnea in children with refractory monosymptomatic nocturnal enuresis

    PubMed Central

    El-Mitwalli, Ashraf; Bediwy, Adel Salah; Zaher, Ashraf Ahmed; Belal, Tamer; Saleh, Abdel Baset M

    2014-01-01

    Background Children with nocturnal enuresis (NE) are believed to have deep sleep with high arousal threshold. Studies suggest that obstructive sleep apnea–hypopnea syndrome (OSAHS) and NE are common problems during childhood. We sought to assess the prevalence of OSAHS in children with refractory NE and whether its severity is associated with the frequency of bedwetting. Methods The study group comprised 43 children with refractory monosymptomatic NE and a control group of 30 children, both aged 6–12 years. All subjects underwent thorough neurological examination, one night of polysomnography only for the patient group, and a lumbosacral plain X-ray to exclude spina bifida. Results The groups were well matched. Two subjects of the control group had mild OSAHS. The mean age of the patients was (9.19±2.4 years), 26 were boys, and 67% showed frequent NE (>3 days bedwetting/week). Patients with NE had significantly higher rates of OSAHS (P<0.0001); three patients had mild, 12 had moderate, and eleven showed severe OSAHS. There was no significant statistical difference among patients having OSAHS in relation to age, sex, or family history of NE. The frequency of bedwetting was statistically significantly higher in patients with severe OSAHS (P=0.003). Conclusion Patients with refractory NE had a significantly higher prevalence of OSAHS with no sex difference. The frequency of bedwetting was higher in patients with severe OSAHS. PMID:24648781

  2. Overnight Pulse Oximetry for Evaluation of Sleep Apnea among Children with Trisomy 21

    PubMed Central

    Coverstone, Andrea M.; Bird, Merielle; Sicard, Melissa; Tao, Yu; Grange, Dorothy K.; Cleveland, Claudia; Molter, David; Kemp, James S.

    2014-01-01

    Study Objectives: For children with trisomy 21, polysomnography at age 4 to assess obstructive sleep disordered breathing (OSDB) is the standard of care. Oximetry alone has been used to screen for disease among children without trisomy 21. This study evaluates the potential usefulness of oximetry scoring in diagnosing OSDB among children with trisomy 21. Methods: A McGill oximetry score from 1 to 4 was derived from a full overnight PSG done on 119 consecutive pediatric subjects with trisomy 21. Most were referred to the sleep laboratory because of suspicion for OSDB. Oximetry scorers were blinded to the child's full PSG and clinical course. Results of the complete PSG were then compared to oximetry scores. Results: Obstructive apnea-hypopnea index (OAHI) was ? 2.5 for 50% of all subjects. Fifty-nine subjects (49.6%) had McGill Score 1 (“inconclusive”); median OAHI was 1.0 (IQR 0.4–3.3). McGill Score was 2 for 43 subjects (36.1%); median OAHI was 4.5 (IQR 1.3-8.8). Seventeen subjects (14.3%) had McGill Scores of 3 or 4; median OAHI was 16.1 (IQR 9.3–45.5, range 2.1 to 101.1). Ten percent of subjects had a considerable number of central events (? 2.5 respiratory events/h but OAHI < 2.5), including 7 with McGill Score 2. Conclusions: In a retrospective cohort of children with trisomy 21, McGill oximetry scores of 3 or 4 reliably identified patients with marked OSDB. The possibility of central apneas causing hypoxemia must be considered in those with McGill Score 2. With these caveats, oximetry screening should be considered when developing streamlined protocols for early intervention to treat OSDB in this population. Citation: Coverstone AM, Bird M, Sicard M, Tao Y, Grange DK, Cleveland C, Molter D, Kemp JS. Overnight pulse oximetry for evaluation of sleep apnea among children with trisomy 21. J Clin Sleep Med 2014;10(12):1309-1315. PMID:25325597

  3. Anatomic Predictors of Retropalatal Mechanical Loads in Patients with Obstructive Sleep Apnea

    Microsoft Academic Search

    Yanru Li; Jingying Ye; Tianzuo Li; Na Lin; Zhenchang Wang; Chenyang Liang; Al Sperry; Demin Han

    2011-01-01

    Background: The retropalatal airway is one of the most collapsible sites during sleep in patients with obstructive sleep apnea (OSA). The primary anatomical contributors to increased collapsibility in the retropalatal segment remain unclear. Objectives: This study seeks to investigate how the balance between pharyngeal soft tissues and the bony enclosure influences retropalatal mechanical loads in patients with OSA. Methods: The

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

    Microsoft Academic Search

    Udaya Seneviratne; Kathiravelu Puvanendran

    2004-01-01

    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

  5. A case of achondroplasia with severe pulmonary hypertension due to obstructive sleep apnea

    Microsoft Academic Search

    Selman Vefa Y?ld?r?m; Cemile Durmaz; Mir Ali Pourbagher; Alper Nabi Erkan

    2006-01-01

    Achondroplasia is the most common skeletal dysplasia in children. Achondroplasic patients have a short cranial face and midface hypoplasia. They often have sleep-related respiratory disturbances that lead to hypoxemia caused by midfacial hypoplasia, a small upper airway, hypotonia of airway muscles, or brain stem compression. It has been well described that obstructive sleep apnea can cause pulmonary hypertension (PH) through

  6. Sleep apnea and nocturnal myoclonus in elderly persons in Vilcabamba, Ecuador.

    PubMed

    Okudaira, N; Fukuda, H; Nishihara, K; Ohtani, K; Endo, S; Torii, S

    1983-07-01

    Four men (M age 90.5 years) and four women (M age 91.2 years) in Vilcabamba, Ecuador (a community noted for people with extreme longevity) volunteered for sleep recordings using four-channel Medilog portable cassette recorder. Of the eight physically healthy persons recorded, only one man displayed sleep apnea syndrome. No nocturnal myoclonus was observed. Low incidence of sleep apnea of elderly persons in Vilcabamba may be due to a low barometric pressure and/or lack of drug abuse. PMID:6863855

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

    PubMed Central

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

    1999-01-01

    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.

  8. Auto-adjusting Positive Airway Pressure Treatment for Sleep Apnea Diagnosed by Home Sleep Testing

    PubMed Central

    Berry, Richard B.; Sriram, Peruvemba

    2014-01-01

    Study Objectives: Compare auto-adjusting positive airway pressure (APAP) treatment with positive airway pressure (PAP) titration by polysomnography (PSG) followed by CPAP treatment in patients diagnosed with obstructive sleep apnea (OSA) by home sleep apnea testing (HSAT). Design: Prospective randomized treatment study. Setting: Tertiary Veterans Administration Medical Center. Participants: 156 patients diagnosed with OSA by HSAT (apneahypopnea index [AHI] ? 10/h) suitable for APAP treatment. Interventions: APAP arm: Treatment with an APAP device, CPAP arm: PSG PAP titration followed by CPAP treatment. Measurements: Mean PAP adherence, Epworth sleepiness scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ). Results: The mean (± SD) age, BMI, and diagnostic AHI (APAP: 28.6 ± 18.5, CPAP: 28.3 ± 16.0/h, p = NS) did not differ between the study arms. After 6 weeks of treatment, 84.6% of 78 patients started on APAP and 84.3% of 70 patients started on CPAP (8 declined treatment after the titration) were using PAP, p = NS. The 90% APAP and level of CPAP were similar (10.8 ± 3.1, 11.7 ± 2.5 cm H2O, p = 0.07). The average nightly PAP use did not differ (APAP: 4.45 ± 2.3, CPAP: 4.0 ± 2.3 h, p = NS). The improvements in the ESS (APAP: ?4.2 ± 4.7, CPAP: ?3.7 ± 4.8, p = NS) and in the FOSQ (APAP: 2.6 ± 3.5, CPAP: 2.2 ± 3.7, p = NS) were not different. Conclusions: Following diagnosis of OSA by HSAT, treatment with APAP results in equivalent PAP adherence and improvement in sleepiness compared to a PSG titration and CPAP treatment. Commentary: A commentary on this article appears in this issue on page 1277. Citation: Berry RB, Sriram P. Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleep testing. J Clin Sleep Med 2014;10(12):1269-1275. PMID:25348244

  9. Dynamics of snoring sounds and its connection with obstructive sleep apnea

    NASA Astrophysics Data System (ADS)

    Alencar, Adriano M.; da Silva, Diego Greatti Vaz; Oliveira, Carolina Beatriz; Vieira, André P.; Moriya, Henrique T.; Lorenzi-Filho, Geraldo

    2013-01-01

    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 s, 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 moderate or severe apnea.

  10. Sleep Apnea Determines Soluble TNF-? Receptor 2 Response to Massive Weight Loss

    PubMed Central

    Pallayova, Maria; Steele, Kimberley E.; Magnuson, Thomas H.; Schweitzer, Michael A.; Smith, Philip L.; Patil, Susheel P.; Bevans-Fonti, Shannon; Polotsky, Vsevolod Y.

    2015-01-01

    Background The effects of surgical weight loss (WL) on inflammatory biomarkers associated with sleep apnea remain unknown. We sought to determine if any bio-markers can predict amelioration of sleep apnea achieved by bariatric surgery. We hypothesized that surgical WL would substantially reduce severity of sleep apnea and levels of proinflammatory cytokines. Methods Twenty-three morbidly obese adults underwent anthropometric measurements, polysomnography, and serum biomarker profiling prior to and 1 year following bariatric surgery. We examined the effect of WL and amelioration of sleep apnea on metabolic and inflammatory markers. Results Surgical WL resulted in significant decreases in BMI (16.7±5.97 kg/m2/median 365 days), apnea–hypopnea index (AHI), CRP, IL-6, sTNF?R1, sTNF?R2, and leptin levels, while ghrelin, adiponectin, and soluble leptin receptor concentrations increased significantly. Utilizing an AHI cutoff of 15 events/h, we found significantly elevated levels of baseline sTNF?R2 and greater post-WL sTNF?R2 decreases in subjects with baseline AHI ?15 events/h compared to those with AHI <15 events/h despite no significant differences in baseline BMI, age, and ?BMI. In a multivariable linear regression model adjusting for sex, age, impaired glucose metabolism, ?BMI, and follow-up period, the post-WL decreases in AHI were an independent predictor of the decreases in sTNF?R2 and altogether accounted for 46% of the variance of ?sTNF?R2 (P=0.011) in the entire cohort. Conclusions Of all the biomarkers, the decrease in sTNF?R2 was independently determined by the amelioration of sleep apnea achieved by bariatric surgery. The results suggest that sTNF?R2 may be a specific sleep apnea biomarker across a wide range of body weight. PMID:21298510

  11. A Combination Appliance for Obstructive Sleep Apnea: The Effectiveness of Mandibular Advancement and Tongue Retention

    PubMed Central

    Dort, Leslie; Remmers, John

    2012-01-01

    Study Objectives: The purpose of this study was to determine if subjects with moderate-to-severe obstructive sleep apnea would experience increasing treatment effect when a tongue retention component was added to a mandibular repositioning appliance. Design: Cohort study. Setting: Sleep clinic. Patients: Forty-four sequentially recruited patients with moderate-to-severe obstructive sleep apnea. Interventions: Subjects were sleep tested at 4 treatment stages of oral appliance therapy. The 4 stages were: 6-mm mandibular protrusion, 8-mm protrusion, 6-mm protrusion with a tongue retention bulb, and 8-mm protrusion with a tongue retention bulb. Measurements and Results: Forty-one of 44 subjects completed the protocol. There was a decrease in mean respiratory disturbance index from 33.5 events/h at baseline to 18.1 events/h at stage 4 (p = 0.001). Mean Epworth Sleepiness Scale (ESS) decreased from 12.3 at baseline to 9.0 at stage 4 (p = 0.0001. Conclusions: A combined approach utilizing both mandibular protrusion and tongue retention can provide effective treatment for moderate-to-severe obstructive sleep apnea. The addition of a tongue bulb may provide further treatment effect when mandibular protrusion is limited. Appliance designs that allow for convenient combination therapy need to be developed for this purpose. Citation: Dort L; Remmers J. A combination appliance for obstructive sleep apnea: the effectiveness of mandibular advancement and tongue retention. J Clin Sleep Med 2012;8(3):265-269. PMID:22701383

  12. Sleep apnea and health-related quality of life in African-American elderly

    Microsoft Academic Search

    Carl Stepnowsky; Sherella Johnson; Joel Dimsdale; Sonia Ancoli-Israel

    2000-01-01

    The relationship between health-related quality of life (HRQOL) and sleep apnea was examined in a sample of elderly African-Americans\\u000a screened for snoring and daytime sleepiness. Seventy African-Americans over the age of 65 years completed a comprehensive\\u000a sleep questionnaire, the Quality of Well-Being Scale (QWB), and the Medical Outcomes Study (MOS) Core Measures of HRQOL (116-item\\u000a Long Version) and had sleep

  13. Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome

    PubMed Central

    Akyol, Selahattin; Çörtük, Mustafa; Baykan, Ahmet Oytun; Kiraz, Kemal; Börekçi, Abdurrezzak; ?eker, Taner; Gür, Mustafa; Çayli, Murat

    2015-01-01

    OBJECTIVE: Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV) is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome. METHODS: We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years) who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI): (1) AHIlow group: 5?AHI<15, (2) AHImid group: 1530. RESULTS: The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all). Multiple linear regression analysis indicated that the MPV was associated with the AHI (?=0.500, p<0.001) and the high sensitivity C-reactive protein (hs-CRP) level (?=0.194, p=0.010). CONCLUSION: The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome.

  14. Obstructive sleep apnea in 2 women with familial partial lipodystrophy due to a heterozygous LMNA R482Q mutation

    Microsoft Academic Search

    Robert A. Hegele; Salam A. Al-Attar; Brian K. Rutt

    2007-01-01

    lthough obstructive sleep apnea has many attributes of a complex genetic trait, 1 few genetic mutations have been identified in patients with the condition. Obesity has been shown to be associated with obstructive sleep apnea in the general population, 2 but few rare genetic syndromes affecting total body adipose content or distribu- tion have been evaluated for possible association with

  15. Vitamin D Levels and Obstructive Sleep Apnea in Children

    PubMed Central

    Kheirandish-Gozal, Leila; Peris, Eduard; Gozal, David

    2014-01-01

    Aims/Hypothesis Obstructive sleep apnea (OSA) is a common health problem in children. African American (AA) and obese children have higher prevalence of OSA, and are also at higher risk for reduced vitamin D levels. We hypothesized that OSA would be associated with lower plasma 25-hydroxyvitamin D (25(OH)D), and increase the risk for metabolic dysfunction and systemic inflammation. Methods In this observational cross-sectional study, 176 prospectively recruited children (mean age: 6.8±0.8 years) underwent overnight polysomnographic evaluation and a fasting blood draw the morning after the sleep study. In addition to lipid profile, HOMA-IR and hsCRP assays, plasma 25(OH)D levels were assessed using ELISA kits. Results AA children, obese children, and children with OSA had significantly lower 25(OH)D levels. Linear associations emerged between 25(OH)D plasma levels and BMI z score, hsCRP, and HOMA-IR, as well as with AHI and SpO2 nadir, the latter 2 associations remaining statistically significant even when controlling for all other potential confounders, and independently accounting for 17.7% of the variance in 25(OH)D (p<0.01). Conclusions 25(OH)D levels are reduced in pediatric OSA, in AA children and in obesity, particularly when all are present, and may play a role in modulating the degree of insulin resistance and systemic inflammation. The short-term and long-term significance of reduced 25(OH)D in pediatric OSA remains undefined. PMID:24684979

  16. Cardiovascular regulation in different sleep stages in the obstructive sleep apnea syndrome.

    PubMed

    Gapelyuk, Andrej; Riedl, Maik; Suhrbier, Alexander; Kraemer, Jan F; Bretthauer, Georg; Malberg, Hagen; Kurths, Jürgen; Penzel, Thomas; Wessel, Niels

    2011-08-01

    Heart rate and blood pressure variability analysis as well as baroreflex sensitivity have been proven to be powerful tools for the assessment of autonomic control in clinical practice. Their ability to detect systematic changes caused by different states, diseases and treatments shall be shown for sleep disorders. Therefore, we consider 18 normotensive and 10 hypertensive patients suffering from obstructive sleep apnea syndrome (OSAS) before and after a three-month continuous positive airway pressure (CPAP) therapy. Additionally, an age and sex matched control group of 10 healthy subjects is examined. Linear and nonlinear parameters of heart rate and blood pressure fluctuation as well as the baroreflex sensitivity are used to answer the question whether there are differences in cardiovascular regulation between the different sleep stages and groups. Moreover, the therapeutic effect of CPAP therapy in OSAS patients shall be investigated. Kruskal-Wallis tests between the sleep stages for each group show significant differences in the very low spectral component of heart rate (VLF/P: 0.0033-0.04 Hz, p<0.01) which indicates differences in metabolic activity during the night. Furthermore, the decrease of Shannon entropy of word distribution as a parameter of systolic blood pressure during non-REM sleep reflects the local dominance of the vagal system (p<0.05). The increased sympathetic activation of the patients leads to clear differences of cardiovascular regulation in different sleep stages between controls and patients. We found a significant reduction of baroreflex sensitivity in slow wave sleep in the OSAS patients (Mann-Whitney test, p<0.05) compared to controls, which disappeared after three months of CPAP therapy. Hence, our results demonstrate the ability of cardiovascular analyzes to separate between healthy and pathological regulation as well as between different severities of OSAS in this retrospective study. PMID:21823997

  17. Metabolic disorders associated with obstructive sleep apnea in adults.

    PubMed

    Lurie, Alain

    2011-01-01

    The relationship between metabolic disorders and obstructive sleep apnea (OSA) is multidirectional. Obesity is recognized as the strongest risk factor for OSA. It is unknown whether metabolic syndrome and insulin resistance/type 2 diabetes mellitus contribute to the development or aggravation of OSA, although this is likely. Conversely, OSA may be a risk factor for metabolic disorders. Strong evidence suggests that OSA may increase the risk of developing insulin resistance, glucose intolerance and type 2 diabetes mellitus. OSA has also been associated with the development and/or aggravation of obesity, dyslipidemia, metabolic syndrome and nonalcoholic fatty liver disease - a liver manifestation of metabolic syndrome. In addition, metabolic disorders are confounding factors in OSA. Metabolic disorders and OSA share common intermediate pathogenic pathways, including alterations in autonomic nervous system regulation, increased inflammatory activity, and alterations in adipokine levels and endothelial dysfunction, which may be involved in the interplay between these conditions. Overall, this complexity makes it especially difficult to reveal and understand the links between OSA and metabolic and cardiovascular disorders. The International Diabetes Federation has recently published clinical practice recommendations suggesting that OSA patients should be routinely screened for markers of metabolic disturbance and cardiovascular risk, such as waist circumference, blood pressure, and fasting lipid and glucose levels. It also recommends that the possibility of OSA should be considered in the assessment of all patients with type 2 diabetes mellitus and metabolic syndrome. PMID:22005190

  18. Obstructive Sleep Apnea and Surgery: Quality Improvement Imperatives and Opportunities.

    PubMed

    Brenner, Michael J; Goldman, Julie L

    2014-03-01

    Obstructive sleep apnea (OSA) is more common in surgical candidates than in the general population and may increase susceptibility to perioperative complications that range from transient desaturation to catastrophic injuries. Understanding the potential impact of OSA on patients' surgical risk profile is of particular interest to otolaryngologists, who routinely perform airway procedures-including surgical procedures for treatment of OSA. Whereas the effects of OSA on long-term health outcomes are well documented, the relationship between OSA and surgical risk is not collinear, and clear consensus on the nature of the association is lacking. Better guidelines for optimization of pain control, perioperative monitoring, and surgical decision making are potential areas for quality improvement efforts. Many interventions have been suggested to mitigate the risk of adverse events in surgical patients with OSA, but wide variations in clinical practice remain. We review the current literature, emphasizing recent progress in understanding the complex pathophysiologic interactions noted in OSA patients undergoing surgery and outlining potential strategies to decrease perioperative risks. PMID:25013745

  19. Obstructive sleep apnea and asthma: associations and treatment implications.

    PubMed

    Prasad, Bharati; Nyenhuis, Sharmilee M; Weaver, Terri E

    2014-04-01

    Obstructive sleep apnea (OSA) and asthma are highly prevalent respiratory disorders and are frequently co-morbid. Risk factors common to the two diseases include obesity, rhinitis, and gastroesophageal reflux (GER). Observational and experimental evidence implicates airways and systemic inflammation, neuromechanical effects of recurrent upper airway collapse, and asthma-controlling medications (corticosteroids) as additional explanatory factors. Therefore, undiagnosed or inadequately treated OSA may adversely affect control of asthma and vice versa. It is important for clinicians to be vigilant and specifically address weight-control, nasal obstruction, and GER in these populations. Utilizing validated screening instruments to affirm high risk of co-morbid OSA or asthma in persistently symptomatic patients will allow clinicians to cost-effectively test and treat appropriate patients, potentially improving outcomes. While non-invasive ventilation in acute asthma improves outcomes, the role of chronic continuous positive airway pressure (CPAP; the first-line treatment for OSA) in improving long-term asthma control is not known. Future research should focus on the impact of optimal CPAP therapy and adherence on asthma symptoms and outcomes. PMID:23890469

  20. Asthma and obstructive sleep apnea: clinical and pathogenic interactions.

    PubMed

    Puthalapattu, Swathy; Ioachimescu, Octavian C

    2014-04-01

    Asthma and obstructive sleep apnea (OSA) are among the most prevalent chronic human diseases of the 21st century. They share several risk and aggravating factors such as obesity, smoking, gastroesophageal reflux, sinonasal disease or upper airway involvement, systemic inflammation, etc. Although the association between OSA and chronic obstructive pulmonary disease or "overlap syndrome" is better known and characterized, the association of asthma and OSA or "alternative overlap syndrome" is less clearly defined and understood. Nevertheless, their coexistence has synergistic effects on patient symptoms, response to therapy, and general outcomes. Taxonomically, asthma and OSA are syndromically defined entities that are quite heterogeneous, being characterized by a plethora of clinical phenotypes. The complex interactions between these conditions should take into account more specific etiopathogenic mechanisms or distinct disease endotypes. The potential clinical, pathogenic, and therapeutic significance of the disease endotypes is still emerging and needs further evaluation. We present here a review on the bidirectional relationships between asthma and OSA, including their clinical, pathophysiologic, and therapeutic connections. Furthermore, we propose here to look at these interactions beyond the development of comprehensive inventories of genotypes, clinical and pathophysiologic phenotypes, but in the larger context of obstructive lung and airway disorders, with the goal to reassess meaningful syndromes based on natural history and predictable patient outcomes, which will help us better stratify therapy in an era of personalized medicine. PMID:24583902

  1. Obstructive Sleep Apnea and Surgery: Quality Improvement Imperatives and Opportunities

    PubMed Central

    Goldman, Julie L.

    2014-01-01

    Obstructive sleep apnea (OSA) is more common in surgical candidates than in the general population and may increase susceptibility to perioperative complications that range from transient desaturation to catastrophic injuries. Understanding the potential impact of OSA on patients’ surgical risk profile is of particular interest to otolaryngologists, who routinely perform airway procedures—including surgical procedures for treatment of OSA. Whereas the effects of OSA on long-term health outcomes are well documented, the relationship between OSA and surgical risk is not collinear, and clear consensus on the nature of the association is lacking. Better guidelines for optimization of pain control, perioperative monitoring, and surgical decision making are potential areas for quality improvement efforts. Many interventions have been suggested to mitigate the risk of adverse events in surgical patients with OSA, but wide variations in clinical practice remain. We review the current literature, emphasizing recent progress in understanding the complex pathophysiologic interactions noted in OSA patients undergoing surgery and outlining potential strategies to decrease perioperative risks. PMID:25013745

  2. Salivary biomarkers indicate obstructive sleep apnea patients with cardiovascular diseases

    PubMed Central

    Zheng, Hui; Li, Ruoxuan; Zhang, Jieni; Zhou, Shaonan; Ma, Qingwei; Zhou, Yanheng; Chen, Feng; Lin, Jiuxiang

    2014-01-01

    Although obstructive sleep apnea (OSA) patients are at high risk of developing cardiovascular disease (CVD), only a small proportion is currently diagnosed. To explore and identify the differentially expressed proteins/peptides of OSA patients with CVDs, a mass spectrometry-based salivary analysis was performed. In our study, eleven peaks were observed differentially expressed in saliva from the non-CVD and CVD groups. Five masses mass peaks (1594.1, 1673.7, 1196.6, 1290.5, and 1447.0?Da) showed an upregulated trend in the CVD group, whereas six mass peaks (3038.6, 2164.3, 2301.4, 3195.0, 2628.4, and 1721.9?Da) were downregulated in the CVD group. In addition, the alpha-2-HS-glycoprotein (AHSG) levels in saliva were verified to be decreased in CVD group compared to non-CVD group. Analysis of the salivary peptidome provides a promising approach to screening for novel biomarkers before further identification, and may contribute to early diagnosis of CVD patients with OSA. PMID:25395095

  3. Effect of Recording Duration on the Diagnostic Accuracy of Out-of-Center Sleep Testing for Obstructive Sleep Apnea

    PubMed Central

    Wittine, Lara M.; Olson, Eric J.; Morgenthaler, Timothy I.

    2014-01-01

    Study Objectives: This study investigated the minimum recording time needed during out-of-center sleep testing (OCST) to accurately diagnose the presence and severity of obstructive sleep apnea (OSA). Design and Setting: A retrospective analysis was conducted of OCSTs performed from October 2009 to May 2012 at the Mayo Clinic Center of Sleep Medicine using the portable Embletta™ system. Patients or Participants: Demographic information was collected for patients who underwent OCSTs during the study period, including presenting symptoms, examination findings, and comorbidities. Intervention: Each study was divided into 60-, 120-, 180-, 240-, 300-, 360-, and 420-min intervals beginning at the recording start time to determine the respiratory event index (REI) for each of these time intervals. These interval values were then compared to the original REI derived from the total recording time (REITRT) by a paired t-test and concordance correlation coefficient (CCC). Measurements and Results: There were significant differences between the REITRT and the REI from the 60-min (P < 0.0001), 120-min (0.0001), 180-min (0.003) and 240-min (0.006) intervals with a lack of concordance, suggesting these intervals are poor diagnostic correlates for the REITRT. REIs determined at 300, 360, and 420 min were not significantly different from the REITRT and had highly significant CCCs, 0.963, 0.987, and 0.995, respectively. Conclusions: The results suggest that at least 300 min recording time during out-of-center sleep testing is needed for accurate diagnosis of obstructive sleep apnea and determination of obstructive sleep apnea severity. Citation: Wittine LM, Olson EJ, Morgenthaler TI. Effect of recording duration on the diagnostic accuracy of out-of-center sleep testing for obstructive sleep apnea. SLEEP 2014;37(5):969-975. PMID:24790276

  4. Craniofacial morphology of Croatian patients with obstructive sleep apnea.

    PubMed

    Vidovi?, Neven; Mestrovi?, Senka; Dogas, Zoran; Bukovi?, Dino; Brakus, Ivan; Brakus, Ratka Bori?; Kovaci?, Ivan

    2013-03-01

    Currently, there is no information available regarding craniofacial morphology of Croatian patients with obstructive sleep apnea (OSA). The aim of the study was to determine the craniofacial characteristics of patients with OSA and to assess the association of cephalometric and anthropometric variables related to craniofacial morphology with the apnea hypopnea index (AHI). Anthropometric measurements and upright lateral cephalometric radiographs were obtained from 20 male patients with OSA and 20 male controls. The 20 OSA patients were classified into two groups on the basis of body mass index (BMI) as obese and non-obese. Twenty three variables were identified and calculated for each cephalometric radiograph. OSA was defined as AHI > or = 5/hour. The OSA patients showed greater body mass index (BMI), neck circumference (NC) and cranial index (CI) and lower facial index (FI) compared to the controls (p < 0.01). The patients with OSA showed significant cephalometric features as opposed to the controls: smaller linear distance between gonion and menton and anterior cranial base, greater linear distance from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate. Furthermore, they showed reduced upper airway width at two levels: the nasopharynx, and the region of posterior airway space, smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx and greater upper airway length. They also displayed significantly increased craniocervical angulation, larger angle between supramentale, menton and hyoid bone and larger angle between posterior nasal spine, supramentale and hyoid bone. The obese OSA patients showed greater neck circumference (NC) compared with the non-obese OSA. The obese OSA patients showed significant cephalometric features compared with the non-obese OSA patients: larger craniocervical angles larger angle between the third cervical vertebra, the centre of sella turcica and the posterior nasal spine, furthermore, greater linear distance between the hyoid bone and the third cervical vertebra and smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx. In our study, AHI was significantly correlated with cephalometric measurements S-Go, S-H, H-C3 and S-PNS-C3. PMID:23697283

  5. Clinical Presentation of Obstructive Sleep Apnea in Patients with End-stage Renal Disease

    PubMed Central

    Beecroft, Jaime M.; Pierratos, Andreas; Hanly, Patrick J.

    2009-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is common in patients with end-stage renal disease (ESRD) and is largely underrecognized. Our objective was to determine whether the presentation of OSA in patients with ESRD differs from the stereotypical presentation in the general population (loud snoring, witnessed apnea, and daytime sleepiness in overweight, middle-aged men). Methods: Seventy-six chronic dialysis patients with OSA were compared to 380 OSA patients with normal renal function who were matched for apnea severity (apnea-hypopnea index). All patients underwent overnight polysomnography and completed the Epworth Sleepiness Scale and a questionnaire to assess symptoms of OSA. Results: Age and gender distribution were similar between groups, however, body mass index was lower in the ESRD group (28 ± 5 vs. 33 ± 14 kg/m2). Patients with ESRD were less likely to report snoring (80% vs. 98%), witnessed apnea during sleep (32% vs. 58%), unrefreshing sleep (55% vs. 73%), and morning headaches (15% vs. 27%). Overnight polysomnography revealed less intense snoring and more sleep disturbance in patients with ESRD. The prevalence and severity of self-reported daytime sleepiness was similar between groups. Conclusions: The presenting symptoms of patients with ESRD and documented OSA differed from a control group of OSA patients matched for AHI. This suggests that the presentation of ESRD patients with OSA may differ from the general population, and this should be appreciated to avoid underdiagnosis of this important comorbidity. Citation: Beecroft JM; Pierratos A; Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with end-stage renal disease. J Clin Sleep Med 2009;5(2):115-121. PMID:19968043

  6. An evaluation of long-term nasal CPAP therapy for sleep apnea.

    PubMed

    Hsu, R W; Huang, W L; King, S L; Chiang, C D

    1992-10-01

    Nasal continuous positive airway pressure (CPAP) is an effective therapy for sleep apnea. Little is known about long-term patient compliance and side effects with this therapeutic modality in the Chinese. In order to evaluate this, we collected 8 obstructive sleep apnea patients who received home nasal CPAP therapy between January 1990 and July 1991. Each received two sets of nap polysomnographic studies. The initial set was performed to diagnose and evaluate patient response to CPAP as well as defining the CPAP pressure the patient would be using at home. The second set of studies were conducted for follow up and re-evaluation. Seven of these patients reported using nasal CPAP during sleep at night, and one did not use it all. Nasal CPAP improved clinical symptoms, particularly daytime sleepiness, and 7 patients were generally satisfied with nasal CPAP. Initially the side effects were a dry throat and nose. After 5 to 15 months of CPAP treatment, the follow-up nap sleep studies showed no significant change in the apnea/hypopnea index, duration of apnea, or oxygen desaturation between the diagnostic and follow-up (without CPAP) studies. However the amount of nasal CPAP pressure setting declined in 4 of 7 patients. Our own experience indicates that long-term nasal CPAP is an important new means of treatment for sleep apnea and allows a normal daytime life. It was well-tolerated by most sleep apnea patients. However, it is necessary to further evaluate of morbidity and the amount of pressure setting relative to long-term home nasal CPAP. PMID:1334787

  7. Life-Threatening Obstructive Sleep Apnea Caused by Adenoid Hypertrophy in an Infant with Noonan Syndrome

    PubMed Central

    Khirani, Sonia; Leboulanger, Nicolas; Ramirez, Adriana; Fauroux, Brigitte

    2012-01-01

    Adenoidectomy is a commonly performed surgery in children, even though its effectiveness is still under investigation. However, in children with risk factors such as age under 3 years old, associated comorbidities, or severe obstructive sleep apneas, a high postoperative respiratory morbidity is possible. We report the case of a 15-month-old boy with Noonan syndrome and a complex clinical history, who presented with a life-threatening obstructive sleep apnea due to hypertrophy of the adenoids which resolved completely after adenoidectomy. PMID:23198236

  8. The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea

    Microsoft Academic Search

    Melinda L. Jackson; Con Stough; Mark E. Howard; Jo Spong; Luke A. Downey; Bruce Thompson

    Purpose  A high prevalence of depressive symptomatology has been reported amongst sufferers of obstructive sleep apnea (OSA), but it\\u000a remains unclear as to whether this is due to their OSA or other factors associated with the disorder. The current study aimed\\u000a to assess the incidence and aetiology of depression in a community sample of individuals presenting to the sleep laboratory\\u000a for

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

    PubMed Central

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

    2013-01-01

    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

  10. Visual Vigilance in Drivers with Obstructive Sleep Apnea

    PubMed Central

    Tippin, Jon; Sparks, JonDavid; Rizzo, Matthew

    2009-01-01

    Objective To determine the effects of obstructive sleep apnea (OSA) on visual vigilance during simulated automobile driving. Methods Twenty-five drivers with OSA and 41 comparison drivers participated in an hour-long drive in a high fidelity driving simulator. Drivers responded to light targets flashed at seven locations across the forward horizon. Dependent measures were percent correct (hit rate, HR), and reaction time (RT). Self-assessment of sleepiness used the Stanford Sleepiness Scale (SSS) before and after the drive and the Epworth Sleepiness Scale (ESS). Results OSA drivers showed reduced vigilance based on lower HR than comparison drivers, especially for peripheral targets (80.7 +/? 14.8% vs. 86.7 +/? 8.8%, p = 0.03). OSAS drivers were sleepier at the end of the drive than comparison drivers (SSS = 4.2 +/? 1.2 vs. 3.6 +/? 1.2, p = 0.03), and increased sleepiness correlated with decreased HR only in those with OSA (r = ?0.49, p = 0.01). Lower HR and higher post-drive SSS predicted greater numbers of driving errors in all subjects. Yet, ESS, pre-drive SSS, and most objective measures of disease severity failed to predict driving and vigilance performance in OSA. Conclusions Reduced vigilance for peripheral visual targets indicates that OSA drivers have restriction of their effective field of view, which may partly explain their increased crash risk. This fatigue-related decline in attention is predicted by increased subjective sleepiness during driving. These findings may suggest a means of identifying and counseling high-risk drivers, and aid in the development of in-vehicle alerting and warning devices. PMID:19616141

  11. The role of drug-induced sleep endoscopy in surgical planning for obstructive sleep apnea syndrome.

    PubMed

    Aktas, Ozturk; Erdur, Omer; Cirik, Ahmet Adnan; Kayhan, Fatma Tulin

    2015-08-01

    This study investigated the role of drug-induced sleep endoscopy (DISE) in the surgical treatment planning of patients with obstructive sleep apnea syndrome (OSAS). This study was conducted using patients diagnosed with OSAS between January 2007 and March 2009, who were scheduled for surgical treatment. DISE was performed using propofol in patients considered to have upper respiratory tract obstruction as indicated by Muller's maneuver. After completing the sleep endoscopy, the patient was intubated and surgery was performed (tonsillectomy and uvulopalatopharyngoplasty). A successful operation was defined as a decrease in the respiratory disturbance index to below 5 or a decrease of ?50 % following the operation. The study included 20 patients (4 female and 16 male) aged 19-57 years. No statistically significant correlation between modified Mallampati class and operation success or between the polysomnographic stage of disease and operation success was identified. A significantly high operation success rate was found in the group with obstruction of the upper airway according to DISE (p < 0.05), whereas a significantly low operation success rate was found in the group with obstruction of the lower airway according to DISE (p < 0.01). DISE may be used to identify the localization of obstruction for diagnostic purposes, and it can be helpful in selecting the treatment method. PMID:24972543

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

    NASA Astrophysics Data System (ADS)

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

    2009-07-01

    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.

  13. [Upper airway's 3D analysis of patients with obstructive sleep apnea using tomographic cone beam].

    PubMed

    Bruwier, A; Poirrier, A L; Limme, M; Poirrier, R

    2014-12-01

    The progress of medical imaging over the last decades has led to a better understanding of the upper airway structure in sleep-disordered patients. The Obstructive Sleep Apnea Syndrome (OSA) is attributed to a functional narrowing of the upper airway, particularly of the oropharynx, during sleep. This narrowing is multifactorial. We have shown that in 60% cases, the maxilla (nasal pyramid) seems too narrow. A mandible retroposition may also play a dominant role in 30% of the cases. Both scenarios can be combined. Cone Beam Computed Tomography (CBCT) is a new medical imaging technique that permits to visualize the upper airway with less ionizing radiation than the conventional scanner. To date, only five authors have performed an upper airway's 3D analysis of sleep apnea patients with cone beam. A better understanding of the affected segment of the upper airway should help refine treatment options. PMID:25796783

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

    PubMed

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

    2015-04-01

    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

  15. Altered cortical and subcortical local coherence in obstructive sleep apnea: a functional magnetic resonance imaging study.

    PubMed

    Santarnecchi, Emiliano; Sicilia, Isabella; Richiardi, Jonas; Vatti, Giampaolo; Polizzotto, Nicola Riccardo; Marino, Daniela; Rocchi, Raffaele; Van De Ville, Dimitri; Rossi, Alessandro

    2013-06-01

    Obstructive sleep apnea (OSA) syndrome is the most common sleep-related breathing disorder, characterized by excessive snoring and repetitive apneas and arousals, which leads to fragmented sleep and, most importantly, to intermittent nocturnal hypoxaemia during apneas. Considering previous studies about morphovolumetric alterations in sleep apnea, in this study we aimed to investigate for the first time the functional connectivity profile of OSA patients and age-gender-matched healthy controls, using resting-state functional magnetic resonance imaging (fMRI). Twenty severe OSA patients (mean age 43.2 ± 8 years; mean apnea-hypopnea index, 36.3 h(-1) ) and 20 non-apneic age-gender-body mass index (BMI)-matched controls underwent fMRI and polysomnographic (PSG) registration, as well as mood and sleepiness evaluation. Cerebro-cerebellar regional homogeneity (ReHo) values were calculated from fMRI acquisition, in order to identify pathology-related alterations in the local coherence of low-frequency signal (<0.1 Hz). Multivariate pattern classification was also performed using ReHo values as features. We found a significant pattern of cortical and subcortical abnormal local connectivity in OSA patients, suggesting an overall rearrangement of hemispheric connectivity balance, with a decrease of local coherence observed in right temporal, parietal and frontal lobe regions. Moreover, an increase in bilateral thalamic and somatosensory/motor cortices coherence have been found, a finding due possibly to an aberrant adaptation to incomplete sleep-wake transitions during nocturnal apneic episodes, induced by repetitive choke sensation and physical efforts attempting to restore breathing. Different hemispheric roles into sleep processes and a possible thalamus key role in OSA neurophysiopathology are intriguing issues that future studies should attempt to clarify. PMID:23171248

  16. Management of Sleep Apnea without High Pretest Probability or with Comorbidities by Three Nights of Portable Sleep Monitoring

    PubMed Central

    Guerrero, Arnoldo; Embid, Cristina; Isetta, Valentina; Farre, Ramón; Duran-Cantolla, Joaquin; Parra, Olga; Barbé, Ferran; Montserrat, Josep M.; Masa, Juan F.

    2014-01-01

    Study Objectives: Obstructive sleep apnea (OSA) diagnosis using simplified methods such as portable sleep monitoring (PM) is only recommended in patients with a high pretest probability. The aim is to determine the diagnostic efficacy, consequent therapeutic decision-making, and costs of OSA diagnosis using polysomnography (PSG) versus three consecutive studies of PM in patients with mild to moderate suspicion of sleep apnea or with comorbidity that can mask OSA symptoms. Design and Setting: Randomized, blinded, crossover study of 3 nights of PM (3N-PM) versus PSG. The diagnostic efficacy was evaluated with receiver operating characteristic (ROC) curves. Therapeutic decisions to assess concordance between the two different approaches were performed by sleep physicians and respiratory physicians (staff and residents) using agreement level and kappa coefficient. The costs of each diagnostic strategy were considered. Patients and Results: Fifty-six patients were selected. Epworth Sleepiness Scale was 10.1 (5.3) points. Bland-Altman plot for apnea-hypopnea index (AHI) showed good agreement. ROC curves showed the best area under the curve in patients with PSG AHI ? 5 [0.955 (confidence interval = 0.862–0.993)]. For a PSG AHI ? 5, a PM AHI of 5 would effectively exclude and confirm OSA diagnosis. For a PSG AHI ? 15, a PM AHI ? 22 would confirm and PM AHI < 7 would exclude OSA. The best agreement of therapeutic decisions was achieved by the sleep medicine specialists (81.8%). The best cost-diagnostic efficacy was obtained by the 3N-PM. Conclusions: Three consecutive nights of portable monitoring at home evaluated by a qualified sleep specialist is useful for the management of patients without high pretest probability of obstructive sleep apnea or with comorbidities. Clinical Trial Registration: http://www.clinicaltrials.gov, registration number: NCT01820156 Citation: Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, Barbé F, Montserrat JM, Masa JF. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable sleep monitoring. SLEEP 2014;37(8):1363-1373. PMID:25083017

  17. Assessment of a wrist-worn device in the detection of obstructive sleep apnea

    Microsoft Academic Search

    Najib T. Ayas; Stephen Pittman; Mary MacDonald; David P. White

    2003-01-01

    Objective: To assess the accuracy of a wrist-worn device (Watch_PAT100) to diagnose obstructive sleep apnea (OSA).Methods: Thirty adult subjects with and without suspected OSA simultaneously had a standard in-laboratory polysomnogram (PSG) and wore the Watch_PAT100 during a full-night recording. PSG sleep and respiratory events were scored according to standard criteria. Watch_PAT data were analyzed with an automated computerized algorithm which

  18. Effect of Bariatric Surgery on Obstructive Sleep Apnea and Hypopnea Syndrome, Electrocardiogram, and Pulmonary Arterial Pressure

    Microsoft Academic Search

    Matilde Valencia-Flores; Arturo Orea; Miguel Herrera; Victoria Santiago; Verónica Rebollar; Violeta A. Castaño; Jorge Oseguera; Jorge Pedroza; Jorge Sumano; Montserrat Resendiz; Guillermo García-Ramos

    2004-01-01

    Background: We evaluated the impact of surgically-induced weight loss on Obstructive Sleep Apnea\\/Hypopnea Syndrome (OSAHS),\\u000a electrocardiographic changes, pulmonary arterial pressure and daytime sleepiness in morbidly obese patients. Methods: 16 women\\u000a and 13 men (n=29) underwent bariatric surgery in a 3-year period. The following tests were performed before and 1 year after\\u000a surgery: nocturnal polysomnography, daytime Multiple Sleep Latency Test (MSLT),

  19. Postoperative Hypoxemia in Morbidly Obese Patients With and Without Obstructive Sleep Apnea Undergoing Laparoscopic Bariatric Surgery

    Microsoft Academic Search

    Shireen Ahmad; Alexander Nagle; Robert J. McCarthy; Paul C. Fitzgerald; John T. Sullivan; Jay Prystowsky

    2008-01-01

    INTRODUCTION: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Obstructive sleep apnea (OSA) is a commonly encoun- tered comorbidity in morbidly obese patients. Sedatives, analgesics, and anesthetics alter airway tone, and airway obstruction and death have been reported in patients with OSA after minimal doses of sedatives and anesthetics, yet there is a

  20. An animal model of a spontaneously reversible obstructive sleep apnea syndrome in the monkey

    Microsoft Academic Search

    P. Philip; C. E. Gross; J. Taillard; B. Bioulac; C. Guilleminault

    2005-01-01

    The anatomies of the tongue and uvula in monkeys share many similarities with humans, such that this species has the closest approximation to the human upper airway than any other species. In this study, we investigated the feasibility of using small monkeys as experimental animals for an obstructive sleep apnea model.Monkeys received intradermal injections of liquid collagen in the uvula,

  1. Support Vector Machines for Automated Recognition of Obstructive Sleep Apnea Syndrome From ECG Recordings

    Microsoft Academic Search

    Ahsan H. Khandoker; Marimuthu Palaniswami; Chandan K. Karmakar

    2009-01-01

    Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular morbidity as well as excessive daytime sleepiness and poor quality of life. In this study, we apply a machine learning technique [support vector machines (SVMs)] for automated recognition of OSAS types from their nocturnal ECG recordings. A total of 125 sets of nocturnal ECG recordings acquired from normal subjects (OSAS- )

  2. Upper Airway Size Analysis by Magnetic Resonance Imaging of Children with Obstructive Sleep Apnea Syndrome

    Microsoft Academic Search

    Raanan Arens; Joseph M. McDonough; Aaron M. Corbin; Nathania K. Rubin; Mary Ellen Carroll; Allan I. Pack; Jianguo Liu; Jayaram K. Udupa

    Detailed analysis of the upper airway has not been performed in The three-dimensional relationship between the upper air- children with obstructive sleep apnea. We used magnetic resonance way, adenoid, and tonsils has not been previously studied in imaging and automatic segmentation to delineate the upper airway children with OSAS. The aim of the present study was to in 20 children

  3. An online sleep apnea detection method based on recurrence quantification analysis.

    PubMed

    Nguyen, Hoa Dinh; Wilkins, Brek A; Cheng, Qi; Benjamin, Bruce Allen

    2014-07-01

    This paper introduces an online sleep apnea detection method based on heart rate complexity as measured by recurrence quantification analysis (RQA) statistics of heart rate variability (HRV) data. RQA statistics can capture nonlinear dynamics of a complex cardiorespiratory system during obstructive sleep apnea. In order to obtain a more robust measurement of the nonstationarity of the cardiorespiratory system, we use different fixed amount of neighbor thresholdings for recurrence plot calculation. We integrate a feature selection algorithm based on conditional mutual information to select the most informative RQA features for classification, and hence, to speed up the real-time classification process without degrading the performance of the system. Two types of binary classifiers, i.e., support vector machine and neural network, are used to differentiate apnea from normal sleep. A soft decision fusion rule is developed to combine the results of these classifiers in order to improve the classification performance of the whole system. Experimental results show that our proposed method achieves better classification results compared with the previous recurrence analysis-based approach. We also show that our method is flexible and a strong candidate for a real efficient sleep apnea detection system. PMID:25014935

  4. Apneia do sono e hipertensão arterial sistêmica Sleep apnea and systemic arterial hypertension

    Microsoft Academic Search

    Rodrigo Pinto Pedrosa; Marília Montenegro Cabral; Levi da Cunha Pedrosa; Dário Celestino; Sobral Filho; Geraldo Lorenzi-Filho

    2009-01-01

    The syndrome of obstructive sleep apnea (OSA) is very prevalent and little recognized in the general population. Among patients with hypertension (HBP) OSAS is found in more than a third part of patients. There is increasing evidence that OSA and hypertension often co-exist not only because they have common risk factors (obesity, sedentary lifestyle and age), but because OSA contributes

  5. Metabolic Alterations and Systemic Inflammation in Obstructive Sleep Apnea among Nonobese and Obese Prepubertal Children

    Microsoft Academic Search

    David Gozal; Oscar Sans Capdevila; Leila Kheirandish-Gozal

    2008-01-01

    Rationale : Obstructive sleep apnea (OSA) has been associated with a higher prevalence and severity of the metabolic syndrome in adult patients, even after controlling for obesity. In contrast, OSA in prepubertal children does not appear to correlate with the magni- tude of such metabolic derangements. Objectives: To further establish the potential mechanistic role of OSA in metabolic regulation in

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

    E-print Network

    Zhou, Yaoqi

    Does Acute Exercise Improve Driving Performance in Patients with Untreated Obstructive Sleep Apnea-intensity exercise improves driving performance in those who have recently been diagnosed with, are awaiting of moderate-intensity exercise (e.g. walking briskly). Measures of interest during the driving simulation

  7. Effect of Obstructive Sleep Apnea on QT Dispersion: A Potential Mechanism of Sudden Cardiac Death

    Microsoft Academic Search

    Louis Voigt; Salman A. Haq; Cristina A. Mitre; Gerard Lombardo; John Kassotis

    2011-01-01

    Objectives: QT dispersion (QTd) measures the variability of the ventricular recovery time. QTd may identify patients at risk for ventricular arrhythmias and sudden cardiac death (SCD). The purpose of our study was to determine the effect of obstructive sleep apnea (OSA) on QTd. Methods: There were 199 patients studied: 101 patients (28 women, 73 men) with OSA diagnosed in our

  8. Polycystic Ovary Syndrome Is Associated with Obstructive Sleep Apnea and Daytime Sleepiness: Role of Insulin Resistance

    Microsoft Academic Search

    ALEXANDROS N. VGONTZAS; RICHARD S. LEGRO; EDWARD O. BIXLER; ALLISON GRAYEV; ANTHONY KALES; GEORGE P. CHROUSOS

    2010-01-01

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of premenopausal women, characterized by chronic hyperan- drogenism, oligoanovulation, and insulin resistance. Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) are strongly associated with insulin resistance and hypercytokinemia, independently of obesity. We hypothesized that women with PCOS are at risk for OSA and EDS. Fifty-three women with PCOS (age

  9. Detection of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome using mismatch negativity?

    PubMed Central

    Wen, Xiaohui; Wang, Ningyu; Liu, Jinfeng; Yan, Zhanfeng; Xin, Zhonghai

    2012-01-01

    In this experiment, 97 patients with obstructive sleep apnea hypopnea syndrome were divided into three groups (mild, moderate, severe) according to minimum oxygen saturation, and 35 healthy subjects were examined as controls. Cognitive function was determined using the mismatch negativity paradigm and the Montreal Cognitive Assessment. The results revealed that as the disease worsened, the mismatch negativity latency was gradually extended, and the amplitude gradually declined in patients with obstructive sleep apnea hypopnea syndrome. Importantly, mismatch negativity latency in severe patients with a persistent time of minimum oxygen saturation < 60 seconds was significantly shorter than that with a persistent time of minimum oxygen saturation > 60 seconds. Correlation analysis revealed a negative correlation between minimum oxygen saturation latency and Montreal Cognitive Assessment scores. These findings indicate that intermittent night-time hypoxemia affects mismatch negativity waveforms and Montreal Cognitive Assessment scores. As indicators for detecting the cognitive functional status of obstructive sleep apnea hypopnea syndrome patients, the sensitivity of mismatch negativity is 82.93%, the specificity is 73.33%, the accuracy rate is 81.52%, the positive predictive value is 85.00%, the negative predictive value is 70.21%, the positive likelihood ratio is 3, and the negative likelihood ratio is 0.23. These results indicate that mismatch negativity can be used as an effective tool for diagnosis of cognitive dysfunction in obstructive sleep apnea hypopnea syndrome patients. PMID:25657698

  10. Obstructive Sleep Apnea as a Risk Factor for Stroke and Death

    Microsoft Academic Search

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

    2005-01-01

    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

  11. Albuminuria and Renal Function in Obese Adults Evaluated for Obstructive Sleep Apnea

    Microsoft Academic Search

    Varun Agrawal; Thomas E. Vanhecke; Baroon Rai; Barry A. Franklin; R. Bart Sangal; Peter A. McCullough

    2009-01-01

    Background: Obstructive sleep apnea (OSA) is associated with hypertension, obesity and metabolic syndrome that are risk factors for cardiovascular and chronic kidney disease. Few data are available regarding renal parameters in patients with OSA. Methods: We conducted a cross-sectional study of 91 obese adults who had routine polysomnography before bariatric surgery. Presence and severity of OSA were determined by the

  12. Evaluation of Home versus Laboratory Polysomnography in the Diagnosis of Sleep Apnea Syndrome

    Microsoft Academic Search

    FLORENCE PORTIER; ADRIANA PORTMANN; PIERRE CZERNICHOW; LIONEL VASCAUT; ETIENNE DEVIN; DANIEL BENHAMOU; ANTOINE CUVELIER; JEAN FRANÇOIS MUIR

    2000-01-01

    The aim of this study was to compare home polysomnography (HoPSG) with laboratory polysomnography (LabPSG) in the diag- nosis of sleep apnea syndrome (SAS). A total of 103 patients re- ferred for investigation of SAS underwent two full polysomnogra- phies, using the portable Minisomno device at home and the Respisomnographe in the laboratory (both devices manufactured by the same company).

  13. Diagnosis of Obstructive Sleep Apnea Syndrome and Its Outcomes With Home Portable Monitoring

    Microsoft Academic Search

    Ana Claudia; Tonelli de Oliveira; Denis Martinez; Luiz Felipe; T. Vasconcelos; Sandro Cadaval Goncalves; Maria do Carmo Lenz; Sandra Costa Fuchs; Miguel Gus; Erlon Oliveira de Abreu-Silva; Leila Beltrami Moreira; Flavio Danni Fuchs

    Background: The use of portable respiratory monitoring (PM) has been proposed for the diagnosis of obstructive sleep apnea syndrome (OSAS), but most studies that validate PM accuracy have not followed the best standards for diagnostic test validation. The objective of the present study was to evaluate the accuracy of PM performed at home to diagnose OSAS and its outcomes after

  14. Elevated Morbidity and Health Care Use in Children with Obstructive Sleep Apnea Syndrome

    Microsoft Academic Search

    Ariel Tarasiuk; Sari Greenberg-Dotan; Tzahit Simon-Tuval; Bruria Freidman; Aviv D. Goldbart; Asher Tal; Haim Reuveni

    Rationale:Health care use, areliable measure ofmorbidity, is notice- ably higher 1 yr before obstructive sleep apnea syndrome (OSAS) diagnosis in preschool children. It is not clear at what age OSAS- related morbidity becomes expressed. Objective: To explore morbidity and health care use among children with OSAS starting from first year of life. Methods: Case-control study, starting from the first year

  15. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition).

    PubMed

    Sharma, Surendra K; Katoch, Vishwa Mohan; Mohan, Alladi; Kadhiravan, T; Elavarasi, A; Ragesh, R; Nischal, Neeraj; Sethi, Prayas; Behera, D; Bhatia, Manvir; Ghoshal, A G; Gothi, Dipti; Joshi, Jyotsna; Kanwar, M S; Kharbanda, O P; Kumar, Suresh; Mohapatra, P R; Mallick, B N; Mehta, Ravindra; Prasad, Rajendra; Sharma, S C; Sikka, Kapil; Aggarwal, Sandeep; Shukla, Garima; Suri, J C; Vengamma, B; Grover, Ashoo; Vijayan, V K; Ramakrishnan, N; Gupta, Rasik

    2015-01-01

    Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ?15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy. PMID:26180408

  16. Sleep Apnea May Boost Depression Risk in Men, Study Finds

    MedlinePLUS

    ... of medicine at the University of Adelaide in Australia. Men who had both undiagnosed, severe apnea and ... Lang, Ph.D., research fellow, University of Adelaide, Australia; Alan Manevitz, M.D., clinical psychiatrist, Lenox Hill ...

  17. [Chemical control of breathing in patients with obstructive sleep apnea].

    PubMed

    Radwan, L; Maszczyk, Z; Koziej, M; Franczuk, M; Koziorowski, A; Kowalski, J; Zieli?ski, J

    1997-01-01

    The authors have studied chemical control of breathing in 37 normocapnic patients with OSA. These patients had increased apnea-hypopnea index (AHI = 51 +/- 22), obesity (BMI = 32.4 +/- 5.6 kg/m2) and normal lung function tests. Control group consisted of 20 healthy subjects with normal weight (BMI = 23.1 +/- 2.4 kg/m2). Respiratory responses (ventilatory and P0.1) to hypercapnic and hypoxic stimulation during rebreathing tests were measured with computerized methods. The obtained results in OSA patients were compared with the data of the control group. The results exceeding mean values of the control group above 1.64 SD were recognized as hyperreactive responses. The majority e.g. 26 patients (OSA-N) had normal respiratory responses during hypercapnic stimulation. delta V/delta PCO2 = 16.8 +/- 4.5 L/min/kPa, P0.1/delta PCO2 = 3.5 +/- 2.4 cm H2O/kPa/. In remaining 11 patients (OSA-H) respiratory responses were significantly increased delta V/delta PCO2 = 39.1 +/- 18.8 L/min/kPa, P0.1/delta PCO2 = 8.6 +/- 3.9 cm H20/kPa). During isocapnic hypoxic stimulation majority e.g. 25 patients (OSA-H) had significantly increased respiratory responses delta V/delta SaO2 = 3.28 +/- 1.63 L/min/%, delta P0.1/delta SaO2 = 0.54 +/- 0.43 cm H2O/%/. In remaining 12 patients (OSA-N) respiratory responses were within normal limits delta V/SaO2 = 1.2 +/- 0.28 L/min/%, delta P0.1/ delta SaO2 = 0.21 +/- 0.07 cm H2O/%/. The above results indicated, that majority OSA patients (67.5%) had increased ventilatory and P0.1 responses to hypoxic stimulation. Among them also 11 patients had increased respiratory responses to hypercapnia. It seems, that increased respiratory responses to hypoxic stimulus in OSA patients are symptoms of protective reaction to hypoxaemia occurring during repetitive sleep apnoea and reveals increased neuro-muscular output. PMID:9410280

  18. Sympathetic and Catecholaminergic Alterations in Sleep Apnea with Particular Emphasis on Children

    PubMed Central

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

    2012-01-01

    Sleep is involved in the regulation of major organ functions in the human body, and disruption of sleep potentially can elicit organ dysfunction. Obstructive sleep apnea (OSA) is the most prevalent sleep disorder of breathing in adults and children, and its manifestations reflect the interactions between intermittent hypoxia, intermittent hypercapnia, increased intra-thoracic pressure swings, and sleep fragmentation, as elicited by the episodic changes in upper airway resistance during sleep. The sympathetic nervous system is an important modulator of the cardiovascular, immune, endocrine and metabolic systems, and alterations in autonomic activity may lead to metabolic imbalance and organ dysfunction. Here we review how OSA and its constitutive components can lead to perturbation of the autonomic nervous system in general, and to altered regulation of catecholamines, both of which then playing an important role in some of the mechanisms underlying OSA-induced morbidities. PMID:22319509

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

    PubMed Central

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

    2002-01-01

    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 "sleep apnea" combined with "epidemiology," "outcome," and "diagnosis and treatment." Citations in this review favour more recent, well controlled and randomized studies, but findings of pilot studies are included where other research is unavailable. MAIN MESSAGE: Obstructive sleep apnea is a disorder with serious medical, socioeconomic, and psychological morbidity, yet most patients with OSA remain undetected. Primary care physicians have a vital role in screening for these patients because diagnosis can be made only through overnight (polysomnographic) studies at sleep clinics. Physicians should consider symptoms of excessive or loud snoring, complaints of daytime sleepiness or fatigue, complaints of unrefreshing sleep, and an excess of weight or body fat distribution in the neck or upper chest area as possible indications of untreated OSA. CONCLUSION: Current research findings indicate that treating OSA patients substantially lowers morbidity and mortality rates and reduces health care costs. Primary care physicians need more information about screening for patients with OSA to ensure proper diagnosis and treatment of those with the condition. PMID:12113194

  20. Lifestyle modifications and the resolution of obstructive sleep apnea syndrome: a case report

    PubMed Central

    Gala, Thaddeus R.; Seaman, David R.

    2011-01-01

    Objective This purpose of this case study is to describe a natural method to help in management of obstructive sleep apnea syndrome (OSAS), which is known to be a common and debilitating condition. Clinical Features Obstructive sleep apnea syndrome is typically managed with a continuous positive airway pressure (CPAP) device, which the patient wears during sleep to help maintain respiration. This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years. Intervention and Outcome After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later. Conclusion Dietary modifications may be an effective tool to improve the management of OSAS. PMID:22014867

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

    NASA Astrophysics Data System (ADS)

    Yadollahi, Azadeh

    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.

  2. Effect of continuous positive airway pressure on proteinuria in obstructive sleep apnea

    PubMed Central

    Honma, Sumiko; Sasaki, Nobuhiro; Hanawa-Yazawa, Shiho; Iwazu, Yoshitaka; Kusano, Eiji; Asano, Yasushi

    2012-01-01

    Obstructive sleep apnea (OSA) is common in patients with renal disease, and an association between OSA and proteinuria has been proposed. However, the effect on proteinuria of OSA treatment with continuous positive airway pressure (CPAP) is unknown. We experienced a case of severe OSA, where proteinuria was clearly improved after CPAP initiation without any changes of medication or body weight. The remarkable reduction of repetitive apnea and hypopnea by CPAP might ameliorate proteinuria by lessening renal hypoxia and sympathetic nerve activation. This case suggests that CPAP is a promising option for OSA with proteinuria.

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

    PubMed Central

    2014-01-01

    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

  4. Effects and Side-Effects of Surgery for Snoring and Obstructive Sleep Apnea – A Systematic Review

    PubMed Central

    Franklin, Karl A.; Anttila, Heidi; Axelsson, Susanna; Gislason, Thorarinn; Maasilta, Paula; Myhre, Kurt I.; Rehnqvist, Nina

    2009-01-01

    Study Objectives: Many patients undergo surgery for snoring and sleep apnea, although the efficacy and safety of such procedures have not been clearly established. Our aim was systematically to review studies of the efficacy and adverse effects of surgery for snoring and obstructive sleep apnea. Design: Systematic review. Measurements: PubMed and Cochrane databases were searched in September 2007. Randomized controlled trials of surgery vs. sham surgery or conservative treatment in adults, with daytime sleepiness, quality of life, apnea-hypopnea index, and snoring as outcomes were included. Observational studies were also reviewed to assess adverse effects. Evidence of effect required at least two studies of medium and high quality reporting the same result. Results: Four studies of benefits and 45 studies of adverse effects were included. There was no significant effect on daytime sleepiness and quality of life after laser-assisted uvulopalatoplasty and radiofrequency ablation. The apnea-hypopnea index and snoring was reduced in one trial after laser-assisted uvulopalatoplasty but not in another trial. Subjective snoring was reduced in one trial after radiofrequency ablation. No trial investigating the effect of any other surgical modality met the inclusion criteria. Persistent side-effects occurred after uvulopalatopharyngoplasty and uvulopalatoplasty in about half the patients and difficulty in swallowing, globus sensation and voice changes were especially common. Conclusions: Only a small number of randomized controlled trials with a limited number of patients assessing some surgical modalities for snoring or sleep apnea are available. These studies do not provide any evidence of effect from laser-assisted uvulopalatoplasty or radiofrequency ablation on daytime sleepiness, apnea reduction, quality of life or snoring. We call for research of randomized, controlled trials of surgery other than uvulopalatopharyngoplasty and uvulopalatoplasty, as they are related to a high risk of long-term side-effects, especially difficulty swallowing. Citation: Franklin KA; Anttila H; Axelsson S; Gislason T; Maasilta P; Myhre KI; Rehnqvist N. Effects and side-effects of surgery for snoring and obstructive sleep apnea – a systematic review. SLEEP 2009;32(1):27–36. PMID:19189776

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

    NASA Astrophysics Data System (ADS)

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

    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.

  6. Medical Therapy for Obstructive Sleep Apnea: A Review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine

    Microsoft Academic Search

    Sigrid C. Veasey; Christian Guilleminault; Kingman P. Strohl; Mark H. Sanders; Robert D. Ballard; Ulysses J. Magalang

    2006-01-01

    A significant number of patients with obstructive sleep apnea neither tolerate positive airway pressure (PAP) therapy nor achieve suc- cessful outcomes from either upper airway surgeries or use of an oral appliance. The purpose of this paper, therefore, was to systematically evaluate available peer-reviewed data on the effectiveness of adjunctive medical therapies and summarize findings from these studies. A review

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

    PubMed Central

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

    2010-01-01

    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

  8. Use of Complementary and Alternative Medicine Treatments by Patients with Obstructive Sleep Apnea Hypopnea Syndrome

    PubMed Central

    Sood, Amit; Narayanan, Sujata; Wahner-Roedler, Dietlind L.; Knudsen, Kayla; Sood, Richa; Loehrer, Laura L.; Hanson, Andrew C.; Kuzniar, Tomasz J.; Olson, Eric J.

    2007-01-01

    Study Objectives: To assess the proportion of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) reporting previous or current use and interest in future use of complementary and alternative medicine (CAM) therapies. Design: Cross-sectional, point-of-care, anonymous survey. Setting: Sleep disorders center at a Midwest tertiary care center. Participants: Six hundred forty-six consecutive patients undergoing polysomnography. Measurements: The survey instrument comprised 45 items specifically related to CAM therapies, in addition to obtaining baseline data. Results: Response rate was 81% (522/646). A total of 406/522 (78%) patients were diagnosed with OSAHS. Mean age ± SD was 57 ± 14 years, and 267 participants (66%) were men. Overall, 237 (58%) participants reported ever using CAM. Ever and current CAM use specifically for improving sleep was reported by 20% and 7% of the participants, respectively. Twenty-six percent of participants reported ever using biologic products, and 52% reported ever using nonbiologic CAM treatments. A high proportion (58%) of the participants showed interest in future CAM use for improving sleep. Conclusion: A high proportion of patients with OSAHS report previous or current use, and interest in future use, of CAM treatments. This underscores the need to conduct further research in this field. Citation: Sood A; Narayanan S; Wahner-Roedler DL; Knudsen K; Sood R; Loehrer LL; Hanson AC; Kuzniar TJ; Olson EJ. Use of complementary and alternative medicine treatments by patients with obstructive sleep apnea hypopnea syndrome. J Clin Sleep Med 2007;3(6):575-579. PMID:17993037

  9. Polycystic Ovary Syndrome, Sleep Apnea, and Daytime Sleepiness and Fatigue

    Microsoft Academic Search

    Alexandros N. Vgontzas; Susan Calhoun

    Although the study of sleep disorders in the general population as well as in specific groups (i.e., patients with hypothyroidism,\\u000a peptic, ulcer, hypertension, and others) can be traced to the first sleep disorder clinics in the 1960s [1–3], the interest\\u000a and published literature on sleep disorders and polycystic ovary syndrome (PCOS) is very recent. It was only in 2001 that

  10. Comparison of dexmedetomidine and propofol used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome

    PubMed Central

    Kuyrukluy?ld?z, Ufuk; Binici, Orhan; Onk, Didem; Ayhan Celik, Serap; Torun, Mumtaz Taner; Unver, Edhem; Ozcicek, Adalet; Alagol, Aysin

    2015-01-01

    Backround: Surgical operations are alternative treatments in persons with Obstructive Sleep Apnea Syndrome who cannot tolerate continuous positive airway pressure therapy. Drug-Induced Sleep Endoscopy is a method with which somnolence is pharmacologically induced and collapse is evaluated through nasal endoscopy in patients with Obstructive Sleep Apnea Syndrome. Aims: We aimed to evaluate efficiency of dexmedetomidine or propofol used for sedation in patients undergoing drug-induced sleep endoscopy. Methods: A total of 40 patients aged between 18 and 65 years old in the ASA STATUS I-II group were included in the study. After premedicat?on w?th midazolam 0.05 mg/kg intravenously, patients were randomly divided into two groups and administered intravenous (iv) propofol with the loading dose of 0.7 mg/kg for 10 minutes, followed 0.5 mg/kg/h infusion (Group P); or dexmedetomidine with the loading dose of 1 mcg/kg for 10 minutes, followed by 0.3 mcg/kg/h infusion (Group D). Haemodynamic and respiratuary parameters, Bispectral index score, Ramsey sedation score, time to achieve sufficient sedation, surgeon’s and patients’ satisfaction, postoperative Aldrete score and side effects were recorded. Results: Time to achieve sufficient sedation, Bispectral index scores at 5, 10 and 15th. minutes intraoperatively, first Aldrete score in the recovery room, SpO2 values and respiratory rates all over the surgical procedure and in the recovery room were found lower in Group P (P<0.05). Bispectral index scores, mean arterial pressure and heart rate in the recovery room were significantly lower in Group D (P<0.05). Conclusion: Dexmedetomidine may be preferred as a safer agent with respecting to respiratory function compared with propofol in obstructive sleep apnea patients who known to be susceptible to hypoxia and hypercarbia.

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

    PubMed

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

    2014-01-01

    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

  12. The Evaluation of Retinal Nerve Fiber Layer Thickness in Patients with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Adam, Mehmet; Bozkurt, Banu; Kerimo?lu, Hürkan; Turan, Meydan

    2013-01-01

    Aim. To evaluate the retinal nerve fiber layer (RNFL) thickness in patients with obstructive sleep apnea syndrome (OSAS) by optical coherence tomography (OCT). Materials and Method. We studied 43 new diagnosed OSAS patients and 40 healthy volunteers. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. RNFL analyses were performed using Stratus OCT. The average and the four-quadrant RNFL thickness were evaluated. Results. There was no difference between the average and the four-quadrant RNFL thickness in OSAS and control groups. There was no correlation between apnea-hypopnea index and intraocular pressure. Body mass index of patients with moderate and severe OSAS was significantly higher in patients with mild OSAS. Conclusion. Mean RNFL thickness did not differ between the healthy and the OSAS subjects, however, the parameters were more variable, with a larger range in OSAS patients compared to controls. PMID:24369492

  13. Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity?

    PubMed

    Dündar, Yusuf; Saylam, Güleser; Tatar, Emel Çadall?; Özdek, Ali; Korkmaz, Hakan; F?rat, Hikmet; Ard?ç, Sad?k

    2015-03-01

    Obstructive sleep apnea/hypopnea syndrome (OSAHS) is an important and more common public health problem with increasing incidence. Polysomonography (PSG) is the gold standard test in OSAHS diagnosis. Apnea-hypopnea index (AHI) is the main parameter of PSG, which is correlated with OSAHS severity. The main complaint of OSAHS patients is daytime sleepiness and the Epworth Sleepiness Scale (ESS) used for evaluation of disease severity. The correlation of AHI with daytime sleepiness and ESS is well known. But there are many patients, which have uncorrelated daytime sleepiness with AHI. This data calls this hypothesis; Are there any other parameters which may affect daytime sleepiness. 648 patients with complaining of snoring and apnea were evaluated by polysomnography and anthropometric measurements. The cut-off value of ESS was accepted 10 as an indicator of severe daytime sleepiness. Patients were divided to groups with the aim of homogenization, according to AHI values. The patients with similar AHI values were analyzed according to their ESS scores. BMI and neck circumference were elevated in daytime sleepiness patients. The nocturnal hypoxemia markers; apnea number/index, maximum duration of apnea, at least SO2 concentration, duration of SO2 less than 90 % were much effected in the group of daytime sleepiness. Beside the fact that our research, AHI is not enough for predicting the daytime sleepiness; anthropometric measurements and the nocturnal hypoxemia markers should be evaluated. PMID:25621248

  14. Effects of Gender on the Prevalence of Obstructive Sleep Apnea in Patients with Coronary Artery Disease

    PubMed Central

    Zhao, Liang-Ping; Tan, Adeline; Tai, Bee-Choo; Loo, Germaine; Tan, Huay-Cheem; Lee, Chi-Hang

    2014-01-01

    Study Objective: Male predominance has been observed in obstructive sleep apnea (OSA) studies conducted in the community and sleep clinics. Due to the different demographic and patient risk profiles of the studies involved, we investigated the effects of gender on OSA prevalence among patients with coronary artery disease (CAD). Methods: We prospectively recruited a cohort of CAD patients for an overnight sleep study using a home testing portable diagnostic device. OSA was defined as apnea-hypopnea index (AHI) ? 15. Results: One hundred sixty-two consecutive patients (male, n = 81; female, n = 81) were recruited, and most (60%) presented with acute coronary syndrome. The female patients were older (61 ± 10 versus 56 ± 10 years, p < 0.001), less likely to be smokers (8.6% versus 34.6%, p < 0.001), and more likely to have diabetes mellitus (70.4% versus 46.9%, p = 0.002) and chronic renal failure (17.3% versus 4.9%, p = 0.012) than the male patients. The sleep study's success rate was higher in female than male patients (88.9% versus 74.1%, p = 0.047). No significant differences were observed between them in the AHI, oxygen desaturation index, baseline SpO2, lowest SpO2, or total time SpO2 < 90%. The prevalence of OSA for the female and male patients was 40.3% and 35.0%, respectively (p = 0.323). Conclusion: Prevalence of OSA is high in CAD patients with no evidence of sex predilection. The lack of male predominance could be due to females being older and with more comorbidities. Citation: Zhao LP, Tan A, Tai BC, Loo G, Tan HC, Lee CH. Effects of gender on the prevalence of obstructive sleep apnea in patients with coronary artery disease. J Clin Sleep Med 2014;10(12):1279-1284. PMID:25325576

  15. An Evaluation of a Novel Mask in Four Patients with Obstructive Sleep Apnea and Overlap Syndromes

    PubMed Central

    Yarahmadi, Alireza; Nader, Nader D.; Zadeii, Gino; Porhomayon, Jahan

    2013-01-01

    We present four cases of adults with obstructive sleep apnea in whom positive airway pressure therapy alone failed to provide adequate oxygenation. We have previously reported the use of dual mask for ventilatory support of a patient postoperatively (Porhomayon et al., 2013). Here, we report an evaluation of the dual mask in four patients with overlap syndromes. Application of dual mask provided adequate oxygenation with lower continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BIPAP) pressure levels. PMID:23970903

  16. The effect of oral appliance therapy on blood pressure in patients with obstructive sleep apnea

    Microsoft Academic Search

    Ryo Otsuka; Fernanda Ribeiro de Almeida; Alan A. Lowe; Wolfgang Linden; Frank Ryan

    2006-01-01

    The objective of the study was to investigate the effects of oral appliance (OA) therapy on ambulatory blood pressure in patients\\u000a with obstructive sleep apnea (OSA). Eleven OSA patients who received OA therapy were prospectively investigated. Ambulatory\\u000a blood pressure was measured for 20 h from 4:00 p.m. to 12:00 noon the next day using an ambulatory blood pressure monitor. The Respiratory

  17. Endothelial mechanisms of endothelial dysfunction in patients with obstructive sleep apnea

    Microsoft Academic Search

    Jing Feng; Dan Zhang; Baoyuan Chen

    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

  18. Predictors of Elevated Nuclear Factor-B-dependent Genes in Obstructive Sleep Apnea Syndrome

    Microsoft Academic Search

    Silke Ryan; Cormac T. Taylor; Walter T. McNicholas

    2006-01-01

    Background: Circulating nuclear factor- B( NF-B)-dependent genes, particularly tumor necrosis factor- (TNF-), are elevated in obstructive sleep apnea syndrome (OSAS) and likely contribute to cardiovasculardisease.Furthermore,TNF-isassociatedwithexces- sive daytime sleepiness. We investigated the predictors of TNF- and related genes in large, well-selected cohorts of subjects with OSAS and control subjects. Methods: We performed a prospective study of 30 subjects who did not

  19. Reliability of Telemedicine in the Diagnosis and Treatment of Sleep Apnea Syndrome

    PubMed Central

    Coma-del-Corral, María Jesús; Alonso-Álvarez, María Luz; Allende, Marta; Cordero, José; Ordax, Estrella; Masa, Fernando

    2013-01-01

    Abstract Background: Advances in information technology and telecommunications have provided the option of making it easier to diagnose and treat obstructive sleep apnea syndrome (OSAS) using telemedicine techniques. This study assessed the feasibility and reliability of respiratory polygraphy and prescription of treatment by pressure adjustment with auto-continuous positive airway pressure (CPAP) systems, both being transmitted telematically to the Sleep Unit, with teleconsultation as a support method. Subjects and Methods: Forty patients were studied from a population 80?km from the Sleep Unit using respiratory polygraphy transmitted in real time. They were divided into two groups: one was seen by conventional consultation, and the other was seen using teleconsultation. We also estimated satisfaction with this system and its costs. Results: The mean patient age was 53±10.3 years, with a body mass index of 31±6.2?kg/m2 and an Epworth score of 12±5.3. In total, 35 patients were diagnosed with OSAS, with an Apnea-Hypopnea Index of ?10, and CPAP treatment was started in 16 of them. The agreement in the Apnea-Hypopnea Index, total apneas and hypopneas, mean oxygen saturation, and time with an oxygen saturation <90% was greater than 90% between the studies transmitted in real time and those stored in the polygraph. The level of compliance with CPAP treatment was 85% for the patients who were seen in a conventional clinic and 75% in those seen by teleconsultation. Conclusions: The use of telematic techniques is useful to establish a diagnostic and therapeutic strategy for OSAS with the creation of a Wide Core Sleep Laboratory as a process controller. PMID:23186084

  20. Correlation of clinical profiles with obstructive sleep apnea and metabolic syndrome

    Microsoft Academic Search

    Ashfaq Hasan; Nazia Uzma; T. L. N. Swamy; Alluri Shoba; B. Santhosh Kumar

    Background  Obstructive sleep apnea (OSA) is a common condition being increasingly recognized and is associated with many diseases. Few\\u000a data are available for Indian patients and public health hazard of the condition continues to be seriously underestimated\\u000a in this country. The objective of this study was to evaluate the prevalence of obesity, hypertension, diabetes mellitus, and\\u000a hyperlipidemia (HLP) in a South

  1. Perioperative Complications of Adenotonsillectomy in Children with Obstructive Sleep Apnea Syndrome

    Microsoft Academic Search

    John C. Sanders; Melinda A. King; Ronald B. Mitchell; James P. Kelly

    2006-01-01

    We evaluated the rate of complications experienced by children who undergo adenotonsillectomy for obstructive sleep apnea syndrome (OSAS), the safety of a standard anesthetic protocol for these children, and preoperative predictors of complications. Sixty-one children with OSAS, confirmed by polysomnography, and 21 children with recurrent tonsillitis were anesthetized using a standard protocol before adenotonsillectomy (ages 2-16 yr, ASA 1-3). The

  2. Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease

    PubMed Central

    Valo, Misa; Wons, Annette; Moeller, Albert; Teupe, Claudius

    2015-01-01

    Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T) and B-type natriuretic peptide (NT-proBNP) in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI), oxygen saturation nadir, and time in bed with oxygen saturation of ?80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively.

  3. Atrial Fibrillation Is Associated With Increased Mean Platelet Volume and Apnea Hypopnea Index in Patients With Obstructive Sleep Apnea.

    PubMed

    Akyüz, Ayd?n; Akkoyun, Dursun Çayan; De?irmenci, Hasan; Alp, Recep

    2015-07-01

    This study investigated whether there is a relationship between atrial fibrillation (AF), mean platelet volume (MPV), and apnea hypopnea index (AHI) in patients who have obstructive sleep apnea syndrome (OSAS). We enrolled patients who had OSAS with either AF or normal sinus rhythm (NSR). We divided 90 patients (aged 50-80 years) into 2 groups: group 1 consisted of 40 patients with OSAS having AF and group 2 of 50 patients with OSAS having NSR. Mean platelet volume was higher in patients with AF than in those with NSR (9.8 ± 0.6 vs 8.4 ± 0.6 fL; P < .001). The MPV and AHI were substantial variables associated with AF (odds ratio [OR] = 2.41; 95% confidence interval [CI], 1.36-5.26; P < .004 and OR = 1.91; 95% CI, 1.26-3.32; P = .02). Elevated MPV value of ?9.4 fL is associated with AF (70% sensitivity and 63% specificity). More research is needed to establish the clinical relevance of this association. PMID:25163774

  4. Association of Sleep Apnea and Snoring With Incident Atrial Fibrillation in the Multi-Ethnic Study of Atherosclerosis.

    PubMed

    Lin, Gen-Min; Colangelo, Laura A; Lloyd-Jones, Donald M; Redline, Susan; Yeboah, Joseph; Heckbert, Susan R; Nazarian, Saman; Alonso, Alvaro; Bluemke, David A; Punjabi, Naresh M; Szklo, Moyses; Liu, Kiang

    2015-07-01

    The association between sleep apnea and atrial fibrillation (AF) has not been examined in a multiethnic adult population in prospective community-based studies. We prospectively (2000-2011) investigated the associations of physician-diagnosed sleep apnea (PDSA), which is considered more severe sleep apnea, and self-reported habitual snoring without PDSA (HS), a surrogate for mild sleep apnea, with incident AF in white, black, and Hispanic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of clinical cardiovascular disease at baseline (2000-2002). Cox proportional hazards models were used to assess the associations, with adjustment for socioeconomic status, traditional vascular disease risk factors, race/ethnicity, body mass index, diabetes, chronic kidney disease, alcohol intake, and lipid-lowering therapy. Out of 4,395 respondents to a sleep questionnaire administered in MESA, 181 reported PDSA, 1,086 reported HS, and 3,128 reported neither HS nor PDSA (unaffected). Over an average 8.5-year follow-up period, 212 AF events were identified. As compared with unaffected participants, PDSA was associated with incident AF in the multivariable analysis, but HS was not (PDSA: hazard ratio = 1.76, 95% confidence interval: 1.03, 3.02; HS: hazard ratio = 1.02, 95% confidence interval: 0.72, 1.44). PDSA, a marker of more severe sleep apnea, was associated with higher risk of incident AF in this analysis of MESA data. PMID:25977516

  5. Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome

    Microsoft Academic Search

    Nir Peled; Avital Greenberg; Giora Pillar; Oren Zinder; Nurit Levi; Peretz Lavie

    1998-01-01

    Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening

  6. A New Animal Model of Obstructive Sleep Apnea Responding to Continuous Positive Airway Pressure

    PubMed Central

    Neuzeret, Pierre-Charles; Gormand, Frédéric; Reix, Philippe; Parrot, Sandrine; Sastre, Jean-Pierre; Buda, Colette; Guidon, Gérard; Sakai, Kazuya; Lin, Jian-Sheng

    2011-01-01

    Study Objectives: An improved animal model of obstructive sleep apnea (OSA) is needed for the development of effective pharmacotherapies. In humans, flexion of the neck and a supine position, two main pathogenic factors during human sleep, are associated with substantially greater OSA severity. We postulated that these two factors might generate OSA in animals. Design: We developed a restraining device for conditioning to investigate the effect of the combination of 2 body positions—prone (P) or supine (S)—and 2 head positions—with the neck flexed at right angles to the body (90°) or in extension in line with the body (180°)—during sleep in 6 cats. Polysomnography was performed twice on each cat in each of the 4 sleeping positions—P180, S180, P90, or S90. The effect of continuous positive airway pressure (CPAP) treatment was then investigated in 2 cats under the most pathogenic condition. Setting: NA. Patients or Participants: NA. Interventions: NA. Measurements and Results: Positions P180 and, S90 resulted, respectively, in the lowest and highest apnea-hypopnea index (AHI) (3 ± 1 vs 25 ± 2, P < 0.001), while P90 (18 ± 3, P < 0.001) and S180 (13 ± 5, P < 0.01) gave intermediate values. In position S90, an increase in slow wave sleep stage 1 (28% ± 3% vs 22% ± 3%, P < 0.05) and a decrease in REM sleep (10% ± 2% vs 18% ± 2%, P < 0.001) were also observed. CPAP resulted in a reduction in the AHI (8 ± 1 vs 27 ± 3, P < 0.01), with the added benefit of sleep consolidation. Conclusion: By mimicking human pathogenic sleep conditions, we have developed a new reversible animal model of OSA. Citation: Neuzeret PC; Gormand F; Reix P; Parrot S; Sastre JP; Buda C; Guidon G; Sakai K; Lin JS. A new animal model of obstructive sleep apnea responding to continuous positive airway pressure. SLEEP 2011;34(4):541-548. PMID:21461333

  7. 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

    Paris-Sud XI, Université de

    . Anthropometric, clinic and biologic factors were recorded at both time-points. RESULTS-At baseline, 14% of men-year incidences were 14% and 6% respectively. Age, anthropometric parameters, blood pressure and sleep.52(1.12-2.05) for smoking. Observed apnea at baseline was not associated with changes in anthropometric or biologic

  8. Effectiveness of Home Single-Channel Nasal Pressure for Sleep Apnea Diagnosis

    PubMed Central

    Masa, Juan F.; Duran-Cantolla, Joaquin; Capote, Francisco; Cabello, Marta; Abad, Jorge; Garcia-Rio, Francisco; Ferrer, Antoni; Mayos, Merche; Gonzalez-Mangado, Nicolas; de la Peña, Monica; Aizpuru, Felipe; Barbe, Ferran; Montserrat, Jose M.; Larrateguy, Luis D.; de Castro, Jorge Rey; Garcia-Ledesma, Estefania; Utrabo, Isabel; Corral, Jaime; Martinez-Null, Cristina; Egea, Carlos; Cancelo, Laura; García-Díaz, Emilio; Carmona-Bernal, Carmen; Sánchez-Armengol, Ángeles; Fortuna, Ana M.; Miralda, Rosa M.; Troncoso, Maria F.; Gonzalez, Monica; Martinez-Martinez, Marian; Cantalejo, Olga; Piérola, Javier; Vigil, Laura; Embid, Cristina; del Mar Centelles, Mireia; Prieto, Teresa Ramírez; Rojo, Blas; Lores, Vanesa

    2014-01-01

    Introduction: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring. Objectives: To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points. Methods: We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives. Results: Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ? 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ? 5 cutoff point, in 74% of patients with a polysomnographic AHI ? 10 cutoff point, and in 61% of patients with a polysomnographic AHI ? 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ? 5 cutoff point, in 64% of patients with a polysomnographic AHI ? 10 cutoff point, and in 57% of patients with a polysomnographic AHI ? 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (? 5 and ? 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ? 15) of diagnosis. Conclusion: Home single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15. Clinical Trials Information: Clinicaltrials.gov identifier: NCT01347398. Citation: Masa JF, Duran-Cantolla J, Capote F, Cabello M, Abad J, Garcia-Rio F, Ferrer A, Mayos M, Gonzalez-Mangado N, de la Peña M, Aizpuru F, Barbe F, Montserrat JM, Spanish Sleep Network. Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis. SLEEP 2014;37(12):1953-1961. PMID:25325484

  9. A new rodent model for obstructive sleep apnea: effects on ATP-mediated dilations in cerebral arteries

    PubMed Central

    Crossland, Randy F.; Durgan, David J.; Lloyd, Eric E.; Phillips, Sharon C.; Reddy, Anilkumar K.; Marrelli, Sean P.

    2013-01-01

    Obstructive sleep apnea (OSA), a condition in which the upper airway collapses during sleep, is strongly associated with metabolic and cardiovascular diseases. Little is known how OSA affects the cerebral circulation. The goals of this study were 1) to develop a rat model of chronic OSA that involved apnea and 2) to test the hypothesis that 4 wk of apneas during the sleep cycle alters endothelium-mediated dilations in middle cerebral arteries (MCAs). An obstruction device, which was chronically implanted into the trachea of rats, inflated to obstruct the airway 30 times/h for 8 h during the sleep cycle. After 4 wk of apneas, MCAs were isolated, pressurized, and exposed to luminally applied ATP, an endothelial P2Y2 receptor agonist that dilates through endothelial-derived nitric oxide (NO) and endothelial-dependent hyperpolarization (EDH). Dilations to ATP were attenuated ?30% in MCAs from rats undergoing apneas compared with those from a sham control group (P < 0.04 group effect; n = 7 and 10, respectively). When the NO component of the dilation was blocked to isolate the EDH component, the response to ATP in MCAs from the sham and apnea groups was similar. This finding suggests that the attenuated dilation to ATP must occur through reduced NO. In summary, we have successfully developed a novel rat model for chronic OSA that incorporates apnea during the sleep cycle. Using this model, we demonstrate that endothelial dysfunction occurred by 4 wk of apnea, likely increasing the vulnerability of the brain to cerebrovascular related accidents. PMID:23761641

  10. [Driving simulators in risk assessment of traffic accident among drivers with obstructive sleep apnea].

    PubMed

    Siedlecka, Jadwiga; Bortkiewicz, Alicja

    2012-01-01

    Sleep disorders in the form of obstructive sleep apnea (OSA) are still underdiagnosed and insufficiently treated in drivers. This is a very important problem, because chronic sleepiness during the day and episodes of sleep during driving a road vehicle are now regarded as one of the main causes of traffic accidents, including fatal ones, caused by professional drivers. For many years driver fatigue has been considered a major risk factor of traffic accidents, while obstructive sleep apnea has remained almost completely disregarded. In the late 1980s and early 1990s epidemiological data began to indicate sleepiness and sleep deficit as the cause of up to 20% of road accidents. Later studies conducted in many countries in different groups of drivers have confirmed that people with breathing problems during sleep are much more likely to cause accidents than healthy ones. These accidents often result from sleep disorders experienced by drivers while driving, during both long monotonous journeys and in heavy urban traffic. The application of treatment involving continuous positive airway pressure (CPAP) reduces the rate of accidents among drivers. In the recent years, the studies of this problem has been expanded by the use of drive simulators that quite accurately simulate real driving conditions. This approach allows to assess the driver's reactions and behaviors in different situations on the road, including the most dangerous ones. By comparing the results from the simulator with those in real conditions it will be possible to see to what extent the risk of accident in simulated conditions correlates with the risk of accident in real life settings. PMID:22779329

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

    PubMed

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

    2015-03-01

    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

  12. Obstructive Sleep Apnea Syndrome in Prader-Willi Syndrome: An Unrecognized and Untreated Cause of Cognitive and Behavioral Deficits?

    Microsoft Academic Search

    Danny Camfferman; Kurt Lushington; Fergal O’Donoghue; R. Doug McEvoy

    2006-01-01

    Prader-Willi Syndrome (PWS) is a rare genetic disorder characterized by a range of physical, psychological, and physiological abnormalities. It is also distinguished by the high prevalence of obstructive sleep apnea syndrome (OSAS), i.e., repetitive upper airway collapse during sleep resulting in hypoxia and sleep fragmentation. In non-PWS populations, OSAS is associated with a range of neurocognitive and psychosocial deficits. Importantly,

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

    PubMed Central

    2014-01-01

    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

  14. Clinical versus electrophysiological assessment of dysautonomia in obstructive sleep apnea syndrome.

    PubMed

    Zakrzewska-Pniewska, Beata; Nojszewska, Monika; Przybylowski, Tadeusz; By?kiniewicz, Krzysztof

    2004-01-01

    To assess the autonomic system in obstructive sleep apnea syndrome (OSAS), the sympathetic skin response (SSR) and the R-R interval variation (RRIV) tests were studied in 34 OSAS patients and in 32 healthy controls. The aim of the study was to evaluate the sympathetic and parasympathetic system function in OSAS, to define the pattern of autonomic abnormalities found in SSR and RRIV in patients, and to analyze the usefulness of both tests in paraclinical assessment of the dysautonomia, compared with clinical symptoms and signs of autonomic nervous system involvement. The correlations between both autonomic tests results were also studied. In OSAS patients, SSR test results were abnormal in about 44% and RRIV results were abnormal in about 21% of patients. The mean values of parameters studied in SSR were significantly different in OSAS patients and controls (P < 0.05), whereas the differences between RRIV results were less important. The SSR and RRIV results in patients with mild apnea (Apnea/ Hypopnea Index (AHI) < 15) were more frequently within normal limits if compared with those of patients with severe apnea, but without reaching statistical significance. The clinical studies results (according to the Autonomic Symptoms Questionnaire) were related to the SSR results (p < 0.05 on chi and Fisher exact test). According to these results, SSR and RRIV are simple paraclinical electrophysiologic tests that confirm clinical dysautonomia. They may be useful as screening tests for assessment of dysautonomia in OSAS. PMID:15622130

  15. Preschool Children with Obstructive Sleep Apnea: The Beginnings of Elevated Blood Pressure?

    PubMed Central

    Nisbet, Lauren C.; Yiallourou, Stephanie R.; Biggs, Sarah N.; Nixon, Gillian M.; Davey, Margot J.; Trinder, John A.; Walter, Lisa M.; Horne, Rosemary S. C.

    2013-01-01

    Study Objectives: In adults and older children, snoring and obstructive sleep apnea (OSA) are associated with elevated blood pressure (BP). However, BP has not been assessed in preschool children, the age of highest OSA prevalence. We aimed to assess overnight BP in preschool children with snoring and OSA using pulse transit time (PTT), an inverse continuous indicator of BP changes. Design: Overnight polysomnography including PTT. Children were grouped according to their obstructive apnea-hypopnea index (OAHI); control (no snoring, with OAHI of one event or less per hour), primary snoring (OAHI one event or less per hour), mild OSA (OAHI greater than one event to five events per hour) and moderate-severe OSA (OAHI more than five events per hour). Setting: Pediatric sleep laboratory. Patients: There were 128 clinically referred children (aged 3-5 years) and 35 nonsnoring community control children. Measurement and Results: PTT was averaged for each 30-sec epoch of rapid eye movement (REM) or nonrapid eye movement (NREM) sleep and normalized to each child's mean wake PTT. PTT during NREM was significantly higher than during REM sleep in all groups (P < 0.001 for all). During REM sleep, the moderate-severe OSA group had significantly lower PTT than the mild and primary snoring groups (P < 0.05 for both). This difference persisted after removal of event-related PTT changes. Conclusions: Moderate-severe OSA in preschool children has a significant effect on pulse transit time during REM sleep, indicating that these young children have a higher baseline BP during this state. We propose that the REM-related elevation in BP may be the first step toward development of daytime BP abnormalities. Given that increased BP during childhood predicts hypertension in adulthood, longitudinal studies are needed to determine the effect of resolution of snoring and/or OSA at this age. Citation: Nisbet LC; Yiallourou SR; Biggs SN; Nixon GM; Davey MJ; Trinder JA; Walter LM; Horne RSC. Preschool children with obstructive sleep apnea: the beginnings of elevated blood pressure? SLEEP 2013;36(8):1219-1226. PMID:23904682

  16. Heritability of Craniofacial Structures in Normal Subjects and Patients with Sleep Apnea

    PubMed Central

    Chi, Luqi; Comyn, Francois-Louis; Keenan, Brendan T.; Cater, Jacqueline; Maislin, Greg; Pack, Allan I.; Schwab, Richard J.

    2014-01-01

    Objectives: Accumulating evidence has shown that there is a genetic contribution to obstructive sleep apnea (OSA).The objectives were to use magnetic resonance imaging (MRI) cephalometry to (1) confirm heritability of craniofacial risk factors for OSA previously shown by cephalometrics; and (2) examine the heritability of new craniofacial structures that are measurable with MRI. Design: A sib pair “quad” design examining apneics, apneic siblings, controls, and control siblings. The study design used exact matching on ethnicity and sex, frequency matching on age, and statistical control for differences in age, sex, ethnicity, height, and weight. Setting: Academic medical center. Patients: We examined 55 apneic probands (apnea-hypopnea index [AHI]: 46.8 ± 33.5 events/h), 55 proband siblings (AHI: 11.1 ± 15.9 events/h), 55 controls (AHI: 2.2 ± 1.7 events/h), and 55 control siblings (AHI: 4.1 ± 4.0 events/h). Interventions: N/A. Measurements and Results: Five independent domains reflecting different aspects of the craniofacial structure were examined. We confirmed heritability of sella–nasion–subspinale (38%, P = 0.002), saddle angle (55%, P < 0.0001), mandibular length (24%, P = 0.02) and lower facial height (33%, P = 0.006) previously measured by cephalometry. In addition, the current study added new insights by demonstrating significant heritability of mandibular width (30%, P = 0.005), maxillary width (47%, P < 0.0001), distance from the hyoid bone to the retropogonion (36%, P = 0.0018) and size of the oropharyngeal space (31%, P = 0.004). Finally, our data indicate that heritability of the craniofacial structures is similar in normal patients and those with apnea. Conclusions: The data support our a priori hypothesis that the craniofacial structures that have been associated with obstructive sleep apnea (OSA) are heritable. We have demonstrated heritability for several intermediate craniofacial phenotypes for OSA. Thus, we believe that future studies should be able to identify genes associated with these intermediate craniofacial phenotypes. Citation: Chi L, Comyn FL, Keenan BT, Cater J, Maislin G, Pack AI, Schwab RJ. Heritability of craniofacial structures in normal subjects and patients with sleep apnea. SLEEP 2014;37(10):1689-1698. PMID:25197806

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

    NASA Astrophysics Data System (ADS)

    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

    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.

  18. Validation of a Portable Monitor for the Diagnosis of Obstructive Sleep Apnea in Morbidly Obese Patients

    PubMed Central

    Fredheim, Jan Magnus; Røislien, J.; Hjelmesæth, J.

    2014-01-01

    Study Objectives: We aimed to validate the diagnostic accuracy and night-to-night variability of a simple 3-channel (type IV monitor) portable sleep monitor, ApneaLink (AL), in a population of morbidly obese subjects. Design: Cross-sectional validation and diagnostic accuracy study. Setting: Public tertiary care obesity center in Norway. Participants: A total of 105 (67 females) treatment seeking morbidly obese subjects were included, mean (SD) age 44.3 (11.4) years and BMI 43.6 (5.6) kg/m2. Interventions: The patients underwent two successive nights of recordings; the first night with the AL only, and the following night with both the reference instrument Embletta (E), a type III portable somnograph, and the AL. Measurements and Results: Main outcomes were diagnostic accuracy of AL as assessed by sensitivity, specificity and area under ROC curves, and level of agreement between AL and E. AL had high diagnostic accuracy at all levels of OSA, and the Bland-Altman plots showed good agreement between AL and E. The sensitivity and specificity of the instrument were 93% and 71% at the AHI cutoff 5 events/h, and 94% and 94% at the AHI cutoff 15, respectively. The night-to-night variability was low. Conclusion: Our results indicate that a simple 3-channel portable sleep monitor (ApneaLink) has a high diagnostic accuracy in diagnosing OSA in morbidly obese treatment seeking patients. Accordingly, this and similar instruments might help non-specialists to diagnose OSA in morbidly obese patients, and, importantly, help non-specialists to refer patients who need specific treatment to specialist without unnecessary delay. Citation: Fredheim JM, Røislien J, Hjelmesæth J. Validation of a portable monitor for the diagnosis of obstructive sleep apnea in morbidly obese patients. J Clin Sleep Med 2014;10(7):751-757. PMID:25024652

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

    PubMed Central

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

    2015-01-01

    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

  20. Model-Based Assessment of Cardiovascular Autonomic Control in Children with Obstructive Sleep Apnea

    PubMed Central

    Chaicharn, Jarree; Lin, Zheng; Chen, Maida L.; Ward, Sally L.D.; Keens, Thomas; Khoo, Michael C. K.

    2009-01-01

    Study Objectives: To quantitatively assess daytime autonomic cardiovascular control in pediatric subjects with and without obstructive sleep apnea syndrome (OSAS). Design: Respiration, R-R intervals, and noninvasive continuous blood pressure were monitored in awake subjects in the supine and standing postures, as well as during cold face stimulation. Setting: Sleep disorders laboratory in a hospital setting. Participants: Ten pediatric patients (age 11.4 ± 3.6 years) with moderate to severe OSAS (obstructive apnea-hypopnea index = 21.0 ± 6.6/ h) before treatment and 10 age-matched normal control subjects (age 11.5 ± 3.7 years). Measurements and Results: Spectral analysis of heart rate variability revealed that high-frequency power was similar and the ratio of low- to high-frequency power was lower in subjects with OSAS vs control subjects. The closed-loop minimal model allowed heart rate variability to be partitioned into a component mediated by respiratory-cardiac coupling and a baroreflex component, whereas blood pressure variability was assumed to result from the direct effects of respiration and fluctuations in cardiac output. Baroreflex gain was lower in subjects with OSAS vs control subjects. Under orthostatic stress, respiratory-cardiac coupling gain decreased in both subject groups, but baroreflex gain decreased only in controls. The model was extended to incorporate time-varying parameter changes for analysis of the data collected during cold face stimulation: cardiac output gain increased in controls but remained unchanged in OSAS. Conclusions: Our findings suggest that vagal modulation of the heart remains relatively normal in pediatric subjects with OSAS. However, baseline cardiovascular sympathetic activity is elevated, and reactivity to autonomic challenges is impaired. Citation: Chaicharn J; Lin Z; Chen ML; Ward SLD; Keens T; Khoo MCK. Model-based assessment of cardiovascular autonomic control in children with obstructive sleep apnea. SLEEP 2009;32(7):927-938. PMID:19639756

  1. Validation of the STOP-BANG Questionnaire among Patients Referred for Suspected Obstructive Sleep Apnea

    PubMed Central

    Boynton, Grace; Vahabzadeh, Arshia; Hammoud, Sami; Ruzicka, Deborah L.; Chervin, Ronald D.

    2014-01-01

    Background The STOP-BANG is a simple obstructive sleep apnea (OSA) screening tool, part questionnaire (STOP) and part demographic or physical measures (BANG), developed for use in preoperative surgical clinics. This study assessed sensitivity and specificity of the instrument among patients referred to a sleep disorders laboratory, and also its performance characteristics when BANG physical measures are patient-reported rather than measured. Methods Adults referred for diagnostic polysomnography completed the STOP questions and answered four yes/no questions (BANG self-reported) about their body mass index (weight and height), age, neck circumference, and gender, which were also assessed by laboratory technologists (BANG-measured). Results Among N=219 subjects (mean age 46.3 ± 13.9 [s.d.] years; 98 [44.8%] males) the sensitivity of the STOP-BANG measured for an apnea/hypopnea index (AHI, events per hour of sleep) >5, >15, and >30 was 82, 93, and 97% respectively. Corresponding negative predictive values were 44, 87, and 96%. Specificities were comparatively low (48, 40, and 33%). The STOP-BANG measured and STOP-BANG self-reported scores showed essentially equivalent test characteristics against polysomnography. Conclusions The STOP-BANG appears to have limited utility in a referred, sleep laboratory setting. Negative results help to identify some individuals as unlikely to have moderate-to-severe apnea, and may thereby prove useful in identification of patients who would benefit more from laboratory studies than home studies. A STOP-BANG in which all information is self-reported may be as effective as the original version, and has potential to facilitate research or community screening where good negative predictive value is required for an effective screening tool. PMID:24800262

  2. Sleep apnea syndrome in Parkinson's disease. A case-control study in 49 patients.

    PubMed

    Diederich, Nico J; Vaillant, Michel; Leischen, Mike; Mancuso, Giovanna; Golinval, Serge; Nati, Romain; Schlesser, Marc

    2005-11-01

    In PD, the impact of nocturnal respiration on sleep continuity and architecture has not been systematically investigated by polysomnography (PSG). We performed a case-control study with retrospective analysis of PSG data of 49 PD patients. After classifying the PD patients according to their apnea/hypopnea index (AHI), they were matched with 49 controls in terms of age, gender, and AHI. There were 21 PD patients (43%) who had sleep apnea syndrome (SAS), classified as mild (AHI, 5-15) in 10 patients, moderate (AHI, >15-30) in 4 patients, and severe (AHI, > 30) in 7 patients. PD patients had more deep sleep (P = 0.02) and more nocturnal awakenings (P < 0.001) than the controls. Their body mass index (BMI) was lower (P = 0.04), and they maintained a more favorable respiratory profile, with higher mean and minimal oxygen saturation values (P = 0.006 and 0.01, respectively). These differences were preserved when only considering PD patients with AHI > 15. PD patients had less obstructive sleep apneas (P = 0.035), independently from the factor AHI. Only the respiratory changes of 4 PD patients with BMI > 27 and AHI > 15 (8%) approximated those seen in the controls. At an early or middle stage of the disease, non-obese PD patients frequently have AHI values suggesting SAS, however, without the oxygen desaturation profile of SAS. Longitudinal studies of patients with such "abortive" SAS are warranted to establish if this finding reflects benign nocturnal respiratory muscle dyskinesia or constitutes a precursor sign of dysautonomia in PD. PMID:16007620

  3. Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches

    PubMed Central

    Zhang, Wang

    2012-01-01

    Obstructive sleep apnea syndrome (OSAS), a chronic condition characterized by collapse of the pharynx during sleep, has been increasingly recognized as a health issue of growing importance over the last decade. Recently emerging evidence suggests that there is a causal link between OSAS and hypertension, and hypertension represents an independent risk factor in OSAS patients. However, the pathophysiological basis for patients with OSAS having an increased risk for hypertension remains to be elucidated. The main acute physiological outcomes of OSAS are intermittent hypoxia, intrapleural pressure changes, and arousal from sleep, which might induce endothelial dysfunction, sympathetic activation, renin–angiotensin–aldosterone system activation, lipid metabolism dysfunction, and increased oxidative stress. This brief review focuses on the current understanding of the complex association between OSAS and hypertension. PMID:23009224

  4. Rhythm disturbances in childhood obstructive sleep apnea during apnea-hypopnea episodes

    PubMed Central

    Khositseth, Anant; Chokechuleekorn, Jittamas; Kuptanon, Teeradej; Leejakpai, Anchalee

    2013-01-01

    Background: Obstructive sleep apnoea (OSA) can result in cardiovascular complications. Nocturnal arrhythmias are reported up to 50% of adult OSA patients. Arrhythmias and heart rate variability in children with OSA have not been well studied. Aims: We sought to study rhythm disturbances in childhood OSA and also to analyze the relationship of heart rate variability to the severity of OSA in children. Methods: In a retrospective cross sectional study, records of children aged < 15 years with history of snoring and suspected OSA, who had undergone polysomnography (PSG) for first time were analyzed. The cardiac rhythm and heart rate variability were studied during PSG. Results: A total of 124 patients diagnosed with OSA were grouped into mild (n = 52), moderate (n = 30), and severe (n = 42) OSA. During PSG, all had sinus arrhythmias and only three patients had premature atrial contractions (PACs). The standard deviation of heart rate (SD-HR) during rapid eye movement (REM) sleep in severe OSA (9.1 ± 2.4) was significantly higher than SD-HR in mild OSA (7.5 ± 1.3, P < 0.0001). The maximum heart rate (max-HR) during REM-sleep in severe OSA (132.1 ± 22.1) was significantly higher than the max-HR in mild OSA (121.3 ± 12.6 bpm, P = 0.016). Conclusions: There was no significant arrhythmia in children with OSA during their sleep. Heart rate variability correlated with the severity of OSA. PMID:23626434

  5. Incidence of hypothyroidism and its correlation with polysomnography findings in obstructive sleep apnea.

    PubMed

    Ozcan, K Murat; Selcuk, Adin; Ozcan, Ibrahim; Ozdas, Talih; Ozdogan, Fatih; Acar, Mustafa; Dere, Huseyin

    2014-11-01

    The aim of this study is to investigate the thyroid functions and its correlation with polysomnography findings in obstructive sleep apnea patients. This study was conducted on 203 patients evaluated with the complaints of snoring, witnessed apnea and daytime sleepiness and established polysomnography (PSG) indication between May 2008 and August 2011. All patients' nocturnal PSG recordings were carried out. The thyroid function was classified as euthyroid, subclinical hypothyroidism and clinical hypothyroidism after analyzing serum TSH and free T4 values. The correlation between the data obtained from PSG records and thyroid function values was statistically compared. Apnea hypopnea index obtained from PSG was in the range of 5.4-132.9/h, and mean value was 32.7/h. The lowest oxygen saturation level was in the range of 20-92 %, and the mean value was 76.4 %. According to PSG results, 55 patients (27.09 %) had mild obstructive sleep apnea syndrome (OSAS), 48 patients (23.65 %) had moderate OSAS and 100 patients (49.26 %) had severe OSAS. On evaluation of the thyroid function test results, 10.8 % (n = 22) of the patients were defined to have subclinical hypothyroidism and 1.97 % (n = 4) clinical hypothyroidism. We found a total of 12.77 % subclinical and clinical hypothyroidism in patients with OSAS. Though the incidence of hypothyroidism was pretty high in patients with OSA, there was no statistically significant correlation between thyroid functions and polysomnography findings. We suggest that evaluation of the thyroid functions is important and necessary in patients with OSAS. Polysomnography findings do not correlate statistically with thyroid function tests, addressing the need for thyroid screening for all OSAS patients. PMID:24609648

  6. Cardiovascular and respiratory regulation during sleep in patients with sleep apnea with and without hypertension

    Microsoft Academic Search

    Thomas Penzel; Alexander Suhrbier; G. Bretthauer; Maik Riedl; Niels Wessel; Jurgen Kurths; Hagen Malberg; Ingo Fietze

    2011-01-01

    Sleep is a physiological process with an internal program of a number of well defined sleep stages and intermediate wakefulness periods. The sleep stages do modulate the autonomous nervous system and thereby the sleep stages are accompanied by different regulation regimes for the cardiovascular and respiratory system. The differences in regulation can be distinguished by new analysis techniques on the

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

    PubMed Central

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

    2014-01-01

    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

  8. Robust spectral analysis of thoraco-abdominal motion and oxymetry in obstructive sleep apnea.

    PubMed

    Nino, Cesar L; Rodriguez-Martinez, Carlos E; Gutierrez, Maria J; Singareddi, Ravi; Nino, Gustavo

    2013-01-01

    The diagnosis of obstructive sleep apnea (OSA) relies on polysomnography (PSG), a multidimensional biosignal recording that is conducted in sleep laboratories. Standard PSG montage involves the use of nasal-oral airflow sensors to visualize cyclic episodes of upper airflow interruption, which are considered diagnostic of sleep apnea. Given the high-cost and discomfort associated with in-laboratory PSG, there is an emergent need for novel technology that simplifies OSA screening and diagnosis with less expensive methods. The main goal of this project was to identify novel OSA signatures based on the spectral analysis of thoraco-abdominal motion channels. Our main hypothesis was that proper spectral analysis can detect OSA cycles in adults using simultaneous recording of oxygen saturation (SaO2) and either, chest or abdominal motion. A sample study on 35 individuals was conducted with statistically significant results that suggest a strong relationship between airflow-independent signals and oxygen saturation. The impact of this new approach is that it may allow the design of more comfortable and reliable portable devices for screening, diagnosis and monitoring of OSA, functioning only with oximetry and airflow-independent (abdominal or chest) breathing sensors. PMID:24110335

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

    PubMed

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

    2015-03-01

    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

  10. Is brain damage really involved in the pathogenesis of obstructive sleep apnea?

    PubMed

    Li, Jie; Li, Ming-Xian; Liu, Sheng-Nan; Wang, Jing-Hua; Huang, Min; Wang, Min; Wang, Shao

    2014-05-28

    Obstructive sleep apnea (OSA) syndrome is a surprisingly complex and highly individualized disease, with different factors contributing toward the disease process. Many factors can induce OSA disease, such as hypertrophy uvula, adenoidectomy, tonsil caused by mechanical obstruction of the airway, airway obstruction on obesity cause of decubitus, etc.; in addition, abnormal structure and function of the central nervous system (CNS) is also one of the important factors. This paper examines the relationship of the CNS with the onset of OSA. Evidence has shown that dysfunction of the CNS may be related to the occurrence of OSA. Although modification of the behaviors of the motor neurons may offer a potentially interesting means of controlling the airway, human afferent and motor pathways that regulate eupnea are still poorly understood. Combining some clinical phenomena of patients with cerebral hemorrhage or brain trauma at the temporal lobe, it seems that no close relation with OSA has been observed in clinical work and animal experiments; however, CNS damage at the temporal lobe is involved in the pathogenesis of OSA. This article examines the role of the CNS in the pathogenesis of OSA and its mechanisms. We have summarized previous findings of OSA-related brain damage, which were obtained by brain functional MRI, clinical, and animal experiment data to better understand the roles of the CNS in the pathogenesis of OSA. More specifically, this review summarizes how altered activity of the limbic system and its related structures could be associated with the occurrence of OSA. This conclusion may contribute toward our understanding of nosogenesis and the treatment of OSA. PMID:24736232

  11. Home-based Diagnosis of Obstructive Sleep Apnea in an Urban Population

    PubMed Central

    Garg, Natasha; Rolle, Andrew J.; Lee, Todd A.; Prasad, Bharati

    2014-01-01

    Study Objectives: Home-based diagnosis of obstructive sleep apnea (OSA) with portable monitoring (PM) is increasingly utilized, but remains understudied in underserved and minority populations. We tested the feasibility of home PM in an urban population at risk for OSA compared to in-laboratory polysomnography (PSG) and examined patient preference with respect to home PM versus PSG. Methods: Randomized crossover study of home PM (WatchPAT200) and in-laboratory simultaneous PSG and PM in 75 urban African Americans with high pre-test probability of OSA, identified with the Berlin questionnaire. Results: Fifty-seven of 75 participants were women, average age 45 ± 11 years (mean ± SD), 35% with ? high school education, and 76% with annual household income < $50,000. Technical failure rates were 5.3% for home vs. 3.1% for in-laboratory PM. There was good agreement between apnea hypopnea index on PSG; AHIPSG and AHI on home PM (mean ± 2 SD of the differences = 0.64 ± 46.5 and intraclass correlation coefficient; ICC = 0.73). The areas under the curve for the receiver-operator characteristic curves for home PM were 0.90 for AHIPSG ? 5, 0.95 for AHIPSG ? 10, and 0.92 for AHIPSG ? 15. 62/75 (82%) participants preferred home over in-laboratory testing. Conclusions: Home PM for diagnosis of OSA in a high risk urban population is feasible, accurate, and preferred by patients. As home PM may improve access to care, the cost-effectiveness of this diagnostic strategy for OSA should be examined in underserved urban and rural populations. Clinical Trials Registration: ClinicalTrials.gov, identifier: NCT01997723 Citation: Garg N, Rolle AJ, Lee TA, Prasad B. Home-based diagnosis of obstructive sleep apnea in an urban population. J Clin Sleep Med 2014;10(8):879-885. PMID:25126034

  12. Obstructive Sleep Apnea Is Associated with Impaired Exercise Capacity: A Cross-Sectional Study

    PubMed Central

    Beitler, Jeremy R.; Awad, Karim M.; Bakker, Jessie P.; Edwards, Bradley A.; DeYoung, Pam; Djonlagic, Ina; Forman, Daniel E.; Quan, Stuart F.; Malhotra, Atul

    2014-01-01

    Objective: Obstructive sleep apnea (OSA) is associated with increased risk of adverse cardiovascular events. Because cardiopulmonary exercise testing (CPET) aids in prognostic assessment of heart disease, there is rising interest in its utility for cardiovascular risk stratification of patients with OSA. However, the relationship between OSA and exercise capacity is unclear. This study was conducted to test the hypothesis that OSA is associated with impaired exercise capacity. Methods: Fifteen subjects with moderate-to-severe OSA (apneahypopnea index [AHI] ? 15 events/h) and 19 controls with mild or no OSA (AHI < 15 events/h) were enrolled. Subjects underwent standard polysomnography to determine AHI and exclude other sleep disorders. Resting metabolic rate was measured via indirect calorimetry, followed by maximum, symptom-limited CPET. Subjects completed a sleep diary and physical activity questionnaire characterizing behaviors in the week prior to testing. Results: Percent predicted peak oxygen uptake (V?O2) was significantly lower in OSA subjects than controls (70.1% ± 17.5% vs 83.8% ± 13.9%; p = 0.02). Each 1-unit increase in log-transformed AHI was associated with a decrease in percent predicted peak O2 of 3.20 (95% CI 0.53-5.88; p = 0.02). After adjusting for baseline differences, this association remained significant (p < 0.01). AHI alone explained 16.1% of the variability observed in percent predicted peak O2 (p = 0.02). Conclusions: OSA is associated with impaired exercise capacity. Further study is needed to evaluate the utility of CPET for prognostic assessment of patients with OSA. Citation: Beitler JR, Awad KM, Bakker JP, Edwards BA, DeYoung P, Djonlagic I, Forman DE, Quan SF, Malhotra A. Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. J Clin Sleep Med 2014;10(11):1199-1204. PMID:25325602

  13. Oscillating Positive Airway Pressure Versus CPAP for the Treatment of Obstructive Sleep Apnea

    PubMed Central

    Haba-Rubio, José; Petitpierre, Nicolas Julien; Cornette, Françoise; Tobback, Nadia; Vat, Sopharat; Giallourou, Theresia; Al-Jumaily, Ahmed; Heinzer, Raphael

    2015-01-01

    Although continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnea (OSA), it is not always well tolerated by the patients. Previous physiological studies showed that pressure oscillations applied to the pharynx could activate upper airway muscles, but it is not clear whether these pressure oscillations could be tolerated during sleep in OSA patients. The aim of this study was to assess the tolerance of oscillating positive airway pressure (O-PAP) (a CPAP device delivering high-frequency pressure oscillations to the upper airway) compared to CPAP. Fourteen OSA patients currently on CPAP [age 59.9?±?10.1?years old, BMI 34.8?±?7.2?kg/m2, initial apnea–hypopnea index (AHI): 58.7?±?25.2?events/h] used O-PAP or CPAP on two consecutive nights under polysomnography, in a single-blind randomized crossover design to assess sleep quality. A subtherapeutic pressure (70% of the optimal titrated pressure) was applied in both conditions and the residual AHI with each technique was also compared. There was no difference in measured or perceived sleep quality between the two treatment modalities (sleep efficiency 90.0% versus 88.1%, p?=?0.54). Despite the small sample, we also found a trend toward a decrease in residual respiratory events with O-PAP compared to CPAP (median AHI 14.3 versus 20.5/h, p?=?0.194). The good tolerance of O-PAP and the positive trend toward a reduction in residual AHI should stimulate further research on the effects of O-PAP in OSA patients. PMID:26029694

  14. The Relationship between Depressive Symptoms and Obstructive Sleep Apnea in Pediatric Populations: A Meta-Analysis

    PubMed Central

    Yilmaz, Elif; Sedky, Karim; Bennett, David S.

    2013-01-01

    Background: A higher incidence of depressive disorders and symptoms has been suggested among children suffering from obstructive sleep apnea (OSA). Yet, the extent to which OSA is related to increased depression is unclear. Objectives: To evaluate (a) the relationship between depressive symptoms and OSA in pediatric populations, and (b) the efficacy of adenotonsillectomy (AT) for decreasing depressive symptoms among children with OSA. Methods: A meta-analysis was conducted to assess the relationship between depressive symptoms and OSA, and the efficacy of AT for decreasing depressive symptoms. Studies reporting depressive symptoms of children with OSA through January 2013 were included. Results: Eleven studies assessed depressive symptoms in both children diagnosed with OSA (n = 894) and a comparison group (n = 1,096). A medium relationship was found between depressive symptoms and OSA (Hedges' g = 0.43, 95% CI: 0.22-0.64; p = 0.0005). Addressing the second question, 9 studies (n = 379 children) examined depressive symptoms pre- and post-AT. A medium improvement in depressive symptoms was found at follow-up (Hedge's g = 0.41, 95% CI: 0.20-0.62; p ? 0.001). Conclusion: Our findings suggest that depressive symptoms are higher among children with OSA. Therefore, patients with depressive symptomatology should receive screening for sleep disordered breathing. Treatment of OSA with AT might decrease clinical symptoms of depression, reduce pharmacotherapy, improve sleep patterns, and promote better health. Citation: Yilmaz E; Sedky K; Bennett DS. The relationship between depressive symptoms and obstructive sleep apnea in pediatric populations: a meta-analysis. J Clin Sleep Med 2013;9(11):1213-1220. PMID:24235907

  15. Obstructive Sleep Apnea, Excessive Daytime Sleepiness, and Morning Plasma TNF-? Levels in Greek Children

    PubMed Central

    Alexopoulos, Emmanouel I.; Theologi, Vasiliki; Malakasioti, Georgia; Maragozidis, Panagiotis; Tsilioni, Irene; Chrousos, George; Gourgoulianis, Konstantinos; Kaditis, Athanasios G.

    2013-01-01

    Background: Obstructive sleep apnea (OSA) has been associated with increased frequency of excessive daytime sleepiness (EDS). Increased plasma TNF-? levels may mediate this association in adults, but conflicting results have been reported in children. We hypothesized that: (i) the higher the OSA severity in childhood, the higher the frequency of EDS and morning plasma TNF-? levels; and (ii) high TNF-? levels predict presence of EDS. Methods: Children without and with snoring underwent polysomnography. EDS was determined by parental response to specific questions, and plasma TNF-? levels were measured. Results: Children with moderate-to-severe OSA (n = 24; 5.7 ± 2 years; apnea-hypopnea index [AHI] 11.5 ± 5.1/h), but not participants with mild OSA (n = 22; 6 ± 2.5 years; AHI 2.1 ± 1/h) were at significantly higher risk for EDS than controls (n = 22; 6.8 ± 2.1 years; AHI 0.5 ± 0.3/h) (OR [95% CI] adjusted for age, gender, and obesity: 9.2 [1.7-50.2] and 3.8 [0.7-21.8], respectively). The 3 groups did not differ regarding TNF-? concentration (0.63 ± 0.2 vs 0.65 ± 0.18 vs 0.63 ± 0.17 pg/mL; P > 0.05). TNF-? levels were associated significantly with body mass index z-score (P < 0.05) and not with polysomnography indices (P > 0.05). Subjects with high TNF-? levels (> 0.57 pg/mL) were not at higher risk for EDS than participants with low levels (OR [95% CI] adjusted for age, gender, and obesity: 1.7 [0.5-5.7]). Conclusions: Increasing severity of OSA is associated with increasing frequency of EDS, but not with elevated plasma TNF-? concentration. High TNF-? levels cannot be used as predictor for the presence of EDS in children with sleep apnea. Citation: Alexopoulos EI; Theologi V; Malakasioti G; Maragozidis P; Tsilioni I; Chrousos G; Gourgoulianis K; Kaditis AG. Obstructive sleep apnea, excessive daytime sleepiness, and morning plasma TNF-? levels in Greek children. SLEEP 2013;36(11):1633-1638. PMID:24179295

  16. Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea\\/hypopnea syndrome

    Microsoft Academic Search

    Pei-Wen Lin; Michael Friedman; Hsin-Ching Lin; Hsueh-Wen Chang; Tanya M. Pulver; Chien-Hung Chin

    2011-01-01

    Background  To compare parameters for retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) measurements, and macular thickness\\u000a in patients with different severities of obstructive sleep apnea\\/hypopnea syndrome (OSAHS) versus normal controls.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients presenting with snoring and daytime sleepiness who underwent overnight polysomnography to determine OSAHS severity\\u000a were recruited, and subsequently referred for ophthalmologic evaluation. Optical coherence tomography was used

  17. The Rematee Bumper Belt® positional therapy device for snoring and obstructive sleep apnea: Positional effectiveness in healthy subjects

    PubMed Central

    Matthews, Les; Fortier, Normand

    2013-01-01

    The present study was designed to investigate body position changes resulting from wearing a Rematee Bumper Belt (Rematee, Canada) during sleep. The majority of obstructive sleep apnea (OSA) patients will experience up to two times as many apneas and hypopneas while supine relative to lateral or prone body positions during sleep. It has been suggested that a positional therapy device could reduce the number of apneas and hypopneas in such patients. The present study was conducted to determine whether the Rematee Bumper Belt positional therapy device could prevent healthy subjects from sleeping in the supine position. Test subjects wore the belt for one to two nights. Each belt was equipped with an accelerometer that was used to measure the orientation of the belt relative to the horizontal plane. The results suggest that the belt creates an exclusion zone approximately 80° wide centred near the supine orientation, where subjects are effectively prevented to enter. Results of the present preliminary study suggests that the Rematee Bumper Belt positional therapy device is effective at limiting healthy subjects from sleeping in a supine position. The device appears to be most effective between 150° and 230°. A device with this capability may provide an inexpensive and potentially effective alternative treatment option for patients with OSA. This device has the capacity for reducing snoring and the apnea-hypopnea index in individuals with positional OSA.

  18. Impact of Acetazolamide and CPAP on Cortical Activity in Obstructive Sleep Apnea Patients

    PubMed Central

    Stadelmann, Katrin; Latshang, Tsogyal D.; Nussbaumer-Ochsner, Yvonne; Tarokh, Leila; Ulrich, Silvia; Kohler, Malcolm; Bloch, Konrad E.; Achermann, Peter

    2014-01-01

    Study Objectives 1) To investigate the impact of acetazolamide, a drug commonly prescribed for altitude sickness, on cortical oscillations in patients with obstructive sleep apnea syndrome (OSAS). 2) To examine alterations in the sleep EEG after short-term discontinuation of continuous positive airway pressure (CPAP) therapy. Design Data from two double-blind, placebo-controlled randomized cross-over design studies were analyzed. Setting Polysomnographic recordings in sleep laboratory at 490 m and at moderate altitudes in the Swiss Alps: 1630 or 1860 m and 2590 m. Patients Study 1: 39 OSAS patients. Study 2: 41 OSAS patients. Interventions Study 1: OSAS patients withdrawn from treatment with CPAP. Study 2: OSAS patients treated with autoCPAP. Treatment with acetazolamide (500–750 mg) or placebo at moderate altitudes. Measurements and Results An evening dose of 500 mg acetazolamide reduced slow-wave activity (SWA; approximately 10%) and increased spindle activity (approximately 10%) during non-REM sleep. In addition, alpha activity during wake after lights out was increased. An evening dose of 250 mg did not affect these cortical oscillations. Discontinuation of CPAP therapy revealed a reduction in SWA (5–10%) and increase in beta activity (approximately 25%). Conclusions The higher evening dose of 500 mg acetazolamide showed the “spectral fingerprint” of Benzodiazepines, while 250 mg acetazolamide had no impact on cortical oscillations. However, both doses had beneficial effects on oxygen saturation and sleep quality. PMID:24710341

  19. Inflammatory proteins in patients with obstructive sleep apnea with and without daytime sleepiness.

    PubMed

    Bravo, Mónica de la Peña; Serpero, Laura D; Barceló, Antonia; Barbé, Ferran; Agustí, Alvar; Gozal, David

    2007-09-01

    Excessive daytime sleepiness (EDS) is one of the most frequent symptoms in patients with obstructive sleep apnea syndrome (OSAS). However, not all patients with OSAS manifest EDS. The aim of this study was to assess whether differential circulatory levels of inflammatory mediators would account for differences in somnolence among patients with OSAS. Patients were prospectively recruited from referral patient cohort to the university hospital sleep center. A total of 50 consecutive patients with OSAS undergoing overnight polysomnography with or without EDS and 20 controls were evaluated. EDS was assessed using the Epworth sleepiness scale (ESS) and the multiple sleep latency test after overnight polysomnography. EDS was defined when the ESS was >10 and the mean sleep latency <10 min. Fasting blood was drawn in the morning after polysomnography. Circulating levels of tumor necrosis factor alpha (TNFalpha), interleukin-6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), 8-isoprostaglandin F2alpha (8-iso-PGF2alpha), and P-selectin were measured with commercially available high sensitivity kits. Although patients with OSAS have elevated levels of ICAM-1, IL-6, and TNFalpha, there were no statistically significant differences in any of the inflammatory mediators between patients with EDS and without EDS. Emergence of EDS in the context of OSA does not appear to result from the selective increase of any particular somnogenic substance, i.e., TNFalpha, IL-6, ICAM-1, 8-iso-PGF2alpha, and P-selectin in the context of sleep-disordered breathing. PMID:17279423

  20. Central sleep apnoea in Rett syndrome.

    PubMed

    d'Orsi, Giuseppe; Demaio, Vincenzo; Scarpelli, Francesco; Calvario, Teresa; Minervini, Mauro G

    2009-10-01

    Breathing disturbances in Rett syndrome were reported almost entirely during wakefulness, with normal respiration during sleep. We studied a case of a proven MECP2 mutation in a girl, whose videopolygraphic and polysomnographic monitoring suggested the evidence of central apnoeas not only during awake, but also during sleep. Apart from prevalent awake respiratory dysfunction, central apnoeas in Rett syndrome may be also present during sleep. PMID:19554256

  1. The effects of CPAP treatment on nasal mucosa in patients with obstructive sleep apnea.

    PubMed

    Saka, Cem; Vuralkan, Erkan; F?rat, Ibrahim Hikmet; Alicura, Sibel; Hücümeno?lu, Sema; Ak?n, Istemihan; Ard?ç, Sad?k; Gökler, Ayhan

    2012-09-01

    The aim of the study was to demonstrate the effects of nasal CPAP treatment on the morphology and function of nasal mucosa in patients with obstructive sleep apnea (OSA). Patients with complaints relevant to OSA underwent respiratory function tests, arterial blood gas analyses and polysomnography. Saccharine test and nasal biopsies were performed to assess the mucociliary transport time and to observe the histopathological changes in patients with apnea-hypopnea index ?15 in whole night polysomnography. Tissue samples were obtained from middle and inferior turbinates and septal mucosa to observe the degree of inflammation and fibrosis by semiquantitative means. Biopsies and mucociliary transport test were performed before and 3 months after the initiation of CPAP treatment. A total of 25 patients with a mean age of 52 were enrolled in the study. While the pretreatment mucociliary transport time before and 3 months after the treatment were 10.50 and 11.50 min respectively. The difference between these values was statistically insignificant. Mean apnea-hypopnea index was 63.19, while mean partial oxygen pressure was 75.46 mmHg. Nasal CPAP treatment was introduced with a mean pressure of 9.54 cmH2O. The degree of inflammation and fibrosis was found to be significantly increased after CPAP treatment. Nasal CPAP leads to alterations in mucosa. Efforts should be directed to make CPAP treatment a safer method via protecting the morphologic and functional properties of the nasal mucosa. PMID:22212699

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

    PubMed

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

    2005-01-01

    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

  3. The Association between Obstructive Sleep Apnea and Metabolic Markers and Lipid Profiles

    PubMed Central

    Wu, Wei-Te; Tsai, Su-Shan; Shih, Tung-Sheng; Lin, Ming-Hsiu; Chou, Tzu-Chieh; Ting, Hua; Wu, Trong-Neng; Liou, Saou-Hsing

    2015-01-01

    Purpose The purpose of this study was to investigate the association between apnea-hypopnea index (AHI) and metabolic markers and whether the elevated risk of Metabolic Syndrome (MetS) is related to Obstructive Sleep Apnea (OSA). Methods This cross-sectional study recruited 246 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test and by blood lipids examination. Severity of OSA was categorized according to the apnea-hypopnea index (AHI). Results The results showed that a 73.3% prevalence of MetS in OSA (AHI > 15) and a 80.0% prevalence of MetS in severe OSA (AHI > 30) were found. After adjusting for confounding variables, an increased level of Body-Mass Index (BMI) and two non-MetS cardiovascular risk factors, total cholesterol/HDL-C ratio and TG/HDL-C ratio was significantly associated with AHI in subjects with severe OSA. MetS was about three times to be present in subjects with severe OSA, even adjusted for BMI. Conclusions The findings showed a high prevalence of MetS in OSA among professional drivers, especially in the severe group category. BMI was the major contributing factor to OSA. However, the present study did not find a sensitive clinical marker of a detrimental metabolic profile in OSA patients. PMID:26115005

  4. The Relationship between Obstructive Sleep Apnea and Atrial Fibrillation: A Complex Interplay

    PubMed Central

    Latina, Jacqueline M.; Estes, N. A. Mark; Garlitski, Ann C.

    2013-01-01

    In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient's risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation. PMID:23533751

  5. [Prevalence of sleep apnea syndrome with primary arterial hypertension in a cardiologic rehabilitation clinic].

    PubMed

    Engel, S; Karoff, M; Raschke, F; Fischer, J

    1995-03-01

    In a group of 132 randomly selected male patients with the admission diagnosis arterial hypertension in a cardiological rehabilitation clinic, nightly monitoring was performed with Mesam 4 with records of the metabolism laboratory values and sleep disturbances longitudinally. Desaturation indexes of > or = 10/h after manual correction for plausibility revealed a total prevalence of 27.3% in the case of breathing disturbances. The prevalence increased to 52% in the over 55 year-old patients with a Broca index of > or = 120% in comparison to merely 15.4% in standard weighted, comparable age group. No differences were found in the laboratory values. These results again show the frequent occurrence of the combination adiposity, hypertension, and sleep apnea syndrome which has often been missed previously in specialist rehabilitation clinics. PMID:7617599

  6. Normal hypercapnic cerebrovascular conductance in obstructive sleep apnea.

    PubMed

    Ryan, Clodagh M; Battisti-Charbonney, Anne; Sobczyk, Olivia; Duffin, James; Fisher, Joseph

    2014-01-01

    Both obstructive sleep apnoea (OSA) and impaired cerebrovascular reactivity (CVR) are associated with an increased risk of stroke. We therefore hypothesized that CVR would be decreased in OSA patients. Since OSA is associated with altered endothelial function and this dysfunction may in turn lead to impaired CVR, we further hypothesized that a CVR decrease could be the responsible mechanism for stroke. Middle cerebral artery blood flow velocity (MCAv) and mean arterial blood pressure (MAP) responses to hypercapnia were measured to determine cerebrovascular conductance (MCAv/MAP). Overnight changes in conductance CVR were assessed in treatment naïve, otherwise healthy OSA (n=13) and non-OSA (n=9) subjects at two isoxic tensions (150 and 50mmHg). We found no significant overnight changes in CVR for either group. There were no differences in CVR between OSA and non-OSA subjects for either isoxic tension, although CVR was increased in hypoxia. PMID:24056149

  7. Validation of a Portable Monitoring System for the Diagnosis of Obstructive Sleep Apnea Syndrome

    PubMed Central

    Santos-Silva, Rogerio; Sartori, Denis E.; Truksinas, Viviane; Truksinas, Eveli; Alonso, Fabiana F. F. D; Tufik, Sergio; Bittencourt, Lia R. A.

    2009-01-01

    Study Objective: To evaluate if a portable monitor could accurately measure the apnea-hypopnea index (AHI) in patients with a suspicion of obstructive sleep apnea (OSA). Design: Prospective and randomized. Setting: Sleep laboratory. Participants: 80 participants: 70 patients with clinical OSA suspicion and 10 subjects without suspicion of OSA. Interventions: N/A Measurements and Results: Three-order randomized evaluations were performed: (1) STD (Stardust II) used at the participants' home (STD home), (2) STD used simultaneously with PSG in the sleep lab (STD+PSG lab), and (3) PSG performed without the STD (PSG lab). Four AHI values were generated and analyzed: (a) STD home; (b) STD from STD+PSG lab; (c) PSG from STD+PSG (named PSG+STD lab); and (d) PSG lab. Two technicians, blinded to study details, performed the analyses of all evaluations. There was a strong correlation between AHI from the STD and PSG recordings for all 4 AHI values (all correlations above 0.87). Sensitivity, specificity, and positive and negative predictive values at AHI cut-off values of 5, 15, and 30 events/hour were calculated. AHI values from the PSG lab and PSG+STD lab were compared to STD home and STD+PSG lab and showed the best results when STD and PSG were performed simultaneously. In all analyses, the area under ROC curve was at least 0.90. With multiple comparisons, diagnostic agreement was between 91% and 75%. The Bland Altman analyses showed strong agreement between AHI values from the STD and PSG recordings, especially when comparing the AHI from simultaneous STD and PSG recordings. Conclusion: These data suggest that the STD is accurate in confirming the diagnosis of OSA where there is a suspicion of the disorder. Better agreement occurred during simultaneous recordings. Citation: Santos-Silva R; Sartori DE; Truksinas V; Truksinas E; Alonso FFFD; TufikS; Bittencourt LRA. Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome. SLEEP 2009;32(5):629-639. PMID:19480230

  8. Alternative Scoring Models of STOP-Bang Questionnaire Improve Specificity To Detect Undiagnosed Obstructive Sleep Apnea

    PubMed Central

    Chung, Frances; Yang, Yiliang; Brown, Russell; Liao, Pu

    2014-01-01

    Background: Obstructive sleep apnea (OSA) is common among surgical patients. The STOP-Bang questionnaire is a validated screening tool with a high sensitivity. However, its moderate specificity may yield fairly high false positive rate. We hypothesized that the specific combinations of predicting factors in the STOP-Bang questionnaire would improve its specificity. Methods: After research ethics approval, consented patients were asked to complete the STOP-Bang questionnaire and then underwent sleep studies. The predictive performance of the STOP-Bang alternative scoring models was evaluated. Five hundred sixteen patients with complete data on the STOP-Bang questionnaire and polysomnography were reported. Results: When the STOP-Bang score was ? 3 (any 3 positive items), the sensitivity and specificity for identifying moderate-severe OSA was 87% and 31%, respectively. The specificity for any 2 positive items from the 4 STOP questions plus BMI > 35 kg/m2, male gender, or neck circumference > 40 cm for identifying moderate-severe OSA was 85%, 77%, and 79%, respectively. Compared with STOP-Bang score ? 3, the predicted probability for severe OSA of the specific combinations of STOP score ? 2 + male and STOP score ? 2 + BMI increased by 36% and 42%, respectively. For severe OSA, the specific combination of STOP score ? 2 + BMI + male demonstrated a specificity of 97% and 86% increase in predicted probability versus any 4 positive items of STOP-Bang questionnaire. Conclusions: The specific constellations of predictive factors improved the specificity of STOP-Bang questionnaire. For patients with STOP score ? 2, male gender, and BMI > 35 kg/m2 were more predictive than age ? 50 and neck circumference > 40 cm. Citation: Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of STOP-Bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med 2014;10(9):951-958. PMID:25142767

  9. Epigenetics modifications and Subclinical Atherosclerosis in Obstructive Sleep Apnea: The EPIOSA study

    PubMed Central

    2014-01-01

    Background Obstructive sleep apnea (OSA) is associated with increased risk for cardiovascular morbidity and mortality. Epidemiological and animal models studies generate hypotheses for innovative strategies in OSA management by interfering intermediates mechanisms associated with cardiovascular complications. We have thus initiated the Epigenetics modification in Obstructive Sleep Apnea (EPIOSA) study (ClinicalTrials.gov identifier: NCT02131610). Methods/design EPIOSA is a prospective cohort study aiming to recruit 350 participants of caucasian ethnicity and free of other chronic or inflammatory diseases: 300 patients with prevalent OSA and 50 non-OSA subjects. All of them will be follow-up for at least 5 years. Recruitment and study visits are performed in single University-based sleep clinic using standard operating procedures. At baseline and at each one year follow-up examination, patients are subjected to a core phenotyping protocol. This includes a standardized questionnaire and physical examination to determine incident comorbidities and health resources utilization, with a primary focus on cardiovascular events. Confirmatory outcomes information is requested from patient records and the regional Department of Health Services. Every year, OSA status will be assessed by full sleep study and blood samples will be obtained for immediate standard biochemistry, hematology, inflammatory cytokines and cytometry analysis. For biobanking, aliquots of serum, plasma, urine, mRNA and DNA are also obtained. Bilateral carotid echography will be performed to assess subclinical atherosclerosis and atherosclerosis progression. OSA patients are treated according with national guidelines. Discussion EPIOSA will enable the prospective evaluation of inflammatory and epigenetics mechanism involved in cardiovascular complication of treated and non-treated patients with OSA compared with non OSA subjects. PMID:25016368

  10. The Tongue-Retaining Device: Efficacy and Side Effects in Obstructive Sleep Apnea Syndrome

    PubMed Central

    Lazard, Diane S.; Blumen, Marc; Lévy, Pierre; Chauvin, Pierre; Fragny, Dorothée; Buchet, Isabelle; Chabolle, Frédéric

    2009-01-01

    Study Objectives: The tongue-retaining device is a customized monobloc oral appliance used in the treatment of obstructive sleep apnea syndrome (OSAS). This study evaluated tongue-retaining device efficacy and its tolerance by patients with OSAS. Methods: The charts of 84 apneic patients were retrospectively analyzed, and patients were contacted by telephone to answer an oral questionnaire. The median follow-up time was 5 years. Results: Based on the apnea-hypopnea index, a complete or partial response was obtained in 71% of the cases. The mean apnea-hypopnea index decreased significantly from 38 to 14 (p < 0.001) with the tongue-retaining device. The subjective intensity of snoring decreased by 68% (p < 0.0001) and the Epworth Sleepiness Scale score decreased from 9 to 6 (p < 0.05). An age of more than 60 years associated with a mandibular protrusion distance inferior or equal to 7 mm was predictive of a nonresponse (odds ratio [OR]: 7.25; 95% confidence interval [CI]: 1.43-36.7; p < 0.02). The compliance rate, as determined by answers to the questionnaire, was 52% after 5 years of follow-up. Nasal obstruction was a negative predictor of good compliance (OR: 6.94; 95% CI: 0.28-0.79; p < 0.005), whereas patients with Class I occlusion were more compliant than patients with Class II or III occlusions (OR: 3.83; 95% CI: 1.00-2.81; p < 0.05). Conclusions: Tongue-retaining device performance tended to be similar to that of the mandibular advancement device. Thus, teams trained in tongue-retaining device fabrication and fitting may propose it as an alternative to continuous positive airway pressure, taking nasal obstruction into consideration as a contraindication. Citation: Lazard DS; Blumen M; Lévy P; Chauvin P; Fragny D; Buchet I; Chabolle F. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med 2009;5(5):431-438. PMID:19961027

  11. Association of Severe Obstructive Sleep Apnea and Elevated Blood Pressure Despite Antihypertensive Medication Use

    PubMed Central

    Walia, Harneet K.; Li, Hong; Rueschman, Michael; Bhatt, Deepak L.; Patel, Sanjay R.; Quan, Stuart F.; Gottlieb, Daniel J.; Punjabi, Naresh M.; Redline, Susan; Mehra, Reena

    2014-01-01

    Rationale: We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defined as ? 3 antihypertensives including a diuretic. Definitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP ? 130/80 not on IAR) and resistant elevated BP (BP ? 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI ? 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 ± 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a finding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use. Commentary: A commentary on this article appears in this issue on page 845. Citation: Walia HK, Li H, Rueschman M, Bhatt DL, Patel SR, Quan SF, Gottlieb DJ, Punjabi NM, Redline S, Mehra R. Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use. J Clin Sleep Med 2014;10(8):835-843. PMID:25126027

  12. Treatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal Study

    PubMed Central

    Huang, Yu-Shu; Guilleminault, Christian; Lee, Li-Ang; Lin, Cheng-Hui; Hwang, Fan-Ming

    2014-01-01

    Objective: To evaluate the efficacy of adenotonsillectomy (AT) in the treatment of children with obstructive sleep apnea (OSA) in a 3-y prospective, longitudinal study with analysis of risk factors of recurrence of OSA. Study Design: An investigation of children (6 to 12 y old) with OSA documented at entry and followed posttreatment at 6, 12, 24, and 36 mo with examination, questionnaires, and polysomnography. Multivariate generalized linear modeling and hierarchical linear models analysis were used to determine contributors to suboptimal long-term resolution of OSA, and Generalized Linear Models were used for analysis of risk factors of recurrence. Results: Of the 135 children, 88 terminated the study at 36 months post-AT. These 88 children (boys = 72, mean age = 8.9 ± 2.7 yersus boys 8.9 ± 2.04 y, girls: 8.8 ± 2.07 y; body mass index [BMI] = 19.5 ± 4.6 kg/m2) had a preoperative mean apnea-hypopnea index (AHI0) of 13.54 ± 7.23 and a mean postoperative AHI at 6 mo (AHI6) of 3.47 ± 8.41 events/h (with AHI6 > 1 = 53.4% of 88 children). A progressive increase in AHI was noted with a mean AHI36 = 6.48 ± 5.57 events/h and AHI36 > 1 = 68% of the studied group. Change in AHI was associated with changes in the OSA-18 questionnaire. The residual pediatric OSA after AT was significantly associated with BMI, AHI, enuresis, and allergic rhinitis before surgery. From 6 to 36 mo after AT, recurrence of pediatric OSA was significantly associated with enuresis, age (for the 24- to 36-mo period), postsurgery AHI6 (severity), and the rate of change in BMI and body weight. Conclusions: Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases. Citation: Huang YS; Guilleminault C; Lee LA; Lin CH; Hwang FM. Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: a prospective longitudinal study. SLEEP 2014;37(1):71-76. PMID:24470697

  13. The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis

    Microsoft Academic Search

    Eun Joong Kim; Ji Ho Choi; Kang Woo Kim; Tae Hoon Kim; Sang Hag Lee; Heung Man Lee; Chol Shin; Ki Yeol Lee; Seung Hoon Lee

    2011-01-01

    Open-mouth breathing during sleep is a risk factor for obstructive sleep apnea (OSA) and is associated with increased disease\\u000a severity and upper airway collapsibility. The aim of this study was to investigate the effect of open-mouth breathing on the\\u000a upper airway space in patients with OSA using three-dimensional multi-detector computed tomography (3-D MDCT). The study design\\u000a included a case–control study

  14. Maintenance of wakefulness test in military personnel with upper airway resistance syndrome and mild to moderate obstructive sleep apnea

    Microsoft Academic Search

    Christopher R. Powers; William C. Frey

    2009-01-01

    Background  Sleep-disordered breathing (SDB) and the associated symptom of excessive daytime sleepiness (EDS) in military personnel has\\u000a influential consequences in both the garrison and the deployed environments. The maintenance of wakefulness test (MWT) is\\u000a a daytime study used to evaluate the tendency to stay awake. We evaluated consecutive patients diagnosed with mild to moderate\\u000a obstructive sleep apnea (OSA) and upper airway

  15. A Randomized, Double Crossover Study to Investigate the Influence of Saline Infusion on Sleep Apnea Severity in Men

    PubMed Central

    Yadollahi, Azadeh; Gabriel, Joseph M.; White, Laura H.; Taranto Montemurro, Luigi; Kasai, Takatoshi; Bradley, T. Douglas

    2014-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is commoner in patients with fluid-retaining states than in those without fluid retention, in men than in women, and worsens with aging. In men, OSA severity is related to the amount of fluid shifting out of the legs overnight, but a cause-effect relationship is not established. Our objective was to test the hypothesis that mimicking fluid overload during sleep would increase severity of OSA more in older (? 40 years) than in younger men (< 40 years). Design: Randomized, single-blind, double crossover study. Setting: Research sleep laboratory. Patients or Participants: Seven older and 10 younger men with non-severe or no sleep apnea, matched for body mass index. Interventions: During the control arm, normal saline was infused to keep the vein open. During intervention, subjects received an intravenous bolus of normal saline (22 mL/kg body weight) after sleep onset while they were wearing compression stockings to prevent fluid accumulation in the legs. Measurements and Results: Compared to younger men, infusion of similar amounts of saline in older men caused a greater increase in neck circumference (P < 0.05) and in the AHI (32.2 ± 22.1 vs. 2.2 ± 7.1, P = 0.002). Conclusions: Older men are more susceptible to the adverse effects of intravenous fluid loading on obstructive sleep apnea severity than younger men. This may be due to age-related differences in the amount of fluid accumulating in the neck or upper airway collapsibility in response to intravenous fluid loading. These possibilities remain to be tested in future studies. Citation: Yadollahi A, Gabriel JM, White LH, Taranto Montemurro L, Kasai T, Bradley TD. A randomized, double crossover study to investigate the influence of saline infusion on sleep apnea severity in men. SLEEP 2014;37(10):1699-1705. PMID:25197812

  16. [Glucose tolerance, insulin resistance and arterial hypertension in patients with obstructive sleep apnea syndrome].

    PubMed

    Fischer, J; Raschke, F

    1995-03-01

    Each of 51 patients (42 male, 9 female) examined by polysomnography for suspected obstructive sleep apnea syndrome (OSAS) was subjected to a glucose load test with 75 g glucose and determination of blood sugar and blood insulin levels (at 0, 30, 60, 120 and 180 min). The patients were divided into 4 groups; with and without excess weight (Broca index < or = > 110%), and with and without pathological apnea index (< or = > 10). There was no significant difference between the groups with respect to age. The corresponding groups did not show any significant differences with regard to Broca index or apnea index. However, the patient group with a Broca index > or = 110% and a pathological apnea index > or = 10 was significantly different to all other groups with regard to glucose and insulin level after 60 min. This group was also significantly different to all other groups with regard to systolic and diastolic blood pressure. The reduced glucose tolerance and increased insulin resistance in combination with arterial hypertension in this patient group is indicative that a combination of adiposity and OSAS represents a particularly high risk factor for the development of arterial hypertension even though the pathological mechanism responsible for the development of arterial hypertension is also present in members of both the normal weight OSAS group and the overweight group without OSAS who exhibit a metabolic predisposition for the development of hypertension. A synergetic interaction of both pathomechanisms favors the development of arterial hypertension. Overweight patients with OSAS thus constitute a high-risk group for the development of cardiovascular diseases. PMID:7617595

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

    NASA Technical Reports Server (NTRS)

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

    1999-01-01

    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.

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

    PubMed

    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

    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

  19. [Nutritional knowlegde and lifestyle of obese patients with diagnosed obturative sleep apnea].

    PubMed

    Bronkowska, Monika; Go?ecki, Marcin; S?omian, Justyna; Miko?ajczak, Jolanta; Kosacka, Monika; Porebska, Irena; Jankowska, Renata; Biernat, Jadwiga; Piesiak, Pawe?

    2010-01-01

    The study was aimed, therefore, at evaluating the nutritional knowledge and selected elements of lifestyle of obese patients with diagnosed obstructive sleep apnea (OSA), treated at the Lower Silesia Center of Pulmonary Diseases in Wroclaw. Assessment of nutritional knowledge was conducted among 49 patients including 12 women and 37 men with diagnosed obstructive sleep apnea (OSA), treated at the Lower Silesia Center of Pulmonary Diseases in Wroclaw. The nutritional knowledge and selected elements of lifestyle were evaluated by means of own-construct, standardized questionnaire elaborated at the Chair of Human Nutrition, Wroclaw University of Life and Environmental Sciences. It included questions from different fields referring to, among others: knowledge on rational nutrition, type of physical activity, frequency of cigarette smoking, etc. Despite the demonstrated some knowledge of good nutrition, its use by patients with OSA in everyday life raises many objections. This could possibly result from the message is not binding on the correct nutrition to their own health. Found in the studied group of patients with OSA obesity and low physical activity, evidence of the need to integrate into the process of treatment of individual dietary counseling. PMID:21365869

  20. Remotely controlled mandibular positioner predicts efficacy of oral appliances in sleep apnea.

    PubMed

    Tsai, Willis H; Vazquez, Juan-Carlos; Oshima, Tsutomu; Dort, Leslie; Roycroft, Brian; Lowe, Alan A; Hajduk, Eric; Remmers, John E

    2004-08-15

    Anterior mandibular positioners (AMPs) have become increasingly popular as alternatives to continuous positive airway pressure for the treatment of obstructive sleep apnea. However, widespread acceptance of AMP is limited by an efficacy rate of 50-80% and an inability to predict which patients will respond to therapy. We evaluated 23 patients with obstructive sleep apnea (respiratory disturbance index [RDI] >/= 15 h(-1)) with a remotely controlled mandibular positioner (RCMP), a temporary oral appliance that can advance or retract the mandible in a process analogous to changing the mask pressure during a continuous positive airway pressure titration study. We hypothesized that the elimination of respiratory events and significant nocturnal oxygen desaturation during an RCMP overnight study would predict AMP efficacy, as defined by an absolute reduction in RDI to less than 15 h(-1), a relative reduction in RDI of more than 30% from baseline, and a subjective improvement in symptoms. AMP compliance was 82%, and therapeutic efficacy was 53%. Among compliant patients, the positive and negative predictive value of an RCMP study in predicting AMP treatment success was 90% and 89%, respectively. An overnight RCMP study is highly predictive of AMP response. PMID:15105166

  1. Inflammatory Response Mechanisms Exacerbating Hypoxemia in Coexistent Pulmonary Fibrosis and Sleep Apnea

    PubMed Central

    Balachandran, Jay

    2015-01-01

    Mediators of inflammation, oxidative stress, and chemoattractants drive the hypoxemic mechanisms that accompany pulmonary fibrosis. Patients with idiopathic pulmonary fibrosis commonly have obstructive sleep apnea, which potentiates the hypoxic stimuli for oxidative stress, culminating in systemic inflammation and generalized vascular endothelial damage. Comorbidities like pulmonary hypertension, obesity, gastroesophageal reflux disease, and hypoxic pulmonary vasoconstriction contribute to chronic hypoxemia leading to the release of proinflammatory cytokines that may propagate clinical deterioration and alter the pulmonary fibrotic pathway. Tissue inhibitor of metalloproteinase (TIMP-1), interleukin- (IL-) 1?, cytokine-induced neutrophil chemoattractant (CINC-1, CINC-2?/?), lipopolysaccharide induced CXC chemokine (LIX), monokine induced by gamma interferon (MIG-1), macrophage inflammatory protein- (MIP-) 1?, MIP-3?, and nuclear factor- (NF-) ?B appear to mediate disease progression. Adipocytes may induce hypoxia inducible factor (HIF) 1? production; GERD is associated with increased levels of lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and tumor necrosis factor alpha (TNF-?); pulmonary artery myocytes often exhibit increased cytosolic free Ca2+. Protein kinase C (PKC) mediated upregulation of TNF-? and IL-1? also occurs in the pulmonary arteries. Increased understanding of the inflammatory mechanisms driving hypoxemia in pulmonary fibrosis and obstructive sleep apnea may potentiate the identification of appropriate therapeutic targets for developing effective therapies. PMID:25944985

  2. Tae-Eum Type as an Independent Risk Factor for Obstructive Sleep Apnea

    PubMed Central

    Lee, Seung Ku; Yoon, Dae Wui; Yi, Hyeryeon; Lee, Si Woo; Kim, Jong Yeol; Shin, Chol

    2013-01-01

    Obstructive sleep apnea (OSA) is prevalent and associated with several kinds of chronic diseases. There has been evidence that a specific type of Sasang constitution is a risk factor for metabolic and cardiovascular diseases that can be found in patients with OSA, but there are no studies that address the association between the Sasang constitution type (SCT) and OSA. The purpose of this study was to investigate the association between the SCT and OSA. A total of 652 participants were included. All participants were examined for demographic information, medical history, and completed an interviewer-administered questionnaire on life style and sleep-related variables. Biochemical analyses were performed to determine the glucose and lipid profiles. An objective recording of OSA was done with an unattended home PSG using an Embla portable device. The apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were significantly higher in the Tae-eum (TE) type as compared to the So-eum (SE) and the So-yang (SY) types. Even after adjusting for confounding variables, the TE type still had a 2.34-fold (95% CI, 1.11–4.94; P = 0.0262) increased risk for OSA. This population-based cohort study found that the TE constitutional type is an independent risk factor for the development of OSA. PMID:23554836

  3. Automated detection of sleep apnea in infants: A multi-modal approach.

    PubMed

    Cohen, Gregory; de Chazal, Philip

    2015-08-01

    This study explores the use and applicability of two minimally invasive sensors, electrocardiogram (ECG) and pulse oximetry, in addressing the high costs and difficulty associated with the early detection of sleep apnea hypopnea syndrome in infants. An existing dataset of 396 scored overnight polysomnography recordings were used to train and test a linear discriminants classifier. The dataset contained data from healthy infants, infants diagnosed with sleep apnea, infants with siblings who had died from sudden infant death syndrome (SIDS) and pre-term infants. Features were extracted from the ECG and pulse-oximetry data and used to train the classifier. The performance of the classifier was evaluated using a leave-one-out cross-validation scheme and an accuracy of 66.7% was achieved, with a specificity of 67.0% and a sensitivity of 58.1%. Although the performance of the system is not yet at the level required for clinical use, this work forms an important step in demonstrating the validity and potential for such low-cost and minimally invasive diagnostic systems. PMID:26073098

  4. Unconstrained video monitoring of breathing behavior and application to diagnosis of sleep apnea.

    PubMed

    Wang, Ching-Wei; Hunter, Andrew; Gravill, Neil; Matusiewicz, Simon

    2014-02-01

    This paper presents a new real-time automated infrared video monitoring technique for detection of breathing anomalies, and its application in the diagnosis of obstructive sleep apnea. We introduce a novel motion model to detect subtle, cyclical breathing signals from video, a new 3-D unsupervised self-adaptive breathing template to learn individuals' normal breathing patterns online, and a robust action classification method to recognize abnormal breathing activities and limb movements. This technique avoids imposing positional constraints on the patient, allowing patients to sleep on their back or side, with or without facing the camera, fully or partially occluded by the bed clothes. Moreover, shallow and abdominal breathing patterns do not adversely affect the performance of the method, and it is insensitive to environmental settings such as infrared lighting levels and camera view angles. The experimental results show that the technique achieves high accuracy (94% for the clinical data) in recognizing apnea episodes and body movements and is robust to various occlusion levels, body poses, body movements (i.e., minor head movement, limb movement, body rotation, and slight torso movement), and breathing behavior (e.g., shallow versus heavy breathing, mouth breathing, chest breathing, and abdominal breathing). PMID:24001952

  5. Anteroposterior Difference in EEG Sleep Depth Measure is Reduced in Apnea Patients

    Microsoft Academic Search

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

    2005-01-01

    In the present work, mean frequencies of FFT amplitude spectra from six EEG derivations were used to provide a frontopolar, a central and an occipital sleep depth measure. Parameters quantifying the anteroposterior differences in these three sleep depth measures during the night were also developed. The method was applied to analysis of 30 all-night recordings from 15 healthy control subjects

  6. Use of the Epworth Sleepiness Scale in Chinese patients with obstructive sleep apnea and normal hospital employees

    Microsoft Academic Search

    K. F Chung

    2000-01-01

    Objective: To determine the use of the Epworth Sleepiness Scale (ESS) in Chinese patients with obstructive sleep apnea syndrome (OSA) and normal hospital employees. Methods: Our sample consisted of 61 healthy controls and 100 patients with OSA. The test–retest reliability, internal consistency, and concurrent validity of the Chinese version of the ESS were analyzed. We also compared the ESS scores

  7. Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow

    Microsoft Academic Search

    Chun Xu; SangHun Sin; Joseph M. McDonough; Jayaram K. Udupa; Allon Guez; Raanan Arens; David M. Wootton

    2006-01-01

    Computational fluid dynamic (CFD) analysis was used to model the effect of airway geometry on internal pressure in the upper airway of three children with obstructive sleep apnea syndrome (OSAS), and three controls. Model geometry was reconstructed from magnetic resonance images obtained during quiet tidal breathing, meshed with an unstructured grid, and solved at normative peak resting flow. The unsteady

  8. Symptoms of Sleep Apnea and Polysomnography as Predictors of Poor Quality of Life in Overweight Children and Adolescents

    Microsoft Academic Search

    Margaret-Ann Carno; Ethan Ellis; Elizabeth Anson; Rachel Kraus; Jonathan Black; Heidi V. Connolly

    2008-01-01

    Objective The goal of this study was to examine the relationship between quality of life (QOL) and symptoms of obstructive sleep apnea (OSA) as well as objectively measured severity of OSA using polysomnography (PSG) in a cohort of overweight and at risk for overweight children and adolescents. Methods One hundred and fifty-one overweight subjects (90 males, average ages of 12.52,

  9. The use of continuous positive airway pressure during an awake craniotomy in a patient with obstructive sleep apnea.

    PubMed

    Huncke, Tessa; Chan, Jenny; Doyle, Werner; Kim, Jung; Bekker, Alex

    2008-06-01

    We describe the anesthetic management of a morbidly obese patient with obstructive sleep apnea who underwent awake craniotomy. The patient's personal continuous positive airway pressure (CPAP) machine was used to support ventilation intraoperatively. Dexmedetomidine was used as the primary sedative. During cortical mapping, the CPAP was discontinued. The patient was comfortable and able to cooperate with language testing. PMID:18617130

  10. Practice Parameters for the Medical Therapy of Obstructive Sleep Apnea Standards of Practice Committee of the American Academy of Sleep Medicine

    Microsoft Academic Search

    Timothy I. Morgenthaler; Sheldon Kapen; Teofilo Lee-Chiong; Cathy Alessi; Brian Boehlecke; Jack Coleman; Vishesh Kapur; Judith Owens; Jeffrey Pancer; Todd Swick

    2006-01-01

    Summary: Therapies for obstructive sleep apnea other than positive air- way pressure, oral appliances, and surgical modifications of the upper airway are reviewed in this practice parameter. Several of these therapies such as weight loss and positional therapy hold some promise. Others, such as serotonergic agents, may gain credibility in the future but lack well-designed clinical trials. No practice parameters

  11. Obstructive Sleep Apnea and Fatigue in Head and Neck Cancer Patients.

    PubMed

    Zhou, Jessica; Jolly, Shruti

    2014-04-23

    There is a systematic relationship between fatigue, sleep, and decreased quality of life in cancer patients, with notably poor sleep quality among many head and neck cancer patients during and after treatment. An often overlooked cause of sleep disturbance in this patient population is obstructive sleep apnea (OSA). This review explores the current literature on the prevalence and clinical correlates of OSA, management outcomes, and data on cytokine-mediated fatigue in OSA. OSA appears to be prevalent in head and neck cancer patients, both at baseline and after treatment, especially with multimodality therapy including radiation therapy. Predictors of developing OSA include larger tumor size and hypopharynx or larynx primary site. There is evidence that the level of fatigue seen in these patients is not necessarily correlated with the severity of their OSA. Current research highlights the role of proinflammatory cytokines, which can also be synergistically activated by radiation therapy, as mediators of fatigue. Primary management of OSA consists of continuous positive airway pressure. Although continuous positive airway pressure has been shown to improve clinical symptoms, compliance with its use remains a problem and will be an area of future research. PMID:24762708

  12. Remotely Controlled Mandibular Protrusion during Sleep Predicts Therapeutic Success with Oral Appliances in Patients with Obstructive Sleep Apnea

    PubMed Central

    Remmers, John; Charkhandeh, Shouresh; Grosse, Joshua; Topor, Zbigniew; Brant, Rollin; Santosham, Peter; Bruehlmann, Sabina

    2013-01-01

    Study Objectives: The present study addresses the need for a validated tool that prospectively identifies favorable candidates for oral appliance therapy in treatment of obstructive sleep apnea. The objective of the study was to evaluate the ability of a mandibular titration study, performed with a remotely controlled mandibular positioner (RCMP), to predict treatment outcome with a mandibular repositioning appliance (MRA) and to predict an effective target protrusive position (ETPP). Design: A prospective, blinded, outcome study. Setting: Standard clinical care with tests performed in the polysomnographic laboratory. Participants: Consecutive patients (n = 67) recruited from a sleep center or a dental practice using broad inclusion criteria (age 21-80 years; AHI > 10/h; BMI < 40 kg/m2). Interventions: Therapeutic outcome with a mandibular protruding oral appliance was predicted following a mandibular protrusive titration study in the polysomnographic laboratory using a remotely controlled positioner and prospectively established predictive rules. An ETPP was also prospectively determined for participants predicted to be therapeutically successful with MRA therapy. All participants were blindly treated with a MRA, at either the predicted ETPP or a sham position, and therapeutic outcome was compared against prediction. Measurements and Results: At the final protrusive position, standard predictive parameters (sensitivity, specificity, positive and negative predictive values) showed statistically significant predictive accuracy (P < 0.05) in the range of 83% to 94%. The predicted ETPP provided an efficacious protrusive position in 87% of participants predicted to be therapeutically successful with MRA therapy (P < 0.05). Conclusions: Using prospectively established rules for interpreting the polysomnographic data, the mandibular titration study predicted mandibular repositioning appliance therapeutic outcome with significant accuracy, particularly with regard to accurately predicting therapeutic success. As well, among the participants predicted to be therapeutically successful with mandibular repositioning appliance therapy, the effective target protrusive position provided efficacious mandibular protrusion in the majority. Citation: Remmers J; Charkhandeh S; Grosse J; Topor Z; Brant R; Santosham P; Bruehlmann S. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. SLEEP 2013;36(10):1517-1525. PMID:24082311

  13. Impact of Obstructive Sleep Apnea on Liver Fat Accumulation According to Sex and Visceral Obesity

    PubMed Central

    Toyama, Yoshiro; Tanizawa, Kiminobu; Kubo, Takeshi; Chihara, Yuichi; Harada, Yuka; Murase, Kimihiko; Azuma, Masanori; Hamada, Satoshi; Hitomi, Takefumi; Handa, Tomohiro; Oga, Toru; Chiba, Tsutomu; Mishima, Michiaki; Chin, Kazuo

    2015-01-01

    Rationale Associations between obstructive sleep apnea (OSA) and liver fat accumulation have been frequently investigated because both morbidities are common. Visceral fat was reported to be closely related to OSA and liver fat accumulation. Recently, sex differences in the association between OSA and mortality have gained much attention. Objectives To investigate the associations among OSA, liver fat accumulation as determined by computed tomography, and visceral fat area and their sex differences. Methods Studied were 188 males and 62 females who consecutively underwent polysomnography and computed tomography. Results Although the apnea-hypopnea index was positively correlated with liver fat accumulation in the total males, none of the OSA-related factors was independently associated with liver fat accumulation in either the total male or female participants in the multivariate analyses. When performing subanalyses using a specific definition for Japanese of obesity or visceral obesity (body mass index (BMI) ?25 kg/m2 or visceral fat area ?100 cm2), in only males without visceral obesity, percent sleep time with oxygen saturation <90%, in addition to BMI, insulin resistance, and serum triglyceride values, was independently correlated with liver fat accumulation (R2 = 15.1%, P<0.001). In males, percent sleep time of oxygen saturation <90% was also a determining factor for alanine aminotransferase values regardless of visceral fat area. In contrast, OSA was not associated with liver fat accumulation or alanine aminotransferase values in females whether or not visceral obesity was absent. Conclusions Sex differences in the visceral fat-dependent impact of OSA on liver fat accumulation existed. Although the mechanisms are not known and ethnic differences may exist in addition to the specific criteria of visceral obesity in Japan, the treatment of male patients with OSA might be favorable from the viewpoint of preventing liver fat accumulation and liver dysfunction even in patients without obvious visceral fat accumulation. PMID:26076443

  14. Obstructive Sleep Apnea Affects Hospital Outcomes of Patients with non-ST-Elevation Acute Coronary Syndromes

    PubMed Central

    Correia, Luis C. L.; Souza, Alexandre C.; Garcia, Guilherme; Sabino, Michael; Brito, Mariana; Maraux, Mayara; Rabelo, Márcia M. N.; Esteves, J. Péricles

    2012-01-01

    Study Objective: We aimed to test the hypothesis that clinically suspected obstructive sleep apnea (OSA) independently predicts worse in-hospital outcome in patients with non-ST elevation acute coronary syndromes. Design: At admission, individuals were evaluated for clinical probability of OSA by the Berlin Questionnaire. Primary cardiovascular endpoint was defined as the composite of death, nonfatal myocardial infarction, or refractory angina during hospitalization. Setting: Coronary care unit. Patients: There were 168 consecutive patients admitted with unstable angina or non-ST elevation acute myocardial infarction. Measurements and Results: During a median hospitalization of 8 days, the incidence of cardiovascular events was 13% (12 deaths, 4 nonfatal myocardial infarctions, and 6 refractory anginas.) Incidence of the primary endpoint was 18% in individuals with high probability of OSA, compared with no events in individuals with low probability (P = 0.002). After logistic regression adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score, anatomic severity of coronary disease, and hospital treatment, probability of OSA remained an independent predictor of events (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 1.3 – 9.0; P = 0.015). Prognostic discrimination of the GRACE score, measured by a C-statistic of 0.72 (95% CI = 0.59-0.85), was significantly improved to 0.82 (95% CI = 0.73-0.92) after inclusion of OSA probability in the predictive model (P = 0.03). Conclusion: Considering the independent prognostic and incremental value of suspected OSA, this condition may represent an aggravating factor for patients with non-ST elevation acute coronary syndrome. Citation: Correia LCL; Souza AC; Garcia G; Sabino M; Brito M; Maraux M; Rabelo MMN; Esteves JP. Obstructive sleep apnea affects hospital outcomes of patients with non-st-elevation acute coronary syndromes. SLEEP 2012;35(9):1241-1245. PMID:22942502

  15. The cerebellum and sleep.

    PubMed

    DelRosso, Lourdes M; Hoque, Romy

    2014-11-01

    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

  16. Dichlorvos-induced central apnea: effects of selective brainstem exposure in the rat.

    PubMed

    Gaspari, Romolo J; Paydarfar, David

    2011-03-01

    The area of the brain responsible for organophosphate (OP)-induced central apnea is unknown. Automatic breathing is governed by circuits in the medulla and pons. Respiratory-related neurons in the brainstem are concentrated in a few areas, including ventral regions of the medulla, which contains a number of sites critical for respiratory rhythmogenesis, including the pre-Bötzinger complex (preBötC). The preBötC contains cholinergic receptors, making it a candidate site of action for the apnea-inducing effect of OP. We analyzed respiratory output during a series of experiments using both intact and reduced Wistar rat preparations exposed to dichlorvos (2,2-dichlorovinyl dimethyl phosphate). Exposure of the brainstem using a working heart-brainstem preparation resulted in a central apnea similar to that seen in intact animal models. In contrast, microdialysis of locally toxic doses of dichlorvos to the ventral region of the medulla resulted in delayed and mild respiratory depression in most animals and apnea in only 29% of the animals. We conclude that exposure of the entire brainstem to OP is sufficient to induce central apnea. Our microdialysis experiments suggest that the neural substrate for OP-induced central apnea involves a specific brainstem site other than the ventral region of the medulla, or apnea might result from a distributed effect involving cholinergic toxicities of multiple brainstem sites. PMID:21241738

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

    PubMed Central

    Ankichetty, Saravanan; Wong, Jean; Chung, Frances

    2011-01-01

    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

  18. Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review.

    PubMed

    Aloia, Mark S; Arnedt, J Todd; Davis, Jennifer D; Riggs, Raine L; Byrd, Desiree

    2004-09-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a well-recognized clinical sleep disorder that results in chronically fragmented sleep and recurrent hypoxemia. The primary daytime sequelae of the disorder include patient reports of excessive daytime sleepiness, depression, and attention and concentration problems. It has been well established that OSAHS negatively impacts certain aspects of cognitive functioning. The primary goals of this article are to (1) clarify the pattern of cognitive deficits that are specific to OSAHS; (2) identify the specific cognitive domains that improve with treatment; and (3) elucidate the possible mechanisms of cognitive dysfunction in OSAHS. At the conclusion of the paper, we propose a potential neurofunctional theory to account for the etiology of cognitive deficits in OSAHS. Thirty-seven peer-reviewed articles were selected for this review. In general, findings were equivocal for most cognitive domains. Treatment, however, was noted to improve attention/vigilance in most studies and consistently did not improve constructional abilities or psychomotor functioning. The results are discussed in the context of a neurofunctional theory for the effects of OSAHS on the brain. PMID:15327723

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

    PubMed Central

    Huang, Yu-Shu; Guilleminault, Christian

    2013-01-01

    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

  20. Automated Recognition of Obstructive Sleep Apnea Syndrome Using Support Vector Machine Classifier

    PubMed Central

    Al-Angari, Haitham M.; Sahakian, Alan V.

    2015-01-01

    Obstructive sleep apnea (OSA) is a common sleep disorder that causes pauses of breathing due to repetitive obstruction of the upper airways of the respiratory system. The effect of this phenomenon can be observed in other physiological signals like the heart rate variability, oxygen saturation, and the respiratory effort signals. In this study, features from these signals were extracted from 50 control and 50 OSA patients from the Sleep Heart Health Study database and implemented for minute and subject classifications. A support vector machine (SVM) classifier was used with linear and second-order polynomial kernels. For the minute classification, the respiratory features had the highest sensitivity while the oxygen saturation gave the highest specificity. The polynomial kernel always had better performance and the highest accuracy of 82.4% (Sen: 69.9%, Spec: 91.4%) was achieved using the combined-feature classifier. For subject classification, the polynomial kernel had a clear improvement in the oxygen saturation accuracy as the highest accuracy of 95% was achieved by both the oxygen saturation (Sen: 100%, Spec: 90.2%) and the combined-feature (Sen: 91.8%, Spec: 98.0%). Further analysis of the SVM with other kernel types might be useful for optimizing the classifier with the appropriate features for an OSA automated detection algorithm. PMID:22287247

  1. Obstructive Sleep Apnea: A Cardiometabolic Risk in Obesity and the Metabolic Syndrome

    PubMed Central

    Drager, Luciano F.; Togeiro, Sônia M.; Polotsky, Vsevolod Y.; Lorenzi-Filho, Geraldo

    2015-01-01

    Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (?60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients. PMID:23770180

  2. Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

    PubMed Central

    Yagihara, Fabiana; Lucchesi, Ligia Mendonça; D'Almeida, Vânia; de Mello, Marco Túlio; Tufik, Sergio; Bittencourt, Lia Rita Azeredo

    2012-01-01

    OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p?=?0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p?=?0.004]. CONCLUSION: Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life. PMID:22760893

  3. Metabolic Activity of the Tongue in Obstructive Sleep Apnea. A Novel Application of FDG Positron Emission Tomography Imaging

    PubMed Central

    Kim, Andrew M.; Keenan, Brendan T.; Jackson, Nicholas; Chan, Eugenia L.; Staley, Bethany; Torigian, Drew A.; Alavi, Abass

    2014-01-01

    Rationale: The metabolic activity of the tongue is unknown in patients with obstructive sleep apnea (OSA). Tongue electromyographic (EMG) activity is increased in patients with OSA. This increase in tongue EMG activity is thought to be related to either increased neuromuscular compensation or denervation with subsequent reinnervation of the muscle fibers. Increased glucose uptake in the tongue would support increased neuromuscular compensation, whereas decreased glucose uptake in the tongue would support denervation with subsequent reinnervation of the muscle fibers. Objectives: To investigate the metabolic activity of the genioglossus and control upper airway muscles in obese patients with sleep apnea compared with obese control subjects. Methods: Obese subjects with and without OSA underwent a standard overnight sleep study to determine an apnea–hypopnea index. Each subject had a positron emission tomography with [18F]-2-fluoro-2-deoxy-d-glucose scan in addition to noncontrast computed tomography or magnetic resonance imaging. Glucose uptake was quantified within upper airway tissues with the standardized uptake value. Measurements and Main Results: We recruited 30 obese control subjects (apnea–hypopnea index, 4.7 ± 3.1 events per hour) and 72 obese patients with sleep apnea (apnea–hypopnea index, 43.5 ± 28.0 events per hour). Independent of age, body mass index, sex, and race, patients with OSA had significantly reduced glucose uptake in the genioglossus (P = 0.03) in comparison with obese normal subjects. No differences in standardized uptake value were found in the control muscles (masseter [P = 0.38] and pterygoid [P = 0.70]) and subcutaneous fat deposits (neck [P = 0.44] and submental [P = 0.95]) between patients with OSA and control subjects. Conclusions: There was significantly reduced glucose uptake in the genioglossus of patients with sleep apnea in comparison with obese normal subjects with [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography imaging. The reduction in glucose uptake was likely secondary to alterations in tongue muscle fiber-type or secondary to chronic denervation. The reduced glucose uptake argues against the neuromuscular compensation hypothesis explaining the increase in tongue EMG activity in obese patients with OSA. PMID:24779734

  4. Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values

    PubMed Central

    Cuccia, Antonino M; Campisi, Giuseppina; Cannavale, Rosangela; Colella, Giuseppe

    2007-01-01

    Background The aim of this paper was to determine the most common craniofacial changes in patients suffering Obstructive Sleep Apnea Syndrome (OSAS) with regards to the degree of obesity. Accordingly, cephalometric data reported in the literature was searched and analyzed. Methods After a careful analysis of the literature from 1990 to 2006, 5 papers with similar procedural criteria were selected. Inclusion criteria were: recruitment of Caucasian patients with an apnea-hypopnea index (AHI) >10 as grouped in non-obese (Body Mass Index – [BMI] < 30) vs. obese (BMI ? 30). Results A low position of the hyoid bone was present in both groups. In non-obese patients, an increased value of the ANB angle and a reduced dimension of the cranial base (S-N) were found to be the most common finding, whereas major skeletal divergence (ANS-PNS ^Go-Me) was evident among obese patients. No strict association was found between OSAS and length of the soft palate. Conclusion In both non-obese and obese OSAS patients, skeletal changes were often evident; with special emphasis of intermaxillary divergence in obese patients. Unexpectedly, in obese OSAS patients, alterations of oropharyngeal soft tissue were not always present and did not prevail. PMID:18154686

  5. Normal-tension glaucoma and obstructive sleep apnea syndrome: a prospective study

    PubMed Central

    2014-01-01

    Background Today, identified risk factors for normal-tension glaucoma (NTG) include abnormal ocular blood flow, abnormal blood coagulation, systemic hypotension, ischemic vascular disorders, and autoimmune diseases. However, pathogenesis of the condition remains unclear. On the other hand, there are also a few studies suggesting that the obstructive sleep apnea syndrome (OSAS) may compromise optic nerve head perfusion and cause glaucomatous optic neuropathy by creating transient hypoxemia and increasing vascular resistance. In this study, we evaluated the possible association between OSAS and NTG. Methods We recruited 24 patients with NTG and 24 age and sex matched controls who were also similar for systemic risk factors such as diabetes mellitus (DM), hypertension (HT) and hypercholesterolemia. All patients and controls underwent over-night polysomnography (PSG) for the diagnosis of OSAS and calculation of Apnea-Hypopnea Index (AHI). Results Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference and body mass index. The subjects with AHI???20 were accepted as OSAS. Ten (41.7%) of 24 patients with NTG and 3 (12.5%) of 24 controls had OSAS (p?

  6. Cognitive dysfunction in type 2 diabetes patients accompanied with obstructive sleep apnea syndrome

    PubMed Central

    Li, Huanyin; Gong, Qi; Shao, Jinshan; Liu, Xueyuan; Zhao, Yanxin

    2014-01-01

    Objective: To investigate cognitive dysfunction of type 2 diabetes patients accompanied with obstructive sleep apnea syndrome (OSAS), and to analyze its relevant characteristics. Methods: Total 115 type 2 diabetes patients were divided into OSAS group (O group, n=83) and non-OSAS group (N group, n=32); Physical examination patients (C1 group, n=64) and OSAS patients without diabetes (C2 group, n=47) served as the control group. Apnea-hypopnea index (AHI), nocturnal lowest saturation of pulse oxygen (LSPO2) and simple mental state examination scale (MMSE) were evaluated. Results: Among diabetes patients, patients with OSAS have lower glycated hemoglobin, platelet count, thrombocytocrit, MMSE score and lowest mean arterial oxygen than non-OSAS patients; cognitive dysfunction state and glycemic control of patients are related to their diabetic duration, and then along with increase of diabetic duration, glycemic control becomes poor, so that cognitive dysfunction becomes more and more obvious. Conclusion: Along with increased diabetic duration in type 2 diabetes accompanied with OSAS, glycemic control becomes poor, so that cognitive dysfunction more easily occurs. Meanwhile, coagulation function of blood system in OSAS patients with diabetes is impacted to some extent. PMID:25674144

  7. Treatment of obstructive sleep apnea in infants with trisomy 21 using oral appliances.

    PubMed

    Linz, Annette; Urschitz, Michael S; Bacher, Margit; Brockmann, Pablo E; Buchenau, Wolfgang; Poets, Christian F

    2013-11-01

    Objective : To perform a retrospective study to evaluate the effect of oral appliances, aimed at increasing the pharyngeal space, on obstructive sleep apnea (OSA) in infants with trisomy 21 (TS21). Design and Setting : Retrospective study in a tertiary referral center. Intervention : We analyzed data from 51 consecutive infants (mean age, 2.7 months) who underwent polysomnography (PSG) and were offered our treatment concept. Primary study variable was the mixed-obstructive apnea index (MOAI); OSA was defined as a MOAI ? 1. Results : Twenty-seven infants (53%) had OSA. Their median MOAI improved from 2.3 (1 to 13) to 0 (0 to 0.2; P < .05). Seven of these infants were treated with an appliance that included some type of velar extension to move the tongue base forward. Of the 24 infants without OSA at admission, follow-up PSG results were available for 13. Three infants from this group had developed OSA by the time of a repeat PSG. Conclusion : In patients with TS21, OSA may already develop in infancy. Early treatment may improve OSA. Oral appliances with some type of velar extension may be considered as an alternative to other treatment procedures. PMID:23092363

  8. Plasma Natriuretic Peptides in Children and Adolescents with Obstructive Sleep Apnea and Their Changes Following Intervention

    PubMed Central

    Li, Albert Martin; Au, Chun Ting; Zhu, Jodie Y.; Chan, Kate Ching Ching; Chan, Michael Ho Ming; Lee, Dennis Lip Yen; Wing, Yun Kwok

    2014-01-01

    Objective: This study aimed to evaluate circulating natriuretic peptides (NP) concentration in obese and non-obese children and adolescents with and without obstructive sleep apnea (OSA), and their levels following OSA treatment. Methods: Subjects with habitual snoring and symptoms suggestive of OSA were recruited. They underwent physical examination and overnight polysomnography (PSG). OSA was diagnosed if obstructive apnea–hypopnea index (OAHI) was ?1/h. Fasting serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were taken after overnight PSG. The subjects were divided into obese, non-obese, with and without OSA groups for comparisons. Results: One hundred fourteen children (77 were boys) with a median [interquartile range (IQR)] age of 10.8 (8.3–12.7) years (range: 2.4–11.8?years) were recruited. Sixty-eight subjects were found to have OSA. NP levels did not differ between subjects with and without OSA in both obese and non-obese groups. Stepwise multiple linear regressions revealed that body mass index (BMI) z-score was the only independent factor associated with NP concentrations. Fifteen children with moderate-to-severe OSA (OAHI >5/h) underwent treatment and there were no significant changes in both ANP and BNP levels after intervention. Conclusion: Body mass index rather than OSA was the main determinant of NP levels in school-aged children and adolescents. PMID:24716190

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

    PubMed Central

    van Maanen, J. Peter; de Vries, Nico

    2014-01-01

    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

  10. Excessive Daytime Sleepiness and Sleep-Disordered Breathing Disturbances in Survivors of Childhood Central Nervous System Tumors

    PubMed Central

    Mandrell, Belinda N.; Wise, Merrill; Schoumacher, Robert A.; Pritchard, Michele; West, Nancy; Ness, Kirsten K.; Crabtree, Valerie McLaughlin; Merchant, Thomas E.; Morris, Brannon

    2011-01-01

    Background Improvements in treatment and management for pediatric central nervous system (CNS) tumors have increased survival rates, allowing clinicians to focus on long-term sequelae, including sleep disorders. The objective of this study was to describe a series of CNS tumor survivors who had sleep evaluations that included polysomnography with attention to sleep disorder in relation to the tumor site. Procedure We report on 31 patients who had retrievable reports including an overnight polysomnography (PSG); 17 also underwent multiple sleep latency tests (MSLT) to characterize their sleepiness. Results Mean age at tumor diagnosis was 7.4 years, mean age at sleep referral 14.3 years, and a mean time between tumor diagnosis and sleep referral of 6.9 years. The most common tumor location was the suprasellar region, the most common reason for sleep referral was excessive daytime sleepiness (EDS), and the most common sleep diagnosis was obstructive sleep apnea (n = 14) followed by central sleep apnea (n=4), hypersomnia due to medical condition (n= 4) and narcolepsy (n=3). Twenty-six of the 31 subjects were obese/overweight, and among those with the concurrent complaint of EDS, the mean sleep latency on MSLT was 3.16 minutes, consistent with excessive sleepiness. Conclusions Suprasellar region tumor survivors who are obese or overweight are more likely to have complaints of EDS and are at greater risk of sleep-disordered breathing. Sleep-related symptoms may not be recognized and referral initiated until years after CNS diagnosis. A periodic and thorough sleep history should be taken when caring for CNS tumor survivors. PMID:22009579

  11. Palatal Implants for Persistent Snoring and Mild Obstructive Sleep Apnea After Laser-Assisted Uvulopalatoplasty

    PubMed Central

    Choi, Ji Ho; Kim, Eun Joong; Kim, Kang Woo; Ju, Young Ho; Park, Euy Hyun

    2014-01-01

    Laser-assisted uvulopalatoplasty (LAUP) was widely performed in 1990s as a surgical therapeutic procedure to improve snoring or mild obstructive sleep apnea (OSA). However, LAUP is not currently recommended as a treatment for OSA because the evidence for its efficacy is insufficient. Little is known about alternative minimally invasive surgery in patients who refuse continuous positive airway pressure or oral appliance after failed LAUP. We present a case of successful surgical treatment of persistent snoring and mild OSA with palatal implants after LAUP. This case suggests that palatal implants may be offered as an alternative surgical procedure for selective patients with persistent or recurrent snoring or mild OSA after LAUP. PMID:24587885

  12. Breaking through Limbo: Experiences of Adults Living with Obstructive Sleep Apnea

    PubMed Central

    Rodgers, Beth

    2013-01-01

    Obstructive sleep apnea (OSA) is a potentially devastating condition that diminishes quality of life and leads to serious consequences without treatment. Diagnosis often is delayed and, once diagnosed, adherence to prescribed therapy tends to be a major barrier to management. This grounded theory study was focused on the experiences of a diverse group of 82 adults who were at various points in the process of obtaining a diagnosis and living with OSA. Participants described being in “limbo” and needing to break through that limbo to be successful at managing their OSA. Results provide new insights into the experience of living with OSA that can be beneficial in promoting treatment and shaping effective management of the condition. PMID:23570652

  13. Continuous positive airway pressure and cardiovascular events in patients with obstructive sleep apnea.

    PubMed

    Pataka, Athanasia; Riha, Renata L

    2013-08-01

    The obstructive sleep apnea syndrome (OSAS) is associated with the development/worsening of cardiovascular disease. OSAS is considered to be an independent risk factor for hypertension and is linked to increased mortality in the context of coronary heart disease, the development of cardiac arrhythmias and increased risk of developing mild pulmonary hypertension. OSAS is also associated with cerebrovascular mortality and morbidity. In heart failure, OSAS can lead to worsening of symptoms. Treatment of OSAS using positive airways pressure therapy (PAP) has been shown in randomized, controlled trials in selected populations to reduce some, but not all of these cardiovascular and cerebrovascular risks. Unequivocal evidence of causality for OSAS in the development, progression, and outcomes of these disorders in all individuals suffering from them, is lacking. Good quality long-term morbidity and mortality data for the effects of OSAS on cardiometabolic health and the impact of PAP treatment are likewise limited. PMID:23873341

  14. Obstructive sleep apnea and heart disease: the biomarkers point of view.

    PubMed

    Vitulano, Nicola; Di Marco Berardino, Alessandro; Re, Antonina; Riccioni, Graziano; Perna, Francesco; Mormile, Flaminio; Valente, Salvatore; Bellocci, Fulvio

    2013-01-01

    Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS. PMID:23277071

  15. The ineffectiveness of magnotherapy in a patient with obstructive sleep apnea syndrome and cardiovascular comorbidity.

    PubMed

    Dagan, Yaron; Borodkin, Katy

    2004-12-01

    Obstructive sleep apnea syndrome (OSAS) is associated with mild to severe cardiovascular risks. The most common standard treatment for OSAS, continuous positive airway pressure, was found to have beneficial effects on cardiovascular sequelae of OSAS. Additionally, commercial companies promote nonprescription treatments for OSAS. These products frequently lack scientific support for their efficacy and need further research. We report an objective test of magnetic therapy, one such product, in a patient with OSAS and cardiovascular comorbidities. Two nights of polysomnographic recording using the split-night protocol did not reveal any consistent differences in OSAS symptoms whether the patient slept with or without the magnetic equipment. It was concluded that magnetic treatment was unsuccessful in reducing OSAS symptoms in our patient and may even increase possible cardiovascular and stroke risks by preventing the patient from pursuing an adequate medical treatment, such as continuous positive airway pressure. PMID:15611896

  16. Nitric Oxide Bioavailability in Obstructive Sleep Apnea: Interplay of Asymmetric Dimethylarginine and Free Radicals

    PubMed Central

    Badran, Mohammad; Ayas, Najib

    2015-01-01

    Obstructive sleep apnea (OSA) occurs in 2% of middle-aged women and 4% of middle-aged men and is considered an independent risk factor for cerebrovascular and cardiovascular diseases. Nitric oxide (NO) is an important endothelium derived vasodilating substance that plays a critical role in maintaining vascular homeostasis. Low levels of NO are associated with impaired endothelial function. Asymmetric dimethylarginine (ADMA), an analogue of L-arginine, is a naturally occurring product of metabolism found in the human circulation. Elevated levels of ADMA inhibit NO synthesis while oxidative stress decreases its bioavailability, so impairing endothelial function and promoting atherosclerosis. Several clinical trials report increased oxidative stress and ADMA levels in patients with OSA. This review discusses the role of oxidative stress and increased ADMA levels in cardiovascular disease resulting from OSA.

  17. Approach to obstructive sleep apnea syndrome at Tokyo Dental College, Ichikawa General Hospital.

    PubMed

    Nakajima, Tsuneya; Hayama, Takashi; Ohkushi, Tetsushi; Nagatomo, Mariko; Ohkawa, Takashi; Ohta, Fumikazu; Matsuwaki, Yoshinori; Asaka, Daiya; Chiba, Shintarou; Endo, Makoto

    2004-08-01

    In this communication, we report the current status of OSAS (Obstructive Sleep Apnea Syndrome) in the southern region of Higashikatsushika around Ichikawa City, our effort to improve patient QOL as well as to establish diagnostic and therapeutic methods, and the results of a comparison of therapeutic options with the focus on improvement of compliance by using nCPAP (nasal continuous positive airway pressure). We examined 112 patients who visited the Otolaryngology Department at Tokyo Dental College, Ichikawa General Hospital, with the chief complaint of nocturnal snoring or sleep apnea from January 2001 to April 2003 and underwent all-night PSG (polysomnography). Based upon the results of these all-night PSGs, 89 and 23 patients were diagnosed as having OSAS and simple snoring, respectively. Using the AHI classification of severity, 58 and 31 patients were assessed as having severe OSAS and mild OSAS, respectively. (1) nCPAP was tried in 61 patients, and 39 patients (63%) were able to continue it. After the introduction of nCPAP, surgery was performed in 18 patients (30%). As a result, weaning from nCPAP was successfully achieved in 10 cases, compliance with nCPAP was improved in six cases, alleviation of symptoms (decreased pressure) was seen in one case, and aggravation was noted in one case. In addition, four patients (7%) unilaterally discontinued nCPAP. (2) Surgery was performed in 34 patients, and 18 of them had surgery after nCPAP was tried. (3) We asked the dental department to make OAs (oral appliances) for 31 patients but seven of them did not attend the department, so a total of 24 patients used OAs. Fourteen patients (58%) were able to tolerate an OA for 3 months or more. Based on these results, we are hoping to achieve a better control of OSAS by combining nCPAP and other modalities. PMID:15779461

  18. Effect of obstructive sleep apnea on frequency of stroke in patients with atrial fibrillation.

    PubMed

    Yaranov, Dmitry M; Smyrlis, Athanasios; Usatii, Natalia; Butler, Amber; Petrini, Joann R; Mendez, Jose; Warshofsky, Mark K

    2015-02-15

    Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation (AF). The aim of this study was to investigate the impact of OSA on stroke rate in patients with AF. Patients with AF and new diagnoses of OSA were identified from retrospective chart review. Those with histories of stroke at the time of the sleep study were excluded. The primary outcome was the incidence of stroke, determined by a physician investigator blinded to the results of polysomnography. Subgroup analysis was performed among different CHADS? and CHA?DS?-VASc scores. Of 5,138 patients screened for OSA, 402 (7.7%) had AF and 332 (6.4%) met the inclusion criteria. Among the study population, the occurrence of first-time stroke was 22.9%. Ischemic stroke was more common in patients with OSA compared with patients without (25.4% vs 8.2% respectively, p = 0.006). After controlling for age, male gender, and coronary artery disease, the association between OSA and stroke remained statistically significant, with an adjusted odds ratio of 3.65 (95% confidence interval 1.252 to 10.623). A positive dose effect of the apnea-hypopnea index on the rate of stroke was observed (p = 0.0045). Subgroup analysis showed significantly higher rates of stroke in patients with CHADS? scores of 0 and CHA?DS?-VASc scores of 0 and 1 and co-morbid OSA. In conclusion, OSA in patients with AF is an independent predictor of stroke. This association may have important clinical implications in ischemic stroke risk stratification. PMID:25529543

  19. Comparing a Combination of Validated Questionnaires and Level III Portable Monitor with Polysomnography to Diagnose and Exclude Sleep Apnea

    PubMed Central

    Pereira, Effie J.; Driver, Helen S.; Stewart, Steven C.; Fitzpatrick, Michael F.

    2013-01-01

    Study Objectives: Questionnaires have been validated as screening tools in adult populations at risk for obstructive sleep apnea (OSA). Portable monitors (PM) have gained acceptance for confirmation of OSA in some patients with a high pretest probability of the disorder. We evaluated the combined diagnostic utility of 3 validated questionnaires and a Level III PM in the diagnosis and exclusion of OSA, as compared with in-laboratory polysomnography (PSG) derived apnea hypopnea index (AHI). Methods: Consecutive patients referred to the Sleep Disorders Clinic completed 3 testing components: (1) 3 questionnaires (Berlin, STOP-Bang, and Sleep Apnea Clinical Score [SACS]); (2) Level III at-home PM (MediByte) study; and (3) Level I in-laboratory PSG. The utility of individual questionnaires, the Level III device alone, and the combination of questionnaires and the Level III device were compared with the PSG. Results: One hundred twenty-eight patients participated in the study (84M, 44F), mean ± SD age 50 ± 12.3years, BMI 31 ± 6.6 kg/m2. At a PSG threshold AHI = 10, the PM derived respiratory disturbance index (RDI) had a sensitivity and specificity of 79% and 86%, respectively. The sensitivity and specificity for the other screening tools were: Berlin 88%, 25%; STOP-Bang 90%, 25%; SACS 33%, 75%. The sensitivity and specificity at a PSG AHI = 15 were: PM 77%, 95%; Berlin 91%, 28%; STOP-Bang 93%, 28%; SACS 35%, 78%. Conclusions: Questionnaires alone, possibly given a reliance on sleepiness as a symptom, cannot reliably rule out the presence of OSA. Objective physiological measurement is critical for the diagnosis and exclusion of OSA. Citation: Pereira EJ; Driver HS; Stewart SC; Fitzpatrick MF. Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea. J Clin Sleep Med 2013;9(12):1259-1266. PMID:24340287

  20. Self-evaluated and Close Relative-Evaluated Epworth Sleepiness Scale vs. Multiple Sleep Latency Test in Patients with Obstructive Sleep Apnea

    PubMed Central

    Li, Yun; Zhang, Jihui; Lei, Fei; Liu, Hong; Li, Zhe; Tang, Xiangdong

    2014-01-01

    Objectives: The aims of this study were to determine (1) the agreement in Epworth Sleepiness Scale (ESS) evaluated by patients and their close relatives (CRs), and (2) the correlation of objective sleepiness as measured by multiple sleep latency test (MSLT) with self-evaluated and close relative-evaluated ESS. Methods: A total of 85 consecutive patients with obstructive sleep apnea (OSA) (70 males, age 46.7 ± 12.9 years old) with an apnea-hypopnea index (AHI) > 5 events per hour (mean 38.9 ± 26.8/h) were recruited into this study. All participants underwent an overnight polysomnographic assessment (PSG), MSLT, and ESS rated by both patients and their CRs. Mean sleep latency < 8 min on MSLT was considered objective daytime sleepiness. Results: Self-evaluated global ESS score (ESSG) was closely correlated with evaluation by CRs (r = 0.79, p < 0.001); the mean ESSG score evaluated by patients did not significantly differ from that evaluated by CRs (p > 0.05). However, Bland- Altman plot showed individual differences between self-evaluated and CR-evaluated ESS scores, with a 95%CI of -9.3 to 7.0. The mean sleep latency on MSLT was significantly associated with CR-evaluated ESSG (r = -0.23, p < 0.05); significance of association with self-evaluated ESSG was marginal (r = -0.21, p = 0.05). Conclusions: CR-evaluated ESS has a good correlation but also significant individual disagreement with self-evaluated ESS in Chinese patients with OSA. CR-evaluated ESS performs as well as, if not better than, self-evaluated ESS in this population when referring to MSLT. Citation: Li Y; Zhang J; Lei F; Liu H; Li Z; Tang X. Self-evaluated and close relative-evaluated Epworth Sleepiness Scale vs. multiple sleep latency test in patients with obstructive sleep apnea. J Clin Sleep Med 2014;10(2):171-176. PMID:24533000

  1. Long-Term Effect of Weight Loss on Obstructive Sleep Apnea Severity in Obese Patients with Type 2 Diabetes

    PubMed Central

    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

    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

  2. Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome

    Microsoft Academic Search

    Michael J. Decker; Shulamit Eyal; Zvika Shinar; Yair Fuxman; Clement Cahan; William C. Reeves; Anda Baharav

    2010-01-01

    Purpose  Newly developed algorithms putatively derive measures of sleep, wakefulness, and respiratory disturbance index (RDI) through\\u000a detailed analysis of heart rate variability (HRV). Here, we establish levels of agreement for one such algorithm through comparative\\u000a analysis of HRV-derived values of sleep–wake architecture and RDI with those calculated from manually scored polysomnographic\\u000a (PSG) recordings.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Archived PSG data collected from 234 subjects who

  3. A Controlled Trial of CPAP Therapy on Metabolic Control in Individuals with Impaired Glucose Tolerance and Sleep Apnea

    PubMed Central

    Weinstock, Tanya G.; Wang, Xuelei; Rueschman, Michael; Ismail-Beigi, Faramarz; Aylor, Joan; Babineau, Denise C.; Mehra, Reena; Redline, Susan

    2012-01-01

    Study Objectives: To address whether treatment of sleep apnea improves glucose tolerance. Design: Randomized, double-blind crossover study. Setting: Sleep clinic referrals. Patients: 50 subjects with moderate to severe sleep apnea (AHI > 15) and impaired glucose tolerance. Interventions: Subjects were randomized to 8 weeks of CPAP or sham CPAP, followed by the alternate therapy after a one-month washout. After each treatment, subjects underwent 2-hour OGTT, polysomnography, actigraphy, and measurements of indices of glucose control. Measurements and Results: The primary outcome was normalization of the mean 2-h OGTT; a secondary outcome was improvement in the Insulin Sensitivity Index (ISI (0,120). Subjects were 42% men, mean age of 54 (10), BMI of 39 (8), and AHI of 44 (27). Baseline fasting glucose was 104 (12), and mean 2-h OGTT was 110 (57) mg/dL. Seven subjects normalized their mean 2-h OGTT after CPAP but not after sham CPAP, while 5 subjects normalized after sham CPAP but not after CPAP. Overall, there was no improvement in ISI (0,120) between CPAP and sham CPAP (3.6%; 95% CI: [-2.2%, 9.7%]; P = 0.22). However, in those subjects with baseline AHI ? 30 (n = 25), there was a 13.3% (95% CI: [5.2%, 22.1%]; P < 0.001) improvement in ISI (0,120) and a 28.7% (95%CI: [-46.5%, ?10.9%], P = 0.002) reduction in the 2-h insulin level after CPAP compared to sham CPAP. Conclusions: This study did not show that IGT normalizes after CPAP in subjects with moderate sleep apnea and obesity. However, insulin sensitivity improved in those with AHI ? 30, suggesting beneficial metabolic effects of CPAP in severe sleep apnea. Clinical Trials Information: ClinicalTrials.gov Identifier: NCT01385995. Citation: Weinstock TG; Wang X; Rueschman M; Ismail-Beigi F; Aylor J; Babineau DC; Mehra R; Redline S. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. SLEEP 2012;35(5):617-625. PMID:22547887

  4. Trazodone Increases the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea and a Low Arousal Threshold

    PubMed Central

    Eckert, Danny J.; Malhotra, Atul; Wellman, Andrew; White, David P.

    2014-01-01

    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

  5. Increased cerebrovascular sensitivity to endothelin-1 in a rat model of obstructive sleep apnea: a role for endothelin receptor B.

    PubMed

    Durgan, David J; Crossland, Randy F; Lloyd, Eric E; Phillips, Sharon C; Bryan, Robert M

    2015-03-01

    Obstructive sleep apnea (OSA) is associated with cerebrovascular diseases. However, little is known regarding the effects of OSA on the cerebrovascular wall. We tested the hypothesis that OSA augments endothelin-1 (ET-1) constrictions of cerebral arteries. Repeated apneas (30 or 60 per hour) were produced in rats during the sleep cycle (8?hours) by remotely inflating a balloon implanted in the trachea. Four weeks of apneas produced a 23-fold increase in ET-1 sensitivity in isolated and pressurized posterior cerebral arteries (PCAs) compared with PCAs from sham-operated rats (EC50=10(-9.2)?mol/L versus 10(-10.6)?mol/L; P<0.001). This increased sensitivity was abolished by the ET-B receptor antagonist, BQ-788. Constrictions to the ET-B receptor agonist, IRL-1620, were greater in PCAs from rats after 2 or 4 weeks of apneas compared with that from sham-operated rats (P=0.013). Increased IRL-1620 constrictions in PCAs from OSA rats were normalized with the transient receptor potential channel (TRPC) blocker, SKF96365, or the Rho kinase (ROCK) inhibitor, Y27632. These data show that OSA increases the sensitivity of PCAs to ET-1 through enhanced ET-B activity, and enhanced activity of TRPCs and ROCK. We conclude that enhanced ET-1 signaling is part of a pathologic mechanism associated with adverse cerebrovascular outcomes of OSA. PMID:25425077

  6. Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure.

    PubMed

    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

    2015-06-01

    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

  7. Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complications.

    PubMed

    Yamauchi, Motoo; Kimura, Hiroshi

    2008-04-01

    Obstructive sleep apnea (OSA) is a major public health problem because of its high prevalence in morbidity and mortality. A growing body of evidence suggests that OSA is an important risk factor for cardiovascular diseases. Although the mechanism for the initiation and aggravation of cardiovascular disease has not been fully elucidated, one theorized mechanism is intermittent hypoxia, which is produced by each sleep-disordered breathing event. This repeated hypoxia and reoxygenation cycle is similar to hypoxia-reperfusion injury, which initiates oxidative stress. Recent studies have suggested that OSA is associated with increased levels of oxidative stress or antioxidant deficiencies or both. Oxidative stress is involved in the activation of redox-sensitive transcription factors, which regulate downstream products such as inflammatory cytokines, chemokines, and adhesion molecules. This pathway may be able to explain the pathogenesis of atherosclerosis, a common pathologic factor underlying all types of cardiovascular disease. In addition, endothelial dysfunction derived from oxidative stress can contribute to cardiovascular diseases. This review summarizes current available evidence for and against the occurrence of oxidative stress in OSA and discusses the putative pathways initiating cardiovascular consequences associated with OSA. PMID:18177236

  8. Measurement, reconstruction, and flow-field computation of the human pharynx with application to sleep apnea.

    PubMed

    Lucey, A D; King, A J C; Tetlow, G A; Wang, J; Armstrong, J J; Leigh, M S; Paduch, A; Walsh, J H; Sampson, D D; Eastwood, P R; Hillman, D R

    2010-10-01

    Repetitive closure of the upper airway characterizes obstructive sleep apnea. It disrupts sleep causing excessive daytime drowsiness and is linked to hypertension and cardiovascular disease. Previous studies simulating the underlying fluid mechanics are based upon geometries, time-averaged over the respiratory cycle, obtained usually via MRI or CT scans. Here, we generate an anatomically correct geometry from data captured in vivo by an endoscopic optical technique. This allows quantitative real-time imaging of the internal cross section with minimal invasiveness. The steady inhalation flow field is computed using a k-? shear-stress transport (SST) turbulence model. Simulations reveal flow mechanisms that produce low-pressure regions on the sidewalls of the pharynx and on the soft palate within the pharyngeal section of minimum area. Soft-palate displacement and side-wall deformations further reduce the pressures in these regions, thus creating forces that would tend to narrow the airway. These phenomena suggest a mechanism for airway closure in the lateral direction as clinically observed. Correlations between pressure and airway deformation indicate that quantitative prediction of the low-pressure regions for an individual are possible. The present predictions warrant and can guide clinical investigation to confirm the phenomenology and its quantification, while the overall approach represents an advancement toward patient-specific modeling. PMID:20550980

  9. Obstructive Sleep Apnea, Oxidative Stress, and Cardiovascular Disease: Evidence from Human Studies

    PubMed Central

    Eisele, Hans-Joachim; Markart, Philipp; Schulz, Richard

    2015-01-01

    Obstructive sleep apnea (OSA) is a frequent disease mainly affecting obese people and caused by repetitive collapse of the upper airways during sleep. The increased morbidity and mortality of OSA are mainly thought to be the consequence of its adverse effects on cardiovascular (CV) health. In this context, oxidative stress induced by nocturnal intermittent hypoxia has been identified to play a major role. This is suggested by biomarker studies in OSA patients showing excessively generated reactive oxygen species from leukocytes, reduced plasma levels of nitrite and nitrate, increased lipid peroxidation, and reduced antioxidant capacity. Biopsy studies complement these findings by demonstrating reduced endothelial nitric oxide synthase expression and increased nitrotyrosine immunofluorescence in the vasculature of these patients. Furthermore, oxidative stress in OSA correlates with surrogate markers of CV disease such as endothelial function, intima-media thickness, and high blood pressure. Continuous positive airway pressure therapy reverses oxidative stress in OSA. The same may be true for antioxidants; however, more studies are needed to clarify this issue.

  10. Analysis of the vertebrobasilar system in patients with obstructive sleep apnea.

    PubMed

    Taskin, Umit; Yigit, Ozgur; Sisman, Ayse S; Ogreden, Sahin; Azizli, Elad; Kantarci, Fatih; Mihmanli, Ismail

    2013-08-01

    We conducted a prospective study to evaluate the vertebrobasilar system in adults with and without obstructive sleep apnea (OSA). Our study population was made up of 48 patients with OSA and 21 healthy volunteers who served as controls; the OSA patients were subdivided into one group with mild or moderate OSA (n = 22) and another with severe OSA (n = 26). Each participant underwent Doppler ultrasonography three times to measure the diameter of the vertebral artery, the peak systolic velocity (PSV), the resistive index (RI), and the vertebral artery flow volume; the mean of the three measurements was calculated for each patient, for the OSA and control groups, and for various subgroups. No significant differences in vessel diameter, PSV, or RI were seen among any of the subgroups. Overall, the vertebral artery flow volume was slightly, but not significantly, higher in all patients with OSA (206 ml/min) than in the control group (177 ml/min); this difference might reflect the body's daytime response to the chronic apneic events experienced during sleep. The only statistically significant difference we found was in vertebral artery flow volume between the controls and the subgroup with mild or moderate OSA (p = 0.026); no difference was seen between the controls and the patients with severe OSA (p = 0.318). Likewise, no significant difference in any of the four parameters was seen when patients were subclassified by body mass index and arterial oxygen saturation level. PMID:23975498

  11. Do obstructive sleep apnea syndrome patients underestimate their daytime symptoms before continuous positive airway pressure treatment?

    PubMed Central

    Leclerc, Gabrielle; Lacasse, Yves; Page, Diane; Sériès, Frédéric

    2014-01-01

    BACKGROUND: Daytime somnolence is an important feature of the obstructive sleep apnea (OSA) hypopnea syndrome and is usually subjectively assessed using the Epworth Sleepiness Scale (ESS). OBJECTIVE: To compare the scores of the ESS and different domains of the Quebec Sleep Questionnaire (QSQ) assessed before and after the first months of continuous positive airway pressure (CPAP) treatment, as well as retrospectively without treatment. METHODS: The ESS score and domain scores of the QSQ were obtained before and after a three-month period of CPAP treatment using a retrospective assessment of the pretreatment scores in 76 untreated OSA patients. RESULTS: Fifty-two patients completed the study. The ESS and QSQ scores significantly improved following CPAP therapy. Retrospective evaluation of the ESS score was significantly worse than pre- and post-treatment values (mean [± SD] pretreatment score 11.0±4.8; retrospective pretreatment score 13.5±5.1). Such differences were not observed in any domain of the QSQ, including the domain assessing hypersomnolence. CONCLUSION: OSA patients underestimated their sleepiness according to the most widely used instrument to assess hypersomnolence. This finding may not be observed with other methods used to assess OSA-related symptoms such as quality of life questionnaires. PMID:24712013

  12. Predicting compliance for mandible advancement splint therapy in 96 obstructive sleep apnea patients.

    PubMed

    Ingman, Tuula; Arte, Sirpa; Bachour, Adel; Bäck, Leif; Mäkitie, Antti

    2013-12-01

    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

  13. Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)

    PubMed Central

    Batool-Anwar, Salma; Goodwin, James L.; Drescher, Amy A.; Baldwin, Carol M.; Simon, Richard D.; Smith, Terry W.; Quan, Stuart F.

    2014-01-01

    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

  14. Modified Uvulopalatopharyngoplasty and Coblation Channeling of the Tongue for Obstructive Sleep Apnea: A Multi-Centre Australian Trial

    PubMed Central

    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

    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

  15. Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: Long-term results

    Microsoft Academic Search

    Michael Scheuller; Dudley Weider

    2001-01-01

    Objective: To evaluate the long-term outcomes of bariatric surgery with respect to respiratory disturbance index (RDI) in sleep apnea syndrome (SAS). Design: Case series with long-term follow-up (1 to 12 years). Setting: Private clinic in an academic tertiary referral center. Patients: Fifteen morbidly obese patients (10 men, 5 women) who were referred for the treatment of severe SAS. Intervention: For

  16. Neuropsychological investigations and event-related potentials in obstructive sleep apnea syndrome before and during CPAP-therapy

    Microsoft Academic Search

    Sylvia Kotterba; Kurt Rasche; Walter Widdig; Christina Duscha; Svenja Blombach; Gerhard Schultze-Werninghaus; Jean-Pierre Malin

    1998-01-01

    Patients with obstructive sleep apnea syndrome (OSAS) suffer from daytime sleepiness and a decline of cognitive functions. The study evaluated whether special cognitive disabilities predominate in OSAS. Besides the number connection test (ZVT), judging information processing and working velocity, computer-assisted (Wiener Testsystem and Zimmermann Testbatterie) neuropsychological testing was performed in 31 OSAS patients (50.1±9.4 years) before starting nasal continuous positive

  17. Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns

    Microsoft Academic Search

    Robert A Weatherly; Evelyn F Mai; Deborah L Ruzicka; Ronald D Chervin

    2003-01-01

    Objectives: Some data suggest that the clinical diagnosis of obstructive sleep apnea (OSA) in a child should be confirmed by polysomnography before adenotonsillectomy (AT), but otolaryngology literature generally does not agree and few studies have examined surgical practice patterns.Methods: We mailed, to 603 members of two North American otolaryngology societies, surveys about children aged 5.0–12.9 years upon whom they performed

  18. Impact of nasal continuous positive airway pressure for congenital adrenal hyperplasia with obstructive sleep apnea and bruxism

    Microsoft Academic Search

    Satoshi Hamada; Kazuo Chin; Takefumi Hitomi; Toru Oga; Tomohiro Handa; Tomomasa Tuboi; Akio Niimi; Michiaki Mishima

    Introduction  Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders in humans. The most frequent CAH variant\\u000a is 21-hydroxylase deficiency. Patients with 21-hydroxylasedeficiency require long-term glucocorticoid replacement treatment.\\u000a Although sleep disturbance is frequently observed under glucocorticoid replacement treatment, a case of obstructive sleep\\u000a apnea(OSA) in patients with CAH has not been reported.\\u000a \\u000a \\u000a \\u000a \\u000a Case report  A 43-year-old man with CAH who

  19. Gender and age differences in symptoms' profile in sleep apnea syndrome: A possible cause of gender bias in diagnosis

    Microsoft Academic Search

    Peretz Lavie; Giora Pillar

    2001-01-01

    Summary\\u000a Objective  To compare the age-dependent severity and clinical profile of men and women with polysomnographically-documented obstructive\\u000a sleep apnea syndrome (OSAS).\\u000a \\u000a \\u000a \\u000a Method  A retrospective comparison of polysomnographic and clinical data obtained from 358 carefully age- and RDI-matched men and\\u000a women with OSAS diagnosed in the Technion Sleep Laboratories.\\u000a \\u000a \\u000a \\u000a Results  We found that women complained significantly more on “difficulties falling asleep”, “early morning awakenings”,

  20. 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

    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

    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

  1. SYSTEMS BIOLOGY ANALYSES OF GENE EXPRESSION AND GENOME WIDE ASSOCIATION STUDY DATA IN OBSTRUCTIVE SLEEP APNEA

    PubMed Central

    LIU, YU; PATEL, SANJAY; NIBBE, ROD; MAXWELL, SEAN; CHOWDHURY, SALIM A.; KOYUTURK, MEHMET; ZHU, XIAOFENG; LARKIN, EMMA K.; BUXBAUM, SARAH G; PUNJABI, NARESH M.; GHARIB, SINA A.; REDLINE, SUSAN; CHANCE, MARK R.

    2015-01-01

    The precise molecular etiology of obstructive sleep apnea (OSA) is unknown; however recent research indicates that several interconnected aberrant pathways and molecular abnormalities are contributors to OSA. Identifying the genes and pathways associated with OSA can help to expand our understanding of the risk factors for the disease as well as provide new avenues for potential treatment. Towards these goals, we have integrated relevant high dimensional data from various sources, such as genome-wide expression data (microarray), protein-protein interaction (PPI) data and results from genome-wide association studies (GWAS) in order to define sub-network elements that connect some of the known pathways related to the disease as well as define novel regulatory modules related to OSA. Two distinct approaches are applied to identify sub-networks significantly associated with OSA. In the first case we used a biased approach based on sixty genes/proteins with known associations with sleep disorders and/or metabolic disease to seed a search using commercial software to discover networks associated with disease followed by information theoretic (mutual information) scoring of the sub-networks. In the second case we used an unbiased approach and generated an interactome constructed from publicly available gene expression profiles and PPI databases, followed by scoring of the network with p-values from GWAS data derived from OSA patients to uncover sub-networks significant for the disease phenotype. A comparison of the approaches reveals a number of proteins that have been previously known to be associated with OSA or sleep. In addition, our results indicate a novel association of Phosphoinositide 3-kinase, the STAT family of proteins and its related pathways with OSA. PMID:21121029

  2. Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation.

    PubMed

    Lin, Qi-Chang; Chen, Li-Da; Yu, Yao-Hua; Liu, Kai-Xiong; Gao, Shao-Yong

    2014-04-01

    Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and mortality. However, the underlying mechanism is unclear. In this cross-sectional study, we investigated the influence of OSA on metabolic syndrome (MetS) and inflammation, which were considered as cardiovascular risks. A total of 144 consecutive male patients who underwent standard polysomnography were enrolled. Fasting blood samples were obtained from all patients for glucose, high-sensitivity C-reactive protein (hs-CRP) and lipids measurement. A metabolic score was established as the total number of the positive diagnostic criteria of metabolic syndrome for each patient. Systolic blood pressure, diastolic blood pressure, fasting glucose, hs-CRP and metabolic score significantly increased with the aggravation of OSA severity. Metabolic score increased from 1.74 ± 1.20 to 2.89 ± 0.99 with OSA severity (p = 0.000). hs-CRP increased from 0.68 (0.43-1.10) to 1.44 (0.62-4.02) mg/L with OSA severity (p = 0.002). After adjustment for confounders, apnea-hypopnea index and body mass index (BMI) were the major contributing factors for metabolic score (? = 0.257, p = 0.003 and ? = 0.344, p = 0.000, respectively), lowest O2 saturation and BMI were the independent predictors of hs-CRP (? = -0.255, p = 0.003 and ? = 0.295, p = 0.001, respectively). OSA is independently associated with sum of metabolic components and hs-CRP. PMID:23995706

  3. Mean platelet volume is increased in patients with severe obstructive sleep apnea.

    PubMed

    Varol, Ercan; Ozturk, Onder; Gonca, Taner; Has, Mehmet; Ozaydin, Mehmet; Erdogan, Dogan; Akkaya, Ahmet

    2010-11-01

    Increased platelet activation and aggregation which are closely related to cardiovascular complications have been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with OSA. The 95 subjects referred for evaluation of OSA underwent overnight polysomnography. Blood samples were taken for MPV determination. According to the apnea-hypopnea index (AHI), subjects were divided into three groups; group 1: control subjects without OSA (AHI < 5, n = 24), group 2: patients with mild to moderate OSA (AHI: 5-30, n = 42), and group 3: severe OSA (AHI > 30, n = 29). Body mass index (BMI) of patients with severe OSA was significantly higher than control subjects (31.5 ± 4.0 vs. 28.2 ± 5.0; p = 0.02). The MPV was significantly higher in patients with severe OSA than in the control group (8.9 ± 1.0 vs. 8.2 ± 0.7 fl; p = 0.01). Correlation analysis within 71 patients with OSA indicated that MPV was correlated with AHI (p < 0.001, r = 0.44) and DI (p = 0.001, r = 0.37). In multivariate regression analysis, when MPV was taken as independent with other study variables which are potential confounders such as age, gender and BMI, MPV was independently correlated with both AHI (? = 0.44, p < 0.001) and DI (? = 0.38, p < 0.001). We have shown that MPV was significantly higher in patients with severe OSA when compared with control subjects and MPV was correlated with AHI and DI. PMID:20849358

  4. Blunted Heart Rate Recovery Is Improved Following Exercise Training in Overweight Adults with Obstructive Sleep Apnea

    PubMed Central

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

    2012-01-01

    Background Obstructive sleep apnea (OSA) predisposes individuals to cardiovascular morbidity, and cardiopulmonary exercise test (CPET) markers prognostic for cardiovascular disease have been found to be abnormal in adults with OSA. Due to the persistence of OSA and its cardiovascular consequences, whether the cardiovascular adaptations normally conferred by exercise are blunted in adults not utilizing established OSA treatment is unknown. The aims of this study were to document whether OSA participants have abnormal CPET responses and determine whether exercise modifies these CPET markers in individuals with OSA. Methods The CPET responses of 43 sedentary, overweight adults (body mass index [BMI]>25) with untreated OSA (apnea-hypopnea index [AHI]?15) were compared against matched non-OSA controls (n=9). OSA participants were then randomized to a 12-week exercise training (n=27) or stretching control treatment (n=16), followed by a post-intervention CPET. Measures of resting, exercise, and post-exercise recovery heart rate (HRR), blood pressure, and ventilation, as well as peak oxygen consumption (VO2peak), were obtained. Results OSA participants had blunted HRR compared to non-OSA controls at 1 (P=.03), 3 (P=.02), and 5 min post-exercise (P=.03). For OSA participants, exercise training improved VO2peak (P=.04) and HRR at 1 (P=.03), 3 (P<.01), and 5 min post-exercise (P<.001) compared to control. AHI change was associated with change in HRR at 5-min post-exercise (r=?.30, P<.05), but no other CPET markers. Conclusions These results suggest that individuals with OSA have autonomic dysfunction, and that exercise training, by increasing HRR and VO2peak, may attenuate autonomic imbalance and improve functional capacity independent of OSA severity reduction. PMID:22572632

  5. Distinct Associations between Hypertension and Obstructive Sleep Apnea in Male and Female Patients

    PubMed Central

    Yu, Qiang; Yin, Guizhi; Zhang, Peng; Song, Zhiping; Chen, Yueguang; Zhang, Dadong; Hu, Wei

    2014-01-01

    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

  6. Polymorphisms in nitric oxide synthase and endothelin genes among children with obstructive sleep apnea

    PubMed Central

    2013-01-01

    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

  7. Increased Risk of Benign Prostate Hyperplasia in Sleep Apnea Patients: A Nationwide Population-Based Study

    PubMed Central

    Chou, Wei-Po; Liu, Mu-En; Lai, Chiou-Lian; Liu, Ching-Kuan; Ku, Yan-Chiou; Tsai, Shih-Jen; Chou, Yii-Her; Chang, Wei-Pin

    2014-01-01

    Background Sleep apnea (SA) is a common sleep disorder characterized by chronic intermittent hypoxia (IH). Chronic IH induces systemic inflammatory processes, which can cause tissue damage and contribute to prostatic enlargement. The purpose of this study was to evaluate the association between benign prostate hyperplasia (BPH) and SA in a Taiwanese population. Methods The study population was identified from Taiwan’s National Health Insurance Research Database (NHIRD) and contained 202 SA patients and 1010 control patients. The study cohort consisted of men aged ?30 years who were newly diagnosed with SA between January 1997 and December 2005. Each patient was monitored for 5 years from the index date for the development of BPH. A Cox regression analysis was used to calculate the hazard ratios (HRs) for BPH in the SA and control patients. Results During the 5-year follow-up, 18 SA patients (8.9%) and 32 non-SA control patients (3.2%) developed BPH. The adjusted HR for BPH was 2.35-fold higher in the patients with SA than in the control patients (95% confidence interval (CI) 1.28–4.29, P<.01). We further divided the SA patients into 4 age groups. After adjusting for potential confounding factors, the highest adjusted HR for BPH in the SA patients compared with the control patients was 5.59 (95% CI?=?2.19–14.31, P<.001) in the patients aged between 51 and 65 years. Conclusion Our study results indicate that patients with SA are associated with increased longitudinal risk of BPH development, and that the effects of SA on BPH development are age-dependent. PMID:24667846

  8. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults

    PubMed Central

    2009-01-01

    Background: Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care. Objective: This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA. Methods: The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique. Recommendations: Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome measures and long-term follow-up are described. Citation: Epstein LJ; Kristo D; Strollo PJ; Friedman N; Malhotra A; Patil SP; Ramar K; Rogers R; Schwab RJ; Weaver EM; Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5(3):263–276. PMID:19960649

  9. Development and evaluation of a self-efficacy instrument for Japanese sleep apnea patients receiving continuous positive airway pressure treatment.

    PubMed

    Saito, Ayako; Kojima, Shigeko; Sasaki, Fumihiko; Hayashi, Masamichi; Mieno, Yuki; Sakakibara, Hiroki; Hashimoto, Shuji

    2015-01-01

    The purpose of this study was to develop and evaluate a self-efficacy instrument for Japanese obstructive sleep apnea (OSA) patients treated with continuous positive airway pressure (CPAP). Analyzed subjects were 653 Japanese OSA patients (619 males and 34 females) treated with CPAP at a sleep laboratory in a respiratory clinic in a Japanese city. Based on Bandura's social cognitive theory, the CPAP Self-Efficacy Questionnaire for Sleep Apnea in Japanese (CSESA-J) was developed by a focus group of experts, using a group interview of OSA patients for the items of two previous self-efficacy scales for Western sleep apnea patients receiving CPAP treatment. CSESA-J has two subscales, one for self-efficacy and the other for outcome expectancy, and consists of a total of 15 items. Content validity was confirmed by the focus group. Confirmatory factor analysis showed that the factor loadings of self-efficacy and outcome expectancy were 0.47-0.76 and 0.41-0.92, respectively, for the corresponding items. CSESA-J had a significant but weak positive association with the General Self-Efficacy Scale, and a strong positive association with "Self-efficacy scale on health behavior in patients with chronic disease." Cronbach's alpha coefficient was 0.85 for the self-efficacy subscale and 0.89 for the outcome expectancy subscale. The intraclass correlation coefficient using data from the first and second measurements with CSESA-J for a subset of 130 subjects was 0.93 for the self-efficacy and outcome expectancy subscales. These results support CSESA-J as a reliable and valid instrument for measuring the self-efficacy of Japanese OSA patients treated with CPAP. Further studies are warranted to confirm validity for female OSA patients and generalizability. PMID:25678832

  10. Obstructive Sleep Apnea, Oxidative Stress and Cardiovascular Disease: Lessons from Animal Studies

    PubMed Central

    Heitmann, Joerg; Seeger, Werner; Weissmann, Norbert; Schulz, Richard

    2013-01-01

    Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular (CV) diseases such as arterial hypertension, heart failure, and stroke. Based on human research, sympathetic activation, inflammation, and oxidative stress are thought to play major roles in the pathophysiology of OSA-related CV diseases. Animal models of OSA have shown that endothelial dysfunction, vascular remodelling, and systemic and pulmonary arterial hypertension as well as heart failure can develop in response to chronic intermittent hypoxia (CIH). The available animal data are clearly in favour of oxidative stress playing a key role in the development of all of these CV manifestations of OSA. Presumably, the oxidative stress is due to an activation of NADPH oxidase and other free oxygen radicals producing enzymes within the CV system as evidenced by data from knockout mice and pharmacological interventions. It is hoped that animal models of OSA-related CV disease will continue to contribute to a deeper understanding of their underlying pathophysiology and will foster the way for the development of cardioprotective treatment options other than conventional CPAP therapy. PMID:23533685

  11. Orofacial findings associated with obstructive sleep apnea in a group of Saudi Children

    PubMed Central

    AlHammad, Nouf S.; Hakeem, Lujain A.; Salama, Fouad S.

    2015-01-01

    Objectives: To evaluate orofacial and occlusion findings associated with obstructive sleep apnea (OSA) in a group of Saudi children. Methods: The sample consisted of 30 OSA patients, and 30 age and gender matched, healthy control. The following facial and occlusal features were evaluated: frontal view, facial profile, mandibular angle, tongue size, dental midline to facial midline, upper to lower dental midline, overjet, overbite, anterior open bite, cross bite, scissors bite, palatal vault, maxillary and mandibular arch crowding and spacing, molar and canine relationship. Results: Participants age ranged from 3 to 8 years. Study group had steeper mandibular angle, deeper palatal vault, and less spaced upper and lower arches. There was no statistically significant difference between the two examined groups regarding facial morphology, facial profile, midline, anterior openbite, tongue size, posterior crossbite, overjet or molar relationship. Conclusion: OSA children have a relatively different orofacial morphology compared with control children. OSA subjects had deeper palatal vault, steeper mandibular plane angle and less spaced upper and lower arches compared to control.

  12. TNF-? Gene Polymorphisms and Excessive Daytime Sleepiness In Pediatric Obstructive Sleep Apnea

    PubMed Central

    Khalyfa, Abdelnaby; Serpero, Laura D.; Kheirandish-Gozal, Leila; Capdevila, Oscar Sans; Gozal, David

    2010-01-01

    Objective To assess sleepiness, TNF-? plasma levels and genomic variance in the TNF-? gene in children with obstructive sleep apnea (OSA). Study design Children being evaluated for OSA (n=60) and matched controls (n=80) were assessed with a modified Epworth scale (ESS) questionnaire and underwent a blood draw the morning after NPSG. TNF-plasma concentrations were assayed using ELISA and genomic DNA was extracted. Genotyping and allelic frequencies were determined for 4 TNF-? single nucleotide polymorphisms using real time PCR genotyping assays. Results Morning TNF-? levels and ESS scores were increased in the presence of OSA but substantial variability was present. Although TNF-? plasma concentrations were globally increased in OSA, most of the variance was attributable to the presence or absence of TNF-? ?308G gene polymorphism. Conclusions TNF-? levels are increased in a subset of children with OSA, particularly among those harboring the TNF-? ?308G single nucleotide polymorphism. Among the latter, significant increases in excessive daytime sleepiness symptoms are also present. The relatively high variability of excessive daytime sleepiness in pediatric OSA may be related to underlying TNF-? gene polymorphisms, particularly ?308G. PMID:20846669

  13. Weight and metabolic effects of cpap in obstructive sleep apnea patients with obesity

    PubMed Central

    2011-01-01

    Background Obstructive sleep apnea (OSA) is associated with obesity, insulin resistance (IR) and diabetes. Continuous positive airway pressure (CPAP) rapidly mitigates OSA in obese subjects but its metabolic effects are not well-characterized. We postulated that CPAP will decrease IR, ghrelin and resistin and increase adiponectin levels in this setting. Methods In a pre- and post-treatment, within-subject design, insulin and appetite-regulating hormones were assayed in 20 obese subjects with OSA before and after 6 months of CPAP use. Primary outcome measures included glucose, insulin, and IR levels. Other measures included ghrelin, leptin, adiponectin and resistin levels. Body weight change were recorded and used to examine the relationship between glucose regulation and appetite-regulating hormones. Results CPAP effectively improved hypoxia. However, subjects had increased insulin and IR. Fasting ghrelin decreased significantly while leptin, adiponectin and resistin remained unchanged. Forty percent of patients gained weight significantly. Changes in body weight directly correlated with changes in insulin and IR. Ghrelin changes inversely correlated with changes in IR but did not change as a function of weight. Conclusions Weight change rather than elimination of hypoxia modulated alterations in IR in obese patients with OSA during the first six months of CPAP therapy. PMID:21676224

  14. Response to Statin Therapy in Obstructive Sleep Apnea Syndrome: A Multicenter Randomized Controlled Trial

    PubMed Central

    Joyeux-Faure, Marie; Baguet, Jean-Philippe; Dias-Domingos, Sonia; Leftheriotis, Georges; Janssens, Jean-Paul; Launois, Sandrine H.; Stanke-Labesque, Françoise; Lévy, Patrick A.; Gagnadoux, Frédéric; Pepin, Jean-Louis

    2014-01-01

    Rationale. Accumulated evidence implicates sympathetic activation as inducing oxidative stress and systemic inflammation, which in turn lead to hypertension, endothelial dysfunction, and atherosclerosis in obstructive sleep apnea (OSA). Statins through their pleiotropic properties may modify inflammation, lipid profile, and cardiovascular outcomes in OSA. Methods. This multicenter, randomized, double-blind study compared the effects of atorvastatin 40?mg/day versus placebo over 12 weeks on endothelial function (the primary endpoint) measured by peripheral arterial tone (PAT). Secondary endpoints included office blood pressure (BP), early carotid atherosclerosis, arterial stiffness measured by pulse wave velocity (PWV), and metabolic parameters. Results. 51 severe OSA patients were randomized. Key demographics for the study population were age 54 ± 11 years, 21.6% female, and BMI 28.5 ± 4.5?kg/m2. In intention to treat analysis, mean PAT difference between atorvastatin and placebo groups was 0.008 (?0.29; 0.28), P = 0.979. Total and LDL cholesterol significantly improved with atorvastatin. Systolic BP significantly decreased with atorvastatin (mean difference: ?6.34?mmHg (?12.68; ?0.01), P = 0.050) whereas carotid atherosclerosis and PWV were unchanged compared to the placebo group. Conclusion. In OSA patients, 3 months of atorvastatin neither improved endothelial function nor reduced early signs of atherosclerosis although it lowered blood pressure and improved lipid profile. This trial is registered with NCT00669695. PMID:25221387

  15. The Correlation of Serum Growth Differentiation Factor-15 Level in Patients with Obstructive Sleep Apnea

    PubMed Central

    Sari, Kamran; Ede, Huseyin; Kapusuz Gencer, Zeliha; Ozkiris, Mahmut; Gocmen, Ayse Yesim; Intepe, Yavuz Selim

    2015-01-01

    Purpose. Growth differentiation factor-(GDF-) is a prognostic biomarker in cardiovascular disorders (CVD). GDF-15 level was not studied in patients with obstructive sleep apnea syndrome (OSAS) before. In this study, we investigated serum GDF-15 levels in OSAS patients and compared them with healthy controls. Material and Methods. Polysomnographically, confirmed forty consecutive OSAS patients (20 men and 20 women) and forty consecutive healthy controls (23 men and 17 women) were enrolled in the study. The samples in each group had similar demographic characteristics and body mass index (BMI) values. Results. In the study, no significant correlation was found about GDF-15 levels of OSAS group and healthy controls. However, there was a significant statistical correlation between age and GDF-15 level. In correlation analysis, there was not any significant correlation between age and BMI. Conclusion. Although various developing biomarkers have been studied in cardiovascular disorders, GDF-15 levels have attracted a widespread interest as predictors of cardiovascular risk. GDF-15 level has not been evaluated previously in patients with OSAS. A significant statistical correlation was found between age and GDF-15 level. To reveal close relation between OSAS and GDF-15, further studies are needed with combination of GDF-15 and other biomarkers in OSAS. PMID:26075263

  16. Obstructive sleep apnea syndrome caused by uncommon tumors of the upper aerodigestive tract

    PubMed Central

    Zhu, Shao-Jun; Wang, Qin-Ying; Zhou, Shui-Hong; Bao, Yang-Yang; Wang, Shen-Qing

    2014-01-01

    Obstructive sleep apnea syndrome (OSAS) is always caused by anatomic abnormalities, including nasal cavity, pharynx, and neuromuscular dysfunctions, leading to airway narrowing. OSAS associated with a mass in the aerodigestive tract is rare. In the present study, we report OSAS caused by 9 cases of preoperative uncommon tumors in the aerodigestive tract. Two tumors in the parapharyngeal space were pleomorphic adenoma, one oropharyngeal tumor was mucoepidermoid carcinoma, one tumor in the right tonsil was schwannoma, and five tumors were non-Hodgkin’s lymphoma (NHL). Of the five NHL cases, one in the nasopharynx was diffuse large B-cell lymphoma, two were mantle cell lymphoma, one was chronic lymphocytic leukemia/small lymphocytic lymphoma, and one was NHL. Tumors in the aerodigestive tract should be considered in the differential diagnosis of OSAS upon exacerbation of snoring or sudden gasping. Further examinations should be performed, including a routine workup (computed tomography (CT) and magnetic resonance imaging) and positron emission tomography/CT. PMID:25400748

  17. Computational fluid dynamics simulation of the upper airway of obstructive sleep apnea syndrome by Muller maneuver.

    PubMed

    Nie, Ping; Xu, Xiao-Long; Tang, Yan-Mei; Wang, Xiao-Ling; Xue, Xiao-Chen; Wu, Ya-Dong; Zhu, Min

    2015-06-01

    This study aimed to use computer simulation to describe the fluid dynamic characteristics in patients with obstructive sleep apnea syndrome (OSAS) and to evaluate the difference between during quiet respiration and the Muller maneuver (MM). Seven patients with OSAS were involved to perform computed tomographic (CT) scanning during quiet respiration and the MM. CT data in DICOM format were transformed into an anatomically three-dimensional computational fluid dynamics (CFD) model of the upper airway. The velocity magnitude, relative pressure, and flow distribution were obtained. Numerical simulation of airflow was performed to discuss how the MM affected airflow in the upper airway. To measure the discrepancy, the SPSS19.0 software package was utilized for statistic analysis. The results showed that the shape of the upper airway became narrower, and the pressure decreased during the MM. The minimal cross-sectional area (MCSA) of velopharynx was significantly decreased (P<0.05) and the airflow velocity in MCSAs of velopharynx and glossopharynx significantly accelerated (P<0.05) during the MM. This study demonstrated the possibility of CFD model combined with the MM for understanding pharyngeal aerodynamics in the pathophysiology of OSAS. PMID:26072090

  18. Patient Perspective on Use of an Interactive Website for Sleep Apnea

    PubMed Central

    Stepnowsky, Carl; Edwards, Christine; Zamora, Tania; Barker, Robert; Agha, Zia

    2013-01-01

    Incomplete patient adherence with nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA) outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control) versus MyCPAP group (intervention). Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4??±??2.4 and 4.1??±??2.3?hrs/nt; P = 0.02; mean??±??SD). Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies. PMID:23573081

  19. Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

    PubMed Central

    Bouloukaki, Izolde; Mermigkis, Charalampos; Kallergis, Eleftherios M; Moniaki, Violeta; Mauroudi, Eleni; Schiza, Sophia E

    2015-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease (CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein (CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS. PMID:25992322

  20. Effect of obstructive sleep apnea on type 2 diabetes mellitus: A comprehensive literature review

    PubMed Central

    Nannapaneni, Srikant; Ramar, Kannan; Surani, Salim

    2013-01-01

    Obstructive sleep apnea (OSA) is frequently associated with obesity and metabolic syndrome. Also frequently associated with metabolic syndrome is type 2 diabetes mellitus (T2DM). Therefore, it is common to find OSA and T2DM together in individuals with metabolic syndrome. Additionally, both OSA and T2DM have a common pathophysiological link with development of insulin resistance. Individuals with severe insulin resistance are likely to have inadequate glycemic control. Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy, nephropathy, neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease. There is extensively published literature exploring the cause-effect relationship between OSA and T2DM. In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM. Specifically, this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy, nephropathy and neuropathy. Additionally, we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA. PMID:24379913

  1. Sleep Apnea Syndrome after Posterior Fossa Surgery: A Case of Acquired Ondine's Curse

    PubMed Central

    Faraji rad, Elnaz; Faraji rad, Mohammad; Amini, Shahram; Zare, Reza

    2015-01-01

    Introduction: Ondine’s Curse is a catastrophic but rare condition in adults. It is referred to as a congenital or acquired condition, in which the patient cannot breathe automatically while asleep. Acquired causes of this disease can be any cause affecting the ventrolateral part of the medulla, which is considered to be the breathing center in humans.  Case Report: A 51-year-old woman, with ataxia and the symptoms and signs of rising Intra-Cranial Pressure, who underwent ventriculoperitoneal shunting and removal of tumour, developed episodic apnea during sleep after surgery and hypercapnia when awake. In her post-operative CT scan, some fine spots of hypodensity in the left lateral part of the medulla were observed. She was managed pharmacologically and underwent tracheotomy. After 50 days, she was discharged from the hospital when she was able to breathe normally. Conclusion: Having experience with this condition after resection of a fourth ventricle tumor, it was found that Ondine’s Curse can be considered as one of the complications of posterior fossa surgery and is curable by proper management. PMID:25745613

  2. Sleep Disorders

    MedlinePLUS

    ... the day, even if you have had enough sleep? You might have a sleep disorder. The most common kinds are Insomnia - a hard time falling or staying asleep Sleep apnea - breathing interruptions during sleep Restless legs syndrome - ...

  3. Evaluation of airway obstruction at soft palate level in male patients with obstructive sleep apnea\\/hypopnea syndrome: Dynamic 3-dimensional CT imaging of upper airway

    Microsoft Academic Search

    Ying Xiao; Xiong Chen; Heshui Shi; Yang Yang; Liechun He; Jiaqi Dong; Weijia Kong

    2011-01-01

    Summary  This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive\\u000a sleep apnea\\/hypopnea syndrome (OSAHS) by using dynamic 3-Dimensional (3-D) CT imaging. A total of 41 male patients who presented\\u000a with 2 of the following symptoms, i.e., daytime sleepiness and fatigue, frequent snoring, and apnea with witness, were diagnosed\\u000a as having OSAHS. They

  4. Management of obstructive sleep apnea syndrome secondary to temporomandibular joint ankylosis by mandibular elongation using distraction osteogenesis.

    PubMed

    Guruprasad, Yadavalli; Hemavathy, O R

    2012-01-01

    Obstructive sleep apnea syndrome (OSAS) is associated with repetitive nocturnal upper airway obstruction leading to daytime sleepiness, cardiovascular derangements, and can be a debilitating, even life-threatening condition. The most favorable treatment for patients with OSAS is multidisciplinary care by a team that represents various dental and medical disciplines. Prescribed therapies might include weight loss, behavior modification, oral appliances, soft tissue surgery, skeletal surgery, or some combination of approaches. Osteogenesis by mandibular distraction has proved effective in children in the treatment of obstructive apnea syndrome associated with congenital malformations. In the adult, the possibility of using distraction osteogenesis in the management of OSAS remains to be defined. We report a case of an adult patient treated for OSAS secondary to temporomandibular joint ankylosis by mandibular distraction followed by interpositional arthroplasty. PMID:22557901

  5. A pilot study to compare the cerebral hemodynamics between patients with obstructive sleep apnea syndrome (OSA) and periodic limb movement syndrome (PLMS) during nocturnal sleep with near-infrared spectroscopy (NIRS)

    NASA Astrophysics Data System (ADS)

    Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Fritschi, Ursula; Hügli, Gordana; Lehner, Isabella; Qi, Ming; Khatami, Ramin

    2014-03-01

    Obstructive sleep apnea syndrome (OSA) and periodic limb movement in sleep syndrome (PLMS) are two common sleep disorders. Previous studies showed that OSA and PLMS share common features, such as increased cardio-vascular risk, both apnea events and limb movements occur periodically, they are usually associated with cortical arousals, and both of them can induce declines in peripheral oxygen saturation measured with pulse oximetry. However, the question whether apnea events and limb movements also show similar characteristics in cerebral hemodynamic and oxygenation has never been addressed. In this pilot study, we will first time compare the cerebral hemodynamic changes induced by apnea events and limb movements in patients with OSA (n=4) and PLMS (n=4) with NIRS. In patients with OSA, we found periodic oscillations in HbO2, HHb, and blood volume induced by apnea/hypopnea events, HbO2 and HHb showed reverse changing trends. By contrast, the periodic oscillations linked to limb movements were only found in HbO2 and blood volume in patients with PLMS. These findings of different cerebral hemodynamics patterns between apnea events and limb movements may indicate different regulations of nervous system between these two sleep disorders.

  6. Magnetic Resonance Spectroscopy and Neurocognitive Dysfunction in Obstructive Sleep Apnea before and after CPAP Treatment

    PubMed Central

    O'Donoghue, Fergal J.; Wellard, R. Mark; Rochford, Peter D.; Dawson, Andrew; Barnes, Maree; Ruehland, Warren R.; Jackson, Melinda L.; Howard, Mark E.; Pierce, Robert J.; Jackson, Graeme D.

    2012-01-01

    Study Objectives: To determine whether cerebral metabolite changes may underlie abnormalities of neurocognitive function and respiratory control in OSA. Design: Observational, before and after CPAP treatment. Setting: Two tertiary hospital research institutes. Participants: 30 untreated severe OSA patients, and 25 age-matched healthy controls, all males free of comorbidities, and all having had detailed structural brain analysis using voxel-based morphometry (VBM). Measurements and Results: Single voxel bilateral hippocampal and brainstem, and multivoxel frontal metabolite concentrations were measured using magnetic resonance spectroscopy (MRS) in a high resolution (3T) scanner. Subjects also completed a battery of neurocognitive tests. Patients had repeat testing after 6 months of CPAP. There were significant differences at baseline in frontal N-acetylaspartate/choline (NAA/Cho) ratios (patients [mean (SD)] 4.56 [0.41], controls 4.92 [0.44], P = 0.001), and in hippocampal choline/creatine (Cho/Cr) ratios (0.38 [0.04] vs 0.41 [0.04], P = 0.006), (both ANCOVA, with age and premorbid IQ as covariates). No longitudinal changes were seen with treatment (n = 27, paired t tests), however the hippocampal differences were no longer significant at 6 months, and frontal NAA/Cr ratios were now also significantly different (patients 1.55 [0.13] vs control 1.65 [0.18] P = 0.01). No significant correlations were found between spectroscopy results and neurocognitive test results, but significant negative correlations were seen between arousal index and frontal NAA/Cho (r = ?0.39, corrected P = 0.033) and between % total sleep time at SpO2 < 90% and hippocampal Cho/Cr (r = ?0.40, corrected P = 0.01). Conclusions: OSA patients have brain metabolite changes detected by MRS, suggestive of decreased frontal lobe neuronal viability and integrity, and decreased hippocampal membrane turnover. These regions have previously been shown to have no gross structural lesions using VBM. Little change was seen with treatment with CPAP for 6 months. No correlation of metabolite concentrations was seen with results on neurocognitive tests, but there were significant negative correlations with OSA severity as measured by severity of nocturnal hypoxemia. Citation: O'Donoghue FJ; Wellard RM; Rochford PD; Dawson A; Barnes M; Ruehland WR; Jackson ML; Howard ME; Pierce RJ; Jackson GD. Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment. SLEEP 2012;35(1):41-48. PMID:22215917

  7. Symptoms of Obstructive Sleep Apnea, Gastroesophageal Reflux and the Risk of Barrett’s Esophagus in a Population-Based Case-Control Study

    PubMed Central

    Lindam, Anna; Kendall, Bradley J.; Thrift, Aaron P.; Macdonald, Graeme A.; O’Brien, Suzanne; Lagergren, Jesper; Whiteman, David C.

    2015-01-01

    Background Gastroesophageal reflux is overrepresented in people with obstructive sleep apnea (OSA) and it has been suggested that OSA worsens gastroesophageal reflux symptoms. Aggravated reflux might lead to an increased risk of Barrett’s esophagus. Aim To assess the association between sleep apnea symptoms and Barrett’s esophagus. Methods Included in a case-control study in Brisbane, Australia were 237 patients with histologically confirmed Barrett’s esophagus and 247 population controls. The controls were randomly selected from the electoral roll and frequency-matched to the cases by age and sex. Information on OSA symptoms (excessive daytime sleepiness and sleep related apnea symptoms), gastroesophageal reflux symptoms and anthropometric measures were collected through interviews and written questionnaires. Multivariable logistic regression provided odds ratios (OR) and 95% confidence intervals (CI), adjusted for potential confounding by BMI and gastroesophageal reflux. Results The prevalence of Barrett’s esophagus was higher among people with excessive daytime sleepiness than those without (24% vs. 18%; p-value 0.1142) and in participants with sleep-related apnea symptoms (20% vs. 13%; p-value 0.1730). However, there were non-significantly increased ORs of Barrett’s esophagus among people with excessive daytime sleepiness (OR 1.42, 95% CI 0.90–2.34) and sleep related apnea symptoms (OR 1.32, 95% CI 0.74–2.36) when adjusting for age, sex and BMI. After further adjustment for gastroesophageal reflux symptoms, the point ORs were no longer increased (OR 1.02, 95% CI 0.61–1.70 for daytime sleepiness and OR 0.72, 95% CI 0.38–1.38 for sleep related apnea symptoms). Conclusions Symptoms of OSA are possibly associated with an increased risk of Barrett’s esophagus, an association that appears to be mediated entirely by gastroesophageal reflux. PMID:26090820

  8. Complete Blood Count Alterations after Six Months of Continuous Positive Airway Pressure Treatment in Patients with Severe Obstructive Sleep Apnea

    PubMed Central

    Sökücü, Sinem Nedime; Özdemir, Cengiz; Dalar, Levent; Karasulu, Levent; Ayd?n, ?enay; Alt?n, Sedat

    2014-01-01

    Study Objectives: The cardiovascular complications caused by obstructive sleep apnea (OSA) decrease after continuous positive airway pressure treatment (CPAP). Mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are newly recognized tools for assessing cardiovascular risk. Methods: From a selection of patients with symptoms of nocturnal snoring and/or excessive daytime sleepiness, 36 males with an apnea-hypopnea index (AHI) > 30/h and 22 age-matched normal male controls with AHI < 5/h were included. Patients with OSA underwent another night of CPAP titration, and 11 patients were excluded at the 6-month evaluation due to poor compliance with the home CPAP therapy. Complete blood count parameters of compliant patients and the control group were evaluated. Results: Compared to controls, MPV values were significantly higher (p = 0.025) in OSA patients, but no significant differences in PDW or RDW were found (p > 0.05). Six months of CPAP therapy resulted in significantly lower MPV values but increased values of PDW and RDW in patients with severe OSA (p = 0.001, p = 0.007, p = 0.001, respectively). Conclusion: Our data suggest that complete blood count parameters in OSA patients such as MPV, PDW and RDW change significantly after CPAP therapy. Citation: Sökücü SN, Özdemir C, Dalar L, Karasulu L, Ayd?n ?, Alt?n S. Complete blood count alterations after six months of continuous positive airway pressure treatment in patients with severe obstructive sleep apnea. J Clin Sleep Med 2014;10(8):873-878. PMID:25126033

  9. Sleep Disorders

    NSDL National Science Digital Library

    Sohmer, Rachel.

    2003-01-01

    For something as critical to our well being as good sleep, human beings suffer from an amazing number of sleeping disorders. The following Web sites explore just a few of these disorders, starting with a brief introduction to the normal stages of sleep from the Sleep Disorders Center of Central Texas (1). Next, the University of Waterloo offers a fascinating look at sleep paralysis, which many researchers consider the "likely source of beliefs concerning not only alien abductions, but all manner of beliefs in alternative realities and otherworldly creatures" (2). The third site (3), provided by the National Women's Health Information Center, is an easy-to-read source for information about insomnia. Likewise, the American Sleep Apnea Association (ASAA) offers an in-depth information packet on snoring and sleep apnea, as well as the ASAA newsletter and other resources (4). The next Web site (5 ) comes from the National Institute of Neurological Disorders and Stroke, and offers an introduction to the phenomenon of narcolepsy, including treatment, prognosis, and related research. Restless legs syndrome may not be as immediately familiar as some of the other sleep disorders addressed above, but a visit to the homepage of the Restless Legs Syndrome Foundation (6) should answer any questions about this "creepy-crawly" sensation in the limbs that occurs during sleep or other inactive periods. Of course, you don't have to have a bona fide sleeping disorder to suffer from sleep deprivation. Visitors to the next Web site from Loughborough University's Sleep Research Centre will find detailed information on how sleep deprivation affects brain function (7). Not surprisingly, the news isn't good. Finally, the Sleep Foundation offers How's Your Sleep, an online quiz designed to help users learn more about what may be affecting their sleep (8).

  10. Oral Appliance Versus Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome: A 2-Year Follow-up

    PubMed Central

    Doff, Michiel H. J.; Hoekema, Aarnoud; Wijkstra, Peter J.; van der Hoeven, Johannes H.; Huddleston Slater, James J. R.; de Bont, Lambert G. M.; Stegenga, Boudewijn

    2013-01-01

    Study Objectives: Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of oral appliance therapy and CPAP in patients with OSAS. Design: Cohort study of a previously conducted randomized clinical trial. Setting: University Medical Center, Groningen, The Netherlands. Patients or Participants: One hundred three patients with OSAS. Interventions: CPAP and oral appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA) Measurements and Results: Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apneahypopnea index (AHI) was < 5 or showed substantial reduction, defined as reduction in the index of at least 50% from the baseline value to a value of < 20 in a patient without OSAS symptoms while undergoing therapy. Regarding the proportions of successful treatments, no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up. More patients (not significant) dropped out under oral appliance therapy (47%) compared with CPAP (33%). Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes. However, CPAP was more effective in lowering the AHI and showed higher oxyhemoglobin saturation levels compared to oral appliance therapy (P < 0.05). Conclusions: Oral appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. Clinical Trial Information: The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apneahypopnea syndrome: oral appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167. Citation: Doff MHJ; Hoekema A; Wijkstra PJ; van der Hoven JH; Slater JJRH; de Bont LGM; Stegenga B. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. SLEEP 2013;36(9):1289-1296. PMID:23997361

  11. Facial Phenotyping by Quantitative Photography Reflects Craniofacial Morphology Measured on Magnetic Resonance Imaging in Icelandic Sleep Apnea Patients

    PubMed Central

    Sutherland, Kate; Schwab, Richard J.; Maislin, Greg; Lee, Richard W.W.; Benedikstdsottir, Bryndis; Pack, Allan I.; Gislason, Thorarinn; Juliusson, Sigurdur; Cistulli, Peter A.

    2014-01-01

    Study Objectives: (1) To determine whether facial phenotype, measured by quantitative photography, relates to underlying craniofacial obstructive sleep apnea (OSA) risk factors, measured with magnetic resonance imaging (MRI); (2) To assess whether these associations are independent of body size and obesity. Design: Cross-sectional cohort. Setting: Landspitali, The National University Hospital, Iceland. Participants: One hundred forty patients (87.1% male) from the Icelandic Sleep Apnea Cohort who had both calibrated frontal and profile craniofacial photographs and upper airway MRI. Mean ± standard deviation age 56.1 ± 10.4 y, body mass index 33.5 ± 5.05 kg/m2, with on-average severe OSA (apnea-hypopnea index 45.4 ± 19.7 h-1). Interventions: N/A. Measurements and Results: Relationships between surface facial dimensions (photos) and facial bony dimensions and upper airway soft-tissue volumes (MRI) was assessed using canonical correlation analysis. Photo and MRI craniofacial datasets related in four significant canonical correlations, primarily driven by measurements of (1) maxillary-mandibular relationship (r = 0.8, P < 0.0001), (2) lower face height (r = 0.76, P < 0.0001), (3) mandibular length (r = 0.67, P < 0.0001), and (4) tongue volume (r = 0.52, P = 0.01). Correlations 1, 2, and 3 were unchanged when controlled for weight and neck and waist circumference. However, tongue volume was no longer significant, suggesting facial dimensions relate to tongue volume as a result of obesity. Conclusions: Significant associations were found between craniofacial variable sets from facial photography and MRI. This study confirms that facial photographic phenotype reflects underlying aspects of craniofacial skeletal abnormalities associated with OSA. Therefore, facial photographic phenotyping may be a useful tool to assess intermediate phenotypes for OSA, particularly in large-scale studies. Citation: Sutherland K, Schwab RJ, Maislin G, Lee RW, Benedikstdsottir B, Pack AI, Gislason T, Juliusson S, Cistulli PA. Facial phenotyping by quantitative photography reflects craniofacial morphology measured on magnetic resonance imaging in icelandic sleep apnea patients. SLEEP 2014;37(5):959-968. PMID:24790275

  12. Does Airway Surgery Lower Serum Lipid Levels in Obstructive Sleep Apnea Patients? A Retrospective Case Review

    PubMed Central

    Li, Li; Zhan, Xiaojun; Wang, Ningyu; Pinto, Jayant Marian; Ge, Xiaohui; Wang, Chunyan; Tian, Jun; Wei, Yongxiang

    2014-01-01

    Background Obstructive sleep apnea (OSA) is tightly linked to increased cardiovascular disease. Surgery is an important method to treat OSA, but its effect on serum lipid levels in OSA patients is unknown. We aimed to evaluate the effect of upper airway surgery on lipid profiles. Material/Methods We performed a retrospective review of 113 adult patients with OSA who underwent surgery (nasal or uvulopalatopharyngoplasty [UPPP]) at a major, urban, academic hospital in Beijing from 2012 to 2013 who had preoperative and postoperative serum lipid profiles. Results Serum TC (4.86±0.74 to 4.69±0.71) and LP(a) (median 18.50 to 10.90) all decreased significantly post-operatively (P<0.01, 0.01, respectively), with no changes in serum HDL, LDL, or TG (P>0.05, all). For UPPP patients (n=51), serum TC, HDL and LP(a) improved (P=0.01, 0.01,<0.01, respectively). For nasal patients (n=62), only the serum LP(a) decreased (P<0.01). In patients with normal serum lipids at baseline, only serum LP(a) decreased (P<0.01). In contrast, in patients with isolated hypertriglyceridemia, the serum HDL, TG and LP(a) showed significant improvements (P=0.02, 0.03, <0.01, respectively). In patients with isolated hypercholesterolemia, the serum LP(a) decreased significantly (P=0.01), with a similar trend for serum TC (P=0.06). In patients with mixed hyperlipidemia, the serum TC and LDL also decreased (P=0.02, 0.03, respectively). Conclusions Surgery may improve blood lipid levels in patients with OSA, especially in patients with preoperative dyslipidemia, potentially yielding a major benefit in metabolism and cardiovascular sequelae. Prospective studies should examine this potential metabolic effect of airway surgery for OSA. PMID:25503376

  13. Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea.

    PubMed

    Kumar, Rajesh; Farahvar, Salar; Ogren, Jennifer A; Macey, Paul M; Thompson, Paul M; Woo, Mary A; Yan-Go, Frisca L; Harper, Ronald M

    2014-01-01

    Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA. PMID:24567910

  14. Telemedicine-Based Approach for Obstructive Sleep Apnea Management: Building Evidence

    PubMed Central

    León, Carmen; Torres, Marta; Embid, Cristina; Roca, Josep; Navajas, Daniel; Farré, Ramon; Montserrat, Josep M

    2014-01-01

    Background Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management. Objective The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients’ CPAP follow-up and training. Methods We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement. Results More than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups. Conclusions OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients’ CPAP training and clinical follow-up. PMID:24554392

  15. Effect of Short Term CPAP Therapy in Obstructive Sleep Apnea Patients with Metabolic Syndrome

    PubMed Central

    C., Balaji; A., Saravanan; K., Ravi

    2015-01-01

    Background Patients of obstructive sleep apnea (OSA) with metabolic syndrome (MetS) are at increased risk of cardiovascular morbidity and mortality. The role of oxidative stress in pathogenesis of OSA and MetS has been widely reported. Continuous positive airway pressure (CPAP) therapy remains the first-line of treatment in OSA. The beneficial effect of long term CPAP therapy in OSA is well-known. However, the effect of short term CPAP on the components of MetS and oxidative stress-antioxidant levels is still unclear. Aim The present study explored the effects of one night of CPAP therapy on the oxidant-antioxidant status and components of MetS in patients of OSA with MetS. Materials and Methods Twenty adult males and postmenopausal females with MetS and symptoms suggestive of OSA were enrolled in the study. None of the subjects were smoker or alcoholic. They did not consume any drugs that would alter their antioxidant levels. Overnight polysomnography was done to confirm diagnosis and assess CPAP pressure. Following which they spent one night in the sleep lab for CPAP therapy. Blood pressure data and blood samples were collected at baseline and after CPAP. Collected samples were transferred immediately to the laboratory for analysis of serum thiol, lipid peroxidation, insulin resistance (HOMA-IR) and lipid profile. Results Paired t-test with two-tail significance was used to compare the changes in study parameters in the same patient before and after treatment. The antioxidant level increased and oxidative stress decreased as evidenced by serum thiol concentration (204.2±65.7 vs 254.9±72 ?mol/L, p<0.001) and lipid peroxidation levels (13.1±6.2 vs 8.4±3.1 ?mol/L, p<0.01).There was a significant decrease in both systolic (132.1±16.1 vs 127.2±14.3 mmHg, p<0.01) and diastolic blood pressure (86.4±9.4 vs 81.2±9.8 mmHg, p<0.01) after one night of CPAP. However, there was no change in lipid parameters and the reduction seen in insulin resistance was not statistically significant. Conclusion One night of CPAP therapy seems to be helpful in reducing oxidative stress, improving antioxidant levels and decreasing the severity of various components of MetS. PMID:26023552

  16. Active upper airway closure during induced central apneas in lambs is complete at the laryngeal level only.

    PubMed

    Fortier, Pierre-Hugues; Reix, Philippe; Arsenault, Julie; Dorion, Dominique; Praud, Jean-Paul

    2003-07-01

    We tested the hypotheses that active upper airway closure during induced central apneas in nonsedated lambs 1). is complete and occurs at the laryngeal level and 2). is not due to stimulation of the superior laryngeal nerves (SLN). Five newborn lambs were surgically instrumented to record thyroarytenoid (TA) muscle (glottal constrictor) electromyographic (EMG) activity with supra- and subglottal pressures. Hypocapnic and nonhypocapnic central apneas were induced before and after SLN sectioning in the five lambs. A total of 174 apneas were induced, 116 before and 58 after sectioning of the internal branch of the SLN (iSLN). Continuous TA EMG activity was observed in 88% of apneas before iSLN section and in 87% of apneas after iSLN section. A transglottal pressure different from zero was observed in all apneas with TA EMG activity, with a mean subglottal pressure of 4.3 +/- 0.8 cmH2O before and 4.7 +/- 0.7 cmH2O after iSLN section. Supraglottal pressure was consistently atmospheric. Sectioning of both iSLNs had no effects on the results. We conclude that upper airway closure during induced central apneas in lambs is active, complete, and occurs at the glottal level only. Consequently, a positive subglottal pressure is maintained throughout the apnea. Finally, this complete active glottal closure is independent from laryngeal afferent innervation. PMID:12626486

  17. The sleep relay--the role of the thalamus in central and decentral sleep regulation.

    PubMed

    Coulon, Philippe; Budde, Thomas; Pape, Hans-Christian

    2012-01-01

    Surprisingly, the concept of sleep, its necessity and function, the mechanisms of action, and its elicitors are far from being completely understood. A key to sleep function is to determine how and when sleep is induced. The aim of this review is to merge the classical concepts of central sleep regulation by the brainstem and hypothalamus with the recent findings on decentral sleep regulation in local neuronal assemblies and sleep regulatory substances that create a scenario in which sleep is both local and use dependent. The interface between these concepts is provided by thalamic cellular and network mechanisms that support rhythmogenesis of sleep-related activity. The brainstem and the hypothalamus centrally set the pace for sleep-related activity throughout the brain. Decentral regulation of the sleep-wake cycle was shown in the cortex, and the homeostat of non-rapid-eye-movement sleep is made up by molecular networks of sleep regulatory substances, allowing individual neurons or small neuronal assemblies to enter sleep-like states. Thalamic neurons provide state-dependent gating of sensory information via their ability to produce different patterns of electrogenic activity during wakefulness and sleep. Many mechanisms of sleep homeostasis or sleep-like states of neuronal assemblies, e.g. by the action of adenosine, can also be found in thalamic neurons, and we summarize cellular and network mechanisms of the thalamus that may elicit non-REM sleep. It is argued that both central and decentral regulators ultimately target the thalamus to induce global sleep-related oscillatory activity. We propose that future studies should integrate ideas of central, decentral, and thalamic sleep generation. PMID:21912835

  18. The Potential Association between Obstructive Sleep Apnea and Diabetic Retinopathy in Severe Obesity—The Role of Hypoxemia

    PubMed Central

    Banerjee, Dev; Leong, Wen Bun; Arora, Teresa; Nolen, Melissa; Punamiya, Vikas; Grunstein, Ron; Taheri, Shahrad

    2013-01-01

    Background Obstructive sleep apnea (OSA) is common in obese patients with type 2 diabetes mellitus (DM) and may contribute to diabetic microvascular complications. Methods To investigate the association between OSA, hypoxemia during sleep, and diabetic retinal complications in severe obesity. This was a prospective observational study of 93 obese patients mean (SD) age: 52(10) years; mean (SD) body mass index (BMI): 47.3(8.3) kg/m2) with DM undergoing retinal screening and respiratory monitoring during sleep. OSA was defined as apnea-hypopnea index (AHI) of ?15 events/hour, resulting in two groups (OSA+ vs. OSA?). Results Forty-six patients were OSA+: median (95% CI) AHI?=?37(23–74)/hour and 47 were OSA–ve (AHI?=?7(4–11)/hour). Both groups were similar for ethnicity, BMI, cardiovascular co-morbidities, diabetes duration, HbA1c, and insulin treatment (p>0.05). The OSA+ group was significantly more hypoxemic. There was no significant difference between OSA+ and OSA? groups for the presence of retinopathy (39% vs. 38%). More OSA+ subjects had maculopathy (22% vs. 13%), but this did not reach statistical significance. Logistic regression analyses showed that AHI was not significantly associated with the presence of retinopathy or maculopathy (p>0.05). Whilst minimum oxygen saturation was not significantly associated with retinopathy, it was an independent predictor for the presence of maculopathy OR?=?0.79 (95% CI: 0.65–0.95; p<0.05), after adjustment. Conclusions The presence of OSA, as determined by AHI, was not associated with diabetic retinal complications. In contrast, severity of hypoxemia during sleep (minimum oxygen saturations) may be an important factor. The importance of hypoxia in the development of retinal complications in patients with OSA remains unclear and further studies assessing the pathogenesis of hypoxemia in patients with OSA and diabetic retinal disease are warranted. PMID:24260240

  19. Cues to Starting CPAP in Obstructive Sleep Apnea: Development and Validation of the Cues to CPAP Use Questionnaire

    PubMed Central

    Olsen, Sara; Smith, Simon; Oei, Tian P.S.; Douglas, James

    2010-01-01

    Background: The reasons that a patient has to start treatment, their “Cues to Action,” are important for determining subsequent health behaviors. Cues to action are an explicit component of the Health Belief Model of continuous positive airway pressure (CPAP) acceptance. At present, there is no scale available to measure this construct for individuals with obstructive sleep apnea (OSA). This paper aims to develop, validate, and describe responding patterns within a sample of patients with OSA to the Cues to CPAP Use Questionnaire (CCUQ). Method: Participants were 63 adult patients diagnosed with OSA who had never tried CPAP when initially recruited. The CCUQ was completed at 1 month after being prescribed CPAP. Results: Exploratory factor analysis (EFA) showed a 3-factor structure of the 9-item CCUQ, with “Health Cues,” “Partner Cues,” and “Health Professional Cues” subscales accounting for 59.91% of the total variance. The CCUQ demonstrated modest internal consistency and split-half reliability. The questionnaire is brief and user friendly, with readability at a seventh-grade level. The most frequently endorsed cues for starting CPAP were Health Professional Cues (prompting by the sleep physician) and Health Cues such as tiredness and concern about health outcomes. Conclusions: This study validates a measure of an important motivational component of the Health Belief Model. Health Professional Cues and internal Health Cues were reported to be the most important prompts to commence CPAP by this patient sample. Citation: Olsen S; Smith S; Oei TPS; Douglas J. Cues to starting CPAP in obstructive sleep apnea: development and validation of the cues to CPAP use questionnaire. J Clin Sleep Med 2010;6(3):229-237. PMID:20572415

  20. [Awake insertion of i-gel under dexmedetomidine sedation in a patient with severe obstructive sleep apnea syndrome].

    PubMed

    Matsunami, Sayuri; Komasawa, Nobuyasu; Kuzukawa, Yosuke; Fujitate, Yasutaka; Minami, Toshiaki

    2014-07-01

    We report a successful awake insertion of the i-gel supraglottic airway device under dexmedetomidine (DEX) sedation in a patient with severe obstructive sleep apnea syndrome and symptomatic angina. A 71-year-old man was scheduled for open stoma closure under general anesthesia. Given the patient's history of difficult mask ventilation during anesthesia for resection of rectal cancer, we decided to perform awake i-gel insertion under DEX sedation and regional anesthesia with lidocaine. The i-gel was inserted successfully with no vital sign change or vomiting. We also performed transversus abdominis plane block and rectus sheath block with ropivacaine, as severe respiratory suppression due to continuous intravenous fentanyl infusion had been observed in the previous operation. No vital sign change or respiratory suppression was noted upon recovery from general anesthesia. Awake insertion of a supraglottic airway device, such as i-gel, under DEX sedation can be effective for airway management in patients with severe obstructive sleep apnea syndrome. PMID:25098143

  1. Pulmonary hypertension in obstructive sleep apnea: is it clinically significant? A critical analysis of the association and pathophysiology

    PubMed Central

    Fares, Wassim H.; Mohsenin, Vahid

    2015-01-01

    Abstract The development of pulmonary hypertension is a poor prognostic sign in patients with obstructive sleep apnea (OSA) and affects both mortality and quality of life. Although pulmonary hypertension in OSA is traditionally viewed as a result of apneas and intermittent hypoxia during sleep, recent studies indicate that neither of these factors correlates very well with pulmonary artery pressure. Human data show that pulmonary hypertension in the setting of OSA is, in large part, due to left heart dysfunction with either preserved or diminished ejection fraction. Longstanding increased left heart filling pressures eventually lead to pulmonary venous hypertension. The combination of hypoxic pulmonary vasoconstriction and pulmonary venous hypertension with abnormal production of mediators will result in vascular cell proliferation and aberrant vascular remodeling leading to pulmonary hypertension. These changes are in many ways similar to those seen in other forms of pulmonary hypertension and suggest shared mechanisms. The majority of patients with OSA do not receive a diagnosis and are undertreated. Appreciating the high prevalence and understanding the mechanisms of pulmonary hypertension in OSA would lead to better recognition and management of the condition. PMID:26064448

  2. Obstructive Sleep Apnea Syndrome (OSAS), Metabolic Syndrome and Mental Health in Small Enterprise Workers. Feasibility of an Action for Health

    PubMed Central

    Garbarino, Sergio; Magnavita, Nicola

    2014-01-01

    Objective To determine the frequency of obstructive sleep apnea syndrome (OSAS), metabolic syndrome and common mental disorders in the working population of 11 small enterprises and the feasibility of a program of action for health. Method The clinical risk of OSAS, the prevalence of metabolic syndrome, and the level of psychological disorders were assessed during routine medical examination at the workplace in 2012. The response to medical advice was assessed in 2013. Results 12.3% of the workers were suspected of being affected by OSAS. One or more components of metabolic syndrome were present in 24.5% of cases. OSAS in “healthy” workers was significantly associated with the presence of one or more components of metabolic syndrome (OR?=?3.83; 95%CI 1.45–10.13) and with a psychological disorders score in the highest quartile (OR?=?4.67; 95%CI?=?1.72–12.64). Workers with suspected OSAS were reluctant to follow advice about undergoing further tests under the NHS. However, in some cases, confirmation of the OSAS diagnosis and subsequent treatment led to an improvement in metabolic condition. Conclusion Although participation in treatment was limited, anecdotal cases support the idea that prevention of obstructive sleep apnea in the workplace might be useful for workers’ health. PMID:24810290

  3. The Incidence and Prevalence of Temporomandibular Disorders and Posterior Open Bite in Patients Receiving Mandibular Advancement Device Therapy for Obstructive Sleep Apnea

    Microsoft Academic Search

    Cristina V. Perez; Reny deLeeuw; Jeffrey P. Okeson; Charles R. Carlson; Hsin-Fang Li; Heather M. Bush; Donald Falace

    2012-01-01

    Purpose This study aims to evaluate the incidence and prevalence of temporomandibular disorders (TMD) in patients receiving a mandibular advancement device (MAD) to treat obstructive sleep apnea using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC\\/TMD). In addition, it also aims to assess the development of posterior open bite (POB). Materials and methods Data from 167 patients were evaluated at

  4. Central sleep apnoea—a clinical review

    PubMed Central

    2015-01-01

    Central sleep apnoea (CSA) is characterised by recurrent apnoeas during sleep with no associated respiratory effort. It mostly results from withdrawal of the wakefulness drive in sleep leaving ventilation under metabolic control. A detailed physiological understanding of the control of breathing in wakefulness and sleep is essential to the understanding of CSA. It encompasses a diverse group of conditions with differing aetiologies and pathophysiology. Likewise treatment varies according to underlying aetiology. Some of the conditions such as idiopathic (primary) CSA (ICSA) are relatively rare and benign. On the other hand Cheyne-Stokes breathing (CSB) pattern is quite common in patients with heart failure and might be a prognostic indicator of poor outcome. Unfortunately modern medical management of heart failure does not seem to have significantly reduced the prevalence of CSA in this group. Since the adoption of positive airway pressure (PAP) as a common treatment modality of obstructive sleep apnoea (OSA), complex CSA has been increasingly observed either as treatment emergent or persistent CSA. Depending on the particular condition, various treatment strategies have been tried in the past two decades which have included hypnotic therapy, respiratory stimulants, judicious administration of carbon dioxide, oxygen therapy, PAP and bi-level ventilatory support with a backup rate. In the past decade adaptive servo ventilation (ASV) has been introduced with much promise. Various studies have shown its superiority over other treatment modalities. Ongoing long term studies will hopefully shed more light on its impact on cardiovascular morbidity and mortality. Other rare forms are still poorly understood and treatments remain suboptimal.

  5. Central sleep apnoea-a clinical review.

    PubMed

    Muza, Rexford T

    2015-05-01

    Central sleep apnoea (CSA) is characterised by recurrent apnoeas during sleep with no associated respiratory effort. It mostly results from withdrawal of the wakefulness drive in sleep leaving ventilation under metabolic control. A detailed physiological understanding of the control of breathing in wakefulness and sleep is essential to the understanding of CSA. It encompasses a diverse group of conditions with differing aetiologies and pathophysiology. Likewise treatment varies according to underlying aetiology. Some of the conditions such as idiopathic (primary) CSA (ICSA) are relatively rare and benign. On the other hand Cheyne-Stokes breathing (CSB) pattern is quite common in patients with heart failure and might be a prognostic indicator of poor outcome. Unfortunately modern medical management of heart failure does not seem to have significantly reduced the prevalence of CSA in this group. Since the adoption of positive airway pressure (PAP) as a common treatment modality of obstructive sleep apnoea (OSA), complex CSA has been increasingly observed either as treatment emergent or persistent CSA. Depending on the particular condition, various treatment strategies have been tried in the past two decades which have included hypnotic therapy, respiratory stimulants, judicious administration of carbon dioxide, oxygen therapy, PAP and bi-level ventilatory support with a backup rate. In the past decade adaptive servo ventilation (ASV) has been introduced with much promise. Various studies have shown its superiority over other treatment modalities. Ongoing long term studies will hopefully shed more light on its impact on cardiovascular morbidity and mortality. Other rare forms are still poorly understood and treatments remain suboptimal. PMID:26101651

  6. Polysomnographic predictors of persistent continuous positive airway pressure adherence in patients with moderate and severe obstructive sleep apnea.

    PubMed

    Chen, Yung-Fu; Hang, Liang-Wen; Huang, Chun-Sen; Liang, Shinn-Jye; Chung, Wei-Sheng

    2015-02-01

    Extensive use of continuous positive airway pressure (CPAP) has positive clinical benefits for most patients with obstructive sleep apnea (OSA). However, patient adherence is a major limiting factor to the effectiveness of CPAP treatment. This study determined the potential and quantifiable factors affecting the willingness of patients with OSA to undertake CPAP treatment by comparing the polysomnographic parameters recorded during diagnosis and titration. Patients with moderate and severe OSA who attended diagnostic polysomnography (PSG) and CPAP titration at the sleep center of China Medical University Hospital (CMUH) were included in the study. A total of 312 patients were divided into persistent users and nonusers of CPAP according to their use of in-home CPAP following titration and a 7-day CPAP trial. Multivariate logistic regression analyses were used to define the potential polysomnographic predictors of persistent CPAP adherence, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Most patients were men older than 50 years who were overweight or obese. Among the patients, 146 (46.8%) became persistent CPAP users. A 10% improvement of oxygen desaturation index (ODI) and a 10% increment in deep sleep percentage increased the chance of persistent CPAP use 1.18-fold and 1.07-fold, respectively. In addition, the improved ODI and deep sleep during CPAP titration increased the chance of persistent CPAP user. The polysomnographic parameters obtained from diagnosis and during titration can facilitate the prediction of persistent CPAP use. PMID:25645986

  7. Efficacy of Home Single-Channel Nasal Pressure for Recommending Continuous Positive Airway Pressure Treatment in Sleep Apnea

    PubMed Central

    Masa, Juan F.; Duran-Cantolla, Joaquin; Capote, Francisco; Cabello, Marta; Abad, Jorge; Garcia-Rio, Francisco; Ferrer, Antoni; Fortuna, Ana M.; Gonzalez-Mangado, Nicolas; de la Peña, Monica; Aizpuru, Felipe; Barbe, Ferran; Montserrat, Jose M.; Larrateguy, Luis D.; de Castro, Jorge Rey; Garcia-Ledesma, Estefania; Corral, Jaime; Martin-Vicente, Maria J.; Martinez-Null, Cristina; Egea, Carlos; Cancelo, Laura; García-Díaz, Emilio; Carmona-Bernal, Carmen; Sánchez-Armengol, Ángeles; Mayos, Merche; Miralda, Rosa M; Troncoso, Maria F.; Gonzalez, Monica; Martinez-Martinez, Marian; Cantalejo, Olga; Piérola, Javier; Vigil, Laura; Embid, Cristina; del Mar Centelles, Mireia; Prieto, Teresa Ramírez; Rojo, Blas; Lores, Vanesa

    2015-01-01

    Introduction: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored. Objectives: To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables. Methods: Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points. Results: Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP. Conclusion: Automatic home single-channel nasal pressure scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary. Clinical Trials Information: Clinicaltrial.gov identifier: NCT01347398. Citation: Masa JF, Duran-Cantolla J, Capote F, Cabello M, Abad J, Garcia-Rio F, Ferrer A, Fortuna AM, Gonzalez-Mangado N, de la Peña M, Aizpuru F, Barbe F, Montserrat JM, Spanish Sleep Network. Efficacy of home single-channel nasal pressure for recommending continuous positive airway pressure treatment in sleep apnea. SLEEP 2015;38(1):13–21. PMID:25325508

  8. Erectile Dysfunction in Patients with Sleep Apnea – A Nationwide Population-Based Study

    PubMed Central

    Su, Yu-Chung; Yang, Chih-Jen; Wu, Meng-Ni; Hsu, Chung-Yao; Hwang, Shang-Jyh; Chong, Inn-Wen; Huang, Ming-Shyan

    2015-01-01

    Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients. PMID:26177206

  9. Parasomnias and sleep disordered breathing in Caucasian and Hispanic children – the Tucson children's assessment of sleep apnea study

    Microsoft Academic Search

    James L Goodwin; Kris L Kaemingk; Ralph F Fregosi; Gerald M Rosen; Wayne J Morgan; Terry Smith; Stuart F Quan

    2004-01-01

    BACKGROUND: Recent studies in children have demonstrated that frequent occurrence of parasomnias is related to increased sleep disruption, mental disorders, physical harm, sleep disordered breathing, and parental duress. Although there have been several cross-sectional and clinical studies of parasomnias in children, there have been no large, population-based studies using full polysomnography to examine the association between parasomnias and sleep disordered

  10. Sleeping Problems

    MedlinePLUS

    ... the legs at night. These are symptoms of restless leg syndrome. Jerking or kicking the legs during sleep. These ... treatments for sleep disorders like sleep apnea and restless leg syndrome. * Link Disclaimer: Links to information and Web sites ...

  11. Altered in vitro Endothelial Repair and Monocyte Migration in Obstructive Sleep Apnea: Implication of VEGF and CRP

    PubMed Central

    Briançon-Marjollet, Anne; Henri, Marion; Pépin, Jean-Louis; Lemarié, Emeline; Lévy, Patrick; Tamisier, Renaud

    2014-01-01

    Study Objectives: Although obstructive sleep apnea (OSA) causes cardiovascular morbidities through atherosclerosis induced by inflammation and endothelial dysfunction, OSA patients exhibit elevated plasma vascular endothelial growth factor (VEGF), which may represent an adaptive response to intermittent hypoxia. The aims of this study were to investigate whether in vitro endothelial wound healing and monocyte migration are affected by patient serum, and to determine the implication of circulating factors (VEGF and C-reactive protein). Patients: Serum was collected from healthy controls (HC), “healthy” OSA, and metabolic syndrome (MS) patients with or without OSA. Measurements and Results: Along with the presence of OSA and/or MS, both VEGF and hsCRP were significantly elevated in patient serum. Their specific role was tested with blocking antibodies on primary endothelial cells for wound healing assay and on human monocytes for migration assay. Endothelial wound healing was reduced with OSA compared to HC serum, and even more significantly using MS+OSA patient serum. Altered wound healing with OSA serum was unmasked when blocking VEGF and restored when blocking CRP. Monocyte migration was activated with OSA serum, and further enhanced by MS+OSA patient serum. Blocking CRP in serum inhibited this migration. Conclusions: Serum from OSA patient alters in vitro endothelial cell repair function and activates monocyte migration; this is further aggravated with the presence of metabolic syndrome. These effects are partly driven by VEGF and CRP, suggesting an unfavorable balance between the pro healing (VEGF) and pro injury (CRP) factors that may promote vascular injury in OSA with and without metabolic syndrome. Citation: Briançon-Marjollet A, Henri M, Pépin JL, Lemarié E, Lévy P, Tamisier R. Altered in vitro endothelial repair and monocyte migration in obstructive sleep apnea: implication of VEGF and CRP. SLEEP 2014;37(11):1825-1832. PMID:25364078

  12. Correlation between the intima-media thickness and Framingham risk score in patients with sleep apnea syndrome

    PubMed Central

    Conkbay?r, I??k; Kuru, Asl?han; F?rat, Hikmet; Sökücü, Sinem Nedime; Dalar, Levent; Ergün, Recai; Uzunmehmeto?lu, Ça?la P?nar; Ergün, Dilek; Ard?c, Sad?k

    2013-01-01

    Background In the present study, we want to demonstrate the correlation between obstructive sleep apnea syndrome (OSAS) whose independent effect on carotid artery intima-media thickness (IMT) was demonstrated, with Framingham risk score (FRS) showing the overall cardiovascular risk. Methods IMT of the carotid artery was measured with ultrasonography and 10-year risk of coronary heart disease (CHD) was defined with FRS in 90 consecutive patients referred to our sleep clinic and who underwent polysomnography (PSG), with vascular risk factors and without a clinical atherosclerotic disease. Results IMT and FRS were found to be statistically significantly increased in the severe OSAS group compared to the other two groups. Carotid IMT was found to be significantly positively correlated with, apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and time duration with oxygen saturation (SpO2) <90%, and negatively correlated with minimum oxygen saturation at sleep (minimum SpO2) and mean SpO2. In control and mild OSAS group IMT and FRS have significantly positive correlation (r: 0.501, P: 0.027; r: 0.625, P<0.001), while in severe OSAS group no significant correlation was detected between IMT and FRS (r: 0.321, P: 0.06). In the regression analysis AHI and ODI were found to be an independent predictor of carotid IMT. ODI was found to have an independent effect on the progression of atherosclerosis. Conclusions Increased carotid IMT in severe OSAS group could not be explained with the classical risk factors. In this respect, FRS might be insufficient to determine correctly the cardiovascular risk and protection strategies against the disease in OSAS patients. PMID:24409351

  13. MafB deficiency causes defective respiratory rhythmogenesis and fatal central apnea at birth

    Microsoft Academic Search

    Bruno Blanchi; Louise M Kelly; Jean-Charles Viemari; Isabelle Lafon; Henri Burnet; Michelle Bévengut; Silke Tillmanns; Laurent Daniel; Thomas Graf; Gerard Hilaire; Michael H Sieweke

    2003-01-01

    The genetic basis for the development of brainstem neurons that generate respiratory rhythm is unknown. Here we show that mice deficient for the transcription factor MafB die from central apnea at birth and are defective for respiratory rhythmogenesis in vitro. MafB is expressed in a subpopulation of neurons in the preBötzinger complex (preBötC), a putative principal site of rhythmogenesis. Brainstems

  14. An observational cohort study of the effects of septoplasty with or without inferior turbinate reduction in patients with obstructive sleep apnea

    PubMed Central

    2014-01-01

    Background The objective of this observational study was to evaluate the outcomes of intranasal surgery in patients with obstructive sleep apnea (OSA) in a single institution in Norway. Methods Fifty-nine patients with OSA and clinically significant nasal obstruction underwent either septoplasty alone or septoplasty with concomitant volume reduction of the turbinates from August 2008 until the end of December 2010. Subjects were scheduled for sleep polygraphy before and 3 months after treatment. In this observational single-centre cohort study we evaluated and compared the effect of these two specific surgical procedures on sleep related parameters. Results There was a significant reduction in the apnea-hypopnea index (AHI) only in the group that had septoplasty with turbinate reduction (17.4, (SD 14.4) – 11.7, (SD 8.2), p <0.01), and this effect was significantly better than in the group treated with septoplasty alone. Other objective parameters remained unchanged. Subjective assessments obtained with a postoperative questionnaire showed an equally positive effect on diurnal sleepiness and nasal obstruction in both groups, and a better effect on sleep quality in the combined treatment group. Conclusion The effect of nasal surgery on obstructive sleep apnea seemed to be greater when there were indications for combined surgery of the inferior turbinates and the nasal septum, compared to when there were indications for septoplasty alone. PMID:25352767

  15. A Comparison of Personality Characteristics and Psychiatric Symptomatology between Upper Airway Resistance Syndrome and Obstructive Sleep Apnea Syndrome

    PubMed Central

    So, Soo-Jung; Kang, Seung-Gul; Cho, Chul-Hyun; Yoon, Ho-Kyoung; Kim, Leen

    2015-01-01

    Objective To investigate the personality characteristics of patients with upper airway resistance syndrome (UARS) and those of patients with obstructive sleep apnea syndrome (OSAS). Methods Eighty-eight patients with UARS and 365 patients with OSAS participated. All patients had a diagnostic full-night attended polysomnography (PSG) and completed the Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Symptom Checklist-90-Revision (SCL-90-R) and Eysenck Personality Questionnaire (EPQ). Results The UARS group scored significantly higher than the OSAS group on the ESS, AIS, and PSQI (p<0.001). The scores of all SCL-90-R subscales in the UARS group were significantly higher than those in the OSA group (all p<0.001, except for somatization, p=0.016). Patients with UARS scored lower on EPQ-E (extroversion/introversion) (p=0.006) and EPQ-L (lie) (p<0.001) than those with OSA. UARS patients also showed higher scores on EPQ-P (psychoticism) (p=0.002) and EPQ-N (neuroticism) (p<0.001) than OSAS patients. Conclusion Our results suggest that patients with UARS have worse subjective sleep quality than OSAS patients in spite of their better PSG findings. UARS patients tend to have more neurotic and sensitive personalities than patients with OSAS, which may be a cause of the clinical features of UARS. PMID:25866518

  16. Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea.

    PubMed

    Bilston, Lynne E; Gandevia, Simon C

    2014-02-01

    The upper airway is a complex, multifunctional, dynamic neuromechanical system. Its patency during breathing requires moment-to-moment coordination of neural and mechanical behavior and varies with posture. Failure to continuously recruit and coordinate dilator muscles to counterbalance the forces that act to close the airway results in hypopneas or apneas. Repeated failures lead to obstructive sleep apnea (OSA). Obesity and anatomical variations, such as retrognathia, increase the likelihood of upper airway collapse by altering the passive mechanical behavior of the upper airway. This behavior depends on the mechanical properties of each upper airway tissue in isolation, their geometrical arrangements, and their physiological interactions. Recent measurements of respiratory-related deformation of the airway wall have shown that there are different patterns of airway soft tissue movement during the respiratory cycle. In OSA patients, airway dilation appears less coordinated compared with that in healthy subjects (matched for body mass index). Intrinsic mechanical properties of airway tissues are altered in OSA patients, but the factors underlying these changes have yet to be elucidated. How neural drive to the airway dilators relates to the biomechanical behavior of the upper airway (movement and stiffness) is still poorly understood. Recent studies have highlighted that the biomechanical behavior of the upper airway cannot be simply predicted from electromyographic activity (electromyogram) of its muscles. PMID:23823151

  17. Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers.

    PubMed Central

    Sériès, F; Côté, C; Simoneau, J A; Gélinas, Y; St Pierre, S; Leclerc, J; Ferland, R; Marc, I

    1995-01-01

    Upper airway dilator muscles play an important role in the pathophysiology of sleep apnea hypopnea syndrome (SAHS). The mechanical and structural characteristics of these muscles remain unknown. The aim of this study was to compare the physiologic, metabolic, and fiber type characteristics of one upper airway dilator muscle (musculus uvulae, MU) in 11 SAHS and in seven nonapneic snorers. The different analyses were done on MU obtained during uvulo-palato-pharyngoplasty. Snorers and SAHS differed only in their apnea + hypopnea indices (11.5 +/- 5.9 and 34.2 +/- 14.6/h, respectively, mean +/- SD). Absolute twitch and tetanic tension production of MU was significantly greater in SAHS than in snorers while the fatigability index was similar in the two groups. Protein content and anaerobic enzyme activities of MU were significantly greater in SAHS than in snorers; no difference was observed for aerobic enzyme activities. The total muscle fiber cross-sectional area of MU was significantly higher in SAHS (2.2 +/- 0.9 mm2) than in snorers (1.1 +/- 0.7 mm2). The surface occupied by type IIA muscle fibers of MU was larger in SAHS (2.00 +/- 0.96) than in snorers (0.84 +/- 0.63 mm2). We conclude that the capacity for tension production and the anaerobic metabolic activity of MU are greater in SAHS than in snorers. PMID:7814616

  18. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint.

    PubMed

    Engleman, Heather M; McDonald, James P; Graham, David; Lello, Glenn E; Kingshott, Ruth N; Coleman, Emma L; Mackay, Thomas W; Douglas, Neil J

    2002-09-15

    Mandibular repositioning splints (MRSs) and continuous positive airway pressure (CPAP) are used to treat the sleep apnea/hypopnea syndrome (SAHS). There are some data suggesting that patients with milder symptoms prefer MRS, but there are few comparative data on outcomes. Therefore, we performed a randomized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new outpatients diagnosed with SAHS (apnea/hypopnea index [AHI] >or= 5/hour, and >or= 2 symptoms including sleepiness). Assessments at the end of both limbs comprised home sleep study, subjective ratings of treatment value, sleepiness, symptoms, and well-being, and objective tests of sleepiness and cognition. Forty-eight of 51 recruited patients completed the trial (12 women; age [mean +/- SD], 46 +/- 9 years; Epworth 14 +/- 4; median AHI, 22/hour; interquartile ratio [IQR], 11-43/hour). Significant (p

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

    E-print Network

    Lagrée, Pierre-Yves

    2007 Nova Science Publishers, Inc. Chapter 2 WHEN A FLUID-STRUCTURE INTERACTION KEEPS YOU AWAKE Syndrome is known to be related with a partial (hypopnea) or to- tal (apnea) collapse of the upper airway. The patency of the upper airway is dictated by a combination of passive mechanical properties and active

  20. Insomnia and sleep apnea in midlife women: prevalence and consequences to health and functioning

    PubMed Central

    Kline, Christopher E.; Nowakowski, Sara

    2015-01-01

    Sleep disturbance is common during the menopausal transition, with numerous downstream consequences to health and functioning, including reduced quality of life, impaired mental health, and increased physical health morbidity. Insomnia affects approximately 50% of midlife women and is characterized by nocturnal symptoms of difficulties initiating or maintaining sleep (or both) and daytime symptoms that impair occupational, social, or other components of functioning. In addition, approximately 20% of midlife women develop sleep-disordered breathing during the menopausal transition. This commentary summarizes the prevalence, risk factors, and treatment options for each of these sleep disorders in midlife women, with specific focus on first-line treatments for insomnia (cognitive behavioral therapy for insomnia) and sleep-disordered breathing (continuous positive airway pressure) and unique considerations for treating sleep disorders in midlife women. Future directions are also discussed.

  1. Insomnia and sleep apnea in midlife women: prevalence and consequences to health and functioning.

    PubMed

    Hall, Martica H; Kline, Christopher E; Nowakowski, Sara

    2015-01-01

    Sleep disturbance is common during the menopausal transition, with numerous downstream consequences to health and functioning, including reduced quality of life, impaired mental health, and increased physical health morbidity. Insomnia affects approximately 50% of midlife women and is characterized by nocturnal symptoms of difficulties initiating or maintaining sleep (or both) and daytime symptoms that impair occupational, social, or other components of functioning. In addition, approximately 20% of midlife women develop sleep-disordered breathing during the menopausal transition. This commentary summarizes the prevalence, risk factors, and treatment options for each of these sleep disorders in midlife women, with specific focus on first-line treatments for insomnia (cognitive behavioral therapy for insomnia) and sleep-disordered breathing (continuous positive airway pressure) and unique considerations for treating sleep disorders in midlife women. Future directions are also discussed. PMID:26097736

  2. DELIRIUM: IS SLEEP IMPORTANT?

    PubMed Central

    Watson, Paula L.; Ceriana, Piero; Fanfulla, Francesco

    2012-01-01

    Delirium and poor sleep quality are common and often co-exist in hospitalized patients. A link between these disorders has been hypothesized but whether this link is a cause and effect relationship or simply an association resulting from shared mechanisms is yet to be determined. Potential shared mechanisms include: abnormalities of neurotransmitters, tissue ischemia, inflammation, and sedative exposure. Sedatives, while decreasing sleep latency, often cause a decrease in slow wave sleep and stage REM sleep and therefore may not provide the same restorative properties as natural sleep. Mechanical ventilation, an important cause of sleep disruption in ICU patients, may lead to sleep disruption not only from the discomfort of the endotracheal tube but also as a result of ineffective respiratory efforts and by inducing central apnea events if not properly adjusted for the patient’s physiologic needs. When possible, efforts should be made to optimize the patient-ventilator interaction to minimize sleep disruptions. PMID:23040286

  3. Long-term effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea.

    PubMed

    Fren?, ?tefan M; Tudorache, Voicu M; Ardelean, Carmen; Mih?icu??, Stefan

    2014-01-01

    Obstructive sleep apnea (OSA) is often linked to high blood pressure and has a particularly high prevalence in patients with resistant hypertension. The effect of continuous positive airway pressure (CPAP) therapy on blood pressure (BP) values has been evaluated in several short-term clinical trials with conflicting results. Our aim was to investigate the role of long-term CPAP treatment in achieving BP control in patients who associate OSA and resistant hypertension. We have included in the study 33 patients with resistant hypertension, diagnosed with OSA in our sleep lab. Data was collected initially and after a mean follow-up period of 4 years. Patients were divided into 2 groups according to the use of CPAP therapy. Patients under CPAP therapy (n = 12) exhibited a higher reduction in both systolic and diastolic pressure and BP control was achieved in 75% of cases, while patients without CPAP treatment (n = 21) remained with refractory hypertension in proportion of 90.5%. A de-escalation of antihypertensive drug regimen by discontinuation of 1 or more drugs was observed in 41.6% (n = 5) of patients from CPAP group and in the other 33.4% (n = 4) the medication remained unchanged, but BP control was reached. Using a direct logistic regression model for examining the impact of different confounders on the probability of diagnosis of resistant hypertension at follow-up, the only statistically significant predictor found was the lack of CPAP usage. PMID:25665364

  4. Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

    PubMed Central

    Pliska, Benjamin T.; Nam, Hyejin; Chen, Hui; Lowe, Alan A.; Almeida, Fernanda R.

    2014-01-01

    Study Objectives: To evaluate the magnitude and progression of dental changes associated with long-term mandibular advancement splint (MAS) treatment of obstructive sleep apnea (OSA). Methods: Retrospective study of adults treated for primary snoring or mild to severe OSA with MAS for a minimum of 8 years. The series of dental casts of patients were analyzed with a digital caliper for changes in overbite, overjet, dental arch crowding and width, and inter-arch relationships. The progression of these changes over time was determined and initial patient and dental characteristics were evaluated as predictors of the observed dental side effects of treatment. Results: A total of 77 patients (average age at start of treatment: 47.5 ± 10.2 years, 62 males) were included in this study. The average treatment length was 11.1 ± 2.8 years. Over the total treatment interval evaluated there was a significant (p < 0.001) reduction in the overbite (2.3 ± 1.6 mm), overjet (1.9 ± 1.9 mm), and mandibular crowding (1.3 ± 1.8 mm). A corresponding significant (p < 0.001) increase of mandibular intercanine (0.7 ± 1.5 mm) and intermolar (1.1 ± 1.4 mm) width as well as incidence of anterior crossbite and posterior open bite was observed. Overbite and mandibular intermolar distance were observed to decrease less with time, while overjet, mandibular intercanine distance, and lower arch crowding all decreased continuously at a constant rate. Conclusions: After an average observation period of over 11 years, clinically significant changes in occlusion were observed and were progressive in nature. Rather than reaching a discernible end-point, the dental side effects of MAS therapy continue with ongoing MAS use. Commentary: A commentary on this article appears in this issue on page 1293. Citation: Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10(12):1285-1291. PMID:25325593

  5. Pilot Randomized Trial of the Effect of Wireless Telemonitoring on Compliance and Treatment Efficacy in Obstructive Sleep Apnea

    PubMed Central

    Palau, Joe J; Marler, Matthew R; Gifford, Allen L

    2007-01-01

    Background Obstructive sleep apnea (OSA) is a prevalent and serious medical condition characterized by repeated complete or partial obstructions of the upper airway during sleep and is prevalent in 2% to 4% of working middle-aged adults. Nasal continuous positive airway pressure (CPAP) is the gold-standard treatment for OSA. Because compliance rates with CPAP therapy are disappointingly low, effective interventions are needed to improve CPAP compliance among patients diagnosed with OSA. Objective The aim was to determine whether wireless telemonitoring of CPAP compliance and efficacy data, compared to usual clinical care, results in higher CPAP compliance and improved OSA outcomes. Methods 45 patients newly diagnosed with OSA were randomized to either telemonitored clinical care or usual clinical care and were followed for their first 2 months of treatment with CPAP therapy. CPAP therapists were not blinded to the participants’ treatment group. Results 20 participants in each group received the designated intervention. Patients randomized to telemonitored clinical care used CPAP an average of 4.1 ± 1.8 hours per night, while the usual clinical care patients averaged 2.8 ± 2.2 hours per night (P = .07). Telemonitored patients used CPAP on 78% ± 22% of the possible nights, while usual care patients used CPAP on 60% ± 32% of the nights (P = .07). No statistically significant differences between the groups were found on measures of CPAP efficacy, including measures of mask leak and the Apnea-Hypopnea Index. Patients in the telemonitored group rated their likelihood to continue using CPAP significantly higher than the patients in the usual care group. Patients in both groups were highly satisfied with the care they received and rated themselves as “not concerned” that their CPAP data were being wirelessly monitored. Conclusions Telemonitoring of CPAP compliance and efficacy data and rapid use of those data by the clinical sleep team to guide the collaborative (ie, patient and provider) management of CPAP treatment is as effective as usual care in improving compliance rates and outcomes in new CPAP users. This study was designed as a pilot—larger, well-powered studies are necessary to fully evaluate the clinical and economic efficacy of telemonitoring for this population. PMID:17513285

  6. A classification algorithm based on spectral features from nocturnal oximetry and support vector machines to assist in the diagnosis of obstructive sleep apnea

    Microsoft Academic Search

    J. Víctor Marcos; Roberto Hornero; Daniel Álvarez; Félix Del Campo; Carlos Zamarrón

    2009-01-01

    The aim of this study is to develop and evaluate an algorithm to help in the diagnosis of the obstructive sleep apnea syndrome (OSAS). Arterial oxygen saturation (SaO2) signals from nocturnal pulse oximetry were used to identify OSAS patients. A total of 149 SaO2 recordings from subjects suspected of OSAS were available. The initial population was divided into a training

  7. Bipolar radiofrequency treatment for snoring with mild to moderate sleep apnea: a comparative study between the radiofrequency assisted uvulopalatoplasty technique and the channeling technique

    Microsoft Academic Search

    Ahmed Bassiouny; Ahmed El Salamawy; Mohamed Abd El-Tawab; Ahmed Atef

    2007-01-01

    We compared radiofrequency techniques used in the treatment of snoring and obstructive sleep apnea [radiofrequency assisted\\u000a uvulopalatoplasty (RAUP) and channeling] as regard the efficacy and morbidity. A pilot, prospective randomized single blinded\\u000a study was conducted on 40 patients in the ENT Department, Kasr Al-Aini Hospital, Cairo University during the period from April\\u000a to December 2003. Patients were randomized into two groups

  8. Lipid peroxides, superoxide dismutase and circulating IL8 and GCP2 in patients with severe obstructive sleep apnea: a pilot study

    Microsoft Academic Search

    Mohammed A. Alzoghaibi; Ahmed S. O. BaHammam

    2005-01-01

    Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality and many other physiological and immunological\\u000a disorders. An increase in hypoxia due to OSA may cause generation of reactive oxygen species (ROS). ROS are toxic to biomembranes\\u000a and may lead to peroxidation of lipids. An increase in systemic biomarkers of inflammation and oxidative stress has been found\\u000a in patients

  9. The anatomic basis for the acquisition of speech and obstructive sleep apnea: Evidence from cephalometric analysis supports The Great Leap Forward Hypothesis

    Microsoft Academic Search

    Terence M. Davidson; Jacob Sedgh; Duyen Tran; Carl J. Stepnowsky

    2005-01-01

    Background and purposeWe previously postulated how evolutionary changes in man's upper respiratory tract to facilitate speech, a phenomenon Jared Diamond calls The Great Leap Forward, have predisposed man to obstructive sleep apnea (OSA) [Diamond J. The Third Chimpanzee: the evolution and future of the human animal. New York: HarperCollins Publishers; 1992. p. 21, 23, 32–54, 54–6; Davidson TM. The Great

  10. Association between the severity of obstructive sleep apnea and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol

    Microsoft Academic Search

    Yoshiyuki Kawano; Akira Tamura; Junichi Kadota

    The positive association between the ratio of serum low-density lipoprotein cholesterol (LDL-C) to serum high-density lipoprotein cholesterol (HDL-C) and cardiovascular events has recently been receiving much attention. However, the association between the severity of obstructive sleep apnea (OSA) and this ratio has not yet been investigated. Accordingly, we sought to clarify this association and the effect of continuous positive airway

  11. Correlation Between Otorhinolaryngologic Evaluation and Severity of Obstructive Sleep Apnea Syndrome in Snorers

    Microsoft Academic Search

    Alfred Dreher; Richard de la Chaux; Christine Klemens; Robert Werner; Fiona Baker; Gabriele Barthlen; Gerd Rasp

    2005-01-01

    Results: The mean±SD AHI of the patients was 19.7±21.5);52patientshadanAHIhigherthan10,which confirmed the diagnosis of OSAS. These patients tended to report the occurrence of apneas more frequently than patients with an AHI of 10 or lower. The average ranks (Mann-Whitney findings) of patients with AHIs higher than 10 vs those with AHIs of 10 or lower were 52 vs 50 for septal

  12. Utility of the pediatric sleep questionnaire and pulse oximetry as screening tools in pediatric patients with suspected obstructive sleep apnea syndrome.

    PubMed

    Peña-Zarza, Jose A; Osona-Rodriguez de Torres, Borja; Gil-Sanchez, Jose Antonio; Figuerola-Mulet, Joan

    2012-01-01

    Objective. To assess the screening tools in snoring patients. Material and Methods. A retrospective review of data was conducted from children between 2 and 15 years old who were referred on suspicion of obstructive sleep apnea-hypopnea (OSAH) between June 2008 and June 2011. We excluded patients with significant comorbidities. Pediatric Sleep Questionnaire (PSQ), physical exam (PE), and pulse-oximetry data were collected and correlated with the results of the nightly polygraph at home. Results. We selected 98 patients. The 22-item version of the PSQ had sensitivity of 96% and specificity of 36.8%. The overall value of the clinic predictor of OSAH (PSQ and PE together) exhibited an increased specificity 57.6% with 94.6% of sensitivity. The nocturnal home oximetry method used alone was very specific, 92.1%, but had a lower sensitivity, 77.1%. The set of clinical assessment tools used together with pulse-oximetry screening provided excellent specificity 98.1% and a positive predictive value 94.1% globally. The performance of this screening tool is related with the severity of OSAH and accuracy is better in moderate and severe cases. Conclusion. The combination of clinical assessment and pulse-oximetry screening can provide a sufficient diagnostic approach for pediatric patients with suspected OSAH at least in moderate and severe cases. PMID:23471006

  13. Anthropometric and craniofacial sexual dimorphism in obstructive sleep apnea patients: is there male-female phenotypical convergence?

    PubMed

    Perri, Rita A; Kairaitis, Kristina; Wheatley, John R; Amis, Terence C

    2015-02-01

    Obstructive sleep apnea (OSA) is more common in men than women. Body size is greater in males (sexual dimorphism), but large body habitus is associated with OSA for both genders. We speculated that male-female phenotypical convergence (reduced sexual dimorphism via identical phenotype acquisition) occurs with OSA and tested hypotheses: (1) phenotypical features pathogenic for OSA differ between OSA and healthy subjects irrespective of gender; and (2) such characteristics exhibit phenotypical convergence. Utilizing an existing database, we calculated male-female (group average) ratios for eight anthropometric and 33 surface cephalometric variables from 104 Caucasian OSA patients [72 males; apnea-hypopnea index (events h(-1) ): males: 42.3 ± 24.7 versus females: 42.6 ± 26.1 (P > 0.9)] and 85 Caucasian, healthy, non-OSA, community volunteers (36 males). Log-transformed data were analysed using a general linear model with post-hoc unpaired t-tests and significance at P < 0.0012 (Bonferroni multiple-comparison correction). OSA patients were older (56.9 ± 14.4 versus 38.0 ± 13.8 years), but there were no within-group gender-based age differences. All anthropometric variables (except height), plus cranial base width, mandibular breadth and retromandibular width diagonal were larger in gender-matched OSA versus healthy comparisons; thus satisfying hypothesis (1). Male-female ratios were mostly >1.0 across groups, but with no significant group × gender interactions no variable satisfied hypothesis (2). Thus, in this exploratory study, OSA patients had gender-common phenotypical differences to healthy subjects, but sexual dimorphism was preserved. Lack of complete phenotypical convergence may indicate gender-based critical phenotype-level attainment for OSA and/or gender-based OSA prevalence arises from factors other than those in this study. PMID:25113616

  14. Sleep Problems in Asthma and COPD

    MedlinePLUS

    ... from symptoms of this sleep problem. What is sleep apnea and why can I get sleep apnea with asthma and/or COPD? Sleep apnea ... thoracic.org/ information-series/index.php). How do sleep problems affect my asthma and/or COPD? People ...

  15. Who Is Getting Tested for Obstructive Sleep Apnea Using a Portable Recording System? Test Results from 193,221 Patients

    PubMed Central

    Cairns, Alyssa; Poulos, Greg; Bogan, Richard

    2014-01-01

    Study Objectives: To address some of the questions about “who” has been tested for OSA (in terms of pretest risk and study outcomes) using a leading national portable recorder (PR; “home sleep test”) Design: This was a retrospective analysis of a large repository of de-identified test results and pretest OSA risk from 2009 to 2013. Setting and Patients: A total of 244,602 patients were referred for testing from a variety of clinical practices across North America. A total of 193,221 studies were included in the final analyses. Interventions: NA. Measurements and Results: The final sample was predominately male (59%), middle-aged (53.5 ± 14.2 years), obese (BMI > 30; 54%), with a large neck circumference (males = 16.9 ± 1.2 in; females = 15.0 ± 1.3 in) and a mild degree of reported sleepiness (ESS 8.7 ± 5.3). Approximately 50% of the sample endorsed a history of hypertension. The majority of patients (89.6%) were at a high risk for OSA as assessed by the ARES screening questionnaire. Of this group, 79.9% had an AHI ? 5 (MAHI = 18.2 ± 18.1) and 98% had an RDI ? 5 (MRDI = 28.0 ± 19.6). The majority of patients (?60%) that screened at no apparent risk for OSA indeed had AHIs < 5 events/h. Those with a high pretest risk for OSA but low test outcomes (AHI < 5) were twice as likely to be female and approximately 20% to 30% more likely to report a history of insomnia, lung disease, and/or stroke. Conclusions: The majority of PR has been conducted on patients with a high degree of suspicion for OSA. These data suggest that PR has been used in patients with a high pretest probability of OSA. Patients with a history of insomnia, stroke, and/or lung disease may especially benefit by a comprehensive evaluation by a physician trained in sleep medicine, especially if PR results are negative for OSA. Future studies should evaluate the utility of gender-appropriate screening measures. Although questionnaire-based screening is helpful in determining OSA risk, it is imperative that it be used in conjunction with clinical decision-making. Citation: Cairns A, Poulos G, Bogan R. Who is getting tested for obstructive sleep apnea using a portable recording system? Test results from 193,221 patients. J Clin Sleep Med 2014;10(11):1193-1198. PMID:25325579

  16. Obstructive Sleep Apnea and Progression of Coronary Artery Calcium: The Multi?Ethnic Study of Atherosclerosis Study

    PubMed Central

    Kwon, Younghoon; Duprez, Daniel A.; Jacobs, David R.; Nagayoshi, Mako; McClelland, Robyn L.; Shahar, Eyal; Budoff, Matthew; Redline, Susan; Shea, Steven; Carr, J. Jeffrey; Lutsey, Pamela L.

    2014-01-01

    Background Obstructive sleep apnea (OSA) is a common condition associated with cardiovascular disease. Its potential effect on progression of subclinical atherosclerosis is not well understood. We tested the hypothesis that self?reported OSA is associated with progression of coronary artery calcium (CAC). We also evaluated whether traditional cardiovascular risk factors accounted for the association. Methods and Results In the Multi?Ethnic Study of Atherosclerosis (MESA) prospective cohort, we studied 2603 participants who at baseline (2002–2004) completed a sleep questionnaire and underwent coronary computed tomography (CT) and, then 8 years later (2010–2011), a repeat coronary CT. Participants were categorized by symptoms of habitual snoring or reported physician diagnosis of OSA. At baseline, 102 (3.9%) reported diagnosed OSA; 666 (25.6%) reported diagnosed habitual snoring; and 1835 (70.5%) reported neither habitual snoring nor OSA (“normal”). At baseline, CAC prevalence was highest among those with OSA but similar for those with and without habitual snoring. During 8 years of follow?up, greater progression of CAC was observed among those with OSA versus normal (mean increase of 204.2 versus 135.5 Agatston units; P=0.01), after accounting for demographics, behaviors, and body habitus. Modest attenuation was observed after adjustment for cardiovascular risk factors (188.7 versus 138.8; P=0.06). CAC progression among habitual snorers was similar to that observed in the normal group. Conclusions OSA was associated with CAC score progression after adjustment for demographics, behaviors, and body mass index. However, the association was not significant after accounting for cardiovascular risk factors, which may mediate the association between OSA and CAC. PMID:25261530

  17. Evaluation and Validation of a Method for Determining Platelet Catecholamine in Patients with Obstructive Sleep Apnea and Arterial Hypertension

    PubMed Central

    Feres, Marcia C.; Cintra, Fatima D.; Rizzi, Camila F.; Mello-Fujita, Luciane; Lino de Souza, Altay A.; Tufik, Sergio; Poyares, Dalva

    2014-01-01

    Background Measurements of plasma and urinary catecholamine are susceptible to confounding factors that influence the results, complicating the interpretation of sympathetic nervous system (SNS) activity in the Obstructive sleep apnea (OSA) and arterial hypertension (HYP) conditions. Objective In this study, we validated a test for platelet catecholamine and compared the catecholamine levels (adrenaline and noradrenaline) in urine, plasma and platelets in patients with OSA and HYP compared with controls. Methods In the validation, 30 healthy, nonsmoking volunteers who were not currently undergoing treatment or medication were selected as the control group. One hundred fifty-four individuals (114 OSA, 40 non-OSA) were consecutively selected from the outpatient clinic of the Sleep Institute and underwent clinical, polysomnographic and laboratory evaluation, including the urinary, plasma and platelet levels of adrenaline (AD) and noradrenaline (NA). Patients were then allocated to groups according to the presence of OSA and/or hypertension. Results A logistic regression model, controlled for age and BMI, showed that urinary AD and urinary NA were risk factors in the OSA+HYP group and the HYP group; however, the model showed higher levels of platelet NA for OSA without HYP. After 1 year of CPAP (continuous upper airway pressure) treatment, patients (n?=?9) presented lower levels of urinary NA (p?=?0.04) and platelet NA (p?=?0.05). Conclusion Urinary NA and AD levels were significantly associated with the condition of hypertension with and without OSA, whereas platelet NA with OSA without comorbidity. These findings suggest that platelet catecholamine levels might reflect nocturnal sympathetic activation in OSA patients without hypertension. PMID:24911183

  18. Usefulness of Fetuin-A to Predict Risk for Cardiovascular Disease Among Patients With Obstructive Sleep Apnea.

    PubMed

    Liu, Alice; Lamendola, Cindy; Ariel, Danit; Abbasi, Fahim; Kim, Sun H; Cardell, James; Tomasso, Vanessa; Xu, Shiming; Patel, Shailja; Mojaddidi, Hafasa; Grove, Kaylene; Kushida, Clete A; Reaven, Gerald M

    2015-07-15

    Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular diseases (CVDs). Fetuin-A, a novel hepatokine, has been associated with the metabolic syndrome (MetS), insulin resistance, and type 2 diabetes mellitus, all of which are highly prevalent in patients with OSA and associated with increased CVD risk. The goal of this study was to determine whether fetuin-A could be involved in the pathogenesis of CVD risk in patients with OSA, through relations of fetuin-A with MetS components and/or insulin resistance. Overweight or obese, nondiabetic volunteers (n = 120) were diagnosed with OSA by in-laboratory nocturnal polysomnography. Steady-state plasma glucose concentrations derived during the insulin suppression test were used to quantify insulin-mediated glucose uptake; higher steady-state plasma glucose concentrations indicated greater insulin resistance. Fasting plasma fetuin-A and lipoprotein concentrations were measured. Whereas neither the prevalence of MetS nor the number of MetS components was associated with tertiles of fetuin-A concentrations, the lipoprotein components of MetS, triglycerides and high-density lipoprotein cholesterol, increased (p <0.01) and decreased (p <0.05), respectively, across fetuin-A tertiles. Additionally, comprehensive lipoprotein analysis revealed that very low density lipoprotein (VLDL) particles and VLDL subfractions (VLDL1+2 and VLDL3) were increased across fetuin-A tertiles. In contrast, neither insulin resistance nor sleep measurements related to OSA were found to be modified by fetuin-A concentrations. In conclusion, abnormalities of lipoprotein metabolism, but not MetS or insulin resistance per se, may represent a mechanism by which fetuin-A contributes to increased CVD risk in patients with OSA. PMID:25960379

  19. Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Con.

    PubMed

    Li, Yanru; Daniels, Lori B; Strollo, Patrick J; Malhotra, Atul

    2015-07-01

    Sleep-disordered breathing (SDB) is one of the most common comorbidities in people with congestive heart failure (CHF). Although SDB has major cardiometabolic consequences, the attributable risk of SDB in asymptomatic CHF patients remains unclear. Whether early intervention using positive airway pressure would improve the prognosis in CHF patients is uncertain. As yet, there is insufficient evidence that routine polysomnography screening is cost-effective for asymptomatic CHF patients. Careful clinical risk evaluation and thoughtful use of limited-channel home sleep testing should be considered before the application of routine polysomnography in all CHF patients. PMID:26112304

  20. The Comorbidity of Sleep Apnea and Mood, Anxiety, and Substance Use Disorders among Obese Military Veterans within the Veterans Health Administration

    PubMed Central

    Babson, Kimberly A.; Del Re, A. C.; Bonn-Miller, Marcel O.; Woodward, Steven H.

    2013-01-01

    Objectives: To determine the relations between obstructive sleep apnea (OSA) diagnosis, the likelihood of being diagnosed with a psychological condition, among obese veterans, after accounting for severity of obesity and the correlated nature of patients within facility. We hypothesized that (1) individuals with a diagnosis of OSA would be more likely to receive a diagnosis of a (a) mood disorder and (b) anxiety disorder, but not (c) substance use disorder. Design: Cross-sectional retrospective database review of outpatient medical records between October 2009 and September 2010, conducted across all 140 Veterans Health Administration (VHA) facilities. Setting: The entire VA Health Care System. Patients or Participants: Population-based sample of veterans with obesity (N = 2,485,658). Main Outcome Measures: Physician- or psychologist-determined diagnosis of psychological conditions including mood, anxiety, and substance use disorders. Results: Using generalized linear mixed modeling, after accounting for the correlated nature of patients within facility and the severity of obesity, individuals with a diagnosis of sleep apnea had increased odds of receiving a mood disorder diagnosis (OR = 1.85; CI = 1.71-1.72; p < 0.001), anxiety disorder diagnosis (OR = 1.82; CI = 1.77-1.84; p < 0.001), but not a diagnosis of substance use disorder. Conclusions: Among obese veterans within VA, OSA is associated with increased risk for having a mood and anxiety disorder, but not substance use disorder, with the strongest associations observed for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In addition, this relation remained after accounting for severity of BMI. Citation: Babson KA; Del Re AC; Bonn-Miller MO; Woodward SH. The comorbidity of sleep apnea and mood, anxiety, and substance use disorders among obese military veterans within the Veterans Health Administration. J Clin Sleep Med 2013;9(12):1253-1258. PMID:24340286

  1. Effect of the velopharynx on intraluminal pressures in reconstructed pharynges derived from individuals with and without sleep apnea.

    PubMed

    Cisonni, Julien; Lucey, Anthony D; Walsh, Jennifer H; King, Andrew J C; Elliott, Novak S J; Sampson, David D; Eastwood, Peter R; Hillman, David R

    2013-09-27

    The most collapsible part of the upper airway in the majority of individuals is the velopharynx which is the segment positioned behind the soft palate. As such it is an important morphological region for consideration in elucidating the pathogenesis of obstructive sleep apnea (OSA). This study compared steady flow properties during inspiration in the pharynges of nine male subjects with OSA and nine body-mass index (BMI)- and age-matched control male subjects without OSA. The k-?SST turbulence model was used to simulate the flow field in subject-specific pharyngeal geometric models reconstructed from anatomical optical coherence tomography (aOCT) data. While analysis of the geometry of reconstructed pharynges revealed narrowing at velopharyngeal level in subjects with OSA, it was not possible to clearly distinguish them from subjects without OSA on the basis of pharyngeal size and shape alone. By contrast, flow simulations demonstrated that pressure fields within the narrowed airway segments were sensitive to small differences in geometry and could lead to significantly different intraluminal pressure characteristics between subjects. The ratio between velopharyngeal and total pharyngeal pressure drops emerged as a relevant flow-based criterion by which subjects with OSA could be differentiated from those without. PMID:23928355

  2. Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment.

    PubMed

    Lin, Shih-Wei; Chou, Yu-Ting; Kao, Kuo-Chin; Chuang, Li-Pang; Yang, Chien-Ming; Hu, Han-Chung; Huang, Chung-Chi; Yang, Cheng-Ta; Chen, Ning-Hung

    2015-03-01

    Neurocognitive dysfunction is a major clinical consequence in patients with obstructive sleep apnea syndrome (OSAS). The effects of continuous positive airway pressure (CPAP) treatment, as the gold standard of treatment in OSAS, on this major complication are controversial. The duration and compliance of CPAP are thought to be important factors but evidence is lacking. This study is designed to evaluate the effects of immediate (one night), long-term (3 months) influence and the compliances of CPAP treatment on the neurocognitive function in OSAS patients. We enrolled newly diagnosed severe OSAS patients. Neurocognitive function test battery, CANTAB (Cambridge Neuropsychological Test Automated Battery), was performed before, one night and 3 months of CPAP treatment. Patients with CPAP compliance rate ? 70 % and < 50 % were grouped into good and poor adherence subjects, respectively. Fourteen patients were enrolled in final analyses. Six of them were in poor compliant group. Improvements in attention domain were found in all subjects after one-night treatment and maintained till three-month follow-up. Additional improvements in some attention performances and visual memory performances were gained only after three-month treatment. Significant changes of decision-making and response control function were found between good and poor compliance groups after three-month treatment. CPAP can improve some neurocognitive function at the very first day used. Longer treatment of CPAP can additionally improve some other neurocognitive functions. Compliance of CPAP has influence on the recovery of neurocognitive functions in patients with severe OSAS. PMID:25621259

  3. Functional polymorphisms in the promoter region of MMP-2 and MMP-9 and susceptibility to obstructive sleep apnea

    PubMed Central

    Cao, Chao; Wu, Bin; Wu, Yanping; Yu, Yiming; Ma, Hongying; Sun, Shifang; Zhang, Qiaoli; Ding, Qunli; Chen, Li; Deng, Zaichun

    2015-01-01

    Genetic susceptibility to obstructive sleep apnea (OSA) has been a research focus in the scientific community in the past few years. In this study, we recruited 375 subjects to investigate whether functional polymorphisms in the promoter region of matrix metalloproteinase (MMP)-2 (-1306C/T) and MMP-9 (-1562C/T) increased susceptibility to OSA. Our study showed no significant association between MMP-2 -1306C/T polymorphism and risk of OSA (T vs. C: OR = 1.01, 95% CI = 0.67–1.52; P = 0.97). Compared with the MMP-9 -1562C allele, the -1562T allele was associated with increased risk of OSA (T vs. C: OR = 1.56, 95% CI = 1.02–2.39; P = 0.04). However, neither MMP-2 -1306C/T nor MMP-9 -1562C/T polymorphism was found to be associated with severity of the disease. Our study suggested that the MMP-2 -1306C/T polymorphism was not associated with OSA susceptibility, whereas the MMP-9 -1562T allele was associated with increased risk of OSA. PMID:25753939

  4. Mean Platelet Volume in Patients with Obstructive Sleep Apnea and Its Relationship with Simpler Heart Rate Derivatives

    PubMed Central

    Akyüz, Ayd?n; Akkoyun, Dursun Çayan; Oran, Mustafa; De?irmenci, Hasan; Alp, Recep

    2014-01-01

    Some studies show increased mean platelet volume (MPV) in obstructive sleep apnea (OSA). The aim of this study was to evaluate MPV in OSA patients without cardiovascular risk factors and the possible association of heart rate derivatives with MPV. A total of 82 patients (aged 30–70 years) were divided into 2 groups according to the presence of either OSA or non-OSA as the control group. The OSA group consisted of 52 patients and the control group consisted of 30 subjects. Neither group was significantly different in terms of MPV values as well as heart rate (HR) derivatives such as minimum HR, maximum HR, the difference between maximum HR and minimum HR, mean HR, and heart rate performance index (HRPI) [(HR max. ? HR min.)/HR mean] (P > 0.05 for all variables). In multivariate analysis, platelet count and percentages of recording time spent at arterial oxygen saturation < 90% significant variables are associated with MPV (? ± SE: ?0.004 ± 0.002, 95% CI, ?0.008 to ?0.001; P = 0.034) and (? ± SE: 2.93 ± 1.93, 95% CI, 0.167 to 5.69; P = 0.038). Consequently, our findings predominantly suggest that there is a casual and reciprocal interaction between MPV and autonomic activation. PMID:25295213

  5. Intermittent Hypoxia-induced Changes in Tumor-associated Macrophages and Tumor Malignancy in a Mouse Model of Sleep Apnea

    PubMed Central

    Almendros, Isaac; Wang, Yang; Becker, Lev; Lennon, Frances E.; Zheng, Jiamao; Coats, Brittney R.; Schoenfelt, Kelly S.; Carreras, Alba; Hakim, Fahed; Zhang, Shelley X.; Farré, Ramon

    2014-01-01

    Rationale: An increased cancer aggressiveness and mortality have been recently reported among patients with obstructive sleep apnea (OSA). Intermittent hypoxia (IH), a hallmark of OSA, enhances melanoma growth and metastasis in mice. Objectives: To assess whether OSA-related adverse cancer outcomes occur via IH-induced changes in host immune responses, namely tumor-associated macrophages (TAMs). Measurements and Main Results: Lung epithelial TC1 cell tumors were 84% greater in mice subjected to IH for 28 days compared with room air (RA). In addition, TAMs in IH-exposed tumors exhibited reductions in M1 polarity with a shift toward M2 protumoral phenotype. Although TAMs from tumors harvested from RA-exposed mice increased TC1 migration and extravasation, TAMs from IH-exposed mice markedly enhanced such effects and also promoted proliferative rates and invasiveness of TC1 cells. Proliferative rates of melanoma (B16F10) and TC1 cells exposed to IH either in single culture or in coculture with macrophages (RAW 264.7) increased only when RAW 264.7 macrophages were concurrently present. Conclusions: Our findings support the notion that IH-induced alterations in TAMs participate in the adverse cancer outcomes reported in OSA. PMID:24471484

  6. To ED or not to ED--is erectile dysfunction in obstructive sleep apnea related to endothelial dysfunction?

    PubMed

    Hoyos, Camilla M; Melehan, Kerri L; Phillips, Craig L; Grunstein, Ronald R; Liu, Peter Y

    2015-04-01

    Both obstructive sleep apnea (OSA) and erectile dysfunction (ErectD) are highly prevalent and largely under diagnosed medical conditions. These disorders often co-exist, with about half of the male OSA population having ErectD and vice versa. OSA is strongly associated with an increased risk of cardiovascular mortality while ErectD has been proposed as a phenotypic marker of cardiovascular disease. This implies that the two conditions may be linked by a common pathophysiological mechanism. In this review we provide evidence supporting the hypothesis that endothelial dysfunction (EndoD) may be the common pathophysiological mechanism linking OSA with both ErectD and cardiovascular complications. EndoD is one of the earliest markers of cardiovascular disease and substantial evidence suggests that OSA independently causes EndoD. There is also strong evidence that causally links EndoD with organic ErectD. Further research should be directed at determining the value of simultaneously assessing both ErectD and OSA in patients presenting with symptoms of either condition. In both ErectD and OSA clinics, identifying both conditions could improve overall cardiovascular risk stratification whilst treatment of OSA could reduce both ErectD and cardiovascular risk. PMID:24813467

  7. The Hypotonic Upper Airway in Obstructive Sleep Apnea Role of Structures and Neuromuscular Activity

    Microsoft Academic Search

    ALAN R. SCHWARTZ; JOSHUA BARON; NORMAN SCHUBERT; DANIEL ALAM; SHARYAR D. SAMADI; PHILIP L. SMITH

    The structural properties of the upper airway determine its collapsibility during periods of muscle hy- potonia. Both rapid-eye-movement (REM) sleep and increases in nasal pressure (P N ) produce hypoto- nia, which persists even after nasal pressure is abruptly reduced. To determine the factors that influ- ence the collapsibility of the hypotonic airway, the critical pressure (Pcrit) and nasal resistance

  8. Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

    Microsoft Academic Search

    Michael F. Fitzpatrick; Christi E. D. Alloway; Tracy M. Wakeford; Alistair W. MacLean; Peter W. Munt; Andrew G. Day

    Manual continuous positive airway pressure (CPAP) titration in a tions (9) can improve the efficiency with which CPAP treat- sleep laboratory is costly and limits access for diagnostic studies. ment is delivered, as compared with conventional in-labora- Many factors affect CPAP compliance, but education and support, tory overnight CPAP titration. Given the high disease rather than in-laboratory CPAP titration, appear

  9. Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort

    PubMed Central

    Marshall, Nathaniel S.; Wong, Keith K.H.; Cullen, Stewart R.J.; Knuiman, Matthew W.; Grunstein, Ronald R.

    2014-01-01

    Objective: To ascertain whether objectively measured obstructive sleep apnea (OSA) independently increases the risk of all cause death, cardiovascular disease (CVD), coronary heart disease (CHD), stroke or cancer Design: Community-based cohort Setting and Participants: 400 residents of the Western Australian town of Busselton Measures: OSA severity was quantified via the respiratory disturbance index (RDI) as measured by a single night recording in November-December 1990 using the MESAM IV device, along with a range of other risk factors. Follow-up for deaths and hospitalizations was ascertained via record linkage to the end of 2010. Results: We had follow-up data in 397 people and then removed those with a previous stroke (n = 4) from the mortality/ CVD/CHD/stroke analyses and those with cancer history from the cancer analyses (n = 7). There were 77 deaths, 103 cardiovascular events (31 strokes, 59 CHD) and 125 incident cases of cancer (39 cancer fatalities) during 20 years follow-up. In fully adjusted models, moderate-severe OSA was significantly associated with all-cause mortality (HR = 4.2; 95% CI 1.9, 9.2), cancer mortality (3.4; 1.1, 10.2), incident cancer (2.5; 1.2, 5.0), and stroke (3.7; 1.2, 11.8), but not significantly with CVD (1.9; 0.75, 4.6) or CHD incidence (1.1; 0.24, 4.6). Mild sleep apnea was associated with a halving in mortality (0.5; 0.27, 0.99), but no other outcome, after control for leading risk factors. Conclusions: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality, incident stroke, and cancer incidence and mortality in this community-based sample. Commentary: A commentary on this article appears in this issue on page 363. Citation: Marshall NS; Wong KK; Cullen SR; Knuiman MW; Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton health study cohort. J Clin Sleep Med 2014;10(4):355-362. PMID:24733978

  10. Diagnostic Thresholds for Quantitative REM Sleep Phasic Burst Duration, Phasic and Tonic Muscle Activity, and REM Atonia Index in REM Sleep Behavior Disorder with and without Comorbid Obstructive Sleep Apnea

    PubMed Central

    McCarter, Stuart J.; St. Louis, Erik K.; Duwell, Ethan J.; Timm, Paul C.; Sandness, David J.; Boeve, Bradley F.; Silber, Michael H.

    2014-01-01

    Objectives: We aimed to determine whether phasic burst duration and conventional REM sleep without atonia (RSWA) methods could accurately diagnose REM sleep behavior disorder (RBD) patients with comorbid OSA. Design: We visually analyzed RSWA phasic burst durations, phasic, “any,” and tonic muscle activity by 3-s mini-epochs, phasic activity by 30-s (AASM rules) epochs, and conducted automated REM atonia index (RAI) analysis. Group RSWA metrics were analyzed and regression models fit, with receiver operating characteristic (ROC) curves determining the best diagnostic cutoff thresholds for RBD. Both split-night and full-night polysomnographic studies were analyzed. Setting: N/A. Participants: Parkinson disease (PD)-RBD (n = 20) and matched controls with (n = 20) and without (n = 20) OSA. Interventions: N/A. Measurements and Results: All mean RSWA phasic burst durations and muscle activities were higher in PD-RBD patients than controls (P < 0.0001), and RSWA associations with PD-RBD remained significant when adjusting for age, gender, and REM AHI (P < 0.0001). RSWA muscle activity (phasic, “any”) cutoffs for 3-s mini-epoch scorings were submentalis (SM) (15.5%, 21.6%), anterior tibialis (AT) (30.2%, 30.2%), and combined SM/AT (37.9%, 43.4%). Diagnostic cutoffs for 30-s epochs (AASM criteria) were SM 2.8%, AT 11.3%, and combined SM/AT 34.7%. Tonic muscle activity cutoff of 1.2% was 100% sensitive and specific, while RAI (SM) cutoff was 0.88. Phasic muscle burst duration cutoffs were: SM (0.65) and AT (0.79) seconds. Combining phasic burst durations with RSWA muscle activity improved sensitivity and specificity of RBD diagnosis. Conclusions: This study provides evidence for REM sleep without atonia diagnostic thresholds applicable in Parkinson disease-REM sleep behavior disorder (PD-RBD) patient populations with comorbid OSA that may be useful toward distinguishing PD-RBD in typical outpatient populations. Citation: McCarter SJ, St. Louis EK, Duwell EJ, Timm PC, Sandness DJ, Boeve BF, Silber MH. Diagnostic thresholds for quantitative REM sleep phasic burst duration, phasic and tonic muscle activity, and REM atonia index in REM sleep behavior disorder with and without comorbid obstructive sleep apnea. SLEEP 2014;37(10):1649-1662. PMID:25197816

  11. [Evaluation of the character of morphologic traits in persons with obstructive sleep apnea].

    PubMed

    Kosi?ska, M; Mrowicka, B; Cofta, S; Rzymkowska, M

    1996-01-01

    The aim of the study was carried out to show the anthropometric analysis of patients with obstructive sleep apnoea syndrome and to answer the question about the relations between the degree of SAS and obesity. The research has begun since May 1993 in an interdisciplinary team. The study was carried out in a group of 40 men diagnosed as SAS in Sleep Apnoea Unit of Department of Pulmonary Diseases. The anthropometric analysis consists of basic somatometric measurements. The relations between obesity and the degree of apnoeas was determined by analysis of variance and the model of single and multiple regression. The obtained results demonstrate the dependence between the grade of apnoeas pathology during sleep and the measurements of upper body parts. The slope of the line B not equal to 0 indicates that the intensity of SAS increases in patients "commonly considered as obese". Obesity is an important factor leading to disturbances in respiratory ventilation. An important development of fatty tissue of the neck can cause pressure changes and can induce adipose degeneration. An increased fatty thickness of the thorax is a factor which can lead to the aggravation of symptoms. PMID:8924881

  12. [Incidence of obstructive sleep apnea syndrome in combination with chronic obstructive respiratory tract disease].

    PubMed

    Fischer, J; Raschke, F

    1993-12-01

    Polysomnographic measurements were performed in 210 indoor patients (age mean = 49.7 +/- 8.9 years, Broca mean = 126.0 +/- 20.7% FEV1%p mean = 79.9 +/- 23.9) of a pneumological rehabilitation centre who had a suspicious history or clinical symptoms of obstructive sleep apnoea. 72 had neither an airway obstruction nor a pathological apnoea index. 58 patients only suffered from airway obstruction and 42 had only a pathological apnoea index. In 38 patients, a pathological apnoea index and also airway obstructions were seen. For the last three groups we calculated the mean of the SaO2-values for an 8 hour night time period with and without n-CPAP-therapy. In both groups with only one disease a typical pattern of the SaO2-values during sleep could be demonstrated. The patients with overlap syndrome (SAS + COB) showed a superposition of both single disease SaO2-time courses even with much lower initial SaO2-values. During n-CPAP-therapy in all groups a reduction of the variations of SaO2 induced by sleep pattern and circadian rhythm are evident. PMID:8153097

  13. A retrospective analysis of airway management in patients with obstructive sleep apnea and its effects on postanesthesia care unit length of stay

    PubMed Central

    Brousseau, Claire A; Dobson, Gregory R; Milne, Andrew D

    2014-01-01

    Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing characterized by periods of partial or complete obstruction of the upper airway during sleep, resulting in oxygen desaturations. Symptoms and risk factors for OSA are of particular importance in the management of OSA patients in the perioperative setting. The present study collected data regarding the intraoperative airway management of OSA patients and their course in the postanesthesia care unit (PACU) over a six-month period. A total of 86 patients underwent general anesthesia, 63 of whom were intubated by direct laryngoscopy. Of these, 43% were classified as a grade 1 view by direct laryngoscopy, 43% were grade 2 and 14% were classified as grade 3. Apnea events or periods of desaturation in the PACU were observed in 27% of cases. Length of stay was significantly longer for cases in which PACU nurses had indicated that OSA had affected the individuals’ postoperative course of treatment. Overall, OSA patients had an increased frequency of grade 3 views compared with the general population, and adjuncts were commonly used to help secure the airway in OSA patients. Symptomatic OSA patients placed increased demands on the PACU in terms of length of stay and hospital resources.

  14. Cerebral hemodynamics in patients with obstructive sleep apnea syndrome monitored with near-infrared spectroscopy (NIRS) during positive airways pressure (CPAP) therapy: a pilot study

    NASA Astrophysics Data System (ADS)

    Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Fritschi, Ursula; Lehner, Isabella; Qi, Ming; Khatami, Ramin

    2014-03-01

    In obstructive sleep apnea syndrome (OSA) the periodic reduction or cessation of breathing due to narrowing or occlusion of the upper airway during sleep leads to daytime symptoms and increased cardiovascular risk, including stroke. The higher risk of stroke is related to the impairment in cerebral vascular autoregulation. Continuous positive airways pressure (CPAP) therapy at night is the most effective treatment for OSA. However, there is no suitable bedside monitoring method evaluating the treatment efficacy of CPAP therapy, especially to monitor the recovery of cerebral hemodynamics. NIRS is ideally suited for non-invasive monitoring the cerebral hemodynamics during sleep. In this study, we will for first time assess dynamic changes of cerebral hemodynamics during nocturnal CPAP therapy in 3 patients with OSA using NIRS. We found periodic oscillations in HbO2, HHb, tissue oxygenation index (TOI) and blood volume associated with periodic apnea events without CPAP in all OSA patients. These oscillations were gradually attenuated and finally eliminated with the stepwise increments of CPAP pressures. The oscillations were totally eliminated in blood volume earlier than in other hemodynamic parameters. These results suggested that 1) the cerebral hemodynamic oscillations induced by OSA events can effectively be attenuated by CPAP therapy, and 2) blood flow and blood volume recovered first during CPAP therapy, followed by the recovery of oxygen consumption. Our study suggested that NIRS is a useful tool to evaluate the efficacy of CPAP therapy in patients with OSA bedside and in real time.

  15. The Proinflammatory RAGE/N