These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Sleep Apnea and Heart Failure: Part II: Central Sleep Apnea  

Microsoft Academic Search

n the first part of this 2-part review, we provided a synopsis of the cardiovascular effects of normal sleep and an overview of the diagnostic, pathophysiological, and therapeu- tic implications of obstructive sleep apnea (OSA) in the setting of heart failure (HF). In this second part, we turn our attention to central sleep apnea (CSA), commonly referred to as Cheyne-Stokes

T. Douglas Bradley; John S. Floras

2003-01-01

2

A Case of Positional Central Sleep Apnea  

PubMed Central

Obstructive sleep apnea results from structural compromise of the upper airway and decreased muscle tone during sleep. Central sleep apnea is usually due to instability of the feedback mechanism of the body that controls respiration. While positional changes commonly affect the severity of obstructive sleep apnea, the effect of positional changes on the severity of central sleep apnea is less well known. Citation: Zaharna M; Rama A; Chan R; Kushida C. A case of positional central sleep apnea. J Clin Sleep Med 2013;9(3):265-268. PMID:23493439

Zaharna, Mia; Rama, Anil; Chan, Rowena; Kushida, Clete

2013-01-01

3

Sodium oxybate-induced central sleep apneas.  

PubMed

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

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

2013-09-01

4

Sleep Apnea  

MedlinePLUS

... shows how the airway can collapse and block air flow to the lungs, causing sleep apnea. Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of your brain that controls your breathing doesn't send the correct signals ...

5

Sleep Apnea  

Microsoft Academic Search

Two types of sleep apnea have been identified: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA occurs when\\u000a the upper airway collapses; in OSA, there is no airflow, often despite great respiratory effort. In CSA, the transitory cessations\\u000a of breathing are because of a drop in respiratory capacity—there is no airflow and no respiratory effort. Excessive daytime\\u000a sleepiness

Cheryl M. Carlucci; Robert A. Hauser

6

Central sleep apnea and chronic heart failure.  

PubMed

Central sleep apnea with Cheyne-Stokes respiration (CSR) during sleep affects about 40 % of patients with chronic heart failure (CHF). During CSR simultaneous periodic fluctuations in wakefulness and respiration with accompanying changes in blood pressure and heart rate are observed. CSR can be described as an oscillation of the ventilatory feedback loop controlling respiration. The major synergistically acting mechanisms causing this oscillation include reduced body stores of oxygen and carbon dioxide, hyperventilation with concomitant hypocapnia, prolonged circulation time, and a relatively high hypercapnic ventilatory response. The repetitive desaturations and arousals following CSR cause daytime symptoms and an increase in sympathetic activity. In CHF chronically increased sympathetic activity has negative effects on left ventricular function and is associated with reduced exercise tolerance and poor prognosis. Therefore CSR is expected to have an unfavorable influence on the course of CHF. Whether successful treatment of nocturnal CSR has any impact on the high mortality of CHF needs to be resolved in controlled studies with sufficient sample size. PMID:10893107

Andreas, S

2000-06-15

7

Sleep Apnea  

MedlinePLUS

... untreated. You are also more likely to have traffic accidents if you drive while you're sleepy. If you have sleep apnea, it is very important to get treatment. ... Do I need a sleep study? What are the health risks associated with sleep apnea? What lifestyle changes ...

8

Central sleep apnea and Cheyne-Stokes respiration.  

PubMed

Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is a form of periodic breathing, commonly observed in patients with heart failure (HF), in which central apneas alternate with hyperpneas that have a waxing-waning pattern of tidal volume. Uniform criteria by which to diagnose a clinically significant degree of CSR-CSA have yet to be established. CSR-CSA is caused by respiratory control system instability characterized by a tendency to hyperventilate. Central apnea occurs when Pa(CO(2)) falls below the threshold for apnea during sleep due to ventilatory overshoot. Patients with CSR-CSA are generally hypocapnic, with a Pa(CO(2)) closer than normal to the apneic threshold such that even slight augmentation in ventilation drives Pa(CO(2)) below threshold and triggers apnea. Factors contributing to hyperventilation in HF include stimulation of pulmonary irritant receptors by pulmonary congestion, increased chemoreceptor sensitivity, reduced cerebrovascular blood flow, and recurrent arousals from sleep. Controversy remains as to whether CSR-CSA is simply a reflection of HF severity, or whether it exerts unique adverse effects on prognosis. The main adverse influence of CSR-CSA on cardiovascular function appears to be excessive sympathetic nervous system activity due to apnea-related hypoxia and arousals from sleep. A number of studies have examined the potential relationship between CSR-CSA and mortality in HF. Most reported that CSR-CSA was associated with an increased risk for mortality, but these studies were small. Further research is therefore needed to elucidate mechanisms which contribute to the pathogenesis of CSR-CSA, and to determine whether its treatment can reduce morbidity and mortality in patients with HF. PMID:18250216

Yumino, Dai; Bradley, T Douglas

2008-02-15

9

Pulse Rate Analysis in Case of Central Sleep Apnea: A New Algorithm for Cardiac Rate Estimation  

E-print Network

Pulse Rate Analysis in Case of Central Sleep Apnea: A New Algorithm for Cardiac Rate Estimation to be efficient on signals modulated by breathing, we demonstrate that in case of lack of respiratory modulation (central sleep apnea), the AM-FM algorithm doesn't perform well in heart rate extraction. We introduce

Paris-Sud XI, Université de

10

Treatment of Central Sleep Apnea in US Veterans  

PubMed Central

Background: There are no standard therapies for the management of central sleep apnea (CSA). Either positive pressure therapy (PAP) or supplemental oxygen (O2) may stabilize respiration in CSA by reducing ventilatory chemoresponsiveness. Additionally, increasing opioid use and the presence of comorbid conditions in US veterans necessitates investigations into alternative titration protocols to treat CSA. The goal was to report on the effectiveness of titration with PAP, used alone or in conjunction with O2, for the management of CSA associated with varying comorbidities and opioid use. Methods: This was a retrospective chart review over 3 years, performed at a VA sleep disorders center. The effects of CPAP, CPAP+O2, and BPAP+O2, used in a step-wise titration protocol, on consecutive patients diagnosed with CSA were studied. Results: CSA was diagnosed in 162 patients. The protocol was effective in eliminating CSA (CAI ? 5/h) in 84% of patients. CPAP was effective in 48%, while CPAP+O2 combination was effective in an additional 25%, and BPAP+O2 in 11%. The remaining 16% were non-responders. Forty-seven patients (29%) were on prescribed opioid therapy for chronic pain, in whom CPAP, CPAP+O2, or BPAP+O2 eliminated CSA in 54%, 28%, and 10% cases,, respectively. CPAP, CPAP+O2, and BPAP+O2 each produced significant declines in the AHI, CAI, and arousal index, and an increase in the SpO2. Conclusion: The data demonstrate that using a titration protocol with CPAP and then PAP with O2 effectively eliminates CSA in individuals with underlying comorbid conditions and prescription opioid use. Comparative studies with other therapeutic modalities are required. Commentary: A commentary on this article appears in this issue on page 565. Citation: Chowdhuri S; Ghabsha A; Sinha P; Kadri M; Narula S; Badr MS. Treatment of central sleep apnea in US veterans. J Clin Sleep Med 2012;8(5):555-563. PMID:23066368

Chowdhuri, Susmita; Ghabsha, Ahmed; Sinha, Prabhat; Kadri, Medina; Narula, Simranjit; Badr, M. Safwan

2012-01-01

11

A case of central sleep apnea strictly dependent upon REM-sleep  

Microsoft Academic Search

Central sleep apnea (CSA) is characterized by the inability to generate regular breathing patterns as a result of the loss\\u000a of metabolic drive and failure of respiratory muscle control. We present the case of a 54-year-old woman with a severe CSA\\u000a strictly dependent upon REM-sleep. Extensive diagnostic workup excluded typical underlying causes and serological analysis\\u000a revealed acute borreliosis infection. The

Armin Steffen; Johann Hagenah; Barbara Wollenberg; Norbert Brüggemann

2010-01-01

12

Development and analysis of a simple grey-box model of central sleep apnea  

E-print Network

In this thesis, we develop and analyze a simple grey-box model that describes the pathophysiology of central sleep apnea (CSA). We construct our model following a thorough survey of published approaches. Special attention ...

Kazerani, Ali

2013-01-01

13

Comparison of patients with central sleep apnea. With and without Cheyne-Stokes respiration.  

PubMed

This study was designed to determine the impact of central sleep apnea with or without Cheyne-Stokes respiration (CSR) on morbidity and mortality. Central sleep apnea was found in 77 male general medical ward in-patients. Cheyne-Stokes respiration was found in 49 of the 77 men; in 15 men, CSR was severe, ie, > or = 25 percent of the night spent in CSR, in 34 men CSR was mild (1 to 25 percent CSR). Twenty-eight men had central sleep apnea but no CSR. An additional 31 patients had no sleep apnea and no CSR. The patients with severe CSR had more central apneas, more, but shorter desaturations, more awakenings and more wake time during the night, but spent more time in bed than those with no CSR or no apnea. Radiographic evidence was consistent with an association of CSR and heart failure. In addition, patients with severe CSR were at almost twice the risk of dying compared with those with no apnea and had a shorter survival time. Nevertheless, we could not confirm that CSR was an independent predictor of elevated mortality risk, implying that some other factors specific to severe CSR predispose these patients to shorter survival time. PMID:8082359

Ancoli-Israel, S; Engler, R L; Friedman, P J; Klauber, M R; Ross, P A; Kripke, D F

1994-09-01

14

Differentiating Obstructive from Central and Complex Sleep Apnea Using an Automated Electrocardiogram-Based Method  

PubMed Central

Study Objectives: Complex sleep apnea is defined as sleep disordered breathing secondary to simultaneous upper airway obstruction and respiratory control dysfunction. The objective of this study was to assess the utility of an electrocardiogram (ECG)-based cardiopulmonary coupling technique to distinguish obstructive from central or complex sleep apnea. Design: Analysis of archived polysomnographic datasets. Setting: A laboratory for computational signal analysis. Interventions: None. Measurements and Results: The PhysioNet Sleep Apnea Database, consisting of 70 polysomnograms including single-lead ECG signals of approximately 8 hours duration, was used to train an ECG-based measure of autonomic and respiratory interactions (cardiopulmonary coupling) to detect periods of apnea and hypopnea, based on the presence of elevated low-frequency coupling (e-LFC). In the PhysioNet BIDMC Congestive Heart Failure Database (ECGs of 15 subjects), a pattern of “narrow spectral band” e-LFC was especially common. The algorithm was then applied to the Sleep Heart Health Study–I dataset, to select the 15 records with the highest amounts of broad and narrow spectral band e-LFC. The latter spectral characteristic seemed to detect not only periods of central apnea, but also obstructive hypopneas with a periodic breathing pattern. Applying the algorithm to 77 sleep laboratory split-night studies showed that the presence of narrow band e-LFC predicted an increased sensitivity to induction of central apneas by positive airway pressure. Conclusions: ECG-based spectral analysis allows automated, operator-independent characterization of probable interactions between respiratory dyscontrol and upper airway anatomical obstruction. The clinical utility of spectrographic phenotyping, especially in predicting failure of positive airway pressure therapy, remains to be more thoroughly tested. Citation: Thomas RJ; Mietus JE; Peng CK; Gilmartin G; Daly RW; Goldberger AL; Gottlieb DJ. Differentiating obstructive from central and complex sleep apnea using an automated electrocardiogram-based method. SLEEP 2007;30(12):1756-1769. PMID:18246985

Thomas, Robert Joseph; Mietus, Joseph E.; Peng, Chung-Kang; Gilmartin, Geoffrey; Daly, Robert W.; Goldberger, Ary L.; Gottlieb, Daniel J.

2007-01-01

15

Central Sleep Apnea Interfering with Adequate Left Ventricular Filling in a Patient with Left Ventricular Assist Device  

PubMed Central

Central sleep apnea is common in patients with advanced heart failure. Apneic episodes are associated with hypoxemia, hypercapnia, and neurohumoral activation resulting in a rise in pulmonary vascular resistance. This case report describes a patient with a left ventricular assist device implanted for severe heart failure in whom unrecognized central sleep apnea resulted in under-filling of the left ventricle and a reduction in left ventricular assist device inflow. Citation: Schaffer SA; Bercovitch RS; Ross HJ; Rao V. Central Sleep apnea interfering with adequate left ventricular filling in a patient with left ventricular assist device. J Clin Sleep Med 2013;9(2):161–162. PMID:23372470

Schaffer, S. Allan; Bercovitch, Robert S.; Ross, Heather J.; Rao, Vivek

2013-01-01

16

Sleep, sleep apnea, and epilepsy  

Microsoft Academic Search

Opinion statement  Sleep disorders occur commonly in patients with epilepsy, and can be responsible for symptoms of daytime somnolence and also\\u000a can contribute to the intractability of epilepsy. The most important aspect of treating sleep disorders, especially sleep\\u000a apnea, is the recognition of the problem. In a busy clinical practice, symptoms of sleep disorders are frequently overlooked\\u000a or mistaken. Whenever sleep

Carl W. Bazil

2004-01-01

17

Role of central/peripheral chemoreceptors and their interdependence in the pathophysiology of sleep apnea.  

PubMed

Unstable periodic breathing with intermittent ventilatory overshoots and undershoots commonly occurs in chronic heart failure, in hypoxia, with chronic opioid use and in certain types of obstructive sleep apnea. Sleep promotes breathing instability because it unmasks a highly sensitive dependence of the respiratory control system on chemoreceptor input, because transient cortical arousals promote ventilatory overshoots and also because upper airway dilator muscle tonicity is reduced and airway collapsibility enhanced. We will present data in support of the premise that carotid chemoreceptors are essential in the pathogenesis of apnea and periodicity; however it is the hyperadditive influence of peripheral chemoreceptor sensory input on central chemosensitivity that accounts for apnea and periodic breathing. This chemoreceptor interdependence also provides a significant portion of the normal drive to breathe in normoxia (i.e. eupnea) and in acute hypoxia. Finally, we discuss the effects of preventing transient hypocapnia (via selective increases in FICO(2)) on centrally mediated types of periodic breathing and even some varieties of cyclical obstructive sleep apnea. PMID:23080181

Dempsey, Jerome A; Smith, Curtis A; Blain, Gregory M; Xie, Ailiang; Gong, Yuansheng; Teodorescu, Mihaela

2012-01-01

18

Sleep Apnea and Hypertension  

Microsoft Academic Search

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

Alisa A. Acosta

19

Obstructive Sleep Apnea  

NSDL National Science Digital Library

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

DDS/DO Sean M. Caples (Mayo Clinic Pulmonary and Critical Care Medicine); Dr. Apoor S. Gami (Mayo Clinic); MD/PhD Virend K. Somers (Mayo Clinic Dept of Internal Medicine)

2005-02-01

20

Obesity and Obstructive Sleep Apnea  

MedlinePLUS

... What To Expect Patient Stories FAQs Anesthesia Topics Obesity and Obstructive Sleep Apnea Share PRINT Print Home > Anesthesia Topics > Detail Page Obesity and Obstructive Sleep Apnea It’s estimated that 60 ...

21

Treatment of Cheyne-Stokes respiration-central sleep apnea in patients with heart failure.  

PubMed

Sleep disordered breathing including obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR) is often accompanied by heart failure. Treatment of OSA centered on continuous positive airway pressure (CPAP) is established. However, treatment of CSR-CSA is still controversial. Since CSR-CSA occurs as a consequence of heart failure, optimization of heart failure is essential to treat CSR-CSA. For treatment directed at CSR-CSA itself, a variety of treatment approaches including night oxygen therapy and noninvasive positive pressure ventilation have been applied. Among them, night oxygen therapy improves patients' symptoms, quality of life (QOL), and left ventricular function, but had yet been shown to improve clinical outcome. For CPAP, there are responders and non-responders and for responders CPAP can also improve survival. Adaptive servo-ventilation (ASV), which most effectively treats CSR-CSA, improves exercise capacity, QOL, and cardiac function. Recent reports suggested ASV may also prevent cardiac events in patients with heart failure. However, further studies are needed to conclude that this treatment improves patient survival. PMID:22370166

Momomura, Shin-ichi

2012-03-01

22

Modeling respiratory movement signals during central and obstructive sleep apnea events using electrocardiogram.  

PubMed

Obstructive sleep apnea (OSA) causes a pause in airflow with continuing breathing effort. In contrast, central sleep apnea (CSA) event is not accompanied with breathing effort. CSA is recognized when respiratory effort falls below 15% of pre-event peak-to-peak amplitude of the respiratory effort. The aim of this study is to investigate whether a combination of respiratory sinus arrhythmia (RSA), ECG-derived respiration (EDR) from R-wave amplitudes and wavelet-based features of ECG signals during OSA and CSA can act as surrogate of changes in thoracic movement signal measured by respiratory inductance plethysmography (RIP). Therefore, RIP and ECG signals during 250 pre-scored OSA and 150 pre-scored CSA events, and 10 s preceding the events were collected from 17 patients. RSA, EDR, and wavelet decomposition of ECG signals at level 9 (0.15-0.32 Hz) were used as input to the support vector regression (SVR) model to recognize the RIP signals and classify OSA from CSA. Using cross-validation test, an optimal SVR (radial basis function kernel; C = 2(8) and ? = 2(-2) where C is the coefficient for trade-off between empirical and structural risk and ? is the width of ?-insensitive region) showed that it correctly recognized 243/250 OSA and 139/150 CSA events (95.5% detection accuracy). Independent test was performed on 80 OSA and 80 CSA events from 12 patients. The independent test accuracies of OSA and CSA detections were found to be 92.5 and 95.0%, respectively. Results suggest superior performance of SVR using ECG as the surrogate in recognizing the reduction of respiratory movement during OSA and CSA. Results also indicate that ECG-based SVR model could act as a potential surrogate signal of respiratory movement during sleep-disordered breathing. PMID:20972625

Khandoker, Ahsan H; Palaniswami, Marimuthu

2011-02-01

23

Pathophysiology of Sleep Apnea  

PubMed Central

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

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

2010-01-01

24

Sleep apnea in congestive heart failure.  

PubMed

Sleep-related breathing disorders, including obstructive sleep apnea (OSA) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA), commonly occur in patients with congestive heart failure (CHF). In this setting they can have adverse pathophysiologic effects on the cardiovascular system. OSA may lead to development or progression of left ventricular (LV) dysfunction by increasing LV afterload through the combined effects of elevations in systemic blood pressure and a generation of exaggerated negative intrathoracic pressure, and by activating the sympathetic nervous system through the influence of hypoxia and arousals from sleep. Abolition of OSA by continuous positive airway pressure (CPAP) can improve cardiac function in patients with CHF. In contrast to OSA, CSR-CSA is likely a consequence rather than a cause of CHF. Here, pulmonary congestion causes hyperventilation by stimulating pulmonary irritant receptors. This leads to reductions in PaCO2 below the apneic threshold during sleep, precipitating posthyperventilatory central apneas. CSR-CSA is associated with increased mortality in CHF, probably because of sympathetic nervous system activation caused by recurrent apnea-induced hypoxia and arousals from sleep. Treatment of CSR-CSA by supplemental O2, theophylline, and CPAP can alleviate central apneas. Of these treatments, however, only CPAP has been shown to improve cardiac function and symptoms of heart failure. We conclude that effective treatments of OSA and CSR-CSA may prove to be useful adjuncts to the standard pharmacologic therapy of patients with CHF. PMID:9554221

Naughton, M T; Bradley, T D

1998-03-01

25

Obstructive sleep apnea.  

PubMed

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

Balachandran, Jay S; Patel, Sanjay R

2014-11-01

26

Obstructive sleep apnea and other sleep-related syndromes.  

PubMed

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

Paiva, Teresa; Attarian, Hrayr

2014-01-01

27

Adaptive Servoventilation in Patients with Central or Complex Sleep Apnea Related to Chronic Opioid Use and Congestive Heart Failure  

PubMed Central

Study Objectives: Adaptive servoventilation (ASV) is often used to treat central sleep apnea (CSA) and complex sleep apnea syndrome (CompSAS). Both CompSAS and CSA may occur in the setting of CHF and with the use of chronic opioids. We hypothesized that ASV would be less successful in treatment of CSA and CompSAS secondary to opioid use than in CHF patients. Methods: Consecutive patients were studied between January and December 2009 who underwent ASV titration for CSA or CompSAS due to CHF (defined as EF < 45%, or > 50% with evidence for diastolic dysfunction on echocardiogram) and chronic opioid users (defined by the use of opioids > 6 months). Results: Study included one hundred and eight patients with 77 males (71.3%) and 31 females (28.7%). Subjects had severe sleep apnea at baseline (AHI 45.6 ± 27.4) and inadequate control of sleep disordered breathing on CPAP (AHI 50.0 ± 32.2, CAI 36.6 ± 32). No significant differences were found between the groups in overall ASV success, defined as AHI < 10/h (p = 0.236). ASV was successful in 28 (59.6%) of those in the opioid group, compared to 43 (70.5%) of those in the CHF group. When ASV success was defined as AHI < 5/h at optimum EEP, there was again no significant difference between the groups (p-value = 0.812). Logistic regression showed unit increases in BMI, unit increases in HCO3, and presence of CSR were each associated with decreased likelihood of ASV success. Conclusion: We did not find a statistically significant difference in the effectiveness of ASV between CHF patients and chronic opioid users, with the overall success rate approaching 70%, as defined by an AHI < 10/h. Commentary: A commentary on this article appears in this issue on page 577. Citation: Ramar K; Ramar P; Morgenthaler TI. Adaptive servoventilation in patients with central or complex sleep apnea related to chronic opioid use and congestive heart failure. J Clin Sleep Med 2012;8(5):569-576. PMID:23066370

Ramar, Kannan; Ramar, Priya; Morgenthaler, Timothy I.

2012-01-01

28

Sleep Apnea Assessment by ECG Pattern  

Microsoft Academic Search

Sleep apnea (SA) is accompanied by a characteristic cyclic variation in heart rate in the waveform of the electrocardiogram (ECG). If sleep apnea were able to be diagnosed with ECG only, it could revolutionalise the diagnosis of sleep apnea by allowing patient's to be diagnosed within their own homes. The most informative feature of ECG recordings is a low frequency

Wenlong Xu; Xiaofang Liu

2009-01-01

29

Obstructive sleep apnea and asthma*  

PubMed Central

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

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

2013-01-01

30

Sleep Related Expiratory Obstructive Apnea in Children  

PubMed Central

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

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

2012-01-01

31

Wireless remote monitoring system for sleep apnea  

NASA Astrophysics Data System (ADS)

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

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

2011-04-01

32

Sleep Apnea Detection  

MedlinePLUS

... at hospitals and major medical centers. During the study, medical staff will watch your child sleep. Several sensors will be attached to your child to monitor breathing, oxygenation, and brain waves (electroencephalogram; EEG). The results of the study will show whether your child suffers from sleep ...

33

Sleep Apnea and Cardiovascular Disease  

Microsoft Academic Search

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

Alexander G. Logan; T. Douglas Bradley

2010-01-01

34

Obstructive sleep apnea  

MedlinePLUS

... Avoid sleeping on your back Lose excess weight Continuous positive airway pressure (CPAP) devices work best to ... and depression Loss of interest in sex Poor performance at work or school Daytime sleepiness because of ...

35

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

PubMed Central

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

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

2014-01-01

36

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

PubMed Central

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) Citation: Aurora RN; Chowdhuri S; Ramar K; Bista SR; Casey KR; Lamm CI; Kristo DA; Mallea JM; Rowley JA; Zak RS; Tracy SL. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. SLEEP 2012;35(1):17-40. PMID:22215916

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

37

[Vertebrobasilar insufficiency and obstructive sleep apnea].  

PubMed

The aim of this article is to point to correlation between vertebrobasilar insufficiency (VBI) and obstructive sleep apnea (OSA) that has not been perceived sufficiently till now. Namely, in the voluminous literature about sleep-disordered breathing, VBI has been cited only as one of the possible causes of central and mixed sleep apnea. However, according to our clinical observation, VBI could be one of the most important factors in etiopathogenesis of OSA. Results of recent research, which confirm the correlation between VBI and OSA, contribute to our hypothesis. High prevalence and pathogenesis of OSA in patients with VBI can be explained by hypoxia of the medulla oblongata during sleep (sleep+positional VBI --> hypoxia of the medulla oblongata --> hypoxia of the respiratory centre which regulates breathing function+hypoxia of the motor nuclei of the IX, X and XII cranial nerves whose neurons regulate the tone in upper airway muscles (IX, X) and tongue (XII) --> OSA). The development of OSA in certain patients with VBI is probably in close correlation with the degree of hypoxia of the medulla oblongata during sleep (moderate VBI --> OSA; severe VBI --> central or mixed sleep apnea). Considering the fact that VBI of vascular and/or compressive etiology can be the primary cause of OSA, the Doppler sonography examination ofVB system (VBS) with the positional functional tests should be included in the diagnostic algorithm for OSA. Since the functional and organic disorders of cervical spine can either cause circulation disturbances in VBS or aggravate insufficient circulation, especially during sleep in certain head and neck positions, detailed examination of cervical spine including physiatric examination, manual functional examination and radiological examination, should become a part of the routine examination in patients with either suspected or confirmed OSA. Circulation in VBS can be improved or normalized by an appropriate therapy for vascular disorders (for example, stenting of vertebral artery), and the compressive effect of cervical spine disorders on circulation in VBS can be reduced or eliminated by an appropriate therapy of cervical spine disorders (for example, manual therapy, physical therapy, kinesitherapy, surgery etc.). OSA symptoms can be significantly reduced or completely cease after an improvement or normalization of circulation in VBS. PMID:21644279

Grgi?, Vjekoslav

2011-01-01

38

Obstructive Sleep Apnea in Children  

PubMed Central

Background: The obesity epidemic has prompted remarkable changes in the proportion of obese children who are referred for habitual snoring. However, the contribution of obesity to adenotonsillar hypertrophy remains undefined. Methods: In our study, 206 nonobese habitually snoring children with polysomnographically diagnosed obstructive sleep apnea (OSA) were matched for age, gender, ethnicity, and obstructive apnea-hypopnea index (OAHI) to 206 obese children. Size estimates of tonsils and adenoids, and Mallampati class scores were obtained, and allowed for the assessment of potential relationships between anatomic factors and obesity in pediatric OSA. Results: The mean OAHI for the two groups was approximately 10.0 episodes/h total sleep time. There was a modest association between adenotonsillar size and OAHI in nonobese children (r = 0.22; p < 0.001) but not in obese children. The mean (± SEM) adenotonsillar size was larger in nonobese children (3.85 ± 0.16 vs 3.01 ± 0.14, respectively; p < 0.0001), and conversely Mallampati class scores were significantly higher in obese children (p < 0.0001). Conclusion: The magnitude of adenotonsillar hypertrophy required for any given magnitude of OAHI is more likely to be smaller in obese children compared to nonobese children. Increased Mallampati scores in obese children suggest that soft-tissue changes and potentially fat deposition in the upper airway may play a significant role in the global differences in tonsillar and adenoidal size among obese and nonobese children with OSA. PMID:19225059

Dayyat, Ehab; Kheirandish-Gozal, Leila; Sans Capdevila, Oscar; Maarafeya, Muna M. A.; Gozal, David

2009-01-01

39

Detection of obstructive sleep apnea through ECG signal features  

Microsoft Academic Search

Obstructive sleep apnea (OSA) is a common disorder in which individuals stop breathing during their sleep. Most of sleep apnea cases are currently undiagnosed because of expenses and practicality limitations of overnight polysomnography (PSG) at sleep labs, where an expert human observer is needed to work over night. New techniques for sleep apnea classification are being developed by bioengineers for

Laiali Almazaydeh; Khaled Elleithy; Miad Faezipour

2012-01-01

40

Could a 'Fat Tongue' Be a Factor in Sleep Apnea?  

MedlinePLUS

... Could a 'Fat Tongue' Be a Factor in Sleep Apnea? In study, obese people with the disorder ... Preidt Tuesday, September 30, 2014 Related MedlinePlus Page Sleep Apnea TUESDAY, Sept. 30, 2014 (HealthDay News) -- Sleep ...

41

Obstructive sleep apnea in a laryngectomy patient: “External obstructive sleep apnea  

Microsoft Academic Search

Obstructive sleep apnea was diagnosed in a man after a total laryngectomy. Excessive daytime sleepiness led to a diagnostic\\u000a investigation. He had occlusion of the tracheal stoma while asleep by his chin and neck structures. This “external” obstructive\\u000a sleep apnea caused repetitive desaturations and arousals typical of sleep apnea. Therapeutic measures to keep the chin off\\u000a the stoma were successful

M. P. Coppola; J. M. Evitts; M. S. Lawee

1996-01-01

42

What Can You Do About Sleep Apnea?  

MedlinePLUS Videos and Cool Tools

... obstructive sleep apnea. It's estimated that more than 15 million Americans suffer from it. Three-quarters of ... the night -- not breathing for periods of 10, 15, 20 seconds, some people even over a minute. ...

43

Obesity, obstructive sleep apnea, and cardiovascular risk  

Microsoft Academic Search

Obesity is a major risk factor for cardiovascular disease, the number one killer of Americans. It is also a major risk factor\\u000a for obstructive sleep apnea, which is rising in the US population as the obesity epidemic continues. Obstructive sleep apnea,\\u000a in turn, has been implicated as a risk factor for hypertension, glucose dysregulation, and cardiovascular disease. Understanding\\u000a the pathophysiologic

Muhammad Iqbal; Syed Shah; Sonalis Fernandez; Jocelyne Karam; Girardin Jean-Louis; Samy I. McFarlane

2008-01-01

44

Chemoreflexes, sleep apnea, and sympathetic dysregulation.  

PubMed

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

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

2014-09-01

45

Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea.  

PubMed

The perioperative care of obstructive sleep apnea (OSA) patients is currently receiving much attention due to an increased risk for complications. It is established that postoperative changes in sleep architecture occur and this may have pathophysiological implications for OSA patients. Upper airway muscle activity decreases during rapid eye movement sleep (REMS). Severe OSA patients exhibit exaggerated chemoreceptor-driven ventilation during non-rapid eye movement sleep (NREMS), which leads to central and obstructive apnea. This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients. In particular, we addressed three questions in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA. Indeed, these classes of drugs alter sleep architecture, which likely significantly contributes to abnormal postoperative sleep architecture, exacerbation of OSA and postoperative complications. PMID:25318836

McEntire, Dan M; Kirkpatrick, Daniel R; Kerfeld, Mitchell J; Hambsch, Zakary J; Reisbig, Mark D; Agrawal, Devendra K; Youngblood, Charles F

2014-11-01

46

Untreated Sleep Apnea May Raise Risk of Surgical Complications  

MedlinePLUS

... features on this page, please enable JavaScript. Untreated Sleep Apnea May Raise Risk of Surgical Complications: Study ... September 26, 2014 Related MedlinePlus Pages After Surgery Sleep Apnea FRIDAY, Sept. 26, 2014 (HealthDay News) -- Screening ...

47

Portable Monitors OK for Spotting Sleep Apnea: New Guidelines  

MedlinePLUS

... JavaScript. Portable Monitors OK for Spotting Sleep Apnea: New Guidelines But the devices aren't for everyone, ... the diagnosis of obstructive sleep apnea, according to new guidelines issued by the American College of Physicians. ...

48

Sleep Apnea May Steal Some of Your Memory  

MedlinePLUS

... JavaScript. Sleep Apnea May Steal Some of Your Memory: Study Remembering everyday things was harder for those ... Preidt Friday, October 31, 2014 Related MedlinePlus Pages Memory Sleep Apnea FRIDAY, Oct. 31, 2014 (HealthDay News) -- ...

49

Study Finds a Connection between Glaucoma and Sleep Apnea  

MedlinePLUS

... News Consumer Alerts Study Finds a Connection Between Glaucoma and Sleep Apnea Tweet Eye Health Lifestyle Topics ... with sleep apnea are more likely to develop glaucoma Over the years, several studies have demonstrated an ...

50

Influence of Pulmonary Capillary Wedge Pressure on Central Apnea in Heart Failure  

Microsoft Academic Search

Background—Recent studies suggest that acute pulmonary congestion induces hyperventilation and that hyperventilation- related hypocapnia leads to ventilatory control instability and central sleep apnea. Whether chronic pulmonary congestion due to congestive heart failure (CHF) is associated with central apnea is unknown. We hypothesized that CHF patients with central apnea would have greater pulmonary capillary wedge pressure (PCWP) than patients without central

Peter Solin; Peter Bergin; Meroula Richardson; David M. Kaye; E. Haydn Walters; Matthew T. Naughton

51

Sleep and Quality of Life in Sleep Apnea  

Microsoft Academic Search

Health-related quality of life (HRQOL) is increasingly recognized as an important parameter in the assessment of the morbidity\\u000a associated with obstructive sleep apnea (OSA). Generic and sleep disorder-specific instruments consistently demonstrate impairment\\u000a in multiple domains of HRQOL in OSA, particularly in the domains of sleep, energy, fatigue, and vigilance. Sleep disorder-specific\\u000a tools are potentially more sensitive than generic tools in

Amy D. Atkeson; Robert C. Basner

52

Obstructive sleep apnea syndrome. Treatment outcome, psychiatric aspects, neuropsychology and quality of life.  

E-print Network

??Background: Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apneas during sleep leading to oxygen desaturation, sleep fragmentation and excessive daytime sleepiness. Prior… (more)

Dahlöf, Pia 1948-

2005-01-01

53

Respiratory mechanics and timing during sleep in occlusive sleep apnea.  

PubMed

Six human obese subjects with the sleep apnea hypersomnolence syndrome associated with upper airway occlusion (UAO) were studied during sleep to characterize respiration. Measurements included the timing components of ventilation, pulmonary resistance, flow, and esophageal and gastric pressures before and during UAOs. During the period between UAOs, the resistance progressively increased (9.4-18.1 cmH2O/l(-1) . s, P less than 0.05) as the ventilation decreased (1.82-0.77 l/s, P less than 0.05), but without changes in esophageal pressure swings. During this period, inspiratory time-to-total cycle time decreased (0.42-0.25 s, P less than 0.05) due to expiratory phase prolongation. The apnea began after expiration and terminated on inspiration with the maximal swings in esophageal and gastric pressure near the termination. During the UAO, the respiratory cycle time decreased slightly, but the expiratory pause time was significantly shortened immediately before ventilation. We suggest that the UAO is but one aspect of this syndrome and that a decrease in central nervous system activity diminishes the respiratory drive before the onset of the UAO. PMID:7372513

Martin, R J; Pennock, B E; Orr, W C; Sanders, M H; Rogers, R M

1980-03-01

54

Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment.  

PubMed

A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction. PMID:15329513

Ogawa, Aiko; Iwase, Takashi; Yamamoto, Takanobu; Nishiyama, Shinichirou; Narui, Koji; Momomura, Shinichi

2004-09-01

55

Sleep apnea and the kidney: is sleep apnea a risk factor for chronic kidney disease?  

PubMed

The prevalence of chronic kidney disease (CKD) is increasing, which presents challenges for both patients and health-care budgets. Although this phenomenon has been attributed to the growth in diabetes, hypertension, and obesity, sleep apnea and nocturnal hypoxemia may also contribute to the pathogenesis of CKD and its progression to kidney failure. Two pathophysiologic mechanisms responsible for CKD are glomerular hyperfiltration and chronic intrarenal hypoxia, resulting in tubulointerstitial injury, the final common pathway to end-stage kidney disease (ESKD). Multiple descriptive studies have demonstrated an association between CKD and sleep apnea. Although sleep apnea is common in patients with CKD and associated with significant nocturnal hypoxemia, it is often relatively free of sleep-related symptoms, making it difficult to detect without objective nocturnal monitoring. Nevertheless, sleep apnea and nocturnal hypoxemia have been associated with loss of kidney function and kidney injury, suggesting that they contribute to the pathogenesis of continued deterioration in kidney function. There are several pathways through which sleep apnea may achieve this, including a direct effect of intrarenal hypoxia and activation of the systemic and renal renin-angiotensin system. Further research is required to better understand these relationships and determine whether specific interventions in patients with sleep apnea have an impact on clinical outcomes, such as reducing the prevalence of CKD and delaying its progression to ESKD. PMID:25288001

Hanly, Patrick J; Ahmed, Sofia B

2014-10-01

56

Intact implicit probabilistic sequence learning in obstructive sleep apnea  

E-print Network

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

Nemeth, Dezso

57

Making sense of oxidative stress in obstructive sleep apnea: mediator or distracter?  

PubMed

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

Zhang, Jing; Veasey, Sigrid

2012-01-01

58

Obstructive sleep apnea and cardiovascular risk  

PubMed Central

Obstructive sleep apnea (OSA) is a form of sleep disordered breathing characterized by episodes of apnea (during sleep) lasting at least 10 seconds per episode. The apneic periods are associated with arterial hypoxemia and disruption of normal sleep as a result of awakenings. It is increasingly being recognized that OSA is a public health hazard and there is increasing evidence that it is associated with an increase in morbidity (and possibly mortality). Patients with OSA also utilize the healthcare resources at higher rates than control patients long before their diagnosis is confirmed. Early recognition of this condition may lead to earlier treatments (eg, nasal CPAP) with reduction of the risk of cardiovascular diseases such as hypertension, ischemic heart disease, arrhythmias, platelet activation and pulmonary hypertension. PMID:18516275

Dorasamy, Punginathn

2007-01-01

59

Epidemiology of Pediatric Obstructive Sleep Apnea  

Microsoft Academic Search

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

Julie C. Lumeng; Ronald D. Chervin

2008-01-01

60

Sleep apnea in heart failure: Implications of sympathetic nervous system activation for disease progression and treatment  

Microsoft Academic Search

Mortality risk in heart failure relates to the degree of chronic sympathetic nervous system activation. Do acute increases\\u000a in central sympathetic outflow, as occur nightly in patients with sleep apnea, augment this risk? This review explores 4 novel\\u000a concepts: 1) sleep disordered breathing is common in heart failure, 2) the acute effects of sleep apnea and the chronic effects\\u000a of

John S. Floras

2005-01-01

61

Altered Cardiovascular Variability in Obstructive Sleep Apnea  

Microsoft Academic Search

Background—Altered cardiovascular variability is a prognostic indicator for cardiovascular events. Patients with obstructive sleep apnea (OSA) are at an increased risk for cardiovascular disease. We tested the hypothesis that OSA is accompanied by alterations in cardiovascular variability, even in the absence of overt cardiovascular disease. Methods and Results—Spectral analysis of variability of muscle sympathetic nerve activity, RR interval, and blood

Krzysztof Narkiewicz; Nicola Montano; Chiara Cogliati; Philippe J. H. van de Borne; Mark E. Dyken; Virend K. Somers

62

Diagnostic Issues in Pediatric Obstructive Sleep Apnea  

PubMed Central

Obstructive sleep apnea syndrome (OSAS) in children includes a spectrum of respiratory disorders with significant morbidities. Diagnosis of OSAS is based on clinical suspicion, history, and physical findings, and confirmation is made by polysomnography. There has been significant progress in recent years in technologies available for diagnosis of OSAS since the consensus statement of the American Thoracic Society in 1996. The current review describes methodologies that are available today for assessment and diagnosis of OSAS in children and summarizes the most recent recommendations of the American Academy of Sleep Medicine Task Force regarding scoring sleep-related respiratory events in children. PMID:18250220

Muzumdar, Hiren; Arens, Raanan

2008-01-01

63

Obstructive Sleep Apnea, Immuno-Inflammation and Atherosclerosis  

E-print Network

pharyngeal collapses occurring during sleep [1]. The upper airway closure could be complete, leadingObstructive 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

Paris-Sud XI, Université de

64

New Research Suggests Glaucoma Screenings for Sleep Apnea Sufferers  

MedlinePLUS

New Research Suggests Glaucoma Screenings for Sleep Apnea Sufferers 08/07/2013 09:00:00 AM Taiwanese study finds significantly higher prevalence for ... sleep apnea are far more likely to develop glaucoma compared to those without the sleep condition. The ...

65

Alcohol, snoring and sleep apnea  

Microsoft Academic Search

We studied the effect of alcohol ingestion on sleep-induced breathing abnormalities and arterial oxyhaemoglobin saturation in seven patients with a range of sleep-induced upper airway occlusion. The characteristics of each patient's sleep-induced breathing abnormality was established on one or more control all-night studies, and then a further all-night study was done immediately following alcohol ingestion. Alcohol increased the duration and

F G Issa; C E Sullivan

1982-01-01

66

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

E-print Network

Does Acute Exercise Improve Driving Performance in Patients with Untreated Obstructive Sleep Apnea of Indianapolis, Indianapolis, Indiana, 46202 Mentors: Anthony S. Kaleth and Sarah Koskie Obstructive Sleep Apnea

Zhou, Yaoqi

67

Therapeutic Strategies for Sleep Apnea in Hypertension and Heart Failure  

PubMed Central

Sleep-disordered breathing (SDB) causes hypoxemia, negative intrathoracic pressure, and frequent arousal, contributing to increased cardiovascular disease mortality and morbidity. Obstructive sleep apnea syndrome (OSAS) is linked to hypertension, ischemic heart disease, and cardiac arrhythmias. Successful continuous positive airway pressure (CPAP) treatment has a beneficial effect on hypertension and improves the survival rate of patients with cardiovascular disease. Thus, long-term compliance with CPAP treatment may result in substantial blood pressure reduction in patients with resistant hypertension suffering from OSAS. Central sleep apnea and Cheyne-Stokes respiration occur in 30–50% of patients with heart failure (HF). Intermittent hypoxemia, nocturnal surges in sympathetic activity, and increased left ventricular preload and afterload due to negative intrathoracic pressure all lead to impaired cardiac function and poor life prognosis. SDB-related HF has been considered the potential therapeutic target. CPAP, nocturnal O2 therapy, and adaptive servoventilation minimize the effects of sleep apnea, thereby improving cardiac function, prognosis, and quality of life. Early diagnosis and treatment of SDB will yield better therapeutic outcomes for hypertension and HF. PMID:23509623

Noda, Akiko; Miyata, Seiko; Yasuda, Yoshinari

2013-01-01

68

Neurocognitive effects of obstructive sleep apnea syndrome  

Microsoft Academic Search

The nature of the neurocognitive deficits found in obstructive sleep apnea is still debatable. What is the extent of higher\\u000a executive versus alertness-based cognitive dysfunction? Are cognitive impairments caused by nighttime hypoxemia or daytime\\u000a sleepiness? This paper demonstrates the importance of a sound theoretical neurocognitive framework to be able to answer these\\u000a questions. A strategy to assess executive function is

Edwin Verstraeten

2007-01-01

69

Obstructive sleep apnea in Treacher Collins syndrome  

Microsoft Academic Search

The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian\\u000a population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated\\u000a with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis\\u000a of

Harriet AkreBritt; Britt Øverland; Pamela Åsten; Nina Skogedal; Ketil Heimdal

70

Obstructive sleep apnea and atrial arrhythmogenesis.  

PubMed

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

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

2014-11-01

71

Sleep Endoscopy in the Evaluation of Pediatric Obstructive Sleep Apnea  

PubMed Central

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

Lin, Aaron C.; Koltai, Peter J.

2012-01-01

72

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

PubMed Central

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

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

2012-01-01

73

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

PubMed

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

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

2014-01-01

74

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

PubMed Central

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/m2 and general obesity was defined as BMI ? 30?kg/m2. 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

Barbosa, Clarita; Andrade, Asterio; Frye, Megan; Williams, Michelle A.

2014-01-01

75

Comparison of Primary-Care Practitioners and Sleep Specialists in the Treatment of Obstructive Sleep Apnea  

Microsoft Academic Search

We wished to determine if being treated for sleep apnea by a sleep specialist increased patient awareness or long-term continuous positive airway pressure (CPAP) compliance. We performed a retrospective telephone survey and laboratory chart review in patients with a diagnosis of sleep apnea evaluated either at a laboratory in which only sleep specialists can order polysomnography (University Specialty Hospital, noted

Steven M. Scharf; Jennifer DeMore; Talia Landau; Patricia Smale

2004-01-01

76

Sleep apnea-hypopnea quantification by cardiovascular data analysis  

E-print Network

Sleep apnea is the most common sleep disturbance and it is an important risk factor for cardiovascular disorders. Its detection relies on a polysomnography, a combination of diverse exams. In order to detect changes due to sleep disturbances such as sleep apnea occurrences, without the need of combined recordings, we mainly analyze systolic blood pressure signals (maximal blood pressure value of each beat to beat interval). Nonstationarities in the data are uncovered by a segmentation procedure, which provides local quantities that are correlated to apnea-hypopnea events. Those quantities are the average length and average variance of stationary patches. By comparing them to an apnea score previously obtained by polysomnographic exams, we propose an apnea quantifier based on blood pressure signal. This furnishes an alternative procedure for the detection of apnea based on a single time series, with an accuracy of 82%.

Camargo, Sabrina; Anteneodo, Celia; Kurths, Juergen; Penzel, Thomas; Wessel, Niels

2014-01-01

77

Obstructive sleep apnea: role of intermittent hypoxia and inflammation.  

PubMed

Obstructive sleep apnea results in intermittent hypoxia via repetitive upper airway obstruction leading to partial or complete upper airway closure, apneas and hypopneas, respectively. Intermittent hypoxia leads to sympathetic nervous system activation and oxidative stress with a resultant systemic inflammatory cascade. The putative mechanism by which obstructive sleep apnea has been linked to numerous pathologic conditions including stoke, cardiovascular disease, hypertension, and metabolic derangements is through these systemic effects. Treatment of obstructive sleep apnea appears to reduce systemic markers of inflammation and ameliorates the adverse sequelae of this disease. PMID:25333334

May, Anna M; Mehra, Reena

2014-10-01

78

Sleep Apnea Syndrome and Diastolic Blood Pressure Elevation during Exercise  

Microsoft Academic Search

Background: Several studies assessing the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for hypertension have produced conflictingresults. Although the sleep apnea syndrome is associated with hypertension, there are no references regarding the blood pressure response of normotensive OSAS patients during exercise. Study Objectives: The aim of this study was to investigate the relationship between diastolic

Stavros Tryfon; Ioannis Stanopoulos; Efi Dascalopoulou; Paraskevi Argyropoulou; Demosthenes Bouros; Euklides Mavrofridis

2004-01-01

79

Cognitive impairment in obstructive sleep apnea.  

PubMed

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

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

2014-10-01

80

Obstructive sleep apnea in Treacher Collins syndrome.  

PubMed

The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS. PMID:21626120

Akre, Harriet; Øverland, Britt; Åsten, Pamela; Skogedal, Nina; Heimdal, Ketil

2012-01-01

81

Abdominal Compression Increases Upper Airway Collapsibility During Sleep in Obese Male Obstructive Sleep Apnea Patients  

PubMed Central

Study Objectives: Abdominal obesity, particularly common in centrally obese males, may have a negative impact on upper airway (UA) function during sleep. For example, cranial displacement of the diaphragm with raised intra-abdominal pressure may reduce axial tension exerted on the UA by intrathoracic structures and increase UA collapsibility during sleep. Design: This study aimed to examine the effect of abdominal compression on UA function during sleep in obese male obstructive sleep apnea patients. Setting: Participants slept in a sound-insulated room with physiologic measurements controlled from an adjacent room. Participants: Fifteen obese (body mass index: 34.5 ± 1.1 kg/m2) male obstructive sleep apnea patients (apnea-hypopnea index: 58.1 ± 6.8 events/h) aged 50 ± 2.6 years participated. Interventions: Gastric (PGA) and transdiaphragmatic pressures (PDI), UA closing pressure (UACP), UA airflow resistance (RUA), and changes in end-expiratory lung volume (EELV) were determined during stable stage 2 sleep with and without abdominal compression, achieved via inflation of a pneumatic cuff placed around the abdomen. UACP was assessed during brief mask occlusions. Measurements and Results: Abdominal compression significantly decreased EELV by 0.53 ± 0.24 L (P = 0.045) and increased PGA (16.2 ± 0.8 versus 10.8 ± 0.7 cm H2O, P < 0.001), PDI (11.7 ± 0.9 versus 7.6 ± 1.2 cm H2O, P < 0.001) and UACP (1.4 ± 0.8 versus 0.9 ± 0.9 cm H2O, P = 0.039) but not RUA (6.5 ± 1.4 versus 6.9 ± 1.4 cm H2O·L/s, P = 0.585). Conclusions: Abdominal compression negatively impacts on UA collapsibility during sleep and this effect may help explain strong associations between central obesity and obstructive sleep apnea. Citation: Stadler DL; McEvoy RD; Sprecher KE; Thomson KJ; Ryan MK; Thompson CC; Catcheside PG. Abdominal compression increases upper airway collapsibility during sleep in obese male obstructive sleep apnea patients. SLEEP 2009;32(12):1579-1587. PMID:20041593

Stadler, Daniel L.; McEvoy, R. Doug; Sprecher, Kate E.; Thomson, Kieron J.; Ryan, Melissa K.; Thompson, Courtney C.; Catcheside, Peter G.

2009-01-01

82

Newer treatment modalities for pediatric obstructive sleep apnea.  

PubMed

The obstructive sleep apnea syndrome is common and its prevalence is expected to increase with the current obesity epidemic. If left untreated, it is associated with important morbidity such as growth failure, neurocognitive impairment, systemic and pulmonary hypertension, and endothelial dysfunction. Recent research has shown that many children, especially the obese or those with other underlying medical conditions, have residual obstructive sleep apnea after adenotonsillectomy (the primary treatment for childhood obstructive sleep apnea). These children could be effectively treated with continuous positive airway pressure but poor adherence is a significant limitation of this therapy. Therefore, new treatment modalities for the pediatric obstructive sleep apnea syndrome are needed. Current research has focused on newer therapies for pediatric obstructive sleep apnea, such as anti-inflammatories, dental treatments, high-flow nasal cannula, and weight loss. However, there are few randomized controlled trials assessing the effectiveness of these therapies. Further research is warranted. PMID:23931720

Tapia, Ignacio E; Marcus, Carole L

2013-09-01

83

Smoking, snoring and obstructive sleep apnea.  

PubMed

Obstructive sleep apnea (OSA), with an apnea/hypopnea index (AHI) > or =5 events per hour, is recognized as an important cause of medical morbidity and mortality, being associated with a wide range of significant medical consequences, including arterial hypertension, cardiovascular diseases, metabolic diseases, neurological diseases and psychological effects. Tobacco smoking is considered a predisposing factor for pulmonary and cardiovasculary diseases and a risk factor for developing OSA. Since snoring is frequent in smokers and a common symptom, even a preclinical form of OSA, it is reasonable to speculate that smoking is an independent risk factor for snoring and may be associated with OSA. Current studies have observed there is a synergistic effect between smoking and OSA, both increasing the risk of cardiovascular disease through oxidative stress, endothelial dysfunction and abnormal inflammatory response. OSA, itself could be responsible for nicotine addiction. PMID:23781575

Trenchea, Mihaela; Deleanu, Oana; Su?a, Maria; Arghir, Oana Cristina

2013-01-01

84

Influence of Weight and Sleep Apnea Status on Immunologic and Structural Features of the Uvula  

Microsoft Academic Search

We investigated the influence of weight and obstructive sleep apnea status on inflammatory and histologic features of the uvula. Tissue samples resected during uvulopalatopharyngoplasty in 11 snorers without obstructive sleep apnea, 11 subjects with obstructive sleep apnea and of similar body mass index and age, and 8 additional obese subjects with obstructive sleep apnea were examined by immunohistochemistry and histologic

Jamila Chakir; Dominick Boivin

2004-01-01

85

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

E-print Network

On the Use of Smartphones for Detecting Obstructive Sleep Apnea Abstract--Obstructive Sleep Apnea of a smartphone's built-in sensors, pervasiveness, computational capabilities, and user- friendly interface using an external oximeter, (2) respiratory effort using the smartphone's built-in microphone, and (3

Aloul, Fadi

86

Childhood Obesity and Obstructive Sleep Apnea  

PubMed Central

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

Narang, Indra; Mathew, Joseph L.

2012-01-01

87

Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome  

PubMed Central

Study Objectives: In children, most obstructive events occur during rapid eye movement (REM) sleep. We hypothesized that children with the obstructive sleep apnea syndrome (OSAS), in contrast to age-matched control subjects, would not maintain airflow in the face of an upper airway inspiratory pressure drop during REM sleep. Design: During slow wave sleep (SWS) and REM sleep, we measured airflow, inspiratory time, inspiratory time/total respiratory cycle time, respiratory rate, tidal volume, and minute ventilation at a holding pressure at which flow limitation occurred and at 5 cm H2O below the holding pressure in children with OSAS and in control subjects. Setting: Sleep laboratory. Participants: Fourteen children with OSAS and 23 normal control subjects. Results: In both sleep states, control subjects were able to maintain airflow, whereas subjects with OSAS preserved airflow in SWS but had a significant decrease in airflow during REM sleep (change in airflow of 18.58 ± 12.41 mL/s for control subjects vs ?44.33 ± 14.09 mL/s for children with OSAS, P = 0.002). Although tidal volume decreased, patients with OSAS were able to maintain minute ventilation by increasing the respiratory rate and also had an increase in inspiratory time and inspiratory time per total respiratory cycle time Conclusion: Children with OSAS do not maintain airflow in the face of upper-airway inspiratory-pressure drops during REM sleep, indicating a more collapsible upper airway, compared with that of control subjects during REM sleep. However, compensatory mechanisms exist to maintain minute ventilation. Local reflexes, central control mechanisms, or both reflexes and control mechanisms need to be further explored to better understand the pathophysiology of this abnormality and the compensation mechanism. Citation: Huang J; Karamessinis LR; Pepe ME; Glinka SM; Samuel JM; Gallagher PR; Marcus CL. Upper airway collapsibility during REM sleep in children with the obstructive sleep apnea syndrome. SLEEP 2009;32(9):1173-1181. PMID:19750922

Huang, Jingtao; Karamessinis, Laurie R.; Pepe, Michelle E.; Glinka, Stephen M.; Samuel, John M.; Gallagher, Paul R.; Marcus, Carole L.

2009-01-01

88

Brain Structural Changes in Obstructive Sleep Apnea  

PubMed Central

Study Objectives: Determine whether obstructive sleep apnea (OSA) subjects show indications of axonal injury. Design: We assessed fiber integrity in OSA and control subjects with diffusion tensor imaging (DTI). We acquired four whole-brain DTI series from each subject. The four series were realigned, and the diffusion tensor calculated at each voxel. Fractional anisotropy (FA), a measure of fiber integrity, was derived from the diffusion tensor, resulting in a whole brain FA “map.” The FA maps were spatially normalized, smoothed, and compared using voxel-based statistics to determine differences between OSA and control groups, with age as a covariate (P < 0.05, corrected for multiple comparisons). Setting: University medical center. Subjects: We studied 41 patients with untreated OSA (mean age ± SD: 46.3 ± 8.9 years; female/male: 7/34) with apnea-hypopnea index 15 to 101 (mean ± SD: 35.7 ± 18.1 events/hour), and 69 control subjects (mean age ± SD: 47.5 ± 8.79 years; female/male: 25/44). Measurements and Results: Multiple regions of lower FA appeared within white matter in the OSA group, and included fibers of the anterior corpus callosum, anterior and posterior cingulate cortex and cingulum bundle, right column of the fornix, portions of the frontal, ventral prefrontal, parietal and insular cortices, bilateral internal capsule, left cerebral peduncle, middle cerebellar peduncle and corticospinal tract, and deep cerebellar nuclei. Conclusions: White matter is extensively affected in OSA patients; the alterations include axons linking major structures within the limbic system, pons, frontal, temporal and parietal cortices, and projections to and from the cerebellum. Citation: Macey PM; Kumar R; Woo MA; Valladares EM; Yan-Go FL; Harper RM. Brain structural changes in obstructive sleep apnea. SLEEP 2008;31(7):967-977. PMID:18652092

Macey, Paul M.; Kumar, Rajesh; Woo, Mary A.; Valladares, Edwin M.; Yan-Go, Frisca L.; Harper, Ronald M.

2008-01-01

89

Contemporary Surgery for Obstructive Sleep Apnea Syndrome  

PubMed Central

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

2009-01-01

90

The relationship of sleepiness and blood pressure to respiratory variables in obstructive sleep apnea.  

PubMed

As a follow-up to a previous assessment of complications of sleep-disturbed breathing in 265 patients, we have reevaluated measures of sleepiness and hypertension in patients with obstructive sleep apnea (OSA) (n = 518), central sleep apnea (n = 50), and subclinical sleep-disordered breathing (SDB) (n = 107). Both subjective and objective (multiple sleep latency test [MSLT]) measures indicated that OSA patients were sleepier than those with subclinical SDB. The OSA patients weighed significantly more than the patients with central sleep apnea or subclinical SDB. They had a higher proportion of men, described more habitual sleepiness, and had a higher likelihood of feeling unrefreshed in the morning compared with the group with subclinical SDB. Among the OSA patients, there was a significant correlation between subjective and objective assessment of sleepiness, but this relationship was quantitatively very small. A forward stepwise regression analysis revealed that weight, and to a lesser degree waking time after sleep onset, could account for 65.5% of the variance in subjective sleepiness. Seventy-five percent of the variance of the mean sleep latency in the MSLT could be accounted for by the mean minimum arterial oxygen saturation in non-REM sleep and the nocturnal sleep latency. Diastolic BP was significantly higher in OSA patients compared with the patients with central sleep apnea and subclinical SDB. When covarying for weight, age, and gender, this effect lost significance. Among OSA patients taken by themselves, 98.3% of the variance in diastolic blood pressure could be accounted for by the mean minimum arterial oxygen saturation in non-REM sleep, with very small additional contributions of apnea/hypopnea index, weight, and age. In summary, among patients across a spectrum of SDB, differences in diastolic BP were primarily associated with weight, age, and gender. Among OSA patients, perhaps because of a more limited variance in weight, diastolic BP was associated with measures of SDB. PMID:7555170

Mendelson, W B

1995-10-01

91

Obstructive Sleep Apnea Mimics Attention Deficit Disorder.  

PubMed

Attention deficit and hyperactivity are known possible symptoms or correlates of obstructive sleep apnea (OSA). However, these associations may be missed in children, because children often fail to report excessive daytime sleepiness, and attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are common primary diagnoses in themselves. We report on a 17-year-old, slender, non-snoring male who presented to his pediatrician with a prolonged history of four complaints: inattention, fidgeting, frequent sinusitis, and somnolence. He was diagnosed with ADHD, while the somnolence, which often abated somewhat upon use of antibiotics for sinusitis, was attributed to the sinus infections. A later sleep study revealed OSA, and thorough additional testing proved that the original ADHD diagnosis was in error. All four conditions were allayed with proper use of a continuous positive airway pressure (CPAP) machine. (J. of Att. Dis. 2013; XX(X) 1-XX). PMID:23529886

Blesch, Lauri; Breese McCoy, Sarah J

2013-03-25

92

A safety trial of sodium oxybate in patients with obstructive sleep apnea: Acute effects on sleep-disordered breathing  

Microsoft Academic Search

ObjectiveSodium oxybate (SXB) is an approved drug for the treatment of excessive daytime sleepiness (EDS) and cataplexy in narcolepsy. Obstructive sleep apnea syndrome (OSAS) is a condition that frequently co-occurs with narcolepsy. Given the known central nervous system (CNS) depressant effects of SXB, this study aimed to examine its effects on sleep-disordered breathing (SDB) and sleep architecture in patients with

Charles F. P. George; Neil Feldman; Neil Inhaber; Teresa L. Steininger; Susanna M. Grzeschik; Chinglin Lai; Yanping Zheng

2010-01-01

93

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

NASA Astrophysics Data System (ADS)

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

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

2005-01-01

94

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

E-print Network

by recurrent pharyngeal collapses occurring during sleep 1 . The upper airway[ ] closure could be completeSemin Immunopathol . Author manuscript Page /1 11 Obstructive sleep apnea, immuno Arnaud Abstract Obstructive sleep apnea (OSA) is a highly prevalent

Boyer, Edmond

95

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

E-print Network

416 IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 15, NO. 3, MAY 2011 Apnea MedAssist: Real-time Sleep Apnea Monitor Using Single-Lead ECG Majdi Bsoul, Member, IEEE, Hlaing Minn, Senior-time sleep apnea monitoring system ``Apnea MedAssist" for recognizing obstruc- tive sleep apnea episodes

Minn, Hlaing

96

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

E-print Network

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

Pennsylvania, University of

97

Cardiovascular disease risk reduction with sleep apnea treatment  

PubMed Central

Cardiovascular diseases are the leading cause of death among adults in developed countries. An increase in prevalent cardiovascular risk factors (e.g., obesity, hypertension and diabetes) has led to a concerted effort to raise awareness of the need to use evidence-based strategies to help patients at risk of developing cardiovascular disease and to reduce their likelihood of suffering a stroke. Sleep apnea has emerged as an important risk factor for the development of cardiovascular disease. Epidemiologic and clinical evidence has prompted the American Heart Association to issue a scientific statement describing the need to recognize sleep apnea as an important target for therapy in reducing cardiovascular disease risks. This article examines evidence supporting associations of sleep apnea with cardiovascular disease and considers evidence suggesting cardiovascular risk reductions through sleep apnea treatment. Perspectives on emerging therapeutic approaches and promising areas of clinical and experimental research are also discussed. PMID:20602560

Jean-Louis, Girardin; Brown, Clinton D; Zizi, Ferdinand; Ogedegbe, Gbenga; Boutin-Foster, Carla; Gorga, Joseph; McFarlane, Samy I

2014-01-01

98

Oral Appliances for Obstructive Sleep Apnea  

PubMed Central

Executive Summary Objective The objective of this review was to determine the clinical effectiveness of oral appliances compared to ‘no treatment’, continuous positive airway pressure (CPAP), or surgery for the management of obstructive sleep apnea (OSA). Clinical Need: Condition and Target Population OSA is characterized by repeated occurrences of upper airway collapse and obstruction during sleep. The condition leads to excessive daytime sleepiness, diminished quality of life, and increased risks of accidents, cardiovascular disease and death. In the general population, the prevalence of OSA is estimated to be 4% in men and 2% in women. Risk factors for OSA include obesity, male gender, increasing age, alcohol use, sedative use, and a family history of OSA. Description of Oral Appliances Oral appliances for OSA fall into two broad categories: mandibular advancement splints (MAS), also known as mandibular repositioning devices, and tongue repositioning or retaining devices. The aim of MAS devices is to advance the mandible forward slightly to enlarge the upper airway and prevent it from collapsing. Similarly, tongue repositioning devices suction the tongue forward to prevent it from falling back and obstructing the airway during sleep. The alternatives to oral appliances include continuous positive airway pressure (CPAP) devices, surgery, drug therapy, positional devices, and lifestyle modification. CPAP is the gold standard of treatment, but despite its effectiveness, compliance rates for CPAP have declined because required systems are noisy and because wearing the mask can be uncomfortable, causing claustrophobia in some users. Evidence-Based Analysis Methods Research Questions Are oral appliances effective in improving sleep-disordered breathing in patients with OSA compared to alternative treatments? Are there safety concerns with oral appliances? What is the evidence regarding patient preference, quality of life, and compliance for oral appliances? If effective, are oral appliances cost effective? Literature Search A literature search was conducted up to February 2009. Systematic reviews, meta-analyses and randomized controlled trials (RCTs) with more than 20 adults with OSA were eligible for inclusion. The primary outcomes of interest were the Apnea Hypopnea Index (AHI), measures of daytime sleepiness, patient preference, compliance, and adverse events. Summary of Findings Five systematic reviews and 16 RCTs that met the inclusion criteria were identified. The systematic reviews consistently concluded that CPAP was more effective than oral appliances at improving sleep disordered breathing, although there may be a niche area for the latter, especially among those with mild OSA as CPAP is difficult to tolerate by some users. Based on the results of the RCTs analyzed for this review, MAS devices are less effective than CPAP when AHI is used as the outcome of interest. MAS devices were shown to decrease AHI levels, but whether this reduction is clinically meaningful is uncertain. The Epworth Sleepiness Scale (ESS) was not able to achieve statistical significance in comparisons of MAS versus CPAP and MAS versus placebo. Nonetheless, after treatment with either MAS or CPAP, patients seem to be able to achieve normal ESS levels. The ESS has substantial limitations including its subjective nature and low construct validity (i.e. it is unclear if the scale is an accurate measure of sleepiness). Adverse events among patients with MAS devices in the RCTs were common, but mostly mild and transient. Jaw discomfort was the most commonly reported adverse event. Based on the results of the RCTs, compliance does not seem to be better or worse with MAS or CPAP. Similarly, there is no clear patient preference for MAS or CPAP among the studies reporting preference and satisfaction. Keywords Obstructive sleep apnea, oral appliances, mandibular advancement splints, tongue repositioning devices PMID:23074535

2009-01-01

99

Insights into obstructive sleep apnea research.  

PubMed

Moderate to severe obstructive sleep apnea (OSA) occurs in 10-17% of middle aged men and 3-9% of middle-aged women with a higher prevalence among obese subjects. This condition is an independent risk factor for many cardiovascular diseases. Intermittent hypoxia is a major pathophysiologic character of OSA; it can lead to oxidative stress and inflammation, which in their turn cause endothelial dysfunction, a hallmark of atherosclerosis. Many animal models have been designed to mimic OSA in human patients to allow more in-depth investigation of biological and cellular mechanisms of this condition. This review discusses the cardiovascular outcomes of OSA and some of the animal models that are being used to investigate it. PMID:24824769

Badran, Mohammad; Ayas, Najib; Laher, Ismail

2014-05-01

100

Sleep Apnea-Hypopnea Quantification by Cardiovascular Data Analysis  

PubMed Central

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

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

2014-01-01

101

Prosthodontic Approach to Treat Obstructive Sleep Apnea  

PubMed Central

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

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

2014-01-01

102

Morbidities associated with obstructive sleep apnea.  

PubMed

Obstructive sleep apnea (OSA)-induced biological changes include intermittent hypoxia, intermittent hypercapnia, intrathoracic pressure changes, sympathetic activation and sleep fragmentation. OSA can cause metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and hypercoagulation, and neurohumoral changes. There is evidence suggesting that OSA is independently associated with metabolic syndrome. OSA has been shown to increase the risk for systemic hypertension, pulmonary vascular disease, ischemic heart disease, cerebral vascular disease, congestive heart failure and arrhythmias. Although there are evidences accumulating that there may be a causal relationship between OSA and cardiovascular disorders, there is a need for more data from randomized controlled intervention trials to confirm this relationship. Many risk factors of OSA (age, male gender and obesity) are also known risk factors for cardiovascular disease. Severe OSA-hypopnea significantly increases the risk of fatal and nonfatal cardiovascular events in both men and women, and continuous positive airway pressure treatment reduces this risk in both. Neurocognitive consequences of OSA include daytime sleepiness, loss of alertness, memory deficit, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life. PMID:23134249

Vijayan, Vannan Kandi

2012-11-01

103

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

E-print Network

-Time Sleep Apnea Detection by Classifier Combination Baile Xie, Student Member, IEEE, and Hlaing Minn, Senior investigates real-time sleep apnea and hypopnea syndrome (SAHS) detection based on electro- cardiograph (ECG ), sleep apnea. I. INTRODUCTION SLEEP apnea and hypopnea syndrome (SAHS) is a com- mon sleep disorder which

Minn, Hlaing

104

Obstructive Sleep Apnea Alters Sleep Stage Transition Matt T. Bianchi1  

E-print Network

Obstructive Sleep Apnea Alters Sleep Stage Transition Dynamics Matt T. Bianchi1 *, Sydney S. Cash1 and Biotechnology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America, 3 Sleep Introduction: Enhanced characterization of sleep architecture, compared with routine polysomnographic metrics

105

A Retrospective Case Series of Adaptive Servoventilation for Complex Sleep Apnea  

PubMed Central

Study Objectives: Central sleep apnea can be refractory to traditional positive airway pressure (PAP) therapy (CPAP or bilevel PAP), whether appearing first as a feature of baseline polysomnography or only later once PAP is applied in what is termed “complex sleep apnea” (CompSA). This retrospective study examined the efficacy of adaptive servoventilation (ASV) in 25 consecutive patients with PAP-refractory central sleep apnea, most exhibiting predominantly obstructive apnea during baseline polysomnography. Methods: Patient characteristics were: age = 59.8 ± 16.5 yr; BMI = 30.4 ± 6.1 kg/m2; apnea/hypopnea index (AHI) = 48.5 ± 30.2/h; and central apnea index (CAI) = 10.8 ± 16.0/h. Following unsuccessful PAP titrations, patients underwent ASV titration. Eighteen met established criteria for CompSA. Results: On traditional PAP, AHI did not improve significantly compared to baseline, whether based on the entire titration (38.5 ± 23.4/h, p = 0.10) or the final PAP pressure(s) (44.4 ± 25.9/h, p = 0.54); CAI tripled across the titration (27.4 ± 23.5/h, p = 0.001) and at the final pressure(s) (34.8 ± 24.2/h, p < 0.001). On ASV, AHI fell to 11.4 ± 8.2/h across the titration (p < 0.001) and decreased further to 3.6 ± 4.2/h at the optimal end expiratory pressure (p < 0.001). AHI was ? 5/h in 80% of patients and < 10/h in 92%. ASV virtually eliminated central apneas at optimal end expiratory pressure (0.7 ± 2.2/h, p < 0.001). Respiratory arousals showed parallel improvements on ASV but not PAP. Conclusions: ASV proved superior to traditional PAP in reducing the AHI, CAI, and respiratory arousals in a heterogeneous patient group with sleep disordered breathing in whom central apneas emerged or persisted on PAP. Citation: Brown SE; Mosko SS; Davis JA; Pierce RA; Godfrey-Pixton TV. A retrospective case series of adaptive servoventilation for complex sleep apnea. J Clin Sleep Med 2011;7(2):187-195. PMID:21509335

Brown, Stephen E.; Mosko, Sarah S.; Davis, James A.; Pierce, R. Ander; Godfrey-Pixton, Tamera V.

2011-01-01

106

Do Patients With Obstructive Sleep Apnea Wake Up With Headaches?  

Microsoft Academic Search

Background: There is a controversy regarding the as- sociation of obstructive sleep apnea (OSA) and morn- ing headaches. This study investigates whether this re- lationship exists. Methods: This is a retrospective study of 80 consecu- tive patients with OSA who underwent sleep polysom- nography from December 1996 to March 1997. Patients were interviewed about their headache history. Head- aches were

N. K. Loh; D. S. Dinner; N. Foldvary; F. Skobieranda; W. W. Yew

1999-01-01

107

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

E-print Network

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

Timmer, Jens

108

Sodium Oxybate and Sleep Apnea: A Clinical Case  

PubMed Central

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

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

2011-01-01

109

Obstructive sleep apnea and the prevalence and incidence of cancer  

PubMed Central

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

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

2014-01-01

110

Obstructive sleep apnea and endothelial progenitor cells  

PubMed Central

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

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

2013-01-01

111

Pathogenic Roles of the Carotid Body Inflammation in Sleep Apnea  

PubMed Central

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

2014-01-01

112

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

113

Psychometric properties of the Lithuanian version of Sleep Apnea Quality of Life Index (a pilot study)  

Microsoft Academic Search

Summary. Objective. To arrange and test for its psychometric properties Lithuanian version of Sleep Apnea Quality of Life Index and assess quality of life among snoring and obstructive sleep apnea patients before and after the treatment. Material and methods. Cross-cultural adaptation of Lithuanian version of Calgary Sleep Apnea Quality of Life Index was accomplished according to generally accepted methodology. In

Virgilijus Uloza; Raimundas Sakalauskas; Skaidrius Miliauskas

2008-01-01

114

Correction of severe sleep apnea in a case of Treacher-Collins syndrome  

Microsoft Academic Search

Among many manifestations of Treacher Collins syndrome, obstructive sleep apnea is of particular significance because it may sometimes lead to life-threatening complications. A case of Treacher Collins syndrome accompanied by severe sleep apnea is presented. Horizontal and segmental osteotomies of the mandible were effective in treatment of the sleep apnea.

K. Ueda; S. Tajima; Y. Tanaka; K. Imai; S. Byun; M. Byun

1996-01-01

115

Detection of Obstructive Sleep Apnea from Cardiac Interbeat Interval Time Series  

E-print Network

Detection of Obstructive Sleep Apnea from Cardiac Interbeat Interval Time Series JE Mietus, CK Peng, USA Abstract We present a new automated method to diagnose and quantify obstructive sleep apnea from intervals that are often associated with prolonged cycles of sleep apnea. This technique employs the Hilbert

116

Original Article HHT based cardiopulmonary coupling analysis for sleep apnea detection  

E-print Network

Original Article HHT based cardiopulmonary coupling analysis for sleep apnea detection Dongdong Liu events detection and estimation of the severity of apnea/hypopnea. Methods: The HHT-CPC sleep spectrogram technique was applied to a total of 69 single-lead ECG signals downloaded from the Physionet Sleep Apnea

117

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

Microsoft Academic Search

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

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

118

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

E-print Network

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

Tang, Wendy

119

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

PubMed

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

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

2011-01-01

120

Obstructive sleep apnea screening by NIRS imaging  

NASA Astrophysics Data System (ADS)

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

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

2007-02-01

121

Obstructive sleep apnea and hypertension: a critical review.  

PubMed

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

Mohsenin, Vahid

2014-10-01

122

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

PubMed Central

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

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

2012-01-01

123

Simulating Sleep Apnea by Exposure to Intermittent Hypoxia Induces Inflammation in the Lung and Liver  

PubMed Central

Sleep apnea is a breathing disorder that results from momentary and cyclic collapse of the upper airway, leading to intermittent hypoxia (IH). IH can lead to the formation of free radicals that increase oxidative stress, and this mechanism may explain the association between central sleep apnea and nonalcoholic steatohepatitis. We assessed the level of inflammation in the lung and liver tissue from animals subjected to intermittent hypoxia and simulated sleep apnea. A total of 12 C57BL/6 mice were divided into two groups and then exposed to IH (n = 6) or a simulated IH (SIH) (n = 6) for 35 days. We observed an increase in oxidative damage and other changes to endogenous antioxidant enzymes in mice exposed to IH. Specifically, the expression of multiple transcription factors, including hypoxia inducible factor (HIF-1?), nuclear factor kappa B (NF-?B), and tumor necrosis factor (TNF-?), inducible NO synthase (iNOS), vascular endothelial growth factor (VEGF), and cleaved caspase 3 were shown to be increased in the IH group. Overall, we found that exposure to intermittent hypoxia for 35 days by simulating sleep apnea leads to oxidative stress, inflammation, and increased activity of caspase 3 in the liver and lung. PMID:23226929

da Rosa, Darlan Pase; Forgiarini, Luiz Felipe; Baronio, Diego; Feijo, Cristiano Andrade; Martinez, Denis; Marroni, Norma Possa

2012-01-01

124

Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea  

PubMed Central

Present study was designed to obtain association between sleep apnea with sleep quality and quality of life in COPD patients. This cross-sectional descriptive study was conducted on 139 patients with COPD in a chest clinic of a university hospital. All patients were evaluated by pulmonary function test for determination of severity of their disease. Also, Berlin questionnaire, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and St. George Respiratory questionnaires (SGRQ) were employed for assessment of patients. Analysis of data showed that quality of sleep was significantly correlated with quality of life (P < 0.001). About half of the patients were at high risk for sleep apnea. The patients were divided into two groups according to the result of Berlin questionnaire. Significant differences were found between the groups for total score and each of three subscores of SGRQ suggesting worse quality of life in overlap syndrome (P < 0.001). Also, patients with overlap syndrome had worse quality of sleep compared to patients without it (8.1 ± 1.7 versus 6.2 ± 2.3; P < 0.001). Stepwise multiple regression analysis showed that severity of COPD, coexisting obstructive sleep apnea, and sleep quality accounted for the SGRQ significantly (r2 (coefficient of determination) = 0.08, 0.21, and 0.18, resp.). It is recommended that patient with COPD be evaluated for sleep apnea and sleep disorders during routine examinations and followups. PMID:24587911

Zohal, Mohammad Ali; Yazdi, Zohreh; Kazemifar, Amir Mohammad; Mahjoob, Parisa; Ziaeeha, Masomeh

2014-01-01

125

Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension  

Microsoft Academic Search

With the growing epidemic of obesity in an aging population, obstructivesleepapnea(OSA)isincreasinglyencounteredin clinical practice. Given the acute cardiopulmonary stressors consequent to repetitive upper airway collapse, as well as evidence for cardiovas- cular homeostatic dysregulation in subjects with sleep apnea, there is ample biologic plausibility that OSA imparts increased cardiovas- cular risk, independent of comorbid disease. Indeed, observational studies have suggested strong

Jason M. Golbin; Virend K. Somers; Sean M. Caples

2008-01-01

126

Acoustic rhinometry findings in patients with mild sleep apnea  

Microsoft Academic Search

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

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

2002-01-01

127

Effect of improved nasal breathing on obstructive sleep apnea  

Microsoft Academic Search

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

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

2000-01-01

128

Compliance with nasal CPAP in obstructive sleep apnea patients  

Microsoft Academic Search

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

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

1997-01-01

129

Predictive Value of Pulmonary Function Parameters for Sleep Apnea Syndrome  

Microsoft Academic Search

Nocturnal polysomnography is the standard diagnostic test for sleep apnea syndrome (SAS) but is both expensive and time-con- suming. We developed a predictive index for SAS based on pulmo- nary function data, including respiratory resistance determined by the forced oscillation technique, from 168 obese snorers with sus- pected SAS. Our model used logistic regression to obtain case-by- case predictions of

FRANÇOISE ZERAH-LANCNER; FREDERIC LOFASO; MARIE PIA; CHRISTOPHE DELCLAUX; FRANÇOISE GOLDENBERG; ANDRÉ COSTE; BRUNO HOUSSET; ALAIN HARF

2000-01-01

130

Obstructive Sleep Apnea Syndrome: Pathogenesis of Neuropsychological Deficits  

Microsoft Academic Search

Neuropsychological deficits have been documented in patients with obstructive sleep apnea syndrome (OSSA). Both nocturnal hypoxemia and impairment of daytime vigilance have been suggested as the pathogenesis of these deficits, yet it remains difficult to find good correlations between cognitive deficits and either of these physiological parameters. In the present study, 10 normal controls were compared to 10 moderately and

Marc-André Bédard; Jacques Montplaisir; François Richer; Isabelle Rouleau; Jacques Malo

1991-01-01

131

Nasal Resistance in Patients with Obstructive Sleep Apnea  

Microsoft Academic Search

The aim of this study was to investigate the relationship between the severity of obstructive sleep apnea (OSA) and nasal resistance (NR). Eighty-five consecutive patients were recruited owing to their symptoms indicating OSA. All patients received polysomnography and anterior rhinomanometry (performed during wakefulness in the supine position). Patients were divided into low and high NR groups according to their rhinomanometric

Hsueh-Yu Li; Pa-Chun Wang; Chung-Yao Hsu; Ming-lung Cheng; Chin-Chia Liou; Ning-Hung Chen

2005-01-01

132

The Impact of Body Posture and Sleep Stages on Sleep Apnea Severity in Adults  

PubMed Central

Study Objectives: Determining the presence and severity of obstructive sleep apnea (OSA) is based on apnea and hypopnea event rates per hour of sleep. Making this determination presents a diagnostic challenge, given that summary metrics do not consider certain factors that influence severity, such as body position and the composition of sleep stages. Methods: We retrospectively analyzed 300 consecutive diagnostic PSGs performed at our center to determine the impact of body position and sleep stage on sleep apnea severity. Results: The median percent of REM sleep was 16% (reduced compared to a normal value of ~25%). The median percent supine sleep was 65%. Fewer than half of PSGs contained > 10 min in each of the 4 possible combinations of REM/NREM and supine/non-supine. Half of patients had > 2-fold worsening of the apnea-hypopnea index (AHI) in REM sleep, and 60% had > 2-fold worsening of AHI while supine. Adjusting for body position had greater impact on the AHI than adjusting for reduced REM%. Misclassification—specifically underestimation of OSA severity—is attributed more commonly to body position (20% to 40%) than to sleep stage (~10%). Conclusions: Supine-dominance and REM-dominance commonly contribute to AHI underestimation in single-night PSGs. Misclassification of OSA severity can be mitigated in a patient-specific manner by appropriate consideration of these variables. The results have implications for the interpretation of single-night measurements in clinical practice, especially with trends toward home testing devices that may not measure body position or sleep stage. Citation: Eiseman NA; Westover MB; Ellenbogen JM; Bianchi MT. The impact of body posture and sleep stages on sleep apnea severity in adults. J Clin Sleep Med 2012;8(6):655-666. PMID:23243399

Eiseman, Nathaniel A.; Westover, M. Brandon; Ellenbogen, Jeffrey M.; Bianchi, Matt T.

2012-01-01

133

Traditional and Nontraditional Cardiovascular Risk Factors in Comorbid Insomnia and Sleep Apnea  

PubMed Central

Objectives: Insomnia and sleep apnea frequently co-occur and are independently associated with an increased risk of cardiovascular disease, but little is known about cardiovascular disease risk among individuals with comorbid insomnia and sleep apnea. The current study examined traditional risk factors and a physiologic biomarker of cardiovascular risk in comorbid insomnia and sleep apnea. Design: Community-based participatory research study. Participants: The sample comprised 795 participants without preexisting cardiovascular disease from the Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) study. Measurements and Results: Participants were assessed for symptoms of insomnia and sleep apnea risk, as well as for presence of obesity, smoking, a sedentary lifestyle, hypertension, dyslipidemia, and diabetes. Baseline resting brachial artery diameter was measured by B-mode ultrasonography. A total of 138 participants (17.4%) met criteria for insomnia syndrome alone, 179 (22.5%) were at high risk for sleep apnea alone, 95 (11.9%) reported both insomnia syndrome and high sleep apnea risk, and 383 (48.2%) reported having neither insomnia nor sleep apnea symptoms Both high sleep apnea risk alone and comorbid insomnia and high sleep apnea risk groups had greater frequencies of obesity, sedentary lifestyle, hypertension, and three or more traditional cardiovascular risk factors and significantly larger brachial artery diameters than the insomnia alone group and those without insomnia or sleep apnea symptoms. No differences in traditional cardiovascular risk factors or brachial artery diameter were found between the high sleep apnea risk and comorbid groups. Conclusions: These findings suggest that sleep apnea is a major contributor to cardiovascular risk and co-occurring insomnia does not appear to add to this risk. Citation: Luyster FS; Kip KE; Buysse DJ; Aiyer AN; Reis SE; Strollo PJ. Traditional and nontraditional cardiovascular risk factors in comorbid insomnia and sleep apnea. SLEEP 2014;37(3):593-600. PMID:24587583

Luyster, Faith S.; Kip, Kevin E.; Buysse, Daniel J.; Aiyer, Aryan N.; Reis, Steven E.; Strollo, Patrick J.

2014-01-01

134

Cardiovascular Consequences of Obese and Nonobese Obstructive Sleep Apnea  

PubMed Central

Obstructive sleep apnea (OSA) continues to garner widespread attention, mostly because of its health-related consequences such as cardiovascular disorders and associated comorbid symptoms such as daytime sleepiness and snoring. OSA is characterized by repeated episodes of partial or complete upper airway closure during sleep, resulting in frequent arousals and sleep fragmentation, apneas and hypopneas, and intermittent hypoxemia. These perturbations can lead to chronic cardiovascular disorders such as hypertension. Among the many risk factors in the pathogenesis of OSA, obesity is one of the most important.1 Obesity, per se, may also predispose to cardiovascular disorders. In this review, the authors explore the complex interactions between obesity, cardiovascular diseases, and OSA. PMID:20451027

Ramar, Kannan; Caples, Sean M.

2014-01-01

135

Sleep apnea and nocturnal hypoventilation after western equine encephalitis.  

PubMed

That viral encephalitis can produce daytime hypoventilation is well appreciated, but an association of this infection with the development of a prolonged disturbance of breathing during sleep once the ventilatory disorder during wakefulness has resolved, has not been reported. We describe a young male who required assisted mechanical ventilation in association with western equine encephalitis. Normal waking ventilation returned over 3 to 4 wk, but frequent apneas and severe hypoventilation persisted during sleep with a near absence of waking ventilatory response to chemical stimuli. Over 3 months there was considerable improvement in breathing during sleep associated with an increase in both hypoxic and hypercapnic ventilatory responsiveness. PMID:6849538

White, D P; Miller, F; Erickson, R W

1983-01-01

136

Update on obstructive sleep apnea and its relation to COPD  

PubMed Central

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

Mieczkowski, Brian; Ezzie, Michael E

2014-01-01

137

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

E-print Network

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

Timmer, Jens

138

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 ...

139

Genioglossus Activity in Children with Obstructive Sleep Apnea during Wakefulness and Sleep Onset  

Microsoft Academic Search

A prominent role for upper airway neuromuscular control mecha- nisms in the pathophysiology of pediatric obstructive sleep apnea syndrome (OSAS) is suggested by the observation that obstruction does not occur during wakefulness and is infrequently seen during non-REM sleep. Using a custom intraoral surface electrode to record genioglossal activity (genioglossal electromyography (EMGgg)), normalized with a maximal maneuver, we studied 10

Eliot S. Katz; David P. White

2003-01-01

140

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

PubMed

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

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

2014-07-01

141

Electroencephalographic changes during respiratory cycles predict sleepiness in sleep apnea.  

PubMed

Common polysomnographic measures of sleep-disordered breathing have shown a disappointing ability to predict important consequences such as excessive daytime sleepiness. Using novel analytic techniques, this study tested the hypothesis that numerous, brief disruptions in cortical activity could occur on a breath-to-breath basis during nonapneic sleep. Spectral analysis proved the existence of respiratory cycle-related electroencephalographic changes in each of 38 adult patients evaluated by polysomnography for sleep-disordered breathing. Furthermore, the tendency for sigma (13-15 Hz) electroencephalographic power to vary with the respiratory cycle predicted next-day sleepiness as measured by the multiple sleep latency test. The predictive value was enhanced when the analysis was limited to those 27 patients who had sleep-disordered breathing (more than 5 apneas or hypopneas per hour of sleep). In contrast, nocturnal rates of apneas and hypopneas, as well as minimal oxygen saturation, did not predict sleepiness as well. On average, sigma power increased notably during inspiration, whereas delta (1-4 Hz) power showed a simultaneous decrease. We conclude that electroencephalographic activity shows detectable changes during nonapneic respiratory cycles in adults evaluated for sleep-disordered breathing. Quantification of these changes, which may reflect numerous inspiratory microarousals, could prove useful in prediction of excessive daytime sleepiness. PMID:15591467

Chervin, Ronald D; Burns, Joseph W; Ruzicka, Deborah L

2005-03-15

142

Application of dual mask for postoperative respiratory support in obstructive sleep apnea patient.  

PubMed

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

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

2013-01-01

143

Predictors of Obstructive Sleep Apnea Severity in Adenotonsillectomy Candidates  

PubMed Central

Study Objectives: There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities. Design: Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire. Setting: Clinical referral setting. Participants: Children, ages 5 to 9.9 y with OSAS. Measurements and Results: Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ? AHI < 30 or 1 ? obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant. Conclusions: Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity. Clinical Trial Registration: Clinicaltrials.gov (#NCT00560859). Citation: Weinstock TG; Rosen CL; Marcus CL; Garetz S; Mitchell RB; Amin R; Paruthi S; Katz E; Arens R; Weng J; Ross K; Chervin RD; Ellenberg S; Wang R; Redline S. Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates. SLEEP 2014;37(2):261-269. PMID:24497655

Weinstock, Tanya G.; Rosen, Carol L.; Marcus, Carole L.; Garetz, Susan; Mitchell, Ron B.; Amin, Raouf; Paruthi, Shalini; Katz, Eliot; Arens, Raanan; Weng, Jia; Ross, Kristie; Chervin, Ronald D.; Ellenberg, Susan; Wang, Rui; Redline, Susan

2014-01-01

144

Lipid peroxidation and osmotic fragility of red blood cells in sleep-apnea patients  

Microsoft Academic Search

Background: Obstructive sleep apnea (OSA) refers to the occurrence of episodes of complete or partial pharyngeal obstruction with oxyhemoglobin desaturation during sleep. These hypoxia\\/reoxygenation episodes may cause generation of reactive oxygen species. Reactive oxygen species are toxic to biomembranes and may lead to the peroxidation of lipids. We tested the hypothesis that obstructive sleep apnea is linked to increased oxidative

Levent Öztürk; Banu Mansour; Meral Yüksel; A. Süha Yalçin; Firuz Çeliko?lu; Nuran Gökhan

2003-01-01

145

SAFETY BOARD WANTS TRUCKERS TESTED FOR SLEEP APNEA Mary Wisniewski, The Chicago Sun-Times  

E-print Network

already have programs to check for and treat the problem. Treatment may include weight loss, surgerySAFETY BOARD WANTS TRUCKERS TESTED FOR SLEEP APNEA Mary Wisniewski, The Chicago Sun-Times May 19 drivers suffer from mild to severe obstructive sleep apnea, or OSA. OSA sufferers sleep poorly at night

Alford, Simon

146

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

E-print Network

is the most vulnerable to obstruction from loss of muscle tone during sleep. On physical exam, a long and widePhysical Modeling of Airflow-Walls Interactions to Understand the Sleep Apnea Syndrome Yohan Payan1, France {pelorson,perrier}@icp.inpg.fr Abstract. Sleep Apnea Syndrome (SAS) is defined as a partial

Payan, Yohan

147

Bench Test Evaluation of Adaptive Servoventilation Devices for Sleep Apnea Treatment  

PubMed Central

Rationale: Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical efficacy of these devices is still questioned. Study Objectives: This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. Methods: The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a flow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. Results: The three devices responded similarly to central events, by increasing pressure support to raise airflow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassified. Conclusion: The tested devices reacted as expected to the disordered breathing events, but not sufficiently to normalize the breathing flow. The device-scored results should be used with caution to judge efficacy, as their validity depends upon the initial settings. Citation: Zhu K; Kharboutly H; Ma J; Bouzit M; Escourrou P. Bench test evaluation of adaptive servoventilation devices for sleep apnea treatment. J Clin Sleep Med 2013;9(9):861-871. PMID:23997698

Zhu, Kaixian; Kharboutly, Haissam; Ma, Jianting; Bouzit, Mourad; Escourrou, Pierre

2013-01-01

148

Physiological Effects of Obstructive Sleep Apnea Syndrome in Childhood  

PubMed Central

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

Muzumdar, Hiren; Arens, Raanan

2013-01-01

149

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

E-print Network

. Obstructive sleep apnea (OSA) is a temporary closure of the upper airway dur- ing sleep when air is prevented Automated Scoring of Obstructive Sleep Apnea and Hypopnea Events Using Short-Term Electrocardiogram, Senior Member, IEEE Abstract--Obstructive sleep apnea or hypopnea causes a pause or reduction in airflow

Khandoker, Ahsan

150

Sleep Apnea - Multiple Languages: MedlinePlus  

MedlinePLUS

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

151

Automated Sleep Apnea Quantification Based on Respiratory Movement  

PubMed Central

Obstructive sleep apnea (OSA) is a prevalent and treatable disorder of neurological and medical importance that is traditionally diagnosed through multi-channel laboratory polysomnography(PSG). However, OSA testing is increasingly performed with portable home devices using limited physiological channels. We tested the hypothesis that single channel respiratory effort alone could support automated quantification of apnea and hypopnea events. We developed a respiratory event detection algorithm applied to thoracic strain-belt data from patients with variable degrees of sleep apnea. We optimized parameters on a training set (n=57) and then tested performance on a validation set (n=59). The optimized algorithm correlated significantly with manual scoring in the validation set (R2 = 0.73 for training set, R2 = 0.55 for validation set; p<0.05). For dichotomous classification, the AUC was >0.92 and >0.85 using apnea-hypopnea index cutoff values of 5 and 15, respectively. Our findings demonstrate that manually scored AHI values can be approximated from thoracic movements alone. This finding has potential applications for automating laboratory PSG analysis as well as improving the performance of limited channel home monitors. PMID:24936142

Bianchi, M.T.; Lipoma, T.; Darling, C.; Alameddine, Y.; Westover, M.B.

2014-01-01

152

Cardiovascular complications of sleep apnea: role of oxidative stress.  

PubMed

Obstructive sleep apnea (OSA) occurs in 2% of middle-aged women and 4% of middle-aged men with a higher prevalence among obese subjects. This condition is considered as an independent risk factor for cerebrovascular and cardiovascular diseases. One of the major pathophysiological characteristics of OSA is intermittent hypoxia. Hypoxia can lead to oxidative stress and overproduction of reactive oxygen species, which can lead to endothelial dysfunction, a hallmark of atherosclerosis. Many animal models, such as the rodent model of intermittent hypoxia, mimic obstructive sleep apnea in human patients and allow more in-depth investigation of biological and cellular mechanisms of this condition. This review discusses the role of oxidative stress in cardiovascular disease resulting from OSA in humans and animal models. PMID:24734153

Badran, Mohammad; Ayas, Najib; Laher, Ismail

2014-01-01

153

Cardiovascular Complications of Sleep Apnea: Role of Oxidative Stress  

PubMed Central

Obstructive sleep apnea (OSA) occurs in 2% of middle-aged women and 4% of middle-aged men with a higher prevalence among obese subjects. This condition is considered as an independent risk factor for cerebrovascular and cardiovascular diseases. One of the major pathophysiological characteristics of OSA is intermittent hypoxia. Hypoxia can lead to oxidative stress and overproduction of reactive oxygen species, which can lead to endothelial dysfunction, a hallmark of atherosclerosis. Many animal models, such as the rodent model of intermittent hypoxia, mimic obstructive sleep apnea in human patients and allow more in-depth investigation of biological and cellular mechanisms of this condition. This review discusses the role of oxidative stress in cardiovascular disease resulting from OSA in humans and animal models. PMID:24734153

Ayas, Najib

2014-01-01

154

Real-Time Sleep Apnea Detection by Classifier Combination  

Microsoft Academic Search

To find an efficient and valid alternative of polysomnography (PSG), this paper investigates real-time sleep apnea and hypopnea syndrome (SAHS) detection based on electrocardiograph (ECG) and saturation of peripheral oxygen (SpO$_2$) signals, individually and in combination. We include ten machine-learning algorithms in our classification experiment. It is shown that our proposed SpO $_2$ features outperform the ECG features in terms

Baile Xie; Hlaing Minn

2012-01-01

155

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea  

PubMed Central

BACKGROUND Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P = 0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%). CONCLUSIONS As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.) PMID:23692173

Marcus, Carole L.; Moore, Renee H.; Rosen, Carol L.; Giordani, Bruno; Garetz, Susan L.; Taylor, H. Gerry; Mitchell, Ron B.; Amin, Raouf; Katz, Eliot S.; Arens, Raanan; Paruthi, Shalini; Muzumdar, Hiren; Gozal, David; Thomas, Nina Hattiangadi; Ware, Janice; Beebe, Dean; Snyder, Karen; Elden, Lisa; Sprecher, Robert C.; Willging, Paul; Jones, Dwight; Bent, John P.; Hoban, Timothy; Chervin, Ronald D.; Ellenberg, Susan S.; Redline, Susan

2013-01-01

156

Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure  

Microsoft Academic Search

Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for hypertension and cardiovascular disease. OSAS is the frequent underlying disease of secondary hypertension and resistant hypertension. OSAS increases both daytime and night-time ambulatory blood pressures through the activation of various neurohumoral factors including the sympathetic nervous system and the renin–angiotensin–aldosterone system. In particular, OSAS predominantly increases ambulatory BP during

Kazuomi Kario

2009-01-01

157

New developments in the therapy of obstructive sleep apnea  

Microsoft Academic Search

This review of the literature summarizes new trends in the diagnosis and treatment of obstructive sleep apnea (OSA) over\\u000a the last 3 years. A literature search in Medline on 5 March 2000 using the keywords “OSA” and “OSAS” identified 123 papers.\\u000a Another 86 articles were added from the references of the first 123 papers. New trends were observed concerning measurements

T. Verse; W. Pirsig

2001-01-01

158

Obstructive sleep apnea and cardiovascular comorbidities: a large epidemiologic study.  

PubMed

Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic cessation of airflow for 10 seconds or more. There is growing awareness that OSA is related to the development and progression of cardiovascular disease. However, only a few studies have associated OSA directly to major cardiovascular events. The aim of this study was to evaluate the relationship between OSA and cardiovascular morbidity in a well defined population of patients.The electronic database of the central district of a major health management organization was searched for all patients diagnosed with OSA in 2002-2010. For each patient identified, an age- and sex-matched patient was randomly selected from the members of the same health management organization who did not have OSA. Data on demographics, socioeconomic status, and relevant medical parameters were collected as well.The study population included 2797 patients, average age 58.1, in which 76.6% were males. There was a significant correlation between OSA and the presence of ischemic heart disease (P?sleep disordered breathing should be routinely assessed in patients with cardiovascular problems. An ear-nose-throat evaluation may also be important to rule out anatomic disorders that cause upper airway obstruction. PMID:25144324

Gilat, Hanna; Vinker, Shlomo; Buda, Inon; Soudry, Ethan; Shani, Michal; Bachar, Gideon

2014-08-01

159

Screening for severe obstructive sleep apnea syndrome in hypertensive outpatients.  

PubMed

The authors attempted to validate a 2-stage strategy to screen for severe obstructive sleep apnea syndrome (s-OSAS) among hypertensive outpatients, with polysomnography (PSG) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinical data; (2) home sleep testing (HST); and (3) 12-channnel, in-laboratory PSG. The authors developed models using clinical or HST data alone (single-stage models) or clinical data in tandem with HST (2-stage models) to predict s-OSAS. For each model, area under receiver operating characteristic curves (AUCs), sensitivity, specificity, negative likelihood ratio, and negative post-test probability (NPTP) were computed. Models were then rank-ordered based on AUC values and NPTP. HST used alone had limited accuracy (AUC=0.727, NPTP=2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s-OSAS, with lower NPTP: (1) facial morphometrics (AUC=0.816, NPTP=0.6%); (2) neck circumference (AUC=0.803, NPTP=1.7%); and Multivariable Apnea Prediction Score (AUC=0.799, NPTP=1.5%) where sensitivity, specificity, and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s-OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in-laboratory PSG. These models were less useful in identifying obstructive sleep apnea syndrome of any severity. PMID:23551728

Gurubhagavatula, Indira; Fields, Barry G; Morales, Christian R; Hurley, Sharon; Pien, Grace W; Wick, Lindsay C; Staley, Bethany A; Townsend, Raymond R; Maislin, Greg

2013-04-01

160

Cardio-respiratory coordination increases during sleep apnea.  

PubMed

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 cardiogram, not only that the occurrence of CRC is significantly more frequent during respiratory sleep disturbances than in normal respiration (p-value<10(-51)) but also more frequent after these events (p-value<10(-15)). Especially, the latter finding contradicts the common assumption that spontaneous CRC can only be observed in epochs of relaxed conditions, while our newly discovered epochs of CRC after disturbances are characterized by high autonomic stress. Our findings on the connection between CRC and the appearance of sleep-disordered events require a substantial extension of the current understanding of obstructive sleep apneas and hypopneas. PMID:24718564

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

2014-01-01

161

Cardio-Respiratory Coordination Increases during Sleep Apnea  

PubMed Central

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

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

2014-01-01

162

Automated Scoring of Obstructive Sleep Apnea and Hypopnea Events Using Short-Term Electrocardiogram Recordings  

Microsoft Academic Search

Obstructive sleep apnea or hypopnea causes a pause or reduction in airflow with continuous breathing effort. The aim of this study is to identify individual apnea and hypopnea events from normal breathing events using wavelet-based features of 5-s ECG signals (sampling rate = 250 Hz) and estimate the surrogate apnea index (AI)\\/hypopnea index (HI) (AHI). Total 82 535 ECG epochs

Ahsan H. Khandoker; Jayavardhana Gubbi; Marimuthu Palaniswami

2009-01-01

163

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

E-print Network

: Obstructive Sleep Apnea (OSA), in which partial (hypopnea) or total (apnea) collapse of the upper airway 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

Lagrée, Pierre-Yves

164

Right and left ventricular functional impairment and sleep apnea.  

PubMed

Obstructive sleep apnea may contribute to the development of pulmonary hypertension and RVF primarily through pulmonary vasoconstriction secondary to hypoxia. Several recent studies indicate, however, that intermittent apnea-related hypoxia is not sufficient to cause sustained pulmonary hypertension. These studies have been consistent in showing that pulmonary hypertension and RVF are almost invariably seen in the presence of diurnal hypoxia. Sustained pulmonary hypertension, therefore, appears to be associated with sustained hypoxia as is the case in COPD. Patients with OSA who have hypoxia while awake are, as a rule, obese and have mild-to-moderate diffuse obstructive airways disease. Thus, most cases of pulmonary hypertension in association with OSA result from a combination of OSA, obesity, and diffuse obstructive airways disease, a so-called overlap syndrome. However, from the therapeutic viewpoint, it is apparent that treatment of OSA by NCPAP or tracheostomy, in such cases, is usually sufficient to reverse pulmonary hypertension and RVF. More recent work has provided strong evidence that OSA can play a role in the pathogenesis of LV heart failure in patients with CHF of otherwise unknown etiology. It is likely that this occurs through a combination of increased LV afterload related to exaggerated negative Pit swings during obstructive apneas, to intermittent hypoxia, and to chronically elevated sympathoadrenal activity. Reversal of OSA by NCPAP in these patients may relieve LV heart failure. These findings add a new dimension to our understanding of the pathophysiologic effects of OSA on the cardiovascular system by demonstrating that the LV is a structure that may suffer functional impairment secondary to the stresses imposed by OSA. Finally, it has now become apparent that CSR in patients with CHF can cause symptoms of a sleep apnea syndrome when associated with intermittent hypoxia and arousals from sleep. Reversal of CSR during sleep by NCPAP can lead to alleviation of these symptoms and possibly to reduced cardiac dyspnea and LV systolic function as well. Taken together, this suggests that much more extensive use of polysomnography may be warranted in the investigation of cardiovascular disease. The reasons are compelling: sleep apnea disorders are common and eminently treatable conditions whose reversal can result in improved right and left heart function and symptomatic improvement in patients with impaired myocardial function. PMID:1521413

Bradley, T D

1992-09-01

165

Support vector regression model for assessing respiratory effort during central apnea events using ECG signals  

Microsoft Academic Search

The aim of the present study is to investigate whether wavelet based features of ECG signals during central sleep apnea (CSA) can act as surrogate of respiratory effort measured by respiratory inductance plethysmography (RIP). Therefore, RIP and ECG signals during 125 pre-scored CSA events and 10 seconds preceding the events were collected from 7 patients. Wavelet decompositions of ECG signals

AH Khandoker; M. Palaniswami

2009-01-01

166

Autonomic function in sleep apnea patients: increased heart rate variability except during REM sleep in obese patients.  

PubMed

The objective of this study was to examine heart rate variability (HRV) among sleep stages in obstructive sleep apnea (OSA) patients. The study was retrospective within subjects and examined the sleep stages and HRV in relation to OSA, age, body mass index (BMI), and sex. Data collected during diagnostic polysomnograms were used in this study. There were 105 clinical patients undergoing polysomnography for suspected OSA. We sampled the electrocardiogram (ECG) from wakefulness, stage 2, and REM sleep and analyzed for frequency domain HRV. Sampled epochs were free of apnea and arousals. Heart rate variability decreased with age. Total frequency variability (TF) and low frequency variability (LF) in wakefulness and REM sleep increased as apnea severity increased. Measures of TF, LF, and the LF/HF ratio were greatest in REM sleep. There was less LF and TF in Stage REM sleep in patients with higher BMI. In conclusion, the decrease in HRV with aging is a robust finding that occurs even in a clinical sleep apnea population. However, apnea does not mimic aging effects on the heart because HRV increased as apnea severity increased. The decrease in HRV during REM sleep in the obese apnea patients suggests the possibility of an autonomic dysfunction in this subgroup. PMID:17171554

Reynolds, Erica B; Seda, Gilbert; Ware, J C; Vinik, Aaron I; Risk, Marcelo R; Fishback, Nancy F

2007-03-01

167

Intention to Exercise in Patients with Obstructive Sleep Apnea  

PubMed Central

Obstructive sleep apnea (OSA) is a common and serious health issue that is strongly associated with excess weight. Exercise may be an effective mechanism for reducing the severity of OSA both in association with, and independent of, reduction in body weight. As such, increased exercise has been suggested as a potential intervention for OSA, particularly for patients with mild to moderate clinical severity. However, it is unknown how ready to engage in exercise patients with OSA are. Self-reported exercise intention was assessed in 206 consecutive patients attending a large tertiary sleep disorders service in Australia. Classification of the patients by Stage of Change, a construct of the Transtheoretical Model of behavior change, was supported by differences between the groups in level of habitual self-reported exercise. Cluster analysis identified 4 potential patient types, with differing profiles in perceived costs and benefits of exercise, and exercise-related self-efficacy. The validity of these patient clusters was also supported by differences between the groups in current self-reported exercise levels. The results may help to identify patients who are more likely to engage in increased exercise, and to identify barriers to exercise in patients less inclined to increase their exercise. Citation: Smith SS; Doyle G; Pascoe T et al. Intention to exercise in patients with obstructive sleep apnea. J Clin Sleep Med 2007;3(7):689–694. PMID:18198801

Smith, Simon S.; Doyle, Geoffrey; Pascoe, Thomas; Douglas, James A; Jorgensen, Greg

2007-01-01

168

[Pediatric obstructive sleep apnea--an orthodontic perspective].  

PubMed

Sleep disturbed breathing in children, is a general term describing a wide range of respiratory disorders that occur during sleep, ranging from snoring to Obstructive Sleep apnea syndrome (OSAS). In recent years, the role of OSAS in a vast range of morbidities has been recognized, namely metabolic, neuro-cognitive and cardio-vascular disorders, thus emphasizing the importance of early detection. The recommended initial treatment for pediatric OSAS consists of surgical removal of adenoids and tonsils. However, today it is clear that there are other factors involved in the etiology of the syndrome. An association is believed to exist between the airway and craniofacial development and vice versa. The structure of the face and jaws has been shown to play an important role in the pathophysiology of OSAS, thus, the orthodontist plays a substantial role in the diagnosis and treatment of these children. Moreover, OSAS is believed to have a direct and indirect effect on oral health. Obstructive Sleep apnea syndrome is also common in adults, but is defined as a separate entity being different in terms of pathophysiology, clinical presentation and treatment. This paper reviews the pathophysiology, diagnosis, clinical implications and available treatment options for pediatric OSAS. Moreover, we will review the impact of the condition on the structures of the face, jaws, mouth and teeth and discuss the dentist's critical role in identifying and treating these problems. PMID:25219101

Tzur-Gadassi, L; Hevroni, A; Gross, M; Davidovich, E

2014-07-01

169

Insular Cortex Metabolite Changes in Obstructive Sleep Apnea  

PubMed Central

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

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

2014-01-01

170

Sleep Apnea Symptoms and Risk of Temporomandibular Disorder  

PubMed Central

The authors tested the hypothesis that obstructive sleep apnea (OSA) signs/symptoms are associated with the occurrence of temporomandibular disorder (TMD), using the OPPERA prospective cohort study of adults aged 18 to 44 years at enrollment (n = 2,604) and the OPPERA case-control study of chronic TMD (n = 1,716). In both the OPPERA cohort and case-control studies, TMD was examiner determined according to established research diagnostic criteria. People were considered to have high likelihood of OSA if they reported a history of sleep apnea or ? 2 hallmarks of OSA: loud snoring, daytime sleepiness, witnessed apnea, and hypertension. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% confidence limits (CL) for first-onset TMD. Logistic regression estimated odds ratios (OR) and 95% CL for chronic TMD. In the cohort, 248 individuals developed first-onset TMD during the median 2.8-year follow-up. High likelihood of OSA was associated with greater incidence of first-onset TMD (adjusted HR = 1.73; 95% CL, 1.14, 2.62). In the case-control study, high likelihood of OSA was associated with higher odds of chronic TMD (adjusted OR = 3.63; 95% CL, 2.03, 6.52). Both studies supported a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD. PMID:23690360

Sanders, A.E.; Essick, G.K.; Fillingim, R.; Knott, C.; Ohrbach, R.; Greenspan, J.D.; Diatchenko, L.; Maixner, W.; Dubner, R.; Bair, E.; Miller, V.E.; Slade, G.D.

2013-01-01

171

Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort.  

PubMed

The authors tested the hypothesis that obstructive sleep apnea (OSA) signs/symptoms are associated with the occurrence of temporomandibular disorder (TMD), using the OPPERA prospective cohort study of adults aged 18 to 44 years at enrollment (n = 2,604) and the OPPERA case-control study of chronic TMD (n = 1,716). In both the OPPERA cohort and case-control studies, TMD was examiner determined according to established research diagnostic criteria. People were considered to have high likelihood of OSA if they reported a history of sleep apnea or ? 2 hallmarks of OSA: loud snoring, daytime sleepiness, witnessed apnea, and hypertension. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% confidence limits (CL) for first-onset TMD. Logistic regression estimated odds ratios (OR) and 95% CL for chronic TMD. In the cohort, 248 individuals developed first-onset TMD during the median 2.8-year follow-up. High likelihood of OSA was associated with greater incidence of first-onset TMD (adjusted HR = 1.73; 95% CL, 1.14, 2.62). In the case-control study, high likelihood of OSA was associated with higher odds of chronic TMD (adjusted OR = 3.63; 95% CL, 2.03, 6.52). Both studies supported a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD. PMID:23690360

Sanders, A E; Essick, G K; Fillingim, R; Knott, C; Ohrbach, R; Greenspan, J D; Diatchenko, L; Maixner, W; Dubner, R; Bair, E; Miller, V E; Slade, G D

2013-07-01

172

Detection of Obstructive Sleep Apnea through Auditory Display of Heart Rate Variability  

E-print Network

Detection of Obstructive Sleep Apnea through Auditory Display of Heart Rate Variability M Ballora the diagnosis of obstructive sleep apnea as a problem of orchestration and melody. 1. Introduction The auditory an extensive set of list and array processing operations, as well as a method for generating ("spawning

173

Sleep Apnea Gear Doesn't Squelch Sex Life, Study Says  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Sleep Apnea Gear Doesn't Squelch Sex Life, Study ... October 22, 2014 Related MedlinePlus Pages Sexual Health Sleep Apnea WEDNESDAY, Oct. 22, 2014 (HealthDay News) -- Your ...

174

Baroreflex Control of Sympathetic Nerve Activity and Heart Rate in Obstructive Sleep Apnea  

Microsoft Academic Search

Patients with obstructive sleep apnea are at increased risk for hypertension. The mechanisms underlying this increased risk are not known. We tested the hypothesis that obstructive sleep apnea, independent of factors such as hypertension, obesity, and age, is characterized by impairment of baroreflex sensitivity. We measured muscle sympathetic nerve activity (MSNA) and heart rate responses to activation and deactivation of

Krzysztof Narkiewicz; Catherine A. Pesek; Masahiko Kato; Bradley G. Phillips; Diane E. Davison; Virend K. Somers

175

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

Microsoft Academic Search

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

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

2003-01-01

176

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

PubMed

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

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

2012-12-27

177

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

Microsoft Academic Search

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

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

178

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

E-print Network

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

Payan, Yohan

179

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

E-print Network

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

Timmer, Jens

180

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

PubMed Central

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

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

2013-01-01

181

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

Microsoft Academic Search

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

Daniel Rodenstein

2009-01-01

182

Management of obstructive sleep apnea in Europe  

Microsoft Academic Search

ObjectivesIn Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of

I. Fietze; T. Penzel; A. Alonderis; F. Barbe; M. R. Bonsignore; P. Calverly; W. De Backer; K. Diefenbach; V. Donic; M. M. Eijsvogel; K. A. Franklin; T. Gislason; L. Grote; J. Hedner; P. Jennum; L. Lavie; P. Lavie; P. Levy; C. Lombardi; W. Mallin; O. Marrone; J. M. Montserrat; E. S. Papathanasiou; G. Parati; R. Plywaczewski; M. Pretl; R. L. Riha; D. Rodenstein; T. Saaresranta; R. Schulz; P. Sliwinski; P. Steiropoulos; J. Svaza; Z. Tomori; P. Tonnesen; G. Varoneckas; J. Verbraecken; J. Vesely; A. Vitols; J. Zielinski; W. T. McNicholas

2011-01-01

183

Oral Appliance Therapy for Obstructive Sleep Apnea  

MedlinePLUS

... lower jaw and tongue slightly forward. This opens space in the back of the throat and reduces tissue obstruction, helping keep the patient’s airway open and clear during sleep. Is Oral Appliance Therapy a medical service? Yes. The U.S. Food and ...

184

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

effort is preserved and increased in the presence of partial or complete occlusion on the upper airway : 10.2337/dc09-1901 #12;Apnea D.E.S.I.R. 17/03/2010 2/17 ABSTRACT OBJECTIVE-Obstructive sleep apnea2010 #12;Apnea D.E.S.I.R. 17/03/2010 3/17 Obstructive sleep apnea is becoming more and more recognized

Paris-Sud XI, Université de

185

Obstructive sleep apnea: The sleeping giant of the childhood obesity epidemic.  

PubMed

Obstructive sleep apnea (OSA) is more common among obese children than in those of normal weight and can have serious consequences for neurocognitive function, behavior, and school performance. This article reviews OSA and steps for identifying the condition early and taking a multidisciplinary approach to long-term treatment. PMID:25180564

Mofid, Marcie

2014-10-01

186

The Consolidation of Implicit Sequence Memory in Obstructive Sleep Apnea  

PubMed Central

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

Malecek, Nick

2014-01-01

187

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

PubMed

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

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

2014-01-01

188

Detection of Sleep Apnea from surface ECG based on features extracted by an Autoregressive Model  

Microsoft Academic Search

This study proposes an alternative evaluation of obstructive sleep apnea (OSA) based on ECG signal during sleep time. OSA is a common sleep disorder produced by repetitive occlusions in the upper airways. This respiratory disturbance produces a specific pattern on ECG. Extraction of ECG characteristics, as heart rate variability (HRV) and peak R area, offers alternative measures for a sleep

Martin O. Mendez; Davide D. Ruini; Omar P. Villantieri; M. Matteucci; T. Penzel; S. Cerutti; A. M. Bianchi

2007-01-01

189

Memory and Obstructive Sleep Apnea: A Meta-Analysis  

PubMed Central

Study Objectives: To examine episodic memory performance in individuals with obstructive sleep apnea (OSA). Design Meta-analysis was used to synthesize results from individual studies examining the impact of OSA on episodic memory performance. The performance of individuals with OSA was compared to healthy controls or normative data. Participants Forty-two studies were included, comprising 2,294 adults with untreated OSA and 1,364 healthy controls. Studies that recorded information about participants at baseline prior to treatment interventions were included in the analysis. Measurements Participants were assessed with tasks that included a measure of episodic memory: immediate recall, delayed recall, learning, and/or recognition memory. Results: The results of the meta-analyses provide evidence that individuals with OSA are significantly impaired when compared to healthy controls on verbal episodic memory (immediate recall, delayed recall, learning, and recognition) and visuo-spatial episodic memory (immediate and delayed recall), but not visual immediate recall or visuo-spatial learning. When patients were compared to norms, negative effects of OSA were found only in verbal immediate and delayed recall. Conclusions: This meta-analysis contributes to understanding of the nature of episodic memory deficits in individuals with OSA. Impairments to episodic memory are likely to affect the daily functioning of individuals with OSA. Citation Wallace A; Bucks RS. Memory and obstructive sleep apnea: a meta-analysis. SLEEP 2013;36(2):203-220. PMID:23372268

Wallace, Anna; Bucks, Romola S.

2013-01-01

190

Frequency of Sleep Apnea in Stroke and TIA Patients: A Meta-analysis  

PubMed Central

Study Objectives: To determine the frequency of sleep disordered breathing (SDB) in ischemic and hemorrhagic stroke and transient ischemic attack (TIA) patients by meta-analysis. Methods: A systematic literature search using Medline, EMBASE and CINAHL and a manual review of references through December 2008 was conducted using specific search terms. The frequency of SDB stratified by apnea hypopnea index (AHI) was extracted by the author. Weighted averages using a random-effects model are reported with 95% confidence intervals. Results: Twenty-nine articles evaluating patients with auto-CPAP, limited-channel sleep study, or full polysomnography were included in this study. In meta-analysis of 2,343 ischemic or hemorrhagic stroke and TIA patients, the frequency of SDB with AHI > 5 was 72% and with AHI > 20 was 38%. Only 7% of the SDB was primarily central apnea. There was no significant difference in SDB prevalence by event type, timing after stroke, or type of monitoring. Males had a higher percentage of SDB (AHI > 10) than females (65% compared to 48% p = 0.001). Patients with recurrent strokes had a higher percentage of SDB (AHI > 10) than initial strokes (74% compared to 57% p = 0.013). Patients with unknown etiology of stroke had a higher and cardioembolic etiology a lower percentage of SDB than other etiologies. Conclusions: SDB is very common in stroke patients irrespective of type of stroke or timing after stroke and is typically obstructive in nature. Since clinical history alone does not identify many patients with SDB, sleep studies should be considered in all stroke and TIA patients. Citation: Johnson KG; Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med 2010;6(2):131-137. PMID:20411688

Johnson, Karin G.; Johnson, Douglas C.

2010-01-01

191

Neural Alterations and Depressive Symptoms in Obstructive Sleep Apnea Patients  

PubMed Central

Study Objectives: Depressive symptoms are common in obstructive sleep apnea (OSA) patients, and brain injury occurs with both OSA and depression independently. The objective was to determine whether brain alterations in OSA bear relationships to depressive symptoms. Design: Cross-sectional study. Setting: University-based medical center. Participants: 40 treatment-naive OSA subjects and 61 control subjects without diagnosed psychopathology. Interventions: None. Measurements and Results: Whole-brain maps of T2 relaxation time, a measure sensitive to injury, were calculated from magnetic resonance images, transformed to common space, and smoothed. Control and OSA groups were classified by Beck Depression Inventory (BDI)-II scores (?12 symptomatic, <10 asymptomatic for depressive symptoms). The OSA group separated into 13 symptomatic (mean ± SD: BDI-II 21 ± 8; age 47.6 ± 11; apnea hypopnea index [AHI] 28.3 ± 17), and 27 asymptomatic (4 ± 3; 47.5 ± 8; 31.5 ± 16) subjects. The control group included 56 asymptomatic (BDI-II 2.5 ± 2.6; age 47.3 ± 9) subjects. Asymptomatic OSA subjects exhibited higher AHI. T2 maps were compared between groups (ANCOVA), with age and gender as covariates. Injury appeared in symptomatic vs asymptomatic OSA subjects in the mid- and anterior cingulate, anterior insular, medial pre-frontal, parietal, and left ventrolateral temporal cortices, left caudate nucleus, and internal capsule. Relative to asymptomatic controls, symptomatic OSA patients showed damage in the bilateral hippocampus and caudate nuclei, anterior corpus callosum, right anterior thalamus, and medial pons. Conclusions: Neural injury differed between OSA patients with and without depressive symptoms. Depressive symptoms may exacerbate injury accompanying OSA, or introduce additional damage in affective, cognitive, respiratory, and autonomic control regions. Citation: Cross RL; Kumar R; Macey PM; Doering LV; Alger JR; Yan-Go FL; Harper RM. Neural alterations and depressive symptoms in obstructive sleep apnea patients. SLEEP 2008;31(8):1103-1109. PMID:18714782

Cross, Rebecca L.; Kumar, Rajesh; Macey, Paul M.; Doering, Lynn V.; Alger, Jeffry R.; Yan-Go, Frisca L.; Harper, Ronald M.

2008-01-01

192

Innovative treatments for adults with obstructive sleep apnea  

PubMed Central

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

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

2014-01-01

193

Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea  

PubMed Central

Study Objectives: Females with obstructive sleep apnea (OSA) show different psychological and physiological symptoms from males, which may be associated with sex-related variations in neural injury occurring with the disorder. To determine whether male- or female-specific brain injury is present in OSA, we assessed influences of sex on white matter changes in the condition. Design: Two-group factorial. Setting: University medical center. Patients or Participants: 80 subjects total, with newly diagnosed, untreated OSA groups of 10 female (age mean ± SE: 52.6 ± 2.4 years, AHI 22.5 ± 4.1 events/h) and 20 male (age 48.9 ± 1.7, AHI 25.5 ± 2.9) patients, and 20 female (age 50.3 ± 1.7) and 30 male (age 49.2 ± 1.4) healthy control subjects. Interventions: None. Measurements and Results: Brain fiber integrity was assessed with fractional anisotropy (FA), a diffusion tensor imaging-derived measure. Sleep quality, daytime sleepiness, depression, and anxiety were assessed with questionnaires. We identified regions of differing injury in male versus female OSA patients by assessing brain regions with significant interaction effects of OSA and sex on FA. Areas of sex-specific, OSA-related FA reductions appeared in females relative to males, including in the bilateral cingulum bundle adjacent to the mid hippocampus, right stria terminalis near the amygdala, prefrontal and posterior-parietal white matter, corpus callosum, and left superior cerebellar peduncle. Females with OSA showed higher daytime sleepiness, anxiety and depression levels, and reduced sleep quality. Conclusions: Sex differences in white matter structural integrity appeared in OSA patients, with females more affected than males. These female-specific structural changes may contribute to or derive from neuropsychological and physiological symptom differences between sexes. Citation: Macey PM; Kumar R; Yan-Go FL; Woo MA; Harper RM. Sex differences in white matter alterations accompanying obstructive sleep apnea. SLEEP 2012;35(12):1603-1613. PMID:23204603

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

2012-01-01

194

EMG activity of cricothyroid and chin muscles during wakefulness and sleeping in the sleep apnea syndrome.  

PubMed

The authors studied the direct and integrated EMG activities of the cricothyroid (CT) and chin muscles in 7 patients with the sleep apnea syndrome. They noted: (1) A tonic activity with phasic inspiratory reinforcements in the CT during wakefulness. (2) A decrease in the tonic activity without any modification of the phasic inspiratory reinforcement during sleep. (3) A decrease or even disappearance of the phasic activity during sleep-induced hypopneas. (4) A complete cessation of both the tonic and the phasic activities of the CT during obstruction apneas: resumption of respiration is marked by the reappearance first of the phasic inspiratory activity and secondly of the tonic one. (5) In some patients similar activities are recorded in the chin muscles during wakefulness, sleep and sleep apnea. These results favor possible obstruction of the upper airway at the laryngeal level: the conjunction of inhibition of the inspiratory activity of the laryngeal muscles with the subsequent closing of the glottis and inspiratory depressure could produce an obstruction. PMID:84745

Kurtz, D; Krieger, J; Stierle, J C

1978-12-01

195

Comparison of primary-care practitioners and sleep specialists in the treatment of obstructive sleep apnea.  

PubMed

We wished to determine if being treated for sleep apnea by a sleep specialist increased patient awareness or long-term continuous positive airway pressure (CPAP) compliance. We performed a retrospective telephone survey and laboratory chart review in patients with a diagnosis of sleep apnea evaluated either at a laboratory in which only sleep specialists can order polysomnography (University Specialty Hospital, noted as USH) or at a laboratory serving the medical community at large (Kernan Hospital, noted as K). Both laboratories are under the same medical director, use the same policies and procedures, equipment, and technician pool. One hundred three patients participated in the survey (approximately 37% of those contacted), 59 from USH and 44 from K. The groups were comparable in terms of demographics, presenting complaints, and apnea severity. In patients treated by sleep specialists, awareness of the disease process was greater and the evaluation was timelier than in patients treated by generalists. However, there was no difference between the groups' long-term self-reported CPAP acceptance or compliance. The most robust predictor of continued CPAP use was the patient's self-report of feeling better. PMID:15389385

Scharf, Steven M; DeMore, Jennifer; Landau, Talia; Smale, Patricia

2004-09-01

196

A failure of adaptive servo-ventilation to correct central apneas in Cheyne-Stokes breathing.  

PubMed

An 80-year-old man with severe central sleep apnea due to Cheyne-Stokes breathing (AHI 41.2) caused by severe cardiac failure underwent a trial of adaptive servo-ventilation (ASV) by full face mask after failure of a fixed CPAP trial. Recommended procedure was closely followed and the ASV device activated normally during central apneas. Initial settings were EEP 5, PSmin 3, PSmax 15 on room air. The device did not capture the thorax or abdomen, as shown by lack of change in respiratory inductive plethysmography, despite expected mask pressure waveforms. Snoring was also detected during apneas with device activation. Desaturation continued, followed by arousals during hyperpnea. On the device, the patient clearly slept for 1-3 epochs during the central apneas only to awaken during hyperpnea. We hypothesize that the failure to capture may have resulted from "reverse" obstructive apnea, possibly due to glottic closure during ASV activation. We suggest that earlier manual adjustments to ASV in cases such as ours, prior to waiting for the recommended 20 to 40 min of sleep, may be appropriate in selected patients. We also consider additional interventions that may increase the likelihood of a successful trial. PMID:22334816

Reddy, Harigopal; Dillard, Thomas A

2012-02-15

197

Sleep Apnea and Markers of Vascular Endothelial Function in a Large Community Sample of Older Adults  

Microsoft Academic Search

Clinical studies have suggested that sleep apnea is associated with impaired brachial artery flow-mediated dilation, a surrogate of en- dothelial dysfunction. We examined this question among older par- ticipants in the baseline examination of the Sleep Heart Health\\/ Cardiovascular Health Study cohort (n 1,037, age 68 years or older, 56% female). Indices of sleep apnea, derived from 12-channel home polysomnography,

F. Javier Nieto; David M. Herrington; Susan Redline; Emelia J. Benjamin; John A. Robbins

2003-01-01

198

Dynamics of Snoring Sounds and Its Connection with Obstructive Sleep Apnea  

E-print Network

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

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

2012-01-01

199

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

PubMed

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

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

2014-10-01

200

Prediagnosis of obstructive sleep apnea via multiclass MTS.  

PubMed

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

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

2012-01-01

201

Prediagnosis of Obstructive Sleep Apnea via Multiclass MTS  

PubMed Central

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

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

2012-01-01

202

The impact of obstructive sleep apnea on chronic kidney disease.  

PubMed

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

Adeseun, Gbemisola A; Rosas, Sylvia E

2010-10-01

203

Obstructive sleep apnea in children: a critical update  

PubMed Central

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

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

2013-01-01

204

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

E-print Network

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

Aloul, Fadi

205

Obstructive sleep apnea: the new cardiovascular disease. Part I: obstructive sleep apnea and the pathogenesis of vascular disease  

PubMed Central

Obstructive sleep apnea (OSA) is increasingly recognized as a novel cardiovascular risk factor. OSA is implicated in the pathogenesis of hypertension, left ventricular dysfunction, coronary artery disease and stroke. OSA exerts its negative cardiovascular consequences through its unique pattern of intermittent hypoxia. Endothelial dysfunction, oxidative stress, and inflammation are all consequences of OSA directly linked to intermittent hypoxia and critical pathways in the pathogenesis of cardiovascular disease in patients with OSA. This review will discuss the known mechanisms of vascular dysfunction in patients with OSA and their implications for cardiovascular disease. PMID:18807180

Khayat, Rami; Hayes, Don

2009-01-01

206

Interactions Between Pregnancy, Obstructive Sleep Apnea, and Gestational Diabetes Mellitus  

PubMed Central

Context: Questionnaire studies linked symptoms of obstructive sleep apnea (OSA) to the risk of gestational diabetes mellitus (GDM). Whether this association is present when OSA is assessed objectively by polysomnography is not known. Objective: The objective of the study was to assess the relationship between pregnancy, OSA, and GDM. Design, Setting, and Participants: We conducted observational case-control studies using polysomnography in 15 nonpregnant, nondiabetic women (NP-NGT), 15 pregnant women with normal glucose tolerance (P-NGT), and 15 pregnant women with GDM (P-GDM). The groups were frequency matched for age and race/ethnicity. Pregnant women were studied during the late second to early third trimester. Main Outcome Measures: Comparisons of OSA diagnosis and sleep parameters between NP-NGT and P-NGT to assess the impact of pregnancy and between P-NGT and P-GDM to explore the association between GDM and OSA were measured. Results: Compared with NP-NGT, P-NGT women had a higher apnea hypopnea index (AHI) (median 2.0 vs 0.5, P = .03) and more disrupted sleep as reflected by a higher wake time after sleep onset (median 66 vs 21 min, P < .01) and a higher microarousal index (median 16.4 vs 10.6, P = .01). Among the pregnant women, P-GDM had markedly lower total sleep time (median 397 vs 464 min, P = .02) and a higher AHI (median 8.2 vs 2.0, P = .05) than P-NGT women. OSA was more prevalent in P-GDM than in P-NGT women (73% vs 27%, P = .01). After adjustment for prepregnancy body mass index, the diagnosis of GDM was associated with a diagnosis of OSA [odds ratio 6.60 (95% confidence interval 1.15–37.96)]. In pregnancy, after adjusting for prepregnancy body mass index, higher microarousal index significantly associated with higher hemoglobin A1c and fasting glucose levels. Higher oxygen desaturation index was associated with higher fasting glucose levels. Conclusion: Pregnancy is associated with sleep disturbances. Sleep is more disturbed in GDM than in P-NGT women. There is a strong association between GDM and OSA. PMID:23966237

Zaidi, Nausheen; Wroblewski, Kristen; Kay, Helen H.; Ismail, Mahmoud; Ehrmann, David A.; Van Cauter, Eve

2013-01-01

207

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

PubMed Central

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

Yuksel, Meral; Okur, Hacer Kuzu; Pelin, Zerrin; Ogunc, Ayliz Velioglu; Ozturk, Levent

2014-01-01

208

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

E-print Network

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

Zemen, Thomas

209

Pathophysiologic Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome  

PubMed Central

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

Zamarron, Carlos; Valdes Cuadrado, Luis; Alvarez-Sala, Rodolfo

2013-01-01

210

Rehabilitation of patients with obstructive sleep apnea syndrome.  

PubMed

The current treatment of obstructive sleep apnea syndrome (OSAS) focuses on alleviation of symptoms by increasing airway patency during sleep through positive airway pressure, oral appliances, changes in sleep position, weight loss, or surgical treatment. Continuous positive airway pressure (CPAP) is currently the treatment of choice and prevents upper airway obstruction, resulting in improved sleep architecture and daytime symptoms. Despite proven efficacy, adherence to CPAP treatment is still not efficient. The new methods of rehabilitation (exercise training programs, hypoglossal nerve stimulation) for patients with OSAS are currently modified. The aim of the present study was to present recent developments in the field of selected aspects of rehabilitation in patients with OSAS. Database search was focused on exercise training programs and electrostimulation of genioglossus muscle. The search for articles on the rehabilitation interventions for OSAS was performed using the PubMed database from 1966 to 2013. Most of the findings have shown beneficial effects of rehabilitation. In detail, we describe the recent developments and potential adverse effects of electrostimulation and physical exercises. According to the results of studies presented, the above therapy might support conventional treatment or may be an alternative for patients with poor compliance to CPAP therapy, mandibular advancement devices, or ineffective results of surgical procedures as well. PMID:23873222

Chwie?ko-Minarowska, Sylwia; Minarowski, ?ukasz; Kuryliszyn-Moskal, Anna; Chwie?ko, Jan; Chyczewska, El?bieta

2013-12-01

211

Orthognathic surgery for obstructive sleep apnea: applying the principles to new horizons in craniofacial surgery.  

PubMed

This article is dedicated to the senior author Dr. Henry K. Kawamoto, Jr, who pioneered the use of orthognathic surgery to treat severe obstructive sleep apnea in 1981. Since that time, his techniques for maxillomandibular advancement have been revised and expanded for improved surgical success. Obstructive sleep apnea is a growing public health concern because it can cause hypertension, cardiac arrhythmias, heart attack, stroke, and, in rare circumstances, sudden death if untreated. When less invasive options fail such as weight loss or dental devices for mandibular repositioning, maxillomandibular advancement is a valuable treatment option for severe obstructive sleep apnea. PMID:23154379

Andrews, Brian T; Lakin, Gregory E; Bradley, James P; Kawamoto, Henry K

2012-11-01

212

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

Microsoft Academic Search

Background  The effects of surgical weight loss (WL) on inflammatory biomarkers associated with sleep apnea remain unknown. We sought\\u000a to determine if any biomarkers can predict amelioration of sleep apnea achieved by bariatric surgery. We hypothesized that\\u000a surgical WL would substantially reduce severity of sleep apnea and levels of proinflammatory cytokines.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty-three morbidly obese adults underwent anthropometric measurements, polysomnography, and serum

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

213

Oral Appliance Treatment for Obstructive Sleep Apnea: An Update  

PubMed Central

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

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

2014-01-01

214

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

PubMed Central

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

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

2013-01-01

215

Ventilatory and Arousal Responses to Hypoxia and Hypercapnia in a Canine Model of Obstructive Sleep Apnea  

Microsoft Academic Search

We have previously described a canine model of obstructive sleep apnea (OSA) in which sleep-wake state is monitored continuously by a computer that produces tracheal occlusion when sleep occurs. Our aim was to assess the effects of long-term application of this model on resting ventilation and on the ventilatory and arousal responses to hypercapnia and hypoxia. Five dogs were maintained

R. JOHN KIMOFF; DINA BROOKS; RICHARD L. HORNER; LOUISE F. KOZAR; CAROLINE L. RENDER-TEIXEIRA; VICTORIA CHAMPAGNE; PIERRE MAYER; ELIOT A. PHILLIPSON

1997-01-01

216

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

E-print Network

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

Southern California, University of

217

Using the Pathophysiology of Obstructive Sleep Apnea to Teach Cardiopulmonary Integration  

ERIC Educational Resources Information Center

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

Levitzky, Michael G.

2008-01-01

218

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

Microsoft Academic Search

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

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

2003-01-01

219

Clinical Presentation of Obstructive Sleep Apnea in Patients with Chronic Kidney Disease  

PubMed Central

Background: Obstructive sleep apnea (OSA) is an important and common comorbidity in patients with chronic kidney disease (CKD). However, few studies have addressed how OSA presents in this patient population and whether it is clinically apparent. Objective: The objectives of this study were to determine if the prevalence and severity of sleep related symptoms distinguished CKD patients with OSA from those without apnea, and whether the clinical presentation of OSA in CKD patients differed from the general OSA population. Methods: One hundred nineteen patients were recruited from outpatient nephrology clinics. All patients completed a sleep history questionnaire, the Epworth Sleepiness Scale (daytime sleepiness, ESS > 10), the Pittsburgh Sleep Quality Index (poor sleep quality, PSQI > 5), and underwent overnight cardiopulmonary monitoring for determination of sleep apnea (respiratory disturbance index ? 15). CKD patients with OSA (n = 46) were compared to (1) CKD patients without OSA (n = 73) and (2) OSA patients without CKD (n = 230) who were referred to the sleep centre. Results: The prevalence of OSA symptoms and PSQI scores did not differ between CKD patients with OSA and CKD patients without apnea. Although the prevalence of daytime sleepiness was higher in CKD patients with OSA compared to CKD patients without apnea (39% vs. 19%, p = 0.033), both daytime sleepiness and other symptoms of sleep apnea were considerably less frequent than in OSA patients without a history of kidney disease. Conclusions: The presence of OSA in patients with CKD is unlikely to be clinically apparent. Consequently, objective cardiopulmonary monitoring during sleep is required to reliably identify this comorbidity. Citation: Nicholl DDM; Ahmed SB; Loewen AHS; Hemmelgarn BR; Sola DY; Beecroft JM; Turin TC; Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with chronic kidney disease. J Clin Sleep Med 2012;8(4):381-387. PMID:22893768

Nicholl, David D. M.; Ahmed, Sofia B.; Loewen, Andrea H. S.; Hemmelgarn, Brenda R.; Sola, Darlene Y.; Beecroft, Jaime M.; Turin, Tanvir C.; Hanly, Patrick J.

2012-01-01

220

Home sleep testing for the diagnosis of obstructive sleep apnea-indications and limitations.  

PubMed

The increasing prevalence and recognition of obstructive sleep apnea (OSA) coupled with an awareness of its detrimental health consequences has resulted in the need for timely and cost efficient access to diagnostic sleep testing and treatment. As a result, increased emphasis is being placed on simplified ambulatory models for the diagnosis and treatment of OSA using home sleep testing (HST). An ambulatory sleep program requires the combination of clinical assessment for identifying patients at high risk for OSA, HST for the diagnosis of OSA, and home auto-titrating positive airway pressure units for treatment. Randomized control trials evaluating the efficacy of this ambulatory approach to diagnose and treat OSA in high-risk patients without significant medical comorbidities reveal the potential for equivalent patient outcomes when compared with the use of polysomnography and in-laboratory continuous positive airway pressure titration. PMID:25353100

Cruz, Sharon De; Littner, Michael R; Zeidler, Michelle R

2014-10-01

221

Mapping Gray Matter Reductions in Obstructive Sleep Apnea: An Activation Likelihood Estimation Meta-Analysis  

PubMed Central

Study Objectives: The authors reviewed the literature on the use of voxel-based morphometry (VBM) in obstructive sleep apnea (OSA) magnetic resonance imaging (MRI) studies via the use of a meta-analysis of neuroimaging to identify consistent and specific structural deficits in patients with sleep apnea compared with healthy subjects. Design: Neuroimaging meta-analysis. Data Sources: We used PubMed to retrieve articles published between January 2000 and February 2012. Study Selection: The authors included all VBM research on patients with OSA and healthy controls. They compared the findings of the studies by using gray matter volume (GMV) or gray matter concentration (GMC) to index differences in gray matter. Data Extraction: Stereotactic data were extracted from eight VBM studies of 213 patients with OSA and 195 control subjects. Results: Regional gray matter reduction in the bilateral parahippocampus and less-convincing right superior frontal and left middle temporal gyri was demonstrated in patients with sleep apnea using an activation likelihood estimation (ALE) procedure to analyze significant differences. Conclusions: Significant reductions in gray matter in patients with sleep apnea occurred in the bilateral parahippocampus and less-convincing frontotemporal regions, which may be related to the neurocognitive processing abnormalities that are common among populations of patients with sleep apnea. Citation: Weng HH; Tsai YH; Chen CF; Lin YC; Yang CT; Tsai YH; Yang CY. Mapping gray matter reductions in obstructive sleep apnea: an activation likelihood estimation meta-analysis. SLEEP 2014;37(1):167-175. PMID:24470705

Weng, Hsu-Huei; Tsai, Yuan-Hsiung; Chen, Chih-Feng; Lin, Yu-Ching; Yang, Cheng-Ta; Tsai, Ying-Huang; Yang, Chun-Yuh

2014-01-01

222

Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study  

Microsoft Academic Search

Background: Under particular conditions a patent foramen ovale (PFO) can potentially give rise to ischemic stroke by means of paradoxic embolization. In obstructive sleep apnea syndrome (OSAS) right to left shunting (RLSh) can occur through PFO during periods of nocturnal apnea. Our study aimed to evaluate the prevalence of PFO diagnosed by means of transcranial Doppler (TcD) in subjects with

Manolo Beelke; Silvia Angeli; Massimo Del Sette; Carlo Gandolfo; Maria Eloisa Cabano; Paola Canovaro; Lino Nobili; Franco Ferrillo

2003-01-01

223

Effects of Surgical Weight Loss on Measures of Obstructive Sleep Apnea: A Meta-Analysis  

Microsoft Academic Search

ObjectiveLimited evidence suggests bariatric surgery can result in high cure rates for obstructive sleep apnea (OSA) in the morbidly obese. We performed a systematic review and meta-analysis to identify the effects of surgical weight loss on the apnea-hypopnea index.

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

2009-01-01

224

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

E-print Network

. Then, simulations of the complete collapsus at the retroglossal level in the upper airway have beenSimulation of the Retroglossal Fluid-Structure Interaction During Obstructive Sleep Apnea Franz an Obstructive Apnea is presented. It is based on simplifications of the full continuum formulation (Navier

Paris-Sud XI, Université de

225

Restricting Calories May Improve Sleep Apnea, Blood Pressure in Obese People  

MedlinePLUS

... Learn More Restricting calories may improve sleep apnea, blood pressure in obese people American Heart Association Meeting ... de Janeiro State University. Download (123.1 kB) Blood Pressure Check (2) copyright American Heart Association Download ( ...

226

[Case of Parkinson's disease presenting with unique dyspneic attacks caused by oromandibular dystonia and sleep apnea syndrome].  

PubMed

A 79-year-old woman with a 4-year history of Parkinson's disease was admitted due to unique dyspneic attacks with cyanosis while eating. Dyspneic attacks with cyanosis occurred mainly during actions such as taking meals or rehabilitation. Due to increased tonus of the orbicularis oris muscle, she was unable to open her mouth and breathe out, and finally experienced hypoxemia as revealed by pulse oxymetry. Dystonic hypertonus was relieved by touching the mandible with the fingers, and she was able to open her mouth again. These symptom was compatible with the sensory trick. Based on these findings, we considered that dyspneic attacks were produced by focal oromandibular dystonia. Polysomnography also showed central sleep apnea. We report herein a rare case of Parkinson's disease presenting with respiratory insufficiency caused by focal dystonia and central sleep apnea. PMID:18018615

Kato, Bunta; Yamada, Koji; Horiuchi, Masahiro; Hirayama, Toshikazu; Hasegawa, Yasuhiro

2007-09-01

227

Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea  

PubMed Central

Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA). Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53 ± 11?yrs; body mass index (BMI) = 45 ± 9?kg/m2) with apnea-hypopnea index (AHI) 33 ± 30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P = 0.006), income level (P < 0.001), and employment status (P = 0.03) between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P = 0.03, P = 0.004, and P = 0.001, resp.), as well as in Hispanics (P = 0.02, P = 0.02, P = 0.03, resp.). Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence. PMID:24649371

Lammi, Matthew R.; Swift, Irene; D'Alonzo, Gilbert E.; Krachman, Samuel L.

2014-01-01

228

Impact of obstructive sleep apnea on abdominal aortic diameters.  

PubMed

Although obesity has been reported to be a potential risk factor for abdominal aortic dilatation, the impact of obstructive sleep apnea (OSA) on the abdominal aortic diameter remains unknown. We retrospectively reviewed 427 patients aged >45 years who underwent polysomnography and abdominal computed tomography from November 2008 to February 2012. Aortic diameters were measured at 3 locations: upper, infrarenal, and lower abdominal aorta. OSA was defined as non-OSA (apnea-hypopnea index [AHI] <10, n = 58), mild to moderate (AHI 10 to 30, n = 167), and severe (AHI ?30, n = 202). Adjusted diameter was not significantly different among OSA severity categories at the upper (21.0, 21.3, and 21.4 mm, respectively) and infrarenal aorta (19.5, 20.2, and 19.9 mm, respectively) but was significantly different at the lower abdominal aorta (17.3, 18.2, and 18.2 mm, respectively, p = 0.006) with larger diameters in patients with OSA. Multivariate linear regression analyses revealed that risk profiles for aortic dilatation varied according to the location and gender and that OSA (AHI ?10) was an independent risk factor for infrarenal and lower abdominal aortic dilatation only in men (? = 0.10 and 0.18, p = 0.049 and 0.001, respectively). In conclusion, OSA may enhance dilatation of the distal abdominal aorta in men. PMID:25086782

Tachikawa, Ryo; Hamada, Satoshi; Azuma, Masanori; Toyama, Yoshiro; Murase, Kimihiko; Tanizawa, Kiminobu; Inouchi, Morito; Handa, Tomohiro; Oga, Toru; Mishima, Michiaki; Chin, Kazuo

2014-08-15

229

Obstructive Sleep Apnea in North American Commercial Drivers  

PubMed Central

The most common medical cause of excessive daytime sleepiness (EDS) is obstructive sleep apnea (OSA). Specifically, among an estimated 14 million US commercial drivers, 17–28% or 2.4 to 3.9 million are expected to have OSA. Based on existing epidemiologic evidence, most of these drivers are undiagnosed and not adequately treated. Untreated OSA increases the risk of vehicular crashes as documented in multiple independent studies and by meta-analysis. Therefore, identifying commercial drivers with OSA and having them effectively treated should decrease crash-related fatalities and injuries. Several strategies are available for screening and identifying drivers with OSA. The simplest and most effective objective strategies use body mass index (BMI) cutoffs for obesity. Functional screens are promising adjuncts to other objective tests. The most effective approach will likely be a combination of a good questionnaire; BMI measures; and a careful physician-obtained history complemented by a functional screen. PMID:24317450

KALES, Stefanos N.; STRAUBEL, Madeleine G.

2013-01-01

230

OBSTRUCTIVE SLEEP APNEA AND METABOLIC DYSFUNCTION IN POLYCYSTIC OVARY SYNDROME  

PubMed Central

Obstructive sleep apnea (OSA) is an underrecognized, yet significant factor in the pathogenesis of metabolic derangements in polycystic ovary syndrome (PCOS). Recent findings suggest that there may be two “subtypes” of PCOS, i.e. PCOS with or without OSA, and these two subtypes may be associated with distinct metabolic and endocrine alterations. PCOS women with OSA may be at much higher risk for diabetes and cardiovascular disease than PCOS women without OSA and may benefit from therapeutic interventions targeted to decrease the severity of OSA. The present chapter will review what is currently known about the roles of sex steroids and adiposity in the pathogenesis of OSA, briefly review the metabolic consequences of OSA as well as the metabolic abnormalities associated with PCOS, review the prevalence of OSA in PCOS and finally present early findings regarding the impact of treatment of OSA on metabolic measures in PCOS. PMID:21112021

Nitsche, Katie; Ehrmann, David A.

2010-01-01

231

Chronic retropharyngeal abscess presenting as obstructive sleep apnea.  

PubMed

Chronic retropharyngeal abscess (RPA) in children is an unusual condition that has rarely been reported in the literature. Pediatric obstructive sleep apnea (OSA) has many etiologies that have been well described, but there have been no reports of a chronic RPA presenting with severe OSA. We describe an infant who presented with severe OSA due to oropharyngeal narrowing by a chronic abscess. An intraoperative magnetic resonance imaging study confirmed the presence of a RPA. Treatment included tracheostomy, surgical drainage, and intravenous followed by oral antibiotics. Physicians evaluating children with recent onset severe OSA after a respiratory infection should include suppurative oropharyngeal pathology in the differential diagnosis. A recent drainage of a head or neck abscess should strengthen that suspicion. PMID:18562883

Zafereo, Mark E; Pereira, Kevin D

2008-06-01

232

Dietary Self-monitoring in Patients with Obstructive Sleep Apnea.  

PubMed

Self-monitoring of food intake is a cornerstone of behavioral weight loss interventions, but its use has not been evaluated in the treatment of obese patients with obstructive sleep apnea (OSA). This pilot study described patterns of adherence to dietary self-monitoring in obese patients with OSA and determined associations between self-monitoring and weight loss, psychosocial functioning, and adherence to continuous positive airway pressure treatment. Participants completed a 6-week behavioral weight loss intervention focused on dietary self-monitoring. Approximately one-third of participants were adherent to self-monitoring throughout the course of the intervention and experienced more weight loss than those who did not self-monitor regularly. More frequent dietary self-monitoring also appeared to be associated with adherence to other health behaviors. These preliminary data suggest that use of dietary self-monitoring may be beneficial for promoting weight loss and adherence to other important health behaviors in OSA patients. PMID:24274238

Hood, Megan M; Nackers, Lisa M; Kleinman, Brighid; Corsica, Joyce; Katterman, Shawn N

2014-01-01

233

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

E-print Network

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

234

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

Microsoft Academic Search

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

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

2005-01-01

235

Autonomic alterations and endothelial dysfunction in pediatric obstructive sleep apnea.  

PubMed

The cardiovascular consequences of obstructive sleep apnea syndrome (OSAS) in children have started to emerge over the last decade. It is clear that the respiratory and sleep alterations that characterize this relatively prevalent condition induce substantial alterations in autonomic nervous system control, ultimately generating high sympathetic outflow and reactivity that reflect an imbalance between sympatho-excitatory and vagal inhibitory inputs. In addition to these important consequences, the constitutive elements of OSAS also elicit a rather extensive activation of systemic inflammatory pathways that in turn pose substantial risk to the integrity and functional homeostasis of the endothelial network. The complex interactions between the multiple injury-associated pathways recruited by OSAS are further compounded by the potential release of angiogenic factors and by the mobilization and homing of progenitor cells that have the potential to repair and restore the OSAS-disrupted vascular function. Improved characterization of the mechanisms involved in every one of these processes and identification of the determinants of susceptibility in pediatric populations along with the interactions with obesity will clearly modify our approaches to OSAS in the future. PMID:20620107

Kheirandish-Gozal, Leila; Bhattacharjee, Rakesh; Gozal, David

2010-08-01

236

Sleep apnea in children with refractory monosymptomatic nocturnal enuresis  

PubMed Central

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

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

2014-01-01

237

Sleep apnea and mandibular advancement device. Revision of the literature.  

PubMed

Sleep apnea and hypopnea syndrome (SAHS) is a disorder characterized by intermittent and repetitive obstruction of the upper airway provoking pharyngeal collapse. It is characterized clinically by a triad of daytime hypersomnia, snoring and pauses in breathing during sleep that are normally reported by the partner. Polysomnography is the chosen method for diagnosing this pathology. Patients with this disorder tend to have the following dental and orofacial signs: a retrognathic jaw, a narrow palate, a wide neck, deviation of the nasal septum and relative macroglossia, among others. Dentists should be ready to evaluate the risk-benefit of certain dental treatment options for this public health problem. The treatment of this problem will depend on its severity, with one of the options being the Mandibular Advancement Device (MAD) that is used especially in the treatment of slight or moderate SAHS and in the treatment of snoring, with results that are occasionally very successful. The objective of this study is to carry out an up-to-date literature review of SAHS and to evaluate the role of the dentist when faced with this pathology. PMID:18758397

Rodríguez-Lozano, Fco Javier; Sáez-Yuguero, Maria del Rosario; Linares Tovar, Eva; Bermejo Fenoll, Ambrosio

2008-09-01

238

The Complex Sleep Apnea Resolution Study: A Prospective Randomized Controlled Trial of Continuous Positive Airway Pressure Versus Adaptive Servoventilation Therapy  

PubMed Central

Introduction: Prior studies show that adaptive servoventilation (ASV) is initially more effective than continuous positive airway pressure (CPAP) for patients with complex sleep apnea syndrome (CompSAS), but choosing therapies has been controversial because residual central breathing events may resolve over time in many patients receiving chronic CPAP therapy. We conducted a multicenter, randomized, prospective trial comparing clinical and polysomnographic outcomes over prolonged treatment of patients with CompSAS, with CPAP versus ASV. Methods: Qualifying participants meeting criteria for CompSAS were randomized to optimized CPAP or ASV treatment. Clinical and polysomnographic data were obtained at baseline and after 90 days of therapy. Results: We randomized 66 participants (33 to each treatment). At baseline, the diagnostic apnea-hypopnea index (AHI) was 37.7 ± 27.8 (central apnea index [CAI] = 3.2 ± 5.8) and best CPAP AHI was 37.0 ± 24.9 (CAI 29.7 ± 25.0). After second-night treatment titration, the AHI was 4.7 ± 8.1 (CAI = 1.1 ± 3.7) on ASV and 14.1 ± 20.7 (CAI = 8.8 ± 16.3) on CPAP (P ? 0.0003). At 90 days, the ASV versus CPAP AHI was 4.4 ± 9.6 versus 9.9 ± 11.1 (P = 0.0024) and CAI was 0.7 ± 3.4 versus 4.8 ± 6.4 (P < 0.0001), respectively. In the intention-to-treat analysis, success (AHI < 10) at 90 days of therapy was achieved in 89.7% versus 64.5% of participants treated with ASV and CPAP, respectively (P = 0.0214). Compliance and changes in Epworth Sleepiness Scale and Sleep Apnea Quality of Life Index were not significantly different between treatment groups. Conclusion: Adaptive servoventilation (ASV) was more reliably effective than CPAP in relieving complex sleep apnea syndrome. While two thirds of participants experienced success with CPAP, approximately 90% experienced success with ASV. Because both methods produced similar symptomatic changes, it is unclear if this polysomnographic effectiveness may translate into other desired outcomes. Clinical Trials: Clinicaltrials.Gov NCT00915499 Citation: Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC, Goldberg R. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. SLEEP 2014;37(5):927-934. PMID:24790271

Morgenthaler, Timothy I.; Kuzniar, Tomasz J.; Wolfe, Lisa F.; Willes, Leslee; McLain, William C.; Goldberg, Rochelle

2014-01-01

239

Higher Prevalence of Smoking in Patients Diagnosed as Having Obstructive Sleep Apnea  

Microsoft Academic Search

Nightly nicotine withdrawal as well as other respiratory and pulmonary effects of smoking may result in sleep-disordered breathing, especially obstructive sleep apnea (OSA). We hypothesize that there is higher prevalence of smoking in patients with OSA. We also hypothesize that smoking is an independent risk factor for OSA. The aim of this study is to determine whether there is a

Ravindra Kashyap; Lynette M. Hock; Teri J. Bowman

2001-01-01

240

Oral Appliances in the Treatment of Obstructive Sleep Apnea and Snoring  

Microsoft Academic Search

This overview summarizes current knowledge of effects, side effects and indications for oral appliances in the treatment of patients with obstructive sleep apnea (OSA) and snoring. Mandibular repositioning appliances (MRAs) in various designs represent the most evaluated type of oral appliance. MRAs relocate the lower jaw forward and downward in order to prevent sleep-induced pharyngeal collapse. Shortterm success rates with

M. Marklund

2006-01-01

241

Vigilance and neuropsychological capacity in obstructive sleep apnea syndrome and chronic obstructive pulmonary disease  

Microsoft Academic Search

Summary  Patients with obstructive sleep apnea syndrome (OSAS) commonly complain of a decline of cognitive functions. These deficits can be due to sleep fragmentation or chronic hypoxemia. Although patients with chronic obstructive pulmonary disease (COPD) present severe hypoxemia neuropsychological deficits are rarely reported. In the present study OSAS- and COPD patients were compared in order to reveal the importance of hypoxemia.

Sylvia Kotterba; K. Rasche; W. Widdig; Svenja Blombach; Katja Duchna; H.-W. Duchna; G. Schultze-Werninghaus; J.-P. Malin

1998-01-01

242

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

PubMed Central

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

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

1999-01-01

243

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

Microsoft Academic Search

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

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

2007-01-01

244

Prevalence and Correlates of Insomnia and Obstructive Sleep Apnea in Chronic Kidney Disease  

PubMed Central

Background: Poor sleep quality, insomnia, and restless legs syndrome (RLS) and sleep apnea are common in patients with chronic kidney disease (CKD). Clinical correlates of these problems are poorly understood. Aims: This study was to find out the prevalence and correlates of insomnia and subjects with ‘high risk for obstructive sleep apnea (OSA)’ in adults with chronic kidney disease. Materials and Methods: One hundred and four adults with CKD were included. Their demographic data, details regarding kidney disease and hemodialysis (HD) were recorded. Presence of insomnia and its severity was assessed. They were screened for sleep apnea using a validated questionnaire. Results: Average age was 54.17 (± 12.96) years. 89.4% had stage 5 nephropathy and 78.8% subjects were on regular HD. Males outnumbered females. Insomnia was reported by 35.5%. Among these, 50% had chronic insomnia. Insomnia subjects had higher prevalence of diabetes (P = 0.01) and depression (P < 0.001). Fifty-one percent subjects were at “high risk for sleep apnea”. They had higher prevalence of diabetes (P < 0.001), coronary disease (P = 0.02), insomnia (P = 0.008), and experienced daytime symptoms of insomnia (P < 0.001). However, in the logistic regression, only male gender (odds ratio, OR = 13.59) and daytime symptoms of insomnia (OR = 7.34) were found to be associated with “higher risk for sleep apnea”. Conclusion: Insomnia was prevalent in CKD. Nearly half of these patients are at high risk for sleep apnea and a third of them suffer from insomnia. Hence, these patients should be screened for sleep disorders. PMID:24404542

Ahmad, Shahbaj; Gupta, Manan; Gupta, Ravi; Dhyani, Mohan

2013-01-01

245

Amelioration of Obstructive Sleep Apnea in REM Sleep Behavior Disorder: Implications for the Neuromuscular Control of OSA  

PubMed Central

Objectives: The relationship between REM sleep behavior disorder (RBD) and obstructive sleep apnea (OSA) remains unclear. We aimed to (1) explore the association of REM-related EMG activity (REMREEA) with OSA in RBD patients; (2) compare the severity of OSA between RBD patients with OSA (RBD-OSA) and their age-, sex-, AHI-, and BMI- matched OSA controls. Design: a. Correlation study in consecutive RBD subjects and b. case-control study Setting: Sleep laboratory Participants: 71 RBD patients in the correlation study and 55 subjects (28 RBD-OSA cases and 27 OSA controls) in the case-control study. Intervention: N/A Methods: Polysomnographic assessment to document the sleep architecture, sleep apnea related parameters, and REMREEA. Results: (1) In the correlation study, increased REMREEA was associated with lower severity of OSA in RBD patients, including total AHI (r = ?0.263), NREM AHI (r = ?0.242), obstructive AHI (r = ?0.265), and mean apnea duration (r = ?0.353) (P < 0.05). (2) In the case-control study, RBD-OSA patients had lesser severity of sleep apnea parameters than OSA controls in terms of higher nadir SpO2 (85.7% ± 4.9% vs 80.8% ± 5.9%, P < 0.01), shorter maximum hypopnea duration (53.8 ± 16.7 vs 69.4 ± 22.4 seconds, P < 0.05), and maximum (45.8 ± 20.5 vs 60.8 ± 19.6 sec, P < 0.01) and mean apnea duration (22.3 ± 8.1 vs 26.3 ± 5.8 sec, P < 0.05). Significant interaction effects indicated that the usual REM sleep exacerbation of sleep apneas was seen only in OSA controls but not in RBD subjects. Conclusions: This study demonstrated that excessive EMG activity in RBD might protect patients against severe OSA and suggests this may be a naturalistic model for understanding neuromuscular control of OSA. Citation: Huang J; Zhang J; Lam SP; Li SX; Ho CKW; Lam V; Yu MWM; Wing YK. Amelioration of obstructive sleep apnea in REM sleep behavior disorder: implications for the neuromuscular control of OSA. SLEEP 2011;34(7):909-915. PMID:21731141

Huang, Jixiong; Zhang, Jihui; Lam, Siu Ping; Li, Shirley Xin; Ho, Crover Kwok Wah; Lam, Venny; Yu, Mandy Wai Man; Wing, Yun-Kwok

2011-01-01

246

Slow wave sleep rebound and REM rebound following the first night of treatment with CPAP for sleep apnea: correlation with subjective improvement in sleep quality  

Microsoft Academic Search

Objective: The purpose of this study was to correlate changes in PSG parameters between the diagnostic polysomnogram (dPSG) and the first night of treatment with continuous positive airway pressure (CPAP) (cpapPSG) to subjective improvement in sleep quality.Background: In patients with obstructive sleep apnea syndrome (OSAS), therapy with CPAP results in reduction of sleep latency, stage 1 sleep, arousal index (Al)

Amit Verma; Rodney A Radtke; Kevan E VanLandingham; John H King; Aatif M Husain

2001-01-01

247

Is Technologist Review of Raw Data Necessary after Home Studies for Sleep Apnea?  

PubMed Central

Study Objectives: As the importance of portable monitors for detection of sleep apnea increases, efficient and cost-minimizing methods for data interpretation are needed. We sought to compare in stroke patients, for whom portable studies often have particular advantages, results from a cardiopulmonary monitoring device with and without manual edits by a polysomnographic technologist. Methods: Participants in an ongoing stroke surveillance study in Corpus Christi, Texas, underwent sleep apnea assessments with the ApneaLink Plus device within 45 days of stroke onset. Recordings were analyzed by the device's software unedited, and again after edits were made to the raw data by a registered polysomnographic technologist. Sensitivity and specificity were calculated, with the edited data as the reference standard. Sleep apnea was defined by 3 different apnea-hypopnea index (AHI) thresholds: ? 5, ? 10, and ? 15. Results: Among 327 subjects, 54% were male, 59% were Hispanic, and the median age was 65 years (interquartile range: 57, 77). The median AHI for the unedited data was 9 (4, 22), and for the edited data was 13 (6, 27) (p < 0.01). Specificity was above 98% for each AHI cutoff, while sensitivity was 81% to 82%. For each cutoff threshold, the edited data yielded a higher proportion of positive sleep apnea screens (p < 0.01) by approximately 10% in each group. Conclusions: For stroke patients assessed with a cardiopulmonary monitoring device, manual editing by a technologist appears likely to improve sensitivity, whereas specificity of unedited data is already excellent. Citation: Brown DL; Chervin RD; Hegeman G; Smith MA; Garcia NM; Morgenstern LB; Lisabeth LD. Is technologist review of raw data necessary after home studies for sleep apnea? J Clin Sleep Med 2014;10(4):371-375. PMID:24733981

Brown, Devin L.; Chervin, Ronald D.; Hegeman, Garnett; Smith, Melinda A.; Garcia, Nelda M.; Morgenstern, Lewis B.; Lisabeth, Lynda D.

2014-01-01

248

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

PubMed

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

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

2014-01-01

249

A combined neuropsychological and brain imaging study of obstructive sleep apnea Running head: Cognitive and brain imaging study of OSA patients  

E-print Network

1 A combined neuropsychological and brain imaging study of obstructive sleep apnea Running head.1365-2869.2008.00705.x #12;2 Patients with obstructive sleep apnea show neuropsychological impairments, neuropsychology, resting state, cognitive reserve INTRODUCTION Obstructive sleep apnea (OSA) is characterized

Paris-Sud XI, Université de

250

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

PubMed

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

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

2011-08-01

251

Regional cerebral blood flow alterations in obstructive sleep apnea.  

PubMed

Obstructive sleep apnea (OSA) is a condition characterized by upper airway muscle atonia with continued diaphragmatic efforts, resulting in repeated airway obstructions, periods of intermittent hypoxia, large thoracic pressure changes, and substantial shifts in arterial pressure with breathing cessation and resumption. The hypoxic exposure and hemodynamic changes likely induce the structural and functional deficits found in multiple brain areas, as shown by magnetic resonance imaging (MRI) procedures. Altered cerebral blood flow (CBF) may contribute to these localized deficits; thus, we examined regional CBF, using arterial spin labeling procedures, in 11 OSA (age, 49.1±12.2 years; 7 male) and 16 control subjects (42.3±10.2 years; 6 male) with a 3.0-Tesla MRI scanner. CBF maps were calculated, normalized to a common space, and regional CBF values across the brain quantified. Lowered CBF values emerged near multiple bilateral brain sites in OSA, including the corticospinal tracts, superior cerebellar peduncles, and pontocerebellar fibers. Lateralized, decreased CBF appeared near the left inferior cerebellar peduncles, left tapetum, left dorsal fornix/stria terminalis, right medial lemniscus, right red nucleus, right midbrain, and midline pons. Regional CBF values in OSA are significantly reduced in major sensory and motor fiber systems and motor regulatory sites, especially in structures mediating motor coordination; those reductions are often lateralized. The asymmetric CBF declines in motor regulatory areas may contribute to loss of coordination between upper airway and diaphragmatic musculature, and lead to further damage in the syndrome. PMID:24076138

Yadav, Santosh K; Kumar, Rajesh; Macey, Paul M; Richardson, Heidi L; Wang, Danny J J; Woo, Mary A; Harper, Ronald M

2013-10-25

252

Obstructive sleep apnea and asthma: associations and treatment implications.  

PubMed

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

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

2014-04-01

253

Gender differences in the clinical manifestation of obstructive sleep apnea.  

PubMed

Obstructive sleep apnea (OSA) has been historically described as a disease primarily of men. However, it is now widely recognized that OSA in women is not as rare as was originally believed. The alarming degree to which OSA is clinically underdiagnosed in women raises the critical concern that women manifest OSA differently. The purpose of this review is to examine the issue of clinically significant gender differences in OSA disease manifestation, which pose unique challenges to diagnosis and management. Within this review, current findings regarding gender differences in OSA polysomnographic features and demographic factors, symptom presentation, functional status, comorbidities, health care utilization, and therapeutic management have been reviewed. Further research in this field is proposed to examine the impact of gender on functional status in individuals with OSA, and the potential gender differences in therapeutic management, particularly the response to continuous positive airway pressure (CPAP) treatment. Additional studies describing the clinical manifestations in men and women at different levels of OSA severity may substantially contribute to the ability to identify and treat OSA in women across a wide spectrum of disease severity. PMID:19403333

Ye, Lichuan; Pien, Grace W; Weaver, Terri E

2009-12-01

254

Salivary biomarkers indicate obstructive sleep apnea patients with cardiovascular diseases  

PubMed Central

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

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

2014-01-01

255

Nonresponders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy  

PubMed Central

Objectives/Hypothesis To examine DISE findings in nonresponders to previous pharyngeal OSA surgery Study Design cross-sectional Methods Drug-induced sleep endoscopy (DISE) using propofol for unconscious sedation was performed in nonresponders to previous OSA surgery (including palate surgery with or without tonsillectomy and possible other procedures), defined by an apnea-hypopnea index >10 events/hour. Recorded findings included the presence and degree of obstruction in the palatal and hypopharyngeal regions, the contributions of specific structures (velum, oropharyngeal lateral walls, tongue, and/or epiglottis) to upper airway obstruction, and the degree of mouth opening. Results Thirty-three nonresponders underwent DISE examinations. Age was 46.2±11.8 years, and 9% (3/33) were female. On diagnostic sleep studies prior to DISE, the apnea-hypopnea index was 43.4±26.6 events/hour. During DISE, a majority of subjects demonstrated residual palatal obstruction, and almost all demonstrated hypopharyngeal obstruction. A diversity of individual structures contributed to upper airway obstruction, often in combination. Moderate to severe mouth opening occurred in one-third of subjects and was associated with narrowing of upper airway dimensions. Conclusions Residual upper airway obstruction in surgery nonresponders likely occurs due to multiple mechanisms, and DISE may enhance the understanding of them. PMID:21557231

Kezirian, Eric J.

2011-01-01

256

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

Microsoft Academic Search

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

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

2003-01-01

257

Is there a place for teaching obstructive sleep apnea and snoring in the predoctoral dental curriculum?  

PubMed

The widespread prevalence of obstructive sleep apnea and apneic snoring is both alarming and well documented. Sleep disorders affect one out of five Americans. Yet, during an attempt to study the prevalence of obstructive sleep apnea and snoring among patients at the University of Tennessee Health Science Center College of Dentistry, a search through the entire school's database for the terms "sleep apnea" and "snoring" found only ninety-two patients who admitted to snoring. Currently, the condition "sleep apnea" is not even on the school's list of health/medical questions. These figures not only are inconsistent with national statistics, but confirm that more needs to be done to make dental students aware of these disorders, include them in patient medical histories, and ultimately educate patients about therapies that can help. Considering the health concerns related to this sleep disorder, the economic impact of insomnia and daytime sleepiness, as well as the fact that the dentist is well poised to reduce symptoms and increase the quality of life among sufferers, mandibular advancement devices should become an educational standard in the predoctoral clinical curriculum of dental schools. Predoctoral clinical curricula need to reflect this current health trend and train dentists to care for these patients comprehensively. PMID:23225683

Ivanoff, Chris S; Hottel, Timothy L; Pancratz, Frank

2012-12-01

258

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

PubMed Central

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

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

2014-01-01

259

Screening of obstructive sleep apnea with empirical mode decomposition of pulse oximetry.  

PubMed

Detection of desaturations on the pulse oximetry signal is of great importance for the diagnosis of sleep apneas. Using the counting of desaturations, an index can be built to help in the diagnosis of severe cases of obstructive sleep apnea-hypopnea syndrome. It is important to have automatic detection methods that allows the screening for this syndrome, reducing the need of the expensive polysomnography based studies. In this paper a novel recognition method based on the empirical mode decomposition of the pulse oximetry signal is proposed. The desaturations produce a very specific wave pattern that is extracted in the modes of the decomposition. Using this information, a detector based on properly selected thresholds and a set of simple rules is built. The oxygen desaturation index constructed from these detections produces a detector for obstructive sleep apnea-hypopnea syndrome with high sensitivity (0.838) and specificity (0.855) and yields better results than standard desaturation detection approaches. PMID:24931493

Schlotthauer, Gastón; Di Persia, Leandro E; Larrateguy, Luis D; Milone, Diego H

2014-08-01

260

Screening of Obstructive Sleep Apnea with Empirical Mode Decomposition of Pulse Oximetry  

E-print Network

Detection of desaturations on the pulse oximetry signal is of great importance for the diagnosis of sleep apneas. Using the counting of desaturations, an index can be built to help in the diagnosis of severe cases of obstructive sleep apnea-hypopnea syndrome. It is important to have automatic detection methods that allows the screening for this syndrome, reducing the need of the expensive polysomnography based studies. In this paper a novel recognition method based on the empirical mode decomposition of the pulse oximetry signal is proposed. The desaturations produce a very specific wave pattern that is extracted in the modes of the decomposition. Using this information, a detector based on properly selected thresholds and a set of simple rules is built. The oxygen desaturation index constructed from these detections produces a detector for obstructive sleep apnea-hypopnea syndrome with high sensitivity ($0.838$) and specificity ($0.855$) and yields better results than standard desaturation detection approach...

Schlotthauer, Gastón; Larrateguy, Luis D; Milone, Diego H

2014-01-01

261

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

PubMed

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

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

2014-12-01

262

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

PubMed Central

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

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

2009-01-01

263

A 2-week, polysomnographic, safety study of sodium oxybate in obstructive sleep apnea syndrome  

Microsoft Academic Search

Purpose  Sodium oxybate (SXB) is approved for cataplexy and excessive daytime sleepiness in narcolepsy. Obstructive sleep apnea syndrome\\u000a (OSAS) affects ?9–50% of narcoleptics. Effects of 2-week SXB administration on apnea–hypopnea index (AHI), oxygen saturation\\u000a (SaO2), and sleep architecture were investigated in OSAS patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  OSAS patients (n?=?48) received 2-week SXB or placebo (PBO) treatment with polysomnography at baseline and day 14. The

Charles F. P. George; Neil Feldman; Yanping Zheng; Teresa L. Steininger; Susanna M. Grzeschik; Chinglin Lai; Neil Inhaber

2011-01-01

264

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

Microsoft Academic Search

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

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

2001-01-01

265

Brown Norway and Zucker Lean Rats Demonstrate Circadian Variation in Ventilation and Sleep Apnea  

PubMed Central

Study Objectives: Circadian rhythms influence many biological systems, but there is limited information about circadian and diurnal variation in sleep related breathing disorder. We examined circadian and diurnal patterns in sleep apnea and ventilatory patterns in two rat strains, one with high sleep apnea propensity (Brown Norway [BN]) and the other with low sleep apnea propensity (Zucker Lean [ZL]). Design/Setting: Chronically instrumented rats were randomized to breathe room air (control) or 100% oxygen (hyperoxia), and we performed 20-h polysomnography beginning at Zeitgeber time 4 (ZT 4; ZT 0 = lights on, ZT12 = lights off). We examined the effect of strain and inspired gas (twoway analysis of variance) and analyzed circadian and diurnal variability. Measurements and Results: Strain and inspired gas-dependent differences in apnea index (AI; apneas/h) were particularly prominent during the light phase. AI in BN rats (control, 16.9 ± 0.9; hyperoxia, 34.0 ± 5.8) was greater than in ZL rats (control, 8.5 ± 1.0; hyperoxia, 15.4 ± 1.1, [strain effect, P < 0.001; gas effect, P = 0.001]). Hyperoxia reduced respiratory frequency in both strains, and all respiratory pattern variables demonstrated circadian variability. BN rats exposed to hyperoxia demonstrated the largest circadian fluctuation in AI (amplitude = 17.9 ± 3.7 apneas/h [strain effect, P = 0.01; gas effect, P < 0.001; interaction, P = 0.02]; acrophase = 13.9 ± 0.7 h; r2 = 0.8 ± 1.4). Conclusions: Inherited, environmental, and circadian factors all are important elements of underlying sleep related breathing disorder. Our method to examine sleep related breathing disorder phenotypes in rats may have implications for understanding vulnerability for sleep related breathing disorder in humans. Citation: Fink AM; Topchiy I; Ragozzino M; Amodeo DA; Waxman JA; Radulovacki MG; Carley DW. Brown Norway and Zucker Lean rats demonstrate circadian variation in ventilation and sleep apnea. SLEEP 2014;37(4):715-721. PMID:24899760

Fink, Anne M.; Topchiy, Irina; Ragozzino, Michael; Amodeo, Dionisio A.; Waxman, Jonathan A.; Radulovacki, Miodrag G.; Carley, David W.

2014-01-01

266

Comparing methods of respiratory event detection during the treatment of obstructive sleep apnea.  

PubMed

Renewed focus on comparative effectiveness research presents a unique opportunity to develop optimal clinical management pathways for patients with obstructive sleep apnea. With this momentum comes the challenge of measuring treatment effect on sleep-disordered breathing, especially in large, multisite studies. In-laboratory polysomnography, the current gold standard sleep assessment of obstructive sleep apnea severity, is costly and imposes significant participant burden. Alternatives include home unattended sleep testing and overnight pulse oximetry recording. Research studies using positive airway pressure treatment have the additional option of using the information recorded by the patient's positive airway pressure device to assess treatment effectiveness. Recent research has shown relatively good agreement between manual identification of residual respiratory events in overnight in-laboratory polysomnography and the automatic event detection utilized in positive airway pressure machines. In addition to assessing the effects of interventions on sleep disordered breathing, obstructive sleep apnea-related comparative effectiveness studies need to assess the impact of the interventions on patient burden, cost of therapy, timeliness of care, improved quality of life and other clinically relevant outcomes. PMID:24236468

Fields, Barry G; Kuna, Samuel T

2012-11-01

267

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

E-print Network

.I. Pack, "Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric-Symposium: Imaging of the Pediatric Upper Airway Novel MRI-based Acquisition Methods Yoon-Chul Kim, Ziyue Wu, Winston. Finally, recent work on 3D real-time MRI acquisition of the upper airway during sleep is presented

Southern California, University of

268

The Dimension of Hyoid Bone Is Independently Associated with the Severity of Obstructive Sleep Apnea  

PubMed Central

Introduction We hypothesized that the size of the hyoid bone itself may affect the severity of sleep apnea. The aim of this study was to identify the relationship between hyoid bone dimensions and the severity of sleep apnea using computerized tomography (CT) axial images. Methods We retrospectively measured the hyoid bone in axial images of neck CTs and correlated these measurements with results of polysomnography in a total of 106 male patients. The new hyoid bone parameters studied in this study were as follows: distance between bilateral lesser horns (LH-d), distance between bilateral greater horns (GH-d), distance from the most anterior end of the hyoid arch to GH-d (AP), distance from the greater to the lesser horn on right and left sides (GH-LH), and the anterior angle between bilateral extensive lines from the greater to the lesser horn (H-angle). Data was analyzed using univariate and multivariate logistic regression, and Pearson correlation tests. Results We found a significant inverse correlation between the apnea-hypopnea index (AHI) and GH-d or AP. Neither the LH-d, GH-LH, nor H-angle were associated with the AHI. The patient group that met the criteria of both GH-d<45.4 and AP<33.4 demonstrated the most severe AHI. Conclusion The lateral width or antero-posterior length of hyoid bone was associated with AHI and predicted the severity of sleep apnea in male patients. This finding supports the role of expansion hyoidplasty for treatment of sleep apnea. Pre-operative consideration of these parameters may improve surgical outcomes in male patients with sleep apnea. PMID:24312562

Ahn, Sang Hyeon; Kim, Chang-Hoon; Yoon, Joo-Heon; Lee, Jeung-Gweon; Cho, Hyung-Ju

2013-01-01

269

Management of obstructive sleep apnea in an edentulous lower jaw patient with a mandibular advancement device.  

PubMed

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

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

2014-01-01

270

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

PubMed Central

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

Keyf, Filiz; Ciftci, Bulent; F?rat Guven, Selma

2014-01-01

271

Sleep estimation using BodyMedia's SenseWear(TM) armband in patients with obstructive sleep apnea  

PubMed Central

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

Sharif, Munir M.; BaHammam, Ahmed S.

2013-01-01

272

Snoring and risk for obstructive sleep apnea among nigerians with heart failure: Prevalence and clinical correlates  

PubMed Central

Background: Heart failure is an important cause of morbidity and mortality in developing nations like Nigeria. Sleep apnea and snoring has recently been recognized to be a cardiovascular risk factor. Sleep apnea is yet to be well studied among Africans with heart failure. We aimed to determine the prevalence of snoring and high risk for obstructive sleep apnea among Nigerians with stable heart failure. Materials and Methods: We studied 103 subjects that included 62 patients with heart failure and 41 control subjects. Demographic parameters and clinical examination were performed on the participants. The Berlin score and the Epworth Sleepiness Scale were administered for each participant. Echocardiography was done on all participants. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 17.0. Results: Snoring was reported in 48.4% of subjects with heart failure compared to 22.0% of control subjects ( P < 0.005). High risk for obstructive sleep apnea using the Berlin score was documented in 51.6% of heart failure subjects compared to 7.31% of controls. Excessive daytime somnolence occurred more in heart failure patients (51.6% vs. 9.8%, P < 0.05). Snorers tended to be older and were more likely to be obese than nonsnorers. Systolic blood pressure and fasting blood sugar were significantly higher among heart failure subjects with snoring than those without snoring (131.9 ± 19.2 vs. 119.2 ± 15.7 and 6.0 ± 0.8 vs. 5.4 ± 2.7, P < 0.005). Conclusion: Heart failure seems to be associated with snoring and a high risk for obstructive sleep apnea among Africans with heart failure. Assessment for sleep disordered breathing should be incorporated into their routine clinical workup. PMID:23580920

Akintunde, Adeseye A.

2013-01-01

273

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

PubMed Central

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

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

2013-01-01

274

Screening of Obstructive Sleep Apnea Syndrome by Heart Rate Variability Analysis  

Microsoft Academic Search

Background—Enhanced nocturnal heart rate variability (HRV) has been evoked in sleep-related breathing disorders. However, its capacity to detect obstructive sleep apnea syndrome (OSAS) has not been systematically determined. Thus, we evaluated the discriminant power of HRV parameters in a first group of patients (G1) and validated their discriminant capacity in a second group (G2). Methods and Results—In G1, 39 of

Frederic Roche; Jean-Michel Gaspoz; Isabelle Court-Fortune; Pascal Minini; Vincent Pichot; David Duverney; Frederic Costes; Jean-Claude Barthelemy

2010-01-01

275

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

Microsoft Academic Search

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

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

276

Muscle fiber area distribution of musculus uvulae in obstructive sleep apnea and non-apneic snorers  

Microsoft Academic Search

OBJECTIVE: To determine whether differences exist in the morphology of upper airway muscles between apneic and non-apneic snorersDESIGN: Muscle characteristic analysis in patients undergoing upper airway surgery in a tertiary sleep center.SUBJECTS: 10 non-apneic snorers and 10 sleep apnea hypopnea syndrome (SAHS).MEASUREMENTS: Frequency distribution of musculus uvulae (MU) muscle fiber area determined from 475±207 (mean±s.d.) and 697±165 type IIA fibers

J-A Simoneau; S St Pierre

2000-01-01

277

Nasal resistances are useful in identifying children with severe obstructive sleep apnea before polysomnography  

Microsoft Academic Search

Objective: In this study, we would like to show that anterior rhinometry measurement of nasal resistance would be a simple and useful test to identify severe obstructive sleep apnea (OSA) in a population of children affected by adenotonsillar hypertrophy. Methods: Seventy-three consecutive children (44 males; mean age 5.4±1.2 years) with adenotonsillar hypertrophy, who complained sleep-disordered breathing, were studied. All the

Maurizio Rizzi; Josè Onorato; Arnaldo Andreoli; Stefano Colombo; Marica Pecis; Paola Marchisio; Marco Morelli; Nicola Principi; Susanna Esposito; Margherita Sergi

2002-01-01

278

AN IMPROVED APPROACH FOR REAL-TIME DETECTION OF SLEEP APNEA  

E-print Network

AN IMPROVED APPROACH FOR REAL-TIME DETECTION OF SLEEP APNEA Baile Xie, Wenxun Qiu Department of Electrical Engineering EC33, University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX 75080, USA of Electrical Engineering EC33, University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX 75080, USA

Minn, Hlaing

279

Influence of chronic barbiturate administration on sleep apnea after hypersomnia presentation: case study  

Microsoft Academic Search

321 When sleepiness is excessive, undesirable, inappropriate or unexplained, it often indicates a clinical disor- der that is generically termed hypersomnia. One of the leading causes of hypersomnia is sleep apnea. We present the case of a 44-year-old woman with a history of bipolar spectrum disorder and epilepsy who ini- tially showed evidence of hypersomnia. The hypersomnia settled with changes

Jatinder Takhar; Joan Bishop

280

Sleep Apnea Detection from ECG Signal: Analysis on Optimal Features, Principal Components, and Nonlinearity  

Microsoft Academic Search

This paper describes implementation of Principal Component Analysis (PCA) on sleep apnea detection using Electrocardiogram (ECG) signal. The statistics of RR-intervals per epoch with 1 minute duration were used as an input. The combination of features proposed by Chazal and Yilmaz was transformed into orthogonal features using PCA. Cross validation, random sampling, and test on train data were used on

Sani M. Isa; Mohamad Ivan Fanany; Wisnu Jatmiko; Aniati Murni Arymurthy

2011-01-01

281

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

Microsoft Academic Search

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- )

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

2009-01-01

282

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

Microsoft Academic Search

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

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

283

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

PubMed

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

Kluszynski, Brendan A; Matt, Bruce H

2006-04-01

284

Obstructive Sleep Apnea in Patients on Conventional and Short Daily Hemodialysis  

Microsoft Academic Search

Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the factors associated with the origin of OSA as well as the cardiovascular consequences in this population are not completely understood. We evaluated, by standard overnight polysomnography, 24-hour ambulatory blood pressure (BP) monitoring and echocardiography in 30 patients (14 males, age 34 ± 11 years, BMI 23.2 ±

Rosilene Motta Elias; Manuel Carlos Martins Castro; Eduardo Lyra de Queiroz; Hugo Abensur; João Egidio Romão-Junior; Geraldo Lorenzi-Filho

2009-01-01

285

Effect of Vertical Dimension on Efficacy of Oral Appliance Therapy in Obstructive Sleep Apnea  

Microsoft Academic Search

The aim of this study was to assess the effect of bite opening induced to derive a placebo effect from the treatment (6); hence, by a mandibular advancement splint (MAS) on efficacy and side it is important to follow patients carefully using objective effects in the treatment of obstructive sleep apnea. In a randomized techniques. crossover fashion, 23 adult patients

Andrew J. Pitsis; M. Ali Darendeliler; Helen Gotsopoulos; Peter Petocz; Peter A. Cistulli

286

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

Microsoft Academic Search

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

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

2009-01-01

287

Controlled Trial of Continuous Positive Airway Pressure in Obstructive Sleep Apnea and Heart Failure  

Microsoft Academic Search

Obstructive sleep apnea (OSA) is highly prevalent among patients with congestive heart failure (CHF) and may contribute to progres- sion of cardiac dysfunction via hypoxia, elevated sympathetic ner- vous system activity, and systemic hypertension. Our aim was to assess the long-term effect of OSA treatment with nocturnal contin- uous positive airway pressure (CPAP) on systolic heart function, sympathetic activity, blood

Darren R. Mansfield; N. Claire Gollogly; David M. Kaye; Meroula Richardson; Peter Bergin; Matthew T. Naughton

288

Effects of Age on Sleep Apnea in Men I. Prevalence and Severity  

Microsoft Academic Search

The effects of age on the prevalence of sleep apnea in the general population remain unclear, be- cause previous studies have focused on specific populations. The effects of age on the severity of ap- nea are unknown. This study was based on a two-stage general random sample of men (aged 20 to 100 yr), consisting of a telephone survey (n

EDWARD O. BIXLER; ALEXANDROS N. VGONTZAS; KATHY TYSON; ANTHONY KALES

289

Obstructive Sleep Apnea Syndrome Fifty-one Consecutive Patients Treated by Maxillofacial Surgery  

Microsoft Academic Search

The place of surgical treatment in obstructive sleep apnea syn- drome (OSAS) remains unclear. Uvulopalatopharyngoplasty (UPPP) has a response rate of 41% overall and only 5% when ret- rolingual narrowing is present. Thus, in cases with suspected hy- popharyngeal collapse maxillofacial surgery has been proposed with improved results. The Stanford group has designed a step- by-step surgical procedure tailored to

GEORGES BETTEGA; JEAN-LOUIS PÉPIN; DAN VEALE; CHRYSTÈLE DESCHAUX; BERNARD RAPHAËL; PATRICK LÉVY

290

Physical Findings and the Risk for Obstructive Sleep Apnea The Importance of Oropharyngeal Structures  

Microsoft Academic Search

In this study, we hypothesized that anatomic abnormalities of the oropharynx, particularly narrowing of the airway by the lateral pharyngeal walls, tonsils, and tongue, would be associated with an increased likelihood for obstructive apnea among patients pre- senting to a sleep disorders center. To test this hypothesis, we used data from a cohort of 420 patients presenting to the Penn

JOSEPH B. SCHELLENBERG; GREG MAISLIN; RICHARD J. SCHWAB

291

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

E-print Network

APNEA Nguyen Quang Vinh1 , Le Page Ronan1 , Goujon Jean-Marc1 , Poffo Luiz1 Thual Monique1 1 UEB). With the aim to monitor sleep apnea, two simulated central sleep apnea were performed and recorded with Biopac with average results for both methods. Further experiments will deal with real sleep apnea cases and algorithm

Boyer, Edmond

292

Comparison of Drug-induced Sleep Endoscopy and Lateral Cephalometry in Obstructive Sleep Apnea  

PubMed Central

Objective To evaluate the association between findings from drug-induced sleep endoscopy (DISE) and lateral cephalometry in obstructive sleep apnea (OSA) Study Design Cross-sectional Methods This was a consecutive series of subjects with OSA who underwent DISE and lateral cephalometry. DISE findings were characterized according to the region/degree of obstruction as well as the VOTE classification. The primary measurements from lateral cephalometry images were SNA, SNB, PNSP, PAS, and MPH, although additional airway measurements were taken. Descriptive statistics summarized DISE and lateral cephalometry findings, and chi-squared and t-tests examined potential associations between their findings. Results Among the 55 subjects, most demonstrated velum-related obstruction, although obstruction related to other structures was also common. Lateral cephalometry findings were within population norms with the exception of an increased MPH and decreased Airway4 and Airway5 measurements. There was little association between DISE and lateral cephalometry findings, although significant associations were identified between tongue-related obstruction and airway measurements posterior to the tongue base. Conclusion DISE and lateral cephalometry are largely distinct airway evaluation techniques in OSA. The use of these techniques remains complementary. PMID:23086863

George, Jonathan R.; Chung, Sooyoun; Nielsen, Ib; Goldberg, Andrew N.; Miller, Arthur; Kezirian, Eric J.

2012-01-01

293

The Impact of Obstructive Sleep Apnea on Motor Skill Acquisition and Consolidation  

PubMed Central

Study Objective: Recent investigations suggest that motor skill learning is impaired in patients with obstructive sleep apnea (OSA) syndrome; however, it is not fully understood at what stages of learning this impairment occurs. The current study aimed to compare motor learning and memory across both daytime acquisition and overnight consolidation. Methods: Twelve OSA patients and twelve control participants, matched for age and education, were recruited and completed the Karolinska Sleepiness Scale and the sequential finger-tapping task (SFTT), a motor skill learning task, both before and after polysomnographic recorded sleep. Results: During the evening acquisition phase both groups showed significant and equitable improvement in the number of correctly typed sequences across trials. On retesting the following morning, the control patients showed significantly greater improvement overnight (15.35%) compared to OSA patients (1.78%). The post sleep improvement in controls, but lacking in OSA patients, was typical of a sleep dependent enhancement effect. The magnitude of improvement overnight for either group was not significantly correlated with any of the recorded sleep variables. Conclusions: These results suggest daytime/practice related acquisition of motor skill is largely intact in OSA patients; however, marked impairment in the consolidation phase is evident following a sleep period. This particular pattern of dysfunction may remain unnoticed following single-day learning/memory assessments. Citation: Landry S, Anderson C, Andrewartha P, Sasse A, Conduit R. The impact of obstructive sleep apnea on motor skill acquisition and consolidation. J Clin Sleep Med 2014;10(5):491-496. PMID:24910549

Landry, Shane; Anderson, Clare; Andrewartha, Peter; Sasse, Anthony; Conduit, Russell

2014-01-01

294

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

Microsoft Academic Search

This study analyses two different methods to detect obstructive sleep apnea (OSA) during sleep time based only on the ECG signal. OSA is a common sleep disorder caused by repetitive occlusions of the upper airways, which produces a characteristic pattern on the ECG. ECG features, such as the heart rate variability (HRV) and the QRS peak area, contain information suitable

M. O. Mendez; J. Corthout; S. Van Huffel; M. Matteucci; T. Penzel; S. Cerutti; A. M. Bianchi

2010-01-01

295

A Novel Approach to Detect the Obscured Upper Body in application to Diagnosis of Obstructive Sleep Apnea  

Microsoft Academic Search

Obstructive Sleep Apnea is increasingly seen as a common and important condition, contributing to sleep disturbance and consequential daytime sleepiness. According to recent research findings, the best predictors of morbidity in individual patients, as assessed by improvements with CPAP (continuous positive airway pressure therapy), are nocturnal oxygen saturation and movements during sleep. Video monitoring and interpretation is less well developed

Ching-Wei Wang; Andrew Hunter

2008-01-01

296

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

PubMed Central

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

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

2012-01-01

297

Response to CPAP Withdrawal in Patients with Mild Versus Severe Obstructive Sleep Apnea/Hypopnea Syndrome  

PubMed Central

Background: Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS), even those generally compliant with CPAP therapy, often intermittently discontinue CPAP. Study Objective: Examine the impact of CPAP withdrawal on sleep, sleep disordered breathing (SDB), and daytime function in subjects with varying severity of OSAHS. Patients and Interventions: Forty-two subjects (26M/16 F) with OSAHS (AHI4% = 45.2 ± 35.5/h pretreatment) on CPAP for 4 months were evaluated on the second night of CPAP withdrawal. Sleep architecture, SDB indices, and subjective/objective daytime function were assessed pretreatment, on CPAP therapy, and after CPAP withdrawal. Comparisons were made between pretreatment and CPAP withdrawal for the entire group, and for subgroups of mild/moderate (AHI4% < 30/h, n = 22) and severe (AHI4% > 30/h, n = 20) SDB. Results: Overall, and for mild/moderate subjects, SDB indices returned to pretreatment values on CPAP withdrawal but with fewer apneas and more hypopneas/RERAs. For severe SDB, the event frequency (AI, AHI4%, and RDI) was lower and O2 desaturation was improved on CPAP withdrawal. Across SDB severity, sleep architecture showed lower %REM (15.6% vs 12.9%, P = 0.009) on the CPAP withdrawal compared to pretreatment. Stanford Sleepiness Score, MSLT, and PVT measures were not significantly different between pretreatment and CPAP withdrawal. Conclusions: Over a wide range of SDB severity CPAP withdrawal results in recurrence of SDB, albeit with less severe O2 desaturation. Subjective/objective daytime function returned to pretreatment levels. Sleep architecture changes on CPAP withdrawal (acute SDB) may reflect reduced sleep pressure compared to pretreatment chronic SDB. Our data suggest detrimental effects of even brief withdrawal of CPAP in subjects with both mild and severe OSAHS. Citation: Young LR; Taxin ZH; Norman RG; Walsleben JA; Rapoport DM; Ayappa I. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome. SLEEP 2013;36(3):405-412. PMID:23449493

Young, Laura R.; Taxin, Zachary H.; Norman, Robert G.; Walsleben, Joyce A.; Rapoport, David M.; Ayappa, Indu

2013-01-01

298

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

PubMed Central

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

Mateika, Jason H.; Syed, Ziauddin

2013-01-01

299

The sleep apnea cardiovascular endpoints (SAVE) trial: Rationale and start-up phase  

PubMed Central

The sleep apnea cardiovascular endpoints (SAVE) study (Clinical Trials Registration Number: NCT00738170) is an academic initiated and conducted, multinational, open, blinded endpoint, randomised controlled trial designed to determine whether treatment of obstructive sleep apnea (OSA) with continuous positive airways pressure (CPAP) can reduce the incidence of serious cardiovascular events in patients with established cardiovascular disease. The answer to this question is of major importance to populations undergoing ageing and lifestyle changes all over the world. The SAVE study brings together respiratory, sleep and cardiovascular clinician-scientists in a unique interdisciplinary collaborative effort with industry sponsors to conduct the largest and most ambitious clinical trial yet conducted in the field of sleep apnea, with a global recruitment target of 5000 patients. Following its launch in Australia and China in late 2008, SAVE has now entered a phase of international expansion with new recruitment networks being established in New Zealand, India and Latin America. This article describes the rationale for the SAVE study, the considerations behind its design, and progress thus far in establishing the recruitment network. The report emphasises the important role that Chinese sleep and cardiovascular investigators have played in the start-up phase of this landmark international project. PMID:22263035

McEvoy, R Doug; Anderson, Craig S; Antic, Nick A; Chen, Baoyuan; He, Quanying; Heeley, Emma; Huang, Shaoguang; Huang, Yining; Wang, Jiguang; Zhong, Nanshan

2010-01-01

300

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

NASA Astrophysics Data System (ADS)

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

Yadollahi, Azadeh

301

Apnea-induced rapid eye movement sleep disruption impairs human spatial navigational memory.  

PubMed

Hippocampal electrophysiology and behavioral evidence support a role for sleep in spatial navigational memory, but the role of particular sleep stages is less clear. Although rodent models suggest the importance of rapid eye movement (REM) sleep in spatial navigational memory, a similar role for REM sleep has never been examined in humans. We recruited subjects with severe obstructive sleep apnea (OSA) who were well treated and adherent with continuous positive airway pressure (CPAP). Restricting CPAP withdrawal to REM through real-time monitoring of the polysomnogram provides a novel way of addressing the role of REM sleep in spatial navigational memory with a physiologically relevant stimulus. Individuals spent two different nights in the laboratory, during which subjects performed timed trials before and after sleep on one of two unique 3D spatial mazes. One night of sleep was normally consolidated with use of therapeutic CPAP throughout, whereas on the other night, CPAP was reduced only in REM sleep, allowing REM OSA to recur. REM disruption via this method caused REM sleep reduction and significantly fragmented any remaining REM sleep without affecting total sleep time, sleep efficiency, or slow-wave sleep. We observed improvements in maze performance after a night of normal sleep that were significantly attenuated after a night of REM disruption without changes in psychomotor vigilance. Furthermore, the improvement in maze completion time significantly positively correlated with the mean REM run duration across both sleep conditions. In conclusion, we demonstrate a novel role for REM sleep in human memory formation and highlight a significant cognitive consequence of OSA. PMID:25355211

Varga, Andrew W; Kishi, Akifumi; Mantua, Janna; Lim, Jason; Koushyk, Viachaslau; Leibert, David P; Osorio, Ricardo S; Rapoport, David M; Ayappa, Indu

2014-10-29

302

Randomized Placebo-controlled Crossover Trial of Continuous Positive Airway Pressure for Mild Sleep Apnea\\/Hypopnea Syndrome  

Microsoft Academic Search

The minimal disease severity at which patients with the sleep apnea\\/hypopnea syndrome (SAHS) gain benefit from treatment is not well characterized, although a pilot study of continuous positive airway pressure (CPAP) therapy showed daytime improvements in patients with 5 to 15 apneas 1 hypopneas per hour slept (AHI). We have thus performed a second, larger, randomized, placebo- controlled study in

HEATHER M. ENGLEMAN; RUTH N. KINGSHOTT; PETER K. WRAITH; THOMAS W. MACKAY; IAN J. DEARY; NEIL J. DOUGLAS

1999-01-01

303

Randomized Placebo-controlled Trial of Continuous Positive Airway Pressure on Blood Pressure in the Sleep Apnea-Hypopnea Syndrome  

Microsoft Academic Search

Arterial blood pressure rises at apnea termination, and there is in- creasing evidence that the sleep apnea-hypopnea syndrome (SAHS) is associated with daytime hypertension but no randomized con- trolled trial evidence of whether SAHS treatment reduces blood pressure exists. We, therefore, conducted a randomized placebo- controlled cross-over study of the effects of 4 wk of continuous positive airway pressure (CPAP)

JACQUELINE F. FACCENDA; THOMAS W. MACKAY; NICHOLAS A. BOON; NEIL J. DOUGLAS

2001-01-01

304

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

PubMed Central

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

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

2013-01-01

305

Diagnostic Value of Screening Instruments for Identifying Obstructive Sleep Apnea in Kidney Failure  

PubMed Central

Background: Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have a high prevalence of obstructive sleep apnea (OSA) that can have significant clinical implications. An accurate clinical screening tool for OSA that identifies patients for further diagnostic testing would assist in the identification of this comorbidity. The Berlin Questionnaire (BQ), Adjusted Neck Circumference (ANC), and STOP-BANG questionnaire are 3 such instruments that have been validated in patients with normal kidney function. Objective: The objective of this study was to determine the validity of these screening instruments in patients with CKD and ESRD, using overnight cardiopulmonary monitoring to diagnose OSA. Methods: One hundred seventy-two patients were recruited from nephrology clinics and hemodialysis units (CKD: n = 109; ESRD: n = 63). All patients completed the BQ, ANC, STOP-BANG, and overnight cardiopulmonary monitoring to diagnose OSA (respiratory disturbance index [RDI] ? 15). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for the BQ, ANC, and STOP-BANG. Results: Obstructive sleep apnea was present in 41 CKD patients (38%) and 32 ESRD patients (51%). All screening instruments had satisfactory sensitivity (56% to 94%) but poor specificity (29% to 77%) and low accuracy (51% to 69%) in both CKD and ESRD patients with RDI ? 15. Using an RDI ? 30 yielded similar results. Conclusions: Current screening questionnaires do not accurately identify patients at high risk for OSA or rule out the presence of OSA in patients with CKD and ESRD. Consequently, objective monitoring during sleep is required to reliably identify sleep apnea in these patient populations. Citation: Nicholl DDM; Ahmed SB; Loewen AHS; Hemmelgarn BR; Sola DY; Beecroft JM; Turin TC; Hanly PJ. Diagnostic value of screening instruments for identifying obstructive sleep apnea in kidney failure. J Clin Sleep Med 2013;9(1):31-38. PMID:23319902

Nicholl, David D. M.; Ahmed, Sofia B.; Loewen, Andrea H. S.; Hemmelgarn, Brenda R.; Sola, Darlene Y.; Beecroft, Jaime M.; Turin, Tanvir C.; Hanly, Patrick J.

2013-01-01

306

Cardiac changes noted within 4 years of transplant in postmortem evaluation of a patient with untreated obstructive sleep apnea.  

PubMed

In this case report, the authors discuss the autopsy findings of biventricular cardiomegaly 4 years after transplantation of an otherwise normal heart in a patient who did not accept treatment for documented severe obstructive sleep apnea. PMID:15211395

Fishback, Nancy F; Wettach, George R

2004-06-01

307

Role of Extracellular Fluid Volume in Inducing or Aggravating Obstructive Sleep Apnea-hypopnea in Patients with Resistant Hypertension.  

E-print Network

??Accumulating evidence suggests that volume overload in drug-resistant hypertension (RH) may contribute to the high prevalence of obstructive sleep apnea-hypopnea (OSAH). Upon recumbency, leg fluid… (more)

Friedman, Oded

2010-01-01

308

The effect of exercise on obstructive sleep apnea: a randomized and controlled trial  

Microsoft Academic Search

Purpose  The aim of the study was to assess the effect of breathing and physical exercise on pulmonary functions, apnea-hypopnea index\\u000a (AHI), and quality of life in patients with obstructive sleep apnea syndrome (OSAS).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty patients with mild to moderate OSAS were included in the study either as exercise or control group. The control group\\u000a did not receive any treatment, whereas

Yesim Salik Sengul; Sevgi Ozalevli; Ibrahim Oztura; Oya Itil; Baris Baklan

2011-01-01

309

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

PubMed Central

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

2014-01-01

310

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

NASA Astrophysics Data System (ADS)

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

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

311

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

PubMed Central

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

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

2011-01-01

312

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

PubMed Central

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

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

2012-01-01

313

Palatal Sensory Threshold Reflects Nocturnal Hypoxemia and Airway Occlusion in Snorers and Obstructive Sleep Apnea Patients  

PubMed Central

Study Objectives: Upper airway sensory deficit has been reported to be associated with snoring or obstructive sleep apnea. There are limited data on the correlation between disease severity and upper airway sensation. In this study, we investigated the relationship between clinical parameters and standardized palatal sensory threshold (SPST) using Semmes Weinstein monofilaments. Methods: We recruited 40 snorers and 19 control subjects. Palatal sensory threshold was measured in all study subjects, using Semmes Weinstein monofilaments. Standardized palatal sensory threshold was determined by subtraction of hard palate sensation from uvular sensation. All subjects with snoring underwent a modified Muller maneuver during wakefulness before polysomnography. Results: SPST was higher in snorers than in control subjects, but did not differ according to the severity of obstructive sleep apnea. Patients with higher SPST (? 0.45 g/mm2) were older and had more severe hypoxemia indices: lower nadir oxyhemoglobin saturation (SpO2) and higher percentage of sleep time at < 90% SpO2. Adjusted for age, sex, neck circumference, and body mass index, SPST was correlated with the apnea-hypopnea index and hypoxemia indices. With a cutoff value ? 0.45 g/mm2, the sensitivity of SPST for nocturnal hypoxemia (nadir SpO2, < 80%) was 81.3%. Patients with higher SPST (? 0.45 g/mm2) showed more airway occlusion in modified Muller maneuver, than those with lower values. Conclusions: The SPST measured using Semmes Weinstein monofilaments reflects nocturnal hypoxemia and airway occlusion. This test provides a potential tissue marker of the severity of hypoxemia in patients who snore. Citation: Kim SW; Park HW; Won SJ; Jeon SY; Jin HR; Lee SJ; Chang DY; Kim DW. Palatal sensory threshold reflects nocturnal hypoxemia and airway occlusion in snorers and obstructive sleep apnea patients. J Clin Sleep Med 2013;9(11):1179-1186. PMID:24235900

Kim, Sang-Wook; Park, Hyun Woo; Won, Sung Jun; Jeon, Sea-Yuong; Jin, Hong Ryul; Lee, So-Jin; Chang, Dong-Yeop; Kim, Dae Woo

2013-01-01

314

[An algorithm based on ECG signal for sleep apnea syndrome detection].  

PubMed

The diagnosis of sleep apnea syndrome (SAS) has a significant importance in clinic for preventing diseases of hypertention, coronary heart disease, arrhythmia and cerebrovascular disorder, etc. This study presents a novel method for SAS detection based on single-channel electrocardiogram (ECG) signal. The method preprocessed ECG and detected QRS waves to get RR signal and ECG-derived respiratory (EDR) signal. Then 40 time- and spectral-domain features were extracted to normalize the signals. After that support vector machine (SVM) was used to classify the signals as "apnea" or "normal". Finally, the performance of the method was evaluated by the MIT-BIH Apnea-ECG database, and an accuracy of 95% in train sets and an accuracy of 88% in test sets were achieved. PMID:24459959

Yu, Xiaomin; Tu, Yuewen; Huang, Chao; Ye, Shuming; Chen, Hang

2013-10-01

315

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

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

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

2006-01-01

316

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

PubMed Central

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

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

2010-01-01

317

Lower Frequency of Obstructive Sleep Apnea in Spondyloarthritis Patients Taking TNF-Inhibitors  

PubMed Central

Study Objectives: Sleep disturbances, including obstructive sleep apnea (OSA), commonly limit function and quality of life in people with spondyloarthritis (SpA). Systemic inflammation has been implicated in the pathophysiology of both OSA and SpA, and suppression of inflammation with tumor necrosis factor ? (TNF) inhibitors may decrease OSA severity. In this study, we compared the frequency of OSA in patients receiving and not receiving TNF-inhibitor therapy. Methods: Data were collected from 63 consecutively screened veterans with SpA. Participant interviews, examinations, chart reviews, and referrals to the Salt Lake City Veteran Affairs (SLCVA) Sleep Center were used to obtain demographic data, comorbidities, SpA features, therapy data, and sleep study outcomes. Results: OSA occurred in 76% of SpA patients. OSA was less common in patients receiving TNF-inhibitor therapy (57%), compared to patients not receiving TNF-inhibitor therapy (91%) (p = 0.01). Conclusions: OSA is underrecognized in veterans with SpA, and TNF-inhibition was associated with a lower frequency of OSA. Citation: Walsh JA; Duffin KC; Crim J; Clegg DO. Lower frequency of obstructive sleep apnea in spondyloarthritis patients taking TNF-inhibitors. J Clin Sleep Med 2012;8(6):643-648. PMID:23243397

Walsh, Jessica A.; Duffin, Kristina Callis; Crim, Julia; Clegg, Daniel O.

2012-01-01

318

Time of day affects chemoreflex sensitivity and the carbon dioxide reserve during NREM sleep in participants with sleep apnea.  

PubMed

Our investigation was designed to determine whether the time of day affects the carbon dioxide reserve and chemoreflex sensitivity during non-rapid eye movement (NREM) sleep. Ten healthy men with obstructive sleep apnea completed a constant routine protocol that consisted of sleep sessions in the evening (10 PM to 1 AM), morning (6 AM to 9 AM), and afternoon (2 PM to 5 PM). Between sleep sessions, the participants were awake. During each sleep session, core body temperature, baseline levels of carbon dioxide (PetCO2 ) and minute ventilation, as well as the PetCO2 that demarcated the apneic threshold and hypocapnic ventilatory response, were measured. The nadir of core body temperature during sleep occurred in the morning and was accompanied by reductions in minute ventilation and PetCO2 compared with the evening and afternoon (minute ventilation: 5.3 ± 0.3 vs. 6.2 ± 0.2 vs. 6.1 ± 0.2 l/min, P < 0.02; PetCO2 : 39.7 ± 0.4 vs. 41.4 ± 0.6 vs. 40.4 ± 0.6 Torr, P < 0.02). The carbon dioxide reserve was reduced, and the hypocapnic ventilatory response increased in the morning compared with the evening and afternoon (carbon dioxide reserve: 2.1 ± 0.3 vs. 3.6 ± 0.5 vs. 3.5 ± 0.3 Torr, P < 0.002; hypocapnic ventilatory response: 2.3 ± 0.3 vs. 1.6 ± 0.2 vs. 1.8 ± 0.2 l·min(-1)·mmHg(-1), P < 0.001). We conclude that time of day affects chemoreflex properties during sleep, which may contribute to increases in breathing instability in the morning compared with other periods throughout the day/night cycle in individuals with sleep apnea. PMID:25213638

El-Chami, Mohamad; Shaheen, David; Ivers, Blake; Syed, Ziauddin; Badr, M Safwan; Lin, Ho-Sheng; Mateika, Jason H

2014-11-15

319

SLEEP, Vol. 30, No. 12, 2007 1756 INTRODUCTION  

E-print Network

SLEEP, Vol. 30, No. 12, 2007 1756 INTRODUCTION STANDARD RECOMMENDATIONS FOR THE SCORING OF RESPIRATORYABNORMALITY IN PATIENTS WITH SLEEP APNEAIDENTIFYOBSTRUCTIVE, CENTRAL,AND MIXED apneas; hypopneas; and periodic are defined by a central apnea index 5/h of sleep and a predominance of central events relative to the total

320

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

PubMed Central

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

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

2014-01-01

321

Novel parameters for evaluating severity of sleep disordered breathing and for supporting diagnosis of sleep apnea-hypopnea syndrome.  

PubMed

Sleep apnea-hypopnea syndrome (SAHS) is a complex public health problem causing increased risk of cardiovascular diseases. Traditionally, evaluation of the severity of the disease is based on Apnea-Hypopnea Index (AHI). It is defined as the average number of apnea and hypopnea events per hour during sleep. However, e.g. the total duration and the morphology of the recorded events are not considered when evaluating the severity of the disease. This is surprising, as increasing the length of apnea and hypopnea events will most likely lead to longer and deeper oxygen desaturation events. Obviously, this is physiologically more stressful and may have more severe health consequences than shorter and shallower desaturation events. Paradoxically, the lengthening of apnea and hypopnea events may even lead to a decrease in AHI and oxygen desaturation index (ODI). This raises the question of whether additional information is needed besides AHI and ODI for the evaluation of the severity of SAHS and its potential cardiovascular consequences. In the present paper, several novel parameters are introduced to bring additional information for evaluation of the severity of SAHS. Besides the number of events per hour, that AHI and ODI takes into account, the duration of the breathing cessations and the morphology of the oxygen desaturation events are considered as important factors that may influence the daytime fatigue and also the related cardiovascular problems. In this study diagnostic ambulatory polygraphy recordings of 19 male patients were retrospectively analysed. Importantly, the novel parameters showed significant variation amongst patients with similar AHI. For example, the correlation between AHI and the Obstruction severity-parameter was only moderate (r(2)=0.604, p<0.001). This suggests that patients with similar AHI may exhibit significantly different cardiovascular stress related to the disease. It is suggested that the present novel parameters might provide additional information over the currently used parameters and support the evaluation of the severity of SAHS. PMID:23360196

Kulkas, A; Tiihonen, P; Eskola, K; Julkunen, P; Mervaala, E; Töyräs, J

2013-02-01

322

Implementation of an innovative postoperative monitoring approach for patients with obstructive sleep apnea.  

PubMed

This article shares how William Osler Health System (Osler) achieved improved quality of care for clinically challenging patients using state-of-the-art technology combined with interprofessional and intermanagerial teamwork in an acute care setting. Obstructive sleep apnea, a respiratory disorder caused by upper airway obstruction, increases the risk of complications after anesthesia. Although an initial postoperative monitoring strategy designed for patients with obstructive sleep apnea at Osler ensured patient safety, it required reorganization to resolve operational challenges. Concerned stakeholders at all levels contributed to the development and implementation of a new program approach focused on remote pulse oximetry monitoring as a component of the standard of care. Osler has developed a case study to share its experience with other hospitals and health systems that are already engaged in or that are considering implementing such a program. PMID:25046966

de Lacy, Jane; Miller-Burnett, Michelle; Bonsell, Pamela; Stith, Keeli; Sanchez, Sharlenne

2014-01-01

323

Hypopharyngeal lipoma causing obstructive sleep apnea: Discovery on dental cone-beam CT.  

PubMed

Cone-beam computed tomography (CBCT) is primarily used for a variety of dental purposes, but it may also yield nondental findings that can have significant implications for patient health. For example, physicians should be aware that CBCT can identify some of the etiopathogenic causes of obstructive sleep apnea, as occurred in the case described in this report. The patient was a 76-year-old man who presented to a dentist for implant therapy. A CBCT that had been performed in preparation for dental implant placement revealed the presence of a large hypopharyngeal lesion that was obstructing the airway. An otolaryngologist excised the lesion, which on biopsy proved to be a lipoma. Following removal of the lesion, the patient's episodic sleep apnea and snoring resolved. Medical physicians should be aware of maxillofacial CBCT technology and its ability to identify lesions that could cause potential life-threatening situations. PMID:23532653

Balasundaram, Ashok

2013-03-01

324

Variability of QT Interval Duration in Obstructive Sleep Apnea: An Indicator of Disease Severity  

PubMed Central

Study Objective: To determine OSA-related changes in variability of QT interval duration and in heart rate variability (HRV), and to evaluate the relationship of these parameters to disease severity. Design: Retrospective analysis of diagnostic sleep records. Settings: Clinical sleep laboratory in a hospital setting. Patients: Twenty patients (12 males and 8 females) without significant comorbidities who were undergoing polysomnography were studied. Measurements and Results: Standard heart rate variability measures and QT variability (Berger algorithm) were computed over consecutive 5-minute ECG epochs throughout the night. The effect of sleep stage and the relationship between these parameters and the severity of OSA as determined by the respiratory disturbance index (RDI) were explored. Further, a linear regression model of QT variability was developed. Severity of OSA (RDI) was 49 ± 28 (range from 17–107) events/hr. QT variability was the only ECG measure significantly correlated with RDI (both log-transformed; r = 0.6, P = 0.006). Further, QT variability was correlated with the minimum oxygen saturation (r = ?0.55, P = 0.01). Sleep stage showed a significant effect on HRV, but not on QT variability. In the regression model, RDI was the strongest predictor of QT variability (R2 increase 38%), followed by high and low frequency power of HRV (R2 increase 10% each). Conclusion: Obstructive sleep apnea is associated with changes in QT interval variability during sleep. The variance of beat-to-beat QT intervals correlates more strongly with the severity of OSA (as determined by RDI) than standard measures of heart rate variability, and is correlated with blood oxygenation, but not sleep stage. Citation: Baumert M; Smith J; Catcheside P; McEvoy RD; Abbott D; Sanders P; Nalivaiko E. Variability of QT interval duration in obstructive sleep apnea: an indicator of disease severity. SLEEP 2008;31(7):959-966. PMID:18652091

Baumert, Mathias; Smith, Janet; Catcheside, Peter; McEvoy, R Douglas; Abbott, Derek; Sanders, Prashanthan; Nalivaiko, Eugene

2008-01-01

325

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

PubMed Central

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

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

2013-01-01

326

Effect of obesity and\\/or sleep apnea on chemosensitivity: differences between men and women  

Microsoft Academic Search

The purpose of this study was to identify if obesity or obstructive sleep apnea (OSA) influence hypercapnic response (HCR) and hypoxic response (HR) taking into account differences between gender. Data are expressed in % predicted based on reference values of our laboratory (‘Respir. Physiol. 113 (1998) 157’). Obese women without OSA (n=117, body mass index (BMI) 43±8 kg\\/m2) demonstrated an

Bertien Buyse; Nikolaos Markous; Michel Cauberghs; Rob Van Klaveren; Erik Muls; Maurits Demedts

2003-01-01

327

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

PubMed Central

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

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

2009-01-01

328

Polysomnography before and after weight loss in obese patients with severe sleep apnea  

Microsoft Academic Search

OBJECTIVE:While obstructive sleep apnea (OSA) is strongly related to obesity, few studies have examined polysomnographic (PSG) changes with major weight loss. We examined the effect of weight loss following laparoscopic adjustable gastric banding (LAGB) on the PSG changes in patients with severe OSA. In addition, we studied daytime sleepiness, the metabolic syndrome and quality of life (QOL).METHODS:A prospective study was

J B Dixon; L M Schachter; P E O'Brien

2005-01-01

329

Comparison of heart rhythm and morphological ECG features in recognition of sleep apnea from the ECG  

Microsoft Academic Search

This study addresses the problem of sleep apnea recognition on a minute-by-minute basis from single-lead ECGs recorded overnight. Analysis of heart rate fluctuations, quantified by the series of RR-intervals, is compared to analysis of ECG morphology variations, assessed using signal vectors from the QRS- and the T-wave region and projecting them onto their first principal component. The resulting series of

C. Maier; H. Dickhaus; M. Bauch; T. Penzel

2003-01-01

330

Can Patient-Specific Classification Improve the Accuracy of Sleep Apnea Detection from the ECG?  

Microsoft Academic Search

\\u000a This study deals with detection of sleep apnea from the ECG and was motivated by the disproportional additional effort which\\u000a seems necessary to increase the detection accuracy significantly above a level which is reachable by comparatively simple\\u000a decision strategies. We suspected that inter and intra-individual variability caused by confounding factors might be the root\\u000a of the problem and were interested

C. Maier; H. Wenz; H. Dickhaus

331

Steps toward subject-specific classification in ECG-based detection of sleep apnea  

Microsoft Academic Search

This study deals with ECG-based recognition of sleep apnea in epochs of 1 min duration using spectral- and correlation-based features extracted from the modulation of QRS amplitude, respiratory myogram interference and RR intervals. On a database comprising 140 simultaneous recordings of polysomnograms (PSGs) and 8-lead Holter-ECGs, it is shown that a single-parameter ROC threshold classification can achieve high detection rates

Christoph Maier; Heinrich Wenz; Hartmut Dickhaus

2011-01-01

332

The analysis of the efficacy of an adhesive sleep apnea mask  

Microsoft Academic Search

A Continuous Positive Airway Pressure (CPAP) mask was augmented to increase compliance amongst obstructive sleep apnea patients (OSA). Bioflex Silicone Gel® adhesive was tested to determine the lifetime and whether it could withstand the highest output pressure of a CPAP machine, 20 cmH2O. A NPC-100 NovaSensor® pressure sensor was used to gather the data. The silicone gel has a lifetime

G. Blazeski; E. Broderick; O. Djomparin; L. Iannotto; D. Perriello

2010-01-01

333

Heart rate regularity analysis obtained from pulse oximetric recordings in the diagnosis of obstructive sleep apnea  

Microsoft Academic Search

Approximate entropy (ApEn) is a technique that can be used to quantify the irregularity or variability of time series. We\\u000a prospectively evaluated the validity of ApEn of heart rate data obtained from pulse oximetric recordings as a diagnostic test\\u000a for obstructive sleep apnea (OSA) in patients clinically suspected of suffering this disease. A sample of 187 referred outpatients\\u000a (147 men

C. Zamarrón; R. Hornero; F. del Campo; D. Abásolo; D. Alvarez

2006-01-01

334

Obstructive Sleep Apnea and Hypopnea Efficacy and Safety of a Long-Acting ? 2 Agonist  

Microsoft Academic Search

The effect of inhaled long-acting ß2-agonists in obstructive sleep apnea syndrome (OSAS) is unknown, although from the pharmacological point of view both therapeutic and adverse effects need to be considered. The purpose of this study was to obtain data on the efficacy and safety of salmeterol in patients with OSAS. In a randomized, double-blind, placebo-controlled, cross-over study, effects of salmeterol

Kurt Rasche; Hans-Werner Duchna; Julia Lauer; Maritta Orth; Sylvia Kotterba; Torsten Thomas Bauer; Adrian Gillissen; Gerhard Schultze-Werninghaus

1999-01-01

335

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

PubMed Central

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

Coma-del-Corral, Maria Jesus; Alonso-Alvarez, Maria Luz; Allende, Marta; Cordero, Jose; Ordax, Estrella; Masa, Fernando

2013-01-01

336

Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea  

Microsoft Academic Search

Background—Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular and cerebrovascular disease. Inflammatory processes associated with OSA may contribute to cardiovascular morbidity in these patients. We tested the hypothesis that OSA patients have increased plasma C-reactive protein (CRP). Methods and Results—We studied 22 patients (18 males and 4 females) with newly diagnosed OSA, who were free of other diseases,

Abu S. M. Shamsuzzaman; Mikolaj Winnicki; Paola Lanfranchi; Robert Wolk; Tomas Kara; Valentina Accurso; Virend K. Somers

2002-01-01

337

Increased Adhesion Molecules Expression and Production of Reactive Oxygen Species in Leukocytes of Sleep Apnea Patients  

Microsoft Academic Search

Obstructive sleep apnea (OSA) is associated with increased cardio- vascular morbidity and mortality. Free radicals and adhesion mole- cules were implicated in the pathogenesis of atherosclerosis lead- ing to cardiovascular disorders. Therefore, we investigated the link between CD15, CD11c, CD11b, and CD64 expression on leukocytes and their ability to generate reactive oxygen species (ROS) in pa- tients with OSA and

LARISSA DYUGOVSKAYA; PERETZ LAVIE; LENA LAVIE

338

Preliminary Functional MRI Neural Correlates of Executive Functioning and Empathy in Children with Obstructive Sleep Apnea  

PubMed Central

Background: Pediatric obstructive sleep apnea (OSA) is associated with neurocognitive deficits. However, the neural substrates underlying such deficits remain unknown. Methods: To examine executive control and emotional processing in OSA, 10 children age 7 to 11 y with polysomnographically diagnosed OSA and 7 age- and sex-matched controls underwent a color-word Stroop task and an empathy task consisting of dynamic visual scenarios depicting interpersonal harm or neutral actions in a magnetic resonance imaging (MRI) scanner. Functional MRI data were processed using MATLAB 7.12 with SPM8 for region of interest (ROI) analyses, and a general linear model was used with regressors for each trial type in each task. Results: For the Stroop task, accuracy was similar in the two groups, with no differences in the effect of incongruency on success rates. OSA showed greater neural activity than controls in eight ROI clusters for incongruent versus congruent trials (P < 0.001). Within the a priori ROIs, the anterior cingulate cortex was significantly different between groups (P < 0.05). For perceiving harm versus neutral actions, ROI analysis revealed a significant correlation between apnea-hypopnea index and left amygdala activity in harm versus neutral actions (r = -0.71, P < 0.05). Conclusions: These results provide the first functional MRI evidence that cognitive and empathetic processing is influenced by obstructive sleep apnea (OSA) in children. Children with OSA show greater neural recruitment of regions implicated in cognitive control, conflict monitoring, and attentional allocation in order to perform at the same level as children without OSA. When viewing empathy-eliciting scenarios, the severity of OSA predicted less sensitivity to harm in the left amygdala. Citation: Kheirandish-Gozal L; Yoder K; Kulkarni R; Gozal D; Decety J. Preliminary functional mri neural correlates of executive functioning and empathy in children with obstructive sleep apnea. SLEEP 2014;37(3):587-592. PMID:24587582

Kheirandish-Gozal, Leila; Yoder, Keith; Kulkarni, Richa; Gozal, David; Decety, Jean

2014-01-01

339

Link between obstructive sleep apnea and increased bone resorption in men  

Microsoft Academic Search

Summary  The bone metabolic abnormalities in patients with obstructive sleep apnea (OSA) were examined. Severity-dependent increases\\u000a in the serum\\/urinary levels of bone resorption markers and their attenuation following continuous positive airway pressure\\u000a therapy in subjects with OSA provide the first evidence of a link between OSA and abnormal bone metabolism.\\u000a \\u000a \\u000a \\u000a Introduction  Hypoxia, microinflammation and oxidative stress, well-known pathophysiological features of obstructive sleep

H. Tomiyama; R. Okazaki; D. Inoue; H. Ochiai; K. Shiina; Y. Takata; H. Hashimoto; A. Yamashina

2008-01-01

340

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

Microsoft Academic Search

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

Nikolaos Zias; Vishnu Bezwada; Sean Gilman; Alexandra Chroneou

2009-01-01

341

Obstructive Sleep Apnea Syndrome Is Associated with Overactive Bladder and Urgency Incontinence in Men  

PubMed Central

Study Objective: To investigate the incidence of overactive bladder (OAB) and urgency incontinence (UI) in men with obstructive sleep apnea syndrome (OSAS). Design: Prospective questionnaire study Setting: Saarland University Hospital Patients: All male patients who underwent full-night in-laboratory polysomnography between November 2006 and April 2007. Interventions: Overactive bladder symptom score (OABSS) and International Consultation on Incontinence Questionnaire, Short-Form (ICIQ-SF). Measurements and Results: OSAS severity was assessed according to the apnea-hypopnea-index (AHI). Return rate of questionnaires was 100% (n = 100). Patients with upper airway resistance syndrome (UARS) served as controls. Evaluation of OABSS revealed that patients with moderate and severe OSAS presented with a significantly higher incidence of symptoms of OAB than patients with mild OSAS and UARS (P < 0.05). Further, the ICIQ-SF revealed a higher occurrence of UI in patients with severe OSAS than in those with mild OSAS and UARS (P < 0.05). Conclusions: Increasing severity of OSAS appears to be associated with an increasing occurrence of overactive bladder and urgency incontinence in men. This relationship may have clinical implications for the treatment of affected patients. Citation: Kemmer H; Mathes AM; Dilk O; Gröschel A; Grass C; Stöckle M. Obstructive Sleep Apnea Syndrome Is Associated with Overactive Bladder and Urgency Incontinence in Men. SLEEP 2009;32(2):271-275. PMID:19238815

Kemmer, Helene; Mathes, Alexander M.; Dilk, Olaf; Groschel, Andreas; Grass, Christian; Stockle, Micheal

2009-01-01

342

MRI of the pharynx in ischemic stroke patients with and without obstructive sleep apnea  

PubMed Central

Background Obstructive sleep apnea (OSA) is common after stroke and associated with poor stroke outcomes. Whether OSA after acute stroke is caused by anatomic, physiologic, or both etiologies has not been studied. We therefore used brain magnetic resonance imaging (MRI) scans to assess oropharyngeal anatomy in stroke patients with and without OSA. Methods Patients within 7 days of ischemic stroke underwent nocturnal polysomnography. Sagittal T1-weighted MRI performed for clinical purposes was used to measure retropalatal distance, soft palatal length, soft palatal thickness, retroglossal space, and tongue length. Nasopharyngeal area and high retropharyngeal area were measured from axial T2-weighted images, and lateral pharyngeal wall thickness from coronal T1-weighted images. Results Among 27 subjects, 18 (67%) had OSA (apnea/hypopnea index (AHI) ?5). Demographics, vascular risk factors, and stroke severity were similar in the two groups. Median retropalatal distance was shorter in subjects with OSA (Wilcoxon rank-sum test, p= 0.03). Shorter retropalatal distance was associated with higher AHI (linear regression, p=0.04). None of the other morphological characteristics differed. Conclusions Anatomic difference between awake acute stroke patients with and without OSA shows that the sleep disorder cannot be attributed solely to sleep, sleeping position, or changes in neuromuscular control that are specific to the sleep state. PMID:20466584

Brown, Devin L.; Bapuraj, J. Rajiv; Mukherji, Suresh K.; Chervin, Ronald D.; Concannon, Maryann; Helman, Joseph I.; Lisabeth, Lynda D.

2010-01-01

343

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

PubMed Central

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

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

2009-01-01

344

Effects of Continuous Positive Airway Pressure on Obstructive Sleep Apnea and Left Ventricular Afterload in Patients With Heart Failure  

Microsoft Academic Search

Background—The objectives of this study were to determine the effects of continuous positive airway pressure (CPAP) on blood pressure (BP) and systolic left ventricular transmural pressure (LVP tm) during sleep in congestive heart failure (CHF) patients with obstructive sleep apnea (OSA). In CHF patients with OSA, chronic nightly CPAP treatment abolishes OSA and improves left ventricular (LV) ejection fraction. We

Ruzena Tkacova; Fiona Rankin; Fabia S. Fitzgerald; John S. Floras; T. Douglas Bradley

345

Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP)  

Microsoft Academic Search

The obstructive sleep apnea syndrome is characterized by nocturnal sleep disturbance, excessive daytime sleepiness and neuropsychological deficits in the areas of memory, attention, and executive tasks. In the present study, these clinical manifestations were assessed in apneic patients before and 6 months after treatment with nasally applied continuous positive airway pressure (CPAP). CPAP treatment was found to restore normal respiration

Marc-André Bédard; Jacques Montplaisir; Jacques Malo; François Richer; Isabelle Rouleau

1993-01-01

346

Association Between Non-erosive Reflux Disease and High Risk of Obstructive Sleep Apnea in Korean Population  

PubMed Central

Background/Aims Obstructive sleep apnea is becoming more important in gastroesophageal reflux disease (GERD) patients. This study investigated the prevalence of high risk for obstructive sleep apnea in GERD patients in comparison with that in healthy controls using the Berlin Questionnaire. We also investigated the risk factors for obstructive sleep apnea in GERD patients. Methods We enrolled 1,007 subjects: 776 healthy controls, 115 individuals with erosive reflux disease, and 116 with non-erosive reflux disease. GERD was diagnosed and classified using endoscopy and a reflux questionnaire. The Berlin Questionnaire was used to evaluate obstructive sleep apnea. Results More patients in the GERD group (28.2%) had higher risk for obstructive sleep apnea than healthy controls (20.4%, P = 0.036). More patients with non-erosive disease (32.8%) had higher risk for obstructive sleep apnea (OSA) than patients with erosive disease (20.9%) and controls (20.4%, P = 0.010). On multivariate analysis, non-erosive disease was a high risk factor for obstructive sleep apnea (odds ratio [OR], 1.82; P = 0.011). Age ? 55 years (OR, 1.83; P < 0.001) and a high body mass index (? 25 kg/m2) (OR, 2.76; P < 0.001) were also identified as risk factors. Nocturnal GERD was related to high risk for OSA in non-erosive disease patients (OR, 2.97; P = 0.019), but not in erosive disease patients. Conclusions High risk for OSA is more prevalent in GERD patients than in controls. Non-erosive reflux disease, age ? 55, and a high BMI are associated with high risk for OSA. PMID:24840371

You, Chan Ran; Oh, Jung Hwan; Seo, Minji; Lee, Hye Yeon; Joo, Hyonsoo; Jung, Sung Hoon; Lee, Sang Haak; Choi, Myung-Gyu

2014-01-01

347

Circadian Variability of Fibrinolytic Markers and Endothelial Function in Patients with Obstructive Sleep Apnea  

PubMed Central

Study Objectives: Obstructive sleep apnea (OSA) is strongly associated with cardiovascular disease, including stroke and acute coronary syndromes. Plasminogen activator inhibitor-1 (PAI-1), the principal inhibitor of tissue-type plasminogen activator (t-PA), has a pronounced circadian rhythm and is elevated in both OSA and cardiovascular disease and may be an important link between the two conditions. Endothelial dysfunction is one of the underlying pathophysiological mechanisms of cardiovascular disease, and may be altered in OSA. Our primary aim was to compare circadian variability of PAI-1 and t-PA in patients with OSA and normal controls by determining the amplitude (peak level) and mesor (rhythm adjusted mean) of PAI-1 and t-PA in serial blood samples over a 24-h period. The secondary aim was to measure markers of endothelial function (brachial and radial artery flow) in patients with OSA compared with normal controls. Setting: Cross-sectional cohort study. Patients or Participants: Subjects age 18 y or older, with a body mass index of 25-45 kg/m2, with or without evidence of untreated OSA. Interventions: Plasma samples were collected every 2 h, in OSA patients and matched controls, over a 24-h period. PAI-1 and t-PA antigen and activity were measured. The presence or absence of OSA (apnea-hypopnea index of 5 or greater) was confirmed by overnight polysomnography. Endothelial function was measured via brachial artery flow mediated vasodilatation and computerized arterial pulse waveform analysis. Measurements and Results: The rhythm-adjusted mean levels of PAI-1 antigen levels in the OSA group (21.8 ng/mL, 95% confidence level [CI], 18 to 25.7) were significantly higher as compared to the non-OSA group (16 ng/mL, 95% CI, 12.2 to 19.8; P = 0.03). The rhythm-adjusted mean levels of PAI-1 activity levels in the OSA group (23.9 IU/mL, 95% CI, 21.4 to 26.5) were also significantly higher than in the non-OSA group (17.2 IU/ mL, 95% CI, 14.6 to 19.9; P < 0.001).There were strong correlations between amplitude of PAI-1 activity and severity of OSA as measured by AHI (P = 0.02), and minimum oxygen levels during sleep (P = 0.04). Endothelial function parameters did not differ significantly between the two groups. Conclusion: The presence of obstructive sleep apnea adversely affects circadian fibrinolytic balance with higher mean plasminogen activator inhibitor-1 activity and antigen, and significantly lower mean tissue-type plasminogen activator activity compared with controls. This perturbation may be an important mechanism for increased cardiovascular events in patients with obstructive sleep apnea. Intermittent hypoxia and changes in circadian clock gene activity in obstructive sleep apnea may be responsible for these findings and warrant further study. Favorable changes in fibrinolytic balance may underlie the reduction in cardiovascular events observed with the treatment of obstructive sleep apnea. Citation: Bagai K; Muldowney JAS; Song Y; Wang L; Bagai J; Artibee KJ; Vaughan DE; Malow BA. Circadian variability of fibrinolytic markers and endothelial function in patients with obstructive sleep apnea. SLEEP 2014;37(2):359-367. PMID:24497664

Bagai, Kanika; Muldowney, James A. S.; Song, Yanna; Wang, Lily; Bagai, Jayant; Artibee, Kay J.; Vaughan, Douglas E.; Malow, Beth A.

2014-01-01

348

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

PubMed Central

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

Alonso-Alvarez, Maria Luz; Cordero-Guevara, Jose Aurelio; Teran-Santos, Joaquin; Gonzalez-Martinez, Monica; Jurado-Luque, Maria Jose; Corral-Penafiel, Jaime; Duran-Cantolla, Joaquin; Kheirandish-Gozal, Leila; Gozal, David

2014-01-01

349

The role of the general dentist in the management of obstructive sleep apnea, application of oral appliance therapy, and the indication for surgery.  

PubMed

The general dentist can play an important role in the recognition and initial diagnosis of patients with obstructive sleep apnea syndrome. Obstructive sleep apnea is defined as the repetitive airway obstruction during sleep due to the collapse of the pharyngeal airway potentially causing cessation of breathing. Although many Americans suffer from symptoms of sleep apnea syndrome, most remain undiagnosed until significant problems occur, such as cardiopulmonary and neurologic dysfunction. In recent years, sleep apnea has become a significant public health concern. Both medical and dental practitioners have become increasingly aware of sleep apnea. Early detection of this condition by the dental practitioner can lead to the prevention of comorbid diseases and improved quality of life for many patients. This article will provide a greater understanding of the pathophysiology, diagnosis, indications, risks, and benefits of treatments available so that dental practitioners can make better treatment recommendations. PMID:24192732

Kelly, Shaunda E; Waite, Peter D

2013-01-01

350

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

PubMed Central

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

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

2014-01-01

351

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

PubMed Central

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

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

2013-01-01

352

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

PubMed Central

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

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

2013-01-01

353

Acetazolamide Attenuates the Ventilatory Response to Arousal in Patients with Obstructive Sleep Apnea  

PubMed Central

Study Objectives: The magnitude of the post-apnea/hypopnea ventilatory overshoot following arousal may perpetuate subsequent respiratory events in obstructive sleep apnea (OSA) patients, potentially contributing to the disorder's severity. As acetazolamide can reduce apnea severity in some patients, we examined the effect of acetazolamide on the ventilatory response to spontaneous arousals in CPAP-treated OSA patients. Design: We assessed the ventilatory response to arousal in OSA patients on therapeutic CPAP before and after administration of acetazolamide for 7 days. Setting: Sleep research laboratory. Participants: 12 (7M/5F) CPAP-treated OSA patients. Interventions: Sustained-release acetazolamide 500 mg by mouth twice daily for one week. Measurements and Results: A blinded investigator identified spontaneous arousals (3-15 s) during NREM sleep. Breath-by-breath measurements of minute ventilation, end-tidal CO2, tidal volume, expiratory/inspiratory-time, and total breath duration were determined (4-s intervals) 32 s prior and 60 s following each arousal. Acetazolamide significantly increased resting ventilation (7.3 ± 0.2 L/min versus 8.2 ± 0.4 L/min; P < 0.05) and attenuated the percent increase in ventilation following arousal by ~2.5 fold (122.0% ± 4.4% versus 108.7% ± 3.5% pre-arousal level; P < 0.05). There was a positive correlation between the mean increase in ventilatory response to arousal and mean AHI (r2 = 0.44, P = 0.01). However, absolute peak levels of ventilation following arousal remained unchanged between conditions (8.8 ± 0.4 L/min versus 8.9 ± 0.1 L/min). Conclusions: Acetazolamide substantially attenuates the increase in ventilation following spontaneous arousal from sleep in OSA patients. This study suggests an additional mechanism by which acetazolamide may contribute to the improvement in ventilatory instability and OSA severity. The data also provide support for reinforcing the importance of ventilatory control in OSA pathogenesis. Citation: Edwards BA; Connolly JG; Campana LM; Sands SA; Trinder JA; White DP; Wellman A; Malhotra A. Acetazolamide attenuates the ventilatory response to arousal in patients with obstructive sleep apnea. SLEEP 2013;36(2):281-285. PMID:23372276

Edwards, Bradley A.; Connolly, James G.; Campana, Lisa M.; Sands, Scott A.; Trinder, John A.; White, David P.; Wellman, Andrew; Malhotra, Atul

2013-01-01

354

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

Microsoft Academic Search

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,

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

2006-01-01

355

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

NASA Astrophysics Data System (ADS)

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

Kamami, Yves-Victor

1995-05-01

356

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

PubMed Central

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

2014-01-01

357

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

NASA Astrophysics Data System (ADS)

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

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

2014-06-01

358

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

PubMed

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?apnea. In addition, the processing of the HRV is a well established low cost and robust technique. PMID:24985458

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

359

C/EBP Homologous Binding Protein (CHOP) Underlies Neural Injury in Sleep Apnea Model  

PubMed Central

Study Objectives: Obstructive sleep apnea (OSA) is associated with cognitive impairment and neuronal injury. Long-term exposure to intermittent hypoxia (LTIH) in rodents, modeling the oxygenation patterns in sleep apnea, results in NADPH oxidase 2 (Nox2) oxidative injury to many neuronal populations. Brainstem motoneurons susceptible to LTIH injury show uncompensated endoplasmic reticulum stress responses with increased (CCAAT/enhancer binding protein homologous protein (CHOP). We hypothesized that CHOP underlies LTIH oxidative injury. In this series of studies, we first determined whether CHOP is upregulated in other brain regions susceptible to LTIH oxidative Nox2 injury and then determined whether CHOP plays an adaptive or injurious role in the LTIH response. To integrate these findings with previous studies examining LTIH neural injury, we examined the role of CHOP in Nox2, hypoxia-inducible factor-1? (HIF-1?) responses, oxidative injury and apoptosis, and neuron loss. Design: Within/between mice subjects. Setting: Laboratory setting. Participants/Subjects: CHOP null and wild-type adult male mice. Interventions: LTIH or sham LTIH. Measurements and Main Results: Relative to wild-type mice, CHOP-/- mice conferred resistance to oxidative stress (superoxide production/ carbonyl proteins) in brain regions examined: cortex, hippocampus, and motor nuclei. CHOP deletion prevented LTIH upregulation of Nox2 and HIF-1? in the hippocampus, cortex, and brainstem motoneurons and protected mice from neuronal apoptosis and motoneuron loss. Conclusions: Endogenous CHOP is necessary for LTIH-induced HIF-1?, Nox2 upregulation, and oxidative stress; CHOP influences LTIH-induced apoptosis in neurons and loss of neurons. Findings support the concept that minimizing CHOP may provide neuroprotection in OSA. Citation: Chou YT; Zhan G; Zhu Y; Fenik P; Panossian L; Li YanPeng; Zhang J; Veasey S. C/EBP homologous binding protein (CHOP) underlies neural injury in sleep apnea model. SLEEP 2013;36(4):481-492. PMID:23564995

Chou, Yu-Ting; Zhan, Guanxia; Zhu, Yan; Fenik, Polina; Panossian, Lori; Li, YanPeng; Zhang, Jing; Veasey, Sigrid

2013-01-01

360

Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea  

PubMed Central

Objective To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA) or if it is part of larger spectrum of cervical lymphoid hypertrophy. Study Design Prospective case control study. Methods A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA and then underwent MRI of the upper airway. 76 matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student’s t-test were used to compare demographic data and lymph node volumes between cohorts. Fisher’s Exact test and Chi-square analysis were used to compare sleep data. Results Patients and controls demonstrated no significant difference in mean age (7.47 vs 8.00 yrs), weight (44.87 vs 38.71 kg), height (124.68 vs 127.65 cm), or body-mass index (23.63 vs 20.87 kg/m2). OSA patients demonstrated poorer sleep measures than controls(p<0.05)in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2, and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs 2403 mm3, p<0.001) upper jugular region (22202 vs 16819 mm3, p<0.005), and adenotonsillar region (18994 vs 12675 mm3, p<0.0001). Conclusions Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA and has ramifications for future research and clinical care. PMID:23666635

Parikh, Sanjay R.; Sadoughi, Babak; Sin, Sanghun; Willen, Seth; Nandalike, Kiran; Arens, Raanan

2013-01-01

361

Monitoring Sound To Quantify Snoring and Sleep Apnea Severity Using a Smartphone: Proof of Concept  

PubMed Central

Study Objectives: Habitual snoring is a prevalent condition that is not only a marker of obstructive sleep apnea (OSA) but can also lead to vascular risk. However, it is not easy to check snoring status at home. We attempted to develop a snoring sound monitor consisting of a smartphone alone, which is aimed to quantify snoring and OSA severity. Methods: The subjects included 50 patients who underwent diagnostic polysomnography (PSG), of which the data of 10 patients were used for developing the program and that of 40 patients were used for validating the program. A smartphone was attached to the anterior chest wall over the sternum. It acquired ambient sound from the built-in microphone and analyzed it using a fast Fourier transform on a real-time basis. Results: Snoring time measured by the smartphone highly correlated with snoring time measured by PSG (r = 0.93). The top 1 percentile value of sound pressure level (L1) determined by the smartphone correlated with the ambient sound L1 during sleep determined by PSG (r = 0.92). Moreover, the respiratory disturbance index estimated by the smartphone (smart-RDI) highly correlated with the apnea-hypopnea index (AHI) obtained by PSG (r = 0.94). The diagnostic sensitivity and specificity of the smart-RDI for diagnosing OSA (AHI ? 15) were 0.70 and 0.94, respectively. Conclusions: A smartphone can be used for effectively monitoring snoring and OSA in a controlled laboratory setting. Use of this technology in a noisy home environment remains unproven, and further investigation is needed. Commentary: A commentary on this article appears in this issue on page 79. Citation: Nakano H; Hirayama K; Sadamitsu Y; Toshimitsu A; Fujita H; Shin S; Tanigawa T. Monitoring sound to quantify snoring and sleep apnea severity using a smartphone: proof of concept. J Clin Sleep Med 2014;10(1):73-78. PMID:24426823

Nakano, Hiroshi; Hirayama, Kenji; Sadamitsu, Yumiko; Toshimitsu, Ayaka; Fujita, Hisayuki; Shin, Shizue; Tanigawa, Takeshi

2014-01-01

362

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

PubMed Central

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

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

2014-01-01

363

Multidimensional scale of perceived social support in patients with obstructive sleep apnea syndrome.  

PubMed

Social support is a very important aspect of debilitating diseases. Obstructive sleep apnea syndrome (OSAS) is a common disabling disease that impairs a patient's quality of life and affects a patient's environment. The Multidimensional Scale of Perceived Social Support (MSPSS) is used to measure the perception of the sufficiency of social support for individuals. The aim of this study is to evaluate the relationship of the MSPSS to the Apnea-Hypopnea Index (AHI), age and gender in patients with OSAS. In this study, 183 subjects with a diagnosis of OSAS were enrolled. Patients were evaluated with the MSPSS in terms of age, gender and polysomnography results. According to the results of this study, the MSPSS has found to be higher in men than in women with OSAS and higher in moderate-severe OSAS than in mild OSAS. The MSPSS can be an important indicator of how patients cope with the disease. PMID:24939177

Günbey, Emre; Karabulut, Hayriye

2014-11-01

364

Massive Scrotal Edema: An Unusual Manifestation of Obstructive Sleep Apnea and Obesity-Hypoventilation Syndrome  

PubMed Central

Obstructive sleep apnea (OSA) may occur in association with obesity-hypoventilation (Pickwickian) syndrome, a disorder of ventilatory control affecting individuals with morbid obesity. Through the pressor effects of chronic hypercapnia and hypoxemia, this syndrome may result in pulmonary hypertension, right heart failure, and massive peripheral edema. We present a case of severe scrotal edema in a 36-year-old male with OSA and obesity-hypoventilation syndrome. A tracheostomy was performed to relieve hypoxemia and led to dramatic improvement of scrotal edema. No scrotal surgery was necessary. Followup at two months showed complete resolution of scrotal edema, improvement in mental status, and normalization of arterial blood gas measurements. This case demonstrates that OSA and obesity-hypoventilation syndrome may present with massive scrotal edema. Furthermore, if OSA is recognized as the cause of right heart failure, and if the apnea is corrected, the resultant improvement in cardiac function may allow reversal of massive peripheral, including scrotal, edema. PMID:23533435

Dreifuss, Stephanie E.; Manders, Ernest K.

2013-01-01

365

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

PubMed

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

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

2014-11-01

366

Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy  

PubMed Central

Rationale: Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals. Objectives: We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal. Methods: We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations. Results: Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal. Conclusion: Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal). Citation: Masa JF; Corral J; Gomez de Terreros J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Zamorano J; Cano R; Monterrat JM. Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy. SLEEP 2013;36(2):249–257. PMID:23372273

Masa, Juan F.; Corral, Jaime; Gomez de Terreros, Javier; Duran-Cantolla, Joaquin; Cabello, Marta; Hernández-Blasco, Luis; Monasterio, Carmen; Alonso, Alberto; Chiner, Eusebi; Aizpuru, Felipe; Zamorano, Jose; Cano, Ricardo; Montserrat, Jose M.; Garcia-Ledesma, Estefania; Pereira, Ricardo; Cancelo, Laura; Martinez, Angeles; Sacristan, Lirios; Salord, Neus; Carrera, Miguel; Sancho-Chust, José N.; Embid, Cristina

2013-01-01

367

Diagnosis of Obstructive Sleep Apnea Using Pulse Oximeter Derived Photoplethysmographic Signals  

PubMed Central

Objectives: Increasing awareness of the high prevalence of obstructive sleep apnea (OSA) and its impact on health in conjunction with high cost, inconvenience, and short supply of in-lab polysomnography (PSG) has led to the development of more convenient, affordable, and accessible diagnostic devices. We evaluated the reliability and accuracy of a single-channel (finger pulse-oximetry) photoplethysmography (PPG)-based device for detection of OSA (Morpheus Ox). Methods: Among a cohort of 73 patients referred for in-laboratory evaluation of OSA, 65 were simultaneously monitored with the PPG based device while undergoing PSG. Among these, 19 had significant cardiopulmonary comorbidities. Using the PSG as the “gold standard,” the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), as well as the positive likelihood ratio (+LR) for an apnea hypopnea index (AHI)PSG > 5/h and AHIPSG > 15/h were calculated for the PPG. Results: Valid results were available for 65 subjects. Mean age: 52.1 ± 14.2, Male: 52%, and BMI: 36.3 ± 9.7 kg/m2. Positive correlation was found between PPG-derived and PSG-derived AHI (r = 0.81, p < 0.001). For AHIPSG > 5/h, sensitivity was 80%, specificity 86%, PPV 93%, NPV 68%, and +LR was 5.9. For AHIPSG > 15/h, sensitivity was 70%, specificity 91%, PPV 80%, NPV 85%, and +LR was 7.83. The corresponding areas under the receiver operator curves were 0.91 and 0.9. Conclusions: PPG-derived data compare well with simultaneous in-lab PSG in the diagnosis of suspected OSA among patients with and without cardiopulmonary comorbidities. Citation: Romem A; Romem A; Koldobskiy D; Scharf SM. Diagnosis of obstructive sleep apnea using pulse oximeter derived photoplethysmographic signals. J Clin Sleep Med 2014;10(3):285-290. PMID:24634626

Romem, Ayal; Romem, Anat; Koldobskiy, Dafna; Scharf, Steven M.

2014-01-01

368

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

PubMed Central

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

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

2013-01-01

369

The correlation of anxiety and depression with obstructive sleep apnea syndrome  

PubMed Central

Background: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway obstruction during sleep. While respiratory pauses followed by loud snoring and daytime sleepiness are the main symptoms of OSAS, the patients may complain from sleep disruption, headache, mood disturbance, irritability, and memory impairment. However, the association of sleep apnea with anxiety and depression is not completely understood. Adherence to continuous positive airway pressure (CPAP), the treatment of choice for OSAS, may be influenced by psychological conditions, especially claustrophobia. The aim of this study was to evaluate the association of OSAS with anxiety and depression symptoms. This study also investigated the association of anxiety with body mass index (BMI) and the severity of OSAS. Materials and Methods: We conducted a cross-sectional study on 178 adult individuals diagnosed with OSAS at the sleep laboratory between September 2008 and May 2012. The participants were interviewed according to a checklist regarding both their chief complaints and other associated symptoms. The psychological status was assessed according to Beck anxiety inventory (BAI) and Beck depression inventory (BDI) scoring. The severity of breathing disorder was classified as mild, moderate, and severe based on apnea–hypopnea index (AHI) which was ascertained by overnight polysomnography. Daytime sleepiness was assessed by Epworth sleepiness scale (ESS). Results: The mean (SD) age of participants was 50.33 years. In terms of sex, 85.5% of the study population were males and14.4% were females. We found no relation between sex and the symptoms of OSAS. Regarding the frequency of anxiety and depression symptoms, 53.9% of the individuals had some degree of anxiety, while 46.1% demonstrated depressive symptoms. In terms of OSAS severity, this study showed that OSAS severity was associated with the frequency of anxiety, chocking, and sleepiness (P : 0.001). According to polysomnographic results, we found that the majority of patients suffering from anxiety and chocking (66.7% and 71.4%, respectively) had severe OSAS, while only 23.1% of patients with sleepiness had severe OSAS. Conclusion: Our study showed that the frequency of anxiety in OSAS patients is higher than in the general population regardless of the gender. Furthermore, it is more likely that OSAS patients present with anxiety and depression than the typical symptoms. PMID:24949026

Rezaeitalab, Fariborz; Moharrari, Fatemeh; Saberi, Soheila; Asadpour, Hadi; Rezaeetalab, Fariba

2014-01-01

370

OSA: the new cardiovascular disease: Part II: overview of cardiovascular diseases associated with obstructive sleep apnea  

PubMed Central

Obstructive sleep apnea (OSA), present in 5–15% of adults, is strongly associated with the incidence and poor outcome of hypertension, coronary artery disease, arrhythmia, heart failure, and stroke. Treatment of OSA completely reverses its cardiovascular consequences. In this review, we discuss the clinical evidence for the strong association between OSA and cardiovascular disease and present an argument for approaching OSA as a cardiovascular disease. We particularly focus on the causative relationship between OSA and hypertension, and on the increasingly recognized relationship between OSA and heart failure. PMID:18758946

Devulapally, Kiran; Pongonis, Raymond

2009-01-01

371

Cephalometric findings in facioscapulohumeral muscular dystrophy patients with obstructive sleep apneas  

Microsoft Academic Search

Purposes  The purposes of the study are: (1) to establish if cephalometry and upper airway examination may provide tools for detecting\\u000a facioscapulohumeral (FSHD) patients at risk for obstructive sleep apnea syndrome (OSAS); and (2) to correlate cephalometry\\u000a and otorhinolaryngologic evaluation with clinical and polysomnographic features of FHSD patients with OSAS.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients were 13 adults affected by genetically confirmed FSHD and OSAS,

Giacomo Della Marca; Francesca Pantanali; Roberto Frusciante; Emanuele Scarano; Alessandro Cianfoni; Lea Calò; Serena Dittoni; Catello Vollono; Anna Losurdo; Elisa Testani; Salvatore Colicchio; Valentina Gnoni; Elisabetta Iannaccone; Benedetto Farina; Tommaso Pirronti; Pietro A. Tonali; Enzo Ricci

2011-01-01

372

Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims  

Microsoft Academic Search

Since sleep apnea (SA)\\u000aand stroke have many shared risk\\u000afactors an independent contribution\\u000aof SA to the overall risk of\\u000astroke is not easily proven and has\\u000abeen questioned recently. To\\u000acontribute to this controversy, we\\u000aanalysed the frequency of SA in\\u000agroups of patients with first and\\u000arecurring ischemic stroke. We\\u000aprospectively studied 102 patients\\u000aadmitted to our

Rainer Dziewas; Marius Humpert; Benjamin Hopmann; Stephan P. Kloska; Peter Lüdemann; Martin Ritter; Ralf Dittrich; E. Bernd Ringelstein; Peter Young; Darius G. Nabavi

2005-01-01

373

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

PubMed Central

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

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

2013-01-01

374

The More the Merrier? Working Towards Multidisciplinary Management of Obstructive Sleep Apnea and Comorbid Insomnia  

PubMed Central

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is associated with negative cardiovascular consequences and adverse events from excessive daytime sleepiness. Insomnia is the inability to initiate or maintain sleep accompanied by daytime dysfunction. OSA and insomnia co-occur at a high rate, and such patients appear to have distinct clinical features of both disorders. Although empirically supported treatments are now available for OSA and insomnia independently, there are currently no standards or guidelines for how to combine or initiate these treatments for patients who suffer from both sleep disorders. Our goal was to review the literature on current diagnostic considerations, clinical features, pathophysiology, and treatment approaches for patients with OSA and comorbid insomnia. In particular, the potential benefits and challenges of using a multidisciplinary treatment model are discussed, including a research strategy that could inform implementation of pulmonary and behavioral sleep medicine treatments. The research, clinical, and policy implications of treating both OSA and insomnia are discussed with the hope that further activity will establish standards or guidelines for patients with OSA and insomnia. PMID:23382086

Ong, Jason C.; Crisostomo, M. Isabel

2013-01-01

375

The relationship between obstructive sleep apnea and atrial fibrillation in special patient populations.  

PubMed

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder associated with both cardiovascular morbidity and mortality. Studies have shown a strong relationship between OSA and the most common cardiac arrhythmia - atrial fibrillation (AF). In this review, the authors intend to analyze AF in the context of OSA in populations of special medical interest; specifically investigating OSA in post-cardioversion, post-pulmonary isolation and post-coronary artery bypass graft patients as well as those afflicted by congestive heart failure, hypertrophic cardiomyopathy, coronary artery disease, erectile dysfunction and stroke. Moreover, the authors will highlight the importance of OSA severity, our current understanding of its mechanistic link to AF pathophysiology and treatment options. PMID:25300372

Drew, Doran; Qaddoura, Amro; Baranchuk, Adrian

2014-11-01

376

Atrial arrhythmias in obstructive sleep apnea: underlying mechanisms and implications in the clinical setting.  

PubMed

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which leads to intermittent hypoxia. The disorder is commonly undiagnosed despite its relationship with substantial cardiovascular morbidity and mortality. Moreover, the effects of the disorder appear to be particularly dangerous in young subjects. In the last decade, substantial clinical evidence has identified OSA as independent risk factor for both bradyarrhythmias and tachyarrhythmias. To date the mechanisms leading to such arrhythmias have not been completely understood. However, recent data from animal models and new molecular analyses have increased our knowledge of the field, which might lead to future improvement in current therapeutic strategies mainly based on continuous positive airway pressure. This paper aims at providing readers a brief and specific revision of current knowledge about the mechanisms underlying atrial arrhythmias in OSA and their clinical and therapeutic implications. PMID:23691306

Filgueiras-Rama, David; Arias, Miguel A; Iniesta, Angel; Armada, Eduardo; Merino, José L; Peinado, Rafael; López-Sendón, J L

2013-01-01

377

Atrial Arrhythmias in Obstructive Sleep Apnea: Underlying Mechanisms and Implications in the Clinical Setting  

PubMed Central

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which leads to intermittent hypoxia. The disorder is commonly undiagnosed despite its relationship with substantial cardiovascular morbidity and mortality. Moreover, the effects of the disorder appear to be particularly dangerous in young subjects. In the last decade, substantial clinical evidence has identified OSA as independent risk factor for both bradyarrhythmias and tachyarrhythmias. To date the mechanisms leading to such arrhythmias have not been completely understood. However, recent data from animal models and new molecular analyses have increased our knowledge of the field, which might lead to future improvement in current therapeutic strategies mainly based on continuous positive airway pressure. This paper aims at providing readers a brief and specific revision of current knowledge about the mechanisms underlying atrial arrhythmias in OSA and their clinical and therapeutic implications. PMID:23691306

Filgueiras-Rama, David; Arias, Miguel A.; Iniesta, Angel; Merino, Jose L.; Peinado, Rafael; Lopez-Sendon, J. L.

2013-01-01

378

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

PubMed Central

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

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

2014-01-01

379

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea  

PubMed Central

Introduction: Obstructive sleep apnea (OSA) is a common comorbid condition in patients with posttraumatic stress disorder (PTSD); insufficiently treated OSA may adversely impact outcomes. Sleep fragmentation and insomnia are common in PTSD and may impair CPAP adherence. We sought to determine the impact of combat-related PTSD on CPAP adherence in soldiers. Methods: Retrospective case-control study. Objective measures of CPAP use were compared between OSA patients with and without PTSD. Groups were matched for age, BMI, and apnea-hypopnea index (AHI). Results: We included 90 patients (45 Control, 45 PTSD). Among the cohort, mean age was 39.9 ± 11.2, mean BMI 27.9 ± 8.0, mean ESS 13.6 ± 5.7, and mean AHI 28.2 ± 22.4. There was a trend towards a higher rate of comorbid insomnia among patients with PTSD (25.8% vs. 11.1%, p = 0.10). PTSD was associated with significantly less use of CPAP. Specifically, CPAP was used on 61.4% ± 22.2% of nights in PTSD patients compared with 76.8% ± 16.4% in patients without PTSD (p = 0.001). Mean nightly use of CPAP was 3.4 ± 1.2 h in the PTSD group compared with 4.7 ± 2.2 h among controls (p < 0.001). Regular use of CPAP (> 4 h per night for > 70% of nights) was also lower among PTSD patients (25.2% vs. 58.3%, p = 0.01). Conclusion: Among soldiers with OSA, comorbid PTSD was associated with significantly decreased CPAP adherence. Given the potential for adverse clinical outcomes, resolution of poor sleep quality should be prioritized in the treatment of PTSD and potential barriers to CPAP adherence should be overcome in patients with comorbid OSA. Citation: Collen JF; Lettieri CJ; Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea. J Clin Sleep Med 2012;8(6):667-672. PMID:23243400

Collen, Jacob F.; Lettieri, Christopher J.; Hoffman, Monica

2012-01-01

380

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

PubMed Central

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

Benton, Marc L.; Friedman, Neil S.

2013-01-01

381

Cardiovascular implications of obstructive sleep apnea associated with the presence of a patent foramen ovale.  

PubMed

Patent foramen ovale (PFO) is a common congenital cardiac abnormality of the atrial septum which occurs in 25% of the population. It allows communication between the right and left atrium enabling right to left shunting of deoxygenated blood (after birth) which may be linked to strokes or transient ischemic attacks. PFO may also have an association with obstructive sleep apnea (OSA). OSA is a common medical condition occurring in 9% of adult males and 4% of adult females. It may increase the risk of cardiovascular disease. OSA causes intermittent hypoxia from episodes of apnea and hypopnea during sleep. Consequently, hypoxic pulmonary vasoconstriction ensues which produces an increased right atrial pressure which may generate a right to left shunt during apneic episodes promoting the occurrence of thromboembolic events. The existence of a PFO may be higher in patients with OSA. The presence of a PFO and OSA may increase the risk of stroke. In this review, the association of PFO and OSA is described along with their implications for cardiovascular disease. The relevant literature and treatment options are discussed to elaborate on the significance of the associated pathology. PMID:24703203

Kar, Subrata

2014-10-01

382

Effects of venous compression of the legs on overnight rostral fluid shift and obstructive sleep apnea.  

PubMed

The amount of fluid displaced overnight from the legs into the neck as a consequence of lying recumbent correlates with the number of apneas and hypopneas per hour of sleep (AHI). Sedentary living promotes dependent fluid accumulation in the legs that can be counteracted by venous compression of the legs (compression stockings). We hypothesized that, in non-obese sedentary men with obstructive sleep apnea (OSA), wearing compression stockings during daytime will reduce the AHI by reducing the amount of fluid available for the displacement into the neck overnight. Polysomnography and measurement of overnight changes in leg fluid volume and neck circumference were performed at baseline and after one day of legs venous compression. The median AHI decreased from 30.9 (interquartile range 19.6-60.4) to 23.4 (12.9-31.8) (P=0.016) in association with a median 40% reduction in the change in leg fluid volume (P=0.016) and a median 42% reduction in the increase in neck circumference (P=0.016). These results provide proof-of-principle that overnight fluid displacement into the neck plays a causative role in OSA. PMID:21220055

Redolfi, Stefania; Arnulf, Isabelle; Pottier, Michel; Bradley, T Douglas; Similowski, Thomas

2011-03-15

383

[Profiles of 939 patients with obstructive sleep apnea syndrome treated with continuous positive pressure].  

PubMed

The aim of this study was to analyze the characteristics of patients on long-term continuous positive pressure therapy for obstructive sleep apnea in order to determine the efficacy, observance, tolerance, degree of patient satisfaction and patient quality of life using the Nottingham scale. A questionnaire was sent to 939 patients treated for at least six months in 11 centers. Factorial analysis of multiple correspondences and two classification analyses were used to establish patient profiles. Factorial analysis evidenced a relationship between patient satisfaction, reduced symptoms, observance and tolerance. The classification analyses distinguished three groups. Group A (n = 596) included primarily men (93%) who were satisfied with the treatment (99%) and showed good observance. Group B (n = 284) was characterized by patient satisfaction, observance, improved symptoms and lower quality of life than group A. Group C was composed of older patients who were satisfied with their treatment and showed good observance but who had no notable improvement in their symptoms. In conclusion, this study pointed out the difficulty in defining which patients with obstructive sleep apnea would benefit most from continuous positive pressure therapy. Good observance is not a sufficient criterion for therapeutic efficacy. PMID:10637910

Sailly, J C; Meslier, N; Grillier-Lanoir, V; Rolland, N; Henderyck, C; Lebrun, T; Racineux, J L

1999-12-01

384

Electrophysiological Assessment of the Effects of Obstructive Sleep Apnea on Cognition  

PubMed Central

We used electrophysiological measures to investigate the effects of obstructive sleep apnea on attention, learning, and memory. Thirty subjects (OSA group, n?=?15, control group n?=?15) participated in n-back tests, accompanied by P300 recordings, to investigate working memory and attention. The mirror-drawing test was used to study procedural memory, and the trail-making test (TMT) was used to evaluate divided attention and executive function. No significant group difference in reaction time was found in the 0-back and 1-back tests. In the 2-back test, reaction times of patients were longer than those of the control group. No P300 wave was obtained in the OSA group in any (0-, 1-, or 2-back) n-back test. In contrast, in the control group, significant P300 waves were recorded except for the 2-back test. The mirror-drawing scores were unaffected by sleep apnea. There was no difference between groups in the TMT-A test on any of the trials. Although no group difference was found in the first or second trials of the TMT-B test, OSA patients were less successful in learning on the third trial. According to our study results, OSA affects attention and executive function adversely however, we could not detect a significant effect on working or procedural memory. PMID:24587405

Gelir, Ethem; Basaran, Cenk; Bayrak, Sibel; Yagc?oglu, Suha; Budak, Murat Timur; F?rat, Hikmet; Ungan, Pekcan

2014-01-01

385

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

Microsoft Academic Search

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

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

2010-01-01

386

Comparison of Atenolol, Amlodipine, Enalapril, Hydrochlorothiazide, and Losartan for Antihypertensive Treatment in Patients with Obstructive Sleep Apnea  

Microsoft Academic Search

We compared the effects of atenolol (50 mg), amlodipine (5 mg), enalapril (20 mg), hydrochlorothiazide (25 mg), and losartan (50 mg) given in once-daily oral doses on office and ambulatory blood pressures (BPs) in patients with hypertension and obstructive sleep apnea (OSA). Each of 40 randomized patients was treated in se- quence with two of the five agents (balanced incomplete

HOLGER KRAICZI; JAN HEDNER; YÜKSEL PEKER; LUDGER GROTE

2000-01-01

387

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

ERIC Educational Resources Information Center

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

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

2011-01-01

388

Can Intensive Support Improve Continuous Positive Airway Pressure Use in Patients with the Sleep Apnea\\/Hypopnea Syndrome?  

Microsoft Academic Search

Continuous positive airway pressure (CPAP) therapy is widely prescribed for patients with the sleep apnea\\/hypopnea syndrome (SAHS), but the use of CPAP for such patients is disappointingly low. We postulated that providing intensive educational programs and nursing support to SAHS patients might improve CPAP use and outcomes. We also examined the hypothesis that CPAP use would be greater among patients

CAROL J. HOY; MARJORIE VENNELLE; RUTH N. KINGSHOTT; HEATHER M. ENGLEMAN; NEIL J. DOUGLAS

1999-01-01

389

Automatic screening of Obstructive Sleep Apnea from the ECG based on Empirical Mode Decomposition and Wavelet Analysis  

E-print Network

as the heart rate variability and the QRS peak area offer alternative measures for cheap, non- invasive. Epidemiological studies indicate a high prevalence of 4% in males and 2% in females in the general population [1 are often precursors of heart failure, for which a sleep apnea patient has a significantly higher

390

T Regulatory Lymphocytes and Endothelial Function in Pediatric Obstructive Sleep Apnea  

PubMed Central

Background Obstructive sleep apnea (OSA) is a low-grade inflammatory disease affecting the cardiovascular and metabolic systems. Increasing OSA severity reduces T-regulatory lymphocytes (Tregs) in OSA children. Since Tregs modulate endothelial activation, and attenuate insulin resistance, we hypothesized that Tregs are associated with endothelial and metabolic dysfunction in pediatric OSA. Methods 50 consecutively recruited children (ages 4.8–12 years) underwent overnight polysomnography and fasting homeostatic model (HOMA) of insulin resistance was assessed. Percentage of Tregs using flow cytometry, and endothelial function, expressed as the time to peak occlusive hyperemia (Tmax), were examined. In a subgroup of children (n?=?21), in vitro Treg suppression tests were performed. Results Circulating Tregs were not significantly associated with either BMI z score or HOMA. However, a significant inverse correlation between percentage of Tregs and Tmax emerged (p<0.0001, r?=??0.56). A significant negative correlation between Tregs suppression and the sleep pressure score (SPS), a surrogate measure of sleep fragmentation emerged (p?=?0.02, r?=??0.51) emerged, but was not present with AHI. Conclusions Endothelial function, but not insulin resistance, in OSA children is strongly associated with circulating Tregs and their suppressive function, and appears to correlate with sleep fragmentation. Thus, alterations in T cell lymphocytes may contribute to cardiovascular morbidity in pediatric OSA. PMID:23936084

Tan, Hui-Leng; Gozal, David; Samiei, Arash; Bhattacharjee, Rakesh; Wang, Yang; Ramirez, Helena Molero; Bandla, Hari P. R.; Kulkarni, Richa; Kheirandish-Gozal, Leila

2013-01-01

391

Classification of Cheyne-Stokes breathing and obstructive sleep apnea using ECG.  

PubMed

High cost of diagnostic studies to detect sleep disordered breathing and lack of availability of certified sleep laboratories in all inhabited areas make investigation of alternative methods of detecting sleep disordered breathing attractive. This study aimed to explore the possibility of discerning obstructive sleep apnea (OSA) from Cheyne-Stokes respiration (CSR) using overnight electrocardiography (ECG). Polysomnographic and ECG signals were acquired from the 13 OSA and 7 CSR volunteer subjects. Two signals: R-Wave Attenuation (RWA) and Heart Rate Variability (HRV) series were derived from the ECG. Using frequency domain analysis, various frequency bands in the power spectrum of RWA and HRV signals were identified that showed sensitivity to OSA and CSR events. A three-stage algorithm was developed to detect and differentiate OSA events from CSR events using RWA and HRV analysis. To test the algorithm, the ECG data was divided into fifteen minute epochs for analysis. Seventy two epochs containing OSA and 72 with CSR events were selected. 48 OSA clips and 48 CSR clips were randomly selected to form the training set. The remaining 24 clips in each category formed the test set. This method produced an average sensitivity of 95.83% and specificity of 79.16% in the training set and sensitivity of 87.5% and a specificity of 75% in the test set. PMID:17947037

Suhas, Sanjee R; Vijendra, Sridhar; Burk, John R; Lucas, Edgar A; Behbehani, Khosrow

2006-01-01

392

Cardiorespiratory Phase-Coupling Is Reduced in Patients with Obstructive Sleep Apnea  

PubMed Central

Cardiac and respiratory rhythms reveal transient phases of phase-locking which were proposed to be an important aspect of cardiorespiratory interaction. The aim of this study was to quantify cardio-respiratory phase-locking in obstructive sleep apnea (OSA). We investigated overnight polysomnography data of 248 subjects with suspected OSA. Cardiorespiratory phase-coupling was computed from the R-R intervals of body surface ECG and respiratory rate, calculated from abdominal and thoracic sensors, using Hilbert transform. A significant reduction in phase-coupling was observed in patients with severe OSA compared to patients with no or mild OSA. Cardiorespiratory phase-coupling was also associated with sleep stages and was significantly reduced during rapid-eye-movement (REM) sleep compared to slow-wave (SW) sleep. There was, however, no effect of age and BMI on phase coupling. Our study suggests that the assessment of cardiorespiratory phase coupling may be used as an ECG based screening tool for determining the severity of OSA. PMID:20485528

Kabir, Muammar M.; Dimitri, Hany; Sanders, Prashanthan; Antic, Ral; Nalivaiko, Eugene; Abbott, Derek; Baumert, Mathias

2010-01-01

393

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

Microsoft Academic Search

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

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

394

Alterations in Circulating T-Cell Lymphocyte Populations in Children with Obstructive Sleep Apnea  

PubMed Central

Study Objectives: Changes in lymphocyte phenotype and functionality have been described in adult patients with obstructive sleep apnea (OSA). We hypothesized that OSA is associated with T lymphocyte alterations in children, particularly in T regulatory lymphocytes (T regs), and aimed to characterize circulating T lymphocyte subsets in children with OSA. Design: Cross-sectional. Setting: Kosair Children's Hospital (Louisville, KY, USA) and Comer Children's Hospital (Chicago, IL, USA). Participants: Consecutively recruited children being evaluated for habitual snoring. Interventions: N/A. Measurements and Results: Overnight polysomnography (PSG) was performed and a fasting blood sample was obtained from the patients. Flow cytometry was performed on peripheral blood mononuclear cells stained for CD3, CD4, CD8, CD25, FOXP3, interleukin-4 (IL-4), interferon-? (IFN-?), and IL-17. Patients were divided into three groups based on their PSG: controls (apnea-hypopnea indices [AHI] < 1/h total sleep time [TST]), mild OSA (1 ? AHI < 5/hTST), moderate-severe OSA (AHI ? 5/h TST). The percentage of CD4+ and T reg lymphocytes differed across groups. Children with moderate-severe OSA had significantly reduced T reg than control children (median [interquartile range] 4.8 [3.8-5.7% CD4+] versus 7.8 [7.0-9.2% CD4+]; P < 0.001). There were also significant differences in the percentage of T helper 1 (Th1) lymphocytes and in Th1:Th2 ratios between groups. Children with moderate-severe OSA had increased Th1 cells (P = 0.001) and Th1:Th2 ratios (P = 0.0026) compared with children with mild OSA and control children. Associations between AHI and T reg (P = 0.0003; r = -0.46), CD4+ lymphocytes (P = 0.0047; r = -0.37), and Th1:Th2 ratios (P = 0.0009; r = 0.43) emerged. In addition, the percentage of T reg was inversely correlated with Th1:Th2 ratios (P = 0.029; r = -0.29). Conclusions: Pediatric OSA is associated with reduced T reg population and altered Th1:Th2 balance toward Th1 predominance, suggesting a shift to a proinflammatory state. The changes in lymphocytic phenotypes associated with OSA may contribute to the variance in systemic inflammation and downstream morbidities associated with this condition. Citation: Tan HL; Gozal D; Wang Y; Bandla HPR; Bhattacharjee R; Kulkarni R; Kheirandish-Gozal L. Alterations in circulating t-cell lymphocyte populations in children with obstructive sleep apnea. SLEEP 2013;36(6):913-922. PMID:23729935

Tan, Hui-Leng; Gozal, David; Wang, Yang; Bandla, Hari P. R.; Bhattacharjee, Rakesh; Kulkarni, Richa; Kheirandish-Gozal, Leila

2013-01-01

395

Abnormal Myelin and Axonal Integrity in Recently Diagnosed Patients with Obstructive Sleep Apnea  

PubMed Central

Study Objectives: Patients with obstructive sleep apnea (OSA) show significant white matter injury; whether that injury represents myelin or axonal damage is unclear. The objective was to examine myelin and axonal changes in patients with newly diagnosed OSA over control subjects. Design: Cross-sectional study. Setting: University-based medical center. Participants: Twenty-three newly-diagnosed, treatment-naïve OSA and 23 age- and sex-matched control subjects. Interventions: None. Measurements and Results: Radial and axial diffusivity maps, calculated from diffusion tensor imaging data (3.0 Tesla MRI scanner), indicating diffusion perpendicular (myelin status) or parallel (axonal status) to fibers, respectively, were normalized, smoothed, and compared between groups (analysis of covariance; covariate: age). Global brain radial and axial diffusivity values, and global brain volume with myelin and axonal changes were determined, and region-of-interest analyses performed in areas of significant differences between groups based on voxel-based procedures. Global radial and axial diffusivity values were significantly reduced in OSA versus control subjects (radial, P = 0.004; axial, P = 0.019), with radial (myelin) diffusivity reduced more than axial (axonal), and more left-sided reduction for both measures. Localized declines for myelin and axonal measures appeared in the dorsal and ventral medulla, cerebellar cortex and deep nuclei, basal ganglia, hippocampus, amygdala, corpus callosum, insula, cingulate and medial frontal cortices, and other cortical areas (P < 0.005), all regions mediating functions affected in OSA. Conclusions: Fiber injury appears in critical medullary respiratory regulatory sites, as well as cognitive and autonomic control areas. Myelin is more affected in newly diagnosed OSA than axons, and primarily on the left side, possibly from the increased myelin sensitivity to hypoxia and asymmetric perfusion. Citation: Kumar R; Pham TT; Macey PM; Woo MA; Yan-Go FL; Harper RM. Abnormal myelin and axonal integrity in recently diagnosed patients with obstructive sleep apnea. SLEEP 2014;37(4):723-732. PMID:24899761

Kumar, Rajesh; Pham, Tiffany T.; Macey, Paul M.; Woo, Mary A.; Yan-Go, Frisca L.; Harper, Ronald M.

2014-01-01

396

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

PubMed Central

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

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

397

Risk of Obstructive Sleep Apnea Lower in Double Reed Wind Musicians  

PubMed Central

Study Objectives: Obstructive sleep apnea (OSA) is caused by a collapse of the upper airway. Respiratory muscle training with a wind instrument (didgeridoo) in patients with moderate OSA has been previously shown to improve OSA symptomology. However, a survey of orchestra members did not indicate a difference in OSA risk between wind and non-wind instrumentalist. The present study examines whether playing of different wind instrument types may affect the risk of OSA. Methods: A national sample of active musicians (n = 906) was surveyed through the internet. Participants' risk for OSA was determined by the Berlin Questionnaire. Additional survey items included questions about general health and musical experience. Results: A binary logistic regression was conducted to determine if OSA risk was predicted by gender, age, number of years playing instrument, number of hours per week playing instrument, and instrument type. Musicians who played a double reed instrument had a lower risk of OSA (p = 0.047) than non-wind instrumentalists. Additionally, in double reed instrumentalists, the number of hours spent playing the instrument predicted lower OSA risk (p = 0.020). The risk for OSA in other wind instruments (i.e., single reed, high brass, and low brass) was not significantly different from non-wind musicians. Conclusions: Playing a double reed musical instrument was associated with a lower risk of OSA. Citation: Ward CP; York KM; McCoy JG. Risk of obstructive sleep apnea lower in double reed wind musicians. J Clin Sleep Med 2012;8(3):251-255. PMID:22701381

Ward, Christopher P.; York, Kaki M.; McCoy, John G.

2012-01-01

398

The incidence of sleep apnea in patients with stroke or transient ischemic attack.  

PubMed

Disorders of breathing during sleep are defined as cessation or reduction of air flow thorough the upper airway, accompanied by a decrease of oxygen saturation. The results of many studies underline the association between sleep-disordered breathing (SDB) and cerebrovascular disorders. SDB, mostly obstructive sleep apnea syndrome (OSAS), is believed to be an independent risk factor of stroke and is related to poor outcome and increased long-term stroke mortality. The present study evaluated the frequency of SDB in patients with stroke or transient ischemic attack transient ischemic attack. We studied 43 patients (mean age 68.5 +/-11.0), which included 35 males and 8 females, with acute stroke (n=37) and transient ischemic attack (n=6). The assessment included body mass index (BMI), age, cardiovascular risk factors, and localization of stroke. All patients underwent all-night screening for SDB with a portable 8-channel recorder. The apnea/hypopnea index (AHI) for the whole group was 13.3 +/-15.2. AHI <5 was found in 16 patients. Overall, SDB was present in 27 (62.8%) patients with stroke and transient ischemic attack, stratified into those with AHI 5-10, (10 patients), 10-20 (8 patients), and AHI>20 (9 patients). In 15 patients, there was an increase in AHI >or=5 on assuming the supine position. The patients' mean BMI was 27.8 +/-4.7. The analysis of BMI, age, and localization of stroke was not sufficient to identify patients with high risk for SDB. We submit that overnight screening for SDB should be routinely performed in every patient after stroke and transient ischemic attack and it should become a diagnostic tool in neurological departments. PMID:17072068

Wierzbicka, A; Rola, R; Wichniak, A; Richter, P; Ryglewicz, D; Jernajczyk, W

2006-09-01

399

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

PubMed Central

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

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

2013-01-01

400

Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients  

PubMed Central

Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient's home. A follow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography. Citation: Collop NA; Anderson WM; Boehlecke B; Claman D; Goldberg R; Gottlieb DJ; Hudgel D; Sateia M; Schwab R. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007;3(7):737–747. PMID:18198809

2007-01-01