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Sample records for osa murdude operatiivne

  1. Intermittent Hypoxemia and OSA

    PubMed Central

    Nieto, F. Javier; Somers, Virend K.

    2015-01-01

    OSA is a common chronic disorder that is associated with significant morbidity and mortality including cardiovascular, metabolic, and neurocognitive disease and increased cancer-related deaths. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals. Intermittent hypoxemia (IH) is now being recognized as a potential major factor contributing to the pathogenesis of OSA-related comorbidities. OSA-related high-frequency IH is characterized by cycles of hypoxemia with reoxygenation that is distinctly different than sustained low-frequency hypoxia and contributes to ischemia-reperfusion injury. Data from both animal and human studies support mechanistic links between IH and its adverse impact at the tissue level. IH promotes oxidative stress by increased production of reactive oxygen species and angiogenesis, increased sympathetic activation with BP elevation, and systemic and vascular inflammation with endothelial dysfunction that contributes to diverse multiorgan chronic morbidity and mortality affecting cardiovascular disease, metabolic dysfunction, cognitive decline, and progression of cancer. Data from observational studies in large population groups also support the role for hypoxia in the pathogenesis of OSA comorbidity. Treatment with CPAP to reverse OSA-related symptoms and comorbidities has been shown to provide variable benefit in some but not all patient groups. Early treatment with CPAP makes intuitive sense to promote maximal functional recovery and minimize residual injury. More studies are needed to determine the interacting effects of IH and obesity, differential effects of both short-term and long-term hypoxemia, and the effect of CPAP treatment. PMID:25560865

  2. Intraoperative BiPAP in OSA Patients.

    PubMed

    Singh, Bhavna P; Ns, Kodandaram

    2015-04-01

    Obstructive sleep apnea syndrome (OSA) is characterized by recurrent episodes of partial or complete upper airway obstructions during sleep. Severe OSA presents with a number of challenges to the anesthesiologist, the most life threatening being loss of the airway. We are reporting a case where we successfully used intraoperative bi level positive pressure ventilation (BiPAP) with moderate sedation and a regional technique in a patient with severe OSA posted for total knee replacement (TKR). A 55-year-old lady with osteoarthritis of right knee joint was posted for total knee replacement. She had severe OSA with an apnea-hypopnea index of 35. She also had moderate pulmonary hypertension due to her long standing OSA. We successfully used in her a combined spinal epidural technique with intraoperative BiPAP and sedation. She had no complications intraoperatively or post operatively and was discharged on day 5. Patients with OSA are vulnerable to sedatives, anaesthesia and analgesia which even in small doses can cause complete airway collapse. The problem, with regional techniques is that it requires excellent patient cooperation. We decided to put our patient on intraoperative BiPAP hoping that this would allow us to sedate her adequately for the surgery. As it happened we were able to successfully sedate her with slightly lesser doses of the commonly used sedatives without any episodes of desaturation, snoring or exacerbation of pulmonary hypertension. Many more trials are required before we can conclusively say that intraoperative BiPAP allows us to safely sedate OSA patients but we hope that our case report draws light on this possibility. Planning ahead and having a BiPAP machine available inside the operating may allow us to use sedatives in these patients to keep them comfortable under regional anaesthesia. PMID:26023625

  3. Intraoperative BiPAP in OSA Patients

    PubMed Central

    Singh, Bhavna P

    2015-01-01

    Obstructive sleep apnea syndrome (OSA) is characterized by recurrent episodes of partial or complete upper airway obstructions during sleep. Severe OSA presents with a number of challenges to the anesthesiologist, the most life threatening being loss of the airway. We are reporting a case where we successfully used intraoperative bi level positive pressure ventilation (BiPAP) with moderate sedation and a regional technique in a patient with severe OSA posted for total knee replacement (TKR). A 55-year-old lady with osteoarthritis of right knee joint was posted for total knee replacement. She had severe OSA with an apnea-hypopnea index of 35. She also had moderate pulmonary hypertension due to her long standing OSA. We successfully used in her a combined spinal epidural technique with intraoperative BiPAP and sedation. She had no complications intraoperatively or post operatively and was discharged on day 5. Patients with OSA are vulnerable to sedatives, anaesthesia and analgesia which even in small doses can cause complete airway collapse. The problem, with regional techniques is that it requires excellent patient cooperation. We decided to put our patient on intraoperative BiPAP hoping that this would allow us to sedate her adequately for the surgery. As it happened we were able to successfully sedate her with slightly lesser doses of the commonly used sedatives without any episodes of desaturation, snoring or exacerbation of pulmonary hypertension. Many more trials are required before we can conclusively say that intraoperative BiPAP allows us to safely sedate OSA patients but we hope that our case report draws light on this possibility. Planning ahead and having a BiPAP machine available inside the operating may allow us to use sedatives in these patients to keep them comfortable under regional anaesthesia. PMID:26023625

  4. Mathematical Objects through the Lens of Two Different Theoretical Perspectives: APOS and OSA

    ERIC Educational Resources Information Center

    Font Moll, Vicenç; Trigueros, María; Badillo, Edelmira; Rubio, Norma

    2016-01-01

    This paper presents a networking of two theories, the APOS Theory and the ontosemiotic approach (OSA), to compare and contrast how they conceptualize the notion of a mathematical object. As context of reflection, we designed an APOS genetic decomposition for the derivative and analyzed it from the point of view of OSA. Results of this study show…

  5. Using an OSAE to Learn about Life in Two New Delhi Hutments

    ERIC Educational Resources Information Center

    Weller, Kay E.

    2005-01-01

    This manuscript is a description of personal observations of two hutments in New Delhi, India. Data was gathered from my hotel window using the OSAE method of landscape observation. The OSAE is the method I use to understand processes that can be seen when studying a landscape. It is the most useful tool I have ever used when teaching geography.…

  6. Obesity and obstructive sleep apnea: or is it OSA and obesity?

    PubMed

    Carter, Robert; Watenpaugh, Donald E

    2008-08-01

    Obstructive sleep apnea (OSA) consists of repetitive choking spells due to sleep-induced reduction of upper airway muscle tone. Millions of adults and children live unaware of this condition, which can have a profound affect on their health and quality of life. Obesity, gender, genetic, and hormonal factors mediate risk for OSA and interact in a multifaceted manner in the pathogenesis of this disease. Obesity is the most established and primary risk factor given that body mass index, visceral fat, and neck circumference are major predictors in the clinical expression of OSA. Many studies have shown weight loss or gain significantly impacts OSA severity. More recently, accumulating evidence indicates OSA promotes weight gain, obesity, and type II diabetes in a variety of ways, such that obesity and OSA form multiple interleaved vicious cycles. Thus, creative strategies to increase physical activity, improve diet, and otherwise facilitate weight management become particularly vital given the epidemics of obesity and OSA in the United States. In this regard, the American College of Sports Medicine recently launched the "Exercise is Medicine" (initiative exerciseismedicine.org). In the future, medications may emerge to treat obesity, OSA, and their sequelae with minimal side effects. However, there are effective ways to approach these problems now without waiting for "the magic pill". PMID:18573643

  7. Osa-containing Brahma chromatin remodeling complexes are required for the repression of Wingless target genes

    PubMed Central

    Collins, Russell T.; Treisman, Jessica E.

    2000-01-01

    The Wingless signaling pathway directs many developmental processes in Drosophila by regulating the expression of specific downstream target genes. We report here that the product of the trithorax group gene osa is required to repress such genes in the absence of the Wingless signal. The Wingless-regulated genes nubbin, Distal-less, and decapentaplegic and a minimal enhancer from the Ultrabithorax gene are misexpressed in osa mutants and repressed by ectopic Osa. Osa-mediated repression occurs downstream of the up-regulation of Armadillo but is sensitive both to the relative levels of activating Armadillo/Pangolin and repressing Groucho/Pangolin complexes present and to the responsiveness of the promoter to Wingless. Osa functions as a component of the Brahma chromatin-remodeling complex; other components of this complex are likewise required to repress Wingless target genes. These results suggest that altering the conformation of chromatin is an important mechanism by which Wingless signaling activates gene expression. PMID:11124806

  8. The WOPR Domain Protein OsaA Orchestrates Development in Aspergillus nidulans

    PubMed Central

    Alkahyyat, Fahad; Ni, Min; Kim, Sun Chang; Yu, Jae-Hyuk

    2015-01-01

    Orchestration of cellular growth and development occurs during the life cycle of Aspergillus nidulans. A multi-copy genetic screen intended to unveil novel regulators of development identified the AN6578 locus predicted to encode a protein with the WOPR domain, which is a broadly present fungi-specific DNA-binding motif. Multi-copy of AN6578 disrupted the normal life cycle of the fungus leading to enhanced proliferation of vegetative cells, whereas the deletion resulted in hyper-active sexual fruiting with reduced asexual development (conidiation), thus named as osaA (Orchestrator of Sex and Asex). Further genetic studies indicate that OsaA balances development mainly by repressing sexual development downstream of the velvet regulator VeA. The absence of osaA is sufficient to suppress the veA1 allele leading to the sporulation levels comparable to veA+ wild type (WT). Genome-wide transcriptomic analyses of WT, veA1, and ΔosaA veA1 strains by RNA-Seq further corroborate that OsaA functions in repressing sexual development downstream of VeA. However, OsaA also plays additional roles in controlling development, as the ΔosaA veA1 mutant exhibits precocious and enhanced formation of Hülle cells compared to WT. The OsaA orthologue of Aspergillus flavus is able to complement the osaA null phenotype in A. nidulans, suggesting a conserved role of this group of WOPR domain proteins. In summary, OsaA is an upstream orchestrator of morphological and chemical development in Aspergillus that functions downstream of VeA. PMID:26359867

  9. Audiologic profile of OSAS and simple snoring patients: the effect of chronic nocturnal intermittent hypoxia on auditory function.

    PubMed

    Martines, Francesco; Ballacchino, Antonella; Sireci, Federico; Mucia, Marianna; La Mattina, Eleonora; Rizzo, Serena; Salvago, Pietro

    2016-06-01

    The objective of this work was to study the effect of nocturnal intermittent hypoxia on auditory function of simple snoring patients and subjects affected by OSAS; we compared the audiologic profile with the severity of OSAS to detect early signs of cochlear damage. One hundred-sixty patients underwent overnight polysomnography, micro-otoscopy, multi-frequency audiometry, acufenometry, TEOAE recording and d-ROMs test. All subjects were divided in four groups, based on presence/absence of AHI (simple snoring without OSAS, mild OSAS, moderate OSAS, severe OSAS). Sixty (37.5 %) patients were not affected by OSAS, 58 (36.25 %) presented a mild OSAS, 18 (11.25 %) a moderate OSAS and 24 (15 %) a severe OSAS; the 57.14 % of moderate to severe OSAS suffered from tinnitus with respect to the 31.03 % of mild OSAS (P = 0.024). A higher percentage (41.66 %) of hearing loss was found among individuals with moderate to severe degree of OSAS (P < 0.0001). All groups were characterized by a mean hearing threshold <25 dB HL for 0.25-3 kHz frequencies and a progressive decrease in hearing sensitivity, particularly for 6-16 kHz frequencies (P < 0.05). The analysis of otoacoustic emissions SNR mean values evidenced a significant difference between simple snoring and severe OSAS individuals for 3 and 4 kHz frequencies (P < 0.05). d-ROM levels resulted higher in patients with severe OSAS with respect to simple snoring subjects (P = 0.004). Our data underline the key role of chronic nocturnal intermittent hypoxia in the development of an early cochlear damage and a more marked high-frequency hearing loss in case of severe OSAS (P < 0.05). PMID:26164293

  10. Comparative Emulsifying Properties of Octenyl Succinic Anhydride (OSA)-Modified Starch: Granular Form vs Dissolved State.

    PubMed

    Matos, María; Marefati, Ali; Gutiérrez, Gemma; Wahlgren, Marie; Rayner, Marilyn

    2016-01-01

    The emulsifying ability of OSA-modified and native starch in the granular form, in the dissolved state and a combination of both was compared. This study aims to understand mixed systems of particles and dissolved starch with respect to what species dominates at droplet interfaces and how stability is affected by addition of one of the species to already formed emulsions. It was possible to create emulsions with OSA-modified starch isolated from Quinoa as sole emulsifier. Similar droplet sizes were obtained with emulsions prepared at 7% (w/w) oil content using OSA-modified starch in the granular form or molecularly dissolved but large differences were observed regarding stability. Pickering emulsions kept their droplet size constant after one month while emulsions formulated with OSA-modified starch dissolved exhibited coalescence. All emulsions stabilized combining OSA-modified starch in granular form and in solution showed larger mean droplet sizes with no significant differences with respect to the order of addition. These emulsions were unstable due to coalescence regarding presence of free oil. Similar results were obtained when emulsions were prepared by combining OSA-modified granules with native starch in solution. The degree of surface coverage of starch granules was much lower in presence of starch in solution which indicates that OSA-starch is more surface active in the dissolved state than in granular form, although it led to unstable systems compared to starch granule stabilized Pickering emulsions, which demonstrated to be extremely stable. PMID:27479315

  11. Development of emulsifying property in Persian gum using octenyl succinic anhydride (OSA).

    PubMed

    Mohammadi, S; Abbasi, S; Scanlon, M G

    2016-08-01

    In the present study, the influence of octenyle succinic anhydride (OSA),gum concentration, pH, temperature and reaction time on esterification of Persian gum (PG), and its soluble (SFPG) and insoluble (IFPG) fractions, were investigated by response surface methodology (RSM) in order to optimize the reaction conditions based on the degree of substitution (DS). The individual effect of all independent variables as well as the interactive effects of temperature-OSA concentration, and OSA-PG concentrations on DS was significant. However, the latter interactive effect (OSA-SFPG) was not significant in case of SFPG. The IFPG did not have any esterification reaction with OSA. The highest DS for PG and SFPG were 0.0285 and 0.0303 at the optimal conditions, respectively. The FTIR spectrums also confirmed the carbonyl group attachment in OSA-PG and OSA-SFPG. The enhancement of emulsifying capability was also confirmed by ECI and EAI values, microscopic images as well as rheological measurements. PMID:27138859

  12. Comparative Emulsifying Properties of Octenyl Succinic Anhydride (OSA)-Modified Starch: Granular Form vs Dissolved State

    PubMed Central

    Marefati, Ali; Gutiérrez, Gemma; Wahlgren, Marie; Rayner, Marilyn

    2016-01-01

    The emulsifying ability of OSA-modified and native starch in the granular form, in the dissolved state and a combination of both was compared. This study aims to understand mixed systems of particles and dissolved starch with respect to what species dominates at droplet interfaces and how stability is affected by addition of one of the species to already formed emulsions. It was possible to create emulsions with OSA-modified starch isolated from Quinoa as sole emulsifier. Similar droplet sizes were obtained with emulsions prepared at 7% (w/w) oil content using OSA-modified starch in the granular form or molecularly dissolved but large differences were observed regarding stability. Pickering emulsions kept their droplet size constant after one month while emulsions formulated with OSA-modified starch dissolved exhibited coalescence. All emulsions stabilized combining OSA-modified starch in granular form and in solution showed larger mean droplet sizes with no significant differences with respect to the order of addition. These emulsions were unstable due to coalescence regarding presence of free oil. Similar results were obtained when emulsions were prepared by combining OSA-modified granules with native starch in solution. The degree of surface coverage of starch granules was much lower in presence of starch in solution which indicates that OSA-starch is more surface active in the dissolved state than in granular form, although it led to unstable systems compared to starch granule stabilized Pickering emulsions, which demonstrated to be extremely stable. PMID:27479315

  13. Pediatric OSAS: Oximetry can provide answers when polysomnography is not available.

    PubMed

    Kaditis, Athanasios; Kheirandish-Gozal, Leila; Gozal, David

    2016-06-01

    Overnight polysomnography is the gold standard tool for the diagnosis of obstructive sleep apnea syndrome (OSAS) in habitually snoring children, but it is expensive and not always available. Nocturnal oximetry has been proposed as an abbreviated and low-cost testing modality for the diagnosis of OSAS. In this systematic review, 25 original articles were evaluated to: (i) summarize reference values of nocturnal oximetry parameters in healthy children; (ii) identify abnormal oximetry patterns that predict OSAS in habitually snoring children; (iii) delineate abnormalities in oximetry that can predict responses to treatment interventions for OSAS and potential complications. Nocturnal SpO2 drops <90%, more than two clusters of desaturation events (≥4%) and oxyhemoglobin desaturation (≥4%) index (ODI4) >2.2 episodes/h are unusual in children without OSAS. At least three clusters of desaturation events, and at least three SpO2 drops below 90% in a nocturnal oximetry recording are indicative of moderate-to-severe OSAS. An ODI4 >2 episodes/h combined with OSAS symptoms also exhibits high positive predictive value for apnea-hypopnea index >1 episode/h. Children without clusters of desaturation events have low risk of major respiratory complications following adenotonsillectomy. Thus, nocturnal oximetry emerges as a valuable tool that can facilitate treatment decisions when polysomnography is not available. PMID:26146027

  14. The investigation of the sludge reduction efficiency and mechanisms in oxic-settling-anaerobic (OSA) process.

    PubMed

    Demir, Özlem; Filibeli, Ayşe

    2016-01-01

    This paper aims to provide a full understanding of the sludge reduction mechanisms in the oxic-settling-anaerobic (OSA) process and presents an evaluation of the sludge reduction efficiencies and sludge characteristics in this process compared to the conventional activated sludge process. Fifty-eight percent reduction in observed yield in the OSA process was achieved compared to the control system at the end of the operational period with no deterioration of effluent quality. The settleability of sludge in the OSA process was also found to be better than that of the control system in terms of sludge volume index. In long-term operation, capillary suction time and specific resistance to filtration values confirmed that the OSA process showed good filterability characteristics. The results of batch experiments showed that higher endogenous respiration in the systems might lead to lower sludge production and that energy uncoupling had only a limited impact on sludge reduction. PMID:27191551

  15. Impact of OSA on Biological Markers in Morbid Obesity and Metabolic Syndrome

    PubMed Central

    Salord, Neus; Gasa, Mercè; Mayos, Mercedes; Fortuna-Gutierrez, Ana Maria; Montserrat, Josep Maria; Sánchez-de-la-Torre, Manuel; Barceló, Antonia; Barbé, Ferran; Vilarrasa, Núria; Monasterio, Carmen

    2014-01-01

    Background and Objective: There is compelling evidence that obstructive sleep apnoea (OSA) can affect metabolic syndrome (MetS) and cardiovascular risk, but the intermediate mechanisms through which it occurs have not been well defined. We explored the impact of OSA in morbidly obese patients with MetS on adipokines, pro-inflammatory markers, endothelial dysfunction, and atherosclerosis markers. Methods: We included 52 morbidly obese patients in an observational study matched for age, gender and central obesity in 3 groups (OSA-MetS, Non-OSA-MetS, and Non OSA-non-MetS). Anthropometrical, blood pressure, and fasting blood measurements were obtained the morning after an overnight polysomnography. VEGF, soluble CD40 ligand (sCD40L), TNF-α, IL-6, leptin, adiponectin, and chemerin were determined in serum by ELISA. OSA was defined as apnea/ hypopnea index ≥ 15 and MetS by NCEP-ATP III. Results: Cases and control subjects did not differ in age, BMI, waist circumference, and gender (43 ± 10 years, 46 ± 5 kg/m2, 128 ± 10 cm, 71% females). The cases had severe OSA with 47 (32-66) events/h, time spent < 90% SpO2 7% (5%-31%). All groups presented similar serum cytokines, adipokines, VEGF, and sCD40L levels. Conclusions: In a morbidly obese population with established MetS, the presence of OSA did not determine any differences in the studied mediators when matched by central obesity. Morbidly obese NonOSA-NonMetS had a similar inflammatory, adipokine VEGF, and sCD40L profile as those with established MetS, with or without OSA. Obesity itself could overwhelm the effect of sleep apnea and MetS in the studied biomarkers. Citation: Salord N; Gasa M; Mayos M; Fortuna-Gutierrez AM; Montserrat JM; Sánchez-de-la-Torre M; Barceló A; Barbé F; Vilarrasa N; Monasterio C. Impact of OSA on biological markers in morbid obesity and metabolic syndrome. J Clin Sleep Med 2014;10(3):263-270. PMID:24634623

  16. Executive Dysfunction in OSA Before and After Treatment: A Meta-Analysis

    PubMed Central

    Olaithe, Michelle; Bucks, Romola S.

    2013-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is a frequent and often underdiagnosed condition that is associated with upper airway collapse, oxygen desaturation, and sleep fragmentation leading to cognitive dysfunction. There is meta-analytic evidence that subdomains of attention and memory are affected by OSA. However, a thorough investigation of the impact of OSA on different subdomains of executive function is yet to be conducted. This report investigates the impact of OSA and its treatment, in adult patients, on 5 theorized subdomains of executive function. Design: An extensive literature search was conducted of published and unpublished materials, returning 35 studies that matched selection criteria. Meta-analysis was used to synthesize the results from studies examining the impact of OSA on executive functioning compared to controls (21 studies), and before and after treatment (19 studies); 5 studies met inclusion in both categories. Measurements: Research papers were selected which assessed 5 subdomains of executive function: Shifting, Updating, Inhibition, Generativity, and Fluid Reasoning. Results: All 5 domains of executive function demonstrated medium to very large impairments in OSA independent of age and disease severity. Furthermore, all subdomains of executive function demonstrated small to medium improvements with CPAP treatment. Discussion: Executive function is impaired across all five domains in OSA; these difficulties improved with CPAP treatment. Age and disease severity did not moderate the effects found; however, further studies are needed to explore the extent of primary and secondary effects, and the impact of age and premorbid intellectual ability (cognitive reserve). Citation: Olaithe M; Bucks RS. Executive dysfunction in OSA before and after treatment: a meta-analysis. SLEEP 2013;36(9):1297-1305. PMID:23997362

  17. Cloning and characterization of hELD/OSA1, a novel BRG1 interacting protein.

    PubMed Central

    Hurlstone, Adam F L; Olave, Ivan A; Barker, Nick; van Noort, Mascha; Clevers, Hans

    2002-01-01

    A highly conserved multisubunit enzymic complex, SWI/SNF, participates in the regulation of eukaryote gene expression through its ability to remodel chromatin. While a single component of SWI/SNF, Swi2 or a related protein, can perform this function in vitro, the other components appear to modulate the activity and specificity of the complex in vivo. Here we describe the cloning of hELD/OSA1, a 189 KDa human homologue of Drosophila Eld/Osa protein, a constituent of Drosophila SWI/SNF. By comparing conserved peptide sequences in Eld/Osa homologues we define three domains common to all family members. A putative DNA binding domain, or ARID (AT-rich DNA-interacting domain), may function in targetting SWI/SNF to chromatin. Two other domains unique to Eld/Osa proteins, EHD1 and EHD2, map to the C-terminus. We show that EHD2 mediates binding to Brahma-related gene 1 (BRG1), a human homologue of yeast Swi2. EHD1 and EHD2 also appear capable of interacting with each other. Using an antibody raised against EHD2 of hELD/OSA1, we detected Eld/Osa1 in endogenous SWI/SNF complexes derived from mouse brain. PMID:11988099

  18. Obstructive Sleep Apnea Syndrome (OSAS) Increases Pedestrian Injury Risk in Children

    PubMed Central

    Avis, Kristin T.; Gamble, Karen L.; Schwebel, David C

    2014-01-01

    Objectives To evaluate pedestrian behavior, including reaction time, impulsivity, risk-taking, attention, and decision-making, in children with obstructive sleep apnea syndrome (OSAS) compared with healthy controls. Study design Using a case control design, sixty 8- to 16-year-olds with newly diagnosed and untreated OSAS engaged in a virtual reality pedestrian environment. Sixty-one healthy children matched using a yoke-control procedure by age, race, gender and household income served as controls. Results Children with OSAS were riskier pedestrians than healthy children of the same age, race, and sex. Children with OSAS waited less time to cross (p<.01). The groups did not differ in looking at oncoming traffic or taking longer to decide to cross. Conclusions Results suggest OSAS may have significant consequences on children’s daytime functioning in a critical domain of personal safety, pedestrian skills. Children with OSAS appeared to have greater impulsivity when crossing streets. Results highlight the need for heightened awareness of the consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention. PMID:25444002

  19. Obstructive sleep apnea (OSA): a cephalometric analysis of severe and non-severe OSA patients. Part II: A predictive discriminant function analysis.

    PubMed

    Tangugsorn, V; Krogstad, O; Espeland, L; Lyberg, T

    2000-01-01

    One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of apnea-hypopnea index (AHI) as severe (AHI > or = 50) and non-severe (AHI < 50). A comprehensive cephalometric analysis of cervicocraniofacial skeletal and upper airway soft tissue morphology was performed in 51 non-severe and 49 severe OSA patients. In addition, a multivariate statistical method (principal component, analysis and predictive discriminant analysis) was performed to identify the components that could correctly differentiate the severe from the non-severe OSA patients. Eight principal components (PCs) of cervicocraniofacial skeletal morphology, 4 PCs of hyoid bone position and head posture, and 7 PCs of upper airway soft tissue morphology, together with the selected demographic variables, were deduced to formulate a linear canonical discriminant function. The equation of a 9-variable model was generated as follows: PDF score = 4.127 - 0.144 (Body Mass Index) - 0.376 (PC1.1) + 0.311 (PC1.4) + 0.214 (PC1.5) + 0.075 (PC 2.1) - 1.309 (PC2.3) + 0.708 (PC3.2) - 0.059 (PC3.3) + 0.609 (PC3.6). The cutoff score was -0.03899. The overall rate of correct classification was 83%. The results showed that Body Mass Index and 8 other PCs contributed significantly to the OSA severity. These analyses are proven to be a useful adjunctive diagnostic tool to select optimal treatment regimens for OSA patients with varying degrees of severity. PMID:11307197

  20. The effect of allergic rhinitis on the degree of stress, fatigue and quality of life in OSA patients.

    PubMed

    Park, Cheol Eon; Shin, Seung Youp; Lee, Kun Hee; Cho, Joong Saeng; Kim, Sung Wan

    2012-09-01

    Both allergic rhinitis (AR) and obstructive sleep apnea (OSA) are known to increase stress and fatigue, but the result of their coexistence has not been studied. The objective of this study was to evaluate the amount of stress and fatigue when AR is combined with OSA. One hundred and twelve patients diagnosed with OSA by polysomnography were enrolled. Among them, 37 patients were diagnosed with AR by a skin prick test and symptoms (OSA-AR group) and 75 patients were classified into the OSA group since they tested negative for allergies. We evaluated the Epworth sleepiness scale (ESS), stress score, fatigue score, ability to cope with stress, and rhinosinusitis quality of life questionnaire (RQLQ) with questionnaires and statistically compared the scores of both groups. There were no significant differences in BMI and sleep parameters such as LSAT, AHI, and RERA between the two groups. However, the OSA-AR group showed a significantly higher ESS score compared to the OSA group (13.7 ± 4.7 vs. 9.3 ± 4.8). Fatigue scores were also significantly higher in the OSA-AR group than in the OSA group (39.8 ± 11.0 vs. 30.6 ± 5.4). The OSA-AR group had a significantly higher stress score (60.4 ± 18.6 vs. 51.2 ± 10.4). The ability to cope with stress was higher in the OSA group, although this difference was not statistically significant. RQLQ scores were higher in the OSA-AR group (60.2 ± 16.7 compared to 25.1 ± 13.9). In conclusion, management of allergic rhinitis is very important in treating OSA patients in order to eliminate stress and fatigue and to minimize daytime sleepiness and quality of life. PMID:22207526

  1. Italian recommendations on dental support in the treatment of adult obstructive sleep apnea syndrome (OSAS)

    PubMed Central

    Levrini, Luca; Sacchi, Franco; Milano, Francesca; Polimeni, Antonella; Cozza, Paolo; Bernkopf, Edoardo; Segù, Marzia; Zucconi, Marco; Vicini, Claudio; Brunello, Enrico

    2015-01-01

    Summary Background The aim of the present article is to present a set of proposed clinical recommendations aimed at Italian dentists involved in the management of patients with obstructive sleep apnea syndrome or snoring. Methods With the purpose of creating a study group, some of the most important Italian scientific societies operating in fields relevant to the issue of sleep medicine in dentistry were asked to appoint a representative. Each member of the study group was required to answer questions regarding the clinical management of OSAS and snoring. Results Oral appliances can be used to treat: - simple snoring, in patients who do not respond to, or do not appear to be suitable candidates for behavioral measures such as weight loss or positional therapy; - mild or moderate OSAS, in patients who prefer OAs to continuous positive airway pressure (CPAP) or who are not suitable candidates for CPAP, because of its failure or failure of behavioral approaches like weight loss or positional therapy; - severe OSAS, in patients who do not respond to or do not tolerate CPAP and in whom no indication for either maxillofacial or ENT surgery appears applicable. Conclusions The application of oral appliances is highly desirable in cases of simple snoring or mild to moderate OSAS, whereas considerable caution is warranted when treating severe OSAS. It is fundamental to ensure that the patient understands his problem and, at the same time, to present all the various treatment options. PMID:26941893

  2. Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with tonsil colonisation by Streptococcus pyogenes

    PubMed Central

    Viciani, Elisa; Montagnani, Francesca; Tavarini, Simona; Tordini, Giacinta; Maccari, Silvia; Morandi, Matteo; Faenzi, Elisa; Biagini, Cesare; Romano, Antonio; Salerni, Lorenzo; Finco, Oretta; Lazzi, Stefano; Ruggiero, Paolo; De Luca, Andrea; Barocchi, Michèle A.; Manetti, Andrea G. O.

    2016-01-01

    The involvement of pathogenic bacteria in obstructive sleep apnoea syndrome (OSAS) has yet to be elucidated. We investigated the possible role of group A streptococcus (GAS) in OSAS pathogenesis. In 40 tonsillectomized patients affected by OSAS and 80 healthy controls, significant (p < 0.0001) association of GAS with paediatric OSAS was found. Supernatant from streptolysin O (SLO)-producing GAS induced production of cysteinyl leukotrienes (CysLTs) in tonsil mononuclear cells (TMCs). CysLTs-treated TMCs showed significant (p < 0.05) proliferation of CD4+ T, CD19+ and CD19+CD27+CD38+ B lymphocytes. We discovered a SLO-dependent activation of CysLTs production through a pathway involving TOLL-like receptor 4 (TLR4), TIR-domain-containing adapter-inducing interferon-β (TRIF), Myeloid differentiation primary response gene 88 (MyD88), and p38 MAP Kinase. In conclusion, we hypothesise that GAS may contribute to paediatric tonsillar hyperplasia through CysLTs production induced by SLO, and this might explain its association with OSAS. PMID:26860261

  3. The chromatin-remodeling protein Osa interacts with CyclinE in Drosophila eye imaginal discs.

    PubMed

    Baig, Jawaid; Chanut, Francoise; Kornberg, Thomas B; Klebes, Ansgar

    2010-03-01

    Coordinating cell proliferation and differentiation is essential during organogenesis. In Drosophila, the photoreceptor, pigment, and support cells of the eye are specified in an orchestrated wave as the morphogenetic furrow passes across the eye imaginal disc. Cells anterior of the furrow are not yet differentiated and remain mitotically active, while most cells in the furrow arrest at G(1) and adopt specific ommatidial fates. We used microarray expression analysis to monitor changes in transcription at the furrow and identified genes whose expression correlates with either proliferation or fate specification. Some of these are members of the Polycomb and Trithorax families that encode epigenetic regulators. Osa is one; it associates with components of the Drosophila SWI/SNF chromatin-remodeling complex. Our studies of this Trithorax factor in eye development implicate Osa as a regulator of the cell cycle: Osa overexpression caused a small-eye phenotype, a reduced number of M- and S-phase cells in eye imaginal discs, and a delay in morphogenetic furrow progression. In addition, we present evidence that Osa interacts genetically and biochemically with CyclinE. Our results suggest a dual mechanism of Osa function in transcriptional regulation and cell cycle control. PMID:20008573

  4. Blood Pressure Increases in OSA due to Maintained Neurovascular Sympathetic Transduction: Impact of CPAP

    PubMed Central

    Tamisier, Renaud; Tan, Can Ozan; Pepin, Jean-Louis; Levy, Patrick; Taylor, J. Andrew

    2015-01-01

    Study Objectives: To test the hypothesis that greater resting sympathetic activity in obstructive sleep apnea (OSA) syndrome would not induce a lesser sympathetic neurovascular transduction. Design: Case-controlled cohort study. Participants: 33 patients with newly diagnosed OSA without comorbidities and 14 healthy controls. Interventions: 6 months of continuous positive airway pressure (CPAP) treatment for OSA patients and follow-up for 9 healthy controls. Measurements and Results: We assessed resting sympathetic outflow and sympathetic neurovascular transduction. Sympathetic activity was directly measured (microneurography) at rest and in response to sustained isometric handgrip exercise. Neurovascular transduction was derived from the relationship of sympathetic activity and blood pressure to leg blood flow during exercise. Despite an elevated sympathetic activity of ∼50% in OSA compared to controls, neurovascular transduction was not different (i.e., absence of tachyphylaxis). After six months of CPAP, there were significant declines in diastolic pressure, averaging ∼4 mm Hg, and in sympathetic activity, averaging ∼20% with no change in transduction. Conclusions: Greater sympathetic activity in obstructive sleep apnea does not appear to be associated with lesser neurovascular transduction. Hence, elevated sympathetic outflow without lesser transduction may underlie the prevalent development of hypertension in this population that is well controlled by continuous positive airway pressure treatment. Citation: Tamisier R, Tan CO, Pepin JL, Levy P, Taylor JA. Blood pressure increases in OSA due to maintained neurovascular sympathetic transduction: impact of CPAP. SLEEP 2015;38(12):1973–1980. PMID:26039959

  5. MR image analytics to characterize upper airway architecture in children with OSAS

    NASA Astrophysics Data System (ADS)

    Tong, Yubing; Udupa, Jayaram K.; Torigian, Drew A.; Matsumoto, Monica M. S.; Sin, Sanghun; Arens, Raanan

    2015-03-01

    Mechanisms leading to Obstructive Sleep Apnea Syndrome (OSAS) in obese children are not well understood. We previously analyzed polysomnographic and demographic data to study the anatomical characteristics of the upper airway and body composition in two groups of obese children with and without OSAS, where object volume was evaluated. In this paper, in order to better understand the disease we expand the analysis considering a variety of features that include object-specific features such as size, surface area, sphericity, and image intensity properties of fourteen objects in the vicinity of the upper airway, as well as inter-object relationships such as distance between objects. Our preliminary results indicate several interesting phenomena: volumes and surface areas of adenoid and tonsils increase statistically significantly in OSAS. Standardized T2-weighted MR image intensities differ statistically significantly between the two groups, implying that perhaps intrinsic tissue composition undergoes changes in OSAS. Inter-object distances are significantly different between the two groups for object pairs (skin, oropharynx), (skin, fat pad), (skin, soft palate), (mandible, tongue), (oropharynx, soft palate), (left tonsil, oropharynx), (left tonsil, fat pad) and (left tonsil, right tonsil). We conclude that treatment methods for OSAS such as adenotonsillectomy should respect proportional object size relationships and spatial arrangement of objects as they exist in control subjects.

  6. Operative Management of OSAS in a Complex Case of Proteus Syndrome

    PubMed Central

    Cantone, Elena; Cavaliere, Michele; Castagna, Giovanni; Marino, Anna; Del Vecchio, Luigi; Iengo, Maurizio

    2015-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common disorder in childhood with high prevalence in syndromic subjects with craniofacial malformations. Proteus Syndrome (PS) is a rare hamartoneoplastic disorder associated with disproportionate and asymmetric overgrowth of body parts and hypertrophy or malformation of lymphatic tissues, such as palatine tonsils. We report a case of a 12-year-old boy diagnosed with Proteus Syndrome (PS) and suffering from OSAS due to asymmetric palatine tonsillar hypertrophy, treated with partial resection of left tonsil. To avoid the risk of a general anesthesia and remove only the obstructive portion of the palatine tonsil bipolar radiofrequency-induced thermotherapy (RFITT) under local anesthesia was performed. Recovery of the obstructive respiratory disease was obtained. To our knowledge, this is the first case reported in the literature of partial tonsillar resection performed in a patient with PS suffering from OSAS under local anesthesia. PMID:26199778

  7. 48 CFR 3033.102-90 - Protests on classified solicitations (OSA).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Protests on classified... PROTESTS, DISPUTES, AND APPEALS Protests 3033.102-90 Protests on classified solicitations (OSA). To ensure that classified information is protected and appropriate security measures are coordinated as...

  8. 48 CFR 3033.102-90 - Protests on classified solicitations (OSA).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Protests on classified... PROTESTS, DISPUTES, AND APPEALS Protests 3033.102-90 Protests on classified solicitations (OSA). To ensure that classified information is protected and appropriate security measures are coordinated as...

  9. 48 CFR 3033.102-90 - Protests on classified solicitations (OSA).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Protests on classified... PROTESTS, DISPUTES, AND APPEALS Protests 3033.102-90 Protests on classified solicitations (OSA). To ensure that classified information is protected and appropriate security measures are coordinated as...

  10. Is There a Relationship Between Obstructive Sleep Apnea (OSA) and Hearing Loss?

    PubMed

    Ekin, Selami; Turan, Mahfuz; Arısoy, Ahmet; Gunbatar, Hulya; Sunnetcioglu, Aysel; Asker, Selvi; Yıldız, Hanifi

    2016-01-01

    BACKGROUND Obstructive sleep apnea (OSA) is a common disorder with an estimated prevalence in the general population of 2-5%. Its main clinical features are loud snoring and breathing stoppage during sleep. Ischemia could be a consequence of noise-induced hearing loss because cochlear oxygen tension is reduced during and after noise exposure. In this study, we evaluated auditory function in patients affected by OSA and simple snoring. MATERIAL AND METHODS A total of 66 participants (male to female ratio: 40:26) were included in the study, of which 21 were in the control group, 18 were in the simple snoring group, and 27 were in the OSA patient group. Polysomnography and audiometric examination were performed in all participants. RESULTS The mean ages of the participants in the control, simple snoring, and OSA groups were 39.14±9.9, 37.28±8.2, and 41.56±8.99 years, respectively. There were no statistically significant differences among groups regarding age or sex; however, there were statistically significant differences among groups in body mass index, apnea-hypopnea index scores, mean saturation, and duration under 90% saturation. In addition, statistically significant differences were found between the patient group and the control and simple snoring groups concerning the mean saturation, duration under 90% saturation, and the extended high frequency of hearing. CONCLUSIONS These data show that snoring may cause hearing loss at extended high frequencies. PMID:27588548

  11. OSAS Surgery and Postoperative Discomfort: Phase I Surgery versus Phase II Surgery

    PubMed Central

    Gasparini, Giulio; Pelo, Sandro; Foresta, Enrico; Boniello, Roberto; Romandini, Mario; Cervelli, Daniele; Azzuni, Camillo; Marianetti, Tito Matteo

    2015-01-01

    Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation. PMID:25695081

  12. A novel integrated, compact OSA and ASE source for increased fober optic sensing capacity

    NASA Astrophysics Data System (ADS)

    West, Linda; Eigen, Daryl J.; Chavez-Pirson, Arturo

    2003-11-01

    Typical fiber Bragg sensing systems, in the 1500nm to 1600nm wavelength range, use gratings spaced approximately 5nm apart. This large spacing is preferred since optical power illuminating the gratings is limited and monitoring systems often have low performance and hence have difficulty in differentiating between closely spaced gratings. In this paper, we present a high power ASE source in combination with an extremely high performance Optical Spectrum Analyzer (OSA), that allows sensing gratings to be closely spaced so many sensing elements can be monitored while maintaining very good wavelength and power detection. The integrated unit can be provided on a PCI card, in a box or as an OEM module to enable a robust, handheld unit. The OSA is built around proprietary Compliant Micro Electro Mechanical (CMEMs) tunable filters, primarily developed for very densely populated Telecommunications applications. The OSA is wavelength calibrated and can be matched to the ASE source to compensate for any spectral power characteristic of the source. This integrated OSA and ASE source will allow the sensing industry to increase grating array sizes while maintaining low cost.

  13. Blood pressure effects of CPAP in nonresistant and resistant hypertension associated with OSA: A systematic review of randomized clinical trials.

    PubMed

    Feldstein, Carlos A

    2016-01-01

    Obstructive sleep apnea (OSA) is a rather common chronic disorder, associated with increased prevalence of hypertension. The pathophysiological mechanisms for hypertension in OSA are at least in part linked to intermittent hypoxia developed during nightly hypopneas and apneas. Hypoxemia stimulates sympathetic overactivity, systemic inflammation, oxidative stress, and endothelial dysfunction. However, it appears that intermittent hypoxemia is not the only factor in the development of hypertension in OSA. Supplemental oxygen therapy that improved oxyhemoglobin saturation to similar levels to those achieved with CPAP treatment did not reduce BP. In this scenario, it could be proposed that hypoxemia acts as a trigger of sympathetic overdrive, which when set is the main factor in the development of hypertension in OSA. This review appraises evidence provided by randomized controlled trials on the BP-lowering effectiveness of continuous positive airway pressure (CPAP) treatment of OSA patients with nonresistant and resistant hypertension. It suggests that CPAP treatment is more effective in treating resistant hypertension than nonresistant hypertension. A possible explanation is that sympathetic overactivity and altered vascular reactivity in OSA could be more severe in resistant hypertension than in nonresistant hypertension. An intricate interaction among compliance, adherence, and their interaction with demographic characteristics, genetic factors, and comorbidities of the population included might explain the differences found between trials on their influence over the antihypertensive effectiveness of CPAP. Further long-term trials are needed in hypertensive OSA patients to assess whether CPAP treatment in OSA patients consistently restores physiological nocturnal BP fall and adjusts resting and circadian heart rate. PMID:27159803

  14. The USC-OSA Student Chapter: goals and benefits for the optics community

    NASA Astrophysics Data System (ADS)

    Gómez-Varela, A. I.; Gargallo, Ana; González Núñez, Héctor; Delgado-García, Tamara; Almaguer-Gómez, Citlalli; Cambronero-López, F.; Flores-Arias, M. T.

    2014-07-01

    The USC-OSA Student Chapter has been constituted in March 2013 by members of the University of Santiago de Compostela (USC) in Spain and sponsored by The Optical Society of America (OSA). It is formed by five graduate and one undergraduate students with the common interest in Optics and Photonics research and a professor of the USC is also involved as a faculty advisor. We decided to start this group with the aim of involving kids, precollege and undergraduate students in the world of Optics and Photonics. The activities that the USC-OSA Student Chapter members intend to realize are mainly educational tasks for the spreading of knowledge in Photonics by means of basic experiments, demonstrations and lectures by leading researchers and teachers. Most of the needed resources to accomplish these activities are provided by the OSA, such as educational posters and a portable kit for demonstrating Optics to students. At this moment the USC-OSA Student Chapter is carrying out several activities, as educational journeys at the Santiago de Compostela University Hospital Complex (CHUS), where hospitalized children can approach to Optics through some simple experiments and games. A teaching program is also being organized in collaboration with Galician secondary schools in order to show students the importance and uses of Optics and Photonics and to arouse their interest in this field, as well as encouraging them to develop their scientific thinking. Another activity will take place in November during the Science Week, which includes a program of lectures targeted to undergraduate students and an exposition of several demonstrations

  15. Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis.

    PubMed

    Pang, Kenny P; Pang, Edward B; Win, Ma Thin Mar; Pang, Kathleen A; Woodson, B Tucker

    2016-09-01

    This study seeks to determine the success rates of the expansion sphincter pharyngoplasty and its variants on the treatment of obstructive sleep apnea (OSA). Systematic review and meta-analysis. Two independent searches of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to OSA and expansion pharyngoplasty. All relevant studies published before 31 March 2015 were included. Five studies were included in the systematic review and meta-analysis. The numbers of patients in each paper ranged from 10 to 85 (total = 155), and mean age ranged from 8 to 56 years. Substantial and consistent improvement in PSG outcomes were observed post-expansion pharyngoplasty patients, with or without multilevel surgery groups. The results showed that the expansion pharyngoplasty technique has significantly lower AHI than control group [Standardised mean difference -7.32, 95 %CI (-11.11, -3.52), p = 0.0002]; however, substantial heterogeneity between these studies were observed. The mean pre-operative AHI (in the five papers) improved from 40.0 ± 12.6 to 8.3 ± 5.2 post-operatively. The overall pro-rated pooled success rate for all the patients was 86.3 %. The expansion pharyngoplasty is effective in the management of patients with OSA. PMID:26541714

  16. Orbital Signature Analyzer (OSA): A spacecraft health/safety monitoring and analysis tool

    NASA Technical Reports Server (NTRS)

    Weaver, Steven; Degeorges, Charles; Bush, Joy; Shendock, Robert; Mandl, Daniel

    1993-01-01

    Fixed or static limit sensing is employed in control centers to ensure that spacecraft parameters remain within a nominal range. However, many critical parameters, such as power system telemetry, are time-varying and, as such, their 'nominal' range is necessarily time-varying as well. Predicted data, manual limits checking, and widened limit-checking ranges are often employed in an attempt to monitor these parameters without generating excessive limits violations. Generating predicted data and manual limits checking are both resource intensive, while broadening limit ranges for time-varying parameters is clearly inadequate to detect all but catastrophic problems. OSA provides a low-cost solution by using analytically selected data as a reference upon which to base its limits. These limits are always defined relative to the time-varying reference data, rather than as fixed upper and lower limits. In effect, OSA provides individual limits tailored to each value throughout all the data. A side benefit of using relative limits is that they automatically adjust to new reference data. In addition, OSA provides a wealth of analytical by-products in its execution.

  17. Valuation of OSA process and folic acid addition as excess sludge minimization alternatives applied in the activated sludge process.

    PubMed

    Martins, C L; Velho, V F; Ramos, S R A; Pires, A S C D; Duarte, E C N F A; Costa, R H R

    2016-01-01

    The aim of this study was to investigate the ability of the oxic-settling-anaerobic (OSA)-process and the folic acid addition applied in the activated sludge process to reduce the excess sludge production. The study was monitored during two distinct periods: activated sludge system with OSA-process, and activated sludge system with folic acid addition. The observed sludge yields (Yobs) were 0.30 and 0.08 kgTSS kg(-1) chemical oxygen demand (COD), control phase and OSA-process (period 1); 0.33 and 0.18 kgTSS kg(-1) COD, control phase and folic acid addition (period 2). The Yobs decreased by 73 and 45% in phases with the OSA-process and folic acid addition, respectively, compared with the control phases. The sludge minimization alternatives result in a decrease in excess sludge production, without negatively affecting the performance of the effluent treatment. PMID:26901714

  18. A 3-week dietary safety study of octenyl succinic anhydride (OSA)-modified starch in neonatal farm piglets.

    PubMed

    Mahadevan, Brinda; Thorsrud, Bjorn A; Brorby, Gregory P; Ferguson, Heather E

    2014-10-01

    Octenyl succinic anhydride (OSA)-modified starch functions as both an emulsifier and emulsion stabilizer in foods, and is intended for use in infant formula, follow-on formula, and formulae for special medical purposes. These formulae predominantly include extensively hydrolyzed protein or free amino acids, rather than intact protein, which otherwise would provide emulsifying functionality. The study objectives were to evaluate (1) the safety of OSA-modified starch after three weeks of administration to neonatal farm piglets, beginning 2 days after birth and (2) the impact of OSA-modified starch on piglet growth. OSA-modified starch was added to formula at concentrations of 2, 4, and 20 g/L. The vehicle control, low-dose, and mid-dose diets were supplemented with Amioca™ Powder to balance the nutritional profiles of all formulations. There were no test article-related effects of any diet containing OSA-modified starch on piglet growth and development (clinical observations, body weight, feed consumption), or clinical pathology parameters (hematology, clinical chemistry, coagulation, urinalysis). In addition, there were no adverse effects at terminal necropsy (macro- and microscopic pathology evaluations). Therefore, dietary exposure to OSA-modified starch at concentrations up to 20 g/L was well tolerated by neonatal farm piglets and did not result in adverse health effects or impact piglet growth. PMID:25019245

  19. Recognition of upper airway and surrounding structures at MRI in pediatric PCOS and OSAS

    NASA Astrophysics Data System (ADS)

    Tong, Yubing; Udupa, J. K.; Odhner, D.; Sin, Sanghun; Arens, Raanan

    2013-03-01

    Obstructive Sleep Apnea Syndrome (OSAS) is common in obese children with risk being 4.5 fold compared to normal control subjects. Polycystic Ovary Syndrome (PCOS) has recently been shown to be associated with OSAS that may further lead to significant cardiovascular and neuro-cognitive deficits. We are investigating image-based biomarkers to understand the architectural and dynamic changes in the upper airway and the surrounding hard and soft tissue structures via MRI in obese teenage children to study OSAS. At the previous SPIE conferences, we presented methods underlying Fuzzy Object Models (FOMs) for Automatic Anatomy Recognition (AAR) based on CT images of the thorax and the abdomen. The purpose of this paper is to demonstrate that the AAR approach is applicable to a different body region and image modality combination, namely in the study of upper airway structures via MRI. FOMs were built hierarchically, the smaller sub-objects forming the offspring of larger parent objects. FOMs encode the uncertainty and variability present in the form and relationships among the objects over a study population. Totally 11 basic objects (17 including composite) were modeled. Automatic recognition for the best pose of FOMs in a given image was implemented by using four methods - a one-shot method that does not require search, another three searching methods that include Fisher Linear Discriminate (FLD), a b-scale energy optimization strategy, and optimum threshold recognition method. In all, 30 multi-fold cross validation experiments based on 15 patient MRI data sets were carried out to assess the accuracy of recognition. The results indicate that the objects can be recognized with an average location error of less than 5 mm or 2-3 voxels. Then the iterative relative fuzzy connectedness (IRFC) algorithm was adopted for delineation of the target organs based on the recognized results. The delineation results showed an overall FP and TP volume fraction of 0.02 and 0.93.

  20. Brain stem activity changes associated with restored sympathetic drive following CPAP treatment in OSA subjects: a longitudinal investigation.

    PubMed

    Lundblad, Linda C; Fatouleh, Rania H; McKenzie, David K; Macefield, Vaughan G; Henderson, Luke A

    2015-08-01

    Obstructive sleep apnea (OSA) is associated with significantly elevated muscle sympathetic nerve activity (MSNA), leading to hypertension and increased cardiovascular morbidity. Although little is known about the mechanisms responsible for the sympathoexcitation, we have recently shown that the elevated MSNA in OSA is associated with altered neural processing in various brain stem sites, including the dorsolateral pons, rostral ventrolateral medulla, medullary raphe, and midbrain. Given the risk associated with elevated MSNA, we aimed to determine if treatment of OSA with continuous positive airway pressure (CPAP) would reduce the elevated MSNA and reverse the brain stem functional changes associated with the elevated MSNA. We performed concurrent recordings of MSNA and blood oxygen level-dependent (BOLD) signal intensity of the brain stem, using high-resolution functional magnetic resonance imaging, in 15 controls and 13 subjects with OSA, before and after 6 mo CPAP treatment. As expected, 6 mo of CPAP treatment significantly reduced MSNA in subjects with OSA, from 54 ± 4 to 23 ± 3 bursts/min and from 77 ± 7 to 36 ± 3 bursts/100 heart beats. Importantly, we found that MSNA-coupled changes in BOLD signal intensity within the dorsolateral pons, medullary raphe, and rostral ventrolateral medulla returned to control levels. That is, CPAP treatment completely reversed brain stem functional changes associated with elevated MSNA in untreated OSA subjects. These data highlight the effectiveness of CPAP treatment in reducing one of the most significant health issues associated with OSA, that is, elevated MSNA and its associated elevated morbidity. PMID:25995345

  1. Brain stem activity changes associated with restored sympathetic drive following CPAP treatment in OSA subjects: a longitudinal investigation

    PubMed Central

    Lundblad, Linda C.; Fatouleh, Rania H.; McKenzie, David K.; Macefield, Vaughan G.

    2015-01-01

    Obstructive sleep apnea (OSA) is associated with significantly elevated muscle sympathetic nerve activity (MSNA), leading to hypertension and increased cardiovascular morbidity. Although little is known about the mechanisms responsible for the sympathoexcitation, we have recently shown that the elevated MSNA in OSA is associated with altered neural processing in various brain stem sites, including the dorsolateral pons, rostral ventrolateral medulla, medullary raphe, and midbrain. Given the risk associated with elevated MSNA, we aimed to determine if treatment of OSA with continuous positive airway pressure (CPAP) would reduce the elevated MSNA and reverse the brain stem functional changes associated with the elevated MSNA. We performed concurrent recordings of MSNA and blood oxygen level-dependent (BOLD) signal intensity of the brain stem, using high-resolution functional magnetic resonance imaging, in 15 controls and 13 subjects with OSA, before and after 6 mo CPAP treatment. As expected, 6 mo of CPAP treatment significantly reduced MSNA in subjects with OSA, from 54 ± 4 to 23 ± 3 bursts/min and from 77 ± 7 to 36 ± 3 bursts/100 heart beats. Importantly, we found that MSNA-coupled changes in BOLD signal intensity within the dorsolateral pons, medullary raphe, and rostral ventrolateral medulla returned to control levels. That is, CPAP treatment completely reversed brain stem functional changes associated with elevated MSNA in untreated OSA subjects. These data highlight the effectiveness of CPAP treatment in reducing one of the most significant health issues associated with OSA, that is, elevated MSNA and its associated elevated morbidity. PMID:25995345

  2. Characterization of Antibiotic-Loaded Alginate-Osa Starch Microbeads Produced by Ionotropic Pregelation

    PubMed Central

    Fontes, Gizele Cardoso; Calado, Verônica Maria Araújo; Rossi, Alexandre Malta; da Rocha-Leão, Maria Helena Miguez

    2013-01-01

    The aim of this study was to characterize the penicillin-loaded microbeads composed of alginate and octenyl succinic anhydride (OSA) starch prepared by ionotropic pregelation with calcium chloride and to evaluate their in vitro drug delivery profile. The beads were characterized by size, scanning electron microscopy (SEM), zeta potential, swelling behavior, and degree of erosion. Also, the possible interaction between penicillin and biopolymers was investigated by differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), and Fourier transform infrared (FTIR) analysis. The SEM micrograph results indicated a homogeneous drug distribution in the matrix. Also, based on thermal analyses (TGA/DSC), interactions were detected between microbead components. Although FTIR spectra of penicillin-loaded microbeads did not reveal the formation of new chemical entities, they confirmed the chemical drug stability. XRD patterns showed that the incorporated crystalline structure of penicillin did not significantly alter the primarily amorphous polymeric network. In addition, the results confirmed a prolonged penicillin delivery system profile. These results imply that alginate and OSA starch beads can be used as a suitable controlled-release carrier for penicillin. PMID:23862146

  3. Liver Steatosis and Fibrosis in OSA patients After Long-term CPAP Treatment: A Preliminary Ultrasound Study.

    PubMed

    Buttacavoli, Maria; Gruttad'Auria, Claudia I; Olivo, Mirko; Virdone, Roberto; Castrogiovanni, Alessandra; Mazzuca, Emilia; Marotta, Anna Maria; Marrone, Oreste; Madonia, Salvatore; Bonsignore, Maria R

    2016-01-01

    In cases of morbid obesity, obstructive sleep apnea (OSA) was associated with biopsy-proven liver damage. The role of non-invasive techniques to monitor liver changes during OSA treatment with continuous positive airway pressure (CPAP) is unknown. We used non-invasive ultrasound techniques to assess liver steatosis and fibrosis in severe OSA patients at diagnosis and during long-term CPAP treatment. Fifteen consecutive patients with severe OSA (apnea hypopnea index 52.5 ± 19.1/h) were studied by liver ultrasound and elastography (Fibroscan) at 6-mo (n = 3) or 1-y (n = 12) follow-up. Mean age was 49.3 ± 11.9 y, body mass index (BMI) was 35.4 ± 6.4 kg/m(2). Adherence to CPAP was ≥5 h/night. At baseline, most patients had severe liver steatosis independent of BMI; at follow-up, liver steatosis was not statistically different, but a relationship between severity of steatosis and BMI became apparent (Spearman's rho: 0.53, p = 0.03). Significant fibrosis as assessed by Fibroscan was absent at diagnosis or follow-up (failure or unreliable measurements in four markedly obese patients). Therefore, ultrasound liver assessment is feasible in most OSA patients, and CPAP treatment may positively affect liver steatosis. PMID:26385053

  4. Oryza sativa H+-ATPase (OSA) is Involved in the Regulation of Dumbbell-Shaped Guard Cells of Rice.

    PubMed

    Toda, Yosuke; Wang, Yin; Takahashi, Akira; Kawai, Yuya; Tada, Yasuomi; Yamaji, Naoki; Feng Ma, Jian; Ashikari, Motoyuki; Kinoshita, Toshinori

    2016-06-01

    The stomatal apparatus consists of a pair of guard cells and regulates gas exchange between the leaf and atmosphere. In guard cells, blue light (BL) activates H(+)-ATPase in the plasma membrane through the phosphorylation of its penultimate threonine, mediating stomatal opening. Although this regulation is thought to be widely adopted among kidney-shaped guard cells in dicots, the molecular basis underlying that of dumbbell-shaped guard cells in monocots remains unclear. Here, we show that H(+)-ATPases are involved in the regulation of dumbbell-shaped guard cells. Stomatal opening of rice was promoted by the H(+)-ATPase activator fusicoccin and by BL, and the latter was suppressed by the H(+)-ATPase inhibitor vanadate. Using H(+)-ATPase antibodies, we showed the presence of phosphoregulation of the penultimate threonine in Oryza sativa H(+)-ATPases (OSAs) and localization of OSAs in the plasma membrane of guard cells. Interestingly, we identified one H(+)-ATPase isoform, OSA7, that is preferentially expressed among the OSA genes in guard cells, and found that loss of function of OSA7 resulted in partial insensitivity to BL. We conclude that H(+)-ATPase is involved in BL-induced stomatal opening of dumbbell-shaped guard cells in monocotyledon species. PMID:27048369

  5. Measurement properties of patient-reported outcome measures (PROMs) in adults with obstructive sleep apnea (OSA): A systematic review.

    PubMed

    Abma, Inger L; van der Wees, Philip J; Veer, Vik; Westert, Gert P; Rovers, Maroeska

    2016-08-01

    This systematic review summarizes the evidence regarding the quality of patient-reported outcome measures (PROMs) validated in patients with obstructive sleep apnea (OSA). We performed a systematic literature search of all PROMs validated in patients with OSA, and found 22 measures meeting our inclusion criteria. The quality of the studies was assessed using the consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist. The results showed that most of the measurement properties of the PROMs were not, or not adequately, assessed. For many identified PROMs there was no involvement of patients with OSA during their development or before the PROM was tested in patients with OSA. Positive exceptions and the best current candidates for assessing health status in patients with OSA are the sleep apnea quality of life index (SAQLI), Maugeri obstructive sleep apnea syndrome (MOSAS) questionnaire, Quebec sleep questionnaire (QSQ) and the obstructive sleep apnea patient-oriented severity index (OSAPOSI). Even though there is not enough evidence to fully judge the quality of these PROMs as outcome measure, when interpreted with caution, they have the potential to add value to clinical research and clinical practice in evaluating aspects of health status that are important to patients. PMID:26433776

  6. Oryza sativa H+-ATPase (OSA) is Involved in the Regulation of Dumbbell-Shaped Guard Cells of Rice

    PubMed Central

    Toda, Yosuke; Wang, Yin; Takahashi, Akira; Kawai, Yuya; Tada, Yasuomi; Yamaji, Naoki; Feng Ma, Jian; Ashikari, Motoyuki; Kinoshita, Toshinori

    2016-01-01

    The stomatal apparatus consists of a pair of guard cells and regulates gas exchange between the leaf and atmosphere. In guard cells, blue light (BL) activates H+-ATPase in the plasma membrane through the phosphorylation of its penultimate threonine, mediating stomatal opening. Although this regulation is thought to be widely adopted among kidney-shaped guard cells in dicots, the molecular basis underlying that of dumbbell-shaped guard cells in monocots remains unclear. Here, we show that H+-ATPases are involved in the regulation of dumbbell-shaped guard cells. Stomatal opening of rice was promoted by the H+-ATPase activator fusicoccin and by BL, and the latter was suppressed by the H+-ATPase inhibitor vanadate. Using H+-ATPase antibodies, we showed the presence of phosphoregulation of the penultimate threonine in Oryza sativa H+-ATPases (OSAs) and localization of OSAs in the plasma membrane of guard cells. Interestingly, we identified one H+-ATPase isoform, OSA7, that is preferentially expressed among the OSA genes in guard cells, and found that loss of function of OSA7 resulted in partial insensitivity to BL. We conclude that H+-ATPase is involved in BL-induced stomatal opening of dumbbell-shaped guard cells in monocotyledon species. PMID:27048369

  7. The Osa-containing SWI/SNF chromatin-remodeling complex regulates stem cell commitment in the adult Drosophila intestine

    PubMed Central

    Zeng, Xiankun; Lin, Xinhua; Hou, Steven X.

    2013-01-01

    The proportion of stem cells versus differentiated progeny is well balanced to maintain tissue homeostasis, which in turn depends on the balance of the different signaling pathways involved in stem cell self-renewal versus lineage-specific differentiation. In a screen for genes that regulate cell lineage determination in the posterior midgut, we identified that the Osa-containing SWI/SNF (Brahma) chromatin-remodeling complex regulates Drosophila midgut homeostasis. Mutations in subunits of the Osa-containing complex result in intestinal stem cell (ISC) expansion as well as enteroendocrine (EE) cell reduction. We further demonstrated that Osa regulates ISC self-renewal and differentiation into enterocytes by elaborating Notch signaling, and ISC commitment to differentiation into EE cells by regulating the expression of Asense, an EE cell fate determinant. Our data uncover a unique mechanism whereby the commitment of stem cells to discrete lineages is coordinately regulated by chromatin-remodeling factors. PMID:23942514

  8. Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)

    PubMed Central

    Batool-Anwar, Salma; Goodwin, James L.; Drescher, Amy A.; Baldwin, Carol M.; Simon, Richard D.; Smith, Terry W.; Quan, Stuart F.

    2014-01-01

    Study Objectives: Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Methods: Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Results: Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m2, and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. Conclusion

  9. Promoter methylation regulates the abundance of osa-miR393a in contrasting rice genotypes under salinity stress.

    PubMed

    Ganie, Showkat Ahmad; Dey, Narottam; Mondal, Tapan Kumar

    2016-01-01

    MicroRNAs (miRNAs) are important molecules that regulate gene expression under salinity stress. Despite their evolutionary conservation, these regulatory elements have been shown to behave differently in different plant species under a particular environmental stress. In this study, we investigated the behavior of salt responsive osa-miR393a and its target gene (TIR1, LOC_Os05g05800) in salt-tolerant (FL478) and salt-sensitive (IR29) rice genotypes. It was found that the mature and precursor sequences of osa-miR393a as well as its cleavage site in TIR1 were conserved among salt tolerant and sensitive genotypes. Promoters of different salt-responsive miRNAs were also found to be less variable between salt-tolerant and salt-susceptible genotypes. Analysis of gene expression, promoter methylation, and cis-element abundance showed that osa-miR393a behaves differently in FL478 and IR29. Salt stress altered the expression pattern of osa-miR393a-TIR1 module in a time-dependent manner in the roots and shoots of two genotypes. Promoter methylation of this regulatory module was also altered at different time points under salt stress. Expression analysis in two genotypes indicated the overall down-regulation of osa-miR393a and up-regulation of TIR1 in FL478 and their reciprocal regulation in IR29. The expression results were complemented by the differential promoter methylation and cis-element abundance of this regulatory module. Together, the results of transcript abundance and promoter methylation of osa-miR393a-TIR1 module signified the association between these two processes which is reported for the first time in plants to the best of our knowledge. PMID:26319531

  10. Landscape-Scale Controls on Aboveground Forest Carbon Stocks on the Osa Peninsula, Costa Rica

    PubMed Central

    Taylor, Philip; Asner, Gregory; Dahlin, Kyla; Anderson, Christopher; Knapp, David; Martin, Roberta; Mascaro, Joseph; Chazdon, Robin; Cole, Rebecca; Wanek, Wolfgang; Hofhansl, Florian; Malavassi, Edgar; Vilchez-Alvarado, Braulio; Townsend, Alan

    2015-01-01

    Tropical forests store large amounts of carbon in tree biomass, although the environmental controls on forest carbon stocks remain poorly resolved. Emerging airborne remote sensing techniques offer a powerful approach to understand how aboveground carbon density (ACD) varies across tropical landscapes. In this study, we evaluate the accuracy of the Carnegie Airborne Observatory (CAO) Light Detection and Ranging (LiDAR) system to detect top-of-canopy tree height (TCH) and ACD across the Osa Peninsula, Costa Rica. LiDAR and field-estimated TCH and ACD were highly correlated across a wide range of forest ages and types. Top-of-canopy height (TCH) reached 67 m, and ACD surpassed 225 Mg C ha-1, indicating both that airborne CAO LiDAR-based estimates of ACD are accurate in tall, high-biomass forests and that the Osa Peninsula harbors some of the most carbon-rich forests in the Neotropics. We also examined the relative influence of lithologic, topoedaphic and climatic factors on regional patterns in ACD, which are known to influence ACD by regulating forest productivity and turnover. Analyses revealed a spatially nested set of factors controlling ACD patterns, with geologic variation explaining up to 16% of the mapped ACD variation at the regional scale, while local variation in topographic slope explained an additional 18%. Lithologic and topoedaphic factors also explained more ACD variation at 30-m than at 100-m spatial resolution, suggesting that environmental filtering depends on the spatial scale of terrain variation. Our result indicate that patterns in ACD are partially controlled by spatial variation in geologic history and geomorphic processes underpinning topographic diversity across landscapes. ACD also exhibited spatial autocorrelation, which may reflect biological processes that influence ACD, such as the assembly of species or phenotypes across the landscape, but additional research is needed to resolve how abiotic and biotic factors contribute to ACD

  11. Landscape-Scale Controls on Aboveground Forest Carbon Stocks on the Osa Peninsula, Costa Rica.

    PubMed

    Taylor, Philip; Asner, Gregory; Dahlin, Kyla; Anderson, Christopher; Knapp, David; Martin, Roberta; Mascaro, Joseph; Chazdon, Robin; Cole, Rebecca; Wanek, Wolfgang; Hofhansl, Florian; Malavassi, Edgar; Vilchez-Alvarado, Braulio; Townsend, Alan

    2015-01-01

    Tropical forests store large amounts of carbon in tree biomass, although the environmental controls on forest carbon stocks remain poorly resolved. Emerging airborne remote sensing techniques offer a powerful approach to understand how aboveground carbon density (ACD) varies across tropical landscapes. In this study, we evaluate the accuracy of the Carnegie Airborne Observatory (CAO) Light Detection and Ranging (LiDAR) system to detect top-of-canopy tree height (TCH) and ACD across the Osa Peninsula, Costa Rica. LiDAR and field-estimated TCH and ACD were highly correlated across a wide range of forest ages and types. Top-of-canopy height (TCH) reached 67 m, and ACD surpassed 225 Mg C ha-1, indicating both that airborne CAO LiDAR-based estimates of ACD are accurate in tall, high-biomass forests and that the Osa Peninsula harbors some of the most carbon-rich forests in the Neotropics. We also examined the relative influence of lithologic, topoedaphic and climatic factors on regional patterns in ACD, which are known to influence ACD by regulating forest productivity and turnover. Analyses revealed a spatially nested set of factors controlling ACD patterns, with geologic variation explaining up to 16% of the mapped ACD variation at the regional scale, while local variation in topographic slope explained an additional 18%. Lithologic and topoedaphic factors also explained more ACD variation at 30-m than at 100-m spatial resolution, suggesting that environmental filtering depends on the spatial scale of terrain variation. Our result indicate that patterns in ACD are partially controlled by spatial variation in geologic history and geomorphic processes underpinning topographic diversity across landscapes. ACD also exhibited spatial autocorrelation, which may reflect biological processes that influence ACD, such as the assembly of species or phenotypes across the landscape, but additional research is needed to resolve how abiotic and biotic factors contribute to ACD

  12. Improved stability and controlled release of CLA with spray-dried microcapsules of OSA-modified starch and xanthan gum.

    PubMed

    He, Huizi; Hong, Yan; Gu, Zhengbiao; Liu, Guodong; Cheng, Li; Li, Zhaofeng

    2016-08-20

    The objective of this investigation was to improve the stability of CLA and to allow for its controlled release by encapsulating it with combinations of octenyl-succinic anhydride (OSA) starch and xanthan gum (XG) in three ratios (OSA/XG: 60/1, 80/1, and 100/1, w/w). The wall material was examined using FTIR and TGA. The microcapsules were characterized by laser particle size analysis (LPS) and SEM. Oxidation of the microcapsules was monitored by headspace method. The results revealed that microcapsules created with an OSA/XG ratio of 60/1 provided superior protection to CLA against oxidation. When CLA-microcapsules were subjected to conditions simulating those in the human gastrointestinal system, 12.1%-50.1% of the CLA was released. CLA encapsulation in spray-dried microcapsules of OSA/XG appears to be an effective technique that provides good protection against oxidation and could be useful in the targeted delivery of functional lipids or other bioactive components to the small intestine. PMID:27178930

  13. Phenolic compounds of 'Galega Vulgar' and 'Cobrançosa' olive oils along early ripening stages.

    PubMed

    Peres, Fátima; Martins, Luisa L; Mourato, Miguel; Vitorino, Conceição; Antunes, Paulo; Ferreira-Dias, Suzana

    2016-11-15

    In this study, the lipophilic and hydrophilic phenol composition of virgin olive oils (VOO) obtained from olives from two of the most important Portuguese cultivars ('Galega Vulgar' and 'Cobrançosa'), harvested at different ripening stages and under two irrigation schemes (rain fed and irrigated), was evaluated. Phenolic alcohols (hydroxytyrosol and tyrosol), phenolic acids and derivatives and flavonoids (luteolin and apigenin), as well as tocopherols were quantified. Lipophilic (>300mgkg(-1)) and hydrophilic phenols (>600mgkg(-1)) were present in high contents in both VOO, for early ripening stages. Gamma-tocopherol content is higher in 'Galega Vulgar' VOO. Total phenols showed a decrease between ripening index 2.5 and 3.5. The dialdehydic form of elenolic acid linked to hydroxytyrosol (3,4-DHPEA-EDA), also known as oleacein, was the major phenolic compound identified in both oils. The concentration of free hydroxytyrosol and tyrosol in both VOO is very low while their esterified derivatives, like 3,4-DHPEA-EDA and p-HPEA-EDA, are much more abundant. PMID:27283606

  14. Topographic Distributions of Emergent Trees in Tropical Forests of the Osa Peninsula, Costa Rica

    NASA Astrophysics Data System (ADS)

    Balzotti, C.; Asner, G. P.; Taylor, P.; Cole, R. J.; Osborne, B. B.; Cleveland, C. C.; Porder, S.; Townsend, A. R.

    2015-12-01

    Tropical rainforests are reservoirs of terrestrial carbon and biodiversity. Large and often emergent trees store disproportionately large amounts of aboveground carbon and greatly influence the structure and functioning of tropical rainforests. Despite their importance, controls on the abundance and distribution of emergent trees are largely unknown across tropical landscapes. Conventional field approaches are limited in their ability to characterize patterns in emergent trees across vast landscapes with varying environmental conditions and floristic composition. Here we used a high-resolution light detection and ranging (LiDAR) sensor, aboard the Carnegie Airborne Observatory Airborne Taxonomic Mapping System (CAO-AToMS), to examine the abundance and distribution of tall emergent tree canopies (ETC) relative to surrounding tree canopies (STC), across the Osa Peninsula, a geologically and topographically diverse region of Costa Rica. The abundance of ETC was clearly influenced by fine-scale topographic variation, with distribution patterns that held across a variety of geologic substrates. Specifically, the density of ETC was much greater on lower slopes and in valleys, compared to upper slopes and ridges. Furthermore, using the CAO high-fidelity imaging spectrometer, ETC had a different spectral signature than that of the STC. Most notably, ETC had lower foliar N than STC, which was verified with an independent field survey of canopy leaf chemistry. The underlying mechanisms to explain the topographic-dependence of ETCs and linkages to canopy N are unknown, and remain an important area of research.

  15. Program for catenary-pantograph analysis, PrOSA statement of methods and validation according EN 50318

    NASA Astrophysics Data System (ADS)

    Finner, Lars; Poetsch, Gero; Sarnes, Bernhard; Kolbe, Michael

    2015-03-01

    DB Systemtechnik is a high-performing, customer-driven service provider that, as well as authoritatively serving the Deutsche Bahn Group by dint of its specialist knowledge is also increasingly active on the global railway market. Development and testing of pantograph models and catenary systems have been part of the company's essential activity fields from the beginning. Therefore, an efficient and high-performing simulation tool is indispensable. That is why DB Systemtechnik spent high efforts to develop the program PrOSA in cooperation with the Heinz-Nixdorf-Institut (HNI) of the university Paderborn to simulate the interaction of pantograph and catenary. This article gives an overview of the most relevant properties of PrOSA. Furthermore, it is described how the benchmark requirements were implemented and processed.

  16. Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study

    PubMed Central

    Crawford-Achour, Emilie; Dauphinot, Virginie; Saint Martin, Magali; Tardy, Magali; Gonthier, Régis; Barthelemy, Jean Claude; Roche, Frédéric

    2015-01-01

    Objective: Obstructive sleep apnea syndrome (OSA) leads to a deterioration in cognitive functions, with regard to memory and executive functions. However, few studies have investigated the impact of treatment on these cognitive functions in elderly subjects. Methods: The study was conducted in a large cohort of subjects aged 65 years or older (the PROOF cohort). Subjects were not diagnosed or treated for OSA. Subjects underwent a polygraphic recording. Cognitive performance was assessed in all OSA subjects at baseline and 10 years later, whether or not they were receiving continuous positive airway pressure (CPAP) therapy. Results: A group of 126 patients were analyzed. Only 26% of them were treated, with therapy initiated at the discretion of the primary care physician. Among treated subjects, self-reported compliance with therapy was good (> 6 h/night on average), and 66% of them reported an improvement in their quality of life. Patients receiving CPAP treatment had a higher apneahypopnea index (p = 0.006), a higher oxygen desaturation index (p < 0.001), and experienced more pronounced daytime repercussions (p = 0.004). These patients showed a statistically significant improvement in mental agility (similarities test; p < 0.0001) and memory performance (Grober and Buschke delayed free recall; p = 0.02). Conclusion: CPAP treatment is associated with the maintenance of memory performance over time. Citation: Crawford-Achour E, Dauphinot V, Saint Martin M, Tardy M, Gonthier R, Barthelemy JC, Roche F. Protective effect of long-term CPAP therapy on cognitive performance in elderly patients with severe OSA: the PROOF study. J Clin Sleep Med 2015;11(5):519–524. PMID:25700873

  17. Breath-by-breath detection of apneic events for OSA severity estimation using non-contact audio recordings.

    PubMed

    Rosenwein, T; Dafna, E; Tarasiuk, A; Zigel, Y

    2015-08-01

    Obstructive sleep apnea (OSA) is a prevalent sleep disorder, characterized by recurrent episodes of upper airway obstructions during sleep. We hypothesize that breath-by-breath audio analysis of the respiratory cycle (i.e., inspiration and expiration phases) during sleep can reliably estimate the apnea hypopnea index (AHI), a measure of OSA severity. The AHI is calculated as the average number of apnea (A)/hypopnea (H) events per hour of sleep. Audio signals recordings of 186 adults referred to OSA diagnosis were acquired in-laboratory and at-home conditions during polysomnography and WatchPat study, respectively. A/H events were automatically segmented and classified using a binary random forest classifier. Total accuracy rate of 86.3% and an agreement of κ=42.98% were achieved in A/H event detection. Correlation of r=0.87 (r=0.74), diagnostic agreement of 76% (81.7%), and average absolute difference AHI error of 7.4 (7.8) (events/hour) were achieved in in-laboratory (at-home) conditions, respectively. Here we provide evidence that A/H events can be reliably detected at their exact time locations during sleep using non-contact audio approach. This study highlights the potential of this approach to reliably evaluate AHI in at home conditions. PMID:26738073

  18. Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis.

    PubMed

    Riaz, Muhammad; Certal, Victor; Nigam, Gaurav; Abdullatif, Jose; Zaghi, Soroush; Kushida, Clete A; Camacho, Macario

    2015-01-01

    Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was -14.78 events/hr [95% CI -19.12, -10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD -2.5 [95% CI -3.2, -1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent). PMID:26798519

  19. Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

    PubMed Central

    Riaz, Muhammad; Certal, Victor; Nigam, Gaurav; Abdullatif, Jose; Zaghi, Soroush; Kushida, Clete A.; Camacho, Macario

    2015-01-01

    Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent). PMID:26798519

  20. Automatic anatomy recognition in post-tonsillectomy MR images of obese children with OSAS

    NASA Astrophysics Data System (ADS)

    Tong, Yubing; Udupa, Jayaram K.; Odhner, Dewey; Sin, Sanghun; Arens, Raanan

    2015-03-01

    Automatic Anatomy Recognition (AAR) is a recently developed approach for the automatic whole body wide organ segmentation. We previously tested that methodology on image cases with some pathology where the organs were not distorted significantly. In this paper, we present an advancement of AAR to handle organs which may have been modified or resected by surgical intervention. We focus on MRI of the neck in pediatric Obstructive Sleep Apnea Syndrome (OSAS). The proposed method consists of an AAR step followed by support vector machine techniques to detect the presence/absence of organs. The AAR step employs a hierarchical organization of the organs for model building. For each organ, a fuzzy model over a population is built. The model of the body region is then described in terms of the fuzzy models and a host of other descriptors which include parent to offspring relationship estimated over the population. Organs are recognized following the organ hierarchy by using an optimal threshold based search. The SVM step subsequently checks for evidence of the presence of organs. Experimental results show that AAR techniques can be combined with machine learning strategies within the AAR recognition framework for good performance in recognizing missing organs, in our case missing tonsils in post-tonsillectomy images as well as in simulating tonsillectomy images. The previous recognition performance is maintained achieving an organ localization accuracy of within 1 voxel when the organ is actually not removed. To our knowledge, no methods have been reported to date for handling significantly deformed or missing organs, especially in neck MRI.

  1. Fatigue, Tiredness, and Lack of Energy Improve with Treatment for OSA

    PubMed Central

    Chotinaiwattarakul, Wattanachai; O'Brien, Louise M.; Fan, Ludi; Chervin, Ronald D.

    2009-01-01

    Objectives: Many patients with obstructive sleep apnea complain of fatigue, tiredness, or lack of energy in addition to sleepiness, or instead of sleepiness. We explored whether self-defined fatigue, tiredness, and lack of energy improve, like sleepiness, after treatment with positive airway pressure (PAP). Methods: We conducted a prospective survey of adults referred to a University-based sleep disorders center and confirmed to have obstructive sleep apnea on polysomnography. Surveys were mailed to 1539 patients 6 months to 3 years after they were prescribed PAP for home use. Results: Participants (n = 313) included 183 who reported using PAP ≥ 5 hours per night, 96 who were considered inadequately treated because they had no active treatment or used PAP < 5 hours per night, and 34 treated by surgery or other means and therefore excluded from subsequent analysis. At follow-up in comparison to baseline, subjects adherent to PAP reported less fatigue, tiredness, lack of energy, and sleepiness (p < 0.05 for each). Improvement of each symptom except for lack of energy was significantly better (p < 0.05) among PAP-adherent subjects than among inadequately treated subjects. Conclusions: Patients' complaints of fatigue, tiredness, and lack of energy, like sleepiness, can improve substantially with good adherence to PAP for obstructive sleep apnea. Therefore, patients who prefer a range of common, related terms other than sleepiness to describe their problem may benefit from investigation and treatment for any underlying sleep-disordered breathing. Citation: Chotinaiwattarakul W; O'Brien LM; Fan L; Chervin RD. Fatigue, tiredness, and lack of energy improve with treatment for OSA. J Clin Sleep Med 2009;5(3):240-245. PMID:19960642

  2. Identification of impact damage in sandwich structures by application of high speed MEMS-OSA to FBG sensors

    NASA Astrophysics Data System (ADS)

    Okabe, Y.; Minakuchi, S.; Takeda, N.

    2005-05-01

    In this research, the authors developed various detection techniques for particular damages, such as debonding and impact damage, in sandwich panels consisting of composite face-sheets and aluminum honeycomb core with small-diameter optical fiber sensors. First, two methods for debonding detection were established taking advantage of the behavior of fillets formed on the adhesive layer between the core and the skin. One method uses the fracture of optical fibers, and the other one uses the shape recovery of the reflection spectrum from a fiber Bragg grating (FBG) sensor because of the release of thermal residual stress in the fillets. Secondly, as for impact damages, chirped FBG sensors were applied to monitor the change in strain distribution of the face-sheet due to the dent caused by the impact loadings. Furthermore, a newly developed MEMS-optical spectrum analyzer (MEMS-OSA) was introduced to identification of impact points and damages. This system could measure the reflection spectrum at very high speed. The change in the form of the reflection spectrum during the impact loading was found to be different depending on the impact energy and the impact location, and this tendency was confirmed by theoretical simulations using the change in the strain distribution obtained by foil strain gauges. These results show that the high speed measurement of the reflection spectrum by MEMS-OSA has a potential to identify the impact location and damage magnitude through the comparison with theoretical simulations.

  3. Underwater topography determines critical breeding habitat for humpback whales near Osa Peninsula, Costa Rica: implications for marine protected areas.

    PubMed

    Oviedo, L; Solís, M

    2008-06-01

    Migrating humpback whales from northern and southern feeding grounds come to the tropical waters near Osa Peninsula, Pacific of Costa Rica, to reproduce and raise their calves. Planning effective marine protected areas that encompass humpback critical habitats require data about which oceanographic features influence distribution during the breeding period. This study examines the relationship between water depth and ocean floor slope with humpback whale distribution, based on sightings during two breeding seasons (2005 and 2006). Data are from the Southern and Northern subpopulations in the Eastern Tropical Pacific (ETP). Analysis followed the basic principles of the Ecological Niche Factors Analysis (ENFA), where indices of Marginality and Tolerance provide insights on the restrictiveness of habitat use. At a fine scale, physical factors such as water depth and slope define the critical breeding and nursing habitat for M. novaeangliae. Divergence in the subsamples means of depths and slope distribution, with the global mean of the study area in both eco-geographical variables, determine habitat requirements restricted by topographic features such as depths (< 100 m) and slope (< 10%), and locate the key breeding and nursing habitat of the species within the continental shelf domains. Proposed Marine Protected Areas (MPA's) network plans should consider connectivity of Cafio Island-Drake Bay and the extension of Corcovado National Park maritime borders. PMID:19256430

  4. Scarlet Macaw (Ara macao, Psittaciformes: Psittacidae) nest characteristics in the Osa Peninsula Conservation Area (ACOSA), Costa Rica.

    PubMed

    Guittar, John L; Dear, Fiona; Vaughan, Christopher

    2009-01-01

    The Scarlet Macaw (Ara macao) is an endangered species. In Costa Rica, the Scarlet Macaw population of the Central Pacific Conservation Area (ACOPAC, n =432 individuals) has undergone considdrable study and has been used effectively as a flagship species for regional conservation. Costa Rica's only other viable Scarlet Macaw population, located in the Osa Peninsula Conservation Area (ACOSA, n=800-1200 individuals), remains virtually unstudied. We studied ACOSA Scarlet Macaw nest cavities from February 19th to March 22nd 2006. Through informal interviews with park guards and residents, we found a total of 57 potential nests in 52 trees. Eleven nests were reported as frequently poached. Scarlet Macaws used 14 identified tree species, ten of which are unrecorded in Costa Rica. The most common nesting trees were Caryocar costaricense (n=12, 24%), Schizolobium parahyba (n=9, 18.0%), Ceibapentandra (n=7, 14.0%) and Ficus sp. (n=5, 10.0%). We compare nesting characteristics to those recorded in ACOPAC. A combination of bottom-up and top-down strategies are necessary to ensure the Scarlet Macaw's long-term success, including environmental education in local schools, community stewardship of active nests, and the advertisement of stricter penalties for poaching. PMID:19637716

  5. Rice microRNA osa-miR1848 targets the obtusifoliol 14α-demethylase gene OsCYP51G3 and mediates the biosynthesis of phytosterols and brassinosteroids during development and in response to stress.

    PubMed

    Xia, Kuaifei; Ou, Xiaojing; Tang, Huadan; Wang, Ren; Wu, Ping; Jia, Yongxia; Wei, Xiaoyi; Xu, Xinlan; Kang, Seung-Hye; Kim, Seong-Ki; Zhang, Mingyong

    2015-11-01

    Phytosterols are membrane components or precursors for brassinosteroid (BR) biosynthesis. As they cannot be transported long distances, their homeostasis is tightly controlled through their biosynthesis and metabolism. However, it is unknown whether microRNAs are involved in their homeostatic regulation. Rice (Oryza sativa) plants transformed with microRNA osa-miR1848 and its target, the obtusifoliol 14α-demethylase gene, OsCYP51G3, were used to investigate the role of osa-miR1848 in the regulation of phytosterol biosynthesis. osa-miR1848 directs OsCYP51G3 mRNA cleavage to regulate phytosterol and BR biosynthesis in rice. The role of OsCYP51G3 as one of the osa-miR1848 targets is supported by the opposite expression patterns of osa-miR1848 and OsCYP51G3 in transgenic rice plants, and by the identification of OsCYP51G3 mRNA cleavage sites. Increased osa-miR1848 and decreased OsCYP51G3 expression reduced phytosterol and BR concentrations, and caused typical phenotypic changes related to phytosterol and BR deficiency, including dwarf plants, erect leaves, semi-sterile pollen grains, and shorter cells. Circadian expression of osa-miR1848 regulated the diurnal abundance of OsCYP51G3 transcript in developing organs, and the response of OsCYP51G3 to salt stress. We propose that osa-miR1848 regulates OsCYP51G3 expression posttranscriptionally, and mediates phytosterol and BR biosynthesis. osa-miR1848 and OsCYP51G3 might have potential applications in rice breeding to modulate leaf angle, and the size and quality of seeds. PMID:26083975

  6. Upper Plate Deformation in Response to Aseismic Ridge Subduction along a Convergent Margin - the Piano Player Model: Osa Peninsula, Costa Rica

    NASA Astrophysics Data System (ADS)

    Gardner, T. W.; Fisher, D. M.; Morell, K. D.; Cupper, M. L.

    2008-12-01

    The Osa Peninsula, an outer forearc high ~20 km inboard of the Middle America Trench, is deforming in response to short wavelength variations in the bathymetry on the subducting aseismic Cocos Ridge, an elongate region of thickened crust ( up to 40% thicker) created by motion of the Cocos plate across the Galapagos Hotspot. Plate convergence is nearly orthogonal to the trench at ~90 mm/yr and the plate interface occurs at a depth ~5 km under the peninsula. Relief on the Cocos Ridge locally exceeds 1 km with the dominant topography expressed as two nearly parallel, but locally offset ridges separated by an axial graben. The strike of these features is sub-parallel to the convergence vector. Modern topography of the Osa Peninsula, elevation of the basement rocks (Early to Middle Tertiary Osa Mélange), elevations of late Quaternary marine deposits, and distribution of late Quaternary deformation rates directly mirror the bathymetry on the Cocos Ridge just outboard of the MAT. New geologic mapping, radiometric dating and fission track analysis constrain distribution and rates of deformation on the Osa Peninsula. The Osa Peninsula is fragmented into a complex set of blocks that vary in size from several kms on a side to <10 kms on a side. These blocks, which closely match the size, distribution and shape of bathymetric features on the incoming Cocos Ridge, are bounded by trench parallel and trench perpendicular, high angle, normal and reverse faults that extend to the plate interface, allowing for grossly different deformation histories over short distances. Fission track analyses of 4 sandstone samples from the Osa Mélange suggest that the basement rocks reached maximum burial temperatures of 60-80 ° C indicating burial depths of ~3-4 kms assuming a reasonable geothermal gradient of ~20 °/km. This suggests a very thin margin wedge prior to late Neogene unroofing. Rates of late Quaternary deformation are constrained by over 30 radiocarbon and 5 Optically Stimulated

  7. Olive Volatiles from Portuguese Cultivars Cobrançosa, Madural and Verdeal Transmontana: Role in Oviposition Preference of Bactrocera oleae (Rossi) (Diptera: Tephritidae).

    PubMed

    Malheiro, Ricardo; Casal, Susana; Cunha, Sara C; Baptista, Paula; Pereira, José Alberto

    2015-01-01

    The olive fly, Bactrocera oleae (Rossi), a serious threat to the olive crop worldwide, displays ovipositon preference for some olive cultivars but the causes are still unclear. In the present work, three Portuguese olive cultivars with different susceptibilities to olive fly (Cobrançosa, Madural, and Verdeal Transmontana) were studied, aiming to determine if the olive volatiles are implicated in this interaction. Olive volatiles were assessed by SPME-GC-MS in the three cultivars during maturation process to observe possible correlations with olive fly infestation levels. Overall, 34 volatiles were identified in the olives, from 7 chemical classes (alcohols, aldehydes, aromatic hydrocarbons, esters, ketones, sesquiterpenes, and terpenes). Generally, total volatile amounts decrease during maturation but toluene, the main compound, increased in all cultivars, particularly in those with higher susceptibility to olive fly. Sesquiterpenes also raised, mainly α-copaene. Toluene and α-copaene, recognized oviposition promoters to olive fly, were correlated with the infestation level of cvs. Madural and Verdeal Trasnmontana (intermediate and highly susceptible cultivars respectively), while no correlations were established with cv. Cobrançosa (less susceptible). No volatiles with inverse correlation were observed. Volatile composition of olives may be a decisive factor in the olive fly choice to oviposit and this could be the basis for the development of new control strategies for this pest. PMID:25985460

  8. The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients' Satisfaction, and Outcome in a Large Health Provider System

    PubMed Central

    Etzioni, Tamar; Fliss, Dan; Pillar, Giora; Shapira, Chen

    2014-01-01

    During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomnography (PSG) to home studies for the diagnosis of obstructive sleep apnea (OSA). We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients' satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs) and 2010 and 2011 (when most studies were ambulatory). Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P < 0.05). 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients' satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0–10; P = 0.11). Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients' satisfaction remained similarly high. The total direct cost of OSA management was reduced. PMID:24876974

  9. Olive Volatiles from Portuguese Cultivars Cobrançosa, Madural and Verdeal Transmontana: Role in Oviposition Preference of Bactrocera oleae (Rossi) (Diptera: Tephritidae)

    PubMed Central

    Malheiro, Ricardo; Casal, Susana; Cunha, Sara C.; Baptista, Paula; Pereira, José Alberto

    2015-01-01

    The olive fly, Bactrocera oleae (Rossi), a serious threat to the olive crop worldwide, displays ovipositon preference for some olive cultivars but the causes are still unclear. In the present work, three Portuguese olive cultivars with different susceptibilities to olive fly (Cobrançosa, Madural, and Verdeal Transmontana) were studied, aiming to determine if the olive volatiles are implicated in this interaction. Olive volatiles were assessed by SPME-GC-MS in the three cultivars during maturation process to observe possible correlations with olive fly infestation levels. Overall, 34 volatiles were identified in the olives, from 7 chemical classes (alcohols, aldehydes, aromatic hydrocarbons, esters, ketones, sesquiterpenes, and terpenes). Generally, total volatile amounts decrease during maturation but toluene, the main compound, increased in all cultivars, particularly in those with higher susceptibility to olive fly. Sesquiterpenes also raised, mainly α-copaene. Toluene and α-copaene, recognized oviposition promoters to olive fly, were correlated with the infestation level of cvs. Madural and Verdeal Trasnmontana (intermediate and highly susceptible cultivars respectively), while no correlations were established with cv. Cobrançosa (less susceptible). No volatiles with inverse correlation were observed. Volatile composition of olives may be a decisive factor in the olive fly choice to oviposit and this could be the basis for the development of new control strategies for this pest. PMID:25985460

  10. Frictional properties of sediments entering the Costa Rica subduction zone offshore the Osa Peninsula: implications for fault slip in shallow subduction zones

    NASA Astrophysics Data System (ADS)

    Namiki, Yuka; Tsutsumi, Akito; Ujiie, Kohtaro; Kameda, Jun

    2014-12-01

    We examined the frictional properties of sediments on the Cocos plate offshore the Osa Peninsula, Costa Rica, and explored variations in the intrinsic frictional properties of the sediment inputs to the Costa Rica subduction zone. Sediment samples were collected at Site U1381A during the Integrated Ocean Drilling Program Expedition 334, and include hemipelagic clay to silty clay material (Unit I) and pelagic silicic to calcareous ooze (Unit II). The frictional properties of the samples were tested at a normal stress of 5 MPa under water-saturated conditions and with slip velocities ranging from 0.0028 to 2.8 mm/s for up to 340 mm of displacement. The experimental results reveal that the steady-state friction coefficient values of clay to silty clay samples are as low as ~0.2, whereas those of silicic to calcareous ooze samples are as high as 0.6 to 0.8. The clay to silty clay samples show a positive dependence of friction on velocity for all tested slip velocities. In contrast, the silicic to calcareous ooze samples show a negative dependence of friction on velocity at velocities of 0.0028 to 0.28 mm/s and either neutral or positive dependence at velocities higher than 0.28 mm/s. Given the low frictional coefficient values observed for the clay to silty clay samples of Unit I, the décollement at the Costa Rica Seismogenesis Project transect offshore the Osa Peninsula likely initiates in Unit I and is initially very weak. In addition, the velocity-strengthening behavior of the clay to silty clay suggests that faults in the very shallow portion of the Costa Rica subduction zone are stable and thus behave as creeping segments. In contrast, the velocity-weakening behavior of the silicic to calcareous ooze favors unstable slip along faults. The shallow seismicity occurred at a depth as shallow as ~9 km along the Costa Rica margin offshore the Osa Peninsula (Mw 6.4, June 2002), indicating that materials characterized by velocity-weakening behavior constitute the fault

  11. [Prevalence and factors associated with the presence of anemia in the elderly of the municipality of Viçosa, State of Minas Gerais, Brazil].

    PubMed

    Milagres, Clarice Santana; de Moraes, Keila Bacelar Duarte; Franceschini, Sylvia Carmo Castro; Sant'Ana, Luciana Ferreira Rocha; Lima, Luciana Moreira; Ribeiro, Andréia Queiroz

    2015-12-01

    Anemia is the most common hematological problem encountered in the elderly population. A cross-sectional, population-based survey was conducted to evaluate the prevalence and factors associated with anemia in the elderly in Viçosa (State of Minas Gerais). Data were collected by means of a household survey and conducting biochemical tests on 349 elderly between June and December 2009. The prevalence of anemia was 11.7% (95% CI 8.3% -15.1%) and was found to be higher among men (15.4%) among those aged 80 years and older (30%) and those who practiced polypharmacy (16.8%). The results obtained indicate anemia determinants similar to those observed in developed countries. The real need of polypharmacy should be evaluated in health care for the elderly, in order to prevent iatrogenic complications, of which anemia is one such complication. PMID:26691798

  12. Interplate seismicity at the CRISP drilling site: The 2002 Mw 6.4 Osa Earthquake at the southeastern end of the Middle America Trench

    NASA Astrophysics Data System (ADS)

    Arroyo, Ivonne G.; Grevemeyer, Ingo; Ranero, Cesar R.; von Huene, Roland

    2014-07-01

    investigate potential relations between variations in seafloor relief and age of the incoming plate and interplate seismicity. Westward from Osa Peninsula in Costa Rica, a major change in the character of the incoming Cocos Plate is displayed by abrupt lateral variations in seafloor depth and thermal structure. Here a Mw 6.4 thrust earthquake was followed by three aftershock clusters in June 2002. Initial relocations indicate that the main shock occurred fairly trenchward of most large earthquakes along the Middle America Trench off central Costa Rica. The earthquake sequence occurred while a temporary network of OBH and land stations ˜80 km to the northwest were deployed. By adding readings from permanent local stations, we obtain uncommon P wave coverage of a large subduction zone earthquake. We relocate this catalog using a nonlinear probabilistic approach within both, a 1-D and a 3-D P wave velocity models. The main shock occurred ˜25 km from the trench and probably along the plate interface at 5-10 km depth. We analyze teleseismic data to further constrain the rupture process of the main shock. The best depth estimates indicate that most of the seismic energy was radiated at shallow depth below the continental slope, supporting the nucleation of the Osa earthquake at ˜6 km depth. The location and depth coincide with the plate boundary imaged in prestack depth-migrated reflection lines shot near the nucleation area. Aftershocks propagated downdip to the area of a 1999 Mw 6.9 sequence and partially overlapped it. The results indicate that underthrusting of the young and buoyant Cocos Ridge has created conditions for interplate seismogenesis shallower and closer to the trench axis than elsewhere along the central Costa Rica margin.

  13. A pilot study to compare the cerebral hemodynamics between patients with obstructive sleep apnea syndrome (OSA) and periodic limb movement syndrome (PLMS) during nocturnal sleep with near-infrared spectroscopy (NIRS)

    NASA Astrophysics Data System (ADS)

    Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Fritschi, Ursula; Hügli, Gordana; Lehner, Isabella; Qi, Ming; Khatami, Ramin

    2014-03-01

    Obstructive sleep apnea syndrome (OSA) and periodic limb movement in sleep syndrome (PLMS) are two common sleep disorders. Previous studies showed that OSA and PLMS share common features, such as increased cardio-vascular risk, both apnea events and limb movements occur periodically, they are usually associated with cortical arousals, and both of them can induce declines in peripheral oxygen saturation measured with pulse oximetry. However, the question whether apnea events and limb movements also show similar characteristics in cerebral hemodynamic and oxygenation has never been addressed. In this pilot study, we will first time compare the cerebral hemodynamic changes induced by apnea events and limb movements in patients with OSA (n=4) and PLMS (n=4) with NIRS. In patients with OSA, we found periodic oscillations in HbO2, HHb, and blood volume induced by apnea/hypopnea events, HbO2 and HHb showed reverse changing trends. By contrast, the periodic oscillations linked to limb movements were only found in HbO2 and blood volume in patients with PLMS. These findings of different cerebral hemodynamics patterns between apnea events and limb movements may indicate different regulations of nervous system between these two sleep disorders.

  14. [Implementation and impact of the National Iron Supplementation Program in the city of Viçosa, State of Minas Gerais].

    PubMed

    Cotta, Rosângela Minardi Mitre; Azeredo, Catarina Machado; Silva, Luciana Saraiva da; Franceschini, Sylvia do Carmo Castro; Sant'ana, Luciana Ferreira da Rocha; Cássia Lanes Ribeiro, Rita de

    2011-10-01

    The scope of this work was to evaluate the implementation of the National Iron Supplementation Program (NISP) in Viçosa in the State of Minas Gerais and its impact on 6- to 18-month-old non-anemic infants assisted by the Family Health Teams. Interviews were conducted with the professionals and with the children's mothers/guardians. The non-anemic children who didn't receive the earlier supplementation (n=133) were given ferrous sulphate syrup for six months. Hemoglobin dosage, anthropometric evaluation and a socioeconomic survey were conducted before and after the six-month period. Children who ingested 75% or more of the prescribed dosage were classified as high adhesion, while the others were classified as low adhesion, according to the mothers' testimonials. With respect to the implementation in the city, the distribution system was not always available to the priority group and there was a lack of training and motivation on the part of most Community Health Agents. The lack of promotion of NISP among the priority group was detected, apart from a mothers' awareness drive. Regarding diet supplementation, children showed low adhesion and the dosage wasn't effective in preventing anemia. Therefore, important operational barriers to implementation were observed. PMID:22031130

  15. Genetic similarity among Agistemus pallinii Matioli et al (Acari: Stigmaeidae) found in citrus orchards in Viçosa, Minas Gerais State, Brazil.

    PubMed

    Matioli, André L; Pallini, Angelo; Tavares, Mara G

    2009-01-01

    Stigmaeidae are very important predators of mite and insect pests on several crops in Brazil. It is considered the second most important family of predatory mites in citrus orchards in Brazil. However, their identification, especially that of the members of the genus Agistemus, is rather difficult based only on morphology. Hence, this study describes the use of random amplified polymorphic DNA (RAPD-PCR) markers to determine the genetic similarity of an Agistemus pallinii Matioli et al population found in 2004 in a citrus orchard in Viçosa, Minas Gerais State, Brazil, preying on Panonychus citri (McGregor). Amplifi cations were performed with 12 random primers (OPAA8, OPAA19, OPAB1, OPAB5, OPAB18, OPAC9, OPAC17, OPAC19, OPAD10, OPAE9, OPAE12 and OPAE17), which generated 119 bands, with 53.8% polymorphism. The coefficients of genetic similarity among the individuals ranged from 0.68 to 0.99, indicating a high genetic similarity among them. The 3D projection analysis clustered the majority of individuals confirming their high similarity. Though individuals of A. pallinii are minute (+/- 360 microm long), the PCR-RAPD technique can still be used for their identification, complementing morphological analyses or for comparison of populations collected in different geographic regions. This is the first molecular study carried out with stigmaeid mites. PMID:19488517

  16. Retinal Atherosclerosis, Ophthalmologically Reported and Documented with OSA in 1987, is now Totally Reversed, and Recorded, Photographically. The Supposition then was that Equivalent Cortical Damage could Respond to the same Healing Protocol.

    NASA Astrophysics Data System (ADS)

    Niemi, Paul N.; O., D.; Mc Leod, David M.; Mc Leod, Roger D.

    2007-10-01

    Documented retinal atherosclerosis, ``silver streaking'' of retinal capillaries, was reported and documented with OSA, in October 1987. That retinal damage, despite claims it usually progresses and is nonreversible, is now completely cleared. The original OSA presentation proposed that equivalent cortical damage was probably present throughout the brain at that time, as attested by failing short-term memory performance and transient ischemic attacks, TIAs, brief vision strokes. The supposition then was that ophthalmologic access to the retina, by some accounts the progenitor of all brain evolution, could provide a means of monitoring the actual circulatory state of inaccessible parts of the brain. To the extent that retinal health was naturopathically restored, and memory performance seems also to have significantly kept pace, is it a tenable premise that such protocols have rather general importance? Can applied optics help establish more appropriate diagnoses, and evaluate treatments for dementia and Alzheimer's disease?

  17. Pre- and in-therapy predictive score models of adult OSAS patients with poor adherence pattern on nCPAP therapy

    PubMed Central

    Wang, Yeying; Geater, Alan F; Chai, Yanling; Luo, Jiahong; Niu, Xiaoqun; Hai, Bing; Qin, Jingting; Li, Yongxia

    2015-01-01

    Objectives To identify patterns of adherence to nasal continuous positive airway pressure (nCPAP) use in the first 3 months of therapy among newly diagnosed adult patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and their predictors. To develop pretherapy and in-therapy scores to predict adherence pattern. Methods Newly diagnosed adult OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures such as Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Zung’s Self-Rating Depression Scale (SDS), and The Pittsburgh Sleep Quality Index (PSQI) at baseline and at the end of 3rd-week therapy were collected. Twelve weeks’ adherence data were collected from the nCPAP memory card, and K-means cluster analysis was used to explore adherence patterns. Predictive scores were developed from the coefficients of cumulative logit models of adherence patterns using variables available at baseline and after 3 weeks of therapy. Performance of the score was validated using 500 bootstrap resamples. Results Seventy six patients completed a 12-week follow-up. Three patterns were revealed. Patients were identified as developing an adherence pattern that was poor (n=14, mean ± SD, 2.3±0.9 hours per night), moderate (n=19, 5.3±0.6 hours per night), or good (n=43, 6.8±0.3 hours per night). Cumulative logit regression models (good → moderate → poor) revealed independent baseline predictors to be ESS (per unit increase) (OR [95% CI], 0.763 [0.651, 0.893]), SDS (1.461 [1.238, 1.724]), and PSQI (2.261 [1.427, 3.584]); and 3-week therapy predictors to be ESS (0.554 [0.331, 0.926]), PSQI (2.548 [1.454, 4.465]), and the changes (3rd week–baseline data) in ESS (0.459 [0.243, 0.868]), FSS (3.556 [1.788, 7.070]), and PSQI (2.937 [1.273, 6.773]). Two predictive score formulas for poor adherence were developed. The area under the curve (AUC) of the receiver operating characteristics (ROC) curves for baseline and 3

  18. Risky consumption habits and safety of fluid milk available in retail sales outlets in Viçosa, Minas Gerais State, Brazil.

    PubMed

    Pieri, Fabio Alessandro; Colombo, Monique; Merhi, Carolina Milner; Juliati, Vinícius Augusto; Ferreira, Marcello Sebe; Nero, Marcelo Antônio; Nero, Luis Augusto

    2014-06-01

    This study aimed to assess raw milk consumption habits in the urban population of Viçosa, Minas Gerais, Brazil, and the microbiological safety and quality of the fluid milk available in retail sales outlets in the same region. A simplified questionnaire regarding raw milk consumption was applied to the persons responsible for food acquisition in 411 residences. The regular consumption of raw milk was observed by 18.5% of the interviewers, and lack of knowledge of possible risks related to this food product. Microbiological safety and quality were assessed for raw (n=69), pasteurized (n=80), and ultra-high-temperature (UHT)-treated milk (n=80) by analyzing the counts of mesophilic aerobes, coliforms, and Escherichia coli, and detection of Listeria monocytogenes and Salmonella spp.; raw milk samples were also subjected to enumeration of coagulase-positive Staphylococcus. Concerning raw milk, 59.4% of the samples were considered as produced in inadequate hygienic conditions, 5.8% of the samples presented counts of coagulase-positive Staphylococcus lower than 100 colony-forming units (CFU)/mL, and no samples presented with positive results for L. monocytogenes or Salmonella spp. All pasteurized and UHT milk samples presented with low counts of mesophilic aerobes and coliforms, while L. monocytogenes and Salmonella spp. were absent. The data demonstrated that raw milk was consumed by the population studied. Despite the absence of potential hazards, raw milk was of poor hygienic quality, in contrast with the processed fluid milk available in retail sales outlets that was safe and of good hygienic quality, highlighting the suitability of pasteurized and UHT milk for human consumption. PMID:24697652

  19. Physical property and Textural transition across the Unconformity and Major Seismic Reflectors in the Upper plate of the Costa Rica Subduction zone offshore Osa Peninsula

    NASA Astrophysics Data System (ADS)

    Hamahashi, M.; Screaton, E.; Tanikawa, W.; Hashimoto, Y.; Martin, K. M.; Saito, S.; Kimura, G.

    2014-12-01

    At the Costa Rica subduction zone offshore Osa Peninsula, the Cocos plate and Cocos Ridge subduct under the Caribbean plate along the Middle America Trench, creating active seismicity. In this region, the Caribbean plate is characterized by a well-consolidated, high velocity framework material beneath the slope sediments, but the nature of the upper plate material is yet unknown. During Integrated Ocean Drilling Program (IODP) Expedition 334 and 344, the unconformity between the slope sediments (Unit 1) and upper plate material (Units 2 and 3) consisting of lithic sedimentary units was penetrated at mid-slope Site 1380. In the current study, to characterize the compaction behavior of the upper plate material, we investigate the physical properties, texture and composition of the sediments at Site 1380 by conducting microstructural observations, resistivity measurements, particle size analyses, X-ray fluorescence and X-ray diffraction analyses. The microstructures of sediments observed through the microscope tend to develop dense and cohesive textures in low porosity sediments, and particle size changes across several unconformities. In particular, the small particle-sized lithic fragments compose larger bodies and form cohesive structures. The cross correlation between measured particle size and shipboard porosity show negative correlation especially at Unit 2, indicating that larger sized particles form smaller or fewer pores. From the results of XRF and XRD analyses, we found that Al, K, Ti tend to concentrate in the higher porosity sediments of Unit 1, whereas Si, Ca, P, Mg, Na, and Mn concentrate in the lower porosity sediments of Unit 2 and 3. The higher concentration in Mg, Na, Mn, Si may be due to minerals such as chlorite, serpentine, amphibole, and sodium manganese. The crossplots between porosity and element concentration show negative correlations in Mg, Na, and Mn with porosity, suggesting that the minerals rich in these elements may relate with the

  20. The impact of pasture conversion on nutrient cycles of tropical streams on the Osa Peninsula, Costa Rica: a paired catchment approach

    NASA Astrophysics Data System (ADS)

    Bringhurst, K.; Jordan, P.

    2011-12-01

    Changes in nutrient and hydrologic cycles caused by land disturbance typically lead to detrimental changes to ecosystems. This study utilized a paired, small-catchment approach to examine the effect of deforestation on nutrient transfer and hydrological discharge and the resulting impact on soils and streams of the Osa Peninsula, Costa Rica. Two first order streams were chosen, the first catchment had been cleared for pasture and the second consisted of undisturbed tropical wet forest. Soil concentrations of organic matter, total and soil available P were higher in the forested catchment with decreases of >33% of each in the deforested catchment. The effect of deforestation on stream discharge was a 59% increase in flow during the wet season and an increase in the Q5:Q95 ratio showing that the deforested stream was flashier. The deforested catchment loss of dissolved inorganic nitrogen (DIN) increased 95% over the forested catchment. Soluble reactive phosphorus (SRP) showed an increase in load of 43% in the deforested catchment compared to the forested catchment. The molar N:P ratios were lower than the Redfield ratio and both streams were well below the level at which N-limitation of lotic algal growth has been reported, therefore it is hypothesized that N is the limiting nutrient in streams in the study area. Soil nutrient depletion in the deforested catchment, accelerated by a changed hydrologic regime, is the likely trajectory of soil-water interactions in this tropical ecosystem. This will likely be among the secondary impacts should deforestation become widespread along this stretch of the Pacific coastline, with associated eutrophication of receiving transitional and coastal waters.

  1. Temporal variations of temperature, salinity and circulation in the Peruípe river estuary (nova Viçosa, BA)

    NASA Astrophysics Data System (ADS)

    Pinheiro Andutta, Fernando; de Miranda, Luiz Bruner; França Schettini, Carlos Augusto; Siegle, Eduardo; da Silva, Mario Pereira; Massaki Izumi, Vitor; Murai Chagas, Felipe

    2013-11-01

    Eulerian profiles of thermohaline properties and currents have been sampled in the Peruípe River Estuary (Nova Viçosa, BA), southern region of the Caravelas-Peruípe Rivers Estuarine System. One station was located near the mouth (C) and other one up the estuary (E). The Hansen-Rattray diagram classification of the upper reaches of the Peruípe river estuary in the wet season changed from Type 2b (partially mixed and highly stratified—ν=0.88) to Type 1b (highly stratified—ν˜1.00) due to the fortnightly tidal modulation. This region was mainly forced by river discharge (RiE=5.7 and RiE=4.1) and characterized by high (RiL>20) and low stabilities (RiL<20) in the neap and spring tidal cycles. However, near the mouth stratification was strongly modulated by the tide, and its classification alternates from being highly stratified (Type 2b—ν=0.92) in the neap tide to being well mixed with low stratification (Type 1a—ν=1.00); the mouth was dominated by fresh water discharge (RiE=12.9) and tidal stirring (RiE=0.6) in the neap and spring tide, respectively, and were associated with high and low stabilities. The classical steady-state salinity and velocity profiles show good agreement (Skill˜1.0) with the corresponding observational profiles when simulated with a classical analytical model. The main characteristics of the nearly steady-state bidirectional (with a weak barolinic signal) and unidirectional velocity profiles were in good agreement with the estuarine quantitative classifications (Types 2b, 1a and 1b). The rate of change of the potential energy due to fortnightly tidal modulation was slightly higher near the mouth (6.1 J m-3 s-1) than in the upper reaches of the estuary (5.2 J m-3 s-1). However, this was not strong enough to generate halocline erosion in the transitional neap to spring tidal cycle, and the estuary classification remained Type 1b. The main conclusions are summarized as follows: (i) Two stations sampled along the Peruípe river

  2. Comprehensive two-dimensional gas chromatography for fingerprint pattern recognition in olive oils produced by two different techniques in Portuguese olive varieties Galega Vulgar, Cobrançosa e Carrasquenha.

    PubMed

    Vaz-Freire, L Torres; da Silva, M D R Gomes; Freitas, A M Costa

    2009-02-01

    For olive oil production a metal hammer-decanter olive processing line was compared to a traditional metal hammer-press line, a discontinuous method which, if properly used, yields high-quality virgin olive oils. Galega, Carrasquenha and Cobrançosa olives (traditional Portuguese varieties) were studied. The analysis of the aroma compounds was performed after headspace-solid phase micro extraction. The analytical results obtained after comprehensive gas chromatography in tandem with time of flight mass spectrometry (GCxGC/ToFMS) for these three different olive oil varieties, from a single year harvest and processed with two different extraction technologies, were compared using statistical image treatment, by means of ImageJ software, for fingerprint recognitions and compared with principal component analysis when the area data of each chromatographic spot of the contour plots were considered. The differences used to classify the olive oils studied under different groups after principal component analysis were observed independently of the treatment used (peak areas or the sum of the pixels counts). When the individual peak areas were considered, more then 75.7% of the total variance is explained by the first two principal components while in the case where the data were subjected to image treatment 84.0% of the total variance is explained by the first two principal components. In both cases the first and second principal components present eigenvalues higher then 1.0. Fingerprint image monitoring of the aroma compounds of the olive oil allowed a rapid differentiation of the three varieties studied as well as the extraction methods used. The volatile compounds responsible for their characterization were tentatively identified in a bi-dimensional polar/non-polar column set in the GCxGC/Tof-MS apparatus. This methodology allowed the reduction of the number of compounds needed for matrices characterization, preserving the efficiency of the discrimination, when

  3. Treatment of patients with OSAS using Nd-YAG laser

    NASA Astrophysics Data System (ADS)

    Kukwa, Andrzej; Tulibacki, Marek P.; Zajac, Andrzej; Dudziec, Katarzyna

    2000-06-01

    The authors present their clinical experience regarding the possibilities of application of Nd:YAG and Ho:YAG lasers for the treatment of disorders in the are of the upper respiratory tract. The patients with symptoms of Obstructive Sleep Aphnoe Syndrom need a various operations techniques. Lasers techniques makes it possible to perform a number of procedures in local anesthesia which considerably improves the economic effectiveness of the treatment. The surgeries performed using laser beam enabled very good effect of treatment.

  4. Diagnostic and therapeutic iter in paediatric OSAS: personal experience.

    PubMed

    Piumetto, E; Sammartano, A M; Meinardi, G; Dagna, F; Gervasio, F C; Albera, R

    2011-06-01

    Obstructive sleep apnoea syndrome in a child is characterized by prolonged episodes of obstructive hypopnoea and/or apnoea of upper airway leading to morbidity. The most common risk factor is adeno-tonsillar hypertrophy. Obstructive sleep apnoea syndrome diagnosis is based on clinical ENT evaluation and an instrumental approach, such as pulse oximetry or the gold standard overnight polysomnography. The aim is to establish, in a population of children with suspected obstructive sleep apnoea syndrome, the frequency of this disorder, the effect of adenotonsillectomy and the risk of post-operative complications. A total of 481 patients (297 male, 184 female) with suspected obstructive sleep apnoea syndrome (aged 2-14 years) were evaluated between March 2007 and April 2010 and divided into 3 morphological phenotypes: classic, adult and congenital. All patients underwent ENT assessment and a pulse oximetry with 4 channels cardiopulmonary monitoring. The examination following the Brouillette criteria was defined as negative, positive or inconclusive; when positive, adenotonsillectomy was the first therapeutic approach. At 6 months after surgery, all patients underwent check-up pulse oximetry. Of the overall sample, 96% of the patients had a classical phenotype, 3% an adult type and 1% a congenital type. The monitoring resulted pathological in 19% (17% of them were at increased post-operative risk), negative in 61% and inconclusive in 20%. All 5 patients with congenital phenotype were positive. Of the positive patients, 86% underwent adenotonsillectomy and a control pulse oximetry 6 months thereafter, 96% resulted negative. Pulse oximetry was efficient in order to avoid incorrect surgery indications, improving appropriateness and safety of adenotonsillectomy in children with obstructive sleep apnoea syndrome. Adenotonsillectomy showed a success rate of 96% and there were no episodes of post-surgery complications in particular in those patients at increased risk. PMID:22058592

  5. Cancer and OSA: Current Evidence From Human Studies.

    PubMed

    Martínez-García, Miguel Ángel; Campos-Rodriguez, Francisco; Barbé, Ferrán

    2016-08-01

    Despite the undeniable medical advances achieved in recent decades, cancer remains one of the main causes of mortality. It is thus extremely important to make every effort to discover new risk factors for this disease, particularly ones that can be treated or modified. Various pathophysiologic pathways have been postulated as possible causes of cancer or its increased aggressiveness, and also of greater resistance to antitumoral treatment, in the presence of both intermittent hypoxia and sleep fragmentation (both inherent to sleep apnea). Thus far, these biological hypotheses have been supported by various experimental studies in animals. Meanwhile, recent human studies drawing on preexisting databases have observed an increase in cancer incidence and mortality in patients with a greater severity of sleep-disordered breathing. However, the methodologic limitations of these studies (which are mostly retrospective and lack any measurement of direct markers of intermittent hypoxia or sleep fragmentation) highlight the need for controlled, prospective studies that would provide stronger scientific evidence regarding the existence of this association and its main characteristics, as well as explore its nature and origin in greater depth. The great epidemiologic impact of both cancer and sleep apnea and the potential for clinical treatment make this field of research an exciting challenge. PMID:27164292

  6. Phenolic compounds and antimicrobial activity of olive (Olea europaea L. Cv. Cobrançosa) leaves.

    PubMed

    Pereira, Ana Paula; Ferreira, Isabel C F R; Marcelino, Filipa; Valentão, Patricia; Andrade, Paula B; Seabra, Rosa; Estevinho, Leticia; Bento, Albino; Pereira, José Alberto

    2007-01-01

    We report the determination of phenolic compounds in olive leaves by reversed-phase HPLC/DAD, and the evaluation of their in vitro activity against several microorganisms that may be causal agents of human intestinal and respiratory tract infections, namely gram positive (Bacillus cereus, B. subtilis and Staphylococcus aureus), gram negative bacteria (Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae) and fungi (Candida albicans and Cryptococcus neoformans). Seven phenolic compounds were identified and quantified: caffeic acid, verbascoside, oleuropein, luteolin 7-O-glucoside, rutin, apigenin 7-O-glucoside and luteolin 4'-O-glucoside. At low concentrations olive leaves extracts showed an unusual combined antibacterial and antifungal action, which suggest their great potential as nutraceuticals, particularly as a source of phenolic compounds. PMID:17873849

  7. Hydrogeological responses to incoming materials at the erosional subduction margin, offshore Osa Peninsula, Costa Rica

    NASA Astrophysics Data System (ADS)

    Kameda, Jun; Harris, Robert N.; Shimizu, Mayuko; Ujiie, Kohtaro; Tsutsumi, Akito; Ikehara, Minoru; Uno, Masaoki; Yamaguchi, Asuka; Hamada, Yohei; Namiki, Yuka; Kimura, Gaku

    2015-09-01

    Bulk mineral assemblages of sediments and igneous basement rocks on the incoming Cocos Plate at the Costa Rica subduction zone are examined by X-ray diffraction analyses on core samples. These samples are from Integrated Ocean Drilling Program Expedition 334 reference Site U1381, ˜ 5 km seaward of the trench. Drilling recovered approximately 100 m of sediment and 70 m of igneous oceanic basement. The sediment includes two lithologic units: hemipelagic clayey mud and siliceous to calcareous pelagic ooze. The hemipelagic unit is composed of clay minerals (˜50 wt.%), quartz (˜5 wt.%), plagioclase (˜5 wt.%), calcite (˜15 wt.%) and ˜30 wt.% of amorphous materials, while the pelagic unit is mostly made up of biogenic amorphous silica (˜50 wt.%) and calcite (˜50 wt.%). The igneous basement rock consists of plagioclase (˜50-60 wt.%), clinopyroxene (˜>25 wt.%), and saponite (˜15-40 wt.%). Saponite is more abundant in pillow basalt than in the massive section, reflecting the variable intensity of alteration. We estimate the total water influx of the sedimentary package is 6.9 m3/yr per m of trench length. Fluid expulsion models indicate that sediment compaction during shallow subduction causes the release of pore water while peak mineral dehydration occurs at temperatures of approximately ˜100°C, 40-30 km landward of the trench. This region is landward of the observed updip extent of seismicity. We posit that in this region the presence of subducting bathymetric relief capped by velocity weakening nannofossil chalk is more important in influencing the updip extent of seismicity than the thermal regime.

  8. The Rochester OSA Optics Suitcase: 13 years of middle school outreach

    NASA Astrophysics Data System (ADS)

    Canavesi, Cristina; Donlon, Theresa M.; Jacobs, Stephen D.

    2012-10-01

    The Rochester Section of the Optical Society of America (ROSA) developed a youth outreach program in 1999 to be presented in middle schools by scientists, engineers and engineering students. The objective was to kindle interest in technology careers, especially those related to optics, photonics, and optical engineering. Three in-class experiments using individual take-home theme packets that explore color in white light were devised early in the program, and these have proven to be the key to its success. Over the past 13 years, with financial support from a variety of organizations and individuals, ROSA has manufactured and delivered over 450 Optics Suitcases to groups in 34 US states and 54 countries. The presentation guide is now available in 4 languages besides English. In this paper, the elements of an Optics Suitcase presentation are reviewed, and examples of outreach events are used to document its success.

  9. Tree Diversity and Dynamics of the Forest of Seu Nico, Viçosa, Minas Gerais, Brazil

    PubMed Central

    Leyh, Werner; Meira-Neto, João A.A.

    2015-01-01

    Abstract Background To understand future changes in community composition due to global changes, the knowledge about forest community dynamics is of crucial importance. To improve our understanding about processes and patterns involved in maintaining species rich Neotropical ecosystems, we provide here a dataset from the one hectare Forest of Seu Nico (FSN) Dynamics Plot from Southeastern Brazil. New information We report diameter at breast height, basal area and height measurements of 2868 trees and treelets identified from two census spanning over a nine-year period. Furthermore, soil properties and understory light availability of all 100 10 x 10m subplots from the one hectare FSN Dynamics Plot during the second census are given. PMID:26312053

  10. Normal fault populations across the Costa Rica margin, NW of the Osa Penninsula, and implications for upper plate stress

    NASA Astrophysics Data System (ADS)

    Bangs, N. L.; McIntosh, K. D.

    2015-12-01

    The upper plate of the Costa Rica subduction zone is dissected by hundreds of normal faults that cut through the uppermost 500 - 1000m of slope sediment cover sequences within the upper slope and outer shelf of the Costa Rica margin. These faults are typically spaced 10s to 100s of m apart and have only small offsets of < 30 m. We have mapped more than 100 of these faults by tracing them along the inline, crossline and horizontal slices through a 3D seismic reflection data volume. These data were acquired on the R/V Langseth in 2011 using a 3,300 in3airgun source and a 6,000 m streamer with inline and crossline spacing of 18.75 m and 12.5 m respectively. Two primary populations of normal faults have conjugate sets that can be mapped across the upper slope and the outer shelf. The first set strikes slightly west of north and rotates systematically from 345° at the northern edge of the survey, which is located midway between the shelf break and the shoreline, to an orientation of 325° beneath the upper slope. We interpret this set as a result of WNW-ESE extension, which has been hypothesized to be a result of the collision between the Cocos Ridge (~75 km to the SE) and the Costa Rica margin (La Femina, et al., 2009). The second set of normal faults strikes east with an azimuth of 85°. This set of faults has a consistent orientation across the shelf and upper slope. This orientation is roughly parallel to the orientation of the subducting basement ridges (78°), which form horst and graben structures on the down going plate. These faults may be a result of uplift and extension as subducting ridges pass underneath. However, beneath the upper slope additional fault populations emerge with dominant azimuths primarily oriented at 5° and 65°. These faults appear to mark the localized extension caused by growth and uplift in the underlying margin wedge. Further, recent movement on shallow thrust faults indicates active shortening of the upper plate. We speculate that the contrast in the variability of fault populations beneath the upper slope and shelf is a result of a change in the competence of upper plate that allows more stress localization within the margin wedge beneath the slope than beneath the shelf. LaFemina, et al. (2009), Fore-arc motion and Cocos Ridge collision in Central America, Geochem. Geophys. Geosyst., 10, Q05S14.

  11. Rapidly evolving narcolepsy-like syndrome coinciding with severe OSA following pharyngoplasty in Prader-Willi syndrome.

    PubMed

    Blecher, Gregory; Wainbergas, Natalie; McGlynn, Michael; Teng, Arthur

    2014-09-01

    Our patient with Prader-Willi syndrome (PWS) not only displayed many typical syndromic features but also presented several unique challenges, with gross velopharyngeal insufficiency necessitating repair and severe obstructive sleep apnea developing thereafter, requiring ongoing non-invasive ventilation. This coincided with development of a narcolepsy-like syndrome, treated with dexamphetamine. Cataplexy, hypnogogic/hypnopompic hallucinations, sleep paralysis were absent and HLA-DQB1*06:02 was negative. Growth hormone (GH) therapy was commenced at 8 months of age and, as recommended, regular polysomnograms were conducted. Adenotonsillar growth on GH therapy is reported as well as several reports of sudden death in PWS patients on GH. Despite GH, lifestyle measures with regular dietician review, and an exercise program, there was progressive excessive weight gain. Our patient also developed moderate tonsil hypertrophy. To our knowledge, this is the first case report of severe obstructive sleep apnea secondary to sphincter pharyngoplasty coinciding with rapidly evolving narcolepsy-like syndrome. PMID:25473585

  12. A novel locus for canine osteosarcoma (OSA1) maps to CFA34, the canine orthologue of human 3q26.

    PubMed

    Phillips, Jeffrey C; Lembcke, Luis; Chamberlin, Tamara

    2010-10-01

    Spontaneous tumors in dogs share many of the same features of their human orthologues including clinical behavior, response to treatment, and molecular defects. It is therefore natural to consider the use of dogs and their spontaneous malignancies in the study of complex disease such as cancer. Scottish Deerhounds are a giant breed of dogs that exhibit a high incidence of bone cancer. Our previous work suggested that osteosarcoma within this breed could be explained by the presence of a major gene of dominant effect. Herein, we use a whole genome mapping approach to evaluate a four-generation pedigree of Scottish Deerhounds for linkage of their osteosarcoma phenotype. Using this approach we found evidence of linkage (Z(max)=5.766) between their phenotype and markers located on CFA34, in a region syntenic to human chromosome 3q26. The identification of this locus provides novel insight into the genetic basis of osteosarcoma in both canines and humans. PMID:20647041

  13. A 51-Year-Old Woman With Hypoacusia and Increased Respiratory Effort in the Supine Position and OSA.

    PubMed

    Fernández-Barriales, Marcos; Vázquez Marcos, Virginia; Álvarez, Ainhoa; Odriozola, Beatriz; Alonso, Juan; Egea Santaolalla, Carlos

    2016-08-01

    A 51-year-old woman with a personal history of vitiligo, normal thyroid hormone studies, a simple hysterectomy for multiple uterine myomas at age 35 years, and childhood adenotonsillectomy was seen for progressive hearing loss. She reported mild asthenia, cold intolerance, mild dysphagia with frequent choking while eating and drinking, and a progressive increase in inspiratory effort, especially in the supine position. Her partner described a progressively worsening history of snoring and witnessed apneic episodes, mostly in the supine position. Mild to moderate daytime sleepiness was also present. PMID:27502995

  14. OSA Proceedings on Advanced Solid-State Lasers. Vol. 10 - Proceedings of the Topical Meeting, Hilton Head, SC, Mar. 18-20, 1991

    SciTech Connect

    Dube, G.; Chase, L. Lawrence Livermore National Laboratory, Livermore, CA )

    1991-01-01

    The present volume on advanced solid-state lasers discusses Cr(3+), Cr(4+), short-pulse, titanium, F-center, mid-IR, and diode-pumped lasers, and nonlinear optics. Attention is given to the stabilization and a spectral characterization of an alexandrite laser for water vapor lidar measurements, crystal growth and spectroscopy of Cr:LiBaAlF6, a Q-switched tunable forsterite laser, and electron paramagnetic resonance spectroscopy of chromium-doped forsterite. Topics addressed include efficient frequency doubling of a self-starting additive-pulse mode-locked diode-pumped Nd:YAG laser, recent advances in Ti:Al2O3 unstable-resonator lasers, all-solid-state operation of a CW Ti:Al2O3 laser, and upconversion studies of flashlamp-pumped Cr,T,Ho:YAG. Also discussed are the top output parameters of an Ho-laser, spectroscopy and the 3-micron laser potential of Er crystals, the pulsed operation of microchip lasers, and blue optical parametric generation in LiB3O5.

  15. [The "Em Comum-Idade" community intervention project: contributions to the promotion of health among the elderly of Viçosa in the State of Minas Gerais, Brazil].

    PubMed

    Almeida, Luciene Fátima Fernandes; de Freitas, Edilaine Lopes; Salgado, Sara Maria Lopes; Gomes, Ivani Soleira; Franceschini, Sylvia do Carmo Castro; Ribeiro, Andréia Queiroz

    2015-12-01

    Actions to promote health among the elderly are extremely important for the prevention of diseases and complications arising from the aging process. In this context, the "Em Comum-Idade" community intervention project emerged. The objective of this article was to evaluate the impact of the actions of this project on anthropometric measurements and functional physical fitness of the participants at the end of the interventions. The variables analyzed were: body mass index, waist circumference, waist hip ratio, waist height ratio, power of the lower members, flexibility of upper and lower members and agility and dynamic balance. The sample consisted of 82 participants. Most participants were female, had not completed elementary school and attended less than 50% of the activities. There were no significant changes in the values of anthropometric measurements between the initial and final evaluations of the participants. Significant improvement was found for the values of tests of functional physical fitness among those who attended most of the actions of the project. It is important to maintain health promotion actions for long periods of time in order to get results that positively impact the health status and quality of life of the elderly. PMID:26691801

  16. Workplace worries: a preliminary look at online sexual activities at the office-emerging issues for clinicians and employers.

    PubMed

    Cooper, Al; Safir, Marilyn P; Rosenmann, Amir

    2006-02-01

    Concerns about the impact of online sexual activities (OSA) on work-life are drastically increasing. This study examined 3,466 respondents who reported OSA, 18.5% of whom reported engaging in OSA at work. They were compared with the 81.5% who engaged in OSA at home, on average time spent in OSA, workplace policies regarding OSA, and relationship status. Two themes were identified and discussed: opportunity and sexual distress. Our findings indicate that participants are cognizant of issues of opportunity (e.g., the OSA from home group was more likely to indicate their workplace has established policies regarding OSA), and privacy, representing an important aspect of this theme (e.g., participants engaging in OSA at work were found to be twice as likely to have extra-marital affairs, compared with the OSA from home group). Secondly, our data suggests that many participants, especially from the OSA at work group, experience OSA-related distress. Engaging in OSA at the workplace may result in decreased productivity, issues of sexual harassment, and concerns about employee well-being. Clearly stated and consistently enforced policies regulating OSA are likely to mitigate workplace OSA. However, a significant minority of employees may have difficulties curbing OSA. Therefore, more sophisticated strategies to deal with workplace OSA should be established. Additional implications of importance for organizations and mental health professionals who support them are discussed. PMID:16497115

  17. Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea.

    PubMed

    von Känel, Roland; Malan, Nico T; Hamer, Mark; Lambert, Gavin W; Schlaich, Markus; Reimann, Manja; Malan, Leoné

    2016-01-01

    A hypercoagulable state might be one important mechanism linking obstructive sleep apnea (OSA) with incident myocardial infarction and stroke. However, previous studies on prothrombotic factors in OSA are not uniform and cross-sectional. We longitudinally studied prothrombotic factors in relation to OSA risk, adjusting for baseline levels of prothrombotic factors, demographics, metabolic parameters, aspirin use, and life style factors. The Berlin Questionnaire and/or neck circumference were used to define high OSA risk in 329 South African teachers (48.0% male, 44.6% black) at baseline and at three-year follow-up. Von Willebrand factor (VWF), fibrinogen, D-dimer, plasminogen activator inhibitor-1, clot lysis time (CLT), and soluble urokinase-type plasminogen activator receptor (suPAR) were measured in plasma. At baseline 35.7% of participants had a high risk of OSA. At follow-up, persistently high OSA risk, persistently low OSA risk, OSA risk remission, and new-onset OSA risk were present in 26.1%, 53.2%, 9.4%, and 11.3% of participants, respectively. New-onset OSA risk was associated with a significant and longitudinal increase in VWF, fibrinogen, CLT, and suPAR relative to persistently low OSA risk; in VWF, fibrinogen, and suPAR relative to remitted OSA risk; and in VWF relative to persistently high OSA risk. Persistently high OSA risk was associated with an increase in CLT and suPAR relative to persistently low OSA risk and in D-dimer relative to remitted OSA risk. Remitted OSA risk was associated with D-dimer decrease relative to persistently low OSA risk. In OSA, hypercoagulability is a dynamic process with a most prominent three-year increase in individuals with new-onset OSA risk. PMID:26335891

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

    PubMed

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

    1999-01-01

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

  19. Hypoglossal nerve conduction findings in obstructive sleep apnea

    PubMed Central

    Ramchandren, Sindhu; Gruis, Kirsten L.; Chervin, Ronald D.; Lisabeth, Lynda D.; Concannon, Maryann; Wolfe, James; Albers, James W.; Brown, Devin L.

    2010-01-01

    Introduction Denervation of oropharyngeal muscles in obstructive sleep apnea (OSA) has been suggested by needle EMG and muscle biopsy, but little is known about oropharyngeal nerve conduction abnormalities in OSA. We sought to compare hypoglossal nerve conduction studies in patients with and without OSA. Methods Unilateral hypoglossal nerve conduction studies were performed on 20 subjects with OSA and 20 age-matched controls using standard techniques. Results Median age was 48 in OSA subjects and 47 in controls. Hypoglossal compound muscle action potential (CMAP) amplitudes were significantly reduced (Wilcoxon Signed Rank test, p =0.01), but prolongation of latencies in OSA subjects did not reach significance in comparison to those in controls. Among a subgroup of subjects without polyneuropathy (15 pairs), reduced amplitudes in OSA subjects retained borderline significance (p=0.05). Discussion Hypoglossal nerve conduction abnormalities may distinguish patients with OSA from controls. These abnormalities could potentially contribute to, or arise from, OSA. PMID:20544939

  20. Mild obstructive sleep apnea does not modulate baroreflex sensitivity in adult patients

    PubMed Central

    Blomster, Henry; Laitinen, Tomi P; Hartikainen, Juha EK; Laitinen, Tiina M; Vanninen, Esko; Gylling, Helena; Sahlman, Johanna; Kokkarinen, Jouko; Randell, Jukka; Seppä, Juha; Tuomilehto, Henri

    2015-01-01

    Background Obstructive sleep apnea (OSA) is a chronic and progressive disease. OSA is associated with increased cardiovascular morbidity and mortality, the risk being more frequently encountered with severe degrees of OSA. Increased sympathetic activation and impaired cardiac autonomic control as reflected by depressed baroreceptor reflex sensitivity (BRS) are possible mechanisms involved in the cardiovascular complications of OSA. However, it is not known at what stage of OSA that changes in BRS appear. The aim of this study was to evaluate BRS in patients with mild OSA. Methods The study population consisted of 81 overweight patients with mild OSA and 46 body weight-matched non-OSA subjects. BRS, apnea-hypopnea index, body mass index, and metabolic parameters were assessed. The phenylephrine test was used to measure BRS. Results Patients in the OSA group were slightly but significantly older than the non-OSA population (50.3±9.3 years vs 45.7±11.1 years, P=0.02). Body mass index, percentage body fat, blood pressure, fasting glucose, insulin, and lipid levels did not differ between the OSA patients and non-OSA subjects. Absolute BRS values in patients with mild OSA and non-OSA subjects (9.97±6.70 ms/mmHg vs 10.51±7.16 ms/mmHg, P=0.67) and BRS values proportional to age-related and sex-related reference values (91.4%±22.7% vs 92.2%±21.8%, P=0.84) did not differ from each other. BRS <50% of the sex-specific reference value was found in 6% of patients with mild OSA and in 2% of non-OSA subjects (P=0.29). Conclusion Patients with mild OSA did not show evidence of disturbed BRS in comparison with weight-matched non-OSA controls. PMID:26203292

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

    PubMed

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

    2016-01-01

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

  2. Managing Comorbid Illness in Obstructive Sleep Apnea: What Can We Learn from Other Diseases?

    PubMed

    Conwell, Walter D; Tsai, Sheila C

    2016-09-01

    Obstructive sleep apnea (OSA) is associated with numerous comorbid medical conditions. Symptoms of OSA may mimic those of comorbid conditions. The presence of OSA may worsen outcomes from the primary condition. Conversely, OSA treatment may benefit both sleep symptomatology and comorbid illness. Because of potential significant benefit, it is important to screen for sleep apnea symptoms, to have a low threshold to perform diagnostic testing, to treat OSA if present, and to closely monitor symptoms. OSA management does not necessarily replace, but rather, should be performed in conjunction with primary therapy for comorbid conditions. PMID:27542877

  3. Classification of vibratory patterns of the upper airway during sleep.

    PubMed

    Alshaer, Hisham; Rudzicz, Frank; Falk, Tiago H; Tseng, Wen-Hou; Bradley, T Douglas

    2013-01-01

    Upper airway (UA) narrowing and collapse during sleep results in obstructive sleep apnea (OSA). We hypothesize that vibratory patterns of snoring can distinguish simple snorers from those with OSA. Samples of breath sounds were collected from 7 snorers without OSA and 5 with OSA. Snoring pitch (F0) contours were found using the robust algorithm for pitch tracking (RAPT). The OSA snoring contours showed fluctuating patterns as compared to the smoother patterns of simple snorers. This suggests that snoring reveals the underlying instabilities of UA tissue in OSA. Conditional random fields, a statistical sequence classifier, gave 75% accuracy in distinguishing the 2 groups. PMID:24110129

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

    PubMed Central

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

    2016-01-01

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

  5. Obstructive Sleep Apnea, Hypertension, and Their Additive Effects on Atherosclerosis

    PubMed Central

    Damiani, Mario Francesco; Zito, Annapaola; Carratù, Pierluigi; Falcone, Vito Antonio; Bega, Elioda; Scicchitano, Pietro; Ciccone, Marco Matteo; Resta, Onofrio

    2015-01-01

    Background and Aims. It is widely accepted that obstructive sleep apnea (OSA) is independently associated with atherosclerosis. Similar to OSA, hypertension (HTN) is a condition associated with atherosclerosis. However, to date, the impact of the simultaneous presence of OSA and HTN on the risk of atherosclerosis has not been extensively studied. The aim of this study was to evaluate the consequences of the coexistence of OSA and HTN on carotid intima-media thickness (IMT) and on inflammatory markers of atherosclerosis (such as interleukin- [IL-] 6 and pentraxin- [PTX-] 3). Methods. The study design allowed us to define 4 groups: (1) controls (n = 30); (2) OSA patients without HTN (n = 30); (3) HTN patients without OSA (n = 30); (4) patients with OSA and HTN (n = 30). In the morning after portable monitoring (between 7 am and 8 am), blood samples were collected, and carotid IMT was measured. Results. Carotid IMT, IL-6, and PTX-3 in OSA normotensive patients and in non-OSA HTN subjects were significantly higher compared to control subjects; in addition, in OSA hypertensive patients they were significantly increased compared to OSA normotensive, non-OSA HTN, or control subjects. Conclusions. OSA and HTN have an additive role in the progression of carotid atherosclerosis and in blood levels of inflammatory markers for atherosclerosis, such as interleukin-6 and pentraxin-3. PMID:26697221

  6. The link between rhinitis and rapid-eye-movement sleep breathing disturbances in children with obstructive sleep apnea

    PubMed Central

    Huseni, Shehlanoor; Gutierrez, Maria J.; Rodriguez-Martinez, Carlos E.; Nino, Cesar L.; Perez, Geovanny F.; Pancham, Krishna

    2014-01-01

    Background: Rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we examined OSA severity and polysomnogram (PSG) features in children with rhinitis and OSA. Given that rapid-eye-movement (REM) sleep is characterized by nasal congestion, we hypothesized that children with rhinitis have more REM-related breathing abnormalities. Methods: We conducted a retrospective cross-sectional analysis of 145 children with PSG-diagnosed OSA. Outcomes included PSG parameters and obstructive apnea–hypopnea index (OAHI) during REM and non-REM. Linear multivariable models examined the joint effect of rhinitis and OSA parameters with control for potential confounders. Results: Rhinitis was present in 43% of children with OSA (n = 63) but overall OAHI severity was unaffected by the presence of rhinitis. In contrast, OAHI during REM sleep in children with moderate–severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/hr; SE = 6.4) compared with those with OSA alone (28.2/hr; SE = 3.8). Conclusion: Rhinitis is highly prevalent in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA. Further research is needed to delineate the link between REM-sleep and the physiology of the nose during health and disease. PMID:24717885

  7. Osteocytes serve as a progenitor cell of osteosarcoma

    PubMed Central

    Sottnik, Joseph L; Campbell, Brittany; Mehra, Rohit; Behbahani-Nejad, Omid; Hall, Christopher L.; Keller, Evan T.

    2016-01-01

    Osteosarcoma (OSA) is the most common primary bone tumor in humans. However, the cell of origin of OSA is not clearly defined although there is evidence that osteoblasts may serve as OSA progenitors. The role of osteocytes, terminally differentiated osteoblasts, as OSA progenitors has yet to be described. Analysis of patient cDNA from publicly available microarray data revealed that patients with OSA have increased expression of dentin matrix phosphoprotein 1 (DMP1), a marker of osteocytes. Analysis of multiple murine, human, and canine OSA cell lines revealed DMP1 expression. To test the tumorigenic potential of osteocytes, MLO-Y4, an SV-40 immortalized murine osteocyte cell line, was injected into subcutaneous and orthotopic (intratibial) sites of mice. Tumor growth occurred in both locations. Orthotopic MLO-Y4 tumors produced mixed osteoblastic/osteolytic radiographic lesions; a hallmark of OSA. Together, these data demonstrate for the first time that osteocytes can serve as OSA progenitors. PMID:24700678

  8. Osteocytes serve as a progenitor cell of osteosarcoma.

    PubMed

    Sottnik, Joseph L; Campbell, Brittany; Mehra, Rohit; Behbahani-Nejad, Omid; Hall, Christopher L; Keller, Evan T

    2014-08-01

    Osteosarcoma (OSA) is the most common primary bone tumor in humans. However, the cell of origin of OSA is not clearly defined although there is evidence that osteoblasts may serve as OSA progenitors. The role of osteocytes, terminally differentiated osteoblasts, as OSA progenitors has yet to be described. Analysis of patient cDNA from publicly available microarray data revealed that patients with OSA have increased expression of dentin matrix phosphoprotein 1 (DMP1), a marker of osteocytes. Analysis of multiple murine, human, and canine OSA cell lines revealed DMP1 expression. To test the tumorigenic potential of osteocytes, MLO-Y4, a SV-40 immortalized murine osteocyte cell line, was injected into subcutaneous and orthotopic (intratibial) sites of mice. Tumor growth occurred in both locations. Orthotopic MLO-Y4 tumors produced mixed osteoblastic/osteolytic radiographic lesions; a hallmark of OSA. Together, these data demonstrate for the first time that osteocytes can serve as OSA progenitors. PMID:24700678

  9. Obstructive Sleep Apnoea and Atrial Fibrillation

    PubMed Central

    Zhang, Ling; Hou, Yuemei; Po, Sunny S

    2015-01-01

    Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with significant morbidity and mortality. Obstructive sleep apnoea (OSA) is common among patients with AF. Growing evidence suggests that OSA is associated with the initiation and maintenance of AF. This association is independent of obesity, body mass index and hypertension. OSA not only promotes initiation of AF but also has a significant negative impact on the treatment of AF. Patients with untreated OSA have a higher AF recurrence rate with drug therapy, electrical cardioversion and catheter ablation. Treatment with continuous positive airway pressure (CPAP) has been shown to improve AF control in patients with OSA. In this article, we will review and discuss the pathophysiological mechanisms of OSA that may predispose OSA patients to AF as well as the standard and emerging therapies for patients with both OSA and AF. PMID:26835094

  10. Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block!

    PubMed

    Ali, Shozab S; Oni, Ebenezer T; Warraich, Haider J; Blaha, Michael J; Blumenthal, Roger S; Karim, Adil; Shaharyar, Sameer; Jamal, Omar; Fialkow, Jonathan; Cury, Ricardo; Budoff, Matthew J; Agatston, Arthur S; Nasir, Khurram

    2014-10-01

    Patients with obstructive sleep apnea (OSA) have a high burden of cardiovascular disease (CVD) but a causal relationship between OSA and atherosclerotic CVD remains unclear. We systematically reviewed the literature analyzing the relationship. A review of the Medline database for studies noninvasively evaluating subclinical CVD in OSA was conducted. A total of fifty-two studies were included in this review. Across the studies the prevalence of atherosclerosis, as assessed by coronary artery calcification, carotid intima-media thickness, brachial artery flow-mediated dilation and pulse wave velocity was higher in patients with OSA and correlated with increasing severity and duration of OSA. This study shows OSA is an independent predictor of subclinical CVD as CVD is more likely to occur in patients with long standing and severe OSA. Further research is however necessary to identify specific OSA populations that would benefit from aggressive screening. PMID:24650521

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

    PubMed

    2015-01-15

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

  12. Ophthalmic Diseases in Patients With Obstructive Sleep Apnea.

    PubMed

    Skorin, Leonid; Knutson, Rachel

    2016-08-01

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

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

    PubMed

    White, David P

    2016-06-01

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

  14. Clinical manifestations of sleep apnea

    PubMed Central

    2015-01-01

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

  15. Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly.

    PubMed

    Daulatzai, Mak Adam

    2015-12-01

    The incidence of dementia and obstructive sleep apnea (OSA) increases with age. Late-onset Alzheimer's disease (AD) is an irreversible neurodegenerative disease of the elderly characterized by amyloid β (Aβ) plaques and neurofibrillary tangles. The disease involves widespread synaptic loss in the neocortex and the hippocampus. Rodent and clinical studies suggest that OSA impairs the structural integrity of several brain regions, including the medial temporal lobe. Indeed, hypoxia, hypertension, hypoperfusion, endothelial dysfunction, inflammation, and oxidative stress noted in OSA patients also occur in AD patients. This Review highlights pathological commonality, showing that OSA upregulates Aβ, tau hyperphosphorylation, and synaptic dysfunction. Indeed, OSA and hypertension trigger hypoperfusion and hypometabolism of brain regions, including cortex and hippocampus. Several studies show that hypertension-driven brain damage and pathogenic mechanisms lead to an Aβ increase. The pathophysiological mechanism by which OSA enhances hypertension may be linked to sympathoexcitation, oxidative stress, and endothelial dysfunction. Strong pathophysiological similarities that exist between OSA and AD are underscored here. For example, the hippocampus is negatively impacted in both OSA and AD. OSA promotes hippocampal atrophy, which is associated with memory impairment. Cognitive impairment, even in the absence of manifest dementia, is an important independent predictor of mortality. However, several pathophysiological mechanisms in OSA are reversible with appropriate therapy. OSA, therefore, is a modifiable risk factor of cognitive dysfunction, and treating OSA prior to mild cognitive impairment may be an effective prevention strategy to reduce risk for cognitive decline and AD in middle-aged persons and the elderly. PMID:26301370

  16. Obstructive Sleep Apnea and the Subsequent Risk of Chronic Rhinosinusitis: A Population-Based Study

    PubMed Central

    Kao, Li-Ting; Hung, Shih-Han; Lin, Herng-Ching; Liu, Chih-Kuang; Huang, Hung-Meng; Wu, Chuan-Song

    2016-01-01

    The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) still remains unclear. This retrospective cohort study aimed to investigate the relationship between OSA and subsequent CRS using a population-based dataset. The study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 971 patients with OSA for the study cohort and 4855 patients without OSA for the comparison cohort. Each patient was tracked for 5 years to determine those who were subsequently diagnosed with CRS. Stratified Cox proportional hazard regression analyses were performed to examine the association of OSA with subsequent CRS. The results revealed that 161 (2.76%) of the total sampled patients were subsequently diagnosed with CRS. Subsequent incidences of CRS were found in 64 (6.59%) patients with OSA and 97 (2.00%) patients without OSA. The adjusted hazard ratio (HR) of subsequent CRS for patients with OSA was 3.18 (95% confidence interval: 2.27~4.45) compared to those without OSA. Furthermore, the HR for CRS was similar for subjects with OSA for both genders (with an adjusted HR of 3.44 for males and 2.63 for females). We concluded that patients with OSA had a higher risk of subsequent CRS compared to patients without OSA regardless of sex. PMID:26861510

  17. Online sexual activity experience of heterosexual students: gender similarities and differences.

    PubMed

    Shaughnessy, Krystelle; Byers, E Sandra; Walsh, Lindsay

    2011-04-01

    This study compared male and female university students' experiences with online sexual activity (OSA) and tested a model explaining gender differences in OSA. OSAs were categorized as non-arousal (e.g., seeking sexuality information), solitary-arousal (e.g., viewing sexually explicit materials), or partnered-arousal (e.g., sharing sexual fantasies). Participants (N = 217) completed measures of OSA experience, sexual attitudes, and sexual experience. Significantly more men than women reported engaging in solitary-arousal and partnered-arousal OSA and doing so more often. However, the men and women who reported having engaged in partnered-arousal activities reported equal frequencies of experience. There were no significant gender differences for engaging in non-arousal OSA experience. These results support the importance of grouping OSAs in terms of the proposed non-arousal, solitary-arousal, and partnered-arousal categories. Attitude toward OSA but not general attitudes toward or experiences with sexuality partially mediated the relationship between gender and frequency of engaging in arousal-oriented OSA (solitary and partnered OSA). This suggests that attitude toward OSA specifically and not gender socialization more generally account for gender differences in OSA experience. PMID:20467798

  18. Osteocalcin and Osteonectin Expression in Canine Osteosarcoma.

    PubMed

    Wehrle-Martinez, A S; Dittmer, K E; Aberdein, D; Thompson, K G

    2016-07-01

    Osteosarcoma (OSA) is a malignant heterogeneous primary bone tumor responsible for up to 90% of all primary bone tumors in dogs. In this study, osteocalcin (OC) and osteonectin (ON) immunoreactivity was evaluated in 23 canine OSAs, 4 chondrosarcomas, 4 fibrosarcomas, 2 hemangiosarcomas, and 4 histiocytic sarcomas. The effects of three different decalcification agents (ethylenediaminetetraetic acid [EDTA], formic acid and hydrochloric acid [HCl]) on the immunoreactivity for OC and ON was also assessed. Immunoreactivity to OC was present in 19/23 (83%) cases of OSA and all cases of chondrosarcoma. In three OSAs the extracellular matrix showed immunoreactivity to OC. None of the fibrosarcomas, histiocytic sarcomas or hemangiosarcomas showed immunoreactivity to OC. The sensitivity and specificity for OC in canine OSA in this study was 83% and 71% respectively. For ON, 100% of both OSAs (23/23) and non-OSAs (14/14) showed cytoplasmic immunoreactivity to this antibody, giving a sensitivity of 100% but a complete lack of specificity. There were no significant differences in immunoreactivity for OC and ON between the different decalcification agents used. In conclusion, OC showed high sensitivity for identifying OSA but it failed to distinguish between OSA and chondrosarcoma, and the osteoid produced by neoplastic cells in most cases did not show immunoreactivity to OC. These factors may limit the practical utility of OC in the diagnosis of OSA in dogs when chondrosarcoma is a differential diagnosis. ON showed no specificity in detecting OSA and has little practical application for the diagnosis of OSA in dogs. PMID:26926085

  19. Analysis of the correlations between oxidative stress, gelatinases and their tissue inhibitors in the human subjects with obstructive sleep apnea syndrome.

    PubMed

    Hopps, E; Lo Presti, R; Montana, M; Canino, B; Calandrino, V; Caimi, G

    2015-12-01

    Obstructive sleep apnea syndrome (OSAS) is commonly associated with endothelial dysfunction, atherosclerosis and cardiovascular disorders. On the basis of this observation, our aim was to examine the oxidative status and the matrix metalloproteases (MMP) profile in a group of subjects with OSAS. We enrolled 48 subjects with OSAS defined after a 1-night cardiorespiratory sleep study, who were subsequently subdivided in two subgroups according to the severity of OSAS (low grade = L-OSAS; high grade= H-OSAS). We measured the parameters of oxidative stress, such as lipid peroxidation, protein oxidation, total antioxidant status (TAS), nitric oxide metabolites (NOx), and the plasma concentrations of the gelatinases (MMP-2 and MMP-9) and their tissue inhibitors (TIMP-1 and TIMP-2). We found a significant impairment of oxidative status in H-OSAS compared to L-OSAS and higher plasma levels of MMP-9 and TIMP-1 in H-OSAS compared to L-OSAS. In this study we observed a positive correlation between TBARS and MMP-9, a positive correlation between PC and MMP-9, and a negative correlation between NOx and MMP-9, especially in the whole group of OSAS subjects. These data underline how strong interrelationships among some parameters of the oxidative stress, in particular those reflecting lipid peroxidation, protein oxidation and NOx, and MMP-9 are evident in OSAS subjects. All these information may be useful in the clinical practice keeping in mind the cardiovascular complications generally accompanying the obstructive sleep apnea syndrome. PMID:26769829

  20. Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients?

    PubMed Central

    Wang, Ping; Yu, Dao-Jiang; Feng, Gang; Long, Zhen-Hai; Liu, Chang-Jiang; Li, Hui; Zhao, Tian-Lan

    2016-01-01

    Controversial findings are reported about the relationship between floppy eyelid syndrome (FES) and obstructive sleep apnea syndrome (OSAS). The main goal of this study was to evaluate whether FES is more prevalent in OSAS patients by performing a meta-analysis. A comprehensive literature search of Pubmed, Embase, and Cochrane databases was performed. Only studies related to the prevalence of FES in OSAS were included in the meta-analysis. We estimated a pooled odds ratio (OR) for the prevalence of FES in OSAS. In total, 6 studies with 767 participants met the inclusion criteria. Using a fixed-effects model, the pooled OR was 4.12. The test for the overall effect revealed that FES was statistically prevalent in OSAS patients when compared with that in non-OSAS subjects (Z = 4.98, p < 0.00001). In the subgroup analysis by OSAS severity, the incidence of FES in OSAS increased with severity of OSAS as indicated with increased OR values (OR = 2.56, 4.62, and 7.64 for mild, moderate, and severe OSAS). In conclusion, the results indicate that FES is more prevalent in OSAS patients. However, this result was based only on unadjusted estimates. Prospective cohort studies are needed to determine whether OSAS is an independent risk factor for FES. PMID:27366328

  1. Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke

    PubMed Central

    Aaronson, Justine A.; van Bennekom, Coen A.M.; Hofman, Winni F.; van Bezeij, Tijs; van den Aardweg, Joost G.; Groet, Erny; Kylstra, Wytske A.; Schmand, Ben

    2015-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is a common sleep disorder in stroke patients and is associated with prolonged hospitalization, decreased functional outcome, and recurrent stroke. Research on the effect of OSA on cognitive functioning following stroke is scarce. The primary objective of this study was to compare stroke patients with and without OSA on cognitive and functional status upon admission to inpatient rehabilitation. Design: Case-control study. Setting and Patients: 147 stroke patients admitted to a neurorehabilitation unit. Interventions: N/A. Measurements: All patients underwent sleep examination for diagnosis of OSA. We assessed cognitive status by neuropsychological examination and functional status by two neurological scales and a measure of functional independence. Results: We included 80 stroke patients with OSA and 67 stroke patients without OSA. OSA patients were older and had a higher body mass index than patients without OSA. OSA patients performed worse on tests of attention, executive functioning, visuoperception, psychomotor ability, and intelligence than those without OSA. No differences were found for vigilance, memory, and language. OSA patients had a worse neurological status, lower functional independence scores, and a longer period of hospitalization in the neurorehabilitation unit than the patients without OSA. OSA status was not associated with stroke type or classification. Conclusions: Obstructive sleep apnea (OSA) is associated with a lower cognitive and functional status in patients admitted for stroke rehabilitation. This underlines the importance of OSA as a probable prognostic factor, and calls for well-designed randomized controlled trials to study its treatability. Citation: Aaronson JA, van Bennekom CA, Hofman WF, van Bezeij T, van den Aardweg JG, Groet E, Kylstra WA, Schmand B. Obstructive sleep apnea is related to impaired cognitive and functional status after stroke. SLEEP 2015;38(9):1431–1437. PMID

  2. Urinary proteomic profiling in severe obesity and obstructive sleep apnoea with CPAP treatment

    PubMed Central

    Seetho, Ian W; Ramírez-Torres, Adela; Albalat, Amaya; Mullen, William; Mischak, Harald; Parker, Robert J; Craig, Sonya; Duffy, Nick; Hardy, Kevin J; Burniston, Jatin G; Wilding, John PH

    2015-01-01

    Introduction Obstructive sleep apnoea (OSA) is common in obesity and is associated with cardiovascular and metabolic complications. Continuous positive airway pressure (CPAP) in OSA may lead to physiological changes reflected in the urinary proteome. The aim of this study was to characterise the urinary proteome in severely obese adult subjects with OSA who were receiving CPAP compared with severely obese subjects without OSA. Methods Severely obese subjects with and without OSA were recruited. Subjects with OSA were receiving CPAP. Body composition and blood pressure measurements were recorded. Urinary samples were analysed by Capillary Electrophoresis–Mass Spectrometry (CE–MS). Results Twenty-seven subjects with OSA-on-CPAP (age 49±7years, BMI 43±7 kg/m2) and 25 controls without OSA (age 52±9years, BMI 39±4 kg/m2) were studied. Age and BMI were not significantly different between groups. Mean CPAP use for OSA patients was 14.5±1.0 months. Metabolic syndrome was present in 14(52%) of those with OSA compared with 6(24%) of controls (p=0.039). A urinary proteome comprising 15 peptides was identified showing differential expression between the groups (p<0.01). Although correction for multiple testing did not reach significance, sequences were determined for 8 peptides demonstrating origins from collagens, fibrinogen beta chain and T-cadherin that may be associated with underlying cardiovascular disease mechanisms in OSA. Conclusions The urinary proteome is compared in OSA with CPAP and without OSA in severe obesity. The effects of CPAP on OSA may lead to changes in the urinary peptides but further research work is needed to investigate the potential role for urinary proteomics in characterising urinary peptide profiles in OSA. PMID:26483946

  3. Overview of proteomics studies in obstructive sleep apnea

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Khayat, Rami; Pleister, Adam

    2016-09-01

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

  5. Role of the Gut Microbiome in Obstructive Sleep Apnea-Induced Hypertension.

    PubMed

    Durgan, David J; Ganesh, Bhanu P; Cope, Julia L; Ajami, Nadim J; Phillips, Sharon C; Petrosino, Joseph F; Hollister, Emily B; Bryan, Robert M

    2016-02-01

    Individuals suffering from obstructive sleep apnea (OSA) are at increased risk for systemic hypertension. The importance of a healthy gut microbiota, and detriment of a dysbiotic microbiota, on host physiology is becoming increasingly evident. We tested the hypothesis that gut dysbiosis contributes to hypertension observed with OSA. OSA was modeled in rats by inflating a tracheal balloon during the sleep cycle (10-s inflations, 60 per hour). On normal chow diet, OSA had no effect on blood pressure; however, in rats fed a high-fat diet, blood pressure increased 24 and 29 mm Hg after 7 and 14 days of OSA, respectively (P<0.05 each). Bacterial community characterization was performed on fecal pellets isolated before and after 14 days of OSA in chow and high-fat fed rats. High-fat diet and OSA led to significant alterations of the gut microbiota, including decreases in bacterial taxa known to produce the short chain fatty acid butyrate (P<0.05). Finally, transplant of dysbiotic cecal contents from hypertensive OSA rats on high-fat diet into OSA recipient rats on normal chow diet (shown to be normotensive) resulted in hypertension similar to that of the donor (increased 14 and 32 mm Hg after 7 and 14 days of OSA, respectively; P<0.05). These studies demonstrate a causal relationship between gut dysbiosis and hypertension, and suggest that manipulation of the microbiota may be a viable treatment for OSA-induced, and possibly other forms of, hypertension. PMID:26711739

  6. An evaluation of the schemes of ocean surface albedo parameterization in shortwave radiation estimation

    NASA Astrophysics Data System (ADS)

    Niu, Hailin; Zhang, Xiaotong; Liu, Qiang; Feng, Youbin; Li, Xiuhong; Zhang, Jialin; Cai, Erli

    2015-12-01

    The ocean surface albedo (OSA) is a deciding factor on ocean net surface shortwave radiation (ONSSR) estimation. Several OSA schemes have been proposed successively, but there is not a conclusion for the best OSA scheme of estimating the ONSSR. On the base of analyzing currently existing OSA parameterization, including Briegleb et al.(B), Taylor et al.(T), Hansen et al.(H), Jin et al.(J), Preisendorfer and Mobley(PM86), Feng's scheme(F), this study discusses the difference of OSA's impact on ONSSR estimation in condition of actual downward shortwave radiation(DSR). Then we discussed the necessity and applicability for the climate models to integrate the more complicated OSA scheme. It is concluded that the SZA and the wind speed are the two most significant effect factor to broadband OSA, thus the different OSA parameterizations varies violently in the regions of both high latitudes and strong winds. The OSA schemes can lead the ONSSR results difference of the order of 20 w m-2. The Taylor's scheme shows the best estimate, and Feng's result just following Taylor's. However, the accuracy of the estimated instantaneous OSA changes at different local time. Jin's scheme has the best performance generally at noon and in the afternoon, and PM86's is the best of all in the morning, which indicate that the more complicated OSA schemes reflect the temporal variation of OWA better than the simple ones.

  7. Oil-suspended particulate matter aggregates: Formation mechanism and fate in the marine environment

    NASA Astrophysics Data System (ADS)

    Loh, Andrew; Shim, Won Joon; Ha, Sung Yong; Yim, Un Hyuk

    2014-12-01

    Oil suspended particulate matter (SPM) aggregates (OSA) are naturally occurring phenomena where oil droplets and particles interact to form aggregates. This aggregation could aid cleanup processes of oil contaminated waters. When OSA is formed, it makes oil less sticky and would facilitate the dispersion of oil into the water column. Increased oil-water surface contact by OSA formation enhances biodegradation of oil. Its applicability as a natural oil clean-up mechanism has been effectively demonstrated over past decades. There are many factors affecting the formation of OSA and its stability in the natural environment that need to be understood. This review provides a current understanding of (1) types of OSA that could be formed in the natural environment; (2) controlling factors and environmental parameters for the formation of OSA; (3) environmental parameters; and (4) fate of OSA and its applicability for oil spill remediation processes.

  8. Relationship between C-reactive protein levels and obstructive sleep apnea syndrome.

    PubMed

    Tie, Y X; Fu, Y Y; Xu, Z; Peng, Y

    2016-01-01

    This study aims to determine the relationship between C-reactive protein levels and obstructive sleep apnea syndrome (OSAS). We recruited 30 OSAS patients into the observation group (OSAS group), and subdivided them into mild, moderate and severe groups according to the apnea hypopnea index. In addition, 20 normal individuals were included in the control group. Plasma CRP levels of two groups were measured. As compared with the control group, the CRP levels in the OSAS group were significantly increased (P < 0.05). ANOVA showed that CRP levels in the three subgroups differ; statistically significant differences between the mild and severe OSA patients were observed (P < 0.05). It was hypothesized that OSAS patients show elevated serum CRP levels, and that serum CRP levels are associated with OSAS severity. PMID:27323094

  9. Manifestations of Insomnia in Sleep Apnea: Implications for Screening and Treatment.

    PubMed

    Bailes, Sally; Rizzo, Dorrie; Baltzan, Marc; Grad, Roland; Pavilanis, Alan; Creti, Laura; Fichten, Catherine S; Libman, Eva

    2016-01-01

    The aims of this study were to examine the presence, type, and severity of insomnia complaints in obstructive sleep apnea (OSA) patients and to assess the utility of the Sleep Symptom Checklist (SSC) for case identification in primary care. Participants were 88 OSA patients, 57 cognitive-behavioral therapy for insomnia (CBT-I) patients, and 14 healthy controls (Ctrl). Each completed a sleep questionnaire as well as the SSC, which includes insomnia, daytime functioning, psychological, and sleep disorder subscales. Results showed that OSA patients could be grouped according to 3 insomnia patterns: no insomnia (OSA), n = 21; insomnia (OSA-I), n = 30, with a subjective complaint and disrupted sleep; and noncomplaining poor sleepers (OSA-I-NC), n = 37. Comparisons among the OSA, CBT-I, and Ctrl groups demonstrate distinct profiles on the SSC subscales, indicating its potential utility for both case identification and treatment planning. PMID:26437146

  10. Predictive factors warrant screening for obstructive sleep apnea in COPD: a Taiwan National Survey

    PubMed Central

    Hang, Liang-Wen; Hsu, Jeng-Yuan; Chang, Chee-Jen; Wang, Hao-Chien; Cheng, Shih-Lung; Lin, Ching-Hsiung; Chan, Ming-Cheng; Wang, Chin-Chou; Perng, Diahn-Warng; Yu, Chong-Jen

    2016-01-01

    Background and objectives COPD and obstructive sleep apnea (OSA) share similar pathological processes and cardiovascular sequelae. Coexisting OSA in COPD – “overlap syndrome” – has worse prognosis than either condition alone, and appropriate treatment improves survival. Our objectives were to ascertain the frequency at which COPD coexists with the risk of OSA in Taiwan and to compare the risk factors, COPD symptoms, and life quality metrics between COPD subgroups with versus without risk of OSA. Methods We conducted a random cross-sectional national telephone survey of adults >40 years old in Taiwan. Participants fulfilling an epidemiological case definition of COPD completed a questionnaire to assess COPD symptoms and OSA risk, comorbidities, and performance of daily activities. Data from COPD cohorts with and without risk of OSA were analyzed and compared. Results Of 6,600 interviews completed, 404 subjects fit the epidemiological case definition of COPD – an overall prevalence of 6.1% in this national sample. Data on OSA risk were available for 292 of this COPD cohort, of whom 29.5% were at risk of OSA. Compared to those without risk of OSA, those with risk of OSA were significantly more likely to have hypertension or cardiovascular disease and diabetes, had significantly higher body mass index and COPD Assessment Test scores, and reported impaired work performance and leisure activities. Conclusion Among adults in Taiwan who fulfill epidemiologic criteria for COPD, 29.5% have coexisting risk of OSA. Comorbid hypertension or cardiovascular disease and diabetes are common and significantly more prevalent among the COPD population at risk of OSA than those who are not. OSA screening is warranted in patients with COPD with those risk factors that are more prevalent in COPD with risk of OSA than without, to target early interventions to reduce adverse cardiovascular sequelae from overlap syndrome. PMID:27099484

  11. Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features

    PubMed Central

    Sunnetcioglu, Aysel; Sertogullarından, Bunyamin; Ozbay, Bulent; Gunbatar, Hulya; Ekin, Selami

    2016-01-01

    Objective : To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods : This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results : The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions : We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture. PMID:26982041

  12. Serum Vitamin D Is Significantly Inversely Associated with Disease Severity in Caucasian Adults with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Kerley, Conor P.; Hutchinson, Katrina; Bolger, Kenneth; McGowan, Aisling; Faul, John; Cormican, Liam

    2016-01-01

    Study Objectives: To evaluate vitamin D (25(OH)D) levels in obstructive sleep apnea syndrome (OSAS) and possible relationships to OSAS severity, sleepiness, lung function, nocturnal heart rate (HR), and body composition. We also aimed to compare the 25(OH)D status of a subset of OSAS patients compared to controls matched for important determinants of both OSAS and vitamin D deficiency (VDD). Methods: This was a cross-sectional study conducted at an urban, clinical sleep medicine outpatient center. We recruited newly diagnosed, Caucasian adults who had recently undergone nocturnal polysomnography. We compared body mass index (BMI), body composition (bioelectrical impedance analysis), neck circumference, sleepiness (Epworth Sleepiness Scale), lung function, and vitamin D status (serum 25-hydrpoxyvitamin D (25(OH)D) across OSAS severity categories and non-OSAS subjects. Next, using a case-control design, we compared measures of serum 25(OH)D from OSAS cases to non-OSAS controls who were matched for age, gender, skin pigmentation, sleepiness, season, and BMI. Results: 106 adults (77 male; median age = 54.5; median BMI = 34.3 kg/m2) resident in Dublin, Ireland (latitude 53°N) were recruited and categorized as non-OSAS or mild/moderate/severe OSAS. 98% of OSAS cases had insufficient 25(OH)D (< 75 nmol/L), including 72% with VDD (< 50 nmol/L). 25(OH)D levels decreased with OSAS severity (P = 0.003). 25(OH)D was inversely correlated with BMI, percent body fat, AHI, and nocturnal HR. Subsequent multivariate regression analysis revealed that 25(OH)D was independently associated with both AHI (P = 0.016) and nocturnal HR (P = 0.0419). Our separate case-control study revealed that 25(OH)D was significantly lower in OSAS cases than matched, non-OSAS subjects (P = 0.001). Conclusions: We observed widespread vitamin D deficiency and insufficiency in a Caucasian, OSAS population. There were significant, independent, inverse relationships between 25(OH)D and AHI as well as

  13. A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease

    PubMed Central

    Maeder, Micha T; Schoch, Otto D; Rickli, Hans

    2016-01-01

    Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA. PMID:27051291

  14. Macrophage Migration Inhibitory Factor Gene Polymorphisms and Plasma Levels in Children With Obstructive Sleep Apnea

    PubMed Central

    Khalyfa, Abdelnaby; Kheirandish-Gozal, Leila; Capdevila, Oscar Sans; Bhattacharjee, Rakesh; Gozal, David

    2012-01-01

    Introduction Obstructive sleep apnea (OSA) is associated with increased risk for cardiovascular and metabolic dysfunction in both adults and children. In adults with OSA, serum levels of macrophage migration inhibitory factor (MIF) are elevated. Therefore, we assessed plasma MIF levels and MIF allelic variant frequencies in children with and without OSA. Methods A total of 614 consecutive children ages 5–8 years were recruited. Children were divided into those with OSA and without OSA (NOSA) based on the apnea-hypopnea index (AHI). In addition to lipid profile, hsCRP, and fasting insulin and glucose levels, plasma MIF levels were assayed using ELISA, and 28 single-nucleotide polymorphisms (SNPs) covering the region were genotyped. Linkage disequilibrium and haplotype blocks were analyzed using Haploview version 4.2 software. Results Morning plasma MIF levels were increased in children with OSA. Of the 28 SNPs tested, the frequency of rs10433310 minor allele was significantly decreased in OSA. This SNP was also associated with reduced fasting insulin and hsCRP levels in OSA. The minor allele frequency of all other 27 SNPs was similar in OSA and NOSA groups. Conclusions Childhood OSA is associated with higher plasma MIF, hsCRP, and fasting insulin levels that promote cardiometabolic risk, and the MIF gene SNP rs10433310 may account for some the variance in such risk. PMID:22451332

  15. Recent advances of the impact of obstructive sleep apnea on systemic hypertension.

    PubMed

    Pedrosa, Rodrigo P; Krieger, Eduardo M; Lorenzi-Filho, Geraldo; Drager, Luciano F

    2011-08-01

    Obstructive sleep apnea (OSA) is a common clinical condition in the general population, especially among patients with cardiovascular diseases. More than just a local phenomenon of upper respiratory tract obstruction, OSA leads to systemic consequences that may include intermittent hypoxia, sudden reduction of the intrathoracic pressure, and the occurrence of micro-awakenings with sleep fragmentation. In the past decades, innumerous evidences have consistently pointed to OSA as an important factor related to the presence of cardiovascular diseases. In particular, the relationship between OSA and systemic hypertension (SH) is the one supported by the largest body of evidence. Currently, there are data suggesting that OSA is an important secondary cause of SH. More importantly, OSA is independently associated with poorer blood pressure control, changes in sleep dip, and presence of target-organ damage such as left ventricular hypertrophy and microalbuminuria. Randomized studies suggest that the management of OSA, especially with continuous positive airway pressure (CPAP) - which is considered the standard treatment for OSA - promotes a significant 24-hour blood pressure reduction, and this effect is more significant in the subgroup of patients with uncontrolled SH and drug-resistant SH. Despite all those evidences, OSA has still been underdiagnosed. The objective of this review is to discuss the recent advances in the pathophysiological mechanisms, clinical presentation, and treatment of OSA, as well as the benefits this treatment can bring on blood pressure. PMID:21359488

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

    PubMed

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

    2016-01-01

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

  17. Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension

    PubMed Central

    Min, Hyun Jin; Cho, Yang-Je; Kim, Chang-Hoon; Kim, Da Hee; Kim, Ha Yan; Choi, Ji In; Lee, Jeung-Gweon

    2015-01-01

    Purpose Resistant hypertension (HTN) occurs in 15-20% of treated hypertensive patients, and 70-80% of resistant hypertensive patients have obstructive sleep apnea (OSA). The characteristics of resistant HTN that predispose patients to OSA have not been reported. Therefore, we aimed to determine the clinical, laboratory, and polysomnographic features of resistant HTN that are significantly associated with OSA. Materials and Methods Hypertensive patients (n=475) who underwent portable polysomnography were enrolled. The patients were categorized into controlled (n=410) and resistant HTN (n=65) groups. The risk factors for the occurrence of OSA in controlled and resistant hypertensive patients were compared, and independent risk factors that are associated with OSA were analyzed. Results Out of 475 patients, 359 (75.6%) were diagnosed with OSA. The prevalence of OSA in resistant HTN was 87.7%, which was significantly higher than that in controlled HTN (73.7%). Age, body mass index, neck circumference, waist circumference, and hip circumference were significantly higher in OSA. However, stepwise multivariate analyses revealed that resistant HTN was not an independent risk factor of OSA. Conclusion The higher prevalence and severity of OSA in resistant HTN may be due to the association of risk factors that are common to both conditions. PMID:26256968

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

    PubMed Central

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

    2014-01-01

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

  19. The Association Between Obstructive Sleep Apnea and Depression in Older Adults

    PubMed Central

    Farajzadeh, Mohammad; Hosseini, Meimanat; Mohtashami, Jamileh; Chaibakhsh, Samira; Zagheri Tafreshi, Mansoureh; Ghanei Gheshlagh, Reza

    2016-01-01

    Background Depression is the most frequent psychiatric disorder among the elderly. Obstructive sleep apnea (OSA) is a chronic and prevalent disease that has an ambiguous role in triggering depression. Several researches with contradictory findings have been performed about the association between OSA and depression. Objectives This study aimed to investigate the association between OSA and depression among elderly. Patients and Methods A total of 350 home residing elderly took part in this case-control study. The participants were selected using clustering method. All cases were divided into two groups of depressed and non-depressed using the geriatric depression scale (GDS). Then they were matched in age, gender, education and body mass index (BMI). Berlin questionnaire (BQ) was used to diagnose OSA. Data analysis was performed using Mann-Whitney U test, t-test, Chi-square and Fisher’s exact tests and odds ratio. Results Totally, 60.6 % of depressed group and 18.9 % of non-depressed group were in high risk for OSA. A significant association was found between OSA and depression (P < 0.001, OR = 6.61, CI 95 % = 4.1 - 10.7). In addition, a significant association was found between gender and OSA (P = 0.008). Conclusions OSA was associated with depression among the elderly patients. Given the high prevalence of OSA in older adults, implementation of screening methods is necessary to identify people at high risk of OSA. PMID:27579333

  20. Obstructive Sleep Apnea and Hypertension in Adolescents: Effect on Neurobehavioral and Cognitive Functioning

    PubMed Central

    Madaeva, Irina; Polyakov, Vladimir; Kolesnikov, Sergey

    2016-01-01

    Background. There are limited published data in regard to the relationship between obstructive sleep apnea (OSA) and hypertension and neurobehavioral and mental status in adolescence. The aim of our study was to evaluate neurobehavioral patterns and cognitive functions in adolescents with hypertension according to absence or presence of OSA. Methods. This was a retrospective cohort study completed at the Scientific Center for Family Health and Human Reproduction Problems. Participants included adolescents aged 14–17 years and referred for 24-hour ambulance blood pressure monitoring (ABPM) and polysomnographic (PSG) studies between 2007 and 2009, inclusive. Results. 18 hypertensive OSA (the 1st group) and 20 hypertensive non-OSA adolescents (the 2nd group) were included in the study. Significant changes of neurobehavioral functioning in OSA patients were shown. Cognitive abilities also were impaired. Verbal and visual memory indexes and attention index were 2.1 and 2.2 times lower, accordingly, in the 1st group than in the 2nd group (P < 0.05). Speech index was significantly 2.8 times lower in OSA patients than in non-OSA patients (P < 0.05). In hypertensive OSA adolescents more significant Spearman correlations between classic sleep parameters and cognitive measures were found compared to patients without OSA. Conclusions. These results suggest that OSA is closely associated with neurobehavioral and cognitive functioning in hypertensive adolescents. PMID:27445534

  1. Obstructive Sleep Apnea and Hypertension in Adolescents: Effect on Neurobehavioral and Cognitive Functioning.

    PubMed

    Madaeva, Irina; Berdina, Olga; Polyakov, Vladimir; Kolesnikov, Sergey

    2016-01-01

    Background. There are limited published data in regard to the relationship between obstructive sleep apnea (OSA) and hypertension and neurobehavioral and mental status in adolescence. The aim of our study was to evaluate neurobehavioral patterns and cognitive functions in adolescents with hypertension according to absence or presence of OSA. Methods. This was a retrospective cohort study completed at the Scientific Center for Family Health and Human Reproduction Problems. Participants included adolescents aged 14-17 years and referred for 24-hour ambulance blood pressure monitoring (ABPM) and polysomnographic (PSG) studies between 2007 and 2009, inclusive. Results. 18 hypertensive OSA (the 1st group) and 20 hypertensive non-OSA adolescents (the 2nd group) were included in the study. Significant changes of neurobehavioral functioning in OSA patients were shown. Cognitive abilities also were impaired. Verbal and visual memory indexes and attention index were 2.1 and 2.2 times lower, accordingly, in the 1st group than in the 2nd group (P < 0.05). Speech index was significantly 2.8 times lower in OSA patients than in non-OSA patients (P < 0.05). In hypertensive OSA adolescents more significant Spearman correlations between classic sleep parameters and cognitive measures were found compared to patients without OSA. Conclusions. These results suggest that OSA is closely associated with neurobehavioral and cognitive functioning in hypertensive adolescents. PMID:27445534

  2. Obstructive Sleep Apnea and Metabolic Syndrome in Spanish Population

    PubMed Central

    Barreiro, Bienvenido; Garcia, Luis; Lozano, Lourdes; Almagro, Pere; Quintana, Salvador; Alsina, Monserrat; Heredia, Jose Luis

    2013-01-01

    Obstructive sleep apnea (OSA) is a clinical picture characterized by repeated episodes of obstruction of the upper airway. OSA is associated with cardiovascular risk factors, some of which are components of metabolic syndrome (MS). Objectives: First, determine the prevalence of MS in patients with OSA visited in sleep clinic. Second, evaluate whether there is an independent association between MS components and the severity of OSA. Methods: Patients with clinical suspicion of OSA were evaluated by polysomnography. Three groups were defined according to apnea hypoapnea index (AHI): no OSA (AHI <5), mild-moderate (AHI≥ 5 ≤30), and severe (AHI> 30). All patients were determined in fasting blood glucose, total cholesterol, HDL cholesterol, triglycerides and insulin. MS was defined according to criteria of National Cholesterol Education Program (NCEP). Results: A total of 141 patients (mean age 54 ± 11 years) were evaluated. According to AIH, 25 subjects had no OSA and 116 had OSA (41mild-moderate and 75 severe). MS prevalence ranged from 43-81% in OSA group. Also, a significant increase in waist circumference, triglycerides, glucose, blood pressure levels, and a decrease in HDL cholesterol levels was observed in more severe OSA patients. All polysomnographic parameters correlated significantly with metabolic abnormalities. After a multiple regression analysis, abdominal obesity (p <0.02), glucose (p <0.01) and HDL cholesterol (p <0.001) were independently associated with OSA. Conclusions: Our findings show high prevalence of MS in OSA, especially in severe group. A significant association between OSA and some of the components of MS was found in Spanish population. PMID:24222804

  3. Obstructive Sleep Apnea in Patients with Branch Retinal Vein Occlusion: A Preliminary Study

    PubMed Central

    Kwon, Hee Jung; Kang, Eui Chun; Lee, Junwon; Han, Jinu

    2016-01-01

    Purpose Our study aimed to determine whether obstructive sleep apnea (OSA) is common among branch retinal vein occlusion (BRVO) patients without systemic risk factors using a Watch PAT-100 portable monitoring device. Methods The study participants included consecutive patients with BRVO of less than 3 months duration without any risk factors known to be associated with OSA (diabetes, coronary artery disease, stroke, hematologic diseases, autoimmune disease, etc.) except for hypertension. All patients underwent full-night unattended polysomnography by means of a portable monitor Watch PAT-100 device. The apnea-hypopnea index (AHI) was calculated as the average number of apnea and hypopnea events per hour of sleep, and an AHI score of five or more events was diagnosed as OSA. Results Among 19 patients (6 males and 13 females), 42.1% (8 of 19) had an AHI reflective of OSA. In the 13 patients who had no concurrent illness, including hypertension, 30.8% (4 of 13) had positive test results for OSA; three of these patients were ranked as mild OSA, while one had moderate OSA. The OSA group had an average AHI of 12.3 ± 7.8, and the average AHI was 2.0 ± 0.9 in the non-OSA group. Although it was not statistically proven, we found that OSA patients experienced a more severe form of BRVO. Conclusions We found a higher than expected rate of OSA in BRVO patients lacking concomitant diseases typically associated with OSA. Our findings suggest that OSA could be an additional risk factor in the pathogenesis of BRVO or at least a frequently associated condition that could function as a triggering factor. PMID:27051260

  4. Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention

    PubMed Central

    Zhang, Jun-jie; Gao, Xiao-fei; Ge, Zhen; Jiang, Xiao-Min; Xiao, Ping-xi; Tian, Nai-liang; Kan, Jing; Lee, Chi-Hang; Chen, Shao-Liang

    2016-01-01

    Background There is a paucity of evidence regarding the association between obstructive sleep apnea (OSA) and patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease. We sought to investigate whether OSA affects the clinical outcomes of patients undergoing PCI. Patients and methods All enrolled individuals treated with PCI were evaluated for OSA by polysomnography. The primary end point was defined as major adverse cardiac events (MACEs) at 2 years, including cardiac death, myocardial infarction (MI), and/or target vessel revascularization. Results A total of 340 consecutive patients undergoing PCI were assigned to the OSA (n=152, apnea–hypopnea index ≥15) and non-OSA (n=188, apnea–hypopnea index <15) groups. The incidence of OSA in patients with coronary artery disease undergoing PCI was 44.7%. Patients in the OSA group had more three-vessel disease (34.9%), increased number of total implanted stents (3.3±2.0), and longer total stent length (83.8±53.1 mm) when compared to the non-OSA group (23.4%, P=0.020; 2.8±1.9, P=0.007; 68.7±48.4, P=0.010). After a median follow-up of 2 years, the incidence of MACEs was significantly higher in patients with OSA (25.0% vs 16.0%, P=0.038), mainly driven by the increased periprocedural MI (19.2% vs 11.2%, P=0.038) in the OSA group. By Cox regression multivariable analysis, the independent predictor of MACEs was OSA (hazard ratio: 1.962, 95% confidence interval: 1.036–3.717, P=0.039). Conclusion There was a high prevalence of moderate-to-severe OSA in patients undergoing PCI, and OSA was associated with significantly increased MACE rate, mainly due to the increase in periprocedural MI rate. PMID:27284240

  5. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

    PubMed Central

    Chiner, Eusebi; Llombart, Mónica; Valls, Joan; Pastor, Esther; Sancho-Chust, José N.; Andreu, Ada Luz; Sánchez-de-la-Torre, Manuel; Barbé, Ferran

    2016-01-01

    Background We hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration. This study evaluated the association between OSA and CAP. Methods We performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group). The controls were matched according to age, sex and body mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale (ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests. Findings No significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI) ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29–6·44, p = 0·01). Patients with severe OSA (AHI≥30) also had a higher risk of CAP (OR = 3·18, 95%CI 1·11–11·56, p = 0·047). In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007). Furthermore, OSA was significantly associated with CAP severity (p = 0·0002), and OSA severity was also associated with CAP severity (p = 0·0006). Conclusions OSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk

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

    PubMed

    Dursunoğlu, Neşe; Dursunoğlu, Dursun

    2005-01-01

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

  7. Obstructive sleep apnea and cancer: effects of intermittent hypoxia?

    PubMed

    Kukwa, Wojciech; Migacz, Ewa; Druc, Karolina; Grzesiuk, Elzbieta; Czarnecka, Anna M

    2015-01-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by pauses in regular breathing. Apneic episodes lead to recurrent hypoxemia-reoxygenation cycles with concomitant cellular intermittent hypoxia. Studies suggest that intermittent hypoxia in OSA may influence tumorigenesis. This review presents recent articles on the potential role of OSA in cancer development. Relevant research has focused on: molecular pathways mediating the influence of intermittent hypoxia on tumor physiology, animal and epidemiological human studies linking OSA and cancer. Current data relating OSA to risk of neoplastic disease remain scarce, but recent studies reveal the potential for a strong relation. More work is, therefore, needed on the impact of OSA on many cancer-related aspects. Results may offer enlightenment for improved cancer diagnosis and treatment. PMID:26562000

  8. A modified oxic-settling-anaerobic activated sludge process using gravity thickening for excess sludge reduction

    NASA Astrophysics Data System (ADS)

    Wang, Jun; Li, Shi-Yu; Jiang, Feng; Wu, Ke; Liu, Guang-Li; Lu, Hui; Chen, Guang-Hao

    2015-09-01

    Oxic-settling-anaerobic process (OSA) was known as a cost-effective way to reduce the excess sludge production with simple upgrade of conventional activated sludge process (CAS). A low oxidation-reduction potential (ORP) level was the key factor to sludge decay and lysis in the sludge holding tank of the OSA process. However, the ORP control with nitrogen purge or chemical dosing in the OSA process would induce extra expense and complicate the operation. Hence, in this study, a sludge holding tank using gravity thickening was applied to OSA process to reduce the excess sludge production without any ORP control. Results showed that the modified OSA process not only reduced the excess sludge production effectively but also improved the sludge settleability without affected the treatment capacity. The reduction of the excess sludge production in the modified OSA process resulted from interactions among lots of factors. The key element of the process was the gravity thickening sludge holding tank.

  9. Functional Role of Neural Injury in Obstructive Sleep Apnea

    PubMed Central

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

    2012-01-01

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

  10. Whole blood hypoxia-related gene expression reveals novel pathways to obstructive sleep apnea in humans.

    PubMed

    Perry, Juliana C; Guindalini, Camila; Bittencourt, Lia; Garbuio, Silverio; Mazzotti, Diego R; Tufik, Sergio

    2013-12-01

    In this study, our goal was to identify the key genes that are associated with obstructive sleep apnea (OSA). Thirty-five volunteers underwent full in-lab polysomnography and, according to the sleep apnea hypopnea index (AHI), were classified into control, mild-to-moderate OSA and severe OSA groups. Severe OSA patients were assigned to participate in a continuous positive airway pressure (CPAP) protocol for 6 months. Blood was collected and the expression of 84 genes analyzed using the RT(2) Profiler™ PCR array. Mild-to-moderate OSA patients demonstrated down-regulation of 2 genes associated with induction of apoptosis, while a total of 13 genes were identified in severe OSA patients. After controlling for body mass index, PRPF40A and PLOD3 gene expressions were strongly and independently associated with AHI scores. This research protocol highlights a number of molecular targets that might help the development of novel therapeutic strategies. PMID:23994550

  11. Cardiovascular consequences of obstructive sleep apnoea.

    PubMed

    Kuniyoshi, Fatima H Sert; Pusalavidyasagar, Snigdha; Singh, Prachi; Somers, Virend K

    2010-02-01

    Obstructive sleep apnoea (OSA) is a form of sleep disordered breathing with a high prevalence rate and is often underdiagnosed. OSA is associated with hypertension, coronary artery disease, stroke, peripheral vascular disease, heart failure, and arrhythmias. The presence of OSA may be a strong predictor of fatal cardiovascular events in patients with cardiovascular disease (CVD). Increased sympathetic drive, activation of metabolic and inflammatory markers, and impaired vascular function are some of the proposed mechanisms that could explain the association between OSA and cardiovascular diseases. Understanding these mechanisms is important for identifying treatment strategies. The presence of OSA should be considered in clinical practice, especially in patients with CVD. Randomized intervention studies are needed to establish whether early identification and treatment of OSA patients reduces cardiovascular morbidity. PMID:20308745

  12. Potential therapeutic targets in obstructive sleep apnoea

    PubMed Central

    Saboisky, Julian P; Chamberlin, Nancy L; Malhotra, Atul

    2009-01-01

    Obstructive sleep apnoea (OSA) is a disease of ever-increasing importance due to its association with multiple impairments and rising prevalence in an increasingly susceptible demographic. The syndrome is linked with loud snoring, disrupted sleep and observed apnoeas. Serious co-morbidities associated with OSA appear to be reversed by continuous positive airway pressure (CPAP) treatment; however, CPAP is variably tolerated leaving many patients untreated and emphasising the need for alternative treatments. Virtually all OSA patients have airways that are anatomically vulnerable to collapse, but numerous pathophysiological factors underlie when and how OSA is manifested. This review describes how the complexity of OSA requires multiple treatment approaches that are individually targeted. This approach may take the form of more specific diagnoses in terms of the mechanisms underlying OSA as well as rational pharmacological treatment directed toward such disparate ends as arousal threshold and ventilatory control/chemosensitivity, and mechanical treatment in the form of surgery and augmentation of lung volumes. PMID:19530985

  13. Consequences of obstructive sleep apnoea syndrome on left ventricular geometry and diastolic function.

    PubMed

    Bodez, Diane; Damy, Thibaud; Soulat-Dufour, Laurie; Meuleman, Catherine; Cohen, Ariel

    2016-01-01

    Obstructive sleep apnoea syndrome (OSAS) is a frequent sleep disorder that is known to be an independent risk factor for arterial hypertension (AHT). Potential confounding factors associated with both OSAS and AHT, such as age, diabetes mellitus and obesity, have been explored extensively, and are considered as independent but additive factors. However, these factors are also contributors to left ventricular (LV) hypertrophy (LVH) and LV diastolic dysfunction, both of which are important causes of cardiovascular morbidity, and have been reported to be associated with OSAS for decades. In this review, we present an overview of how OSAS may promote changes in LV geometry and diastolic dysfunction through its best-known cardiovascular complication, arterial hypertension. We also summarize the epidemiological links between OSAS and LVH, outline diastolic dysfunction in OSAS patients, and try to highlight the mechanisms responsible, focusing on the effect of confounding factors. PMID:27344377

  14. [Variable magnetic field of 8 Hz corrects the opioid system activity in mollusks behind the ferromagnetic screening].

    PubMed

    Temur'iants, N A; Kostiuk, A S

    2014-01-01

    The three phases of mollusk nociception alteration as a result of extended ferromagnetic screening combined with exposure to a variable magnetic field of 8 Hz correlated with phase changes in the opioid system activity (OSA) deduced from the naloxone action on the thermal avoidance response. On phase I, OSA inactivation was inhibited and, consequently, hyperalgesia progression was expedited. On phase II, OSA rose so that naloxone annulled completely the antinociceptive effect produced by the ferromagnetic screening. On phase III, OSA declined progressively, as naloxone merely reduced the antinociceptive effect because of apparently, growing OSA tolerance to the ferromagnetic screening. Phase I was absent when mollusks were exposed to the ferromagnetic screening and variable magnetic field; however, OSA changes on phases II and III were present. It was concluded that the variable magnetic field of 8 Hz can be used for correcting changes in the opioid system activity in mollusks behind the ferromagnetic screening. PMID:25163338

  15. A modified oxic-settling-anaerobic activated sludge process using gravity thickening for excess sludge reduction

    PubMed Central

    Wang, Jun; Li, Shi-Yu; Jiang, Feng; Wu, Ke; Liu, Guang-Li; Lu, Hui; Chen, Guang-Hao

    2015-01-01

    Oxic-settling-anaerobic process (OSA) was known as a cost-effective way to reduce the excess sludge production with simple upgrade of conventional activated sludge process (CAS). A low oxidation-reduction potential (ORP) level was the key factor to sludge decay and lysis in the sludge holding tank of the OSA process. However, the ORP control with nitrogen purge or chemical dosing in the OSA process would induce extra expense and complicate the operation. Hence, in this study, a sludge holding tank using gravity thickening was applied to OSA process to reduce the excess sludge production without any ORP control. Results showed that the modified OSA process not only reduced the excess sludge production effectively but also improved the sludge settleability without affected the treatment capacity. The reduction of the excess sludge production in the modified OSA process resulted from interactions among lots of factors. The key element of the process was the gravity thickening sludge holding tank. PMID:26350761

  16. An algorithm of dental/dentofacial-based options for managing patients with obstructive sleep apnoea referred to a dentist/dental specialist by a physician.

    PubMed

    Kılınç, D D; Didinen, S

    2016-07-01

    There are so many documents in the literature discoursing the aetiology, nature, diagnosis and treatment planning of obstructive sleep apnoea (OSA). Almost all of them mention that OSA has to be evaluated and treated through the multidisciplinary teamwork of physicians and dentists. Due to a lack in the literature, this article focuses on dentists' and dental specialists' role in the treatment algorithm of OSA. PMID:27388089

  17. Age-Group-Specific Associations between the Severity of Obstructive Sleep Apnea and Relevant Risk Factors in Male and Female Patients

    PubMed Central

    Deng, Xingqi; Gu, Wei; Li, Yanyan; Liu, Mei; Li, Yan; Gao, Xiwen

    2014-01-01

    Aim To seek accurate and credible correlation manner between gender, age, and obesity; and the severity of obstructive sleep apnea (OSA) in large-scale population. Methods Totals of 1,975 male and 378 female OSA patients were sequentially recruited. Centralized covariant tendencies between age, body mass index (BMI), and waist hip ratio (WHR); and OSA severity, were explored in a gender-specific manner via multiple statistical analyses. The accuracies of observed correlations were further evaluated by adaptive multiple linear regression. Results All of age, BMI, WHR, smoking, drinking, and OSA severity differed between males and females. BMI and WHR were positively and (approximately) linearly associated with OSA severity in both males and females. Restricted cubic spline analysis was more effective than was the Pearson correlation approach in correlating age with AHI, and provided age crossover points allowing further piecewise linear modeling for both males and females. Multiple linear regression showed that increasing age was associated with OSA exacerbation in males aged ≤40 years and in females aged 45–53 years. BMI, WHR, and diabetes were independently associated with OSA severity in males with age-group-specific pattern. In females, only BMI was associated with OSA severity at all ages. Conclusions In male patients, BMI and WHR are prominent risk factors for OSA exacerbation. Age and diabetes are associated with OSA severity in males of particular ages. In females, BMI is also a prominent risk factor for severe OSA, and OSA severity increased with age in the range 45–53 years. PMID:25211035

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

    PubMed Central

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

    2014-01-01

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

  19. Consensus & Evidence-based INOSA Guidelines 2014 (First edition).

    PubMed

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

    2015-01-01

    Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or ≥ 15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy. PMID:26410986

  20. Sleep · 8: Paediatric obstructive sleep apnoea

    PubMed Central

    Nixon, G; Brouillette, R

    2005-01-01

    In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research. PMID:15923253

  1. Anthropometric and craniofacial sexual dimorphism in obstructive sleep apnea patients: is there male-female phenotypical convergence?

    PubMed

    Perri, Rita A; Kairaitis, Kristina; Wheatley, John R; Amis, Terence C

    2015-02-01

    Obstructive sleep apnea (OSA) is more common in men than women. Body size is greater in males (sexual dimorphism), but large body habitus is associated with OSA for both genders. We speculated that male-female phenotypical convergence (reduced sexual dimorphism via identical phenotype acquisition) occurs with OSA and tested hypotheses: (1) phenotypical features pathogenic for OSA differ between OSA and healthy subjects irrespective of gender; and (2) such characteristics exhibit phenotypical convergence. Utilizing an existing database, we calculated male-female (group average) ratios for eight anthropometric and 33 surface cephalometric variables from 104 Caucasian OSA patients [72 males; apnea-hypopnea index (events h(-1) ): males: 42.3 ± 24.7 versus females: 42.6 ± 26.1 (P > 0.9)] and 85 Caucasian, healthy, non-OSA, community volunteers (36 males). Log-transformed data were analysed using a general linear model with post-hoc unpaired t-tests and significance at P < 0.0012 (Bonferroni multiple-comparison correction). OSA patients were older (56.9 ± 14.4 versus 38.0 ± 13.8 years), but there were no within-group gender-based age differences. All anthropometric variables (except height), plus cranial base width, mandibular breadth and retromandibular width diagonal were larger in gender-matched OSA versus healthy comparisons; thus satisfying hypothesis (1). Male-female ratios were mostly >1.0 across groups, but with no significant group × gender interactions no variable satisfied hypothesis (2). Thus, in this exploratory study, OSA patients had gender-common phenotypical differences to healthy subjects, but sexual dimorphism was preserved. Lack of complete phenotypical convergence may indicate gender-based critical phenotype-level attainment for OSA and/or gender-based OSA prevalence arises from factors other than those in this study. PMID:25113616

  2. A longitudinal study of CPAP therapy for patients with chronic cough and obstructive sleep apnoea

    PubMed Central

    2013-01-01

    Background Chronic cough patients are rendered therapies for gastro-esophageal reflux (GERD), upper airway cough syndrome (UACS) and cough-variant asthma (CVA) with varying benefit. Idiopathic or unexplained cough has emerged as an important clinical entity in both primary care and subspecialty clinics. Recent evidence points to a link between chronic cough and untreated obstructive sleep apnea (OSA). Methods A prospective observational study was done to evaluate the effect of OSA therapy in patients with chronic cough. Patients enrolled into the study underwent questionnaires to evaluate for GERD, UACS and CVA along with screening questionnaires for OSA and daytime sleepiness. The Leicester cough questionnaire (LCQ) was done at baseline and during serial visits to evaluate cough intensity and was used as the primary outcome measure of the effect of CPAP therapy on chronic cough. Results Out of 37 patients enrolled into the study, only 28 patients had follow up LCQ scores available and therefore underwent analysis. 22/28 patients were suspected to have OSA based on abnormal STOP-BANG screening questionnaire scores and overnight oximetry abnormalities. Of these 19/28 patients had overnight attended polysomnography with definitive diagnosis of OSA yielding a 68% prevalence of OSA in our chronic cough population. Chronic cough patients treated for OSA tended to be older with a significantly higher BMI than chronic cough patients without OSA. Significant improvement of LCQ scores occurred with CPAP therapy for OSA in chronic cough patients. Conclusion OSA is significantly prevalent in chronic cough patients. Subjects with chronic cough and OSA tend to be older and obese. Treatment of OSA in chronic cough patients yields significant improvement in their health status. PMID:23845135

  3. Which components of the CHA2DS2-VASc score are the most important in obstructive sleep apnea patients with atrial fibrillation?

    PubMed

    Platek, Anna E; Szymanski, Filip M; Filipiak, Krzysztof J; Kotkowski, Marcin; Karpinski, Grzegorz; Opolski, Grzegorz

    2016-04-01

    Elevated thromboembolic risk is observed in patients with atrial fibrillation. The arrhythmia often co-exists with other diseases like obstructive sleep apnea (OSA), which adds to the thrombogenic profile and makes the proper assessment of thromboembolic risk difficult. The aim of the study was to establish how the prevalence of thromboembolic risk factors differs in patients with and without OSA. CHA2DS2-VASc score was used to assess thromboembolic risk in continuous atrial fibrillation patients prequalified for atrial fibrillation ablation. All 266 patients included in the study had a polygraphy examination. Patients were divided into a group with apnea-hypopnea index (AHI) <15/h, and those with AHI 15/h or above, who were considered as having OSA. The study population was aged 57.6 ± 10.1 years, and 65.0% of the subjects were male. OSA was diagnosed in 47 patients. In OSA patients, the following CHA2DS2-VASc risk factors had significantly higher prevalence: congestive heart failure (6.5 vs. 0.5%; P = 0.02), arterial hypertension (93.5 vs. 70.9%; P = 0.01), diabetes mellitus (26.1 vs. 6.8%; P = 0.003), and history of vascular disease (23.9 vs. 8.2%; P = 0.006) than in non-OSA patients. Nonsignificant differences were noticed in the history of stroke, age categories, or sex. After dividing patients into four groups, that is non-OSA, mild OSA, moderate OSA, and severe OSA the same risk factors as previously stated remained significant (P < 0.05). The strongest contributors, responsible for elevated thromboembolic risk observed in atrial fibrillation patients with OSA are congestive heart failure, arterial hypertension, diabetes mellitus, and vascular disease. Higher comorbidity burden is another argument for including OSA into the risk assessment schemes in atrial fibrillation patients. PMID:27023880

  4. Consensus & evidence-based INOSA Guidelines 2014 (first edition).

    PubMed

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

    2014-09-01

    Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy. PMID:25366217

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

    PubMed

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

    2015-01-01

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

  6. Consensus & Evidence-based INOSA Guidelines 2014 (First edition)

    PubMed Central

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

    2014-01-01

    Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy. PMID:25366217

  7. Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma

    PubMed Central

    Taillé, Camille; Rouvel-Tallec, Anny; Stoica, Maria; Danel, Claire; Dehoux, Monique; Marin-Esteban, Viviana; Pretolani, Marina; Aubier, Michel; d’Ortho, Marie-Pia

    2016-01-01

    Background Obstructive sleep apnoea (OSA) is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA. Materials and Methods An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM) thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies. Results In total, 27/55 patients (49%) had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2±1.6 event/h [5–35]), the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8±0.4 vs. 7.8±0.4 μm, p<0.05). RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05). OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment. Conclusion Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling. PMID:26934051

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

    PubMed Central

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

    2015-01-01

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

  9. Effects of obstructive sleep apnoea risk on postoperative respiratory complications: protocol for a hospital-based registry study

    PubMed Central

    Shin, Christina H; Zaremba, Sebastian; Devine, Scott; Nikolov, Milcho; Kurth, Tobias; Eikermann, Matthias

    2016-01-01

    Introduction Obstructive sleep apnoea (OSA), the most common type of sleep-disordered breathing, is associated with significant immediate and long-term morbidity, including fragmented sleep and impaired daytime functioning, as well as more severe consequences, such as hypertension, impaired cognitive function and reduced quality of life. Perioperatively, OSA occurs frequently as a consequence of pre-existing vulnerability, surgery and drug effects. The impact of OSA on postoperative respiratory complications (PRCs) needs to be better characterised. As OSA is associated with significant comorbidities, such as obesity, pulmonary hypertension, myocardial infarction and stroke, it is unclear whether OSA or its comorbidities are the mechanism of PRCs. This project aims to (1) develop a novel prediction score identifying surgical patients at high risk of OSA, (2) evaluate the association of OSA risk on PRCs and (3) evaluate if pharmacological agents used during surgery modify this association. Methods Retrospective cohort study using hospital-based electronic patient data and perioperative data on medications administered and vital signs. We will use data from Partners Healthcare clinical databases, Boston, Massachusetts. First, a prediction model for OSA will be developed using OSA diagnostic codes and polysomnography procedural codes as the reference standard, and will be validated by medical record review. Results of the prediction model will be used to classify patients in the database as high, medium or low risk of OSA, and we will investigate the effect of OSA on risk of PRCs. Finally, we will test whether the effect of OSA on PRCs is modified by the use of intraoperative pharmacological agents known to increase upper airway instability, including neuromuscular blockade, neostigmine, opioids, anaesthetics and sedatives. Ethics and dissemination The Partners Human Research Committee approved this study (protocol number: 2014P000218). Study results will be made

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

    PubMed Central

    Lindberg, Eva

    2015-01-01

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

  11. Distinct severity stages of obstructive sleep apnoea are correlated with unique dyslipidaemia: large-scale observational study

    PubMed Central

    Guan, Jian; Yi, Hongliang; Zou, Jianyin; Meng, Lili; Tang, Xulan; Zhu, Huaming; Yu, Dongzhen; Zhou, Huiqun; Su, Kaiming; Yang, Mingpo; Chen, Haoyan; Shi, Yongyong; Wang, Yue; Wang, Jian; Yin, Shankai

    2016-01-01

    Background Dyslipidaemia is an intermediary exacerbation factor for various diseases but the impact of obstructive sleep apnoea (OSA) on dyslipidaemia remains unclear. Methods A total of 3582 subjects with suspected OSA consecutively admitted to our hospital sleep centre were screened and 2983 (2422 with OSA) were included in the Shanghai Sleep Health Study. OSA severity was quantified using the apnoea–hypopnea index (AHI), the oxygen desaturation index and the arousal index. Biochemical indicators and anthropometric data were also collected. The relationship between OSA severity and the risk of dyslipidaemia was evaluated via ordinal logistic regression, restricted cubic spline (RCS) analysis and multivariate linear regressions. Results The RCS mapped a nonlinear dose–effect relationship between the risk of dyslipidaemia and OSA severity, and yielded knots of the AHI (9.4, 28.2, 54.4 and 80.2). After integrating the clinical definition and RCS-selected knots, all subjects were regrouped into four AHI severity stages. Following segmented multivariate linear modelling of each stage, distinguishable sets of OSA risk factors were quantified: low-density lipoprotein cholesterol (LDL-C), apolipoprotein E and high-density lipoprotein cholesterol (HDL-C); body mass index and/or waist to hip ratio; and HDL-C, LDL-C and triglycerides were specifically associated with stage I, stages II and III, and stages II–IV with different OSA indices. Conclusions Our study revealed the multistage and non-monotonic relationships between OSA and dyslipidaemia and quantified the relationships between OSA severity indexes and distinct risk factors for specific OSA severity stages. Our study suggests that a new interpretive and predictive strategy for dynamic assessment of the risk progression over the clinical course of OSA should be adopted. PMID:26883674

  12. Associations between Cardioembolic Stroke and Obstructive Sleep Apnea

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  14. Liking for high fat foods in patients with Obstructive Sleep Apnoea.

    PubMed

    Smith, Simon S; Waight, Catherine; Doyle, Geoffrey; Rossa, Kalina R; Sullivan, Karen A

    2014-07-01

    Excess weight and obesity are factors that are strongly associated with risk for Obstructive Sleep Apnoea (OSA). Weight loss has been associated with improvements in clinical indicators of OSA severity; however, patients' beliefs about diet change have not been investigated. This study utilized a validated behaviour change model to estimate the relationship between food liking, food intake and indices of OSA severity. Two-hundred and six OSA patients recruited from a Sleep Disorders Clinic completed standardized questionnaires of: a) fat and fibre food intake, food liking, and food knowledge and; b) attitudes and intentions towards fat reduction. OSA severity and body mass index (BMI) were objectively measured using standard clinical guidelines. The relationship between liking for high fat food and OSA severity was tested with hierarchical regression. Gender and BMI explained a significant 20% of the variance in OSA severity, Fibre Liking accounted for an additional 6% (a negative relationship), and Fat Liking accounted for a further 3.6% of variance. Although the majority of individuals (47%) were currently "active" in reducing fat intake, overall the patients' dietary beliefs and behaviours did not correspond. The independent relationship between OSA severity and liking for high fat foods (and disliking of high fibre foods) may be consistent with a two-way interaction between sleep disruption and food choice. Whilst the majority of OSA patients were intentionally active in changing to a healthy diet, further emphasis on improving healthy eating practices and beliefs in this population is necessary. PMID:24699392

  15. BMI1 Is Expressed in Canine Osteosarcoma and Contributes to Cell Growth and Chemotherapy Resistance

    PubMed Central

    Gandour-Edwards, Regina; Withers, Sita S.; Holt, Roseline; Rebhun, Robert B.

    2015-01-01

    BMI1, a stem cell factor and member of the polycomb group of genes, has been shown to contribute to growth and chemoresistance of several human malignancies including primary osteosarcoma (OSA). Naturally occurring OSA in the dog represents a large animal model of human OSA, however the potential role of BMI1 in canine primary and metastatic OSA has not been examined. Immunohistochemical staining of canine primary and metastatic OSA tumors revealed strong nuclear expression of BMI1. An identical staining pattern was found in both primary and metastatic human OSA tissues. Canine OSA cell lines (Abrams, Moresco, and D17) expressed high levels of BMI1 compared with canine osteoblasts and knockdown or inhibition of BMI1 by siRNA or by small molecule BMI1-inhibitor PTC-209 demonstrated a role for BMI1 in canine OSA cell growth and resistance to carboplatin and doxorubicin chemotherapy. These findings suggest that inhibition of BMI1 in primary or metastatic OSA may improve response to chemotherapy and that the dog may serve as a large animal model to evaluate such therapy. PMID:26110620

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

    PubMed

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

    2014-12-01

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

  17. Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients with Cirrhosis

    PubMed Central

    Bajaj, Jasmohan S; Thacker, Leroy R; Leszczyszyn, David; Taylor, Samuel A; Heuman, Douglas M; Raman, Shekar; Sterling, Richard K; Siddiqui, Muhammad S; Stravitz, R Todd; Sanyal, Arun J; Puri, Puneet; Luketic, Velimir; Matherly, Scott; Fuchs, Michael; White, Melanie B; Noble, Nicole A; Unser, Ariel B; Wade, James B

    2014-01-01

    Background & Aims: In patients with cirrhosis, sleep disturbances are assumed to result from hepatic encephalopathy (HE). The effects of obstructive sleep apnea (OSA) on cognition, sleep parameters, or driving in patients with cirrhosis are unclear. Methods: We performed a cross-sectional, prospective study of 118 subjects. Subjects were assigned to 1 of 4 groups: those with OSA and cirrhosis (without HE or ascites, n=34), those with only cirrhosis (n=30), those with only OSA only (n=29), and those without OSA or cirrhosis (controls, n=25). None of OSA patients were receiving continuous positive airway pressure (CPAP) therapy. Subjects underwent cognitive testing (paper–pencil tests for psychomotor speed and attention, as well as executive function tests), sleep assessment (daytime sleepiness and night-time sleep quality) and a monotonous driving simulation (worsening lane deviations over time indicate poor performance). We also tested patients with OSA, with cirrhosis (n=10) and without cirrhosis (n=7), before and after CPAP therapy. Results: Daytime sleepiness and sleep quality were worse in subjects in the OSA groups (with or without cirrhosis) than subjects with cirrhosis alone or controls. Of subjects with only OSA, 36% had impaired psychomotor speed and attention, compared to >60% of subjects in both cirrhosis groups. In contrast, executive function was uniformly worse in subjects with OSA, with or without cirrhosis, than groups without OSA. Simulator performance (lane deviations) worsened over time in both OSA groups. CPAP therapy significantly increased executive function and sleep quality, and reduced simulator lane deviations and sleepiness, in subjects with and without cirrhosis. After CPAP therapy, performance on the paper–pencil test performance improved significantly only in subjects with OSA without cirrhosis. Conclusion: OSA should be considered in evaluating sleep impairment in patients with cirrhosis. In patients with cirrhosis and OSA

  18. Sleep-disordered breathing in Down syndrome.

    PubMed

    Lal, Chitra; White, David R; Joseph, Jane E; van Bakergem, Karen; LaRosa, Angela

    2015-02-01

    OSA is associated with significant adverse outcomes with far-reaching health-care implications. OSA is much more common and severe in patients with Down syndrome (DS) than in the general population, yet there is a striking lack of literature in this area. In this review article, we have summarized the current state of knowledge and presented the available data on OSA in DS. The higher prevalence and severity of OSA in patients with DS may be related to unique upper airway anatomic features as well as increased risk for obesity, hypothyroidism, gastroesophageal reflux disease, and generalized hypotonia. Although many of the manifestations of OSA in patients with DS are similar to those seen in the general population, the relative morbidity is significantly higher. For individuals with DS who already face cognitive challenges, the added impact of OSA on cognitive function may hinder their ability to function independently and reach their full potential. Screening and evaluation for OSA should be done in children and adults with DS. Treatment of OSA in DS involves the use of CPAP, upper airway surgery, and dental appliances, along with weight-reduction strategies, nasal steroids, and oral leukotriene modifiers as adjunctive treatments. The treatment plan should be individualized for each patient with DS, taking into account age, comorbid conditions, and barriers to treatment adherence. Future research should aim to better characterize OSA, further evaluate neurocognitive outcomes, and evaluate the efficacy of treatments in patients with DS. PMID:25644910

  19. A Pediatric Grading Scale for Lingual Tonsil Hypertrophy.

    PubMed

    Friedman, Norman R; Prager, Jeremy D; Ruiz, Amanda G; Kezirian, Eric J

    2016-01-01

    Lingual tonsil hypertrophy (LTH) is a common finding for children with residual obstructive sleep apnea (OSA) following an adenotonsillectomy. Secondary to the significant morbidity associated with OSA, identification and treatment of residual OSA are paramount. A dedicated LTH grading scale for children does not exist. The current adult LTH scale is impractical for children. Imaging is not routine for children, since it frequently requires sedation. We present a pediatric LTH grading scale with substantial interrater reliability to facilitate standardization of endoscopy findings and promote outcomes-based research for OSA surgery in children. PMID:26307581

  20. Sleep Disordered Breathing: Hypertension and Cardiac Structure and Function.

    PubMed

    Querejeta Roca, Gabriela; Shah, Amil M

    2015-12-01

    Obstructive sleep apnea (OSA) is a common form of sleep disordered breathing and has a relatively high prevalence in the general population. The frequency and severity of OSA is associated with age, male sex, and obesity, and OSA has been linked to cardiovascular complications and death. Importantly, OSA has a strong association with both prevalent and incidental hypertension and has a particularly high prevalence in patients with resistant hypertension. In these patients, CPAP and other OSA-directed treatments have been proposed as therapy to help control blood pressure (BP), especially in patients who have not attained optimal BP control despite maximum pharmacological therapy. OSA has also been associated with alterations in cardiac structure and function, although most studies are small and highly limited in study design. Existing data suggest an association between OSA greater left ventricle (LV) mass and hypertrophy that appears independent of confounders including hypertension and obesity. Although less clear and more controversial, OSA severity has been linked to LV systolic and diastolic function, pulmonary hypertension, and right ventricular hypertrophy. Further studies are needed to confirm the potential causal role of OSA in these observed associations with cardiac abnormalities. PMID:26493391

  1. Perioperative sleep apnea: a real problem or did we invent a new disease?

    PubMed Central

    Zaremba, Sebastian; Mojica, James E.; Eikermann, Matthias

    2016-01-01

    Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery. PMID:27006758

  2. Clinical Issues-April 2016.

    PubMed

    Fearon, Mary C; Ogg, Mary J

    2016-04-01

    Creating a just culture Key words: just culture, TeamSTEPPS, human error, briefing, huddle. Circulating while administering moderate sedation/analgesia Key words: moderate sedation/analgesia, RN circulator. Monitoring RN leaving room during administration of moderate sedation Key words: moderate sedation/analgesia, propofol. Screening for obstructive sleep apnea before administering moderate sedation Key words: moderate sedation/analgesia, obstructive sleep apnea, OSA. Assessment for obstructive sleep apnea Key words: moderate sedation/analgesia, obstructive sleep apnea, OSA, OSA questionnaires, OSA checklist. PMID:27004508

  3. Obstructive sleep apnea and vascular disease

    PubMed Central

    Lanfranchi, Paola; Somers, Virend A

    2001-01-01

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

  4. Continuous positive airway pressure therapy is associated with improvement in overactive bladder symptoms in women with obstructive sleep apnea syndrome

    PubMed Central

    Ipekci, Tumay; Cetintas, Gulgun; Celik, Orcun; Sarac, Sema; Tunckiran, Ahmet; Ilbey, Yusuf Ozlem

    2016-01-01

    Introduction To evaluate the impact of continuous positive airway pressure (CPAP) therapy on overactive bladder (OAB) symptoms in women with obstructive sleep apnea syndrome (OSAS). Material and methods One-hundred and fifty women underwent an overnight polysomnography study between May 2014 and September 2014. Their voiding symptoms were evaluated using the OAB symptom score (OABSS) and International Consultation on Incontinence Questionnaire Short-Form at OSAS diagnosis and approximately 3-months after CPAP therapy. OSAS severity was assessed according to the apnea-hypopnea-index. Results We evaluated 140 women and 111 of them (79.3%) reported symptoms consistent with OAB. There were no statistically significant differences between OSAS severity with a prevalence of OAB (p = 0.92). The prevalence of urinary incontinence (UI) was 35.7% (n = 50) and 39.6% (n = 44) in all patients and patients with OAB, respectively. There were no statistically significant differences between UI with OAB (p = 0.58). Baseline OABSS is comparable between OSAS severity (p = 0.143). After 3-months CPAP therapy, OABSS and ICIQ-SF sum scores were significantly decreased in patients with severe and moderate OSAS (p <0.01), however, change of OABSS sum score was insignificant in patients with mild OSAS (p = 0.44). Conclusions CPAP therapy improves the OAB, OABSS and ICIQ-SF scores in women with severe and moderate OSAS. OSAS-induced OAB may be alleviated following CPAP therapy. PMID:27123331

  5. [Multisystemic involvement in obstructive sleep apnea].

    PubMed

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

    2014-06-01

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

  6. Uvulopalatopharyngoplasty (UPPP)

    MedlinePlus

    Palate surgery; Uvulopalatal flap procedure; UPPP; Laser-assisted uvulopalaplasty; Radiofrequency palatoplasty; Velopharyngeal insufficiency - UPPP; Obstructive sleep apnea - uvulopalaplasty; OSA - uvulopalaplasty

  7. Consequences of Obstructive Sleep Apnea in Children.

    PubMed

    Blechner, Michael; Williamson, Ariel A

    2016-01-01

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

  8. Obstructive Sleep Apnoea: From pathogenesis to treatment: Current controversies and future directions

    PubMed Central

    Eastwood, Peter R.; Malhotra, Atul; Palmer, Lyle J.; Kezirian, Eric J.; Horner, Richard L.; Ip, Mary S.; Thurnheer, Robert; Antic, Nick A.; Hillman, David R.

    2015-01-01

    Obstructive sleep apnoea (OSA) is a common disease, recognized as an independent risk factor for a range of clinical conditions, such as hypertension, stroke, depression and diabetes. Despite extensive research over the past two decades, the mechanistic links between OSA and other associated clinical conditions, including metabolic disorders and cardiovascular disease, remain unclear. Indeed, the pathogenesis of OSA itself remains incompletely understood. This review provides opinions from a number of leading experts on issues related to OSA and its pathogenesis, interaction with anaesthesia, metabolic consequences and comorbidities, cardiovascular disease, genetics, measurement and diagnosis, surgical treatment and pharmacotherapeutic targets. PMID:20136736

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

    PubMed

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

    2016-06-01

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

  10. Obstructive sleep apnoea in children with craniofacial syndromes

    PubMed Central

    Cielo, Christopher M.

    2014-01-01

    Summary Obstructive sleep apnoea syndrome (OSAS) is common in children. Craniofacial anomalies such as cleft palate are among the most common congenital conditions. Children with a variety of craniofacial conditions, including cleft palate, micrognathia, craniosynostosis, and midface hypoplasia are at increased risk for OSAS. Available evidence, which is largely limited to surgical case series and retrospective studies, suggests that OSAS can be successfully managed in these children through both surgical and non-surgical techniques. Prospective studies using larger cohorts of patients and including polysomnograms are needed to better understand the risk factors for this patient population and the efficacy of treatment options for OSAS and their underlying conditions. PMID:25555676

  11. The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

    PubMed Central

    Lee, Pi-Chang; Hwang, Betau; Soong, Wen-Jue; Meng, C. C. Laura

    2012-01-01

    Background. The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA. Methods. Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale. Results. The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery. Conclusion. This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale. PMID:22645449

  12. Cytotoxic action of Brazilian propolis in vitro on canine osteosarcoma cells.

    PubMed

    Cinegaglia, N C; Bersano, P R O; Búfalo, M C; Sforcin, J M

    2013-09-01

    Osteosarcoma (OSA) is a primary bone neoplasm frequently diagnosed in dogs. The biology of OSA in pet dogs is identical to that of pediatric patients, and it has been considered an excellent model in vivo to study human OSA. Since the individual response to chemotherapy is unpredictable and considering that propolis is a natural product with several biological properties, this work evaluated the cytotoxic action of propolis on canine OSA cells. The primary cell culture of canine OSA was obtained from the tumor of a dog with OSA. Cell viability was assessed after incubation with propolis, 70% ethanol (propolis solvent), and carboplatin after 6, 24, 48, and 72 h. Cell viability was analyzed by the crystal violet method. Data showed that canine OSA cells were sensitive to propolis in a dose- and time-dependent manner and had a distinct morphology compared to control. Its solvent (70% ethanol) had no effect on cell viability, suggesting that the cytotoxic action was exclusively due to propolis. Our propolis sample exerted a cytotoxic effect on canine OSA cells, and its introduction as a possible therapeutic agent in vivo could be investigated, providing a new contribution to OSA treatment. PMID:23074147

  13. Obstructive Sleep Apnea and Diabetic Nephropathy

    PubMed Central

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

    2013-01-01

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

  14. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis

    PubMed Central

    Auckley, Dennis; Ramachandran, Satya Krishna; Memtsoudis, Stavros; Mokhlesi, Babak

    2015-01-01

    Background Diagnosing obstructive sleep apnea (OSA) is clinically relevant because untreated OSA has been associated with increased morbidity and mortality. The STOP-Bang questionnaire is a validated screening tool for OSA. We conducted a systematic review and meta-analysis to determine the effectiveness of STOP-Bang for screening patients suspected of having OSA and to predict its accuracy in determining the severity of OSA in the different populations. Methods A search of the literature databases was performed. Inclusion criteria were: 1) Studies that used STOP-Bang questionnaire as a screening tool for OSA in adult subjects (>18 years); 2) The accuracy of the STOP-Bang questionnaire was validated by polysomnography—the gold standard for diagnosing OSA; 3) OSA was clearly defined as apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) ≥ 5; 4) Publications in the English language. The quality of the studies were explicitly described and coded according to the Cochrane Methods group on the screening and diagnostic tests. Results Seventeen studies including 9,206 patients met criteria for the systematic review. In the sleep clinic population, the sensitivity was 90%, 94% and 96% to detect any OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥15), and severe OSA (AHI ≥30) respectively. The corresponding NPV was 46%, 75% and 90%. A similar trend was found in the surgical population. In the sleep clinic population, the probability of severe OSA with a STOP-Bang score of 3 was 25%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the probability rose proportionally to 35%, 45%, 55% and 75%, respectively. In the surgical population, the probability of severe OSA with a STOP-Bang score of 3 was 15%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the probability increased to 25%, 35%, 45% and 65%, respectively. Conclusion This meta-analysis confirms the high performance of the STOP-Bang questionnaire in the sleep

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

    PubMed Central

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

    2016-01-01

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

  16. A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in drivers: A pilot study

    PubMed Central

    Quaranta, Vitaliano Nicola; Dragonieri, Silvano; Carratù, Pierluigi; Falcone, Vito Antonio; Carucci, Elisa; Ranieri, Teresa; Ventura, Valentina; Resta, Onofrio

    2016-01-01

    Background: Falling asleep behind the wheel is one of the most relevant consequences of obstructive sleep apnea (OSA). We created a new screening questionnaire, named the Driver Sleepiness Score (DSS), aiming to assess sleepiness in drivers with suspected OSA. The primary aim of our study was to evaluate sleepiness in drivers with a suspicion of OSA by the DSS in order to assess its correlation with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and total sleep time with oxyhemoglobin saturation below 90% (TST90). We also aimed to assess the diagnostic accuracy of DSS for three different cutoffs of AHI (AHI = 5, AHI = 15, AHI = 30), which allow stratification of the severity of OSA. Materials and Methods: Seventy-three driving patients at risk for OSA participated in the study. DSS and the Epworth Sleepiness Scale (ESS) were both administered in operator-dependent modality and in randomized sequence. Results: The DSS showed higher accuracy in screening patients with mild OSA [area under curve (AUC): 0.88 vs 0.74] and moderate OSA (AUC: 0.88 vs 0.79), whereas ESS showed higher accuracy in screening patients with severe OSA (AUC: 0.91 vs 0.78). A DSS score ≥ 7 is the optimal cutoff for distinguishing true positives from false positives for the presence of OSA and for its different severity levels. The administration of both questionnaires increases the accuracy for the detection of all OSA severity levels. Conclusions: If validated, DSS may qualify as a new screening tool specifically for drivers with the suspicion of having OSA, in combination with the ESS. PMID:26933301

  17. Support vector machines for automated recognition of obstructive sleep apnea syndrome from ECG recordings.

    PubMed

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

    2009-01-01

    Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular morbidity as well as excessive daytime sleepiness and poor quality of life. In this study, we apply a machine learning technique [support vector machines (SVMs)] for automated recognition of OSAS types from their nocturnal ECG recordings. A total of 125 sets of nocturnal ECG recordings acquired from normal subjects (OSAS - ) and subjects with OSAS (OSAS +), each of approximately 8 h in duration, were analyzed. Features extracted from successive wavelet coefficient levels after wavelet decomposition of signals due to heart rate variability (HRV) from RR intervals and ECG-derived respiration (EDR) from R waves of QRS amplitudes were used as inputs to the SVMs to recognize OSAS +/- subjects. Using leave-one-out technique, the maximum accuracy of classification for 83 training sets was found to be 100% for SVMs using a subset of selected combination of HRV and EDR features. Independent test results on 42 subjects showed that it correctly recognized 24 out of 26 OSAS + subjects and 15 out of 16 OSAS - subjects (accuracy = 92.85%; Cohen's kappa value of 0.85). For estimating the relative severity of OSAS, the posterior probabilities of SVM outputs were calculated and compared with respective apnea/hypopnea index. These results suggest superior performance of SVMs in OSAS recognition supported by wavelet-based features of ECG. The results demonstrate considerable potential in applying SVMs in an ECG-based screening device that can aid a sleep specialist in the initial assessment of patients with suspected OSAS. PMID:19129022

  18. Risk of Obstructive Sleep Apnea Lower in Double Reed Wind Musicians

    PubMed Central

    Ward, Christopher P.; York, Kaki M.; McCoy, John G.

    2012-01-01

    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

  19. Cumulative Association of Obstructive Sleep Apnea Severity and Short Sleep Duration with the Risk for Hypertension

    PubMed Central

    Priou, Pascaline; Le Vaillant, Marc; Meslier, Nicole; Paris, Audrey; Pigeanne, Thierry; Nguyen, Xuan-Lan; Alizon, Claire; Bizieux-Thaminy, Acya; Leclair-Visonneau, Laurene; Humeau, Marie-Pierre; Gagnadoux, Frédéric

    2014-01-01

    Obstructive sleep apnea (OSA) and short sleep duration are individually associated with an increased risk for hypertension (HTN). The aim of this multicenter cross-sectional study was to test the hypothesis of a cumulative association of OSA severity and short sleep duration with the risk for prevalent HTN. Among 1,499 patients undergoing polysomnography for suspected OSA, 410 (27.3%) previously diagnosed as hypertensive and taking antihypertensive medication were considered as having HTN. Patients with total sleep time (TST) <6 h were considered to be short sleepers. Logistic regression procedures were performed to determine the independent association of HTN with OSA and sleep duration. Considering normal sleepers (TST ≥6 h) without OSA as the reference group, the odds ratio (OR) (95% confidence intervals) for having HTN was 2.51 (1.35–4.68) in normal sleepers with OSA and 4.37 (2.18–8.78) in short sleepers with OSA after adjustment for age, gender, obesity, diabetes, depression, current smoking, use of thyroid hormones, daytime sleepiness, poor sleep complaint, time in bed, sleep architecture and fragmentation, and study site. The risk for HTN appeared to present a cumulative association with OSA severity and short sleep duration (p<0.0001 for linear trend). The higher risk for HTN was observed in short sleepers with severe OSA (AHI ≥30) (OR, 4.29 [2.03–9.07]). In patients investigated for suspected OSA, sleep-disordered breathing severity and short sleep duration have a cumulative association with the risk for prevalent HTN. Further studies are required to determine whether interventions to optimize sleep may contribute to lower BP in patients with OSA. PMID:25531468

  20. The Potential Association between Obstructive Sleep Apnea and Diabetic Retinopathy in Severe Obesity—The Role of Hypoxemia

    PubMed Central

    Banerjee, Dev; Leong, Wen Bun; Arora, Teresa; Nolen, Melissa; Punamiya, Vikas; Grunstein, Ron; Taheri, Shahrad

    2013-01-01

    Background Obstructive sleep apnea (OSA) is common in obese patients with type 2 diabetes mellitus (DM) and may contribute to diabetic microvascular complications. Methods To investigate the association between OSA, hypoxemia during sleep, and diabetic retinal complications in severe obesity. This was a prospective observational study of 93 obese patients mean (SD) age: 52(10) years; mean (SD) body mass index (BMI): 47.3(8.3) kg/m2) with DM undergoing retinal screening and respiratory monitoring during sleep. OSA was defined as apnea-hypopnea index (AHI) of ≥15 events/hour, resulting in two groups (OSA+ vs. OSA−). Results Forty-six patients were OSA+: median (95% CI) AHI = 37(23–74)/hour and 47 were OSA–ve (AHI = 7(4–11)/hour). Both groups were similar for ethnicity, BMI, cardiovascular co-morbidities, diabetes duration, HbA1c, and insulin treatment (p>0.05). The OSA+ group was significantly more hypoxemic. There was no significant difference between OSA+ and OSA− groups for the presence of retinopathy (39% vs. 38%). More OSA+ subjects had maculopathy (22% vs. 13%), but this did not reach statistical significance. Logistic regression analyses showed that AHI was not significantly associated with the presence of retinopathy or maculopathy (p>0.05). Whilst minimum oxygen saturation was not significantly associated with retinopathy, it was an independent predictor for the presence of maculopathy OR = 0.79 (95% CI: 0.65–0.95; p<0.05), after adjustment. Conclusions The presence of OSA, as determined by AHI, was not associated with diabetic retinal complications. In contrast, severity of hypoxemia during sleep (minimum oxygen saturations) may be an important factor. The importance of hypoxia in the development of retinal complications in patients with OSA remains unclear and further studies assessing the pathogenesis of hypoxemia in patients with OSA and diabetic retinal disease are warranted. PMID:24260240

  1. Topography-specific spindle frequency changes in Obstructive Sleep Apnea

    PubMed Central

    2012-01-01

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

  2. Obstructive sleep apnea in young infants with Down syndrome evaluated in a Down syndrome specialty clinic.

    PubMed

    Goffinski, Alida; Stanley, Maria A; Shepherd, Nicole; Duvall, Nichole; Jenkinson, Sandra B; Davis, Charlene; Bull, Marilyn J; Roper, Randall J

    2015-02-01

    Children with Down syndrome (DS) experience congenital and functional medical issues that predispose them to obstructive sleep apnea (OSA). Research utilizing stringent age criteria among samples of infants with DS and OSA is limited. This study examines clinical correlates of OSA among infants with DS. A retrospective chart review was conducted of infants ≤6 months of age referred to a DS clinic at a tertiary children's hospital over five-years (n = 177). Chi-square tests and binary logistic regression models were utilized to analyze the data. Fifty-nine infants underwent polysomnography, based on clinical concerns. Of these, 95% (56/59) had studies consistent with OSA. Among infants with OSA, 71% were identified as having severe OSA (40/56). The minimum overall prevalence of OSA among the larger group of infants was 31% (56/177). Significant relationships were found between OSA and dysphagia, congenital heart disease (CHD), prematurity, gastroesophageal reflux disease (GERD), and other functional and anatomic gastrointestinal (GI) conditions. Results indicate that odds of OSA in this group are higher among infants with GI conditions in comparison to those without. Co-occurring dysphagia and CHD predicted the occurrence of OSA in 36% of cases with an overall predictive accuracy rate of 71%. Obstructive sleep apnea is relatively common in young infants with DS and often severe. Medical factors including GI conditions, dysphagia and CHD may help to identify infants who are at greater risk and may warrant evaluation. Further studies are needed to assess the impact of OSA in infants with DS. PMID:25604659

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

    PubMed

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

    2016-04-01

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

  4. Neurobehavioral Functioning in Adolescents With and Without Obesity and Obstructive Sleep Apnea

    PubMed Central

    Xanthopoulos, Melissa S.; Gallagher, Paul R.; Berkowitz, Robert I.; Radcliffe, Jerilynn; Bradford, Ruth; Marcus, Carole L.

    2015-01-01

    Study Objectives: Children and adults with obstructive sleep apnea syndrome (OSAS) exhibit neurobehavioral abnormalities, but few studies have evaluated the transitional stage of adolescence. Obesity is also associated with neurobehavioral abnormalities, and many patients with OSAS are obese. However, the confounding effect of obesity on neurobehavioral abnormalities in adolescents with OSAS has not been evaluated. We hypothesized that obese adolescents with OSAS would exhibit more neurobehavioral abnormalities than obese and lean adolescents without OSAS. Design: Cross-sectional, case control. Setting: Sleep Center and community. Participants: Obese adolescents with OSAS compared to (1) nonsnoring, obese controls without OSAS, and (2) nonobese, nonsnoring controls. Interventions: Neurobehavioral evaluation. Measurements and Results: Obese adolescents with OSAS had significantly worse executive function and attention compared to both obese (P < 0.001) and lean (P < 0.001) controls, and more depression (P = 0.004) and externalizing symptoms than lean controls (P = 0.008). A higher percentage of participants in the OSAS group scored in the clinically abnormal range on executive functioning, attention, sleepiness, and behavioral functioning than lean controls. Mediation analyses indicated that level of sleep apnea significantly mediated the effect of body mass on executive functioning, attention, and behavior. Conclusions: Obese adolescents with OSAS show impaired executive and behavioral function compared to obese and lean controls, and are more likely to score in the clinically abnormal range on measures of neurobehavioral functioning. These results are especially concerning given that the frontal lobe is still developing during this critical age period. We speculate that untreated OSAS during adolescence may lead to significant neurobehavioral deficits in adulthood. Citation: Xanthopoulos MS, Gallagher PR, Berkowitz RI, Radcliffe J, Bradford R, Marcus CL

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

    PubMed Central

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

    2009-01-01

    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

  6. Biomarkers of cardiovascular stress in obstructive sleep apnea.

    PubMed

    Maeder, Micha T; Mueller, Christian; Schoch, Otto D; Ammann, Peter; Rickli, Hans

    2016-09-01

    Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder associated with "cardiovascular stress", i.e. cardiovascular risk factors, cardiovascular diseases, and an increased risk of heart failure, stroke, and death. Experimental and clinical studies have characterized potential underlying mechanisms including biventricular dysfunction, atherosclerosis, and arrhythmia. Assessment of these cardiovascular features of OSA requires a spectrum of clinical tools including ECG, echocardiography, exercise testing, and angiography. In contrast to many cardiovascular diseases, the role of blood biomarkers to characterize cardiovascular function and cardiovascular risk in OSA is poorly defined. In the present review we summarize the available data on biomarkers potentially providing information on cardiovascular features in OSA patients without overt cardiovascular disease. The vast majority of studies on biomarkers of cardiovascular stress in OSA evaluated B-type natriuretic peptide (BNP)/N-terminal-B-type natriuretic peptide (NT-proBNP), and cardiac troponins (cTn). Although some studies found significant associations between these cardiac biomarkers and the presence and severity of OSA, data remain conflicting. Also, the detailed pathophysiological mechanisms underlying the link between OSA and hemodynamic cardiac stress (BNP/NT-proBNP) and cardiomyocyte damage (cTn) are poorly understood. Major research efforts are required to establish the clinical role of cardiovascular biomarkers in patients with OSA. PMID:27380998

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

    PubMed Central

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

    2014-01-01

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

  8. Metabolomics Profiling for Obstructive Sleep Apnea and Simple Snorers

    PubMed Central

    Xu, Huajun; Zheng, Xiaojiao; Qian, Yingjun; Guan, Jian; Yi, Hongliang; Zou, Jianyin; Wang, Yuyu; Meng, Lili; Zhao, Aihua; Yin, Shankai; Jia, Wei

    2016-01-01

    Few clinical studies have explored altered urinary metabolite levels in patients with obstructive sleep apnea (OSA). Thus, we applied a metabolomics approach to analyze urinary metabolites in three groups of participants: patients with polysomnography (PSG)-confirmed OSA, simple snorers (SS), and normal subjects. Ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry and gas chromatography coupled with time-of-flight mass spectrometry were used. A total of 21 and 31 metabolites were differentially expressed in the SS and OSA groups, respectively. Patients with OSA had 18 metabolites different from those with SS. Of the 56 metabolites detected among the 3 groups, 24 were consistently higher or lower. A receiver operator curve analysis revealed that the combination of 4-hydroxypentenoic acid, arabinose, glycochenodeoxycholate-3-sulfate, isoleucine, serine, and xanthine produced a moderate diagnostic score with a sensitivity (specificity) of 75% (78%) for distinguishing OSA from those without OSA. The combination of 4-hydroxypentenoic acid, 5-dihydrotestosterone sulfate, serine, spermine, and xanthine distinguished OSA from SS with a sensitivity of 85% and specificity of 80%. Multiple metabolites and metabolic pathways associated with SS and OSA were identified using the metabolomics approach, and the altered metabolite signatures could potentially serve as an alternative diagnostic method to PSG. PMID:27480913

  9. Nano-encapsulation of coenzyme Q10 using octenyl succinic anhydride modified starch

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Octenyl succinic anhydride modified starch (OSA-ST) was used to encapsulate Coenzyme Q10 (CoQ10). CoQ10 was dissolved in rice bran oil (RBO), and incorporated into an aqueous OSA-ST solution. High pressure homogenization (HPH) of the mixture was conducted at 170 MPa for 5-6 cycles. The resulting ...

  10. Analysis of octenylsuccinate rice and tapioca starches: Distribution of octenylsuccinic anhydride groups in starch granules.

    PubMed

    Whitney, Kristin; Reuhs, Bradley L; Ovando Martinez, Maribel; Simsek, Senay

    2016-11-15

    Characterization of the fine structure of octenylsuccinic anhydride (OSA) starch would lead to a better understanding of functional properties. OSA rice and tapioca starches were analyzed using microscopy, liquid chromatography and nuclear magnetic resonance. Chain length distribution of amylopectin changed significantly (P<0.05) after OSA esterification. Weight averaged degree of polymerization (DPw) decreased significantly (P<0.05) from 16.47 to 13.29 and from 14.87 to 12.47 in native and OSA rice and tapioca starches, respectively. The chain length distribution of pure amylopectin fractions suggested that OSA groups were not present in the amylopectin portion of the starch. (1)H NMR analysis of pure amylose and amylopectin fractions indicated that OSA substitution was present only in amylose fractions of rice and tapioca starches. Esterification with 3% OSA results in starch that has OSA substituted mainly on amylose chains or possibly on amylopectin chains that have been hydrolyzed from the amylopectin molecules during esterification. PMID:27283674

  11. Obstructive Sleep Apnea

    PubMed Central

    Drager, Luciano F.; Polotsky, Vsevolod Y.

    2011-01-01

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

  12. Obstructive Sleep Apnea Syndrome: From Phenotype to Genetic Basis

    PubMed Central

    Casale, M; Pappacena, M; Rinaldi, V; Bressi, F; Baptista, P; Salvinelli, F

    2009-01-01

    Obstructive sleep apnea syndrome (OSAS) is a complex chronic clinical syndrome, characterized by snoring, periodic apnea, hypoxemia during sleep, and daytime hypersomnolence. It affects 4-5% of the general population. Racial studies and chromosomal mapping, familial studies and twin studies have provided evidence for the possible link between the OSAS and genetic factors and also most of the risk factors involved in the pathogenesis of OSAS are largely genetically determined. A percentage of 35-40% of its variance can be attributed to genetic factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAS phenotype. Although the role of specific genes that influence the development of OSAS has not yet been identified, current researches, especially in animal model, suggest that several genetic systems may be important. In this chapter, we will first define the OSAS phenotype, the pathogenesis and the risk factors involved in the OSAS that may be inherited, then, we will review the current progress in the genetics of OSAS and suggest a few future perspectives in the development of therapeutic agents for this complex disease entity. PMID:19794884

  13. The Interaction between Obstructive Sleep Apnea and Parkinson's Disease: Possible Mechanisms and Implications for Cognitive Function

    PubMed Central

    Kaminska, Marta; Lafontaine, Anne-Louise; Kimoff, R. John

    2015-01-01

    Parkinson's disease (PD) is a relentlessly progressive neurodegenerative disorder associated with hallmark motor and nonmotor symptoms (NMS) such as sleep disturbances and cognitive dysfunction. While dopaminergic treatments have improved the motor aspects of PD, progression remains inevitable. Research has recently increasingly focused on strategies to modify disease progression and on nonmotor manifestations of PD, given their impact on patients' quality of life. Obstructive sleep apnea (OSA) is a treatable sleep disorder, common in the general population, associated with excessive daytime sleepiness and neurocognitive deficits. Neuroimaging has demonstrated structural and functional changes in OSA patients; in animal models, OSA causes brain inflammation and oxidative injury, including in key areas involved in PD pathophysiology such as locus coeruleus. The prevalence of OSA in PD has been variable in studies to date, and potential consequences and interrelationship between the two disorders have not been well studied. There is however emerging evidence that OSA is associated with increased NMS in PD, particularly cognitive dysfunction. This review focuses on the possible interrelationship between OSA and PD. Mechanisms promoting OSA in PD will be reviewed, as well as mechanisms whereby OSA can affect the neurodegenerative process in PD. PMID:26509097

  14. To ED or not to ED--is erectile dysfunction in obstructive sleep apnea related to endothelial dysfunction?

    PubMed

    Hoyos, Camilla M; Melehan, Kerri L; Phillips, Craig L; Grunstein, Ronald R; Liu, Peter Y

    2015-04-01

    Both obstructive sleep apnea (OSA) and erectile dysfunction (ErectD) are highly prevalent and largely under diagnosed medical conditions. These disorders often co-exist, with about half of the male OSA population having ErectD and vice versa. OSA is strongly associated with an increased risk of cardiovascular mortality while ErectD has been proposed as a phenotypic marker of cardiovascular disease. This implies that the two conditions may be linked by a common pathophysiological mechanism. In this review we provide evidence supporting the hypothesis that endothelial dysfunction (EndoD) may be the common pathophysiological mechanism linking OSA with both ErectD and cardiovascular complications. EndoD is one of the earliest markers of cardiovascular disease and substantial evidence suggests that OSA independently causes EndoD. There is also strong evidence that causally links EndoD with organic ErectD. Further research should be directed at determining the value of simultaneously assessing both ErectD and OSA in patients presenting with symptoms of either condition. In both ErectD and OSA clinics, identifying both conditions could improve overall cardiovascular risk stratification whilst treatment of OSA could reduce both ErectD and cardiovascular risk. PMID:24813467

  15. Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery.

    PubMed

    White-Dzuro, Gabrielle A; Maynard, Ken; Zuckerman, Scott L; Weaver, Kyle D; Russell, Paul T; Clavenna, Matthew J; Chambless, Lola B

    2016-07-01

    Patients undergoing transsphenoidal surgery (TSS) have an anterior skull base defect that limits the use of positive pressure ventilation post-operatively. Obstructive sleep apnea (OSA) can be seen in these patients and is treated with continuous positive airway pressure (CPAP). In our study we documented the incidence of pre-existing OSA and reported the incidence of diagnosed pneumocephalus and its relationship to OSA. A retrospective review was conducted from a surgical outcomes database. Electronic medical records were reviewed, with an emphasis on diagnosis of OSA and documented symptomatic pneumocephalus. A total of 324 patients underwent 349 TSS for sellar mass resection. The average body mass index of the study cohort was 32.5kg/m(2). Sixty-nine patients (21%) had documented OSA. Only 25 out of 69 (36%) had a documented post-operative CPAP plan. Out of all 349 procedures, there were two incidents of pneumocephalus diagnosed. Neither of the patients had pre-existing OSA. One in five patients in our study had pre-existing OSA. Most patients returned to CPAP use within several weeks of TSS for resection of a sellar mass. Neither of the patients with pneumocephalus had pre-existing OSA and none of the patients with early re-initiation of CPAP developed this complication. This study provides preliminary evidence that resuming CPAP early in the post-operative period might be less dangerous than previously assumed. PMID:26916903

  16. A multifactorial model of masticatory performance: the Suita study.

    PubMed

    Kosaka, T; Ono, T; Kida, M; Kikui, M; Yamamoto, M; Yasui, S; Nokubi, T; Maeda, Y; Kokubo, Y; Watanabe, M; Miyamoto, Y

    2016-05-01

    Previous studies have identified various factors related to masticatory performance. This study was aimed to investigate variations and impacts of factors related to masticatory performance among different occlusal support areas in general urban population in Japan. A total of 1875 Japanese subjects (mean age: 66·7 years) were included in the Suita study. Periodontal status was evaluated using the Community Periodontal Index (CPI). The number of functional teeth and occlusal support areas (OSA) were recorded, and the latter divided into three categories of perfect, decreased and lost OSA based on the Eichner Index. Masticatory performance was determined by means of test gummy jelly. For denture wearers, masticatory performance was measured with the dentures in place. The multiple linear regression analysis showed that, when controlling for other variables, masticatory performance was significantly associated with sex, number of functional teeth, maximum bite force and periodontal status in perfect OSA. Masticatory performance was significantly associated with number of functional teeth, maximum bite force and periodontal status in decreased OSA. In lost OSA, masticatory performance was significantly associated with maximum bite force. Maximum bite force was a factor significantly influencing masticatory performance that was common to all OSA groups. After controlling for possible confounding factors, the number of functional teeth and periodontal status were common factors in the perfect and decreased OSA groups, and only sex was significant in the perfect OSA group. These findings may help in providing dietary guidance to elderly people with tooth loss or periodontal disease. PMID:26662207

  17. Metabolomics Profiling for Obstructive Sleep Apnea and Simple Snorers.

    PubMed

    Xu, Huajun; Zheng, Xiaojiao; Qian, Yingjun; Guan, Jian; Yi, Hongliang; Zou, Jianyin; Wang, Yuyu; Meng, Lili; Zhao, Aihua; Yin, Shankai; Jia, Wei

    2016-01-01

    Few clinical studies have explored altered urinary metabolite levels in patients with obstructive sleep apnea (OSA). Thus, we applied a metabolomics approach to analyze urinary metabolites in three groups of participants: patients with polysomnography (PSG)-confirmed OSA, simple snorers (SS), and normal subjects. Ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry and gas chromatography coupled with time-of-flight mass spectrometry were used. A total of 21 and 31 metabolites were differentially expressed in the SS and OSA groups, respectively. Patients with OSA had 18 metabolites different from those with SS. Of the 56 metabolites detected among the 3 groups, 24 were consistently higher or lower. A receiver operator curve analysis revealed that the combination of 4-hydroxypentenoic acid, arabinose, glycochenodeoxycholate-3-sulfate, isoleucine, serine, and xanthine produced a moderate diagnostic score with a sensitivity (specificity) of 75% (78%) for distinguishing OSA from those without OSA. The combination of 4-hydroxypentenoic acid, 5-dihydrotestosterone sulfate, serine, spermine, and xanthine distinguished OSA from SS with a sensitivity of 85% and specificity of 80%. Multiple metabolites and metabolic pathways associated with SS and OSA were identified using the metabolomics approach, and the altered metabolite signatures could potentially serve as an alternative diagnostic method to PSG. PMID:27480913

  18. Brain Structure Network Analysis in Patients with Obstructive Sleep Apnea

    PubMed Central

    Luo, Yun-gang; Wang, Defeng; Liu, Kai; Weng, Jian; Guan, Yuefeng; Chan, Kate C. C.; Chu, Winnie C. W.; Shi, Lin

    2015-01-01

    Childhood obstructive sleep apnea (OSA) is a sleeping disorder commonly affecting school-aged children and is characterized by repeated episodes of blockage of the upper airway during sleep. In this study, we performed a graph theoretical analysis on the brain morphometric correlation network in 25 OSA patients (OSA group; 5 female; mean age, 10.1 ± 1.8 years) and investigated the topological alterations in global and regional properties compared with 20 healthy control individuals (CON group; 6 females; mean age, 10.4 ± 1.8 years). A structural correlation network based on regional gray matter volume was constructed respectively for each group. Our results revealed a significantly decreased mean local efficiency in the OSA group over the density range of 0.32–0.44 (p < 0.05). Regionally, the OSAs showed a tendency of decreased betweenness centrality in the left angular gyrus, and a tendency of decreased degree in the right lingual and inferior frontal (orbital part) gyrus (p < 0.005, uncorrected). We also found that the network hubs in OSA and controls were distributed differently. To the best of our knowledge, this is the first study that characterizes the brain structure network in OSA patients and invests the alteration of topological properties of gray matter volume structural network. This study may help to provide new evidence for understanding the neuropathophysiology of OSA from a topological perspective. PMID:26413809

  19. Does Obstructive Sleep Apnea Influence Perioperative Outcome? A Qualitative Systematic Review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing.

    PubMed

    Opperer, Mathias; Cozowicz, Crispiana; Bugada, Dario; Mokhlesi, Babak; Kaw, Roop; Auckley, Dennis; Chung, Frances; Memtsoudis, Stavros G

    2016-05-01

    Obstructive sleep apnea (OSA) is a commonly encountered problem in the perioperative setting even though many patients remain undiagnosed at the time of surgery. The objective of this systematic review was to evaluate whether the diagnosis of OSA has an impact on postoperative outcomes. We performed a systematic review of studies published in PubMed-MEDLINE, MEDLINE In-Process, and other nonindexed citations, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment up to November 2014. Studies of adult patients with a diagnosis of OSA or high risk thereof, published in the English language, undergoing surgery or procedures under anesthesia care, and reporting ≥1 postoperative outcome were included. Overall, the included studies reported on 413,304 OSA and 8,556,279 control patients. The majority reported worse outcomes for a number of events, including pulmonary and combined complications, among patients with OSA versus the reference group. The association between OSA and in-hospital mortality varied among studies; 9 studies showed no impact of OSA on mortality, 3 studies suggested a decrease in mortality, and 1 study reported increased mortality. In summary, the majority of studies suggest that the presence of OSA is associated with an increased risk of postoperative complications. PMID:27101493

  20. Supra-Epiglottic Upper Airway Volume in Elderly Patients with Obstructive Sleep Apnea Hypopnea Syndrome

    PubMed Central

    Abdirahman Mohamed Moussa, Syad; Celle, Sébastien; Laurent, Bernard; Barthélémy, Jean-Claude; Barral, Fabrice-Guy; Roche, Frédéric

    2016-01-01

    Objective Small upper airway measurements areas and high body mass index are recognized risk factors for obstructive sleep apnea syndrome (OSAS) in non-elderly populations; however, there is limited information regarding elderly patients. We evaluated whether upper airway volume is associated with OSAS and OSAS treated with continuous positive airway pressure (CPAP) treatment and whether BMI is correlated with upper airway volume and measurements in elderly subjects. Methods In 60 volunteers aged 75.58±0.9 years: 20 OSAS, 20 OSAS chronically treated with CPAP, and 20 controls, semi-automatic segmentation, retropalatal distance and transverse diameter of the supra-epiglottic upper airway were evaluated using 3DT1-weighted magnetic resonance imaging. Anteroposterior to transverse diameter ratio was defined as retropalatar diameter/transverse diameter. Results There were no significant differences in supra-epiglottic upper airway volume between OSAS, CPAP treated patients, and controls. There were significant differences in retropalatal distance and anteroposterior to transverse diameter ratio between OSAS, CPAP treated patients, and controls (P = 0.008 and P<0.0001 respectively). There was a significant correlation between body mass index and retropalatal distance (P<0.05) but not with supra-epiglottic upper airway volume. Conclusion In elderly subjects, OSAS and body mass index are not associated with changes in supra-epiglottic upper airway volume but are associated with modification of pharynx shape. PMID:27336305

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

    PubMed Central

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

    2015-01-01

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

  2. A Prognosis Tool Based on Fuzzy Anthropometric and Questionnaire Data for Obstructive Sleep Apnea Severity.

    PubMed

    Wang, Kung-Jeng; Chen, Kun-Huang; Huang, Shou-Hung; Teng, Nai-Chia

    2016-04-01

    Obstructive sleep apnea (OSA) are linked to the augmented risk of morbidity and mortality. Although polysomnography is considered a well-established method for diagnosing OSA, it suffers the weakness of time consuming and labor intensive, and requires doctors and attending personnel to conduct an overnight evaluation in sleep laboratories with dedicated systems. This study aims at proposing an efficient diagnosis approach for OSA on the basis of anthropometric and questionnaire data. The proposed approach integrates fuzzy set theory and decision tree to predict OSA patterns. A total of 3343 subjects who were referred for clinical suspicion of OSA (eventually 2869 confirmed with OSA and 474 otherwise) were collected, and then classified by the degree of severity. According to an assessment of experiment results on g-means, our proposed method outperforms other methods such as linear regression, decision tree, back propagation neural network, support vector machine, and learning vector quantization. The proposed method is highly viable and capable of detecting the severity of OSA. It can assist doctors in pre-diagnosis of OSA before running the formal PSG test, thereby enabling the more effective use of medical resources. PMID:26932370

  3. The Association Between Obstructive Sleep Apnea and Alzheimer’s Disease: A Meta-Analysis Perspective

    PubMed Central

    Emamian, Farnoosh; Khazaie, Habibolah; Tahmasian, Masoud; Leschziner, Guy D.; Morrell, Mary J.; Hsiung, Ging-Yuek R.; Rosenzweig, Ivana; Sepehry, Amir A.

    2016-01-01

    Alzheimer’s disease (AD) and obstructive sleep apnea (OSA) are highly prevalent, chronic conditions with intriguing, yet poorly understood epidemiological overlap. To date, the amount of OSA syndrome present in patients with AD across literature remains unknown. To address this question, we collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. The results of our quantitative meta-analysis suggest that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. Moreover, these data suggest that around half of patients with AD have experienced OSA at some point after their initial diagnosis. The additive impact of progressive changes in sleep quality and structure, changes in cerebral blood flow and the cellular redox status in OSA patients may all be contributing factors to cognitive decline and may further aggravate AD progression. It is hoped that the high OSA rate in AD patients, as suggested by the findings of our meta-analysis, might provide a sufficient clinical incentive to alert clinicians the importance of screening patients for OSA in AD, and stimulate further research in this area. PMID:27148046

  4. The Relationship Between Volume Overload in End-Stage Renal Disease and Obstructive Sleep Apnea.

    PubMed

    Roumelioti, Maria-Eleni; Brown, Lee K; Unruh, Mark L

    2015-01-01

    Obstructive sleep apnea (OSA) is common, underdiagnosed, and undertreated among patients with end-stage renal disease (ESRD). As in all cases, pathogenesis of OSA is related to repeated upper airway (UA) occlusion or narrowing, but in ESRD, additional contributory factors likely include uremic destabilization of central respiratory control and anatomic changes in the UA related to fluid status. Pulmonary congestion is common in acute and chronic kidney failure and is a consequence of cardiomyopathy and fluid overload, two potentially reversible risk factors. Emerging evidence suggests that volume overload also reduces the UA caliber. The diminution in UA area as well as destabilization of ventilatory control in ESRD have been postulated as causes of increased OSA prevalence and severity in these patients, and creates a vicious cycle wherein OSA exacerbates fluid overload disorders such as in congestive heart failure (CHF) and ESRD, which then further worsen OSA. Dialysis modalities may differ in their effects on volume status, the accumulation of uremic toxins, and acid-base status, and as a consequence, on the emergence and severity of OSA. Given the contribution of excess fluid to both the severity of nocturnal hypoxia and UA narrowing, establishing and maintaining dry weight is of particular importance when managing OSA in ESRD. Clinical trials to determine the extent to which more aggressive fluid removal in ESRD patients may alleviate OSA are needed. PMID:25940851

  5. Circulating adhesion molecules in obstructive sleep apnea and cardiovascular disease

    PubMed Central

    Pak, Victoria M.; Grandner, Michael A.; Pack, Allan I.

    2013-01-01

    SUMMARY Over 20 years of evidence indicates a strong association between obstructive sleep apnea (OSA) and cardiovascular disease. Although inflammatory processes have been heavily implicated as an important link between the two, the mechanism for this has not been conclusively established. Atherosclerosis may be one of the mechanisms linking OSA to cardiovascular morbidity. This review addresses the role of circulating adhesion molecules in patients with OSA, and how these may be part of the link between cardiovascular disease and OSA. There is evidence for the role of adhesion molecules in cardiovascular disease risk. Some studies, albeit with small sample sizes, also show higher levels of adhesion molecules in patients with OSA compared to controls. There are also studies that show that levels of adhesion molecules diminish with continuous positive airway pressure therapy. Limitations of these studies include small sample sizes, cross-sectional sampling, and inconsistent control for confounding variables known to influence adhesion molecule levels. There are potential novel therapies to reduce circulating adhesion molecules in patients with OSA to diminish cardiovascular disease. Understanding the role of cell adhesion molecules generated in OSA will help elucidate one mechanistic link to cardiovascular disease in patients with OSA. PMID:23618532

  6. New Data Pre-processing on Assessing of Obstructive Sleep Apnea Syndrome: Line Based Normalization Method (LBNM)

    NASA Astrophysics Data System (ADS)

    Akdemir, Bayram; Güneş, Salih; Yosunkaya, Şebnem

    Sleep disorders are a very common unawareness illness among public. Obstructive Sleep Apnea Syndrome (OSAS) is characterized with decreased oxygen saturation level and repetitive upper respiratory tract obstruction episodes during full night sleep. In the present study, we have proposed a novel data normalization method called Line Based Normalization Method (LBNM) to evaluate OSAS using real data set obtained from Polysomnography device as a diagnostic tool in patients and clinically suspected of suffering OSAS. Here, we have combined the LBNM and classification methods comprising C4.5 decision tree classifier and Artificial Neural Network (ANN) to diagnose the OSAS. Firstly, each clinical feature in OSAS dataset is scaled by LBNM method in the range of [0,1]. Secondly, normalized OSAS dataset is classified using different classifier algorithms including C4.5 decision tree classifier and ANN, respectively. The proposed normalization method was compared with min-max normalization, z-score normalization, and decimal scaling methods existing in literature on the diagnosis of OSAS. LBNM has produced very promising results on the assessing of OSAS. Also, this method could be applied to other biomedical datasets.

  7. Disparities and genetic risk factors in obstructive sleep apnea.

    PubMed

    Dudley, Katherine A; Patel, Sanjay R

    2016-02-01

    Obstructive sleep apnea (OSA) is an increasingly prevalent condition. A growing body of literature supports substantial racial disparities in the prevalence, risk factors, presentation, diagnosis, and treatment of this disease. Craniofacial structure among Asians appears to confer an elevated risk of OSA despite lower rates of obesity. Among African Americans, Native Americans, and Hispanics, OSA prevalence is increased, likely due in part to obesity. The burden of symptoms, particularly excessive daytime sleepiness, is higher among African Americans, although Hispanics more often report snoring. Limited data suggest that African Americans may be more susceptible to hypertension in the setting of OSA. While differences in genetic risk factors may explain disparities in OSA burden, no definitive genetic differences have yet been identified. In addition to disparities in OSA development, disparities in OSA diagnosis and treatment have also been identified. Increased severity of disease at diagnosis among African Americans suggests a delay in diagnosis. Treatment outcomes are also suboptimal among African Americans. In children, tonsillectomy is less likely to cure OSA and more commonly associated with complications in this group. Among adults, adherence to continuous positive airway pressure (CPAP) is substantially lower in African Americans. The reasons for these disparities, particularly in outcomes, are not well understood and should be a research priority. PMID:26428843

  8. The Effect of Treatment of Obstructive Sleep Apnea on Quality of Life in Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Hsiao, Kai Hsun; Nixon, Gillian M.

    2008-01-01

    Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who…

  9. A Comparison of Personality Characteristics and Psychiatric Symptomatology between Upper Airway Resistance Syndrome and Obstructive Sleep Apnea Syndrome

    PubMed Central

    So, Soo-Jung; Kang, Seung-Gul; Cho, Chul-Hyun; Yoon, Ho-Kyoung; Kim, Leen

    2015-01-01

    Objective To investigate the personality characteristics of patients with upper airway resistance syndrome (UARS) and those of patients with obstructive sleep apnea syndrome (OSAS). Methods Eighty-eight patients with UARS and 365 patients with OSAS participated. All patients had a diagnostic full-night attended polysomnography (PSG) and completed the Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Symptom Checklist-90-Revision (SCL-90-R) and Eysenck Personality Questionnaire (EPQ). Results The UARS group scored significantly higher than the OSAS group on the ESS, AIS, and PSQI (p<0.001). The scores of all SCL-90-R subscales in the UARS group were significantly higher than those in the OSA group (all p<0.001, except for somatization, p=0.016). Patients with UARS scored lower on EPQ-E (extroversion/introversion) (p=0.006) and EPQ-L (lie) (p<0.001) than those with OSA. UARS patients also showed higher scores on EPQ-P (psychoticism) (p=0.002) and EPQ-N (neuroticism) (p<0.001) than OSAS patients. Conclusion Our results suggest that patients with UARS have worse subjective sleep quality than OSAS patients in spite of their better PSG findings. UARS patients tend to have more neurotic and sensitive personalities than patients with OSAS, which may be a cause of the clinical features of UARS. PMID:25866518

  10. Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea

    PubMed Central

    Gasparini, Giulio; Vicini, Claudio; De Benedetto, Michele; Salamanca, Fabrizio; Sorrenti, Giovanni; Romandini, Mario; Bosi, Marcello; Saponaro, Gianmarco; Foresta, Enrico; Laforì, Andreina; Meccariello, Giuseppe; Bianchi, Alessandro; Toraldo, Domenico Maurizio; Campanini, Aldo; Montevecchi, Filippo; Rizzotto, Grazia; Cervelli, Daniele; Moro, Alessandro; Arigliani, Michele; Gobbi, Riccardo; Pelo, Sandro

    2015-01-01

    Rationale. The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. Objectives. To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. Methods. Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. Measurements and Main Results. The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81–1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82–0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76–0.92) for severe OSA (AHI ≥ 30). Conclusions. The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed. PMID:26636102

  11. Iowa gambling task performance in overweight children and adolescents at risk for obstructive sleep apnea.

    PubMed

    McNally, Kelly A; Shear, Paula K; Tlustos, Sarah; Amin, Raouf S; Beebe, Dean W

    2012-05-01

    Obstructive sleep apnea (OSA) is a nocturnal respiratory disorder associated with cognitive and behavioral sequelae, including impairments in executive functioning (EF). Previous literature has focused on "cool" EF, meaning abilities such as working memory and planning that do not involve affective control requirements. Little is known about the impact OSA may have on "hot" EF that involves regulation of affect and risk-related decision-making, and that may be particularly salient during adolescence, when these skills are rapidly developing. This study examined performance on the Iowa Gambling Task (IGT), a task believed to assess aspects of "hot" EF, in overweight adolescents at risk for OSA. Consistent with hypotheses, individuals without OSA made more beneficial decisions on the IGT over time, but participants with OSA did not benefit from feedback and continued to make choices associated with higher initial rewards, but greater long-term losses. The relationship between developmental level and IGT performance was moderated by OSA status. Individuals with OSA did not demonstrate the expected developmental gains in performance during the IGT. This finding suggests that OSA may impact the development of critical aspects of EF, or at least the expression of these skills during the developmentally important period of adolescence. PMID:22300670

  12. Biological plausibility linking sleep apnoea and metabolic dysfunction.

    PubMed

    Gileles-Hillel, Alex; Kheirandish-Gozal, Leila; Gozal, David

    2016-05-01

    Obstructive sleep apnoea (OSA) is a very common disorder that affects 10-25% of the general population. In the past two decades, OSA has emerged as a cardiometabolic risk factor in both paediatric and adult populations. OSA-induced metabolic perturbations include dyslipidaemia, atherogenesis, liver dysfunction and abnormal glucose metabolism. The mainstay of treatment for OSA is adenotonsillectomy in children and continuous positive airway pressure therapy in adults. Although these therapies are effective at resolving the sleep-disordered breathing component of OSA, they do not always produce beneficial effects on metabolic function. Thus, a deeper understanding of the underlying mechanisms by which OSA influences metabolic dysfunction might yield improved therapeutic approaches and outcomes. In this Review, we summarize the evidence obtained from animal models and studies of patients with OSA of potential mechanistic pathways linking the hallmarks of OSA (intermittent hypoxia and sleep fragmentation) with metabolic dysfunction. Special emphasis is given to adipose tissue dysfunction induced by sleep apnoea, which bears a striking resemblance to adipose dysfunction resulting from obesity. In addition, important gaps in current knowledge and promising lines of future investigation are identified. PMID:26939978

  13. The Association Between Obstructive Sleep Apnea and Alzheimer's Disease: A Meta-Analysis Perspective.

    PubMed

    Emamian, Farnoosh; Khazaie, Habibolah; Tahmasian, Masoud; Leschziner, Guy D; Morrell, Mary J; Hsiung, Ging-Yuek R; Rosenzweig, Ivana; Sepehry, Amir A

    2016-01-01

    Alzheimer's disease (AD) and obstructive sleep apnea (OSA) are highly prevalent, chronic conditions with intriguing, yet poorly understood epidemiological overlap. To date, the amount of OSA syndrome present in patients with AD across literature remains unknown. To address this question, we collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. The results of our quantitative meta-analysis suggest that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. Moreover, these data suggest that around half of patients with AD have experienced OSA at some point after their initial diagnosis. The additive impact of progressive changes in sleep quality and structure, changes in cerebral blood flow and the cellular redox status in OSA patients may all be contributing factors to cognitive decline and may further aggravate AD progression. It is hoped that the high OSA rate in AD patients, as suggested by the findings of our meta-analysis, might provide a sufficient clinical incentive to alert clinicians the importance of screening patients for OSA in AD, and stimulate further research in this area. PMID:27148046

  14. PAHs in leachates from thermal power plant wastes and ash-based construction materials.

    PubMed

    Irha, Natalya; Reinik, Janek; Jefimova, Jekaterina; Koroljova, Arina; Raado, Lembi-Merike; Hain, Tiina; Uibu, Mai; Kuusik, Rein

    2015-08-01

    The focus of the current study is to characterise the leaching behaviour of polycyclic aromatic hydrocarbons (PAHs) from oil shale ashes (OSAs) of pulverised firing (PF) and circulating fluidised-bed (CFB) boilers from Estonian Thermal Power Plant (Estonia) as well as from mortars and concrete based on OSAs. The target substances were 16 PAHs from the EPA priority pollutant list. OSA samples and OSA-based mortars were tested for leaching, according to European standard EN 12457-2 (2002). European standard CEN/TC 15862(2012) for monolithic matter was used for OSA-based concrete. Water extracts were analysed by GC-MS for the concentration of PAHs. Naphthalene, acenaphthene, fluorene, phenanthrene, anthracene, fluoranthene and pyrene were detected. Still, the release of PAHs was below the threshold limit value for inert waste. The amount of the finest fraction (particle size <0.045 mm), the content of the Al-Si glass phase and the surface characteristics were the main factors, which could affect the accessibility of PAHs for leaching. The mobility of PAHs from OSA of CFB and PF boilers was 20.2 and 9.9%, respectively. Hardening of OSA-based materials did not lead to the immobilisation of soluble PAHs. Release of PAHs from the monolith samples did not exceed 0.5 μg/m(2). In terms of leaching of PAHs, OSA is safe to be used for construction purposes. PMID:25869435

  15. Obstructive Sleep Apnea Impairs Postexercise Sympathovagal Balance in Patients with Metabolic Syndrome

    PubMed Central

    Cepeda, Felipe X.; Toschi-Dias, Edgar; Maki-Nunes, Cristiane; Rondon, Maria Urbana P.B.; Alves, Maria Janieire N.N.; Braga, Ana Maria F.W.; Martinez, Daniel G.; Drager, Luciano F.; Lorenzi-Filho, Geraldo; Negrao, Carlos E.; Trombetta, Ivani C.

    2015-01-01

    Study Objectives: The attenuation of heart rate recovery after maximal exercise (ΔHRR) is independently impaired by obstructive sleep apnea (OSA) and metabolic syndrome (MetS). Therefore, we tested the hypotheses: (1) MetS + OSA restrains ΔHRR; and (2) Sympathetic hyperactivation is involved in this impairment. Design: Cross-sectional study. Participants: We studied 60 outpatients in whom MetS had been newly diagnosed (ATP III), divided according to apnea-hypopnea index (AHI) ≥ 15 events/h in MetS + OSA (n = 30, 49 ± 1.7 y) and AHI < 15 events/h in MetS - OSA (n = 30, 46 ± 1.4 y). Normal age-matched healthy control subjects (C) without MetS and OSA were also enrolled (n = 16, 46 ± 1.7 y). Interventions: Polysomnography, microneurography, cardiopulmonary exercise test. Measurements and Results: We evaluated OSA (AHI - polysomnography), muscle sympathetic nerve activity (MSNA - microneurography) and cardiac autonomic activity (LF = low frequency, HF = high frequency, LF/HF = sympathovagal balance) based on spectral analysis of heart rate (HR) variability. ΔHRR was calculated (peak HR minus HR at first, second, and fourth minute of recovery) after cardiopulmonary exercise test. MetS + OSA had higher MSNA and LF, and lower HF than MetS - OSA and C. Similar impairment occurred in MetS - OSA versus C (interaction, P < 0.01). MetS + OSA had attenuated ΔHRR at first, second, and at fourth minute than did C, and attenuated ΔHRR at fourth minute than did MetS - OSA (interaction, P < 0.001). Compared with C, MetS - OSA had attenuated ΔHRR at second and fourth min (interaction, P < 0.001). Further analysis showed association of the ΔHRR (first, second, and fourth minute) and AHI, MSNA, LF and HF components (P < 0.05 for all associations). Conclusions: The attenuation of heart rate recovery after maximal exercise is impaired to a greater degree where metabolic syndrome (MetS) is associated with moderate to severe obstructive sleep apnea (OSA) than by MetS with no or

  16. Sleep Apnea in Patients with and without a Right-to-Left Shunt

    PubMed Central

    Mojadidi, Mohammad Khalid; Bokhoor, Pooya Isaac; Gevorgyan, Rubine; Noureddin, Nabil; MacLellan, W. Cameron; Wen, Eugenia; Aysola, Ravi; Tobis, Jonathan M.

    2015-01-01

    Objectives: To assess the presence of right-to-left shunting (RLS) in patients with obstructive sleep apnea (OSA), and compare clinical characteristics and parameters of the sleep studies of patients with and without RLS. Background: The most common cause of RLS is due to intermittent flow through a patent foramen ovale (PFO). PFO occurs more frequently in patients with OSA and may be involved in the exacerbation of OSA. Methods: Patients with an abnormal polysomnogram seen at UCLA-Santa Monica Sleep Medicine Clinic were enrolled. A diagnosis of RLS was made using a transcranial Doppler (TCD) bubble study. Gender and age-matched controls were drawn from patients referred for cardiac catheterization who underwent a TCD. The frequency of RLS in OSA patients and the controls was evaluated. Clinical characteristics and polysomnogram parameters were compared between OSA patients with and without a RLS. Results: A total of 100 OSA patients and 200 controls participated in the study. The prevalence of RLS was higher in patients with OSA compared to the control group (42% versus 19%; p < 0.0001). Patients with OSA and a RLS had a lower apnea-hypopnea index (AHI), less obstructive apnea, and fewer hypopnea episodes than patients with OSA without a RLS. The baseline and nadir SpO2 were similar in both groups and did not correlate with the level of RLS assessed by TCD. The degree of desaturation for a given respiratory disturbance, as measured by oxygen desaturation index (ODI)/AHI ratio, was higher in OSA patients with RLS versus OSA patients without RLS (0.85 ± 0.07 versus 0.68 ± 0.04; p < 0.0001). Conclusion: RLS, most commonly due to a PFO, occurs 2.2 times more frequently in OSA patients compared to a control population that was matched for age and gender. The severity of sleep apnea is not greater in OSA patients who have a PFO. However, patients with OSA and a PFO are more likely to become symptomatic at a younger age with an equivalent decrease in nocturnal SpO2

  17. Obstructive sleep apnea in North American commercial drivers.

    PubMed

    Kales, Stefanos N; Straubel, Madeleine G

    2014-01-01

    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

  18. Where There Is Smoke…There Is Sleep Apnea

    PubMed Central

    Dixon-Williams, Sherrie; Thornton, J. Daryl

    2014-01-01

    Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed. PMID:25451354

  19. Obstructive sleep apnea and metabolic bone disease: Insights in to the relationship between bone and sleep

    PubMed Central

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

    2015-01-01

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

  20. Update on paediatric obstructive sleep apnoea

    PubMed Central

    Dehlink, Eleonora

    2016-01-01

    Obstructive sleep apnoea (OSA) is one of the most common causes of sleep-disordered breathing (SDB) in children. It is associated with significant morbidity, potentially impacting on long-term neurocognitive and behavioural development, as well as cardiovascular outcomes and metabolic homeostasis. The low grade systemic inflammation and increased oxidative stress seen in this condition are believed to underpin the development of these OSA-related morbidities. The significant variance in degree of end organ morbidity in patients with the same severity of OSA highlights the importance of the interplay of genetic and environmental factors in determining the overall OSA phenotype. This review seeks to summarize the current understanding of the aetiology and mechanisms underlying OSA, its risk factors, diagnosis and treatment. PMID:26904263

  1. Cognitive impairment in obstructive sleep apnea.

    PubMed

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

    2014-10-01

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

  2. Differences in Perceptions of the Diagnosis and Treatment of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Therapy Among Adherers and Nonadherers

    PubMed Central

    Sawyer, Amy M.; Deatrick, Janet A.; Kuna, Samuel T.; Weaver, Terri E.

    2010-01-01

    Obstructive sleep apnea (OSA) patients’ consistent use of CPAP is critical to realizing improved functional outcomes and reducing untoward health risks associated with OSA. We conducted a mixed methods concurrent, nested study to describe OSA patients’ beliefs and perceptions of the diagnosis and CPAP treatment that importantly differentiate adherent from nonadherent patients prior to and after the first week of treatment when the pattern of CPAP use is established. Guided by social cognitive theory, themes were derived from 30 interviews conducted post-diagnosis and after one week CPAP use. Directed content analysis followed by categorization of participants as adherent/nonadherent from objectively measured CPAP use preceded across-case analysis among 15 participants with severe OSA. Beliefs and perceptions that differed between adherers and nonadherers included OSA risk perception, symptom recognition, self-efficacy, outcome expectations, treatment goals, and treatment facilitators/barriers. Our findings suggest opportunities for developing and testing tailored interventions to promote CPAP use. PMID:20354236

  3. Effect of telemetric monitoring in the first 30 days of continuous positive airway pressure adaptation for obstructive sleep apnoea syndrome - a controlled pilot study.

    PubMed

    Frasnelli, Matthias; Baty, Florent; Niedermann, Jolanda; Brutsche, Martin H; Schoch, Otto D

    2016-06-01

    Obstructive sleep apnoea syndrome (OSAS) is characterised by repetitive collapse of the upper airway during sleep. Continuous positive airway pressure (CPAP) applied via a mask is the standard treatment for OSAS. CPAP adherence is crucial in therapy to prevent the deleterious consequences of OSAS. We hypothesised that a combination of supervision by telemetry together with targeted telephone support in the first month of CPAP would increase CPAP adherence and treatment success. A total of 113 OSAS patients followed by telemetry-triggered interventions used the device for 5.3 h/night on 28/30 nights, significantly more than the 110 OSAS patients in the control group with 4.6 h/night and 27/30 nights. Telemetry-triggered interventions have a significant impact on adherence rate in early CPAP treatment. These results can be reached with an acceptable additional effort. PMID:26253747

  4. PubMed Central

    DE NUCCIO, F.; DE BENEDETTO, M.; SCODITTI, E.

    2015-01-01

    SUMMARY Obstructive sleep apnoea syndrome (OSAS) is associated with severe cerebro-cardiovascular morbidity and mortality. It is an independent risk factor for atherosclerosis, arterial thrombosis and metabolic syndrome, and recently has been associated with an increased incidence of cancer and death. A causal link between OSAS and atherosclerosis has been partially established. Recent research on atherosclerosis in OSAS has focused on thrombotic tendency and blood viscosity, providing new insight into disease mechanisms. Hypoxia is a critical pathophysiological element in OSAS that leads to intensive sympathetic activity, in association with inflammation, oxidative stress and procoagulant activity. Hypoxia and the induction of oxidative stress can simultaneously represent an underlying mechanism in the pathogenesis of cancer development and progression. This mini-review will discuss the latest findings on the association and potential relationship between OSA and pathological vascular sequelae. PMID:26019388

  5. The use of portable monitoring for sleep apnea diagnosis in adults.

    PubMed

    Oliveira, Marcia G; Garbuio, Silvério; Treptow, Erika C; Polese, Jessica F; Tufik, Sergio; Nery, Luiz E; Bittencourt, Lia

    2014-02-01

    Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases. PMID:24308652

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

    PubMed

    Mohsenin, Vahid

    2014-10-01

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

  7. Differences in perceptions of the diagnosis and treatment of obstructive sleep apnea and continuous positive airway pressure therapy among adherers and nonadherers.

    PubMed

    Sawyer, Amy M; Deatrick, Janet A; Kuna, Samuel T; Weaver, Terri E

    2010-07-01

    Obstructive sleep apnea (OSA) patients' consistent use of continuous positive airway pressure (CPAP) therapy is critical to realizing improved functional outcomes and reducing untoward health risks associated with OSA. We conducted a mixed methods, concurrent, nested study to explore OSA patients' beliefs and perceptions of the diagnosis and CPAP treatment that differentiate adherent from nonadherent patients prior to and after the first week of treatment, when the pattern of CPAP use is established. Guided by social cognitive theory, themes were derived from 30 interviews conducted postdiagnosis and after 1 week of CPAP use. Directed content analysis, followed by categorization of participants as adherent/nonadherent from objectively measured CPAP use, preceded across-case analysis among 15 participants with severe OSA. Beliefs and perceptions that differed between adherers and nonadherers included OSA risk perception, symptom recognition, self-efficacy, outcome expectations, treatment goals, and treatment facilitators/ barriers. Our findings suggest opportunities for developing and testing tailored interventions to promote CPAP use. PMID:20354236

  8. Obstructive sleep apnea syndrome in a publicly funded healthcare system.

    PubMed Central

    Tran, Dana; Wallace, Jeanne

    2005-01-01

    BACKGROUND: Despite its current recognition as a major health concern, little has been published about obstructive sleep apnea syndrome (OSAS) as a health problem in public healthcare systems where limited resources, language and cultural differences may present barriers to detection and treatment. OBJECTIVE: To describe patients referred for suspected OSAS in a large county-funded healthcare system. METHOD: A retrospective, descriptive observational study that included all patients referred for an OSAS evaluation between September 2000 and September 2002. RESULTS: Only 123 patients were referred and 115 completed an evaluation during the two-year period: 99% met OSAS diagnostic criteria, which was severe in 79% and frequently complicated by related comorbid conditions. CPAP acceptance was lower than in the previous series, especially among Hispanics. CONCLUSIONS: The findings suggest that referral for OSAS evaluation was limited to those most severely affected and raise the possibility of underdetection and undertreatment in the ublic sector. PMID:15779501

  9. Obstructive Sleep Apnea in North American Commercial Drivers

    PubMed Central

    KALES, Stefanos N.; STRAUBEL, Madeleine G.

    2013-01-01

    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

  10. Sleep Disturbances in Persons Living with HIV

    PubMed Central

    Taibi, Diana M.

    2012-01-01

    Up to 70% of persons living with HIV (PLWH) experience sleep disturbances. Insomnia and obstructive sleep apnea syndrome (OSAS) are common disorders seen in the primary care of PLWH. This paper reviews the current evidence and practice recommendations for treating these conditions. Insomnia is evaluated by clinical interview, questionnaires, and sleep diaries. The recommended first-line treatment is cognitive-behavioral therapy for insomnia (CBT-I), delivered by a trained therapist. Certain sedative medications may be useful, but over-the-counter treatments (particularly those containing antihistamines) are not recommended. OSAS is diagnosed by overnight sleep study but can be screened for in primary care. The STOP-BANG is a useful 8-item screening tool. The gold standard of treatment for OSAS is the use of a continuous positive airway pressure device. Treatment of insomnia and OSAS is important for improving quality of life and preventing associated health problems (especially cardiovascular disease in OSAS) in PLWH. PMID:23290379