Science.gov

Sample records for adult obstructive sleep

  1. Obstructive sleep apnea - adults

    MedlinePlus

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

  2. Obstructive sleep apnea - adults

    MedlinePlus

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

  3. Adult obstructive sleep apnoea.

    PubMed

    Jordan, Amy S; McSharry, David G; Malhotra, Atul

    2014-02-22

    Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss. PMID:23910433

  4. Respiratory rate variability in sleeping adults without obstructive sleep apnea.

    PubMed

    Gutierrez, Guillermo; Williams, Jeffrey; Alrehaili, Ghadah A; McLean, Anna; Pirouz, Ramin; Amdur, Richard; Jain, Vivek; Ahari, Jalil; Bawa, Amandeep; Kimbro, Shawn

    2016-09-01

    Characterizing respiratory rate variability (RRV) in humans during sleep is challenging, since it requires the analysis of respiratory signals over a period of several hours. These signals are easily distorted by movement and volitional inputs. We applied the method of spectral analysis to the nasal pressure transducer signal in 38 adults with no obstructive sleep apnea, defined by an apnea-hypopnea index <5, who underwent all-night polysomnography (PSG). Our aim was to detect and quantitate RRV during the various sleep stages, including wakefulness. The nasal pressure transducer signal was acquired at 100 Hz and consecutive frequency spectra were generated for the length of the PSG with the Fast Fourier Transform. For each spectrum, we computed the amplitude ratio of the first harmonic peak to the zero frequency peak (H1/DC), and defined as RRV as (100 - H1/DC) %. RRV was greater during wakefulness compared to any sleep stage, including rapid-eye-movement. Furthermore, RRV correlated with the depth of sleep, being lowest during N3. Patients spent most their sleep time supine, but we found no correlation between RRV and body position. There was a correlation between respiratory rate and sleep stage, being greater in wakefulness than in any sleep stage. We conclude that RRV varies according to sleep stage. Moreover, spectral analysis of nasal pressure signal appears to provide a valid measure of RRV during sleep. It remains to be seen if the method can differentiate normal from pathological sleep patterns. PMID:27597768

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

    SciTech Connect

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

    1983-03-01

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

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

    PubMed

    Semelka, Michael; Wilson, Jonathan; Floyd, Ryan

    2016-09-01

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

  7. Usage of Positional Therapy in Adults with Obstructive Sleep Apnea

    PubMed Central

    de Vries, Grietje E.; Hoekema, Aarnoud; Doff, Michiel H.J.; Kerstjens, Huib A.M.; Meijer, Petra M.; van der Hoeven, Johannes H.; Wijkstra, Peter J.

    2015-01-01

    Study Objectives: Many positional therapy (PT) strategies are available for treating positional obstructive sleep apnea (OSA). PT is primarily supplied to selected patients as a secondary treatment option when other therapies have failed. To our knowledge this is the largest study to date to assess effectiveness and long-term compliance of PT (both commercial waistband and self-made constructions, mimicking the tennis ball technique) as primary treatment in patients with different positional OSA severities. Methods: PT was used by 53 patients, of which 40 patients underwent a follow-up polygraphic evaluation under treatment after a median time interval of 12 weeks. Patients were routinely contacted regarding their clinical status and treatment compliance. Results: PT was successful in 27 out of 40 patients (68%). Overall AHI reduced significantly from a median (interquartile range [IQR]) AHI of 14.5 (10.7–19.6) to 5.9 (3.1–8.5), p < 0.001. The commercial waistband and self-made constructions were equally effective (median (IQR) reduction in overall AHI (Δ9.6 (5.5–11.9) and Δ6.8 (3.2–11.3) respectively), p = 0.22). Short-term compliance was good as most patients used PT more than 7 hours/night (mean 7.2 ± SD 1.4) and more than 6 days/week (mean 6.5 ± SD 1.3). However, after mean 13 ± 5 months, 26 patients (65%) reported they no longer used PT, especially patients with moderate positional OSA (89%). Conclusions: On the short-term, PT using the tennis ball technique, is an easy method to treat most patients with positional OSA, showing significant reductions in AHI. Unfortunately, long-term compliance is low and close follow-up of patients on PT with regard to their compliance is necessary. Citation: de Vries GE, Hoekema A, Doff MH, Kerstjens HA, Meijer PM, van der Hoeven JH, Wijkstra PJ. Usage of positional therapy in adults with obstructive sleep apnea. J Clin Sleep Med 2015;11(2):131–137. PMID:25406271

  8. 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

  9. [Perioperative management of adult patients with obstructive sleep apnea].

    PubMed

    Rösslein, Martin

    2015-03-01

    Obstructive sleep apnea (OSA) is a common sleep related breathing disorder with an increasing prevalence. Most surgical patients with OSA have not been diagnosed prior to surgery and are at an increased risk of developing perioperative complications. Preoperative identification of these patients is important in order to take appropriate measures concerning a safe perioperative management. While the level of scientific evidence for single measures is still low, several steps seem prudent: Preoperatively, sedating medications should only be applied with extreme caution. Anesthetic management should focus on regional anesthetic techniques and reduction of systemic opioids. In the case of general anesthesia, an increased risk of a patient presenting with a difficult airway should be appreciated. The extent and duration of postoperative continuous monitoring has to be determined on an individual basis. A preoperatively existing therapy with continuous positive airway pressure should be continued postoperatively as soon as possible. Patients with OSA may be managed on an outpatient basis if certain requirements are met. PMID:25850644

  10. 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

  11. Obstructive sleep apnoea syndrome.

    PubMed

    Lévy, Patrick; Kohler, Malcolm; McNicholas, Walter T; Barbé, Ferran; McEvoy, R Doug; Somers, Virend K; Lavie, Lena; Pépin, Jean-Louis

    2015-01-01

    Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te. PMID:27188535

  12. 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

  13. Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

    PubMed Central

    Aurora, R. Nisha; Casey, Kenneth R.; Kristo, David; Auerbach, Sanford; Bista, Sabin R.; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I.

    2010-01-01

    Background: Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP),radiofrequency ablation (RFA), and palatal implants. Recommendations: The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive

  14. Obstructive Sleep Apnea and Depression

    PubMed Central

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

    2011-01-01

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

  15. 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

  16. Breaking through Limbo: Experiences of Adults Living with Obstructive Sleep Apnea

    PubMed Central

    Rodgers, Beth

    2013-01-01

    Obstructive sleep apnea (OSA) is a potentially devastating condition that diminishes quality of life and leads to serious consequences without treatment. Diagnosis often is delayed and, once diagnosed, adherence to prescribed therapy tends to be a major barrier to management. This grounded theory study was focused on the experiences of a diverse group of 82 adults who were at various points in the process of obtaining a diagnosis and living with OSA. Participants described being in “limbo” and needing to break through that limbo to be successful at managing their OSA. Results provide new insights into the experience of living with OSA that can be beneficial in promoting treatment and shaping effective management of the condition. PMID:23570652

  17. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea.

    PubMed

    Chung, Frances; Memtsoudis, Stavros G; Ramachandran, Satya Krishna; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony G; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandez, Adrian V; Kaw, Roop; Kezirian, Eric J; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R; Auckley, Dennis

    2016-08-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence. PMID:27442772

  18. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

    PubMed Central

    Memtsoudis, Stavros G.; Ramachandran, Satya Krishna; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P.; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony G.; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandez, Adrian V.; Kaw, Roop; Kezirian, Eric J.; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R.; Auckley, Dennis

    2016-01-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients’ conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence. PMID:27442772

  19. Effectiveness of Ramelteon for Insomnia Symptoms in Older Adults with Obstructive Sleep Apnea: A Randomized Placebo-Controlled Pilot Study

    PubMed Central

    Gooneratne, Nalaka S.; Gehrman, Philip; Gurubhagavatula, Indira; Al-Shehabi, Erica; Marie, Elisabeth; Schwab, Richard

    2010-01-01

    Study Objectives: To evaluate the effectiveness of ramelteon, a melatonin receptor agonist, for the treatment of insomnia in older adults starting auto-titrating positive airway pressure (APAP) therapy for sleep apnea. Methods: A parallel group, randomized, double-blind, placebo-controlled pilot effectiveness clinical trial. The study enrolled 21 research study participants who were ≥ 60 years old and had obstructive sleep apnea, defined by an apnea-hypopnea index (AHI) ≥ 5 events/h, with complaints of insomnia. The primary outcome measure was change in sleep onset latency determined from polysomnography at 4 weeks. Research study participants, all of whom were starting on APAP, were randomized to ramelteon 8 mg (n = 8) or placebo (n = 13). Results: Ramelteon treatment was associated with a statistically significant difference in sleep onset latency (SOL) as measured by polysomnography of 28.5 min (± 16.2 min) compared to placebo (95% C.I. 8.5 min to 48.6 min, effect size 1.35, p = 0.008). This was due to a 10.7 (± 17.0) min SOL reduction in the ramelteon arm and a 17.8 (± 23.5) min SOL increase in the placebo arm. No change was noted in subjective sleep onset latency (−1.3 min, ± 19.3 min, 95% C.I.: −21.4 min to 18.7 min). No statistically significant changes were noted in the AHI, sleep efficiency (polysomnography and self-report), APAP adherence, Pittsburgh Sleep Quality Index global score, or Epworth Sleepiness Scale score when comparing ramelteon vs. placebo. Four adverse events occurred in the ramelteon arm and 2 in the placebo arm; none were considered to be related to treatment. Conclusions: Ramelteon was effective in improving objective, but not subjective, sleep onset latency even in older adults who were starting APAP therapy for sleep apnea. Further research is warranted in examining the role of ramelteon in the care of older adults with insomnia symptoms and sleep apnea. Citation: Gooneratne NS; Gehrman P; Gurubhagavatula I; Al-Shehabi E

  20. Effects of Exercise and Weight Loss in Older Adults with Obstructive Sleep Apnea

    PubMed Central

    Dobrosielski, Devon A.; Patil, Susheel; Schwartz, Alan R.; Bandeen-Roche, Karen; Stewart, Kerry J.

    2014-01-01

    Purpose Obstructive sleep apnea (OSA) is prevalent among older individuals and is linked to increased cardiovascular disease morbidity. This study examined the change in OSA severity following exercise training and dietary induced weight loss in older adults and the association between the changes in OSA severity, body composition and aerobic capacity with arterial distensibility. Methods Obese adults (n=25) with OSA, aged 60 years or older, were instructed to participate in supervised exercise (3 days/week) and follow a calorie-restricted diet. Baseline assessments of OSA parameters, body weight and composition, aerobic capacity and arterial distensibility were repeated at 12 weeks. Results Nineteen participants completed the intervention. At 12 weeks, there were reductions in body weight (−9%) and percentage total body fat (−5%) and trunk fat (−8%), while aerobic capacity improved by 20% (all p’s<0.01). The apnea-hypopnea index (AHI) decreased by 10 events per hour (p<0.01) and nocturnal SaO2 (mean SaO2) improved from 94.9% at baseline to 95.2% post intervention (p=0.01). Arterial distensibility for the group was not different from baseline (p=0.99), yet individual changes in distensibility were associated with the change in nocturnal desaturations (r=−0.49, p=0.03), but not with the change in body weight, AHI or aerobic capacity. Conclusion The severity of OSA was reduced following an exercise and weight loss program among older adults, suggesting that this lifestyle approach may be an effective first line non-surgical and non-pharmacological treatment for older patients with OSA. PMID:24870569

  1. 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

  2. An official ATS/AASM/ACCP/ERS workshop report: Research priorities in ambulatory management of adults with obstructive sleep apnea.

    PubMed

    Kuna, Samuel T; Badr, M Safwan; Kimoff, R John; Kushida, Clete; Lee-Chiong, Teofilo; Levy, Patrick; McNicholas, Walter T; Strollo, Patrick J

    2011-03-01

    An international workshop was held to determine the research priorities for incorporating ambulatory management of adults with obstructive sleep apnea into healthcare systems. The workshop identified the barriers preventing incorporation of portable monitor testing into clinical management pathways and determined the research and development needed to address those barriers. The workshop promoted interaction and collaboration among diverse stakeholders who have interest and expertise in the development and evaluation of portable monitor technology and its clinical application. The consensus of the workshop participants was that outcomes-based research studies are needed to demonstrate the efficacy and cost effectiveness of portable monitor testing. Closely related to this objective is the need to develop clinical sleep research networks capable of performing adequately powered studies. Recommendations were developed regarding research study design and methodology that includes the need to standardize technology, identify the patients most appropriate for ambulatory management of obstructive sleep apnea, ensure patient safety, and identify sources of research funding. The evidence resulting from high-quality comparative effectiveness studies that include cost effectiveness as an outcome will allow decision makers to develop healthcare policies regarding the clinical application of portable monitor testing for the ambulatory management of patients with obstructive sleep apnea. PMID:21364215

  3. Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis

    PubMed Central

    Caples, Sean M.; Rowley, James A.; Prinsell, Jeffrey R.; Pallanch, John F.; Elamin, Mohamed B.; Katz, Sheri G.; Harwick, John D.

    2010-01-01

    A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA. Citation: Caples SM; Rowley JA; Prinsell JR; Pallanch JF; Elamin MB; Katz SG; Harwick JD. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. SLEEP 2010;33(10):1396-1407. PMID:21061863

  4. 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

  5. Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults.

    PubMed

    Blackman, Adam; McGregor, Catherine; Dales, Robert; Driver, Helen S; Dumov, Ilya; Fleming, Jon; Fraser, Kristin; George, Charlie; Khullar, Atul; Mink, Joe; Moffat, Murray; Sullivan, Glendon E; Fleetham, John A; Ayas, Najib; Bradley, T Douglas; Fitzpatrick, Michael; Kimoff, John; Morrison, Debra; Ryan, Frank; Skomro, Robert; Series, Frederic; Tsai, Willis

    2010-01-01

    The present position paper on the use of portable monitoring (PM) as a diagnostic tool for obstructive sleep apnea⁄hypopnea (OSAH) in adults was based on consensus and expert opinion regarding best practice standards from stakeholders across Canada. These recommendations were prepared to guide appropriate clinical use of this new technology and to ensure that quality assurance standards are adhered to. Clinical guidelines for the use of PM for the diagnosis and management of OSAH as an alternative to in-laboratory polysomnography published by the American Academy of Sleep Medicine Portable Monitoring Task Force were used to tailor our recommendations to address the following: indications; methodology including physician involvement, physician and technical staff qualifications, and follow-up requirements; technical considerations; quality assurance; and conflict of interest guidelines. When used appropriately under the supervision of a physician with training in sleep medicine, and in conjunction with a comprehensive sleep evaluation, PM may expedite treatment when there is a high clinical suspicion of OSAH. PMID:21037998

  6. 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

  7. 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

  8. Obstructive Sleep Apnea

    MedlinePlus

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

  9. Prevalence and risks of habitual snoring and obstructive sleep apnea symptoms in adult dental patients

    PubMed Central

    Al-Jewair, Thikriat S.; Nazir, Mohammed A.; Al-Masoud, Naif N.; Alqahtani, Nasser D.

    2016-01-01

    Objectives: To determine the prevalence of habitual snoring and risk of obstructive sleep apnea (OSA) among dental patients and investigate factors associated with high-risk OSA. Methods: This cross-sectional study was performed at the Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Kingdom of Saudi Arabia, between October and December 2014. A total of 200 consecutive female and male dental patients were included in this study. Subjective and objective assessments were carried out. Habitual snoring and risk of OSA were assessed using the Arabic version of the Berlin questionnaire. Two trained investigators carried out the objective measurements of anthropometric data, blood pressure, oxygen saturation, pulse rate, and clinical examination of upper-airway, and dental occlusion. Results: Habitual snoring was present in 18.2% of the females and 81.8% of the males (p<0.05). Breathing pauses during sleep of more than once a week occurred in 9% (n=17) of the sample. Of the males, 78.3% were at high risk of OSA compared with 21.7% of the females. Multivariate analysis for risk of OSA revealed that obese patients were almost 10 times more likely to report OSA symptoms than their non-obese counterparts (odds ratio: 9.9, 95% confidence intervals: 4.4-22.1). Tongue indentations, tonsil size, and a high Epworth Sleepiness Scale score were also independent risks of OSA. Conclusion: Tongue indentations and tonsil grades III and IV were significantly associated with risk of OSA. This validates the important role of dentists in the recognition of the signs and symptoms of OSA. PMID:26837402

  10. 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

  11. 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

  12. Obstructive sleep apnea and asthma*

    PubMed Central

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

    2013-01-01

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

  13. 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

  14. Obstructive sleep apnoea and arthrogryposis

    PubMed Central

    Jon, Cindy; Mosquera, Ricardo Alberto; Mitchell, Sarah; Mazur, Lynnette J

    2014-01-01

    Arthrogryposis is a rare condition characterised by multiple congenital joint contractures. We present a case of a 10-year-old child with arthrogryposis and snoring. Polysomnography revealed significant obstructive sleep apnoea and hypoventilation that improved but did not completely resolve with adenotonsillectomy. With continuous positive airway pressure (CPAP) therapy, there was full resolution of all sleep disordered breathing. Initially, the patient admitted to difficulty tolerating nasal CPAP at home. However, she steadily improved adherence to therapy and admitted that with nasal CPAP use for the whole night, she felt more energised during the daytime. PMID:24907203

  15. The role of upper airway stimulation therapy in the multidisciplinary management approach of obstructive sleep apnea in the adult patient.

    PubMed

    Doghramji, Karl; Boon, Maurits

    2016-09-01

    Upper airway stimulation therapy (UAS) is a novel and effective treatment modality for obstructive sleep apnea (OSA). It is indicated for patients who are intolerant to traditional forms of therapy such as CPAP, and who have moderate to severe disease. Its success also relies upon the absence of certain upper airway structural and functional abnormalities. Therefore, the implementation of UAS necessitates a comprehensive evaluation with the coordinated efforts of otolaryngologist and sleep specialist, utilizing the consultative input of various other specialists. This same collaborative process also underlies the successful long-term followup care of patients following implantation surgery. Laryngoscope, 126:S9-S11, 2016. PMID:27572121

  16. Obstructive sleep apnea in atrial fibrillation patients.

    PubMed

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

    2006-06-28

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

  17. 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

  18. Surgical Approaches to Obstructive Sleep Apnea.

    PubMed

    MacKay, Stuart G; Chan, Lyndon

    2016-09-01

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

  19. The Relationship Between Obstructive Sleep Apnea and Self-Reported Stroke or Coronary Heart Disease in Overweight and Obese Adults with Type 2 Diabetes Mellitus

    PubMed Central

    Rice, Thomas B.; Foster, Gary D.; Sanders, Mark H.; Unruh, Mark; Reboussin, David; Kuna, Samuel T.; Millman, Richard; Zammit, Gary; Wing, Rena R.; Wadden, Thomas A.; Kelley, David; Pi-Sunyer, Xavier; Newman, Anne B.

    2012-01-01

    Study Objectives: Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common, increasingly recognized as comorbid conditions, and individually implicated in the development of cardiovascular disease (CVD). We sought to determine the association between OSA and CVD in an overweight and obese population with T2DM. Design: Cross-sectional. Setting: Ancillary study to the Look AHEAD trial. Participants: Three hundred five participants of the Sleep AHEAD study who underwent unattended full polysomnography at home with measurement of the apnea-hypopnea index (AHI). Measurements and Results: Self-reported prevalent CVD was obtained at the initial assessment of the parent study and included a history of the following conditions: stroke, carotid endarterectomy, myocardial infarction, coronary artery bypass grafting, and percutaneous coronary intervention. Logistic regression was used to assess the association of OSA, measured continuously and categorically, with prevalent CVD. OSA was present (AHI ≥ 5) in 86% of the population, whereas the prevalence of all forms of CVD was just 14%. The AHI was associated with stroke with an adjusted odds ratio (95% confidence interval) of 2.57 (1.03, 6.42). Neither the continuously measured AHI nor the categories of OSA severity were significantly associated with the other forms of CVD assessed. Conclusions: We found suggestive evidence of a greater prevalence of stroke at greater values of the AHI. OSA was not associated with prevalent coronary heart disease in the Sleep AHEAD trial. Future studies should confirm the link between OSA and stroke and examine mechanisms that link OSA to stroke in adults with T2DM. Citation: Rice TB; Foster GD; Sanders MH; Unruh M; Reboussin D; Kuna ST; Millman R; Zammit G; Wing RR; Wadden TA; Kelley D; Pi-Sunyer X; Newman AB. The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus

  20. Cough in obstructive sleep apnoea.

    PubMed

    Chan, Kevin; Ing, Alvin; Birring, Surinder S

    2015-12-01

    Obstructive Sleep Apnoea (OSA) has recently been reported to be a cause of chronic cough. It should be considered when cough remains unexplained following investigations and treatments for common causes. The presence of nocturnal cough, snoring and gastro-oesophageal reflux may be helpful in identifying patients who require further investigation. Daytime somnolence is often absent. Continuous positive airway pressure (CPAP) therapy has been reported to be effective in alleviating cough. Therapy for gastro-oesophageal reflux disease, if present, should be optimised. The mechanism of the association between OSA and cough is not clear, but airway inflammation, gastro-oesophageal reflux disease, increased cough reflex sensitivity and tracheobronchomalacia are possible explanations. Further studies should identify clinical predictors of OSA-cough, establish mechanisms and the optimal therapy. PMID:26068465

  1. Health promotion in obstructive sleep apnea syndrome.

    PubMed

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

    2015-04-01

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

  2. Pathophysiology of Pediatric Obstructive Sleep Apnea

    PubMed Central

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

    2008-01-01

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

  3. Does obstructive sleep apnea worsen during REM sleep?

    PubMed

    Peregrim, I; Grešová, S; Pallayová, M; Fulton, B L; Štimmelová, J; Bačová, I; Mikuľaková, A; Tomori, Z; Donič, V

    2013-01-01

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

  4. The pathogenesis of obstructive sleep apnea

    PubMed Central

    Schwartz, Alan R.

    2015-01-01

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

  5. The Effect of Changes in Cardiorespiratory Fitness and Weight on Obstructive Sleep Apnea Severity in Overweight Adults with Type 2 Diabetes

    PubMed Central

    Kline, Christopher E.; Reboussin, David M.; Foster, Gary D.; Rice, Thomas B.; Strotmeyer, Elsa S.; Jakicic, John M.; Millman, Richard P.; Pi-Sunyer, F. Xavier; Newman, Anne B.; Wadden, Thomas A.; Zammit, Gary; Kuna, Samuel T.

    2016-01-01

    Study Objectives: To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) severity prior to and following adjustment for changes in weight over the course of a 4-y weight loss intervention. Methods: As secondary analyses of a randomized controlled trial, 263 overweight/obese adults with type 2 diabetes and OSA participated in an intensive lifestyle intervention or education control condition. Measures of OSA severity, cardiorespiratory fitness, and body weight were obtained at baseline, year 1, and year 4. Change in the apnea-hypopnea index (AHI) served as the primary outcome. The percentage change in fitness (submaximal metabolic equivalents [METs]) and change in weight (kg) were the primary independent variables. Primary analyses collapsed intervention conditions with statistical adjustment for treatment group and baseline METs, weight, and AHI among other relevant covariates. Results: At baseline, greater METs were associated with lower AHI (B [SE] = −1.48 [0.71], P = 0.038), but this relationship no longer existed (B [SE] = −0.24 [0.73], P = 0.75) after adjustment for weight (B [SE] = 0.31 [0.07], P < 0.0001). Fitness significantly increased at year 1 (+16.53 ± 28.71% relative to baseline), but returned to near-baseline levels by year 4 (+1.81 ± 24.48%). In mixed-model analyses of AHI change over time without consideration of weight change, increased fitness at year 1 (B [SE] = −0.15 [0.04], P < 0.0001), but not at year 4 (B [SE] = 0.04 [0.05], P = 0.48), was associated with AHI reduction. However, with weight change in the model, greater weight loss was associated with AHI reduction at years 1 and 4 (B [SE] = 0.81 [0.16] and 0.60 [0.16], both P < 0.0001), rendering the association between fitness and AHI change at year 1 nonsignificant (B [SE] = −0.04 [0.04], P = 0.31). Conclusions: Among overweight/obese adults with type 2 diabetes, fitness change did not influence OSA severity change when weight change was

  6. Serum sex hormone levels in different severity of male adult obstructive sleep apnea-hypopnea syndrome in East Asians.

    PubMed

    Dong, Jia-Qi; Chen, Xiong; Xiao, Ying; Zhang, Rui; Niu, Xun; Kong, Wei-Jia

    2015-08-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious health issue, which can impact the hormone secretion. The aim of this study is to analyze the relationship between serum sex hormone concentrations and different severity degree of OSAHS, and to evaluate the influence of OSAHS on sex hormone levels. We enrolled 116 subjects who were subjected to polysomnography (PSG). They were divided into three groups: control group (n=10) [apnea hypopnea index (AHI) <5/h], mild-moderate OSAHS group (n=15) (5≤AHI<30/h), and severe OSAHS group (n=91) (AHI≥30/h). The patients in OSAHS group were subdivided into obesity and non-obesity subgroups. The parameters such as AHI, body mass index (BMI), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) were recorded. Serum levels of testosterone, polactin, estradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH) were determined in the morning immediately after waking up. Mean levels of hormones were compared among groups. The correlation between hormone levels and sleep-breathing parameters was analyzed. No significant differences in serum sex hormone levels were found among control, mild-moderate OSAHS, and severe OSAHS groups (P>0.05). There was no correlation between AHI and sex hormone levels (P>0.05). Testosterone was significantly negatively correlated with BMI (P<0.05). These results suggested that BMI might have a direct effect on testosterone level, and it might be an important factor affecting testosterone level in male OSAHS patients, and there may be no correlation between severity of OSAHS and sex hormones levels. PMID:26223926

  7. Obstructive Sleep Apnea and Atrial Arrhythmogenesis

    PubMed Central

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

    2014-01-01

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

  8. [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

  9. Health Promotion in Obstructive Sleep Apnea Syndrome

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

  11. Hot tonsillectomy for paediatric obstructive sleep apnoea

    PubMed Central

    Coyle, Paula; Marzouk, Sherief Deya; Gerolympou, Margarita; Marais, Joe

    2014-01-01

    Obstructive sleep apnoea is a common presentation in paediatric ear, nose and tongue (ENT) outpatients. The use of sleep studies is controversial however once a diagnosis has been made, frequently treatment is surgery. Should these patients be operated on as urgent cases? A 5-year-old boy was admitted under the paediatric team with difficultly breathing and desaturations to 77%. The patient had previously been seen by ENT as an outpatient with an 8-month history of obstructive sleep apnoea and was listed for an adenotonsillectomy with the standard waiting time. During this admission he had an emergency adenotonsillectomy. The patient improved immediately with no large desaturations in recovery and normal observations throughout his stay. It is never ideal to do a paediatric emergency operation and we have reviewed the evidence base to answer the question: Should these patients be treated urgently when seen in outpatients? PMID:24907212

  12. 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

  13. Sleep and sleep disorders in older adults.

    PubMed

    Crowley, Kate

    2011-03-01

    A common but significant change associated with aging is a profound disruption to the daily sleep-wake cycle. It has been estimated that as many as 50% of older adults complain about difficulty initiating or maintaining sleep. Poor sleep results in increased risk of significant morbidity and mortality. Moreover, in younger adults, compromised sleep has been shown to have a consistent effect on cognitive function, which may suggest that sleep problems contribute to the cognitive changes that accompany older age. The multifactorial nature of variables affecting sleep in old age cannot be overstated. Changes in sleep have been thought to reflect normal developmental processes, which can be further compromised by sleep disturbances secondary to medical or psychiatric diseases (e.g., chronic pain, dementia, depression), a primary sleep disorder that can itself be age-related (e.g., Sleep Disordered Breathing and Periodic Limb Movements During Sleep), or some combination of any of these factors. Given that changes in sleep quality and quantity in later life have implications for quality of life and level of functioning, it is imperative to distinguish the normal age-related sleep changes from those originating from pathological processes. PMID:21225347

  14. Chronic obstructive pulmonary disease and obstructive sleep apnoea—the overlap syndrome

    PubMed Central

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are highly prevalent disorders and the co-existence of both disorders, termed the overlap syndrome, affects at least 1% of the adult population. Patients with the overlap syndrome typically experience more pronounced nocturnal oxygen desaturation and there is a high prevalence of pulmonary hypertension in such patients. Recent evidence suggests that the prevalence of each disorder together is higher than might be predicted by simple prevalence statistics, although the evidence is not clear-cut in this regard. Sleep itself can have several negative effects in patients with COPD. Sleep quality is diminished with reduced amounts of slow wave and rapid-eye-movement (REM) sleep, which may contribute to daytime symptoms such as fatigue and lethargy. Furthermore, normal physiological adaptations during sleep that result in mild hypoventilation in normal subjects are more pronounced in COPD, which can result in clinically important nocturnal oxygen desaturation. Management of sleep disorders in patients with COPD should address both sleep quality and disordered gas exchange. Non-invasive pressure support is beneficial in selected cases, particularly during acute exacerbations associated with respiratory failure, and is particularly helpful in patients with the overlap syndrome. There is limited evidence of benefit from pressure support in the chronic setting in COPD patients without OSA. PMID:26904264

  15. Cognitive complaints in obstructive sleep apnea.

    PubMed

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

    2015-02-01

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

  16. Patients with Obstructive Sleep Apnea at Altitude.

    PubMed

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

    2015-06-01

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

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

    PubMed

    Paiva, Teresa; Attarian, Hrayr

    2014-01-01

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

  18. 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

  19. Obstructive Sleep Apnea and Sickle Cell Anemia

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Panossian, Lori A; Veasey, Sigrid C

    2012-05-01

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

  1. Sleep Discrepancy, Sleep Complaint, and Poor Sleep Among Older Adults

    PubMed Central

    2013-01-01

    Objectives. Discrepancy between self-report- and actigraphy-measured sleep, often considered an artifact of measurement error, has been well documented among insomnia patients. Sleep problems are common among older adults, and this discrepancy may represent meaningful sleep-related phenomenon, which could have clinical and research significance. Method. Sleep discrepancy was examined in 4 groups of older adults (N = 152, mean age = 71.93 years) based on sleep complaint versus no complaint and presence versus absence of insomnia symptoms. Participants completed the Beck Depression Inventory-second edition (BDI-II) and 14 nights of sleep diaries and actigraphy. Results. Controlling for covariates, group differences were found in the duration and frequency of discrepancy in sleep onset latency (SOLd) and wake after sleep onset (WASOd). Those with insomnia symptoms and complaints reported greater duration and frequency of WASOd than the other 3 groups. Quantities of SOLd and WASOd were related to BDI-II score and group status, indicating that sleep discrepancy has meaningful clinical correlates. Discussion. Discrepancy occurred across all groups but was pronounced among the group with both insomnia symptoms and complaints. This discrepancy may provide a means of quantifying and conceptualizing the transition from wake to sleep among older adults, particularly those with sleeping problems. PMID:23804432

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

    PubMed

    Dinç, Aykut Erdem; Yılmaz, Metin; Tutar, Hakan; Aydil, Utku; Kızıl, Yusuf; Damar, Murat; Kemaloğlu, Yusuf K

    2014-10-01

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

  3. 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

  4. Obstructive sleep apnea presenting as pseudopheochromocytoma.

    PubMed

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

    2016-01-01

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

  5. 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

  6. Glaucoma and obstructive sleep apnoea syndrome.

    PubMed

    Faridi, Omar; Park, Sung Chul; Liebmann, Jeffrey M; Ritch, Robert

    2012-01-01

    Glaucoma is increasingly recognized as a manifestation of both ocular and systemic risk factors. A number of disorders associated with reduced blood flow and ischaemia, collectively termed vascular risk factors, such as migraine, Raynaud's phenomenon, atrial fibrillation and reduced nocturnal blood pressure, lead to decreased ocular perfusion pressure. During sleep, alterations occur in cardiovascular physiology that are balanced by autoregulation to maintain homeostasis. However, in obstructive sleep apnoea (OSA), the normal physiological balance is upset. A potentially modifiable risk factor, OSA has been increasingly associated with glaucoma independent of intraocular pressure. OSA may alter blood flow to the optic nerve head and, in combination with other predisposing factors, lead to decreased ocular perfusion pressure. This in turn may directly affect the optic nerve or it may indirectly increase its susceptibility to other insults. The purpose of this review is to shed light on the association between OSA and glaucoma. PMID:22339817

  7. 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

  8. Obstructive sleep apnea presenting as pseudopheochromocytoma

    PubMed Central

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

    2016-01-01

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

  9. 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

  10. 77 FR 25226 - Proposed Recommendations on Obstructive Sleep Apnea

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

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

  11. Does nasal decongestion improve obstructive sleep apnea?

    PubMed

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

    2008-12-01

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

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

    PubMed

    Oomen, Karin P Q; Modi, Vikash K

    2013-09-01

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

  13. Sleep Perception in Obstructive Sleep Apnea: A Study Using Polysomnography and the Multiple Sleep Latency Test

    PubMed Central

    Nam, Hyunwoo; Lim, Jae-Sung; Kim, Jun-Soon; Lee, Keon-Joo; Koo, Dae Lim

    2016-01-01

    Background and Purpose Discrepancies between objectively measured sleep and subjective sleep perception in patients with insomnia have been reported. However, few studies have investigated sleep-state misperception in patients with obstructive sleep apnea (OSA). We designed this study to 1) delineate the factors that could affect this discrepancy and 2) infer an underlying mechanism in patients with OSA. Methods We recruited patients who visited our sleep clinic for the evaluation of their snoring and/or observed OSA. Participants completed a structured questionnaire and underwent overnight polysomnography. On the following day, five sessions of the multiple sleep latency test (MSLT) were applied. We divided the patients into two groups: normal sleep perception and abnormal perception. The abnormal-perception group included patients whose perceived total sleep time was less than 80% of that measured in polysomnography. Results Fifty OSA patients were enrolled from a university hospital sleep clinic. Excessive daytime sleepiness, periodic limb movement index (PLMI), and the presence of dreaming were positively associated with poor sleep perception. REM sleep near the sleep termination exerted important effects. Respiratory disturbance parameters were not related to sleep perception. There was a prolongation in the sleep latency in the first session of the MSLT and we suspected that a delayed sleep phase occurred in poor-sleep perceivers. Conclusions As an objectively good sleep does not match the subjective good-sleep perception in OSA, physicians should keep in mind that OSA patients who perceive that they have slept well does not mean that their OSA is less severe. PMID:27074296

  14. Insular Cortex Metabolite Changes in Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

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

  15. Obstructive sleep apnea – management update

    PubMed Central

    Hukins, Craig A

    2006-01-01

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

  16. 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

  17. Coblation endoscopic lingual lightening (CELL) for obstructive sleep apnea.

    PubMed

    Li, Hsueh-Yu; Lee, Li-Ang; Kezirian, Eric J

    2016-01-01

    This study investigated the feasibility, safety and efficacy of Coblation endoscopic lingual lightening (CELL) surgery for obstructive sleep apnea (OSA). This study was a retrospective case series in a tertiary referral sleep center. Twenty-five adults with moderate to severe OSA and determined to have retropalatal and tongue base obstruction based on Friedman tongue position III and fiberoptic endoscopy underwent CELL in combination with modified uvulopalatopharyngoplasty, known as relocation pharyngoplasty. CELL involves transoral resection of tongue base muscle tissue and lingual tonsil using Coblation under endoscopic guidance. The mean operation time for CELL was 42.6 ± 13.7 min. Total blood loss for CELL plus relocation pharyngoplasty was <50 ml in all patients. Mean postoperative pain score (sum of total pain scores/sum of total hospitalization day, visual analog scale, 0-10) was 2.6 ± 0.6. Postoperative bleeding and taste disturbance extending beyond 3 months occurred in one patient (4 %) individually. No patients reported tongue weakness or speech dysfunction. Epworth sleepiness scale improved from 9.6 ± 4.9 to 7.5 ± 4.3 (p = 0.023). Apnea-hypopnea index decreased from 45.7 ± 21.7 to 12.8 ± 8.2 events/hour (p < 0.001) 6 months after surgery. The overall response rate was 80 %. CELL is feasible, safe and effective in treating tongue base obstruction in OSA patients who underwent simultaneous relocation pharyngoplasty. PMID:25577994

  18. Pharyngeal fat in obstructive sleep apnea.

    PubMed

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

    1993-08-01

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

  19. An update on cardiovascular effects of obstructive sleep apnoea syndrome.

    PubMed

    Uyar, Meral; Davutoglu, Vedat

    2016-09-01

    Obstructive sleep apnoea syndrome is an important health problem which may cause or worsen systemic diseases. Chronic intermittent hypoxia during repetitive airflow cessations may cause endothelial dysfunction. Sleep apnoea is also shown to be associated with hypercoagulability which may be due to decreased nitric oxide levels and impaired vasodilatation. Endothelial dysfunction, increased systemic inflammation, sympathetic nervous system activation, increased oxidative stress and dysglycaemia may all contribute to cardiovascular processes such as hypertension, arrhythmia, stroke, heart failure and coronary artery disease in patients with obstructive sleep apnoea. Treatment approaches in patients with obstructive sleep apnoea mainly focus on maintaining upper airway patency either with positive airway pressure devices or upper airway appliances. Strategies involving positive airway pressure therapy are associated with decreased morbidity and mortality. Obstructive sleep apnoea should be suspected as an underlying mechanism in patients with cardiovascular disease and warrants appropriate treatment. PMID:27317753

  20. Biomarkers associated with obstructive sleep apnea: A scoping review.

    PubMed

    Canto, Graziela De Luca; Pachêco-Pereira, Camila; Aydinoz, Secil; Major, Paul W; Flores-Mir, Carlos; Gozal, David

    2015-10-01

    The overall validity of biomarkers in the diagnosis of obstructive sleep apnea (OSA) remains unclear. We conducted a scoping review to provide assessments of biomarkers characteristics in the context of obstructive sleep apnea (OSA) and to identify gaps in the literature. A scoping review of studies in humans without age restriction that evaluated the potential diagnostic value of biological markers (blood, exhaled breath condensate, salivary, and urinary) in the OSA diagnosis was undertaken. Retained articles were those focused on the identification of biomarkers in subjects with OSA, the latter being confirmed with a full overnight or home-based polysomnography (PSG). Search strategies for six different databases were developed. The methodology of selected studies was classified using an adaptation of the evidence quality criteria from the American Academy of Pediatrics. Additionally the biomarkers were classified according to their potential clinical application. We identified 572 relevant studies, of which 117 met the inclusion criteria. Eighty-two studies were conducted in adults, 34 studies involved children, and one study had a sample composed of both adults and children. Most of the studies evaluated blood biomarkers. Potential diagnostic biomarkers were found in nine pediatric studies and in 58 adults studies. Only nine studies reported sensitivity and specificity, which varied substantially from 43% to 100%, and from 45% to 100%, respectively. Studies in adults have focused on the investigation of IL-6, TNF-α and hsCRP. There was no specific biomarker that was tested by a majority of authors in pediatric studies, and combinatorial urine biomarker approaches have shown preliminary promising results. In adults IL-6 and IL-10 seem to have a favorable potential to become a good biomarker to identify OSA. PMID:25645128

  1. Sleep complaints and sleep breathing disorders in upper and lower obstructive lung diseases.

    PubMed

    Ferrando, Matteo; Bagnasco, Diego; Roustan, Valeria; Canonica, Giorgio Walter; Braido, Fulvio; Baiardini, Ilaria

    2016-08-01

    Upper and lower obstructive lung diseases can induce sleep complaints and can be part of the pathogenesis of sleep breathing disorders. In fact, the physiological changes of the pattern of respiration during sleep, added to the airways disease can lead to symptomatic worsening of rhinitis, asthma and chronic obstructive pulmonary diseases (COPD); moreover, their functional and anatomical features can lead to sleep breathing disorders such as obstructive sleep apnea syndrome (OSAS). This review highlights the above-mentioned relationships and the effect of disease management on its comorbidities and the patient's quality of life. Rhinitis, asthma and COPD represent causes of sleep complaints that may be reduced with optimal management of these obstructive airways diseases. Continuous positive airway pressure (CPAP) treatment of sleep apnea needs to be tailored after optimization of the therapy of concomitant diseases, but it can often ameliorate comorbid disease. PMID:27621908

  2. Sleep complaints and sleep breathing disorders in upper and lower obstructive lung diseases

    PubMed Central

    Ferrando, Matteo; Bagnasco, Diego; Roustan, Valeria; Canonica, Giorgio Walter; Braido, Fulvio

    2016-01-01

    Upper and lower obstructive lung diseases can induce sleep complaints and can be part of the pathogenesis of sleep breathing disorders. In fact, the physiological changes of the pattern of respiration during sleep, added to the airways disease can lead to symptomatic worsening of rhinitis, asthma and chronic obstructive pulmonary diseases (COPD); moreover, their functional and anatomical features can lead to sleep breathing disorders such as obstructive sleep apnea syndrome (OSAS). This review highlights the above-mentioned relationships and the effect of disease management on its comorbidities and the patient’s quality of life. Rhinitis, asthma and COPD represent causes of sleep complaints that may be reduced with optimal management of these obstructive airways diseases. Continuous positive airway pressure (CPAP) treatment of sleep apnea needs to be tailored after optimization of the therapy of concomitant diseases, but it can often ameliorate comorbid disease. PMID:27621908

  3. Sleep-related breathing disorders. 6. Obstructive sleep apnoea syndrome in infants and children: established facts and unsettled issues.

    PubMed Central

    Gaultier, C.

    1995-01-01

    The presence of increased upper airway resistive loads during sleep can now be diagnosed by paediatricians. However, diagnostic criteria need to be further clarified to allow accurate identification of episodes of partial airway obstruction. New technological advances can be expected to help to determine the clinical usefulness of ambulatory testing during sleep and thus to establish the indications for polysomnographic investigations in the laboratory. A thorough investigation of the anatomical abnormalities that contribute to airways obstruction is essential for selecting the most appropriate therapy. However, the order in which these investigations should be performed remains unclear. The diagnostic tools, including questionnaires and sleep testing, and methods aimed at investigating pathophysiological mechanisms should be standardised for multicentre studies. Familial factors should be taken into account. The best strategy for preventing the complications of the OSA syndrome is to identify the disorder as early as possible. This requires close cooperation between adult physicians and paediatricians called upon to evaluate sleep-related disorders. PMID:8553280

  4. 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

  5. In the clinic. Obstructive sleep apnea.

    PubMed

    Balachandran, Jay S; Patel, Sanjay R

    2014-11-01

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

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

    PubMed Central

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

    2013-01-01

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

  7. Prosthodontic Approach to Treat Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

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

  8. Obstructive sleep apnoea syndrome and its management

    PubMed Central

    Caruso, Daniela; Di Maria, Giuseppe

    2015-01-01

    Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment. Nasal CPAP (nCPAP) is highly effective in controlling symptoms, improving quality of life and reducing the clinical sequelae of sleep apnoea. Other positive airway pressure modalities are available for patients intolerant to CPAP or requiring high levels of positive pressure. Mandibular advancement devices, particularly if custom made, are effective in mild to moderate OSA and provide a viable alternative for patients intolerant to CPAP therapy. The role of surgery remains controversial. Uvulopalatopharyngoplasty is a well established procedure and can be considered when treatment with CPAP has failed, whereas maxillar-mandibular surgery can be suggested to patients with a craniofacial malformation. A number of minimally invasive procedures to treat snoring are currently under evaluation. Weight loss improves symptoms and morbidity in all patients with obesity and bariatric surgery is an option in severe obesity. A multidisciplinary approach is necessary for an accurate management of the disease. PMID:26336596

  9. Facial morphology and obstructive sleep apnea

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-09-01

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

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

    PubMed Central

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

    2016-01-01

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

  12. Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal.

    PubMed

    Camacho, Macario; Zaghi, Soroush; Chang, Edward T; Song, Sungjin A; Szelestey, Blake; Certal, Victor

    2016-01-01

    Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed. PMID:26925105

  13. Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

    PubMed Central

    Camacho, Macario; Zaghi, Soroush; Chang, Edward T.; Song, Sungjin A.; Szelestey, Blake; Certal, Victor

    2016-01-01

    Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed. PMID:26925105

  14. [Hungarian Society for Sleep Medicine guideline for detecting drivers with obstructive sleep apnea syndrome].

    PubMed

    Szakács, Zoltán; Ádám, Ágnes; Annus, János Kristóf; Csatlós, Dalma; László, Andrea; Kalabay, László; Torzsa, Péter

    2016-06-01

    Obstructive sleep apnea is the most frequent sleep-disordered breathing. The prevalence of sleep apnea in the general population is 2-4% and the main characteristics of the disease are the intermittent cessation or substantial reduction of airflow during sleep, which is caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. Untreated patients are 4-6 times more likely to cause traffic accidents than their healthy counterparts. The aims of the obstructive sleep apnea screening are to prevent and reduce the incidence of serious car accidents, which are often caused by one of the most dangerous sleep disorders. Since April 1, 2015 a modification of the 13/1992 regulation has been in force in Hungary which orders screening of obstructive sleep apnea during medical checkup of drivers. The Hungarian Society for Sleep Medicine made a guideline according to the regulation which was adapted to national circumstances and family doctors, occupational health specialists can more easily screen obstructive sleep apnea in suspected patients. In sleep ambulances the disease can be diagnosed and effective treatment can be started. Patients receiving appropriate treatment and with appropriate compliance can get their driving licence under regular care and control. PMID:27233832

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

    PubMed

    Khatri, Sumita B; Ioachimescu, Octavian C

    2016-02-01

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

  16. Sleep Symptoms and Polysomnographic Patterns of Obstructive Sleep Apnea in Obese Children

    PubMed Central

    TAVASOLI, Azita; JALILOLGHADR, Shabnam; LOTFI, Shiva

    2016-01-01

    Objective This study was conducted to investigate the sleep symptoms and polysomnographic patterns of obstructive sleep apnea in overweight and obese children. Materials & Methods Overweight or obese children aging 6-18 yr old referred during 2010 to Endocrinology Clinic of Ghods Hospital in Ghazvin, central Iran were enrolled in the study. Polysomnography was done for the diagnosis of obstructive sleep apnea and the BEARS and Children’s Sleep Habits questionnaires were used to survey sleep behaviors. Results: We enrolled 30 children (14 males, 16 females). Twenty-one cases had body mass index (BMI) >95% and 9 had 85% sleep talking 10 (33.3%); bedtime resistance 9 (30%); nightmares 8 (26.6%); waking up problems 6 (20%); sleep walking 6 (20%); difficult breathing 4 (13.3%); bedwetting 3 (10%) and sleep onset delay 2 (6.06%). Severe, moderate and mild apnea – hypopnea Index (AHI) were seen in 12, 9 and 6 subjects, respectively. A significant Pearson correlation was found between the BMI values and sleep latency. Conclusion : Prevalence of obstructive sleep apnea is high among overweight and obese children. Physicians should be familiar with its manifestations and consider polysomnography as an invaluable diagnostic test. There was no relation between the degree of obesity and severity of obstructive sleep apnea. PMID:27057182

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

    PubMed Central

    Mieczkowski, Brian; Ezzie, Michael E

    2014-01-01

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

  18. Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.

    PubMed

    Wolfe, Robert M; Pomerantz, Jonathan; Miller, Deborah E; Weiss-Coleman, Rebecca; Solomonides, Tony

    2016-01-01

    The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period. PMID:26957384

  19. Obstructive sleep apnea screening by NIRS imaging

    NASA Astrophysics Data System (ADS)

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

    2007-02-01

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

  20. Cluster headache with obstructive sleep apnea and periodic limb movements during sleep: a case report.

    PubMed

    Pelin, Zerrin; Bozluolcay, Melda

    2005-01-01

    We report the case of a man with episodic cluster headache who suffered from severe obstructive sleep apnea (OSA) as well as periodic limb movements during sleep (PLMS). His attacks of headache occurred primarily during sleep being timely to REM sleep as 90 to 120 minutes interval. OSAs were more frequent and prolonged during REM sleep and oxygen saturation decreased to 81% during this sleep period. Periodic limb movements were also observed in our patient that were more frequent during the first half of the polysomnographic recordings. This case is one of the few reporting cases with CH who had both OSA and PLMS. PMID:15663620

  1. Oxidative Stress in Children with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Tauman, Riva; Lavie, Lena; Greenfeld, Michal; Sivan, Yakov

    2014-01-01

    Study Objectives: Pediatric obstructive sleep apnea (OSA) is associated with cardiovascular consequences, including accelerated atherosclerosis and endothelial dysfunction. Increased lipid peroxidation, a marker of oxidative stress, has been identified in adults with OSA in a severity-dependent manner, with attenuation following treatment with continuous positive airway pressure therapy. Studies on oxidative stress in children with OSA are sparse and results are inconclusive. The objective of this study was to compare lipid peroxidation in children with OSA to non-OSA children. Methods: A prospective cross-sectional study of 26 children with polysomnography-confirmed OSA (oAHI ≥ 5/h TST) was conducted. Thirty age- and body mass index z-score-matched children with primary snoring (PS) served as a comparison group (oAHI ≤ 1/h TST). Fasting blood samples were obtained on the morning following the sleep study. Plasma oxidized low-density lipoprotein (oxLDL) concentrations were measured by enzyme-linked immunosorbent assay. Results: There were no group differences in patient characteristics and their lipid profiles. The mean oxLDL levels of the OSA group were significantly higher than those of the comparison group (53.1 ± 13.0 vs. 45.7 ± 10.0 U/L, respectively, p = 0.02). There was a significant positive correlation between plasma oxLDL and the apnea hypopnea index (r = 0.29, p = 0.03) and between oxLDL and the oxygen desaturation index (r = 0.51, p = 0.003), and a significant negative correlation between SpO2 nadir and oxLDL (r = −0.29, p = 0.03). Conclusions: OSA in children is associated with increased lipid peroxidation in a severity-dependent manner. Lipid peroxidation levels correlate with the degree of intermittent hypoxia. Citation: Tauman R, Lavie L, Greenfeld M, Sivan Y. Oxidative stress in children with obstructive sleep apnea syndrome. J Clin Sleep Med 2014;10(6):677-681. PMID:24932149

  2. OBSTRUCTIVE SLEEP APNEA AND CENTRAL SEROUS CHORIORETINOPATHY

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2013-06-01

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

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

    PubMed

    Strauss, M

    1990-02-01

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

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

    PubMed

    Veney, Amy J

    2013-01-01

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

  6. Anaesthetic Management in Obstructive Sleep Apnoea Syndrome for Adenotonsillectomy.

    PubMed

    Şanlı, Mukadder; Toplu, Yüksel; Özgül, Ülkü; Kayhan, Gülay Erdoğan; Gülhaş, Nurçin

    2014-08-01

    The anaesthetic management of adenotonsillectomy in children with obstructive sleep apnoea syndrome is characteristic due to respiratory and cardiac side effects. A detailed physical examination in the preoperative period should be performed, including children's respiratory and cardiac systems. If they have an active infection, surgery should be postponed until the end of medical treatment. Preparation for difficult airway management should be done in the preoperative period. In this case, we presented a report of two children who had obstructive sleep apnoea syndrome, with airway management performed at the right lateral position to prevent the pharyngeal collapse and rapid sequence intubation performed using a short-acting muscle relaxant. PMID:27366426

  7. Anaesthetic Management in Obstructive Sleep Apnoea Syndrome for Adenotonsillectomy

    PubMed Central

    Şanlı, Mukadder; Toplu, Yüksel; Özgül, Ülkü; Kayhan, Gülay Erdoğan; Gülhaş, Nurçin

    2014-01-01

    The anaesthetic management of adenotonsillectomy in children with obstructive sleep apnoea syndrome is characteristic due to respiratory and cardiac side effects. A detailed physical examination in the preoperative period should be performed, including children’s respiratory and cardiac systems. If they have an active infection, surgery should be postponed until the end of medical treatment. Preparation for difficult airway management should be done in the preoperative period. In this case, we presented a report of two children who had obstructive sleep apnoea syndrome, with airway management performed at the right lateral position to prevent the pharyngeal collapse and rapid sequence intubation performed using a short-acting muscle relaxant. PMID:27366426

  8. Obstructive apnea during sleep is associated with peripheral vasoconstriction

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  9. [Experiences with therapy of pediatric sleep apnea syndrome and obstructive nasopharyngeal respiratory pattern with nasal BIPAP and CPAP therapy].

    PubMed

    Zwacka, G; Scholle, S

    1995-03-01

    Sleep-apnea in childhood shows a frequency similar to adults but it is caused by many other reasons. Therapeutic effects of nasal CPAP and BIPAP can replace surgical ENT-Therapy in large extent mainly in ages at 2-5 years. But also in older children is it possible to treat obstructive sleep apnea and hypoventilation neuromuscular diseases by BIPAP. Examples for treatment of children by BIPAP who are two years old were given. Other demonstrated cases cover children with stridor congenitus, obstructive sleep apnea, hypoventilation, adenoidal breathing disturbances with primary surgical treated tonsillar hyperplasia and one case of thoracal postobstructive malformation with therapeutic BIPAP options. PMID:7617601

  10. Association between Positional Dependency and Obstruction Site in Obstructive Sleep Apnea Syndrome

    PubMed Central

    Sunwoo, Woong Sang; Hong, Sung-Lyong; Kim, Sang-Wook; Park, Sung Joon; Han, Doo Hee; Kim, Jeong-Whun; Lee, Chul Hee

    2012-01-01

    Objectives The purpose of this study is to find out associations between positional dependency and obstructive levels based on sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea syndrome (OSAS). Methods Retrospective review was made of 91 OSAS patients who underwent polysomnography and SVF from August 2009 through June 2010. Polysomnography variables including apnea-hypopnea index (AHI), supine AHI, non-supine AHI, time spent in supine sleep position of the total sleep time and positional dependency (PD) were analyzed. Obstruction sites were evaluated as SVF variables. Results Of 91 patients, 65 (71.4%) were positional patients (PP) and 26 (28.6%) were non-positional patients (NPP). An analysis of polysomnography variables according to PD revealed that overall AHI, non-supine AHI and supine AHI in PP was significantly lower than that in NPP. The patients with soft palate obstruction (SP type) were more likely to have PD than the patients with tongue base obstruction (TB type; P=0.046). PD was inversely related to OSAS severity significantly (P=0.001). Conclusion These results provide evidence that positional dependent patients may have higher success rate of soft palate OSA surgery alone than non-positional dependent patients. Although PD may be associated with obstruction site, PD only itself may not be useful in planning surgical treatment for OSAS. PMID:23205227

  11. Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea

    PubMed Central

    Kothare, Sanjeev V.; Rosen, Carol L.; Lloyd, Robin M.; Paruthi, Shalini; Thomas, Sherene M.; Troester, Matthew M.; Carden, Kelly A.

    2015-01-01

    The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: insomnia, obstructive sleep apnea in adults, obstructive sleep apnea in children, restless legs syndrome, and narcolepsy. This paper describes the rationale, background, general methods development, and considerations in implementation of these quality measures in obstructive sleep apnea (OSA) in children. This document describes measurement methods for five desirable process measures: assessment of symptoms and risk factors of OSA, initiation of an evidence-based action plan, objective evaluation of high-risk children with OSA by obtaining a polysomnogram (PSG), reassessment of signs and symptoms of OSA within 12 months, and documentation of objective assessment of positive airway pressure adherence. When these five process measures are met, clinicians should be able to achieve the two defined outcomes: improve detection of childhood OSA and reduce signs and symptoms of OSA after initiation of a management plan. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with childhood OSA. Citation: Kothare SV, Rosen CL, Lloyd RM, Paruthi S, Thomas SM, Troester MM, Carden KA. Quality measures for the care of pediatric patients with obstructive sleep apnea. J Clin Sleep Med 2015;11(3):385–404. PMID:25700879

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed Central

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

    2008-01-01

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

  14. Sleep Changes in Older Adults

    MedlinePlus

    ... ages can have a sleep disorder such as sleep apnea. Restless legs syndrome or periodic limb movement disorder ... that can cause problems with sleep. What is sleep apnea? Sleep apnea is a disorder in which a ...

  15. 77 FR 23794 - Proposed Recommendations on Obstructive Sleep Apnea

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-20

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

  16. Chronic obstructive pulmonary disease - adults - discharge

    MedlinePlus

    ... visit when they're all better. Save Your Energy at Home Place items you use often in ... or the skin around your fingernails are blue Alternative Names COPD - adults - discharge; Chronic obstructive airways disease - ...

  17. Sleep in Chronic Obstructive Pulmonary Disease: Evidence Gaps and Challenges

    PubMed Central

    Li, Yanru; Owens, Robert L.; Malhotra, Atul

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) prevalence is rising to epidemic proportions due to historical smoking trends, the aging of the population, and air pollution. Although blaming the victims has been common in COPD, the majority of COPD worldwide is now thought to be nonsmoking related, that is, caused by air pollution and cookstove exposure. It is increasingly appreciated that subjective and objective sleep disturbances are common in COPD, although strong epidemiological data are lacking. People with obstructive sleep apnea (OSA) plus COPD (the so-called overlap syndrome) have a high risk of cardiovascular death, although again mechanisms are unknown and untested. This review aims to draw attention to the problem of sleep in COPD, to encourage clinicians to ask their patients about symptoms, and to stimulate further research in this area given the large burden of the disease. PMID:27445564

  18. Sleep in Chronic Obstructive Pulmonary Disease: Evidence Gaps and Challenges.

    PubMed

    Jen, Rachel; Li, Yanru; Owens, Robert L; Malhotra, Atul

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) prevalence is rising to epidemic proportions due to historical smoking trends, the aging of the population, and air pollution. Although blaming the victims has been common in COPD, the majority of COPD worldwide is now thought to be nonsmoking related, that is, caused by air pollution and cookstove exposure. It is increasingly appreciated that subjective and objective sleep disturbances are common in COPD, although strong epidemiological data are lacking. People with obstructive sleep apnea (OSA) plus COPD (the so-called overlap syndrome) have a high risk of cardiovascular death, although again mechanisms are unknown and untested. This review aims to draw attention to the problem of sleep in COPD, to encourage clinicians to ask their patients about symptoms, and to stimulate further research in this area given the large burden of the disease. PMID:27445564

  19. An evaluation of a novel mask in four patients with obstructive sleep apnea and overlap syndromes.

    PubMed

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

    2013-01-01

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

  20. Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure.

    PubMed

    Davies, Charles R; Harrington, John J

    2016-09-01

    There is evidence that obstructive sleep apnea (OSA) can negatively impact attention, memory, learning, executive function, and overall intellectual function in adults and children. Imaging techniques, including MRI, MR diffusion tensor imaging, MR spectroscopy, and fMRI, have provided additional insight into the anatomic and functional underpinnings of OSA-related cognitive impairment. Both animal and human studies have looked to elucidate the separate effects of oxygen desaturation and sleep fragmentation on independent aspects of cognition. Data from animal models point to neuro-inflammation and oxidative stress as driving factors of cognitive impairment. PMID:27542875

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

    PubMed Central

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

    2015-01-01

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

  2. Metabolic and Glycemic Sequelae of Sleep Disturbances in Children and Adults

    PubMed Central

    Koren, Dorit; O'Sullivan, Katie L.; Mokhlesi, Babak

    2015-01-01

    The prevalence of obesity in adults and children has increased greatly in the past three decades, as have metabolic sequelae, such as insulin resistance and type 2 diabetes mellitus (T2DM). Sleep disturbances are increasingly recognized as contributors to this widespread epidemic in adults, and data are emerging in children as well. The categories of sleep disturbances that contribute to obesity and its glycemic co-morbidities include the following: (1) alterations of sleep duration, chronic sleep restriction and excessive sleep; (2) alterations in sleep architecture; (3) sleep fragmentation; (4) circadian rhythm disorders and disruption (i.e., shift work); and (5) obstructive sleep apnea. This article reviews current evidence supporting the contributions that these sleep disorders play in the development of obesity, insulin resistance, and T2DM as well as possibly influences on glycemic control in type 1 diabetes, with a special focus on data in pediatric populations. PMID:25398202

  3. Oxidative stress in patients with obstructive sleep apnoea syndrome.

    PubMed

    Passali, D; Corallo, G; Yaremchuk, S; Longini, M; Proietti, F; Passali, G C; Bellussi, L

    2015-12-01

    Obstructive sleep apnoea syndrome (OSAS) is a disorder that leads to metabolic abnormalities and increased cardiovascular risk. The aim of this study was to identify early laboratory markers of cardiovascular disease through analysis of oxidative stress in normal subjects and patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in 20 adult patients with OSAS and a control group of 20 normal subjects. Laboratory techniques for detecting and quantifying free radical damage must be targeted to assess the pro-oxidant component and the antioxidant in order to obtain an overall picture of oxidative balance. No statistical differences in age, sex distribution, or BMI were found between the two groups (p>0.05). There were significant differences in the apnoea/hypopnoea index (AHI) between OSAS patients and the control group (p<0.05). Statistically significant differences in isoprostane, advanced oxidation protein products (AOPP) and non-protein bound iron (NPBI) levels were found between the study and control groups. No significant difference in the levels of thiol biomarkers was found between the two groups. The main finding of the present study was increased production of oxidative stress biomarkers in OSAS patients. The major difference between thiols and other oxidative stress biomarkers is that thiols are antioxidants, while the others are expressions of oxidative damage. The findings of the present study indicate that biomarkers of oxidative stress in OSAS may be used as a marker of upper airway obstructive episodes due to mechanical trauma, as well as a marker of hypoxaemia causing local oropharyngeal inflammation. PMID:26900248

  4. Sleep Disorders in Adult Sickle Cell Patients

    PubMed Central

    Sharma, Sunil; Efird, Jimmy T.; Knupp, Charles; Kadali, Renuka; Liles, Darla; Shiue, Kristin; Boettger, Peter; Quan, Stuart F.

    2015-01-01

    Study Objectives: While sleep apnea has been studied in children with sickle cell disease (SCD), little is known about sleep disorders in adult sickle cell patients. The objective of this study was to evaluate sleep disordered breathing and its polysomnographic characteristics in adult patients with sickle cell disease. Methods: The analysis cohort included 32 consecutive adult SCD patients who underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center after reporting symptoms suggesting disordered sleep or an Epworth Sleepiness Scale score ≥ 10. Epworth score, sleep parameters, comorbid conditions, and narcotic use were reviewed and compared in patients with and without sleep disordered breathing. SCD complication rates in the two groups also were compared. Results: In adult SCD patients who underwent overnight polysomnography, we report a high prevalence (44%) of sleep disordered breathing. Disease severity was mild to moderate (mean apnea-hypopnea index = 17/h (95% CI: 10–24/h). Concomitant sleep disorders, including insomnia complaints (57%) and delayed sleep-phase syndrome (57%), also were common in this population. In this limited cohort, we did not find increased SCD complications associated with sleep disordered breathing in adult patients with sickle cell disease. Conclusions: A high burden of sleep disordered breathing and other sleep-related complaints were identified in the adult sickle cell population. Our results provide important information on this unique population. Citation: Sharma S, Efird JT, Knupp C, Kadali R, Liles D, Shiue K, Boettger P, Quan SF. Sleep disorders in adult sickle cell patients. J Clin Sleep Med 2015;11(3):219–223. PMID:25515282

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

    NASA Astrophysics Data System (ADS)

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

    2009-10-01

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

  6. Nonalcoholic fatty liver disease and obstructive sleep apnea.

    PubMed

    Aron-Wisnewsky, Judith; Clement, Karine; Pépin, Jean-Louis

    2016-08-01

    Obstructive sleep apnea (OSA) and more importantly its hallmark, chronic intermittent hypoxia (CIH), are established factors in the pathogenesis and exacerbation of nonalcoholic fatty liver disease (NAFLD). This has been clearly demonstrated in rodent models exposed to intermittent hypoxia, and strong evidence now also exists in both paediatric and adult human populations. OSA and CIH induce insulin-resistance and dyslipidemia which are involved in NAFLD physiopathogenesis. CIH increases the expression of the hypoxia inducible transcription factor HIF1α and that of downstream genes involved in lipogenesis, thereby increasing β-oxidation and consequently exacerbating liver oxidative stress. OSA also disrupts the gut liver axis, increasing intestinal permeability and with a possible role of gut microbiota in the link between OSA and NAFLD. OSA patients should be screened for NAFLD and vice versa those with NAFLD for OSA. To date there is no evidence that treating OSA with continuous positive airway pressure (CPAP) will improve NAFLD but it might at least stabilize and slow its progression. Nevertheless, these multimorbid patients should be efficiently treated for all their metabolic co-morbidities and be encouraged to follow weight stabilization or weight loss programs and physical activity life style interventions. PMID:27324067

  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. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

    PubMed

    Lee, Li-Ang; Lo, Yu-Lun; Yu, Jen-Fang; Lee, Gui-She; Ni, Yung-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses. PMID:27471038

  9. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

    PubMed Central

    Lee, Li-Ang; Lo, Yu-Lun; Yu, Jen-Fang; Lee, Gui-She; Ni, Yung-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40–300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05–1.49) and body mass index (OR, 1.48, 95% CI 1.02–2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301–850 Hz; OR, 0.84, 95% CI 0.74–0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301–850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses. PMID:27471038

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

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Levitzky, Michael G.

    2008-01-01

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

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

    PubMed

    Lack, Leon; Sweetman, Alexander

    2016-09-01

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

  13. Oxygen desaturation during night sleep affects decision-making in patients with obstructive sleep apnea.

    PubMed

    Delazer, Margarete; Zamarian, Laura; Frauscher, Birgit; Mitterling, Thomas; Stefani, Ambra; Heidbreder, Anna; Högl, Birgit

    2016-08-01

    This study assessed decision-making and its associations with executive functions and sleep-related factors in patients with obstructive sleep apnea. Thirty patients with untreated obstructive sleep apnea and 20 healthy age- and education-matched controls performed the Iowa Gambling Task, a decision-making task under initial ambiguity, as well as an extensive neuropsychological test battery. Patients, but not controls, also underwent a detailed polysomnographic assessment. Results of group analyses showed that patients performed at the same level of controls on the Iowa Gambling Task. However, the proportion of risky performers was significantly higher in the patient group than in the control group. Decision-making did not correlate with executive functions and subjective ratings of sleepiness, whereas there was a significant positive correlation between advantageous performance on the Iowa Gambling Task and percentage of N2 sleep, minimal oxygen saturation, average oxygen saturation and time spent below 90% oxygen saturation level. Also, the minimal oxygen saturation accounted for 27% of variance in decision-making. In conclusion, this study shows that a subgroup of patients with obstructive sleep apnea may be at risk of disadvantageous decision-making under ambiguity. Among the sleep-related factors, oxygen saturation is a significant predictor of advantageous decision-making. PMID:26899164

  14. Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index

    PubMed Central

    Shechter, Ari; St-Onge, Marie-Pierre; Kuna, Samuel T.; Zammit, Gary; RoyChoudhury, Arindam; Newman, Anne B.; Millman, Richard P.; Reboussin, David M.; Wadden, Thomas A.; Jakicic, John M.; Pi-Sunyer, F. Xavier; Wing, Rena R.; Foster, Gary D.

    2014-01-01

    Study Objectives: To determine if weight loss and/or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). Methods: This was a randomized controlled trial including 264 overweight/obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. Results: Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a significant positive association between AHI and stage 1 sleep (p < 0.001), and a significant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a significant positive association with change in body weight (p = 0.009). Conclusions: Compared to control, the ILI did not induce significant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more influenced by weight than AHI. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT00194259 Citation: Shechter A, St-Onge MP, Kuna ST, Zammit G, RoyChoudhury A, Newman AB, Millman RP, Reboussin DM, Wadden TA, Jakicic JM, Pi-Sunyer FX, Wing RR, Foster GD, Sleep AHEAD Research Group of the Look AHEAD Research Group. Sleep architecture following a

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

    PubMed Central

    McKay, Mary Pat

    2015-01-01

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

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

    PubMed

    McKay, Mary Pat

    2015-11-01

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

  17. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

    PubMed Central

    Ramar, Kannan; Dort, Leslie C.; Katz, Sheri G.; Lettieri, Christopher J.; Harrod, Christopher G.; Thomas, Sherene M.; Chervin, Ronald D.

    2015-01-01

    Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. Recommendations: We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) We suggest that sleep physicians conduct follow-up sleep testing

  18. 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

  19. 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

  20. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... Devices § 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to...

  1. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... Devices § 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to...

  2. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... Devices § 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to...

  3. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... Devices § 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to...

  4. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... Devices § 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to...

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

    SciTech Connect

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

    1988-01-01

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

  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. Maxillomandibular Advancement in the Management of Obstructive Sleep Apnea

    PubMed Central

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

    2012-01-01

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

  8. 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

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

    PubMed

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

    2016-09-01

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

  10. Tongue Fat and its Relationship to Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

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

  11. Prolonged partial upper airway obstruction during sleep - an underdiagnosed phenotype of sleep-disordered breathing.

    PubMed

    Anttalainen, Ulla; Tenhunen, Mirja; Rimpilä, Ville; Polo, Olli; Rauhala, Esa; Himanen, Sari-Leena; Saaresranta, Tarja

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea-hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment. PMID:27608271

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

    PubMed

    Mihalj, Mario; Lušić, Linda; Đogaš, Zoran

    2016-06-01

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

  13. 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

  14. Obstructive sleep apnea, pain, and opioids: is the riddle solved?

    PubMed Central

    Lam, Karen K.; Kunder, Samuel; Wong, Jean; Doufas, Anthony G.; Chung, Frances

    2016-01-01

    Purpose of review Perioperative opioid-based pain management of patients suffering from obstructive sleep apnea (OSA) may present challenges because of concerns over severe ventilatory compromise. The interaction between intermittent hypoxia, sleep fragmentation, pain, and opioid responses in OSA, is complex and warrants a special focus of perioperative outcomes research. Recent findings Life-threatening opioid-related respiratory events are rare. Epidemiologic evidence suggests that OSA together with other serious renal and heart disease, is among those conditions predisposing patients for opioid-induced ventilatory impairment (OIVI) in the postoperative period. Both intermittent hypoxia and sleep fragmentation, two distinct components of OSA, enhance pain. Intermittent hypoxia may also potentiate opioid analgesic effects. Activation of major inflammatory pathways may be responsible for the effects of sleep disruption and intermittent hypoxia on pain and opioid analgesia. Recent experimental evidence supports that these, seemingly contrasting, phenotypes of pain-increasing and opioid-enhancing effects of intermittent hypoxia, are not mutually exclusive. Although the effect of intermittent hypoxia on OIVI has not been elucidated, opioids worsen postoperative sleep-disordered breathing in OSA patients. A subset of these patients, characterized by decreased chemoreflex responsiveness and high arousal thresholds, might be at higher risk for OIVI. Summary OSA may complicate opioid-based perioperative management of pain by altering both pain processing and sensitivity to opioid effect. PMID:26545144

  15. 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

  16. Timing Matters: Circadian Rhythm in Sepsis, Obstructive Lung Disease, Obstructive Sleep Apnea, and Cancer.

    PubMed

    Truong, Kimberly K; Lam, Michael T; Grandner, Michael A; Sassoon, Catherine S; Malhotra, Atul

    2016-07-01

    Physiological and cellular functions operate in a 24-hour cyclical pattern orchestrated by an endogenous process known as the circadian rhythm. Circadian rhythms represent intrinsic oscillations of biological functions that allow for adaptation to cyclic environmental changes. Key clock genes that affect the persistence and periodicity of circadian rhythms include BMAL1/CLOCK, Period 1, Period 2, and Cryptochrome. Remarkable progress has been made in our understanding of circadian rhythms and their role in common medical conditions. A critical review of the literature supports the association between circadian misalignment and adverse health consequences in sepsis, obstructive lung disease, obstructive sleep apnea, and malignancy. Circadian misalignment plays an important role in these disease processes and can affect disease severity, treatment response, and survivorship. Normal inflammatory response to acute infections, airway resistance, upper airway collapsibility, and mitosis regulation follows a robust circadian pattern. Disruption of normal circadian rhythm at the molecular level affects severity of inflammation in sepsis, contributes to inflammatory responses in obstructive lung diseases, affects apnea length in obstructive sleep apnea, and increases risk for cancer. Chronotherapy is an underused practice of delivering therapy at optimal times to maximize efficacy and minimize toxicity. This approach has been shown to be advantageous in asthma and cancer management. In asthma, appropriate timing of medication administration improves treatment effectiveness. Properly timed chemotherapy may reduce treatment toxicities and maximize efficacy. Future research should focus on circadian rhythm disorders, role of circadian rhythm in other diseases, and modalities to restore and prevent circadian disruption. PMID:27104378

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  19. 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

  20. 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

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

    PubMed

    Chang, Sun Jung; Chae, Kyu Young

    2010-10-01

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

  2. Severe onychophagia and finger mutilation associated with obstructive sleep apnea.

    PubMed

    Nino, Gustavo; Singareddy, Ravi

    2013-04-15

    Untreated obstructive sleep apnea (OSA) can lead to important neurobehavioral consequences including cognitive deficits, hyperactivity/inattention, daytime sleepiness, and mood disturbances. Interestingly, the potential role of OSA in the pathogenesis of impulse-control disorders such as nail biting (onychophagia) is currently unknown. We present a case of a man with severe onychophagia and biting-induced finger mutilation that was completely resolved after diagnosis and treatment of severe OSA. Accordingly, this report represents an important clinical observation that suggests a connection between sleep physiology and the neurobiological circuits implicated in the regulation of impulse-control behaviors. Further research in this area may improve our current understanding of the neurobehavioral consequences of untreated OSA. PMID:23585754

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

    PubMed

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

    2014-12-01

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

  4. 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

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

    PubMed

    Soose, Ryan J

    2016-06-01

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

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

    PubMed

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

    2008-06-15

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

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

    PubMed

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

    2016-06-01

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

  8. 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

  9. 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

  10. Serotnin as a possible biomarker in obstructive sleep apnea.

    PubMed

    Lipford, Melissa C; Ramar, Kannan; Liang, Yao-Jen; Lin, Chii-Wann; Chao, Yun-Ting; An, Jen; Chiu, Chih-Hsien; Tsai, Yi-Ju; Shu, Chih-Hung; Lee, Fei-Peng; Chiang, Rayleigh Ping-Ying

    2016-08-01

    Obstructive sleep apnea (OSA) is a highly prevalent disease which carries substantial public health burden. Polysomnography is the standard procedure used to diagnose OSA. However cost, accessibility, technical requirements, and skilled interpretation needs constrain its widespread use and have a role in the under-diagnosis of sleep disordered breathing. There is a clinical need to develop expedient and widely accessible tools to detect this disorder., Several biochemical markers have recently been proposed as diagnostic tools in OSA. Numerous neurochemicals directly influence the activity of upper airway dilator motor neurons, which subsequently influence respiration during sleep. Serotonin (5-HT) is one such neurochemical that has a key role in ventilatory stimulation. Herein, we review the current evidence demonstrating relationships between multiple biomarkers and sleep disordered breathing and focus on relationships between OSA and 5-HT. We discuss the possibility of biomarker-driven detection technology in the future as a means of diagnosing and monitoring OSA. Finally, we explore the specific role 5-HT may have in the future in both the diagnosis and treatment of OSA. PMID:26694311

  11. Obstructive sleep apnea syndrome and the quality of life

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  13. Trazodone increases arousal threshold in obstructive sleep apnoea

    PubMed Central

    Heinzer, R.C.; White, D.P.; Jordan, A.S.; Lo, Y.L.; Dover, L.; Stevenson, K.; Malhotra, A.

    2009-01-01

    A low arousal threshold is believed to predispose to breathing instability during sleep. The present authors hypothesised that trazodone, a nonmyorelaxant sleep-promoting agent, would increase the effort-related arousal threshold in obstructive sleep apnoea (OSA) patients. In total, nine OSA patients, mean±SD age 49±9 yrs, apnoea/hypopnoea index 52±32 events·h-1, were studied on 2 nights, one with trazodone at 100 mg and one with a placebo, in a double blind randomised fashion. While receiving continuous positive airway pressure (CPAP), repeated arousals were induced: 1) by increasing inspired CO2 and 2) by stepwise decreases in CPAP level. Respiratory effort was measured with an oesophageal balloon. End-tidal CO2 tension (PET,CO2) was monitored with a nasal catheter. During trazodone nights, compared with placebo nights, the arousals occurred at a higher PET,CO2 level (mean±SD 7.30±0.57 versus 6.62±0.64 kPa (54.9±4.3 versus 49.8±4.8 mmHg), respectively). When arousals were triggered by increasing inspired CO2 level, the maximal oesophageal pressure swing was greater (19.4±4.0 versus 13.1±4.9 cmH2O) and the oesophageal pressure nadir before the arousals was lower (-5.1±4.7 versus -0.38±4.2 cmH2O) with trazodone. When arousals were induced by stepwise CPAP drops, the maximal oesophageal pressure swings before the arousals did not differ. Trazodone at 100 mg increased the effort-related arousal threshold in response to hypercapnia in obstructive sleep apnoea patients and allowed them to tolerate higher CO2 levels. PMID:18256066

  14. Derived Arterial Stiffness is Increased in Patients with Obstructive Sleep Apnea and Periodic Limb Movements during Sleep

    PubMed Central

    Drakatos, Panagis; Higgins, Sean; Pengo, Martino F.; Kent, Brian D.; Muza, Rex; Karkoulias, Kiriakos; Leschziner, Guy; Williams, Adrian

    2016-01-01

    Study Objectives: Both periodic limb movements during sleep (PLMS) and obstructive sleep apnea (OSA) have been associated with increased risk of cardiovascular disease (CVD). OSA has also been linked to increased large arterial stiffness, which is considered an independent risk factor for CVD. We utilized a previously validated index of large artery stiffness (SIDVP) derived from the digital volume pulse (DVP) to seek comparison in patients with PLMS and OSA. Methods: Forty-nine adult male subjects, without known comorbidities that could affect arterial stiffness or on vasoactive medication, were retrospectively identified and categorized into controls (n = 8), PLMS (n = 13), OSA (n = 17), and OSA/PLMS (n = 11). The cutoff for PLMS was a periodic limb movement index (PLMI) > 15 events/h, and for OSA an apnea-hypopnea index (AHI) > 10 events/h. SIDVP was derived from the raw data of photoplethysmography of the nocturnal polysomnography, averaged for 2 min prior to sleep study initiation (baseline), after completion in the morning, and every half hour after sleep onset. Results: The groups were age/body mass index-matched. Controls showed lower baseline, morning, and overall SIDVP compared to the other groups (p < 0.01). Patients with PLMS (PLMI: 50.69 ± 9.7 events/h) and the OSA group (AHI: 29.7 ± 2 events/h) demonstrated similar overall SIDVP (6.78 ± 0.08 versus 6.94 ± 0.04, respectively, p = 0.5), whereas the OSA/PLMS (AHI: 29.35 ± 8, PLMI: 50.63 ± 7.2) group demonstrated the highest (7.40 ± 0.06, p < 0.001). Conclusions: Based on an easily reproducible and applicable marker of large arterial stiffness, patients with significant PLMS had higher SIDVP when compared to controls and comparable to those with moderate/severe OSA. The OSA/PLMS group had the highest SIDVP, implying a possible additive effect of OSA and PLMS on arterial stiffness. Citation: Drakatos P, Higgins S, Pengo MF, Kent BD, Muza R, Karkoulias K, Leschziner G, Williams A. Derived arterial

  15. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

    PubMed Central

    Camacho, Macario; Certal, Victor; Abdullatif, Jose; Zaghi, Soroush; Ruoff, Chad M.; Capasso, Robson; Kushida, Clete A.

    2015-01-01

    Objective: To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data. Data Sources: Web of Science, Scopus, MEDLINE, and The Cochrane Library. Review Methods: The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results: Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apneahypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) −14.26 [95% confidence interval (CI) −20.98, −7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P = 0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y. Conclusion: Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments. Citation: Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM

  16. Analysis of Sleep Parameters in Patients with Obstructive Sleep Apnea Studied in a Hospital vs. a Hotel-Based Sleep Center

    PubMed Central

    Hutchison, Kimberly N.; Song, Yanna; Wang, Lily; Malow, Beth A.

    2008-01-01

    Background: Polysomnography is associated with changes in sleep architecture called the first-night effect. This effect is believed to result from sleeping in an unusual environment and the technical equipment used to study sleep. Sleep experts hope to decrease this variable by providing a more familiar, comfortable atmosphere for sleep testing through hotel-based sleep centers. In this study, we compared the sleep parameters of patients studied in our hotel-based and hospital-based sleep laboratories. Methods: We retrospectively reviewed polysomnograms completed in our hotel-based and hospital-based sleep laboratories from August 2003 to July 2005. All patients were undergoing evaluation for obstructive sleep apnea. Hospital-based patients were matched for age and apnea-hypopnea index with hotel-based patients. We compared the sleep architecture changes associated with the first-night effect in the two groups. The associated conditions and symptoms listed on the polysomnography referral forms are also compared. Results: No significant differences were detected between the two groups in sleep onset latency, sleep efficiency, REM sleep latency, total amount of slow wave sleep (NREM stages 3 and 4), arousal index, and total stage 1 sleep. Conclusions: This pilot study failed to show a difference in sleep parameters associated with the first-night effect in patients undergoing sleep studies in our hotel and hospital-based sleep laboratories. Future studies need to compare the first-night effect in different sleep disorders, preferably in multi-night recordings. Citation: Hutchison KN; Song Y; Wang L; Malow BA. Analysis of sleep parameters in patients with obstructive sleep apnea studied in a hospital vs. A hotel-based sleep center. J Clin Sleep Med 2008;4(2):119–122. PMID:18468309

  17. [The research progress of relationship between the obstructive sleep apnea hypopnea syndrome and asthma].

    PubMed

    Wang, Jinfeng; Xie, Yuping; Ma, Wei

    2015-02-01

    Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by repeated episodes of upper airway obstruction that results in brief periods of breathing cessation (apnea) or a marked reduction in airflow (hypopnea) during sleep. Asthma is a chronic inflammatory disease of the airways characterized by revesible air-flow obstruction and bronchial hyperresponsiveness. This article reviewed related reseaches progress of relationship between the obstructive sleep apnea hypopnea syndrom and asthma in the vascular endothelial growth factor, systemic inflammation, leptin, obesity, gastroesophageal reflux disease and upper airway diseases, excessive daytime sleepiness and asthma control. PMID:26121849

  18. Wireless Wearable Multisensory Suite and Real-Time Prediction of Obstructive Sleep Apnea Episodes

    PubMed Central

    Cheng, Changqing; Sangasoongsong, Akkarapol; Wongdhamma, Woranat; Bukkapatnam, Satish T. S.

    2013-01-01

    Obstructive sleep apnea (OSA) is a common sleep disorder found in 24% of adult men and 9% of adult women. Although continuous positive airway pressure (CPAP) has emerged as a standard therapy for OSA, a majority of patients are not tolerant to this treatment, largely because of the uncomfortable nasal air delivery during their sleep. Recent advances in wireless communication and advanced (“bigdata”) preditive analytics technologies offer radically new point-of-care treatment approaches for OSA episodes with unprecedented comfort and afforadability. We introduce a Dirichlet process-based mixture Gaussian process (DPMG) model to predict the onset of sleep apnea episodes based on analyzing complex cardiorespiratory signals gathered from a custom-designed wireless wearable multisensory suite. Extensive testing with signals from the multisensory suite as well as PhysioNet's OSA database suggests that the accuracy of offline OSA classification is 88%, and accuracy for predicting an OSA episode 1-min ahead is 83% and 3-min ahead is 77%. Such accurate prediction of an impending OSA episode can be used to adaptively adjust CPAP airflow (toward improving the patient's adherence) or the torso posture (e.g., minor chin adjustments to maintain steady levels of the airflow). PMID:27170854

  19. 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

  20. Movement Distribution: A New Measure of Sleep Fragmentation in Children with Upper Airway Obstruction

    PubMed Central

    Coussens, Scott; Baumert, Mathias; Kohler, Mark; Martin, James; Kennedy, Declan; Lushington, Kurt; Saint, David; Pamula, Yvonne

    2014-01-01

    Study Objectives: To develop a measure of sleep fragmentation in children with upper airway obstruction based on survival curve analysis of sleep continuity. Design: Prospective repeated measures. Setting: Hospital sleep laboratory. Participants: 92 children aged 3.0 to 12.9 years undergoing 2 overnight polysomnographic (PSG) sleep studies, 6 months apart. Subjects were divided into 3 groups based on their obstructive apnea and hypopnea index (OAHI) and other upper airway obstruction (UAO) symptoms: primary snorers (PS; n = 24, OAHI < 1), those with obstructive sleep apnea syndrome (OSAS; n = 20, OAHI ≥ 1) and non-snoring controls (C; n = 48, OAHI < 1). Interventions: Subjects in the PS and OSAS groups underwent tonsillectomy and adenoidectomy between PSG assessments. Measurements and Results: Post hoc measures of movement and contiguous sleep epochs were exported and analyzed using Kaplan-Meier estimates of survival to generate survival curves for the 3 groups. Statistically significant differences were found between these group curves for sleep continuity (P < 0.05) when using movement events as the sleep fragmenting event, but not if stage 1 NREM sleep or awakenings were used. Conclusion: Using conventional indices of sleep fragmentation in survival curve analysis of sleep continuity does not provide a useful measure of sleep fragmentation in children with upper airway obstruction. However, when sleep continuity is defined as the time between gross body movements, a potentially useful clinical measure is produced. Citation: Coussens S, Baumert M, Kohler M, Martin J, Kennedy D, Lushington K, Saint D, Pamula Y. Movement distribution: a new measure of sleep fragmentation in children with upper airway obstruction. SLEEP 2014;37(12):2025-2034. PMID:25325486

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

    PubMed

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

    2015-10-01

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

  2. Sleep Position Trainer versus Tennis Ball Technique in Positional Obstructive Sleep Apnea Syndrome

    PubMed Central

    Eijsvogel, Michiel M.; Ubbink, Rinse; Dekker, Janita; Oppersma, Eline; de Jongh, Frans H.; van der Palen, Job; Brusse-Keizer, Marjolein G.

    2015-01-01

    Study Objective: Positional therapy (PT) is an effective therapy in positional obstructive sleep apnea syndrome (POSAS) when used, but the compliance of PT is low. The objective of this study was to investigate whether a new kind of PT is effective and can improve compliance. Methods: 29 patients were treated with the sleep position trainer (SPT), 26 patients with the tennis ball technique (TBT). At baseline and 1 month polysomnography, Epworth Sleepiness Scale (ESS) and the Quebec Sleep Questionnaire (QSQ) were taken. Daily compliance was objectively measured in both groups. Results: Both therapies prevent supine sleep position to a median of 0% (min-max: SPT 0.0% to 67%, TBT 0.0% to 38.9%), resulting in a treatment success (AHI < 5) in 68.0% of the SPT and 42.9% of the TBT patients. The ESS at baseline was < 10 in both groups. Sleep quality parameters, such as wake after sleep onset (WASO; p = 0.001) and awakenings (p = 0.006), improved more in the SPT group. Total QSQ scores (0.4 ± 0.2, p = 0.03), the QSQ domains nocturnal symptoms (0.7 ± 0.2, p = 0.01), and social interactions (0.8 ± 0.3, p = 0.02) changed in favor of the SPT group. Effective compliance (≥ 4 h/night + ≥ 5 days/week) was 75.9% for the SPT and 42.3% for the TBT users (p = 0.01). Conclusion: In mild POSAS with normal EES the new SPT device and the standard TBT are equally effective in reducing respiratory indices. However, compared to the TBT, sleep quality, quality of life, and compliance improved significantly more in the SPT group. Citation: Eijsvogel MM, Ubbink R, Dekker J, Oppersma E, de Jongh FH, van der Palen J, Brusse-Keizer MG. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. J Clin Sleep Med 2015;11(2):139–147. PMID:25515276

  3. Impact of rail medical standard on obstructive sleep apnoea prevalence

    PubMed Central

    Colquhoun, C. P.

    2016-01-01

    Background The 2004 edition of the National Standard for Health Assessment of Rail Safety Workers (the standard) used the Epworth Sleepiness Scale (ESS) to screen for excessive daytime sleepiness related to obstructive sleep apnoea (OSA). The 2012 edition of the standard expanded the OSA screening matrix to include body mass index, comorbid hypertension and type 2 diabetes as triggers requiring a sleep study to be undertaken irrespective of the ESS. Aims To assess the impact of the new standard on the estimated prevalence of OSA in railway workers. Methods An analysis of data on safety critical employees referred for rail safety health assessment during the 2013 calendar year and meeting the criteria for sleep study referral. Sleep study outcomes were used to assess the predictive value of screening under the new standard. Results A total of 200/4311 workers were investigated with a sleep study. One hundred and ninety-three met the new risk factor criteria and 182 (91%) were newly diagnosed with OSA. The prevalence of OSA in the study population was 7%, compared with 2% in 2009. No worker reported an elevated ESS. The false positive to true positive ratio was 0.1 (95% CI 0.06–0.16). Conclusions The new medical standard has resulted in an increased estimate of the prevalence of OSA in rail workers. This study supports the use of objective clinical risk factors to select workers for further investigation, aiming to minimize the risk of accidents associated with excessive daytime sleepiness and other comorbid conditions of OSA. PMID:26276756

  4. 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

  5. Temporal sleep patterns in adults using actigraph.

    PubMed

    Matuzaki, Lia; Santos-Silva, Rogerio; Marqueze, Elaine Cristina; de Castro Moreno, Claudia Roberta; Tufik, Sergio; Bittencourt, Lia

    2014-09-01

    The aim of the present study was to characterize the temporal patterns of sleep and wakefulness in a sample of the adult subjects from São Paulo city. All subjects filled the Morningness/Eveningness Questionnaire (MEQ) and wore an actigraph for at least three consecutive days. A total of 359 subjects were considered for the analyses. The mean age was 43±14 years, the mean body mass index was 26.7±5.7 kg/m(2), and 60% were female. The mean MEQ score was 58.0±10.7. The sleep pattern evaluated by the actigraphic analyses showed that 92% had a monophasic sleep pattern, 7% biphasic, and 1% polyphasic sleep pattern. Cluster analysis, based on time to sleep onset, sleep efficiency, sleep latency, and total sleep time, was able to identify three different groups denominated: morning type, evening type, and undefined type. Morning type subjects were more frequent, older, and had higher MEQ scores than evening type subjects. Our results showed that the actigraph objectively assessed the sleep-wake cycle and was able to discriminate between morning and evening type individuals. These findings suggest that the actigraph could be a valuable tool for assessing temporal sleep patterns, including the circadian preferences. PMID:26483920

  6. Temporal sleep patterns in adults using actigraph

    PubMed Central

    Matuzaki, Lia; Santos-Silva, Rogerio; Marqueze, Elaine Cristina; de Castro Moreno, Claudia Roberta; Tufik, Sergio; Bittencourt, Lia

    2014-01-01

    The aim of the present study was to characterize the temporal patterns of sleep and wakefulness in a sample of the adult subjects from São Paulo city. All subjects filled the Morningness/Eveningness Questionnaire (MEQ) and wore an actigraph for at least three consecutive days. A total of 359 subjects were considered for the analyses. The mean age was 43±14 years, the mean body mass index was 26.7±5.7 kg/m2, and 60% were female. The mean MEQ score was 58.0±10.7. The sleep pattern evaluated by the actigraphic analyses showed that 92% had a monophasic sleep pattern, 7% biphasic, and 1% polyphasic sleep pattern. Cluster analysis, based on time to sleep onset, sleep efficiency, sleep latency, and total sleep time, was able to identify three different groups denominated: morning type, evening type, and undefined type. Morning type subjects were more frequent, older, and had higher MEQ scores than evening type subjects. Our results showed that the actigraph objectively assessed the sleep-wake cycle and was able to discriminate between morning and evening type individuals. These findings suggest that the actigraph could be a valuable tool for assessing temporal sleep patterns, including the circadian preferences. PMID:26483920

  7. Use of modified barium swallow study to measure posterior airway space in obstructive sleep apnea.

    PubMed

    Crosby, Tyler; Phillips, Jeff; Carbo, Alberto; Babcock, Kelley; Nathan, Cherie-Ann

    2016-06-01

    Conclusion Measurement of the posterior airway space (PAS) using modified barium swallow (MBS) appears to correlate well with CT imaging. This data suggests MBS may be a low-cost alternative imaging modality to assess obstructive sleep apnea patients. Objectives Obstructive sleep apnea research has focused on imaging modalities that supplement polysomnography in evaluation of potential sites of airway obstruction. While several techniques have been used to assess the PAS, many incur significant costs and risks to the patient. This study proposes use of MBS as a simple modality to measure PAS. Advantages include its simplicity, lower radiation, and dynamic tongue base visualization, which may help predict surgical outcomes. It is hypothesized that cephalometric measurements obtained using MBS will correlate well with CT. Methods Thirty-six adult patients who underwent both CT imaging and MBS for head and neck cancer were included. Cephalometric measurements of the PAS were obtained using each imaging modality. Statistical analysis focused on correlating measurements taken using CT and MBS. Results The average PAS measurements were 12.53 ± 1.81 mm and 12.80 ± 1.75 mm by MBS and CT imaging, respectively. In comparing the two modalities, Pearson correlation between CT and MBS measurements revealed significant positive correlations between r = 0.769 and 0.937. PMID:26852777

  8. 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

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

    PubMed Central

    2014-01-01

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

  10. Oral Appliance Treatment for Obstructive Sleep Apnea: An Update

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Puthalapattu, Swathy; Ioachimescu, Octavian C

    2014-04-01

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

  12. 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

  13. Management of obstructive sleep apnea in children: A practical approach.

    PubMed

    Pereira, Kevin D; Jon, Cindy K; Szmuk, Peter; Lazar, Rande H; Mitchell, Ron B

    2016-07-01

    The management of sleep disordered breathing (SDB) in children differs between institutions, and there is a need for an updated review of current practice. Literature was reviewed using the PubMed database from 1995 to 2015 by four tertiary care providers experienced in the management of children with SDB. Articles were selected for clinical applicability, strength of evidence, and practicality for practicing clinicians. Fifty-five articles were identified by tertiary care providers in pediatric anesthesiology, pediatric pulmonology, sleep medicine, and pediatric otolaryngology. Each reviewed and analyzed literature independently based on their specialties, and a consensus document was created. The consensus was that the majority of children with SDB do not undergo polysomnography (PSG) before adenotonsillectomy (T&A). Indications for PSG are presented, with a practical approach recommended for the otolaryngologist. Clinical practice guidelines are available from leading national societies, but their recommendations differ. T&A is the first-line treatment and is highly effective in normal-weight but not in obese children. The perioperative management of children is challenging and needs to be individualized. Young children, those with severe obstructive sleep apnea, and those with significant comorbidities need to be observed overnight. PMID:27434480

  14. Sleep-Related Painful Erections in a Patient With Obstructive Sleep Apnea Syndrome.

    PubMed

    Abouda, Maher; Jomni, Taieb; Yangui, Ferdaws; Charfi, Mohamed Ridha; Arnulf, Isabelle

    2016-01-01

    Sleep-related painful erection (SRPE) is a rare sleep disorder characterized by recurrent, painful penile erections occurring when awakening from rapid eye movement sleep, while erections are painless during wakefulness. Almost 35 cases have been reported worldwide, and only two of them had an associated obstructive sleep apnea syndrome (OSAS). We report a new case of a 61-year-old man suffering from SRPE associated with OSAS. The adequate treatment of respiratory events with continuous positive airway pressure did not alleviate the SRPE symptoms and excessive daytime sleepiness. The SRPE diagnosis was made by polysomnography coupled with video surveillance when the patient was referred to the sleep laboratory for residual excessive daytime sleepiness. The patient had 2-4 episodes of SRPE/night. Beta-blocker did not alleviate the SRPE, but a transient improvement was noted when the patient was treated with paroxetine. In contrast with the two previously published cases of SRPE plus OSAS, continuous positive airway treatment did not improve SRPE symptoms in our patient. PMID:26392186

  15. Independent Association between Sleep Fragmentation and Dyslipidemia in Patients with Obstructive Sleep Apnea

    PubMed Central

    Qian, Yingjun; Yi, Hongliang; Zou, Jianyin; Meng, Lili; Tang, Xulan; Zhu, Huaming; Yu, Dongzhen; Zhou, Huiqun; Su, Kaiming; Guan, Jian; Yin, Shankai

    2016-01-01

    Obstructive sleep apnea (OSA) is independently associated with dyslipidemia. Previous studies have demonstrated that sleep fragmentation can impair lipid metabolism. The present study aimed to identify whether sleep fragmentation is independently associated with dyslipidemia, in a large-scale, clinic-based consecutive OSA sample. This cross-sectional study was conducted among 2,686 patients who underwent polysomnography (PSG) for suspicion of OSA from January 2008 to January 2013 at the sleep laboratory. Multivariate regression analyses were performed to evaluate the independent associations between the microarousal index (MAI) and lipid profiles adjusting for potential confounders, including metabolic syndrome components and nocturnal intermittent hypoxia. The adjusted odds ratios (ORs) for various types of dyslipidemia according to MAI quartiles, as determined by logistic regression were also evaluated. MAI was found positively associated with low-density lipoprotein cholesterol (LDL-c) but not with total cholesterol (TC), triglyceride (TG) or high-density lipoprotein cholesterol (HDL-c). Furthermore, the adjusted ORs (95% confidence interval) for hyper-LDL cholesterolemia increased across MAI quartiles, as follows: 1 (reference), 1.3 (1.1–1.7), 1.6 (1.2–2.0), and 1.6 (1.2–2.1) (p = 0.001, linear trend). Sleep fragmentation in OSA is independently associated with hyper-LDL cholesterolemia, which may predispose patients with OSA to a higher risk of cardiovascular disease. PMID:27184822

  16. Variations of snoring properties with macro sleep stages in a population of Obstructive Sleep Apnea patients.

    PubMed

    Akhter, S; Abeyratne, U R; Swarnkar, V

    2013-01-01

    Snoring is common in Obstructive Sleep Apnea (OSA) patients. Snoring originates from the vibration of soft tissues in the upper airways (UA). Frequent UA collapse in OSA patients leads to sleep disturbances and arousal. In a routine sleep diagnostic procedure, sleep is broadly divided into rapid eye movement (REM), non-REM (NREM) states. These Macro-Sleep States (MSS) are known to be involved with different neuromuscular activities. These differences should influence the UA mechanics in OSA patients as well as the snoring sound (SS). In this paper, we propose a logistic regression model to investigate whether the properties of SS from OSA patients can be separated into REM/NREM group. Analyzing mathematical features of more than 500 SS events from 7 OSA patients, the model achieved 76% (± 0.10) sensitivity and 75% (± 0.10) specificity in categorizing REM and NREM related snores. These results indicate that snoring is affected by REM/NREM states and proposed method has potential in differentiating MSS. PMID:24109938

  17. Independent Association between Sleep Fragmentation and Dyslipidemia in Patients with Obstructive Sleep Apnea.

    PubMed

    Qian, Yingjun; Yi, Hongliang; Zou, Jianyin; Meng, Lili; Tang, Xulan; Zhu, Huaming; Yu, Dongzhen; Zhou, Huiqun; Su, Kaiming; Guan, Jian; Yin, Shankai

    2016-01-01

    Obstructive sleep apnea (OSA) is independently associated with dyslipidemia. Previous studies have demonstrated that sleep fragmentation can impair lipid metabolism. The present study aimed to identify whether sleep fragmentation is independently associated with dyslipidemia, in a large-scale, clinic-based consecutive OSA sample. This cross-sectional study was conducted among 2,686 patients who underwent polysomnography (PSG) for suspicion of OSA from January 2008 to January 2013 at the sleep laboratory. Multivariate regression analyses were performed to evaluate the independent associations between the microarousal index (MAI) and lipid profiles adjusting for potential confounders, including metabolic syndrome components and nocturnal intermittent hypoxia. The adjusted odds ratios (ORs) for various types of dyslipidemia according to MAI quartiles, as determined by logistic regression were also evaluated. MAI was found positively associated with low-density lipoprotein cholesterol (LDL-c) but not with total cholesterol (TC), triglyceride (TG) or high-density lipoprotein cholesterol (HDL-c). Furthermore, the adjusted ORs (95% confidence interval) for hyper-LDL cholesterolemia increased across MAI quartiles, as follows: 1 (reference), 1.3 (1.1-1.7), 1.6 (1.2-2.0), and 1.6 (1.2-2.1) (p = 0.001, linear trend). Sleep fragmentation in OSA is independently associated with hyper-LDL cholesterolemia, which may predispose patients with OSA to a higher risk of cardiovascular disease. PMID:27184822

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

    PubMed

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

    2000-01-01

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

  19. Significance of vaspin in obstructive sleep apnea-hypopnea syndrome

    PubMed Central

    PAN, ZHE; ZHUANG, XIANGHUA; LI, XIAOBO; HUANG, SHAOYI; ZHANG, LIANG; LOU, FUCHEN; CHEN, SHIHONG; NI, YIHONG

    2016-01-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a commonly-diagnosed chronic sleep disorder. It is considered to be an important independent risk factor in the development of insulin resistance (IR). Patients with OSAHS exhibit a variety of metabolic disorders, including obesity and metabolic syndrome. Visceral adipose tissue-derived serpin (vaspin) is an adipokine that is considered to be a link between obesity and IR. The present study aimed to evaluate the levels of plasma vaspin in patients with OSAHS and examine their potential correlation with sleep characteristics. A total of 20 healthy male subjects and 42 male patients with OSAHS were selected, and patients were divided into mild (n=22) and severe (n=20) OSAHS groups. The 20 patients in the severe OSAHS group received nasal continuous positive airway pressure (nCPAP) treatment for 2 months. Venous blood samples were drawn from all patients in a fasting state prior to and subsequent to nCPAP treatment, which were used to measure the levels of biochemical indicators. The sleep parameters and serologic index changes were compared prior to and following treatment. The values of contractive pressure (SBP), neck circumference (NC), waist circumference (WC), waist-to-hip ratio (WHR), body mass index (BMI) and hip circumference (HC) in the two OSAHS groups were significantly increased compared with those in the control group. In addition, the levels of vaspin in OSAHS patients were markedly increased and vaspin was revealed to be positively associated with fasting blood sugar, fasting insulin, triglycerides, homeostasis model assessment-IR, apnea-hypopnea index (AHI), NC, WC, BMI and WHR (P<0.05). After 2 months of nCPAP treatment, the SBP and AHI were significantly reduced. In conclusion, vaspin may have an important role in OSAHS patients with IR and treatment using nCPAP may improve the condition of OSAHS patients. PMID:26998001

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

    PubMed

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

    2011-08-01

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

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

    PubMed Central

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

    2014-01-01

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

  2. Impact of nasal obstruction on sleep quality: a community-based study of women.

    PubMed

    Bengtsson, Caroline; Jonsson, Lars; Holmström, Mats; Svensson, Malin; Theorell-Haglöw, Jenny; Lindberg, Eva

    2015-01-01

    The aim of the study was to analyse the impact of self-reported nasal obstruction on sleep quality in women. A community-based sample of 400 women underwent a full night of polysomnography. Airway diseases, allergies and sleep-related symptoms were assessed by questionnaires. Women with subjective nasal obstruction were subdivided into three groups: persistent nasal obstruction (PNO, n = 46), hay fever (n = 88) and nasal obstruction at night (NON, n = 30). Sleep problems and related daytime symptoms were most prevalent among women with NON. After adjusting for age, BMI, smoking and asthma, NON was an independent predictor of 'Difficulties inducing sleep due to nasal obstruction' [adjusted odds ratio (95 % CI): 89.5 (27.0-296.7)], 'Snoring' [4.2 (1.7-10.2)], 'Sweating at night' [2.6 (1.1-6.1)], 'Difficulties maintaining sleep' [2.7 (1.2-6.2)], and 'Waking up hastily gasping for breath' [32.2 (8.7-119.1)]. 'Dry mouth on awakening' [7.7 (3.2-18.4)], 'Waking up unrefreshed' [2.7 (1.2-6.0)], 'Excessive daytime sleepiness' [2.6 (1.1-6.0)], and 'Daytime nasal obstruction' [12.2 (4.8-31.2)] were also associated with NON. Persistent nasal obstruction and hay fever were both associated with some reported sleep problems due to an overlap with NON. When women with NON were excluded, only 'Daytime nasal obstruction' was still significantly associated with PNO, while hay fever was associated with 'Daytime nasal obstruction' and 'Waking up hastily gasping for breath'. There were no significant differences in objectively measured sleep variables between any of the three subgroups and the study cohort. Self-reported nasal obstruction at night in women has a significant effect on several subjective day- and nighttime symptoms, but it does not appear to affect objectively measured sleep quality. PMID:24792065

  3. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea

    PubMed Central

    de Godoy, Luciana Balester Mello; Luz, Gabriela Pontes; Palombini, Luciana Oliveira; e Silva, Luciana Oliveira; Hoshino, Wilson; Guimarães, Thaís Moura; Tufik, Sergio; Bittencourt, Lia; Togeiro, Sonia Maria

    2016-01-01

    Purpose To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS), mild Obstructive Sleep Apnea (OSA) and normal individuals. Methods UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale—ESS—≥ 10) and/or fatigue (Modified Fatigue Impact Scale—MFIS—≥ 38) associated to Apnea/hypopnea index (AHI) ≤ 5 and Respiratory Disturbance Index (RDI) > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10) and/or fatigue (MFIS ≥ 38) associated to AHI ≥ 5 and ≤ 15 events/hour. “Control group” criteria were AHI < 5 events/hour and RDI ≤ 5 events/hour and ESS ≤ 9, without any sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in “control group”), adjusted for age, gender, body mass index (BMI) and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT) was performed five times (each two hours) from 8 a.m. to 4 p.m. Results UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire—FOSQ—and Pittsburgh Sleep Quality Index—PSQI: p < 0.05) and more fatigue than mild OSA patients (p = 0.003) and scored significantly higher in both Beck inventories than “control group” (p < 0.02). UARS patients had more lapses early in the morning (in time 1) compared to the results in the afternoon (time 5) than mild OSA (p = 0.02). Mild OSA patients had more lapses in times 2 than in time 5 compared to “control group” (p = 0.04). Conclusions UARS patients have a worse sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls. PMID:27228081

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

    PubMed Central

    Abboud, François; Kumar, Ravinder

    2014-01-01

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

  5. 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

  6. 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

  7. 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

  8. 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

  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. [Implantable nerve stimulation for obstructive sleep apnea hypopnea syndrome].

    PubMed

    Afonso Delgado, Lidia; Micoulaud Franchi, Jean-Arthur; Monteyrol, Pierre-Jean; Philip, Pierre

    2016-02-01

    Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disorder that has been identified as a contributor to cardiovascular disease making it a major public health problem. Continuous positive airway pressure is the standard treatment but compliance is suboptimal. Mandibular advancement devices and surgery have limited indications, inconstant efficiency and potential irreversible side effects. Stimulation of the hypoglossal nerve, that innervates the genioglossus, a protrusor muscle of the tongue, is now a new treatment option for moderate and severe cases of OSAHS. Two types of stimulation are currently available: stimulation synchronous with inspiration and continuous stimulation. The indication of each type of stimulation and long-term effects still need to be assessed but the implantable nerve stimulation is a promising treatment for patients without a therapy solution so far. PMID:26796478

  11. Epidemiology, pathophysiology, and clinical features of obstructive sleep apnea.

    PubMed

    Madani, Mansoor; Madani, Farideh

    2009-11-01

    The normal cycle of respiration includes a unique balancing force between many upper airway structures that control its dilation and closure. Alteration of this delicate equilibrium, possibly by an increased airflow resistance, can cause various degrees of obstructive sleep apnea (OSA). OSA is now recognized as a major illness, an important cause of medical morbidity and mortality affecting millions of people worldwide, and a major predisposing factor for several systemic conditions, such as hypertension, cardiovascular disease, stroke, diabetes, and even sexual dysfunction. Initial evaluation for possible OSA may be done by dental professionals who can provide guidance for its comprehensive evaluation and management. Because of the complexity of the disease, factors contributing to its development must be identified. Some factors caused by the patient's anatomic structures are slightly easier to rectify, whereas others may relate to the patient's age, sex, habits, or associated illnesses, including obesity. In this article, various epidemiologic, pathophysiologic, and clinical features of OSA are discussed. PMID:19944337

  12. 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

  13. [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

  14. Monitoring of obstructive sleep apnea in heart failure patients.

    PubMed

    Patangay, Abhilash; Vemuri, Prashanthi; Tewfik, Ahmed

    2007-01-01

    This research aims to develop a non-intrusive system to monitor obstructive sleep apnea (OSA) in heart failure patients. Heart sounds and ECG are used to develop a support vector machine (SVM) based classifier. The RMS energy in wavelet sub-bands are used as feature vectors. Feature reduction is performed to minimize complexity without loss of performance. Data from 17 patients is parsed into two minute epochs and randomly partitioned into training and test datasets. The training set is used for parameter optimization of the SVM algorithm and a test data set is used to estimate the generalization error of the algorithm. The proposed algorithm has a 85.5% sensitivity and 92.2% specificity for the detection of OSA epochs. PMID:18002139

  15. Craniocervical Posture in Patients with Obstructive Sleep Apnea

    PubMed Central

    Piccin, Chaiane Facco; Pozzebon, Daniela; Scapini, Fabricio; Corrêa, Eliane Castilhos Rodrigues

    2016-01-01

    Introduction  Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep. Objective  The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI). Methods  This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. Results  The groups were homogeneous regarding gender (12 men and 9 women in each group), age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years), and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2). We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. Conclusion  OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization. PMID:27413397

  16. 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

  17. Obstructive sleep apnea screening by integrating snore feature classes.

    PubMed

    Abeyratne, U R; de Silva, S; Hukins, C; Duce, B

    2013-02-01

    Obstructive sleep apnea (OSA) is a serious sleep disorder with high community prevalence. More than 80% of OSA suffers remain undiagnosed. Polysomnography (PSG) is the current reference standard used for OSA diagnosis. It is expensive, inconvenient and demands the extensive involvement of a sleep technologist. At present, a low cost, unattended, convenient OSA screening technique is an urgent requirement. Snoring is always almost associated with OSA and is one of the earliest nocturnal symptoms. With the onset of sleep, the upper airway undergoes both functional and structural changes, leading to spatially and temporally distributed sites conducive to snore sound (SS) generation. The goal of this paper is to investigate the possibility of developing a snore based multi-feature class OSA screening tool by integrating snore features that capture functional, structural, and spatio-temporal dependences of SS. In this paper, we focused our attention to the features in voiced parts of a snore, where quasi-repetitive packets of energy are visible. Individual snore feature classes were then optimized using logistic regression for optimum OSA diagnostic performance. Consequently, all feature classes were integrated and optimized to obtain optimum OSA classification sensitivity and specificity. We also augmented snore features with neck circumference, which is a one-time measurement readily available at no extra cost. The performance of the proposed method was evaluated using snore recordings from 86 subjects (51 males and 35 females). Data from each subject consisted of 6-8 h long sound recordings, made concurrently with routine PSG in a clinical sleep laboratory. Clinical diagnosis supported by standard PSG was used as the reference diagnosis to compare our results against. Our proposed techniques resulted in a sensitivity of 93±9% with specificity 93±9% for females and sensitivity of 92±6% with specificity 93±7% for males at an AHI decision threshold of 15 events

  18. Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea.

    PubMed

    Wu, Meng-Ni; Lai, Chiou-Lian; Liu, Ching-Kuan; Yen, Chen-Wen; Liou, Li-Min; Hsieh, Cheng-Fang; Tsai, Ming-Ju; Chen, Sharon C-J; Hsu, Chung-Yao

    2015-12-01

    Because the impact of periodic limb movements in sleep (PLMS) is controversial, no consensus has been reached on the therapeutic strategy for PLMS in obstructive sleep apnea (OSA). To verify the hypothesis that PLMS is related to a negative impact on the cardiovascular system in OSA patients, this study investigated the basal autonomic regulation by heart rate variability (HRV) analysis. Sixty patients with mild-to-moderate OSA who underwent polysomnography (PSG) and completed sleep questionnaires were analysed retrospectively and divided into the PLMS group (n = 30) and the non-PLMS group (n = 30). Epochs without any sleep events or continuous effects were evaluated using HRV analysis. No significant difference was observed in the demographic data, PSG parameters or sleep questionnaires between the PLMS and non-PLMS groups, except for age. Patients in the PLMS group had significantly lower normalized high frequency (n-HF), high frequency (HF), square root of the mean of the sum of the squares of difference between adjacent NN intervals (RMSSD) and standard deviation of all normal to normal intervals index (SDNN-I), but had a higher normalized low frequency (n-LF) and LF/HF ratio. There was no significant difference in the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Short-Form 36 and the Hospital Anxiety and Depression Scale between the two groups. After adjustment for confounding variables, PLMS remained an independent predictor of n-LF (β = 0.0901, P = 0.0081), LF/HF ratio (β = 0.5351, P = 0.0361), RMSSD (β = -20.1620, P = 0.0455) and n-HF (β = -0.0886, P = 0.0134). In conclusion, PLMS is related independently to basal sympathetic predominance and has a potentially negative impact on the cardiovascular system of OSA patients. PMID:26118626

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

    PubMed

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

    2014-04-01

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

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

    PubMed

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

    2015-01-01

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

  1. Emerging technology: electrical stimulation in obstructive sleep apnoea

    PubMed Central

    Steier, Joerg

    2015-01-01

    Electrical stimulation (ES) of the upper airway (UAW) dilator muscles for patients with obstructive sleep apnoea (OSA) has been used for several decades, but in recent years research in this field has experienced a renaissance; the results of several studies have triggered a steady rise in the interest in this topic. Prospective trials, although still lacking a sham-controlled and randomised approach, have revealed the potential of ES. Hypoglossal nerve stimulation (HNS) leads to a significant reduction in the apnoea-hypopnoea index and the oxygen desaturation index (ODI). There are similar results published from feasibility studies for transcutaneous ES. A limitation of HNS remains the invasive procedure, the costs involved and severe adverse events, while for the non-invasive approach complications are rare and limited. The limiting step for transcutaneous ES is to deliver a sufficient current without causing arousal from sleep. Despite the progress up to date, numerous variables including optimal stimulation settings, different devices and procedures remain to be further defined for the invasive and the non-invasive method. Further studies are required to identify which patients respond to this treatment. ES of the UAW dilator muscles in OSA has the potential to develop into a clinical alternative to continuous positive airway pressure (CPAP) therapy. It could benefit selected patients who fail standard therapy due to poor long-term compliance. It is likely that international societies will need to review and update their existing guidance on the use of ES in OSA. PMID:26380757

  2. 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

  3. 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

  4. Obstructive sleep apnoea/hypopnoea syndrome and hypertension.

    PubMed

    Al-Abri, Mohammed A; Al-Hashmi, Khamis M

    2008-11-01

    The obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a common disorder, affecting around 2-4% of the middle-aged population. There is a strong association between OSAHS and hypertension, based on animal, large epidemiological and interventional studies. The epidemiological studies have shown a dose-response relationship between apnoea/hypopnoea index (AHI) and the risk of developing hypertension. Different mechanisms may have a role in the process of elevated blood pressure in OSAHS. Sympathetic activity is increased in OSAHS patients during sleep and wakefulness. This increase in sympathetic activity is probably due to activation of baroreflexes and chemoreflexes by frequent arousals and hypoxaemia a result of apnoea or hypopnoea events. Continuous positive airway pressure (CPAP) has been shown to reduce sympathetic stimulation and blood pressure in OSAHS patients. Altered endothelial function may also have a role in the pathogenesis of hypertension in OSAHS subjects. Reduction of nitric oxide (NO) production and increase in the formation of free radicals may be responsible for the impairment of the vasodilatation of micro-vasculature in these subjects as a result of hypoxaemia. It has been shown that effective CPAP therapy has a reversible effect on endothelial dysfunction. PMID:21748071

  5. [Epworth drowsiness scale value in obstructive sleep apnea syndrome].

    PubMed

    Uribe Echevarría, E M; Alvarez, D; Giobellina, R; Uribe Echevarría, A M

    2000-01-01

    Hypersomnia is one of the most consulted symptoms among patients evaluated at sleep disorder centers and it is frequently related to obstructive sleep apnea syndrome (OSAS). Our hypothesis is that Epworth sleepiness scale (ESS) is the parameter with the greatest predictive value in the OSAS diagnosis. We compared patients with OSAS diagnosis to a control group. In both groups we compared ESS with body mass index (BMI), neck circumference (NC), waist perimeter (WP). Anthropometric index (BMI, NC and WC), were similar in both groups (p < 0.10). When we analyzed ESS, a score greater than 10 was observed in the OSAS group, with a significant difference between groups (p < 0.001). Epworth sleepiness scale yielded 60% of sensibility, 82% of specificity and a positive predictive value of 85%. The negative predictive value was 52%. Confidence index was 70%. The relationship between OSAS and ESS scale was significant (Pearson Chi-Square value 7.5). Odds Ratio for apneas was 15 and its confidence interval was lower than 1.5 and upper than 141. We conclude that with ESS score exceeding 10 points OSAS should be suspected. PMID:11436699

  6. Altered clot microstructure detected in obstructive sleep apnoea hypopnoea syndrome

    PubMed Central

    D׳Silva, Lindsay; Wilczynska, Maria; Lewis, Keir; Lawrence, Matthew; Hawkins, Karl; Williams, Rhodri; Stanford, Sophia; Davidson, Simon; Morris, Keith; Evans, Adrian

    2016-01-01

    Abnormal clot microstructure plays a pivotal role in the pathophysiology of thromboembolic diseases. Assessing the viscoelastic properties of clot microstructure using novel parameters, Time to Gel Point (TGP), Fractal Dimension (df) and clot elasticity (G׳GP) could explain the increased cardiovascular and thromboembolic events in patients with Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS). We wanted to compare TGP, df, and G׳GP and their diurnal variation in OSAHS and symptomatic comparators. thirty six patients attending a sleep disturbed breathing clinic with symptoms of OSAHS were recruited. TGP, df and G׳GP were measured alongside standard coagulation screening, thrombin generation assays, and platelet aggregometry at 16:00 h and immediately after an in-patient sleep study at 07:30 h. OSAHS group had significantly lower afternoon df than comparators (1.705±0.033 vs. 1.731±0.031, p<0.05). df showed diurnal variation and only in the OSAHS group, being significantly lower in the afternoon than morning (p<0.05). Diurnal changes in df correlated with 4% DR, even after controlling for BMI (r=0.37, p=0.02). The lower df in the afternoon in OSAHS suggests a partial compensatory change that may make up for other pro-clotting abnormalities/hypertension during the night. The change to the thrombotic tendency in the afternoon is biggest in severe OSAHS. df Shows promise as a new microstructural indicator for abnormal haemostasis in OSAHS. PMID:27226818

  7. Selected surgical managements in snoring and obstructive sleep apnea patients

    PubMed Central

    Olszewska, Ewa; Rutkowska, Justyna; Czajkowska, Aneta; Rogowski, Marek

    2012-01-01

    Summary Background The diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients. Material/Methods A precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires. Results In most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days. Conclusions Surgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery. PMID:22207114

  8. Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

    PubMed Central

    Budhiraja, Rohit; Siddiqi, Tauseef A.; Quan, Stuart F.

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors—some of them unique to COPD—can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPD— an association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifically in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259–270. PMID:25700872

  9. Mandibular Movements Identify Respiratory Effort in Pediatric Obstructive Sleep Apnea

    PubMed Central

    Martinot, Jean-Benoît; Senny, Fréderic; Denison, Stéphane; Cuthbert, Valérie; Gueulette, Emmanuelle; Guénard, Hervé; Pépin, Jean-Louis

    2015-01-01

    Study Objectives: Obstructive sleep apnea-hypopnea (OAH) diagnosis in children is based on the quantification of flow and respiratory effort (RE). Pulse transit time (PTT) is one validated tool to recognize RE. Pattern analysis of mandibular movements (MM) might be an alternative method to detect RE. We compared several patterns of MM to concomittant changes in PTT during OAH in children with adenotonsillar hypertrophy. Methods: Participants: 33 consecutive children with snoring and symptoms/signs of OAH. Measurements: MMs were measured during polysomnography with a magnetometer device (Brizzy Nomics, Liege, Belgium) placed on the chin and forehead. Patterns of MM were evaluated representing peak to peak fluctuations > 0.3 mm in mandibular excursion (MML), mandibular opening (MMO), and sharp MM (MMS), which closed the mouth on cortical arousal (CAr). Results: The median (95% CI) hourly rate of at least 1 MM (MML, or MMO, or MMS) was 18.1 (13.2–36.3) and strongly correlated with OAHI (p = 0.003) but not with central apnea-hypopnea index (CAHI; p = 0.292). The durations when the MM amplitude was > 0.4 mm and PTT > 15 ms were strongly correlated (p < 0.001). The mean (SD) of MM peak to peak amplitude was larger during OAH than CAH (0.9 ± 0.7 mm and 0.2 ± 0.3 mm; p < 0.001, respectively). MMS at the termination of OAH had larger amplitude compared to MMS with CAH (1.5 ± 0.9 mm and 0.5 ± 0.7 mm, respectively, p < 0.001). Conclusions: MM > 0.4 mm occurred frequently during periods of OAH and were frequently terminated by MMS corresponding to mouth closure on CAr. The MM findings strongly correlated with changes in PTT. MM analysis could be a simple and accurate promising tool for RE characterization and optimization of OAH diagnosis in children. Citation: Martinot JB, Senny F, Denison S, Cuthbert V, Gueulette E, Guénard H, Pépin JL. Mandibular movements identify respiratory effort in pediatric obstructive sleep apnea. J Clin Sleep Med 2015;11(5):567–574. PMID

  10. Tube Law of the Pharyngeal Airway in Sleeping Patients with Obstructive Sleep Apnea

    PubMed Central

    Genta, Pedro R.; Edwards, Bradley A.; Sands, Scott A.; Owens, Robert L.; Butler, James P.; Loring, Stephen H.; White, David P.; Wellman, Andrew

    2016-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is characterized by repetitive pharyngeal collapse during sleep. However, the dynamics of pharyngeal narrowing and re-expansion during flow-limited breathing are not well described. The static pharyngeal tube law (end-expiratory area versus luminal pressure) has demonstrated increasing pharyngeal compliance as luminal pressure decreases, indicating that the airway would be sucked closed with sufficient inspiratory effort. On the contrary, the airway is rarely sucked closed during inspiratory flow limitation, suggesting that the airway is getting stiffer. Therefore, we hypothesized that during inspiratory flow limitation, as opposed to static conditions, the pharynx becomes stiffer as luminal pressure decreases. Methods: Upper airway endoscopy and simultaneous measurements of airflow and epiglottic pressure were performed during natural nonrapid eye movement sleep. Continuous positive (or negative) airway pressure was used to induce flow limitation. Flow-limited breaths were selected for airway cross-sectional area measurements. Relative airway area was quantified as a percentage of end-expiratory area. Inspiratory airway radial compliance was calculated at each quintile of epiglottic pressure versus airway area plot (tube law). Results: Eighteen subjects (14 males) with OSA (apnea-hypopnea index = 57 ± 27 events/h), aged 49 ± 8 y, with a body mass index of 35 ± 6 kg/m2 were studied. A total of 163 flow limited breaths were analyzed (9 ± 3 breaths per subject). Compliances at the fourth (2.0 ± 4.7 % area/cmH2O) and fifth (0.0 ± 1.7 % area/cmH2O) quintiles were significantly lower than the first (12.2 ± 5.5 % area/cmH2O) pressure quintile (P < 0.05). Conclusions: The pharyngeal tube law is concave (airway gets stiffer as luminal pressure decreases) during respiratory cycles under inspiratory flow limitation. Citation: Genta PR, Edwards BA, Sands SA, Owens RL, Butler JP, Loring SH, White DP, Wellman A. Tube law of

  11. 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

  12. Insomnia Severity, Subjective Sleep Quality, and Risk for Obstructive Sleep Apnea in Veterans With Gulf War Illness.

    PubMed

    Chao, Linda L; Abadjian, Linda R; Esparza, Iva L; Reeb, Rosemary

    2016-09-01

    Despite the fact that sleep disturbances are common in veterans with Gulf War Illness (GWI), there has been a paucity of published sleep studies in this veteran population to date. Therefore, the present study examined subjective sleep quality (assessed with the Pittsburgh Sleep Quality Index), insomnia severity (assessed with the Insomnia Severity Index), and risk for obstructive sleep apnea (assessed with the STOP questionnaire) in 98 Gulf War veterans. Veterans with GWI, defined either by the Kansas or Centers for Disease Control and Prevention criteria, had greater risk for obstructive sleep apnea (i.e., higher STOP scores) than veterans without GWI. This difference persisted even after accounting for potentially confounding demographic (e.g., age, gender) and clinical variables. Veterans with GWI, defined by either the Kansas or Centers for Disease Control and Prevention criteria, also had significantly greater insomnia severity and poorer sleep quality than veterans without GWI (p < 0.05), even after accounting for potentially confounding variables. Furthermore, there were significant, positive correlations between insomnia severity, subjective sleep quality, and GWI symptom severity (p ≤ 0.01). In stepwise linear regression models, insomnia severity significantly predicted GWI status over and above demographic and clinical variables. Together these findings provide good rationale for treating sleep disturbances in the management of GWI. PMID:27612364

  13. Measurement properties of a screening questionnaire of obstructive sleep apnea risk: Little information, great prediction?☆☆

    PubMed Central

    Sargento, Paulo; Perea, Victoria; Ladera, Valentina; Lopes, Paulo; Oliveira, Jorge

    2014-01-01

    Introduction Previous research had shown the suitability of several questionnaires predicting the obstructive sleep apnea syndrome. Measurement properties of an online screening questionnaire were studied. Methods The sample consisted of 184 Portuguese adults (89 men and 95 women); 46 of them were polysomnographically diagnosed with the untreated obstructive sleep apnea syndrome. The participants were assessed with an online questionnaire of sleep apnea risk, from University of Maryland. Results A principal component factor analysis was performed, revealing a single factor (49.24% of the total variance). Internal consistency was minimally adequate (α=0.74). The mean of inter-item correlation was of 0.35 (0.120.61), whereas the item-total correlations were considered good (0.520.81). The total score for patients was significantly higher than for healthy participants (p<0.000), but no significant statistical differences between severity groups of patients were found (p>0.05). Furthermore, the ability of the measure in discriminating between healthy subjects and OSA subjects was good. Overall data from the Rasch analysis was consistent with the guidelines of Linacre, scores show good model fit and psychometric adequacy. Conclusions The measure showed an adequate structural, internal and criterion validity, suggesting this as a useful and effective screening for sleep apnea risk in Portuguese adults. PMID:26483909

  14. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome

    PubMed Central

    Goel, Amrit K; Talwar, Deepak; Jain, Sushil K

    2015-01-01

    Background and Aim: The obstructive sleep apnea–hypopnea syndrome (OSAHS) is a common chronic respiratory disease, characterized by repetitive complete or partial collapse of the upper airway during sleep. The clinical spectrum extends between stoppage of breathing, snoring, daytime somnolence, and fatigue, to serious cardiovascular disease, stroke, metabolic syndrome, increased morbidity, and mortality. We aim to evaluate the short-term use of nasal continuous positive airway pressure (nCPAP) therapy for the clinical profile and exercise capacity of patients with OSAHS. Patient Selection: Twenty patients diagnosed with moderate-to-severe OSAHS were enrolled in the study (study group — 15; clinically and PSG-matched control group — 5). Materials and Methods: Each patient was clinically evaluated for sleep-related symptoms, and also assessed with spirometry, the six-minute walk test (6MWT), and a symptom-limited incremental cardiopulmonary exercise test (CPET). The study group patients were administered nCPAP therapy for eight hours each night for four weeks, while the control group patients were just observed. They were re-assessed after four weeks and the data were statistically analyzed between the two groups. Results: The study group patients showed a significant (P- < 0.05) improvement in the OSAHS symptoms—the Epworth sleepiness score, six-minute walk distance; duration of exercise, power output, peak oxygen uptake, anaerobic threshold, diastolic blood pressure, dyspnea, and fatigue—in comparison with the control group patients. The improvement in exercise capacity following nCPAP therapy was attributed to the relief of disabling the OSAHS symptoms and improved cardiovascular, ventilator, and musculoskeletal functions. Conclusion: All OSAHS patients must be treated with nCPAP. PMID:25983407

  15. Preliminary evaluation of Wearable Wellness System for Obstructive Sleep Apnea detection.

    PubMed

    Crupi, R; Faetti, T; Paradiso, R

    2015-08-01

    Several studies have proven how sleep deprivation has a negative impact on daily life, affecting people's psychophysical state. In this field, research is focusing on the improvement of unobtrusive sleep monitoring devices for promoting sleep hygiene and early detection of sleep disorders. This study aims to assess the use of a textile-based wearable system, with its associated apnea detection algorithm, in monitoring of Obstructive Sleep Apnea Syndrome (OSAs). The system has been compared through the simultaneous acquisition of physiological signals in parallel with polysomnograph in laboratory and home environments. Results show that such a wearable system could be successfully used for early detection of OSAs (Obstructive Sleep Apnea Syndrome) and could stimulate people to a better self healthcare looking for a specialized medic examination and eventually undergoing to proper treatment avoiding the onset of OSAs co-morbidities. PMID:26737206

  16. Hurler's syndrome with cor pulmonale secondary to obstructive sleep apnoea treated by continuous positive airway pressure.

    PubMed

    Chan, D; Li, A M; Yam, M C; Li, C K; Fok, T F

    2003-01-01

    A 6-year-old boy with Hurler's syndrome presented with right heart failure and pulmonary hypertension secondary to severe obstructive sleep apnoea. Both his sleep apnoea and cor pulmonale were effectively controlled with continuous positive airway pressure therapy. PMID:12969215

  17. Obstructive sleep apnoea: patients' experiences of oral appliance treatment.

    PubMed

    Nordin, E; Stenberg, M; Tegelberg, Å

    2016-06-01

    Over the past few decades, there has been a pronounced increase in the number of patients being treated by general dental practitioners for obstructive sleep apnoea (OSA). The purpose of this study was to survey the care and patient experiences and the self-reported effectiveness of OSA treatment with an oral appliance (OA) incorporating mandibular advancement. The design was a retrospective, cross-sectional study, with follow-up between 6 months to 1 year after commencement of treatment. A survey form was posted to 1150 subjects, identified in the regional register over a 1-year period as having been treated with an OA for OSA. The questionnaire comprised 70 questions and assertions in various domains, such as general health/lifestyle, changes in symptoms/quality of life and sleep-related experiences, daytime sleepiness, changes in life situation, evaluation of treatment and the value of treatment. The overall response rate was 64% (n = 738). Treatment with OA gave relief of symptoms in 83% of the respondents. Quality of life, somatic and cognitive symptoms improved significantly in patients who used the appliance frequently (P < 0·001). Daytime sleepiness decreased significantly (P < 0·001). Treatment satisfaction and willingness to recommend the similar treatment to a friend were high (>85%). OA treatment of OSA by general dental practitioners is a safe procedure. Most of the survey respondents experienced relief of symptoms. Those who used their appliance frequently reported improvement in quality of life, somatic and cognitive symptoms. Excessive daytime sleepiness was reduced in the majority of the patients under treatment. PMID:26969447

  18. Effect of Obstructive Sleep Apnea in Acute Coronary Syndrome.

    PubMed

    Leão, Sílvia; Conde, Bebiana; Fontes, Paulo; Calvo, Teresa; Afonso, Abel; Moreira, Ilídio

    2016-04-01

    The effect of obstructive sleep apnea (OSA) on clinical outcomes after acute coronary syndrome (ACS) is incompletely defined. We sought to determine the prevalence of OSA in patients with ACS and evaluate prognostic impact of OSA and continuous positive airway pressure (CPAP) therapy in these patients. This was a prospective longitudinal cohort study of 73 patients admitted on cardiac intensive care unit for ACS. Cardiorespiratory sleep study and/or polysomnography were performed in all patients. CPAP was recommended if Apnea-Hypopnea Index ≥5. The main study outcome was a composite of death for any cause, myocardial infarction, and myocardial revascularization. OSA was diagnosed in 46 patients (63%). Age and cardiovascular risk factors were not significantly different between groups. OSA was classified as mild (m-OSA) in 14 patients (30%) and as moderate-to-severe (s-OSA) in 32 patients (70%). After a median follow-up of 75 months (interquartile range 71 to 79), patients with s-OSA had lower event-free survival rate. After adjustment for gender, patients with s-OSA showed a significantly higher incidence of the composite end point (hazard ratio 3.58, 95% CI 1.09 to 17.73, p = 0.035). Adherence to CPAP occurred in 19 patients (41%), but compliance to CPAP therapy did not reduce the risk of composite end point (hazard ratio 0.87, 95% CI 0.31 to 2.46, p = 0.798). In conclusion, OSA is an underdiagnosed disease with high prevalence in patients with ACS. It is urgent to establish screening protocols because those have high diagnostic yield and allow identifying a group of patients with manifestly unfavorable prognosis. PMID:26857162

  19. Abnormalities of Lipoprotein Concentrations in Obstructive Sleep Apnea Are Related to Insulin Resistance

    PubMed Central

    Liu, Alice; Cardell, James; Ariel, Danit; Lamendola, Cindy; Abbasi, Fahim; Kim, Sun H.; Holmes, Tyson H.; Tomasso, Vanessa; Mojaddidi, Hafasa; Grove, Kaylene; Kushida, Clete A.; Reaven, Gerald M.

    2015-01-01

    Study Objective: Prevalence of cardiovascular disease (CVD) is increased in patients with obstructive sleep apnea (OSA), possibly related to dyslipidemia in these individuals. Insulin resistance is also common in OSA, but its contribution to dyslipidemia of OSA is unclear. The study's aim was to define the relationships among abnormalities of lipoprotein metabolism, clinical measures of OSA, and insulin resistance. Design: Cross-sectional study. OSA severity was defined by the apnea-hypopnea index (AHI) during polysomnography. Hypoxia measures were expressed as minimum and mean oxygen saturation, and the oxygen desaturation index. Insulin resistance was quantified by determining steady-state plasma glucose (SSPG) concentrations during the insulin suppression test. Fasting plasma lipid/lipoprotein evaluation was performed by vertical auto profile methodology. Setting: Academic medical center. Participants: 107 nondiabetic, overweight/obese adults. Measurements and Results: Lipoprotein particles did not correlate with AHI or any hypoxia measures, nor were there differences noted by categories of OSA severity. By contrast, even after adjustment for age, sex, and BMI, SSPG was positively correlated with triglycerides (r = 0.30, P < 0.01), very low density lipoprotein (VLDL) and its subclasses (VLDL1+2) (r = 0.21–0.23, P < 0.05), and low density lipoprotein subclass 4 (LDL4) (r = 0.30, P < 0.01). SSPG was negatively correlated with high density lipoprotein (HDL) (r = −0.38, P < 0.001) and its subclasses (HDL2 and HDL3) (r = −0.32, −0.43, P < 0.01), and apolipoprotein A1 (r = −0.33, P < 0.01). Linear trends of these lipoprotein concentrations across SSPG tertiles were also significant. Conclusions: Pro-atherogenic lipoprotein abnormalities in obstructive sleep apnea (OSA) are related to insulin resistance, but not to OSA severity or degree of hypoxia. Insulin resistance may represent the link between OSA-related dyslipidemia and increased cardiovascular disease

  20. Worsening of Obstructive Sleep Apnea Associated with Catheter-Related Superior Vena Cava Syndrome

    PubMed Central

    Jouvenot, Marie; Willoteaux, Serge; Meslier, Nicole; Gagnadoux, Frédéric

    2015-01-01

    There is growing evidence that fluid accumulation in the neck contributes to the pathogenesis of obstructive sleep apnea (OSA). We describe a case of catheter-related superior v ena cava (SVC) thrombosis revealed by rapid onset of typical symptoms of OSA. A marked improvement in OSA severity was observed after central venous catheter removal, anticoagulant therapy, and SVC angioplasty Citation: Jouvenot M, Willoteaux S, Meslier N, Gagnadoux F. Worsening of obstructive sleep apnea associated with catheter-related superior vena cava syndrome. J Clin Sleep Med 2015;11(6):681–682. PMID:25766698

  1. Speckle tracking echocardiography in chronic obstructive pulmonary disease and overlapping obstructive sleep apnea

    PubMed Central

    Pizarro, Carmen; van Essen, Fabian; Linnhoff, Fabian; Schueler, Robert; Hammerstingl, Christoph; Nickenig, Georg; Skowasch, Dirk; Weber, Marcel

    2016-01-01

    Background COPD and congestive heart failure represent two disease entities of growing global burden that share common etiological features. Therefore, we aimed to identify the degree of left ventricular (LV) dysfunction in COPD as a function of COPD severity stages and concurrently placed particular emphasis on the presence of overlapping obstructive sleep apnea (OSA). Methods A total of 85 COPD outpatients (64.1±10.4 years, 54.1% males) and 20 controls, matched for age, sex, and smoking habits, underwent speckle tracking echocardiography for LV longitudinal strain imaging. Complementary 12-lead electrocardiography, laboratory testing, and overnight screening for sleep-disordered breathing using the SOMNOcheck micro® device were performed. Results Contrary to conventional echocardiographic parameters, speckle tracking echocardiography revealed significant impairment in global LV strain among COPD patients compared to control smokers (−13.3%±5.4% vs −17.1%±1.8%, P=0.04). On a regional level, the apical septal LV strain was reduced in COPD (P=0.003) and associated with the degree of COPD severity (P=0.02). With regard to electrocardiographic findings, COPD patients exhibited a significantly higher mean heart rate than controls (71.4±13.0 beats per minute vs 60.3±7.7 beats per minute, P=0.001) that additionally increased over Global Initiative for Chronic Obstructive Lung Disease stages (P=0.01). Albeit not statistically significant, COPD led to elevated N-terminal pro-brain natriuretic peptide levels (453.2±909.0 pg/mL vs 96.8±70.0 pg/mL, P=0.08). As to somnological testing, the portion of COPD patients exhibiting overlapping OSA accounted for 5.9% and did not significantly vary either in comparison to controls (P=0.07) or throughout the COPD Global Initiative for Chronic Obstructive Lung Disease stages (P=0.49). COPD-OSA overlap solely correlated with nocturnal hypoxemic events, whereas LV performance status was unrelated to coexisting OSA. Conclusion

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

    PubMed Central

    Goldman, Julie L.

    2014-01-01

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

  3. 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

  4. 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

  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. 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

  7. Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea.

    PubMed

    Diaz-Abad, Montserrat; Chatila, Wissam; Lammi, Matthew R; Swift, Irene; D'Alonzo, Gilbert E; Krachman, Samuel L

    2014-01-01

    Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA). Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53 ± 11 yrs; body mass index (BMI) = 45 ± 9 kg/m(2)) with apnea-hypopnea index (AHI) 33 ± 30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P = 0.006), income level (P < 0.001), and employment status (P = 0.03) between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P = 0.03, P = 0.004, and P = 0.001, resp.), as well as in Hispanics (P = 0.02, P = 0.02, P = 0.03, resp.). Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence. PMID:24649371

  8. Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

    PubMed

    Abuyassin, Bisher; Sharma, Kumar; Ayas, Najib T; Laher, Ismail

    2015-08-01

    Chronic kidney disease (CKD) is associated with high mortality rates and heavy economic and social burdens. Nearly 10% of the United States population suffer from CKD, with fatal outcomes increased by 16-40 times even before reaching end-stage renal disease. The prevalence of obstructive sleep apnea (OSA) is between 3% and 7% in the general population, and has increased dramatically during the last 2 decades along with increased rates of obesity. However, the prevalence of OSA is much greater in patients with CKD. In addition, aggressive dialysis improves OSA. The current literature suggests a bidirectional association between CKD and OSA through a number of potential pathological mechanisms, which increase the possibility of both diseases being possible risk factors for each other. CKD may lead to OSA through a variety of mechanisms, including alterations in chemoreflex responsiveness, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins. It is also being increasingly recognized that OSA can also accelerate loss of kidney function. Moreover, animals exposed to intermittent hypoxia suffer histopathological renal damage. Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction, activation of the sympathetic nervous system, and increased oxidative stress. PMID:25845900

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

    PubMed Central

    Dort, Leslie; Remmers, John

    2012-01-01

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

  10. Sleepiness and nocturnal hypoxemia in Peruvian men with obstructive sleep apnea

    PubMed Central

    de Castro, Jorge Rey; Mezones-Holguín, Edward

    2014-01-01

    Purpose To evaluate the intensity of nocturnal hypoxemia associated with sleepiness in Peruvian men with a diagnosis of obstructive sleep apnea (OSA). Methods We carried out a secondary data analysis based on a study which includes patients with OSA who were seen in a private hospital in Lima, Peru from 2006 to 2012. We included male adults who had polysomnographic recordings and who answered the Epworth sleepiness scale (ESE). The intensity of nocturnal hypoxemia (oxygen saturation ≤90 %) was classified in four new categories: 0, <1, 1 to 10 and >10 % total sleep time with nocturnal hypoxemia (NH). When the ESE score was higher than 10, we used the definitions presence or absence of sleepiness. We used Poisson regression models with robust variance to estimate crude and adjusted prevalence ratios (PR) for association between sleepiness and NH. Results 518 male patients with OSA were evaluated. Four hundred and fifty-two (87 %) patients had NH and 262 (51 %) had sleepiness. Of the 142 (27.4 %) patients who had >10 % total sleep time with NH, 98 (69.0 %) showed sleepiness and had a greater probability of sleepiness prevalence, with a crude PR of 1.82 (95 % CI 1.31–2.53). This association persisted in the multivariate models. Conclusions We found an association between NH and sleepiness. Only patients with the major intensity of NH (over 10 % of the total sleep time) had a greater probability of sleepiness. This suggests that sleepiness probably occurs after a chronic process and after overwhelming compensatory mechanisms. PMID:24249663

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

    PubMed Central

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

    2014-01-01

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

  12. Model-based stability assessment of ventilatory control in overweight adolescents with obstructive sleep apnea during NREM sleep.

    PubMed

    Nava-Guerra, L; Tran, W H; Chalacheva, P; Loloyan, S; Joshi, B; Keens, T G; Nayak, K S; Davidson Ward, S L; Khoo, M C K

    2016-07-01

    Obstructive sleep apnea (OSA) involves the interplay of several different factors such as an unfavorable upper airway anatomy, deficiencies in pharyngeal muscle responsiveness, a low arousal threshold, and ventilatory control instability. Although the stability of ventilatory control has been extensively studied in adults, little is known about its characteristics in the pediatric population. In this study, we developed a novel experimental setup that allowed us to perturb the respiratory system during natural non-rapid eye movement (NREM) sleep conditions by manipulating the inspiratory pressure, provided by a bilevel pressure ventilator, to induce sighs after upper airway stabilization. Furthermore, we present a modeling framework that utilizes the noninvasively measured ventilatory responses to the induced sighs and spontaneous breathing data to obtain representations of the processes involved in the chemical regulation of respiration and extract their stability characteristics. After validation with simulated data, the modeling technique was applied to data collected experimentally from 11 OSA and 15 non-OSA overweight adolescents. Statistical analysis of the model-derived stability parameters revealed a significantly higher plant gain and lower controller gain in the OSA group (P = 0.046 and P = 0.007, respectively); however, no differences were found in loop gain (LG) and circulatory time delay between the groups. OSA severity and LG, within the 0.03-0.04-Hz frequency band, were significantly negatively associated (r = -0.434, P = 0.026). Contrary to what has been found in adults, our results suggest that in overweight adolescents, OSA is unlikely to be initiated through ventilatory instability resulting from elevated chemical loop gain. PMID:27174926

  13. 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

  14. 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

  15. 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

  16. Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men

    PubMed Central

    Cao, Yingting; Wittert, Gary; Taylor, Anne W.; Adams, Robert; Shi, Zumin

    2016-01-01

    Background: macronutrient intake has been found to affect sleep parameters including obstructive sleep apnoea (OSA) in experimental studies, but there is uncertainty at the population level in adults. Methods: cross-sectional analysis was conducted of participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort (n = 784, age 35–80 years). Dietary intake was measured by a validated food frequency questionnaire. Self-reported poor sleep quality and daytime sleepiness were measured by questionnaires. Overnight in-home polysomnography (PSG) was conducted among participants with without previously diagnosed OSA. Results: after adjusting for demographic, lifestyle factors, and chronic diseases, the highest quartile of fat intake was positively associated with excessive daytime sleepiness (relative risk ratio (RRR) = 1.78, 95% CI 1.10, 2.89) and apnoea-hypopnoea index (AHI) ≥20, (RRR = 2.98, 95% CI 1.20–7.38). Body mass index mediated the association between fat intake and AHI (30%), but not daytime sleepiness. There were no associations between other intake of macronutrient and sleep outcomes. Conclusion: high fat is associated with daytime sleepiness and AHI. Sleep outcomes are generally not assessed in studies investigating the effects of varying macronutrient diets on weight loss. The current result highlights the potential public health significance of doing so. PMID:27070639

  17. Effect of obstructive sleep apnea on mitral valve tenting.

    PubMed

    Pressman, Gregg S; Figueredo, Vincent M; Romero-Corral, Abel; Murali, Ganesan; Kotler, Morris N

    2012-04-01

    Obstructive apneas produce high negative intrathoracic pressure that imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no obstructive sleep apnea (OSA; AHI <15) and moderate/severe OSA (AHI ≥15). Mitral valve tenting height and area, left ventricular (LV) long and short axes, and LV end-diastolic volume were measured in addition to tissue Doppler parameters. Comparisons of measurements at baseline and follow-up between and within groups were obtained; correlations between absolute changes (Δ) in echocardiographic parameters were also performed. After a mean follow-up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 to 1.28 ± 0.17 cm, p = 0.001) in moderate/severe OSA as did tenting area (2.30 ± 0.41 to 2.66 ± 0.60 cm(2), p = 0.0002); Δtenting height correlated with ΔLV end-diastolic volume (rho 0.43, p = 0.01) and Δtenting area (rho 0.35, p = 0.04). In patients with mild/no OSA there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 to 2.31 ± 0.43 cm(2), p = 0.05). Septal tissue Doppler early diastolic wave decreased (8.04 ± 2.49 to 7.10 ± 1.83 cm/s, p = 0.005) in subjects with moderate/severe OSA but not in in those with mild/no OSA. In conclusion, in patients with moderate/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry. PMID:22264596

  18. 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

  19. Does Neck-to-Waist Ratio Predict Obstructive Sleep Apnea in Children?

    PubMed Central

    Katz, Sherri Lynne; Vaccani, Jean-Philippe; Barrowman, Nick; Momoli, Franco; Bradbury, Carol L.; Murto, Kimmo

    2014-01-01

    Objectives: Central adiposity and large neck circumference are associated with obstructive sleep apnea (OSA) in adults but have not been evaluated in children as predictors of OSA. Study objectives were to determine whether (1) anthropometric measures including neck-to-waist ratio are associated with OSA in older children; (2) body fat distribution, measured by neck-to-waist ratio, is predictive of OSA in overweight/obese children. Methods: Cross-sectional study involving children 7-18 years scheduled to undergo polysomnography at a tertiary care children's hospital. OSA was defined as total apnea-hypopnea index > 5 events/h and/or obstructive apnea index > 1 event/h. Recursive partitioning was used to select candidate predictors of OSA from: age, sex, height and weight percentile, body mass index (BMI) z-score, neck-to-waist ratio, tonsil size, and Mallampati score. These were then evaluated using log binomial models and receiver operator characteristic analysis. Results: Two hundred twenty-two participants were included; 133 (60%) were overweight/obese, 121 (55%) male,47 (21%) had OSA. Neck-to-waist ratio (relative risk [RR] 1.97 per 0.1 units, 95% CI 1.48 to 2.84) and BMI z-score (RR 1.63 per unit, 95% CI 1.30 to 2.05) were identified as independent predictors of OSA. Considering only overweight/obese children, neck-to-waist ratio (RR 2.16 per 0.1 units, 95% CI 1.79 to 2.59) and BMI z-score (RR 2.02 per unit, 95% CI 1.25 to 3.26) also independently predicted OSA. However, in children not overweight/obese, these variables were not predictive of OSA. Conclusions: Neck-to-waist ratio, an index of body fat distribution, predicts OSA in older children and youth, especially in those who were overweight/obese. Citation: Katz SL, Vaccani JP, Barrowman N, Momoli F, Bradbury CL, Murto K. Does neck-to-waist ratio predict obstructive sleep apnea in children? J Clin Sleep Med 2014;10(12):1303-1308. PMID:25325606

  20. Nocturnal Diaphoresis Secondary to Mild Obstructive Sleep Apnea in a Patient with a History of Two Malignancies

    PubMed Central

    Vorona, Robert Daniel; Szklo-Coxe, Mariana; Fleming, Mark; Ware, J. Catesby

    2013-01-01

    Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom. Citation: Vorona RD; Szklo-Coxe M; Fleming M; Ware JC. Nocturnal diaphoresis secondary to mild obstructive sleep apnea in a patient with a history of two malignancies. J Clin Sleep Med 2013;9(7):717-719. PMID:23853568

  1. Effects of obesity upon genioglossus structure and function in obstructive sleep apnoea.

    PubMed

    Carrera, M; Barbé, F; Sauleda, J; Tomás, M; Gómez, C; Santos, C; Agustí, A G N

    2004-03-01

    Obesity is a common feature of the obstructive sleep apnoea syndrome. It can influence the structure and function of skeletal muscles. However, its effects upon the upper airway muscles have not been explored directly. This study assessed the structure and function of the genioglossus in patients with obstructive sleep apnoea syndrome and in healthy subjects (with and without obesity, defined by a body mass index > 30 kg x m(-2)). Further, to investigate the effects of continuous positive airway pressure (CPAP) treatment, patients with obstructive sleep apnoea syndrome after at least 1 yr under CPAP were also studied. The study found that obese and nonobese patients showed different in vitro geniglossus endurance properties. In obese patients, geniglossus endurance was indistinguishable from normal while, nonobese patients, at diagnosis, showed increased genioglossus fatigability; this was not observed in patients treated with CPAP. By contrast, patients with obstructive sleep apnoea syndrome showed at diagnosis a higher percentage of type II fibres than controls and patients under CPAP treatment independently of obesity. This difference is mainly due to a predominance of subtype IIb fibre. This difference was not observed in the group of patients treated with CPAP. Genioglossus twitch force was normal in all patients. These results suggest that different pathogenic mechanisms may underlie the development of obstructive sleep apnoea syndrome in obese and nonobese patients. This observation may have potential clinical implications. PMID:15065833

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

    PubMed Central

    Gharibeh, Tarek; Mehra, Reena

    2010-01-01

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

  3. Sleep protects memories from interference in older adults.

    PubMed

    Sonni, Akshata; Spencer, Rebecca M C

    2015-07-01

    In a recent study, we demonstrated that sleep-dependent consolidation of declarative memories is preserved in older adults. The present study examined whether this benefit of sleep for declarative learning in older adults reflects a passive role of sleep in protecting memories from decay or an active role in stabilizing them. Young and older adults learned a visuospatial task, and recall was probed after sleep or wake. Although a reduction in performance was observed after sleep and wake, task-related interference before recall had a larger detriment on performance in the wake condition. This was true for young and high performing older adults only. Low performing older adults did not receive a benefit of sleep on the visuospatial task. Performance changes were associated with early night nonrapid eye movement sleep in young adults and with early night rapid eye movement sleep in high performing older adults. These results demonstrate that performance benefits from sleep in older adults as a result of an active memory stabilization process; importantly, the extent of this benefit of sleep is closely linked to the level of initial acquisition of the episodic information in older adults. PMID:25890819

  4. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea.

    PubMed

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

    1992-01-01

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

  5. Effect of obstructive sleep apnea syndrome on corneal thickness.

    PubMed

    Koseoglu, Handan Inonu; Kanbay, Asiye; Ortak, Huseyin; Karadağ, Remzi; Demir, Osman; Demir, Selim; Gunes, Alper; Doruk, Sibel

    2016-06-01

    Obstructive sleep apnea syndrome (OSAS) might be a risk factor for the development of eye disorders. The aim of the study was to evaluate the effect of OSAS on central corneal thickness (CCT). A total of 195 patients were enrolled in the study, and underwent polysomnography. Patients were divided according to their apnea-hypopnea index (AHI) scores into control group (AHI < 5), mild (AHI, 5-15), moderate (AHI, 15-30), and severe OSAS (AHI > 30) groups. In ophthalmological examinations, CCT, auto refractometer measurement, tear break-up time, and Schrimer's test results were evaluated. Central corneal thickness was significantly decreased in patients with OSAS compared to the control group (542.14 ± 31.21 vs. 569.92 ± 13.46, p < 0.001). As the severity of OSAS increased, CCT decreased (mild OSAS = 567.48 ± 23 mm, moderate OSAS = 530.21 ± 30.2 mm, and severe OSAS = 557.97 ± 16.52 mm, respectively, p < 0.001). The mean values of auto refractometer, tear break-up time, and Schrimer's test were similar between the groups (p > 0.05). CCT was negatively correlated with AHI, oxygen desaturation index, desaturation percentages, and positively correlated with minimum oxygen saturation values (p < 0.05). This study showed that central corneal thickness is inversely correlated with the severity of OSAS. OSAS affects all organ systems particularly cardiovascular and neurological mechanisms. Further studies are warranted to evaluate the effect of OSAS treatment on CCT. PMID:26292644

  6. Role of Orexin in Respiratory and Sleep Homeostasis during Upper Airway Obstruction in Rats

    PubMed Central

    Tarasiuk, Ariel; Levi, Avishag; Berdugo-Boura, Nilly; Yahalom, Ari; Segev, Yael

    2014-01-01

    Study Objectives: Chronic upper airway obstruction (UAO) elicits a cascade of complex endocrine derangements that affect growth, sleep, and energy metabolism. We hypothesized that elevated hypothalamic orexin has a role in maintaining ventilation during UAO, while at the same time altering sleep-wake activity and energy metabolism. Here, we sought to explore the UAO-induced changes in hypothalamic orexin and their role in sleep-wake balance, respiratory activity, and energy metabolism. Interventions: The tracheae of 22-day-old Sprague-Dawley rats were surgically narrowed; UAO and sham-operated control animals were monitored for 7 weeks. We measured food intake, body weight, temperature, locomotion, and sleep-wake activity. Magnetic resonance imaging was used to quantify subcutaneous and visceral fat tissue volumes. In week 7, the rats were sacrificed and levels of hypothalamic orexin, serum leptin, and corticosterone were determined. The effect of dual orexin receptor antagonist (almorexant 300 mg/kg) on sleep and respiration was also explored. Measurements and Results: UAO increased hypothalamic orexin mRNA and protein content by 64% and 65%, respectively. UAO led to 30% chronic sleep loss, excessive active phase sleepiness, decreased body temperature, increased food intake, reduction of abdominal and subcutaneous fat tissue volume, and growth retardation. Administration of almorexant normalized sleep but induced severe breathing difficulties in UAO rats, while it had no effect on sleep or on breathing of control animals. Conclusions: In upper airway obstruction animals, enhanced orexin secretion, while crucially important for respiratory homeostasis maintenance, is also responsible for chronic partial sleep loss, as well as considerable impairment of energy metabolism and growth. Citation: Tarasiuk A, Levi A, Berdugo-Boura N, Yahalom A, Segev Y. Role of orexin in respiratory and sleep homeostasis during upper airway obstruction in rats. SLEEP 2014

  7. 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

  8. Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism

    PubMed Central

    Yamauchi, Motoo; Fujita, Yukio; Kumamoto, Makiko; Yoshikawa, Masanori; Ohnishi, Yoshinobu; Nakano, Hiroshi; Strohl, Kingman P.; Kimura, Hiroshi

    2015-01-01

    Study Objectives: Obstructive sleep apnea (OSA) can be severe and present in higher numbers during rapid eye movement (REM) than nonrapid eye movement (NREM) sleep; however, OSA occurs in NREM sleep and can be predominant. In general, ventilation decreases an average 10% to 15% during transition from wakefulness to sleep, and there is variability in just how much ventilation decreases. As dynamic changes in ventilation contribute to irregular breathing and breathing during NREM sleep is mainly under chemical control, our hypothesis is that patients with a more pronounced reduction in ventilation during the transition from wakefulness to NREM sleep will have NREM- predominant rather than REM-predominant OSA. Methods: A retrospective analysis of 451 consecutive patients (apnea-hypopnea index [AHI] > 5) undergoing diagnostic polysomnography was performed, and breath-to-breath analysis of the respiratory cycle duration, tidal volume, and estimated minute ventilation before and after sleep onset were examined. Values were calculated using respiratory inductance plethysmography. The correlation between the percent change in estimated minute ventilation during wake-sleep transitions and the percentage of apnea-hypopneas in NREM sleep (%AHI in NREM; defined as (AHI-NREM) / [(AHI-NREM) + (AHI-REM)] × 100) was the primary outcome. Results: The decrease in estimated minute ventilation during wake-sleep transitions was 15.0 ± 16.6% (mean ± standard deviation), due to a decrease in relative tidal volume. This decrease in estimated minute ventilation was significantly correlated with %AHI in NREM (r = −0.222, p < 0.01). Conclusions: A greater dynamic reduction in ventilation back and forth from wakefulness to sleep contributes to the NREM predominant OSA phenotype via induced ventilatory instability. Citation: Yamauchi M, Fujita Y, Kumamoto M, Yoshikawa M, Ohnishi Y, Nakano H, Strohl KP, Kimura H. Nonrapid eye movement-predominant obstructive sleep apnea: detection and

  9. Ventilatory Responses to Hypercapnia during Wakefulness and Sleep in Obese Adolescents With and Without Obstructive Sleep Apnea Syndrome

    PubMed Central

    Yuan, Haibo; Pinto, Swaroop J.; Huang, Jingtao; McDonough, Joseph M.; Ward, Michelle B.; Lee, Yin N.; Bradford, Ruth M.; Gallagher, Paul R.; Shults, Justine; Konstantinopoulou, Sophia; Samuel, John M.; Katz, Eliot S.; Hua, Shucheng; Tapia, Ignacio E.; Marcus, Carole L.

    2012-01-01

    Study Objectives: Abnormal ventilatory drive may contribute to the pathophysiology of the childhood obstructive sleep apnea syndrome (OSAS). Concomitant with the obesity epidemic, more adolescents are developing OSAS. However, few studies have specifically evaluated the obese adolescent group. The authors hypothesized that obese adolescents with OSAS would have a blunted hypercapnic ventilatory response (HCVR) while awake and blunted ventilatory responses to carbon dioxide (CO2) during sleep compared with obese and lean adolescents without OSAS. Design: CVR was measured during wakefulness. During nonrapid eye movement (NREM) and rapid eye movement (REM) sleep, respiratory parameters and genioglossal electromyogram were measured during CO2 administration in comparison with room air in obese adolescents with OSAS, obese control study participants, and lean control study participants. Setting: Sleep laboratory. Participants: Twenty-eight obese patients with OSAS, 21 obese control study participants, and 37 lean control study participants. Results: The obese OSAS and obese control groups had a higher HCVR compared with the lean control group during wakefulness. During both sleep states, all 3 groups had a response to CO2; however, the obese OSAS group had lower percentage changes in minute ventilation, inspiratory flow, inspiratory time, and tidal volume compared with the 2 control groups. There were no significance differences in genioglossal activity between groups. Conclusions: HCVR during wakefulness is increased in obese adolescents. Obese adolescents with OSAS have blunted ventilatory responses to CO2 during sleep and do not have a compensatory prolongation of inspiratory time, despite having normal CO2 responsivity during wakefulness. Central drive may play a greater role than upper airway neuromotor tone in adapting to hypercapnia. Citation: Yuan H; Pinto SJ; Huang J; McDonough JM; Ward MB; Lee YN; Bradford RM; Gallagher PR; Shults J; Konstantinopoulou S

  10. Role of sleep continuity and total sleep time in executive function across the adult lifespan.

    PubMed

    Wilckens, Kristine A; Woo, Sarah G; Kirk, Afton R; Erickson, Kirk I; Wheeler, Mark E

    2014-09-01

    The importance of sleep for cognition in young adults is well established, but the role of habitual sleep behavior in cognition across the adult life span remains unknown. We examined the relationship between sleep continuity and total sleep time as assessed with a sleep-detection device, and cognitive performance using a battery of tasks in young (n = 59, mean age = 23.05) and older (n = 53, mean age = 62.68) adults. Across age groups, higher sleep continuity was associated with better cognitive performance. In the younger group, higher sleep continuity was associated with better working memory and inhibitory control. In the older group, higher sleep continuity was associated with better inhibitory control, memory recall, and verbal fluency. Very short and very long total sleep time was associated with poorer working memory and verbal fluency, specifically in the younger group. Total sleep time was not associated with cognitive performance in any domains for the older group. These findings reveal that sleep continuity is important for executive function in both young and older adults, but total sleep time may be more important for cognition in young adults. PMID:25244484

  11. The role of sleep continuity and total sleep time in executive function across the adult lifespan

    PubMed Central

    Wilckens, Kristine A.; Woo, Sarah G.; Kirk, Afton R.; Erickson, Kirk I.; Wheeler, Mark E.

    2015-01-01

    The importance of sleep for cognition in young adults is well established, but the role of habitual sleep behavior in cognition across the adult lifespan remains unknown. We examined the relationship between sleep continuity and total sleep time assessed with a sleep detection device and cognitive performance using a battery of tasks in young (n = 59, mean age = 23.05) and older (n = 53, mean age = 62.68) adults. Across age groups, higher sleep continuity was associated with better cognitive performance. In the younger group, higher sleep continuity was associated with better working memory and inhibitory control. In the older group, higher sleep continuity was associated with better inhibitory control, memory recall, and verbal fluency. Very short and very long total sleep time was associated with poorer working memory and verbal fluency, specifically in the younger group. Total sleep time was not associated with cognitive performance in any domains for the older group. These findings reveal that sleep continuity is important for executive function in both young and older adults, but total sleep time may be more important for cognition in young adults. PMID:25244484

  12. Pulmonary hypertension due to obstructive sleep apnea in a child with Rubinstein-Taybi syndrome.

    PubMed

    Choi, Hyung Soon; Yu, Jeong Jin; Kim, Young-Hwue; Ko, Jae-Kon; Park, In-Sook

    2012-06-01

    Rubinstein-Taybi syndrome (RTS) is characterized by peculiar facies, mental retardation, broad thumbs, and great toes. Approximately one-third of the affected individuals have a variety of congenital heart diseases. They can also have upper airway obstruction during sleep, due to hypotonia and the anatomy of the oropharynx and airway, which make these patients susceptible to obstructive sleep apnea (OSA). In our case, pulmonary hypertension was caused, successively, by congenital heart defects (a large patent ductus arteriosus and arch hypoplasia) and obstructive sleep apnea during early infancy. The congenital heart defects were surgically corrected, but persistent pulmonary hypertension was identified 2 months after the operation. This pulmonary hypertension was due to OSA, and it was relieved by nasal continuous positive airway pressure. This case is the first report of pulmonary hypertension from OSA in a young infant with RTS. PMID:22745646

  13. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea.

    PubMed

    Suratt, P M; Dee, P; Atkinson, R L; Armstrong, P; Wilhoit, S C

    1983-04-01

    Because it has been suggested that patients with obstructive sleep apnea have a narrower pharyngeal airway than normal persons, we performed lateral fluoroscopy and computed tomographic (CT) scans of the pharynx in patients with this syndrome. Fluoroscopy in 6 sleeping patients showed that the obstruction always began during inspiration when the soft palate touched the tongue and posterior pharyngeal wall. The CT scans in 9 awake subjects demonstrated that the narrowest section of the airway in patients and in control subjects was the region posterior to the soft palate. The cross-sectional area of this region was significantly narrower in patients than it was in control subjects (p less than 0.001). Because a narrow airway would be more likely to collapse during inspiration than a normal one would (Bernoulli's Principle), we conclude that the narrow airways we observed in awake patients may be an important contributing factor in the pathogenesis of obstructive sleep apnea. PMID:6838055

  14. [Changes in the upper airway in patients with sleep obstructive apnea and/or chronic snoring treated with mandibular appliances].

    PubMed

    Cobo, J; de Carlos, F; Díaz Esnal, B; Fernández, M P; Llorente, S; Llorente, J

    2001-01-01

    We have analysed the possible modifications in the upper airways (UA) of the lateral cranial teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharynx in all the subjects studied. The study of the changes in the UA using the lateral cranial teleradiography in order to evaluate the effectiveness of the MAD can contribute to consider its effectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography. PMID:11692961

  15. Association between obstructive sleep apnea severity and glucose control in patients with untreated versus treated diabetes.

    PubMed

    Priou, Pascaline; Le Vaillant, Marc; Meslier, Nicole; Chollet, Sylvaine; Pigeanne, Thierry; Masson, Philippe; Bizieux-Thaminy, Acya; Humeau, Marie-Pierre; Goupil, François; Ducluzeau, Pierre-Henri; Gagnadoux, Frédéric

    2015-08-01

    The purpose of this study was to determine whether the association between obstructive sleep apnea severity and glucose control differs between patients with newly diagnosed and untreated type 2 diabetes, and patients with known and treated type 2 diabetes. This multicentre cross-sectional study included 762 patients investigated by sleep recording for suspected obstructive sleep apnea, 497 of whom were previously diagnosed and treated for type 2 diabetes (treated diabetic patients), while 265 had no medical history of diabetes but had fasting blood glucose ≥126 mg dL(-1) and/or glycated haemoglobin (HbA1c ) ≥6.5% consistent with newly diagnosed type 2 diabetes (untreated diabetic patients). Multivariate regression analyses were performed to evaluate the independent association between HbA1c and obstructive sleep apnea severity in treated and untreated patients with diabetes. In untreated diabetic patients, HbA1c was positively associated with apnea-hypopnea index (P = 0.0007) and 3% oxygen desaturation index (P = 0.0016) after adjustment for age, gender, body mass index, alcohol habits, metabolic dyslipidaemia, hypertension, statin use and study site. The adjusted mean value of HbA1c increased from 6.68% in the lowest quartile of the apnea-hypopnea index (<17) to 7.20% in the highest quartile of the apnea-hypopnea index (>61; P = 0.033 for linear trend). In treated patients with diabetes, HbA1c was associated with non-sleep variables, including age, metabolic dyslipidaemia and insulin use, but not with obstructive sleep apnea severity. Obstructive sleep apnea may adversely affect glucose control in patients with newly diagnosed and untreated type 2 diabetes, but may have a limited impact in patients with overt type 2 diabetes receiving anti-diabetic medications. PMID:25703309

  16. Obstructive jaundice in adult Ethiopians in a referral hospital.

    PubMed

    Bekele, Z; Yifru, A

    2000-10-01

    Forty-nine adult Ethiopians with obstructive jaundice were studied. Right upper quadrant pain was the main presenting complaint (89%). Most (94%) of the jaundiced patients had right upper quadrant tenderness. In 87% the obstruction was corroborated by ultrasonographic examination, but causal factors were identified in only 39%. Operative findings showed that choledocholithiasis (41%) and malignant conditions (22%) were the two important causes of obstructive jaundice among the adult patients seen at a referral hospital in Addis Ababa. The causes and the outcome of the different types of surgical procedures used in the management are discussed. PMID:11125501

  17. A novel implantable device for the treatment of obstructive sleep apnea: clinical safety and feasibility

    PubMed Central

    Pavelec, Vaclav; Rotenberg, Brian W; Maurer, Joachim T; Gillis, Edward; Verse, Thomas

    2016-01-01

    Objective Many cases of obstructive sleep apnea (OSA) involve collapse of the tongue base and soft palate during sleep, causing occlusion of the upper airway and leading to oxygen desaturation. Existing therapies can be effective, but they are plagued by patient adherence issues and the invasiveness of surgical approaches. A new, minimally invasive implant for OSA has been developed, which is elastic and contracts a few weeks after deployment, stabilizing the surrounding soft tissue. The device has had good outcomes in preclinical testing; this report describes the preliminary feasibility and safety of its implementation in humans. Patients and methods A prospective, multicenter, single-arm feasibility study was conducted. Subjects were adults with moderate-to-severe OSA who had previously failed or refused conventional continuous positive airway pressure treatment. Intraoperative feasibility data, postoperative pain, and safety information were collected for a 30-day postoperative period. Results Forty subjects participated (37 men, three women; average age of 46.1 years); each received two tongue-base implants and two soft-palate implants. Surgical procedure time averaged 43 minutes. Postsurgical pain resolved readily in most cases; at 30 days post implantation, <20% of subjects reported pain, which averaged less than two out of ten. Adverse events were generally the mild and expected sequelae of a surgical procedure with general anesthesia and intraoral manipulation. The device was well tolerated. Implant extrusions were reported with soft-palate implants (n=12), while tongue-base implants required few revisions (n=2). Quantitative and qualitative sleep effectiveness outcomes (including full-night polysomnographic and quality-of-life measures) will be presented in a subsequent report. Conclusion Implantation of the device was feasible. Although a relatively high rate of extrusions occurred in the now-discontinued palate implants, tongue-base implants were

  18. Comparison of Standard and Novel Signal Analysis Approaches to Obstructive Sleep Apnea Classification

    PubMed Central

    Roebuck, Aoife; Clifford, Gari D.

    2015-01-01

    Obstructive sleep apnea (OSA) is a disorder characterized by repeated pauses in breathing during sleep, which leads to deoxygenation and voiced chokes at the end of each episode. OSA is associated by daytime sleepiness and an increased risk of serious conditions such as cardiovascular disease, diabetes, and stroke. Between 2 and 7% of the adult population globally has OSA, but it is estimated that up to 90% of those are undiagnosed and untreated. Diagnosis of OSA requires expensive and cumbersome screening. Audio offers a potential non-contact alternative, particularly with the ubiquity of excellent signal processing on every phone. Previous studies have focused on the classification of snoring and apneic chokes. However, such approaches require accurate identification of events. This leads to limited accuracy and small study populations. In this work, we propose an alternative approach which uses multiscale entropy (MSE) coefficients presented to a classifier to identify disorder in vocal patterns indicative of sleep apnea. A database of 858 patients was used, the largest reported in this domain. Apneic choke, snore, and noise events encoded with speech analysis features were input into a linear classifier. Coefficients of MSE derived from the first 4 h of each recording were used to train and test a random forest to classify patients as apneic or not. Standard speech analysis approaches for event classification achieved an out-of-sample accuracy (Ac) of 76.9% with a sensitivity (Se) of 29.2% and a specificity (Sp) of 88.7% but high variance. For OSA severity classification, MSE provided an out-of-sample Ac of 79.9%, Se of 66.0%, and Sp = 88.8%. Including demographic information improved the MSE-based classification performance to Ac = 80.5%, Se = 69.2%, and Sp = 87.9%. These results indicate that audio recordings could be used in screening for OSA, but are generally under-sensitive. PMID:26380256

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

    PubMed Central

    Ronchi, Paolo; Ambrosoli, Alessandro; Caprioglio, Alberto

    2013-01-01

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

  20. [Role of immune system in the pathomechanism of obstructive sleep apnea].

    PubMed

    Chorostowska-Wynimko, Joanna; Kedzior, Marta E

    2008-01-01

    Immune system plays an essential role in the pathomechanism of obstructive sleep apnea syndrome (OSA), in the development of certain OSA complications, like the increased risk of cardiovascular diseases. Indeed, it is the sleep fragmentation and chronic intermittent hypoxia/reoxygenation, that stimulates increased immunoreactivity and chronic inflammatory response, both systemic and local in the upper airways. This review summarizes current evidence on the most important regulatory mechanisms involving immune cells and mediators. PMID:18464225

  1. New Approaches to Positive Airway Pressure Treatment in Obstructive Sleep Apnea.

    PubMed

    Kuźniar, Tomasz J

    2016-06-01

    Continuous positive airway pressure (CPAP) is a mainstay of therapy in patients with obstructive sleep apnea (OSA). This technology has gone through tremendous changes that resulted in devices that can recognize and differentiate sleep-disordered breathing events, adjust their output to these events, monitor usage, and communicate with the treatment team. This article discusses recent developments in treatment of OSA with PAP. PMID:27236053

  2. Sleep disorders in children.

    PubMed

    Hoban, Timothy F

    2010-01-01

    Although sleep disorders such as insomnia and obstructive sleep apnea are common in both children and adults, the clinical features and treatments for these conditions differ considerably between these two populations. Whereas an adult with obstructive sleep apnea typically presents with a history of obesity, snoring, and prominent daytime somnolence, a child with the condition is more likely to present with normal body weight, tonsillar hypertrophy, and inattentiveness during school classes. The adult with suspected sleep apnea almost always undergoes a baseline polysomnogram and proceeds to treatment only if this test confirms the diagnosis, while many children with suspected sleep apnea are treated empirically with adenotonsillectomy without ever receiving a sleep study to verify the diagnosis. This article reviews sleep disorders in children, with a particular focus on age-related changes in sleep, conditions that primarily affect children, and disorders for which clinical manifestations and treatment differ substantially from the adult population. PMID:20146688

  3. Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults

    PubMed Central

    Hwangbo, Young; Kim, Won-Joo; Chu, Min Kyung; Yun, Chang-Ho

    2016-01-01

    Background and Purpose Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. Methods The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS. Results The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27–2.54] and 0.01–2 hours (OR, 1.42; 95% CI, 1.02–1.98). However, habitual sleep duration was not significantly related to EDS. Conclusions EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS. PMID:26833986

  4. Obstructive sleep apnea syndrome with bilateral papilledema and vision loss in a 3-year-old child.

    PubMed

    Quinn, Anthony G; Gouws, Pieter; Headland, Sophie; Oades, Patrick; Pople, Ian; Taylor, David; Benton, J Sarah; Buncic, J Raymond; Henderson, John; Fleming, Peter

    2008-04-01

    We describe bilateral papilledema and vision loss in a 3-year-old child with obstructive sleep apnea. Although lumbar puncture initially disclosed a normal opening pressure, cerebrospinal fluid (CSF) pressure monitoring during sleep confirmed intermittent episodes of elevated intracranial pressure corresponding to increased airway resistance. The association of obstructive sleep apnea and raised intracranial pressure is recognized in children with craniosynostosis but has not been reported in its absence. PMID:18289895

  5. Assessment of pulmonary arterial stiffness in obstructive sleep apnea.

    PubMed

    Ozkececi, Gulay; Ulasli, Sevinc Sarinc; Akci, Onder; Dural, İbrahim Ethem; Avsar, Alaettin; Unlu, Mehmet; Onrat, Ersel

    2016-05-01

    Pulmonary hypertension (PH) is one of the major complications of obstructive sleep apnea syndrome (OSAS). Pulmonary arterial stiffness (PAS) can be used in determination of PH. The aim of the present study was to evaluate the PAS and cardiac function of patients with OSAS and analyses the relationship between OSAS severity and PAS. Sixty newly diagnosed patients with OSAS (mean age 49.6 ± 11.7 years) and 30 healthy controls (mean age 46.4 ± 14 years) were enrolled. Right ventricle (RV) and left ventricle (LV) echocardiographic parameters and PAS values of study groups were compared. There were no significant differences in terms of LV ejection fraction, LV Tei-index and tricuspid annular plane systolic excursion. PAS, mean pulmonary arterial pressure (PAP) and RV Tei-index were significantly higher but tricuspid annulus early diastolic myocardial velocity was lower in patients with OSAS than control subjects (respectively p < 0.001, p < 0.001, p = 0.001, p = 0.001). Moreover, we found a higher PAS in OSAS patients without PH compared to controls (p < 0.001). When we investigated the relationship between polysomnographic variables and echocardiographic parameters, we found positive correlations between apnea hypopnea index and total oxygen desaturation with PAS and mean PAP (r = 0.384, p < 0.001; r = 0.404, p < 0.001; r = 0.36, p < 0.001; r = 0.349, p = 0.001 respectively). PAS and mean PAP were increased in patients with OSAS. Pulmonary vascular bed may be affected due to the fluctuation of PAP during day and night time. Therefore, assessment of PAS can be more useful than PAP in OSAS patients. PMID:26783146

  6. Sleep characteristics of Veterans Affairs Adult Day Health Care participants.

    PubMed

    Hughes, Jaime M; Martin, Jennifer L

    2015-01-01

    Addressing sleep disturbance can help to slow functional decline, delay nursing home admission, and improve overall health among older adults; however, sleep is not widely studied in high-risk older adults such as Adult Day Health Care (ADHC) participants. Sixty-eight ADHC participants were interviewed for sleep disturbance using a 28-item screening questionnaire. More than two thirds (n = 48, 70.6%) reported one or more characteristics of poor sleep, and 38% of participants met basic criteria for insomnia. Individuals with insomnia attended ADHC less frequently, reported worse sleep quality and shorter sleep duration, and were more likely to endorse trouble falling asleep, staying asleep, and waking up too early (ps < 0.001). Research is needed to better understand perceptions, predictors, and outcomes of sleep disturbance within ADHC participants. PMID:24654988

  7. Long-term facilitation in obstructive sleep apnea patients during NREM sleep.

    PubMed

    Aboubakr, S E; Taylor, A; Ford, R; Siddiqi, S; Badr, M S

    2001-12-01

    Repetitive hypoxia followed by persistently increased ventilatory motor output is referred to as long-term facilitation (LTF). LTF is activated during sleep after repetitive hypoxia in snorers. We hypothesized that LTF is activated in obstructive sleep apnea (OSA) patients. Eleven subjects with OSA (apnea/hypopnea index = 43.6 +/- 18.7/h) were included. Every subject had a baseline polysomnographic study on the appropriate continuous positive airway pressure (CPAP). CPAP was retitrated to eliminate apnea/hypopnea but to maintain inspiratory flow limitation (sham night). Each subject was studied on 2 separate nights. These two studies are separated by 1 mo of optimal nasal CPAP treatment for a minimum of 4-6 h/night. The device was capable of covert pressure monitoring. During night 1 (N1), study subjects used nasal CPAP at suboptimal pressure to have significant air flow limitation (>60% breaths) without apneas/hypopneas. After stable sleep was reached, we induced brief isocapnic hypoxia [inspired O(2) fraction (FI(O(2))) = 8%] (3 min) followed by 5 min of room air. This sequence was repeated 10 times. Measurements were obtained during control, hypoxia, and at 5, 20, and 40 min of recovery for ventilation, timing (n = 11), and supraglottic pressure (n = 6). Upper airway resistance (Rua) was calculated at peak inspiratory flow. During the recovery period, there was no change in minute ventilation (99 +/- 8% of control), despite decreased Rua to 58 +/- 24% of control (P < 0.05). There was a reduction in the ratio of inspiratory time to total time for a breath (duty cycle) (0.5 to 0.45, P < 0.05) but no effect on inspiratory time. During night 2 (N2), the protocol of N1 was repeated. N2 revealed no changes compared with N1 during the recovery period. In conclusion, 1) reduced Rua in the recovery period indicates LTF of upper airway dilators; 2) lack of hyperpnea in the recovery period suggests that thoracic pump muscles do not demonstrate LTF; 3) we speculate that LTF

  8. Detrimental role of prolonged sleep deprivation on adult neurogenesis

    PubMed Central

    Fernandes, Carina; Rocha, Nuno Barbosa F.; Rocha, Susana; Herrera-Solís, Andrea; Salas-Pacheco, José; García-García, Fabio; Murillo-Rodríguez, Eric; Yuan, Ti-Fei; Machado, Sergio; Arias-Carrión, Oscar

    2015-01-01

    Adult mammalian brains continuously generate new neurons, a phenomenon called adult neurogenesis. Both environmental stimuli and endogenous factors are important regulators of adult neurogenesis. Sleep has an important role in normal brain physiology and its disturbance causes very stressful conditions, which disrupt normal brain physiology. Recently, an influence of sleep in adult neurogenesis has been established, mainly based on sleep deprivation studies. This review provides an overview on how rhythms and sleep cycles regulate hippocampal and subventricular zone neurogenesis, discussing some potential underlying mechanisms. In addition, our review highlights some interacting points between sleep and adult neurogenesis in brain function, such as learning, memory, and mood states, and provides some insights on the effects of antidepressants and hypnotic drugs on adult neurogenesis. PMID:25926773

  9. Detrimental role of prolonged sleep deprivation on adult neurogenesis.

    PubMed

    Fernandes, Carina; Rocha, Nuno Barbosa F; Rocha, Susana; Herrera-Solís, Andrea; Salas-Pacheco, José; García-García, Fabio; Murillo-Rodríguez, Eric; Yuan, Ti-Fei; Machado, Sergio; Arias-Carrión, Oscar

    2015-01-01

    Adult mammalian brains continuously generate new neurons, a phenomenon called adult neurogenesis. Both environmental stimuli and endogenous factors are important regulators of adult neurogenesis. Sleep has an important role in normal brain physiology and its disturbance causes very stressful conditions, which disrupt normal brain physiology. Recently, an influence of sleep in adult neurogenesis has been established, mainly based on sleep deprivation studies. This review provides an overview on how rhythms and sleep cycles regulate hippocampal and subventricular zone neurogenesis, discussing some potential underlying mechanisms. In addition, our review highlights some interacting points between sleep and adult neurogenesis in brain function, such as learning, memory, and mood states, and provides some insights on the effects of antidepressants and hypnotic drugs on adult neurogenesis. PMID:25926773

  10. Adults with ADHD and Sleep Complaints: A Pilot Study Identifying Sleep-Disordered Breathing Using Polysomnography and Sleep Quality Assessment

    ERIC Educational Resources Information Center

    Surman, Craig B. H.; Thomas, Robert J.; Aleardi, Megan; Pagano, Christine; Biederman, Joseph

    2006-01-01

    Objective: ADHD and sleep-disordered breathing are both prevalent in adulthood. Because both conditions may be responsible for similar symptoms of cognitive impairment, the authors investigate whether their presentation may overlap in adults diagnosed with ADHD. Method: Data are collected from six adults with sleep complaints who were diagnosed…

  11. Ambulatory Diagnosis and Management of Obstructive Sleep Apnea: Screening Questionnaires, Diagnostic Tests, and the Care Team.

    PubMed

    McEvoy, R Doug; Chai-Coetzer, Ching Li; Antic, Nick A

    2016-09-01

    Obstructive sleep apnea has increased in prevalence in recent years and despite the expansion in sleep medicine services there is a significant unmet burden of disease. This burden presents a challenge to specialists and requires a reappraisal of service delivery, including a move toward lower-cost, simplified methods of diagnosis and treatment, an expansion of the sleep apnea workforce to include suitably trained and equipped primary care physicians and nurses, and the incorporation of chronic disease management principles that link patients to relevant community resources and empower them through new technologies to engage more fully in their own care. PMID:27542873

  12. 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

  13. The effectiveness of nasal surgery on psychological symptoms in patients with obstructive sleep apnea and nasal obstruction.

    PubMed

    Xiao, Yang; Han, Demin; Zang, Hongrui; Wang, Danni

    2016-06-01

    Conclusion Nasal obstruction can aggravate the psychological status of OSA patients, and nasal surgery should reduce this aggravation. Nasal surgery significantly improved sleep latency and ameliorated several polysomnographic characteristics. Background The aim of this study was to investigate the psychological status of patients with obstructive sleep apnea (OSA) and nasal obstruction and to evaluate the effects of nasal surgery on the psychological symptoms and polysomnographic (PSG) parameters of these patients. Methods The study was designed as a prospective comparative study. This study compared 30 patients (all male) with nasal obstruction and 30 matched patients without nasal obstruction using the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List 90 (SCL-90). All of the patients had been previously diagnosed with OSA (apnea hypopnea index [AHI] ≥ 5 events/h) via a whole-night polysomnographic examination. Nasal obstruction was assessed using a visual analogue scale (VAS). The patients with nasal obstruction underwent nasal surgery, and their weight, VAS, nocturnal PSG characteristics, and psychological symptoms at baseline and 3 months after surgery were compared. Results The OSA patients with nasal obstruction suffered from significantly longer sleep latency on the PSQI and higher somatization and anxiety scores on the SCL-90 than the subjects without nasal obstruction (p < 0.05). The nasal obstruction symptoms significantly improved after surgery (VAS decreased from 6.18 ± 1.85 to 1.87 ± 1.76, p < 0.01). The assessments also showed a significant reduction in weight (from 84.60 ± 11.30 kg to 82.27 ± 9.87 kg, p < 0.05) between the pre-operative and post-operative values. Although there was significant reduction in the AHI (from 49.67 ± 19.49/h to 43.07 ± 21.86/h, p < 0.01) and a significant improvement in lowest oxygen saturation (LSpO2, from 73.83 ± 8.49% to 75.97 ± 9.86%, p

  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. Impact of obstructive sleep apnea on cardiovascular outcomes in patients treated with percutaneous coronary intervention: rationale and design of the sleep and stent study.

    PubMed

    Loo, Germaine; Koo, Chieh-Yang; Zhang, Junjie; Li, Ruogu; Sethi, Rithi; Ong, Thun-How; Tai, Bee-Choo; Lee, Chi-Hang

    2014-05-01

    Elucidating the effects of obstructive sleep apnea (OSA) on cardiovascular outcomes is crucial in risk assessments and therapeutic recommendations for affected individuals. The Sleep and Stent Study is a multicenter observational study investigating the relationships between OSA and cardiovascular outcomes in patients treated with percutaneous coronary intervention (PCI). Eight centers in 5 countries (Singapore, China and Hong Kong, India, Myanmar, and Brazil) are participating in the study, and the recruitment target is 1600 patients. Adult patients age 18 to 80 years who have undergone successful PCI are eligible. Recruited patients will undergo an overnight sleep study using a level-3 portable diagnostic device before hospital discharge. The sleep tracings will be analyzed by a certified sleep technologist and audited by a sleep physician, both of whom will be blinded to other study data. The patients will be divided into 2 groups based on apnea-hypopnea index (AHI): OSA (AHI ≥15) and non-OSA (AHI <15) groups. The primary study endpoint of cardiovascular death, myocardial infarction, stroke, and unplanned revascularization will be compared between the OSA and non-OSA groups at a median follow-up of 2 years. Secondary endpoints include all-cause mortality, target-vessel revascularization, stent thrombosis, and hospitalization for heart failure. As of December 31, 2013, a total of 1358 patients have been recruited. Based on the complete preliminary results of the first 785 recruited patients, the prevalence of OSA was 48.3%. We expect the follow-up for primary endpoint to be completed in late 2015; study results will be presented in 2016. PMID:24945037

  16. The Effects of Sleep Continuity Disruption on Positive Mood and Sleep Architecture in Healthy Adults

    PubMed Central

    Finan, Patrick H.; Quartana, Phillip J.; Smith, Michael T.

    2015-01-01

    Objective: The purpose of this study was to test an experimental model of the effects of sleep continuity disturbance on sleep architecture and positive mood in order to better understand the mechanisms linking insomnia and depression. Design: Participants were randomized to receive 3 consecutive nights of sleep continuity disruption via forced nocturnal awakenings (FA, n = 21), or one of two control conditions: restricted sleep opportunity (RSO, n = 17) or uninterrupted sleep (US, n = 24). Setting: The study was set in an inpatient clinical research suite. Participants: Healthy, good-sleeping men and women were included. Measurement and Results: Polysomnography was used to measure sleep architecture, and mood was assessed via self-report each day. Compared to restricted sleep opportunity controls, forced awakenings subjects had significantly less slow wave sleep (P < 0.05) after the first night of sleep deprivation, and significantly lower positive mood (P < 0.05) after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood (P = 0.002). Conclusions: To our knowledge, this is the first human experimental study to demonstrate that, despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood. With these findings, we provide temporal evidence in support of a putative biologic mechanism (slow wave sleep deficit) that could help explain the strong comorbidity between insomnia and depression. Citation: Finan PH, Quartana PJ, Smith MT. The effects of sleep continuity disruption on positive mood and sleep architecture in healthy adults. SLEEP 2015;38(11):1735–1742. PMID:26085289

  17. Modafinil in obstructive sleep apnea-hypopnea syndrome: a pilot study in 6 patients.

    PubMed

    Arnulf, I; Homeyer, P; Garma, L; Whitelaw, W A; Derenne, J P

    1997-01-01

    We studied the effects of modafinil, a vigilance-enhancing drug, on excessive daytime sleepiness, memory, night sleep and respiration in 6 patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) using a double-blind random cross-over design with 24-hour polysomnography, verbal memory test and a 5-week sleep-wake diary kept by the patients. There were two 2-week treatment periods in which either modafinil or placebo was used; they were separated by a 1-week wash-out period. Our results show that modafinil reduces daytime sleep duration, lengthens the duration of subjective daytime vigilance and improves long-term memory in patients with OSAHS without modifying night sleep and respiration events. PMID:9097352

  18. The sympathetic nervous system and catecholamines metabolism in obstructive sleep apnoea

    PubMed Central

    Bisogni, Valeria; Pengo, Martino F.; Maiolino, Giuseppe

    2016-01-01

    Obstructive sleep apnoea (OSA) is the most common sleep disorder of breathing in middle-aged and overweight subjects. It features recurrent episodes of upper airway total (apnoea) o partial (hypopnea) collapse during sleep, which are associated with a reduction in blood oxygen saturation and with arousal from sleep to re-establish airway patency. An association of OSA with dysregulation of the autonomous nervous system (ANS) and altered catecholamines (CAs) metabolism has been contended for years. However, the pathophysiology mechanisms underlying these alterations remain to be fully clarified. Nonetheless, these alterations are deemed to play a key pathogenic role in the established association of OSA with several conditions besides arterial hypertension (HT), including coronary artery disease, stroke, and, more in general, with increased risk of cardiovascular (CV) events. Hence, in this review we will analyse the relationship between the sleep disturbances associated with OSA and the altered function of the ANS, including CAs metabolism. PMID:26904265

  19. Sleep Related Breathing Disorders in Adults with Down Syndrome.

    ERIC Educational Resources Information Center

    Resta, Onofrio; Barbaro, Maria Pia Foschino; Giliberti, Tiziana; Caratozzolo, Gennaro; Cagnazzo, Maria Grazia; Scarpelli, Franco; Nocerino, Maria Cristina

    2003-01-01

    This study evaluated sleep-related breathing disorders in six adults with Down syndrome. Five were found to have respiratory events justifying the diagnosis of sleep apnea syndrome. Results suggest that the nocturnal respiratory pattern of adults with Down syndrome depends on several pathogenetic factors such as age, severity of upper airway…

  20. Design of a new controller to treat the obstructive sleep apnea

    NASA Astrophysics Data System (ADS)

    Netzel, Thomas

    2002-06-01

    The obstructive sleep apnoea (OSA) is a sleep related breathing disorder caused by a relaxation of the upper airway structure during the sleep that leads to a complete closure of the upper airway. The most successful therapy is the nasal continuous positive airway pressure (nCPAP) treatment that keeps the airway opened. More recent devices use an automatic adaptation of the applied pressure. Either the forced oscillation technique (FOT) or the evaluation of the inspiration flow contour are used to evaluate the severity of obstructions. Both methods have disadvantages that may lead to wrong applied pressures. Based on the precise measurement of airflow and mask pressure during nCPAP with a Weinmann SOMNOsmart and additional polysomnography a new parameter set is presented that uses the advantage of both methods to detect the obstructive sleep apnoea. To evaluate the applicability of this parameter set to control Auto-nCPAP-devices a fuzzy-controller is designed under MATLAB/Simulink using an A/D-D/A-converter to control the blower of the SOMNOsmart during Auto-nCPAP-therapy. Obstructive events are detected and treated with a rise of nCPAP-pressure depending on the inspiratory flow requirement. The pressure is lowered after the end of flow limited phases. Although temporary low pressures no oxygen desaturation is recognized by the pulse oxymeter.

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

    NASA Astrophysics Data System (ADS)

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

    2013-01-01

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

  2. Is Metabolic Syndrome Associated with Obstructive Sleep Apnea in Obese Adolescents?

    PubMed Central

    Erdim, Ibrahim; Akcay, Teoman; Yilmazer, Rasim; Erdur, Omer; Kayhan, Fatma Tulin

    2015-01-01

    Objective: To investigate whether there is an association between metabolic syndrome and obstructive sleep apnea syndrome (OSAS) in obese adolescents. Methods: In total, 240 pubertal children or prepubertal children older than 11 y recruited consecutively from the pediatric endocrinology unit, obesity clinic. Patients with tonsillar and adenoid hypertrophy (grade 3/4), systemic illnesses, or chronic drug usage were excluded. After anthropometric measurement and laboratory study, patients were divided into two groups according to metabolic syndrome (MS): MS and non-MS. Overnight polysomnographic evaluation was performed and 104 subjects were included for statistical analysis. The two groups were compared in terms of sleep efficiency, number of awakenings per night, oxygen desaturation index, snoring time, and obstructive/central/ mixed apnea-hypopnea index (AHI). Results: Of the obese adolescents, 51 had MS and 53 did not. The AHI was ≥ 1 in 25 of the 53 non-MS children (47.2%) and in 25 of the 51 MS children (49%). The median obstructive AHI value was 0.9 (0.2–2.4) and total AHI was 0.9 (0.2–2.5) in the MS group; these values were 0.9 (0.25–3.55) and 0.9 (0.3–3.55), respectively, in the non-MS group. Obstructive, central, mixed, and total AHI values in the MS and non-MS groups were not statistically significantly different (p > 0.05). Conclusions: In our study, we did not find an association between MS and sleep apnea in obese adolescents. Citation: Erdim I, Akcay T, Yilmazer R, Erdur O, Kayhan FT. Is metabolic syndrome associated with obstructive sleep apnea in obese adolescents? J Clin Sleep Med 2015;11(12):1371–1376. PMID:26156956

  3. Absence of rapid eye movements during sleep in adult zebrafish.

    PubMed

    Árnason, B B; Þorsteinsson, H; Karlsson, K Æ

    2015-09-15

    Sleep is not a uniform phenomenon, but is organized in alternating, fundamentally different states, rapid eye movement sleep and non-rapid eye movement sleep. Zebrafish (Danio rerio) have recently emerged as an excellent model for sleep research. Zebrafish are well characterized in terms of development, neurobiology and genetics. Moreover, there are many experimental tools not easily applied in mammalian models that can be readily applied to zebrafish, making them a valuable additional animal model for sleep research. Sleep in zebrafish is defined behaviorally and exhibits the hallmarks of mammalian sleep (e.g. sleep homeostasis and pressure). To our knowledge no attempts have been made to discern if sleep in zebrafish entails alternations of REM-NREM sleep cycles which are critical for further development of the model. In the current experiment we quantify two key REM sleep components, rapid eye movements and respiratory rates, across sleep-wake cycles. We find no sleep-related rapid eye movements. During sleep respiratory rates, however, are reduced and become less regular, further establishing that the behavioral definition used truly captures a change in the fish's physiology. We thus fail to find evidence for REM-NREM sleep cycles in zebrafish but demonstrate a physiological change that occurs concomitantly with the previously defined behavioral state of sleep. We do not rule out that other phasic REM components (e.g. atonia, cardiac arrhythmias, myoclonic twitches or desynchronized EEG) are coherently expressed during sleep but we conclude that adult zebrafish do not have REM-sleep-related rapid eye movements. PMID:26003945

  4. Association between Nighttime Sleep and Napping in Older Adults

    PubMed Central

    Goldman, Suzanne E.; Hall, Martica; Boudreau, Robert; Matthews, Karen A.; Cauley, Jane A.; Ancoli-Israel, Sonia; Stone, Katie L.; Rubin, Susan M.; Satterfield, Suzanne; Simonsick, Eleanor M.; Newman, Anne B.

    2008-01-01

    Study Objectives: Napping might indicate deficiencies in nighttime sleep, but the relationship is not well defined. We assessed the association of nighttime sleep duration and fragmentation with subsequent daytime sleep. Design: Cross-sectional study. Participants: 235 individuals (47.5% men, 29.7% black), age 80.1 (2.9) years. Measurements and Results: Nighttime and daytime sleep were measured with wrist actigraphy and sleep diaries for an average of 6.8 (SD 0.7) nights. Sleep parameters included total nighttime sleep (h), movement and fragmentation index (fragmentation), and total daytime sleep (h). The relationship of total nighttime sleep and fragmentation to napping (yes/no) was assessed using logistic regression. In individuals who napped, mixed random effects models were used to determine the association between the previous night sleep duration and fragmentation and nap duration, and nap duration and subsequent night sleep duration. All models were adjusted for age, race, gender, BMI, cognitive status, depression, cardiovascular disease, respiratory symptoms, diabetes, pain, fatigue, and sleep medication use. Naps were recorded in sleep diaries by 178 (75.7%) participants. The odds ratios (95% CI) for napping were higher for individuals with higher levels of nighttime fragmentation (2.1 [0.8, 5.7]), respiratory symptoms (2.4 [1.1, 5.4]), diabetes (6.1 [1.2, 30.7]), and pain (2.2 [1.0, 4.7]). Among nappers, neither sleep duration nor fragmentation the preceding night was associated with nap duration the next day. Conclusion: More sleep fragmentation was associated with higher odds of napping although not with nap duration. Further research is needed to determine the causal association between sleep fragmentation and daytime napping. Citation: Goldman SE; Hall M; Boudreau R; Matthews KA; Cauley JA; Ancoli-Israel S; Stone KL; Rubin SM; Satterfield S; Simonsick EM; Newman AB. Association between nighttime sleep and napping in older adults. SLEEP 2008

  5. 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

  6. Computational Modeling of Airway Obstruction in Sleep Apnea in Down Syndrome: A Feasibility Study.

    PubMed

    Mylavarapu, Goutham; Subramaniam, Dhananjay; Jonnagiri, Raghuvir; Gutmark, Ephraim J; Fleck, Robert J; Amin, Raouf S; Mahmoud, Mohamed; Ishman, Stacey L; Shott, Sally R

    2016-07-01

    Current treatment options are successful in 40% to 60% of children with persistent obstructive sleep apnea after adenotonsillectomy. Residual obstruction assessments are largely subjective and do not clearly define multilevel obstruction. We endeavor to use computational fluid dynamics to perform virtual surgery and assess airflow changes in patients with Down syndrome and persistent obstructive sleep apnea. Three-dimensional airway models were reconstructed from respiratory-gated computed tomography and magnetic resonance imaging. Virtual surgeries were performed on 10 patients, mirroring actual surgeries. They demonstrated how surgical changes affect airflow resistance. Airflow and upper airway resistance was calculated from computational fluid dynamics. Virtual and actual surgery outcomes were compared with obstructive apnea-hypopnea index values. Actual surgery successfully treated 6 of 10 patients (postoperative obstructive apnea-hypopnea index <5). In 8 of 10 subjects, both apnea-hypopnea index and the calculated upper airway resistance after virtual surgery decreased as compared with baseline values. This is a feasibility and proof-of-concept study. Further studies are needed before using these techniques in surgical planning. PMID:27048669

  7. Obstructive sleep apnea in Prader-Willi syndrome: risks and advantages of adenotonsillectomy.

    PubMed

    Giordano, Leone; Toma, Salvatore; Palonta, Francesca; Teggi, Roberto; Zucconi, Marco; Di Candia, Stefania; Bussi, Mario

    2015-01-01

    Obstructive sleep apnea is a well-known clinical manifestation of Prader-Willi syndrome. The aim of our study is to evaluate the efficacy of adenotonsillectomy for the treatment of the disorder as well as the improvement of their post-operative quality of life. Five patients with moderate to severe obstructive sleep apneas and adenotonsillar hypertrophy of grade III-IV underwent adenotonsillectomy. Pre- and postoperative apneas and Quality of Life were assessed respectively with a polysomnography with multi-sleep latency test and with the pediatric Quality of Life questionnaire, performed before and 6 months after surgery. A decrease of apnea/hypopnea index values has been detected between pre- and post-surgery (t=2.64, P=0.005), as well as oxygen desaturation index values (t=5.51, P=0.005), multi-sleep latency test (t=4.54, P=0.01), and of the values of pediatric Quality of Life questionnaire. No correlation has been detected between body mass index and apnea/hypopnea index, oxygen desaturation index and multi-sleep latency test values pre- and post-adenotonsillectomy. A correlation has been found between multi-sleep latency test and oxygen desaturation index values post-surgery (P=0.04). No post-operative complications were observed. Our data underline the efficacy of surgery in Prader-Willi patients with adenotonsillar hypertrophy in order to improve their quality of life. PMID:26429118

  8. Objective assessment of sleep and sleep problems in older adults with intellectual disabilities.

    PubMed

    van de Wouw, Ellen; Evenhuis, Heleen M; Echteld, Michael A

    2013-08-01

    Little is known about sleep in older adults with intellectual disability (ID). Aim of this study was to investigate sleep and its associated factors, and to estimate the prevalence of sleep problems in this population. This study was part of the healthy aging and intellectual disabilities study. Sleep was assessed using the Actiwatch, a watch-like device that measures sleep and wakefulness based on movement activity. Participants (n=551) wore the Actiwatch at least seven days and nights continuously. Variables of interest were time in bed (TIB), sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency and get-up time latency. Multivariate analyses were used to investigate factors associated with these sleep parameters. Provisional definitions were drafted to estimate the prevalence of sleep problems. Mean TIB was 630 min. Longer TIB was independently associated with higher age, more severe level of ID, living at a central facility, wheelchair dependence, female gender and depressive symptoms (adjusted R(2)=.358, F-change=8.302, p<.001). The prevalence of sleep problems was 23.9% settling problem, 63.1% night waking problem, 20.9% short sleep time, 9.3% early waking problem. 72% of the participants had at least one problem, 12.3% had three or more sleep problems. Older adults with ID lie in bed very long, and the prevalence of sleep problems is high. Further research should focus on causality of the relationships found in this study, and effects of sleep problems on health and well-being in this population. PMID:23692894

  9. 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

  10. Modified STOP-Bang Tool for Stratifying Obstructive Sleep Apnea Risk in Adolescent Children

    PubMed Central

    Combs, Daniel; Goodwin, James L.; Quan, Stuart F.; Morgan, Wayne J.; Parthasarathy, Sairam

    2015-01-01

    Purpose Obstructive sleep apnea (OSA) is prevalent in children and diagnostic polysomnography is costly and not readily available in all areas. We developed a pediatric modification of a commonly used adult clinical prediction tool for stratifying the risk of OSA and the need for polysomnography. Methods A total of 312 children (age 9–17 years) from phase 2 of the Tucson Children’s Assessment of Sleep Apnea cohort study, with complete anthropomorphic data, parent questionnaires, and home polysomnograms were included. An adolescent modification of STOP-Bang (teen STOP-Bang) was developed and included snoring, tired, observed apnea, blood pressure ≥ 95th percentile, BMI > 95th percentile, academic problems, neck circumference >95th percentile for age, and male gender. An apnea-hypopnea index ≥ 1.5 events/hour was considered diagnostic of OSA. Results Receiver Operator Characteristic (ROC) curves for parent-reported STOP-Bang scores were generated for teenage and pre-teen children. A STOP-Bang score of < 3 in teenagers was associated with a negative predictive value of 0.96. ROC curves were also generated based upon child-reported sexual maturity rating (SMR; n = 291). The ability of teen STOP-Bang to discriminate the presence or absence of OSA as measured by the AUC for children with SMR ≥ 4 (0.83; 95%CI 0.71–0.95) was better than children with SMR < 4 (0.63; 95%CI 0.46–0.81; p = 0.048). Conclusions In community dwelling adolescents, teen STOP-Bang may be useful in stratifying the risk of OSA. PMID:26581088

  11. Risk of Common Mental Disorders in Relation to Symptoms of Obstructive Sleep Apnea Syndrome among Ethiopian College Students

    PubMed Central

    Rutagarama, Ornella; Gelaye, Bizu; Tadesse, Mahlet G; Lemma, Seblewengel; Berhane, Yemane; Williams, Michelle A

    2016-01-01

    Background The Berlin and Epworth Sleepiness Scale (ESS) are simple, validated, and widely used questionnaires designed to assess symptoms of obstructive sleep apnea syndrome (OSAS) a common but often unrecognized cause of morbidity and mortality. Methods A cross-sectional study was conducted among 2,639 college students to examine the extent to which symptoms of OSAS are associated with the odds of common mental disorders (CMDs). The General Health Questionnaire (GHQ-12) was used to evaluate the presence of CMDs while the Berlin and ESS were used to assess high-risk for obstructive sleep apnea (OSA) and excessive daytime sleepiness, respectively. Logistic regression procedures were used to derive odds ratios (OR) and 95% confidence intervals (CI) assessing the independent and joint associations of high-risk for OSA and excessive daytime sleepiness with odds of CMDs. Results Approximately 19% of students had high-risk for OSA while 26.4% had excessive daytime sleepiness. Compared to students without high-risk for OSA and without excessive daytime sleepiness (referent group), students with excessive daytime sleepiness only (OR=2.01; 95%CI: 1.60-2.52) had increased odds of CMDs. The odds of CMDs for students with high-risk OSA only was 1.26 (OR=1.26; 95%CI 0.94-1.68). Students with both high-risk for OSA and excessive daytime sleepiness, compared to the referent group, had the highest odds of CMDs (OR=2.45; 95%CI: 1.69-3.56). Conclusion Our findings indicate that symptoms of OSAS are associated with increased risk of CMDs. These findings emphasize the comorbidity of sleep disorders and CMDs and suggest that there may be benefits to investing in educational programs that extend the knowledge of sleep disorders in young adults. PMID:26925424

  12. Long-Term Continuous Positive Airway Pressure Therapy Normalizes High Exhaled Nitric Oxide Levels in Obstructive Sleep Apnea

    PubMed Central

    Chua, Ai-Ping; Aboussouan, Loutfi S.; Minai, Omar A.; Paschke, Kelly; Laskowski, Daniel; Dweik, Raed A.

    2013-01-01

    Study Objectives: Upper airway inflammation and oxidative stress have been implicated in the pathogenesis of obstructive sleep apnea (OSA) and may be linked to cardiovascular consequences. We prospectively examined fraction of exhaled nitric oxide (FENO), a surrogate marker of upper airway inflammation using a portable nitric oxide analyzer (NIOX MINO). Design: In consecutive adult nonsmokers with suspected OSA, FENO was measured immediately before and after polysomnographic studies, and within 1-3 months following continuous positive airway pressure (CPAP) therapy. Measurement and Results: FENO levels were increased in the 75 patients with OSA compared to the 29 controls, both before sleep (13.4 ± 6.5 ppb vs. 6.5 ± 3.5; p < 0.001) and after sleep (19.0 ± 7.7 ppb vs. 6.9 ± 3.7; p < 0.001). Furthermore, in patients with OSA, FENO levels were significantly higher post-sleep than pre-sleep (19.0 ± 7.7 ppb vs. 13.4 ± 6.5; p < 0.001), while there was no significant overnight change in patients without OSA. The rise in FENO correlated with the apnea-hypopnea index (r = 0.65, p < 0.001), nadir oxygen saturation (r = 0.54, p < 0.001), and arousal index (r = 0.52, p < 0.001). Thirty-seven of these patients underwent CPAP titration and treatment. Successful titration was associated with a lower overnight increase in FENO (7.2 ± 3.3 vs. 11.0 ± 4.3, p = 0.02). FENO levels declined after 1-3 months of CPAP therapy (11.7 ± 4.4 ppb, p < 0.001). Conclusions: FENO levels are elevated in OSA, correlate with severity, and decrease after positive pressure therapy. This study supports the role of upper airway inflammation in OSA pathogenesis and a possible role for FENO in monitoring CPAP therapy. Citation: Chua AP; Aboussouan LS; Minai OA; Paschke K; Laskowski D; Dweik RA. Long-term continuous positive airway pressure therapy normalizes high exhaled nitric oxide levels in obstructive sleep apnea. J Clin Sleep Med 2013;9(6):529-535. PMID:23772184

  13. Interaction of Sleep Duration and Sleep Quality on Hypertension Prevalence in Adult Chinese Males

    PubMed Central

    Lu, Kai; Chen, Jia; Wu, Shouling; Chen, Ji; Hu, Dayi

    2015-01-01

    Background Previous studies demonstrated conflicting results about the association of sleep duration and hypertension. Given the potential relationship between sleep quality and hypertension, this study aimed to investigate the interaction of self-reported sleep duration and sleep quality on hypertension prevalence in adult Chinese males. Methods We undertook a cross-sectional analysis of 4144 male subjects. Sleep duration were measured by self-reported average sleep time during the past month. Sleep quality was evaluated using the standard Pittsburgh Sleep Quality Index. Hypertension was defined as blood pressure level ≥140/90 mm Hg or current antihypertensive treatment. The association between hypertension prevalence, sleep duration, and sleep quality was analyzed using logistic regression after adjusting for basic cardiovascular characteristics. Results Sleep duration shorter than 8 hours was found to be associated with increased hypertension, with odds ratios and 95% confidence intervals (CIs) of 1.25 (95% CI, 1.03–1.52) for 7 hours, 1.41 (95% CI, 1.14–1.73) for 6 hours, and 2.38 (95% CI, 1.81–3.11) for <6 hours. Using very good sleep quality as the reference, good, poor, and very poor sleep quality were associated with hypertension, with odds ratios of 1.20 (95% CI, 1.01–1.42), 1.67 (95% CI, 1.32–2.11), and 2.32 (95% CI, 1.67–3.21), respectively. More importantly, further investigation of the association of different combinations of sleep duration and quality in relation to hypertension indicated an additive interaction. Conclusions There is an additive interaction of poor sleep quality and short sleep duration on hypertension prevalence. More comprehensive measurement of sleep should be performed in future studies. PMID:25912096

  14. Treatment of snoring with positional therapy in patients with positional obstructive sleep apnea syndrome.

    PubMed

    Chen, Wen-Chyuan; Lee, Li-Ang; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2015-01-01

    Position therapy plays a role in treating snoring and obstructive sleep apnea syndrome (OSAS). The purpose of this study was to investigate whether position therapy using a head-positioning pillow (HPP) could reduce snoring sounds in patients with mild-to-moderate positional OSAS, taking into account the potential confounding effects of body weight. A total of 25 adults with positional OSAS (apnea-hypopnea index [AHI]supine:AHInon-supine ≥ 2) were prospectively enrolled. Patients were asked to use their own pillows at home during the first night (N0), and the HPP during the second (N1) and third (N2) nights. The primary outcome measures included the subjective snoring severity (SS, measured on a visual analogue scale ranging from 0 to 10) and the objective snoring index (SI, expressed as the number of snoring events per hour measured on an acoustic analytical program). Both endpoints were recorded over three consecutive nights. From N0 to N2, the median SS and SI values in the entire study cohort decreased significantly from 5.0 to 4.0 and from 218.0 events/h to 115.0 events/h, respectively. In the subgroup of overweight patients, SS showed a significant improvement, whereas SI did not. Both SS and SI were found to be significantly improved in normal-weight patients. PMID:26657174

  15. Modified maxillomandibular advancement for obstructive sleep apnoea: towards a better outcome for Asians.

    PubMed

    Liao, Y-F; Chiu, Y-T; Lin, C-H; Chen, Y-A; Chen, N-H; Chen, Y-R

    2015-02-01

    Excluding tracheostomy, maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnoea (OSA). However, the anticipated facial changes may prevent acceptance of this procedure by patients with bimaxillary protrusion, a common feature of Asian faces. We therefore developed a modified MMA technique for such cases, consisting of anterior segmental osteotomies together with standard Le Fort I and bilateral sagittal split osteotomies. A prospective study of 20 consecutive Taiwanese adults with moderate-to-severe OSA who underwent modified MMA and postsurgical orthodontics was undertaken to evaluate the efficacy with regard to OSA and the postoperative facial appearance and dental occlusion. After modified MMA, the mean apnoea-hypopnoea index decreased from 41.6±19.2 n/h to 5.3±4.0 n/h (P<0.001). All patients had a successful outcome. No patient was dissatisfied with their postoperative facial appearance. The mean Peer Assessment Rating score decreased from 21.9±14.3 to 1.7±1.6 (P=0.001). The data suggest that the modified MMA is effective in treating patients with moderate-to-severe OSA without negatively affecting facial appearance or dental occlusion. To achieve a better outcome, surgical-orthodontic integration is warranted. The surgery-first approach can achieve early improvement. PMID:25305697

  16. Modafinil/armodafinil in obstructive sleep apnoea: a systematic review and meta-analysis.

    PubMed

    Chapman, Julia L; Vakulin, Andrew; Hedner, Jan; Yee, Brendon J; Marshall, Nathaniel S

    2016-05-01

    Modafinil is used internationally to treat residual sleepiness despite continuous positive airway pressure in obstructive sleep apnoea (res-OSA). In 2011, the European Medicines Agency removed the indication based on an unfavourable risk-benefit profile in two trials for efficacy and all accumulated safety data. We performed a meta-analysis of all randomised controlled trials of modafinil (or armodafinil) in res-OSA to quantify efficacy and safety.We systematically searched and assessed studies from major databases, conferences and trials registries to find randomised, placebo-controlled trials of modafinil/armodafinil for ≥2 weeks in adult res-OSA treating sleepiness.We analysed 10 of the 232 articles identified that met inclusion criteria (1466 patients). Modafinil/armodafinil improved the Epworth Sleepiness Scale score (2.2 points, 95% CI 1.5-2.9) and the Maintenance of Wakefulness Test over placebo (3 min, 95% CI 2.1-3.8 min). Modafinil/armodafinil tripled adverse events and doubled adverse events leading to withdrawal but did not increase serious adverse events (hospitalisations or death).Modafinil and armodafinil improve subjective and objective daytime sleepiness in res-OSA. We believe our analysis is a fairer analysis of the risk-benefit profile of this indication. Clinicians may want to use this data to balance the risks and benefits on a case-by-case basis with their patients. PMID:26846828

  17. Treatment of snoring with positional therapy in patients with positional obstructive sleep apnea syndrome

    PubMed Central

    Chen, Wen-Chyuan; Lee, Li-Ang; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2015-01-01

    Position therapy plays a role in treating snoring and obstructive sleep apnea syndrome (OSAS). The purpose of this study was to investigate whether position therapy using a head-positioning pillow (HPP) could reduce snoring sounds in patients with mild-to-moderate positional OSAS, taking into account the potential confounding effects of body weight. A total of 25 adults with positional OSAS (apnea-hypopnea index [AHI]supine:AHInon-supine ≥ 2) were prospectively enrolled. Patients were asked to use their own pillows at home during the first night (N0), and the HPP during the second (N1) and third (N2) nights. The primary outcome measures included the subjective snoring severity (SS, measured on a visual analogue scale ranging from 0 to 10) and the objective snoring index (SI, expressed as the number of snoring events per hour measured on an acoustic analytical program). Both endpoints were recorded over three consecutive nights. From N0 to N2, the median SS and SI values in the entire study cohort decreased significantly from 5.0 to 4.0 and from 218.0 events/h to 115.0 events/h, respectively. In the subgroup of overweight patients, SS showed a significant improvement, whereas SI did not. Both SS and SI were found to be significantly improved in normal-weight patients. PMID:26657174

  18. The effect of increased lung volume in chronic obstructive pulmonary disease on upper airway obstruction during sleep.

    PubMed

    Biselli, Paolo; Grossman, Peter R; Kirkness, Jason P; Patil, Susheel P; Smith, Philip L; Schwartz, Alan R; Schneider, Hartmut

    2015-08-01

    Patients with chronic obstructive pulmonary disease (COPD) exhibit increases in lung volume due to expiratory airflow limitation. Increases in lung volumes may affect upper airway patency and compensatory responses to inspiratory flow limitation (IFL) during sleep. We hypothesized that COPD patients have less collapsible airways inversely proportional to their lung volumes, and that the presence of expiratory airflow limitation limits duty cycle responses to defend ventilation in the presence of IFL. We enrolled 18 COPD patients and 18 controls, matched by age, body mass index, sex, and obstructive sleep apnea disease severity. Sleep studies, including quantitative assessment of airflow at various nasal pressure levels, were conducted to determine upper airway mechanical properties [passive critical closing pressure (Pcrit)] and for quantifying respiratory timing responses to experimentally induced IFL. COPD patients had lower passive Pcrit than their matched controls (COPD: -2.8 ± 0.9 cmH2O; controls: -0.5 ± 0.5 cmH2O, P = 0.03), and there was an inverse relationship of subject's functional residual capacity and passive Pcrit (-1.7 cmH2O/l increase in functional residual capacity, r(2) = 0.27, P = 0.002). In response to IFL, inspiratory duty cycle increased more (P = 0.03) in COPD patients (0.40 to 0.54) than in controls (0.41 to 0.51) and led to a marked reduction in expiratory time from 2.5 to 1.5 s (P < 0.01). COPD patients have a less collapsible airway and a greater, not reduced, compensatory timing response during upper airway obstruction. While these timing responses may reduce hypoventilation, it may also increase the risk for developing dynamic hyperinflation due to a marked reduction in expiratory time. PMID:26048975

  19. Treatment of Insomnia, Insomnia Symptoms, and Obstructive Sleep Apnea During and After Menopause: Therapeutic Approaches

    PubMed Central

    Tal, Joshua Z.; Suh, Sooyeon A.; Dowdle, Claire L.; Nowakowski, Sara

    2015-01-01

    Understanding sleep complaints among menopausal women is an emerging area of clinical and research interest. Several recent reviews have focused on mechanisms of menopausal insomnia and symptoms. In this review, we present a discussion on the most relevant and recent publications on the treatment of sleep disorders for menopausal women, with a focus on menopause-related insomnia, insomnia symptoms, and obstructive sleep apnea. We discuss both nonpharmacological and pharmacological treatments, including cognitive-behavioral therapy for insomnia (CBT-I), complementary and alternative medicine, hormone replacement therapy, sedative hypnotics, antidepressants, and continuous positive airway pressure. In addition, we briefly discuss methods and considerations of assessment of sleep disorders in menopausal women. PMID:26478725

  20. Upper Airway Stimulation for Obstructive Sleep Apnea: Past, Present, and Future

    PubMed Central

    Dedhia, Raj C.; Strollo, Patrick J.; Soose, Ryan J.

    2015-01-01

    Obstructive sleep apnea (OSA) is an increasingly prevalent clinical problem with significant effects on both personal and public health. Continuous positive airway pressure (CPAP) has demonstrated excellent efficacy and low morbidity; long-term adherence rates approach 50%. Although traditional upper airway surgical procedures target the anatomic component of obstruction, upper airway stimulation tackles the twin goals of improving anatomic and neuromuscular pathology. After decades of trials demonstrating proof of concept of hypoglossal nerve stimulation in animal and human subjects, the results of a large multicenter, prospective trial were recently published. The trial demonstrated that hypoglossal nerve stimulation led to significant improvements in objective and subjective measurements of the severity of OSA. This novel approach is the first to combine sleep surgery techniques with a titratable medical device for the treatment of OSA. Further research is required to define optimal patient selection and device performance and to demonstrate long-term effectiveness. Citation: Dedhia RC, Strollo PJ, Soose RJ. Upper airway stimulation for obstructive sleep apnea: past, present, and future. SLEEP 2015;38(6):899– 906. PMID:25409109

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

    PubMed

    Mickelson, Samuel A

    2009-11-01

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

  2. New neurons in the adult brain: The role of sleep and consequences of sleep loss

    PubMed Central

    Meerlo, Peter; Mistlberger, Ralph E.; Jacobs, Barry L.; Heller, H. Craig; McGinty, Dennis

    2009-01-01

    Research over the last few decades has firmly established that new neurons are generated in selected areas of the adult mammalian brain, particularly the dentate gyrus of the hippocampal formation and the subventricular zone of the lateral ventricles. The function of adult-born neurons is still a matter of debate. In the case of the hippocampus, integration of new cells in to the existing neuronal circuitry may be involved in memory processes and the regulation of emotionality. In recent years, various studies have examined how the production of new cells and their development into neurons is affected by sleep and sleep loss. While disruption of sleep for a period shorter than one day appears to have little effect on the basal rate of cell proliferation, prolonged restriction or disruption of sleep may have cumulative effects leading to a major decrease in hippocampal cell proliferation, cell survival and neurogenesis. Importantly, while short sleep deprivation may not affect the basal rate of cell proliferation, one study in rats shows that even mild sleep restriction may interfere with the increase in neurogenesis that normally occurs with hippocampus-dependent learning. Since sleep deprivation also disturbs memory formation, these data suggest that promoting survival, maturation and integration of new cells may be an unexplored mechanism by which sleep supports learning and memory processes. Most methods of sleep deprivation that have been employed affect both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Available data favor the hypothesis that decreases in cell proliferation are related to a reduction in REM sleep, whereas decreases in the number of cells that subsequently develop into adult neurons may be related to reductions in both NREM and REM sleep. The mechanisms by which sleep loss affects different aspects of adult neurogenesis are unknown. It has been proposed that adverse effects of sleep disruption may be mediated by stress and

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

    PubMed Central

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

    2014-01-01

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

  4. Effects of Suvorexant, an Orexin Receptor Antagonist, on Respiration during Sleep In Patients with Obstructive Sleep Apnea

    PubMed Central

    Sun, Hong; Palcza, John; Card, Deborah; Gipson, Adrianna; Rosenberg, Russell; Kryger, Meir; Lines, Christopher; Wagner, John A.; Troyer, Matthew D.

    2016-01-01

    Study Objectives: To investigate the respiratory effects of suvorexant, an orexin receptor antagonist for treating insomnia, in patients with obstructive sleep apnea (OSA). Methods: This was a randomized, double-blind, placebo-controlled, 2-period (4 days per period), crossover, sleep laboratory study. Twenty-six patients aged 18–65 years with mild (apnea-hypopnea index [AHI] ≥ 5 and < 15) to moderate (AHI ≥ 15 and < 30) OSA were randomized to receive suvorexant 40 mg or placebo in period-1 and then crossed over to the other treatment in period-2. Breathing during sleep was measured by AHI (primary endpoint) and oxygen saturation assessed by pulse oximetry (SpO2, secondary endpoint). The study was powered to rule out a mean increase in AHI between suvorexant and placebo of 5 or greater on Day 4. Results: There was a small increase in mean AHI (2.66) in OSA patients after multiple doses of suvorexant relative to placebo, with the upper 90% CI bound slightly exceeding 5.00 (0.22, 5.09). No increase in mean AHI was observed after a single dose of suvorexant versus placebo (mean difference = −0.47 [−3.20, 2.26]), and there was no treatment effect on mean SpO2 during total sleep time after single or multiple doses (Day 1: mean difference = −0.04 [−0.49, 0.42]; Day 4: mean difference = −0.06 [−0.45, 0.33]). There was inter- and intra-individual variability in suvorexant respiratory effects. Conclusions: Suvorexant 40 mg, twice the 20 mg maximum recommended dose for treating insomnia in the USA and Japan, does not appear to have clinically important respiratory effects during sleep in patients with mild to moderate OSA as assessed by mean AHI and SpO2. Due to inter- and intra-individual variability in respiratory effects, suvorexant should be used with caution in patients with compromised respiratory function, and at the lowest effective dose. Clinical Trial Registration: clinicaltrials.gov, NCT01300455. Citation: Sun H, Palcza J, Card D, Gipson A

  5. 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

  6. Beneficial Impact of Sleep Extension on Fasting Insulin Sensitivity in Adults with Habitual Sleep Restriction

    PubMed Central

    Leproult, Rachel; Deliens, Gaétane; Gilson, Médhi; Peigneux, Philippe

    2015-01-01

    Study Objectives: A link between sleep loss and increased risk for the development of diabetes is now well recognized. The current study investigates whether sleep extension under real-life conditions is a feasible intervention with a beneficial impact on glucose metabolism in healthy adults who are chronically sleep restricted. Design: Intervention study. Participants: Sixteen healthy non-obese volunteers (25 [23, 27.8] years old, 3 men). Intervention: Two weeks of habitual time in bed followed by 6 weeks during which participants were instructed to increase their time in bed by one hour per day. Measurements and Results: Continuous actigraphy monitoring and daily sleep logs during the entire study. Glucose and insulin were assayed on a single morning blood sample at the end of habitual time in bed and at the end of sleep extension. Home polysomnography was performed during one weekday of habitual time in bed and after 40 days of sleep extension. Sleep time during weekdays increased (mean actigraphic data: +44 ± 34 minutes, P < 0.0001; polysomnographic data: +49 ± 68 minutes, P = 0.014), without any significant change during weekends. Changes from habitual time in bed to the end of the intervention in total sleep time correlated with changes in glucose (r = +0.53, P = 0.041) and insulin levels (r = −0.60, P = 0.025), as well as with indices of insulin sensitivity (r = +0.76, P = 0.002). Conclusions: In healthy adults who are chronically sleep restricted, a simple low cost intervention such as sleep extension is feasible and is associated with improvements in fasting insulin sensitivity. Citation: Leproult R, Deliens G, Gilson M, Peigneux P. Beneficial impact of sleep extension on fasting insulin sensitivity in adults with habitual sleep restriction. SLEEP 2015;38(5):707–715. PMID:25348128

  7. The Development of a Screening Questionnaire for Obstructive Sleep Apnea in Children with Down Syndrome.

    PubMed

    Sanders, Emma; Hill, Catherine Mary; Evans, Hazel Jean; Tuffrey, Catherine

    2015-01-01

    Obstructive sleep apnea is a condition which affects an estimated 50% of children with Down syndrome, particularly in their early years. It can cause serious sequelae in affected children but may not be recognized by parents or health professionals. Routine screening has been recommended in some countries, but is not standard practice. There are no validated questionnaire-based tools available to screen this population of children for this particular sleep-related disorder. Using existing validated sleep questionnaire items, we have developed a questionnaire to screen children with Down syndrome up to 6 years of age for obstructive sleep apnea, which corresponds with the recommendations made in UK national guidelines. This paper describes these first steps in demonstrating content validity for a new questionnaire, which will be subject to further in-depth psychometric analysis. Relevance, clarity, and age appropriateness were rated for 33 items using a content review questionnaire by a group of 18 health professionals with expertise in respiratory pediatrics, neurodevelopmental pediatrics, and sleep physiology. The content validity index was calculated for individual items and contributed to decisions about item inclusion. Scale level content validity index for the modified questionnaire of 14 items was at an accepted level of 0.78. Two parents of children with Down syndrome took part in cognitive interviews after completing the modified questionnaire. We describe the development of this 14 item questionnaire to screen for OSA in children with DS from infancy to 6 years. PMID:26539127

  8. Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children: preliminary notes.

    PubMed

    Defabjanis, Patrizia

    2003-01-01

    Respiratory disorders in the upper respiratory tract during sleep are most often part of a continuous pathological process of long standing. Schematically, three clinical syndromes with increasing severity are described: breathing with the mouth open, snoring and sleep apneal hypopnea syndrome. Obstructive sleep apnea syndrome (OSAS) is a subtle, but severe sleep disorder of early childhood. It is often difficult to detect and may have long-term consequences, including failure to thrive, behavioral disturbances, developmental delay, and cor pulmonale. These conditions always include a functional maxillofacial perturbation, which may be associated with a constitutional or acquired morphological disorder. Pediatric dentists must be aware of the problems connected with mouth breathing and OSAS (obstructive sleep apnea syndrome) in children as any delay in diagnosis and treatment may cause prolonged morbidity. They also have a role in the diagnosis and co-management of these patients because the signs and symptoms may be recognizable in the dental practice. Besides the medical approach itself, the treatment sometimes is surgical, always orthopedic: the earlier it is initiated, the more effective, simple and unrestraining it is. The aim of this work is to focus attention on the early diagnosis and prevention of these pathologies. Diagnostic guidelines will be illustrated. PMID:12597677

  9. Is Perioperative Fluid and Salt Balance a Contributing Factor in Postoperative Worsening of Obstructive Sleep Apnea?

    PubMed

    Lam, Thach; Singh, Mandeep; Yadollahi, Azadeh; Chung, Frances

    2016-05-01

    An understanding of the potential mechanisms underlying recurrent upper airway collapse may help anesthesiologists better manage patients in the postoperative period. There is convincing evidence in the sleep medicine literature to suggest that a positive fluid and salt balance can worsen upper airway collapse in patients with obstructive sleep apnea through the redistribution of fluid from the legs into the neck and upper airway while supine, in a process known as "rostral fluid shift." According to this theory, during the day the volume from a fluid bolus or from fluid overload states (i.e., heart failure and chronic kidney disease) accumulates in the legs due to gravity, and when a person lies supine at night, the fluid shifts rostrally to the neck, also owing to gravity. The fluid in the neck can increase the extraluminal pressure around the upper airways, causing the upper airways to narrow and predisposing to upper airway collapse. Similarly, surgical patients also incur large fluid and salt balance shifts, and when recovered supine, this may promote fluid redistribution to the neck and upper airways. In this commentary, we summarize the sleep medicine literature on the impact of fluid and salt balance on obstructive sleep apnea severity and discuss the potential anesthetic implications of excessive fluid and salt volume on worsening sleep apnea. PMID:27101494

  10. The Development of a Screening Questionnaire for Obstructive Sleep Apnea in Children with Down Syndrome

    PubMed Central

    Sanders, Emma; Hill, Catherine Mary; Evans, Hazel Jean; Tuffrey, Catherine

    2015-01-01

    Obstructive sleep apnea is a condition which affects an estimated 50% of children with Down syndrome, particularly in their early years. It can cause serious sequelae in affected children but may not be recognized by parents or health professionals. Routine screening has been recommended in some countries, but is not standard practice. There are no validated questionnaire-based tools available to screen this population of children for this particular sleep-related disorder. Using existing validated sleep questionnaire items, we have developed a questionnaire to screen children with Down syndrome up to 6 years of age for obstructive sleep apnea, which corresponds with the recommendations made in UK national guidelines. This paper describes these first steps in demonstrating content validity for a new questionnaire, which will be subject to further in-depth psychometric analysis. Relevance, clarity, and age appropriateness were rated for 33 items using a content review questionnaire by a group of 18 health professionals with expertise in respiratory pediatrics, neurodevelopmental pediatrics, and sleep physiology. The content validity index was calculated for individual items and contributed to decisions about item inclusion. Scale level content validity index for the modified questionnaire of 14 items was at an accepted level of 0.78. Two parents of children with Down syndrome took part in cognitive interviews after completing the modified questionnaire. We describe the development of this 14 item questionnaire to screen for OSA in children with DS from infancy to 6 years. PMID:26539127

  11. 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

  12. Development of a Five-Dimensional Measure of Adult Sleep Quality

    ERIC Educational Resources Information Center

    Fortunato, Vincent J.; LeBourgeois, Monique K.; Harsh, John

    2008-01-01

    This article describes the development of a measure of adult sleep quality: the Adult Sleep-Wake Scale (ADSWS). The ADSWS is a self-report pencil-and-paper measure of sleep quality consisting of five behavioral dimensions (Going to Bed, Falling Asleep, Maintaining Sleep, Reinitiating Sleep, and Returning to Wakefulness). Data were collected from…

  13. [Recent developments in the diagnosis and treatment of obstructive sleep apnea].

    PubMed

    Stuck, B A; Maurer, J T

    2016-02-01

    Over the past years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have further evolved. Based on a review of current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of this disease. In the third edition of the "International Classification of Sleep Disorders", the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancement of new diagnostic tools (e. g., peripheral arterial tonometry and pulse wave analysis) has further expanded the diagnostic possibilities. Drug-induced sleep endoscopy enables reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still under discussion. The relevance of positional OSA has received increasing attention-the proportion of patients in whom sleeping position significantly impacts disease is reported to be above 50 %. For these patients, the introduction of the sleep position trainer has made a new therapeutic option available. Furthermore, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum of OSA treatment. For the established surgical treatment options, randomized trials with superior methodology have been published, particularly for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice. PMID:26666555

  14. Iron Stores, Periodic Leg Movements, and Sleepiness in Obstructive Sleep Apnea

    PubMed Central

    O'Brien, Louise M.; Koo, Julie; Fan, Ludi; Owusu, Jocelynn T.; Chotinaiwattarakul, Wattanachai; Felt, Barbara T.; Chervin, Ronald D.

    2009-01-01

    Study Objectives: Most clinical sleep studies are performed for suspected obstructive sleep apnea (OSA), yet one-quarter to one-half show periodic leg movements (PLMs), for reasons that remain unknown. Several other disparate sleep disorders also increase the risk for PLMs. We examined the novel hypotheses that OSA as a representative sleep disorder could promote lower body iron stores, as reflected by serum ferritin levels, and, through downstream effects on dopaminergic transmission, increase PLMs and daytime sleepiness. Methods: Subjects were recruited as they underwent laboratory-based polysomnography for suspected OSA. Serum ferritin levels were measured the next morning. Each subject completed an Epworth Sleepiness Scale and a brief questionnaire to assess for restless legs syndrome (RLS). Results: The frequency of apneic events showed no association with serum ferritin levels, before or after adjustment for age, sex, body mass index, and likely RLS (each p value > 0.3). Serum ferritin levels did not predict the frequency of PLMs (p = 0.7) or Epworth scores (p = 0.8). Iron deficiency as a dichotomous variable, determined by ferritin levels less than < 50μg/L or in combination with low transferrin saturation or mean corpuscular volume, showed similar results. In exploratory analyses, contrary to expectations, lower minimum oxygen saturation and increased sleep-stage shifts predicted increased rather than decreased ferritin levels (p = 0.03 and p = 0.02, respectively). Conclusions: Results of this study, powered to detect small to moderate effect sizes, strongly suggest that OSA does not cause lower serum ferritin levels, which, in turn, cannot explain PLMs or daytime sleepiness in these patients. Citation: O'Brien LM; Koo J; Fan L; Owusu JT; Chotinaiwattarakul W; Felt BT; Chervin RD. Iron stores, periodic leg movements, and sleepiness in obstructive sleep apnea. J Clin Sleep Med 2009;5(6):525-531. PMID:20465018

  15. Effects of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea on Cognitive Functions: Evidence for a Common Nature

    PubMed Central

    Andreou, Georgia; Makanikas, Konstantinos

    2014-01-01

    Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS. PMID:24649370

  16. Sleep and pain sensitivity in adults.

    PubMed

    Sivertsen, Børge; Lallukka, Tea; Petrie, Keith J; Steingrímsdóttir, Ólöf Anna; Stubhaug, Audun; Nielsen, Christopher Sivert

    2015-08-01

    Sleep problems and pain are major public health concerns, but the nature of the association between the 2 conditions is inadequately studied. The aim of this study was to determine whether a range of sleep measures is associated with experimental increased pain sensitivity. A cross-sectional large population-based study from 2007 to 2008, the Tromsø 6 study, provided data from 10,412 participants (age: mean [SD], 58 [13] years; 54% women). Self-reported sleep measures provided information on sleep duration, sleep onset latency (SOL), and sleep efficiency, as well as frequency and severity of insomnia. The main outcome measure was pain sensitivity tests, including assessment of cold-pressor pain tolerance. We found that all sleep parameters, except sleep duration, were significantly associated with reduced pain tolerance. Both the frequency and severity of insomnia, in addition to SOL and sleep efficiency, were associated with pain sensitivity in a dose-response manner. Adjusting for demographics and psychological distress reduced the strengths of the hazard ratios, but most associations remained significant in the fully adjusted models. There was also a synergistic interaction effect on pain tolerance when combining insomnia and chronic pain. We conclude that sleep problems significantly increase the risk for reduced pain tolerance. Because comorbid sleep problems and pain have been linked to elevated disability, the need to improve sleep among patients with chronic pain, and vice versa, should be an important agenda for future research. PMID:25915149

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

    PubMed

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

    2013-01-01

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

  18. [Obstructive sleep apnea-hypopnea syndrome in children: beyond adenotonsillar hypertrophy].

    PubMed

    Esteller, Eduard

    2015-01-01

    The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner. PMID:25107357

  19. Dental devices; classification for intraoral devices for snoring and/or obstructive sleep apnea. Final rule.

    PubMed

    2002-11-12

    The Food and Drug Administration (FDA) is classifying the intraoral devices for snoring and/or obstructive sleep apnea into class II (special controls). These devices are used to control or treat simple snoring and/or obstructive sleep apnea. This classification is based on the recommendations of the Dental Devices Panel (the Panel), and is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA). Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of the guidance document that will serve as the special control for this final rule. PMID:12428642

  20. [Desflurane Anesthesia in a Morbidly Obese Patient with Severe Obstructive Sleep Apnea].

    PubMed

    Nakagawa, Yuichi; Kinomoto, Masashi; Fujii, Aya; Hara, Yuko

    2015-04-01

    A 33-year-old morbidly obese patient (body mass index = 59.5 kg x m(-2)) with severe obstructive sleep apnea was scheduled to undergo osteosynthesis of right radial, ulnar and femoral fractures under general anesthesia. Awake intubation under conscious sedation using fantanyl and midazolam was performed by the Pentax-AWS Airwayscope. By using desflurane under continuous infusion of remifentanil 0.2-0.5 μg x kg(-1) x min(-1), BIS values were maintained between 40 and 60 during the surgery. Although duration of surgery was long (430 minutes), the times from discontinuation of the anesthetic drug to eye opening and extubation were 82 seconds and 8.5 minutes, respectively. Respiratory depression was minimal during postoperative period. In this case desflurane was safely used in a morbidly obese patient with severe obstructive sleep apnea. PMID:26419105

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

    PubMed

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

    2014-01-01

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

  2. Sleep and adult neurogenesis: implications for cognition and mood.

    PubMed

    Mueller, Anka D; Meerlo, Peter; McGinty, Dennis; Mistlberger, Ralph E

    2015-01-01

    The hippocampal dentate gyrus plays a critical role in learning and memory throughout life, in part by the integration of adult-born neurons into existing circuits. Neurogenesis in the adult hippocampus is regulated by numerous environmental, physiological, and behavioral factors known to affect learning and memory. Sleep is also important for learning and memory. Here we critically examine evidence from correlation, deprivation, and stimulation studies that sleep may be among those factors that regulate hippocampal neurogenesis. There is mixed evidence for correlations between sleep variables and rates of hippocampal cell proliferation across the day, the year, and the lifespan. There is modest evidence that periods of increased sleep are associated with increased cell proliferation or survival. There is strong evidence that disruptions of sleep exceeding 24 h, by total deprivation, selective REM sleep deprivation, and chronic restriction or fragmentation, significantly inhibit cell proliferation and in some cases neurogenesis. The mechanisms by which sleep disruption inhibits neurogenesis are not fully understood. Although sleep disruption procedures are typically at least mildly stressful, elevated adrenal corticosterone secretion is not necessary for this effect. However, procedures that prevent both elevated corticosterone and interleukin 1β signaling have been found to block the effect of sleep deprivation on cell proliferation. This result suggests that sleep loss impairs hippocampal neurogenesis by the presence of wake-dependent factors, rather than by the absence of sleep-specific processes. This would weigh against a hypothesis that regulation of neurogenesis is a function of sleep. Nonetheless, impaired neurogenesis may underlie some of the memory and mood effects associated with acute and chronic sleep disruptions. PMID:24218292

  3. Evaluation of right ventricular remodeling using cardiac magnetic resonance imaging in co-existent chronic obstructive pulmonary disease and obstructive sleep apnea.

    PubMed

    Sharma, Bhavneesh; Neilan, Tomas G; Kwong, Raymond Y; Mandry, Damien; Owens, Robert L; McSharry, David; Bakker, Jessie P; Malhotra, Atul

    2013-02-01

    Untreated chronic obstructive pulmonary disease (COPD) co-existing with obstructive sleep apnea (OSA), also known as overlap syndrome, has higher cardiovascular mortality than COPD alone but its underlying mechanism remains unclear. We hypothesize that the presence of overlap syndrome is associated with more extensive right ventricular (RV) remodeling compared to patients with COPD alone. Adult COPD patients (GOLD stage 2 or higher) with at least 10 pack-years of smoking history were included. Overnight laboratory-based polysomnography was performed to test for OSA. Subjects with an apnea-hypopnea index (AHI) >10/h were classified as having overlap syndrome (n = 7), else classified as having COPD-only (n = 11). A cardiac MRI was performed to assess right and left cardiac chambers sizes, ventricular masses, and cine function. RV mass index (RVMI) was markedly higher in the overlap group than the COPD-only group (19 ± 6 versus 11 ± 6; p = 0.02). Overlap syndrome subjects had a reduced RV remodeling index (defined as the ratio between RVMI and RV end-diastolic volume index) compared to the COPD-only group (0.27 ± 0.06 versus 0.18 ± 0.08; p = 0.02). In the overlap syndrome subjects, the extent of RV remodeling was associated with severity of oxygen desaturation (R(2) = 0.65, p = 0.03). Our pilot results suggest that untreated overlap syndrome may cause more extensive RV remodeling than COPD alone. PMID:23272670

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  6. Caffeine Consumption and Sleep Quality in Australian Adults.

    PubMed

    Watson, Emily J; Coates, Alison M; Kohler, Mark; Banks, Siobhan

    2016-01-01

    Caffeine is commonly consumed to help offset fatigue, however, it can have several negative effects on sleep quality and quantity. The aim of this study was to determine the relationship between caffeine consumption and sleep quality in adults using a newly validated caffeine food frequency questionnaire (C-FFQ). In this cross sectional study, 80 adults (M ± SD: 38.9 ± 19.3 years) attended the University of South Australia to complete a C-FFQ and the Pittsburgh Sleep Quality Index (PSQI). Caffeine consumption remained stable across age groups while the source of caffeine varied. Higher total caffeine consumption was associated with decreased time in bed, as an estimate of sleep time (r = -0.229, p = 0.041), but other PSQI variables were not. Participants who reported poor sleep (PSQI global score ≥ 5) consumed 192.1 ± 122.5 mg (M ± SD) of caffeine which was significantly more than those who reported good sleep quality (PSQI global score < 5; 125.2 ± 62.6 mg; p = 0.008). The C-FFQ was found to be a quick but detailed way to collect population based caffeine consumption data. The data suggests that shorter sleep is associated with greater caffeine consumption, and that consumption is greater in adults with reduced sleep quality. PMID:27527212

  7. Caffeine Consumption and Sleep Quality in Australian Adults

    PubMed Central

    Watson, Emily J.; Coates, Alison M.; Kohler, Mark; Banks, Siobhan

    2016-01-01

    Caffeine is commonly consumed to help offset fatigue, however, it can have several negative effects on sleep quality and quantity. The aim of this study was to determine the relationship between caffeine consumption and sleep quality in adults using a newly validated caffeine food frequency questionnaire (C-FFQ). In this cross sectional study, 80 adults (M ± SD: 38.9 ± 19.3 years) attended the University of South Australia to complete a C-FFQ and the Pittsburgh Sleep Quality Index (PSQI). Caffeine consumption remained stable across age groups while the source of caffeine varied. Higher total caffeine consumption was associated with decreased time in bed, as an estimate of sleep time (r = −0.229, p = 0.041), but other PSQI variables were not. Participants who reported poor sleep (PSQI global score ≥ 5) consumed 192.1 ± 122.5 mg (M ± SD) of caffeine which was significantly more than those who reported good sleep quality (PSQI global score < 5; 125.2 ± 62.6 mg; p = 0.008). The C-FFQ was found to be a quick but detailed way to collect population based caffeine consumption data. The data suggests that shorter sleep is associated with greater caffeine consumption, and that consumption is greater in adults with reduced sleep quality. PMID:27527212

  8. The Prioritization of Clinical Risk Factors of Obstructive Sleep Apnea Severity Using Fuzzy Analytic Hierarchy Process

    PubMed Central

    Maranate, Thaya; Pongpullponsak, Adisak; Ruttanaumpawan, Pimon

    2015-01-01

    Recently, there has been a problem of shortage of sleep laboratories that can accommodate the patients in a timely manner. Delayed diagnosis and treatment may lead to worse outcomes particularly in patients with severe obstructive sleep apnea (OSA). For this reason, the prioritization in polysomnography (PSG) queueing should be endorsed based on disease severity. To date, there have been conflicting data whether clinical information can predict OSA severity. The 1,042 suspected OSA patients underwent diagnostic PSG study at Siriraj Sleep Center during 2010-2011. A total of 113 variables were obtained from sleep questionnaires and anthropometric measurements. The 19 groups of clinical risk factors consisting of 42 variables were categorized into each OSA severity. This study aimed to array these factors by employing Fuzzy Analytic Hierarchy Process approach based on normalized weight vector. The results revealed that the first rank of clinical risk factors in Severe, Moderate, Mild, and No OSA was nighttime symptoms. The overall sensitivity/specificity of the approach to these groups was 92.32%/91.76%, 89.52%/88.18%, 91.08%/84.58%, and 96.49%/81.23%, respectively. We propose that the urgent PSG appointment should include clinical risk factors of Severe OSA group. In addition, the screening for Mild from No OSA patients in sleep center setting using symptoms during sleep is also recommended (sensitivity = 87.12% and specificity = 72.22%). PMID:26221183

  9. The Use of Media as a Sleep Aid in Adults.

    PubMed

    Exelmans, Liese; Van den Bulck, Jan

    2016-01-01

    A sample of 844 adults, aged 18-94 years old, was queried about media habits and sleep behavior in face-to-face interviews with standardized questionnaires. A substantial proportion of this sample reported using books (39.8%), television (31.2%), music (26.0%), Internet (23.2%), and videogames (10.3%) as a sleep aid. The use of media as sleep aids was associated with increased fatigue and higher scores on the Pittsburgh Sleep Quality Index (PSQI), indicating poorer sleep quality. There was no relationship with sleep duration. Finally, results suggest that media use coincides with later bedtimes, but also later rise times, a process called time shifting. PMID:25313639

  10. Sleep Duration and Obesity in Adults: What Are the Connections?

    PubMed

    Theorell-Haglöw, Jenny; Lindberg, Eva

    2016-09-01

    Collectively, cross-sectional and longitudinal studies on self-reported sleep duration and obesity do not show a clear pattern of association with some showing a negative linear relationship, some showing a U-shaped relationship, and some showing no relationship. Associations between sleep duration and obesity seem stronger in younger adults. Cross-sectional studies using objectively measured sleep duration (actigraphy or polysomnography (PSG)) also show this mixed pattern whereas all longitudinal studies to date using actigraphy or PSG have failed to show a relationship with obesity/weight gain. It is still too early and a too easy solution to suggest that changing the sleep duration will cure the obesity epidemic. Given novel results on emotional stress and poor sleep as mediating factors in the relationship between sleep duration and obesity, detection and management of these should become the target of future clinical efforts as well as future research. PMID:27372108

  11. Simulated Obstructive Sleep Apnea Increases P-Wave Duration and P-Wave Dispersion

    PubMed Central

    Wons, Annette M.; Rossi, Valentina; Bratton, Daniel J.; Schlatzer, Christian; Schwarz, Esther I.; Camen, Giovanni; Kohler, Malcolm

    2016-01-01

    Background A high P-wave duration and dispersion (Pd) have been reported to be a prognostic factor for the occurrence of paroxysmal atrial fibrillation (PAF), a condition linked to obstructive sleep apnea (OSA). We tested the hypothesis of whether a short-term increase of P-wave duration and Pd can be induced by respiratory manoeuvres simulating OSA in healthy subjects and in patients with PAF. Methods 12-lead-electrocardiography (ECG) was recorded continuously in 24 healthy subjects and 33 patients with PAF, while simulating obstructive apnea (Mueller manoeuvre, MM), obstructive hypopnea (inspiration through a threshold load, ITH), central apnea (AP), and during normal breathing (BL) in randomized order. The P-wave duration and Pd was calculated by using dedicated software for ECG-analysis. Results P-wave duration and Pd significantly increased during MM and ITH compared to BL in all subjects (+13.1ms and +13.8ms during MM; +11.7ms and +12.9ms during ITH; p<0.001 for all comparisons). In MM, the increase was larger in healthy subjects when compared to patients with PAF (p<0.05). Conclusion Intrathoracic pressure swings through simulated obstructive sleep apnea increase P-wave duration and Pd in healthy subjects and in patients with PAF. Our findings imply that intrathoracic pressure swings prolong the intra-atrial and inter-atrial conduction time and therefore may represent an independent trigger factor for the development for PAF. PMID:27071039

  12. Origins of and implementation concepts for upper airway stimulation therapy for obstructive sleep apnea.

    PubMed

    Strohl M D, Kingman P; Baskin M D, Jonathan; Lance M D, Colleen; Ponsky M D, Diana; Weidenbecher M D, Mark; Strohl B A, Madeleine; Yamauchi M D, Motoo

    2016-07-01

    Upper airway stimulation, specifically hypoglossal (CN XII) nerve stimulation, is a new, alternative therapy for patients with obstructive sleep apnea hypopnea syndrome who cannot tolerate positive airway pressure, the first-line therapy for symptomatic patients. Stimulation therapy addresses the cause of inadequate upper airway muscle activation for nasopharyngeal and oropharyngeal airway collapse during sleep. The purpose of this report is to outline the development of this first-in-class therapy and its clinical implementation. Another practical theme is assessment of the features for considering a surgically implanted device and the insight as to how both clinical and endoscopic criteria increase the likelihood of safe and durable outcomes for an implant and how to more generally plan for management of CPAP-intolerant patients. A third theme is the team building required among sleep medicine and surgical specialties in the provision of individualized neurostimulation therapy. PMID:27424823

  13. Toward numerical simulations of fluid-structure interactions for investigation of obstructive sleep apnea

    NASA Astrophysics Data System (ADS)

    Huang, Chien-Jung; Huang, Shao-Ching; White, Susan M.; Mallya, Sanjay M.; Eldredge, Jeff D.

    2016-04-01

    Obstructive sleep apnea (OSA) is a medical condition characterized by repetitive partial or complete occlusion of the airway during sleep. The soft tissues in the airway of OSA patients are prone to collapse under the low-pressure loads incurred during breathing. This paper describes efforts toward the development of a numerical tool for simulation of air-tissue interactions in the upper airway of patients with sleep apnea. A procedure by which patient-specific airway geometries are segmented and processed from dental cone-beam CT scans into signed distance fields is presented. A sharp-interface embedded boundary method based on the signed distance field is used on Cartesian grids for resolving the airflow in the airway geometries. For simulation of structure mechanics with large expected displacements, a cut-cell finite element method with nonlinear Green strains is used. The fluid and structure solvers are strongly coupled with a partitioned iterative algorithm. Preliminary results are shown for flow simulation inside the three-dimensional rigid upper airway of patients with obstructive sleep apnea. Two validation cases for the fluid-structure coupling problem are also presented.

  14. Greater night-to-night variability in sleep discrepancy among older adults with a sleep complaint compared to noncomplaining older adults.

    PubMed

    Kay, Daniel B; Dzierzewski, Joseph M; Rowe, Meredeth; McCrae, Christina S

    2013-04-01

    Research in younger adults suggests sleep discrepancy (objective/subjective measurement difference) is a consistent pattern that primarily occurs within individuals with insomnia. To examine whether older adults exhibit a similar pattern, this study compared night-to-night inconsistency in sleep discrepancy between older adults with and without sleep complaints. Older adults (N = 103; mean age = 72.81, SD = 7.12) wore an Actiwatch-L® (24 hr per day) and concurrently completed sleep diaries for 14 days. Sleep discrepancy = diary (sleep onset latency [SOL] or wake [time] after sleep onset [WASO]) - actigraphy (SOL or WASO). Both groups exhibited sleep discrepancy, but complainers exhibited significantly more night-to-night variability. Sleep discrepancy was a variable behavior that was not limited to insomnia, but instead manifested by degree throughout our older sample. Greater attention to variability in sleep research and clinical practice is warranted. PMID:23137288

  15. Sleep apnea and oxygen saturation in adults at 2640 m above sea level☆

    PubMed Central

    Bazurto Zapata, Maria Angelica; Dueñas Meza, Elida; Jaramillo, Claudia; Maldonado Gomez, Dario; Torres Duque, Carlos

    2014-01-01

    Purpose To describe the SpO2 in wakefulness, sleep and during the apnea–hypopnea in adults living in Bogotá, located at 2640 m above sea level. Methods Descriptive observational study in adults referred for polysomnogram (PSG). A normal Apnea hypopnea index (AHI) was defined as ≤5 and obstructive sleep apnea (OSA) was classified as mild (AHI 5–15), moderate (AHI 15–30), and severe (AHI >30). T-test or ANOVA test for SpO2 differences between groups was used. Results 1799 patients, 33% women. 222 (12.8%) did not have OSA (normal IAH), 268 (14.9%) mild OSA, 315 (17.5%) moderate ,and 993 (55.2%) severe. In all cases a low SpO2 (SpO2<90%) was found. The SpO2 was lower when the AHI was higher, in wakefulness, in non-REM and in REM (p<0.001). For all grades of severity, SpO2 decreased significantly from wakefulness to non-REM sleep and to REM sleep (p<0.001). Patients with severe OSA had higher desaturation during wakefulness (85.2±6.6%), non-REM sleep (83.1±7.7%), REM sleep (78.8±10.2), and during events (75.1±9.1%). Conclusions Patients with OSA at 2640 m have nocturnal desaturation lower than 88%, which decreases with higher severity of OSA. The clinical impact of sleep disorders at this point may be greater than at sea level and should be studied. PMID:26483911

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

    PubMed Central

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

    2013-01-01

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

  17. Selective indication for positive airway pressure (PAP) in sleep-related breathing disorders with obstruction

    PubMed Central

    Stasche, Norbert

    2006-01-01

    Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders (SRBD). A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV) must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP), most commonly used for symptomatic obstructive sleep apnoea (OSA) without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP). Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV), which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal PAP device

  18. Sleep disordered breathing in patients with chronic obstructive pulmonary disease.

    PubMed

    Aoki, Takuya; Akinori, Ebihara; Yogo, Yurika; Sakamaki, Fumio; Suzuki, Yukio; Suemasu, Keiichi

    2005-06-01

    Sleep-related disordered breathing (SDB) and its influence on desaturation were examined in stable COPD patients with waking SpO2 > 90%. With respiratory inductance plethysmography, thoracic-abdominal respiratory movements for all events with more than 4% desaturation were analyzed in 26 patients. Types of SDB were confirmed by full polysomnography. Irregular breathing induced desaturation, while stable respiration continued during some desaturation events. Three types of altered ventilation were observed: hypoventilation, paradoxical movement and periodic breathing. An unusual type of paradoxical movement, with normal airflow despite progressive desaturation, was observed in REM sleep. Patients were divided into desaturation (15 patients) and non-desaturation (11 patients) groups. Daytime arterial blood gas, lung function values, and 6-min walking distance did not differ. Awake, mode, maximum and minimum nocturnal SpO2 were lower in the desaturation group. SDB-induced desaturation events in the desaturation group were more frequent (9.2+/-3.5 vs. 1.8+/-2.2 times), a greater SpO2 decrease (11.4+/-7.1% vs. 5.2+/-2.1%) and longer duration (73.2+/-34.8 vs. 18.8+/-39.0 min). Patterns of SDB in the desaturation group were hypoventilation (74.4+/-23.4%), paradoxical movement (10.2+/-14.5%), periodic breathing (12.1+/-18.3%) and unclassified (5.8+/-11.2%). These results reveal that lower SpO2 and SDB influence nocturnal desaturation in stable COPD patients. PMID:17136951

  19. Pulmonary haemodynamics in obstructive sleep apnoea: time course and associated factors.

    PubMed

    Schäfer, H; Hasper, E; Ewig, S; Koehler, U; Latzelsberger, J; Tasci, S; Lüderitz, B

    1998-09-01

    Changes in pulmonary artery pressure within an obstructive apnoea and elevations of transmural pulmonary artery pressure (Ppa,tm) towards the end of apnoea are well known. The purpose of our study was to examine which factors contribute to the increase of Ppa,tm in an apnoea. In addition, the time course of Ppa,tm and associated factors during a sleep study was investigated. We analysed the association of changes in arterial oxygen saturation (Sa,O2), oesophageal pressure (Poes) to estimate intrathoracic pressure, systolic blood pressure (BPsys) to estimate left ventricular afterload, apnoea duration and the change in Ppa,tm (deltaPpa,tm) during the course of obstructive apnoeas. Consecutive apnoeas in nonrapid eye movement (NREM)-sleep at the beginning, the middle and the end of the sleep study were analysed in six patients with obstructive sleep apnoea. The mean systolic Ppa,tm was 28.0+/-12.1 mmHg at the beginning of apnoea and 38.6+/-15.5 mmHg at the end (deltaPpa,tm 10.5+/-7.4 mmHg; p<0.0001). DeltaSa,O2 (p<0.0001; odds ratio (OR) 1.45; confidence interval (CI) 1.20-1.76) and deltaPoes (p<0.0001; OR 1.22; CI 1.11-1.34) were independently associated with deltaPpa,tm in a multiple regression analysis. Apnoea duration as well as deltaPoes, deltaPpa,tm and deltaSa,O2 were all significantly higher (p<0.05) in apnoeas at the middle of the sleep study than at the beginning or the end. In conclusion, hypoxaemia and mechanical factors as an increase in negative thoracic pressure contribute to elevations of the transmural pulmonary artery pressure during an obstructive apnoea. The time course of pulmonary haemodynamics within a steep study reveals that the highest transmural pulmonary artery pressure occurs in the middle of the night with no progressive increase towards the end of the sleep study. PMID:9762799

  20. Long-Term Effect of Weight Loss on Obstructive Sleep Apnea Severity in Obese Patients with Type 2 Diabetes

    PubMed Central

    Kuna, Samuel T.; Reboussin, David M.; Borradaile, Kelley E.; Sanders, Mark H.; Millman, Richard P.; Zammit, Gary; Newman, Anne B.; Wadden, Thomas A.; Jakicic, John M.; Wing, Rena R.; Pi-Sunyer, F. Xavier; Foster, Gary D.

    2013-01-01

    Study Objectives: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. Design: Randomized controlled trial with follow-up at 1, 2, and 4 years. Setting: 4 Look AHEAD clinical centers. Participants: Two hundred sixty-four obese adults with type 2 diabetes and OSA. Interventions: Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. Measurements: Change in apnea-hypopnea index on polysomnogram. Results: The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). Conclusions: Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss. Citation: Kuna ST; Reboussin DM; Borradaile KE; Sanders MH; Millman RP; Zammit G; Newman AB; Wadden TA; Jakicic JM; Wing RR; Pi-Sunyer FX; Foster GD; Sleep AHEAD Research Group. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes

  1. Clinical Usefulness of Watch-PAT for Assessing the Surgical Results of Obstructive Sleep Apnea Syndrome

    PubMed Central

    Park, Chong Yoon; Hong, Joon Hyeong; Lee, Jae Heon; Lee, Kyu Eun; Cho, Hyun Sang; Lim, Su Jin; Kwak, Jin Wook; Kim, Kyung Soo; Kim, Hyun Jik

    2014-01-01

    Objective: This study aimed to assess the accuracy and clinical efficacy of a wrist-worn device that is based on peripheral arterial tonometry (watch-PAT) to evaluate the surgical results of obstructive sleep apnea (OSA) syndrome subjects. Study Design and Method: Thirty-five subjects who were diagnosed with OSA and underwent sleep surgeries such as septoplasty, tonsillectomy, or uvuloplasty to correct their airway collapse, participated in this study; the watch-PAT-derived respiratory disturbance index (RDI), apnea and hypopnea index (AHI), lowest oxygen saturation, and valid sleep time were measured after the sleep surgery. Results: The present study showed that RDI (32.8 ± 10.7 vs 14.8 ± 7.5), AHI (30.3 ± 8.6 vs 13.4 ± 8.2 events/h), lowest oxygen saturation (78.2% ± 8.4% vs 90.5% ± 7.1%), and valid sleep time (329.1 ± 47.2 min and a postoperative value of 389.1 ± 50.1 min) recovered to within a normal range after surgery in 28 subjects. In addition, good agreement was found between watch-PAT-derived factors and visual analogue scales for changes in subjective symptoms, such as snoring, apnea, and daytime somnolence. Seven of the 35 subjects showed no improvement for their subjective symptoms and complained of snoring and apnea after surgery. We found that the RDI and AHI of those 7 subjects were not reduced, and the changes between pre- and postoperative values which were measured with watch-PAT were minimal. Their postoperative lowest oxygen saturation and valid sleep time were not elevated per the watch-PAT. The results support a strong correlation between the findings from watch-PAT and improved symptoms after surgical correction of an airway collapse. Conclusions: Our study provides evidence that the factors measured by the watch-PAT might be reliable indicators of symptomatic changes in OSA subjects after sleep surgery and also shows that the watch-PAT is a highly sensitive portable device for estimating treatment results in OSA. Citation: Park CY

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

    PubMed Central

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

    2012-01-01

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

  3. 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

  4. Continuous Positive Airway Pressure Compliance in Patients with Obstructive Sleep Apnea

    PubMed Central

    Afsharpaiman, Shahla; Vahedi, Encieh; Aqaee, Hossein

    2016-01-01

    Background: Obstructive sleep apnea (OSA) is a common condition in adults. In most cases, first-line therapy includes treatment with positive airway pressure devices. However, because of discomfort, continuous positive airway pressure (CPAP) compliance is often poor. To determine the willingness of patients to use CPAP device, the relationship of demographic and polysomnographic variables with tolerance and the willingness to use CPAP, was evaluated. Materials and Methods: In this cross-sectional study, 120 OSA patients who were treated with CPAP in Baqiyatallah Hospital, Tehran, Iran, were selected by convenience sampling. Polysomnographic variables, willingness to use CPAP for short and long periods of time and possible complications were evaluated. Results: One hundred-twenty cases with a mean age of 53±10.3 years were assessed. The mean Epworth Sleepiness Scale (ESS) score was 11.9 ± 6.2 in CPAP users versus 11.8±6.1 in patients who did not use CPAP. The willingness to use CPAP for short-term was significantly different between the two groups (P=0.008). The average minimum oxygen saturation rate of patients was 75.21% in CPAP users versus 71.63% in non CPAP users. Also, the average desaturation index was higher in CPAP users (54.5 vs. 44.98). The mean ESS was 14.03 ± 6.19 in those who accepted long-term treatment versus 8.85 ± 4.89 (P=0.003). Skin wounds and rhinitis were reported in 4.1% and 4.1% of patients, respectively. Conclusion: It is concluded that high CPAP compliance rates are achievable through comprehensive CPAP therapy.

  5. Abdominal adiposity and obstructive airway disease: testing insulin resistance and sleep disordered breathing mechanisms

    PubMed Central

    2012-01-01

    Background This study examined associations of abdominal adiposity with lung function, asthma symptoms and current doctor-diagnosed asthma and mediation by insulin resistance (IR) and sleep disordered breathing (SDB). Methods A random sample of 2500 households was drawn from the community of Whyalla, South Australia (The Whyalla Intergenerational Study of Health, WISH February 2008 - July 2009). Seven-hundred twenty-two randomly selected adults (≥18 years) completed clinical protocols (32.2% response rate). Lung function was measured by spirometry. Post-bronchodilator FEV1/FVC was used to measure airway obstruction and reversibility of FEV1 was calculated. Current asthma was defined by self-reported doctor-diagnosis and evidence of currently active asthma. Symptom scores for asthma (CASS) and SDB were calculated. Intra-abdominal fat (IAF) was estimated using dual-energy x-ray absorptiometry (DXA). IR was calculated from fasting glucose and insulin concentrations. Results The prevalence of current doctor-diagnosed asthma was 19.9% (95% CI 16.7 – 23.5%). The ratio of observed to expected cases given the age and sex distribution of the population was 2.4 (95%CI 2.1, 2.9). IAF was not associated with current doctor-diagnosed asthma, FEV1/FVC or FEV1 reversibility in men or women but was positively associated with CASS independent of IR and SDB in women. A 1% increase in IAF was associated with decreases of 12 mL and 20 mL in FEV1 and FVC respectively in men, and 4 mL and 7 mL respectively in women. SDB mediated 12% and 26% of these associations respectively in men but had minimal effects in women. Conclusions In this population with an excess of doctor-diagnosed asthma, IAF was not a major factor in airway obstruction or doctor-diagnosed asthma, although women with higher IAF perceived more severe asthma symptoms which did not correlate with lower FEV1. Higher IAF was significantly associated with lower FEV1 and FVC and in men SDB mechanisms may

  6. Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with Obstructive Sleep Apnea

    PubMed Central

    Thomas, Robert J.; Karumanchi, S. Ananth; Parikh, Samir M.

    2016-01-01

    Background Obstructive sleep apnea (OSA) is a well-established risk factor for hypertension and cardiovascular morbidity and mortality. More recently, OSA has been implicated as an independent risk factor for chronic kidney disease. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a well-accepted early biomarker of subclinical kidney tubular injury, preceding an increase in serum creatinine. The goal of this study was to determine if an association exists between OSA and increased urinary NGAL levels. Methods We prospectively enrolled adult patients from the sleep clinic of an academic medical center. Each underwent polysomnography and submitted a urine specimen upon enrollment. We measured NGAL and creatinine levels on all urine samples before participants received treatment with continuous positive airway pressure (CPAP), and, in a subset of OSA patients, after CPAP therapy. We compared the urinary NGAL/creatinine ratio between untreated participants with and without OSA, and within a subset of 11 OSA patients also after CPAP therapy. Results A total of 49 subjects were enrolled: 16 controls based on an apnea-hypopnea index (events with at least 4% oxygen desaturation; AHI-4%) <5 events/hour (mean AHI-4% = 0.59 +/- 0.60); 33 OSA patients based on an AHI-4% >5 events/hour (mean AHI-4% = 43.3 +/- 28.1). OSA patients had a higher mean body-mass index than the control group (36.58 +/- 11.02 kg/m2 vs. 26.81 +/- 6.55 kg/m2, respectively; p = 0.0005) and were more likely to be treated for hypertension (54.5% vs. 6.25% of group members, respectively; p = 0.0014). The groups were otherwise similar in demographics, and there was no difference in the number of diabetic subjects or in the mean serum creatinine concentration (control = 0.86 +/- 0.15 mg/dl, OSA = 0.87 +/- 0.19 mg/dl; p = 0.7956). We found no difference between the urinary NGAL-to-creatinine ratios among untreated OSA patients versus control subjects (median NGAL/creatinine = 6.34 ng/mg vs. 6.41 ng

  7. Genotype-Phenotype Interactions In Pediatric Obstructive Sleep Apnea

    PubMed Central

    Kheirandish-Gozal, Leila; Gozal, David

    2013-01-01

    Pediatric sleep disordered breathing (PSDB) is not only a very frequent condition affecting 2–4% of all children, but is also associated with an increased risk for a variety of manifestations underlying end-organ injury and dysfunction that impose both immediate and potentially long-term morbidities and corresponding inherent elevations in healthcare costs. One of the major problems with the creation of valid algorithms aiming to stratify diagnostic and treatment prioritization lies in our current inability to predict and identify those children who are most at-risk for PSDB-induced adverse consequences. Thus, improved our understanding of the mechanisms governing phenotype variance in PSDB is essential. Here, we examine some of the potential underpinnings of phenotypic variability in PSDB, and further propose a conceptual framework aimed at facilitating the process of advancing knowledge in this frequent disorder. PMID:23563156

  8. Quality of Life and Obstructive Sleep Apnea Symptoms After Pediatric Adenotonsillectomy

    PubMed Central

    Mitchell, Ron B.; Parker, Portia D.; Moore, Reneé H.; Rosen, Carol L.; Giordani, Bruno; Muzumdar, Hiren; Paruthi, Shalini; Elden, Lisa; Willging, Paul; Beebe, Dean W.; Marcus, Carole L.; Chervin, Ronald D.; Redline, Susan

    2015-01-01

    BACKGROUND AND OBJECTIVES: Data from a randomized, controlled study of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) were used to test the hypothesis that children undergoing surgery had greater quality of life (QoL) and symptom improvement than control subjects. The objectives were to compare changes in validated QoL and symptom measurements among children randomized to undergo adenotonsillectomy or watchful waiting; to determine whether race, weight, or baseline OSAS severity influenced changes in QoL and symptoms; and to evaluate associations between changes in QoL or symptoms and OSAS severity. METHODS: Children aged 5 to 9.9 years with OSAS (N = 453) were randomly assigned to undergo adenotonsillectomy or watchful waiting with supportive care. Polysomnography, the Pediatric Quality of Life inventory, the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire, the 18-item Obstructive Sleep Apnea QoL instrument, and the modified Epworth Sleepiness Scale were completed at baseline and 7 months. Changes in the QoL and symptom surveys were compared between arms. Effect modification according to race and obesity and associations between changes in polysomnographic measures and QoL or symptoms were examined. RESULTS: Greater improvements in most QoL and symptom severity measurements were observed in children randomized to undergo adenotonsillectomy, including the parent-completed Pediatric Quality of Life inventory (effect size [ES]: 0.37), the 18-item Obstructive Sleep Apnea QoL instrument (ES: –0.93), the modified Epworth Sleepiness Scale score (ES: –0.42), and the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire (ES: –1.35). Effect modification was not observed by obesity or baseline severity but was noted for race in some symptom measures. Improvements in OSAS severity explained only a small portion of the observed changes. CONCLUSIONS: Adenotonsillectomy compared with watchful waiting resulted in significantly

  9. Habitual Sleep, Reasoning, and Processing Speed in Older Adults with Sleep Complaints.

    PubMed

    McCrae, Christina S; Vatthauer, Karlyn E; Dzierzewski, Joseph M; Marsiske, Michael

    2012-04-01

    The relationship between habitual sleep and cognition in older adults with sleep complaints is poorly understood, because research has focused on younger adults, used experimental or retrospective quasi-experimental designs, and generally produced equivocal results. Prospective studies using sleep diaries are rare, but may provide important insights into this relationship as they offer greater ecological validity and allow for examination of the impact of night-to-night variability in sleep (an often overlooked aspect of sleep) on cognitive performance. Seventy-two older adults (M(age) = 70.18 years, SD(age) = 7.09 years) completed fourteen consecutive days of sleep diaries and paper/pencil self-administered cognitive tasks, including measures of processing speed (Symbol Digit) and reasoning (Letter Series). Regression analyses revealed increased average total wake time (TWT) during the night was associated with higher Symbol Digit scores, β = 0.45, P < 0.05. Night-to-night variability in either total sleep time (TST) or TWT was not associated with either cognitive measure. Implications and potential explanations for these initially counterintuitive findings are discussed. PMID:23243328

  10. Habitual Sleep, Reasoning, and Processing Speed in Older Adults with Sleep Complaints

    PubMed Central

    Vatthauer, Karlyn E.; Dzierzewski, Joseph M.; Marsiske, Michael

    2012-01-01

    The relationship between habitual sleep and cognition in older adults with sleep complaints is poorly understood, because research has focused on younger adults, used experimental or retrospective quasi-experimental designs, and generally produced equivocal results. Prospective studies using sleep diaries are rare, but may provide important insights into this relationship as they offer greater ecological validity and allow for examination of the impact of night-to-night variability in sleep (an often overlooked aspect of sleep) on cognitive performance. Seventy-two older adults (Mage = 70.18 years, SDage = 7.09 years) completed fourteen consecutive days of sleep diaries and paper/pencil self-administered cognitive tasks, including measures of processing speed (Symbol Digit) and reasoning (Letter Series). Regression analyses revealed increased average total wake time (TWT) during the night was associated with higher Symbol Digit scores, β = 0.45, P < 0.05. Night-to-night variability in either total sleep time (TST) or TWT was not associated with either cognitive measure. Implications and potential explanations for these initially counterintuitive findings are discussed. PMID:23243328

  11. Changes in REM-Sleep Percentage Over the Adult Lifespan

    PubMed Central

    Floyd, Judith A.; Janisse, James J.; Jenuwine, Elizabeth S.; Ager, Joel W.

    2007-01-01

    Study Objectives: To resolve inconsistencies in previously reported changes in percentage of rapid eye movement sleep (REM%) over the adult lifespan and to identify gaps in available information about adults' REM sleep. Design: A research synthesis approach specifically designed to detect nonlinear change. Cubic B smoothing splines were fitted to scatterplots generated from reported means and variance for REM%, REM minutes, and total sleep time. Participants: 382 English-language research reports provided REM% values for 4171 subjects; REM minutes values for 2722 subjects; and values of total sleep time for 5037 subjects. Samples were composed of subjects described by authors as normal or healthy. Mean ages of samples ranged from 18.0 to 91.7 years. Setting: University research center. Interventions: N/A. Measurements and Results: Two coders extracted information. Intercoder reliability was above cutoffs for excellent. Authors often failed to describe screening procedures used to determine subjects' health status. Few results were reported separately for women. The functional relationship between age and REM% was essentially linear over much of the adult lifespan, decreasing about 0.6% per decade. The best estimate of when REM% ceased its small linear decline was the mid-70s, after which time a small increase in REM% was observed due to REM minutes increasing while total sleep time declined. Conclusions: Ability to detect both linear and nonlinear change in REM%, REM minutes, and total sleep time over the lifespan was useful for resolving inconsistent findings about the existence of changes in REM% with aging. This approach to research synthesis also facilitated identification of ages for which little normative information about REM sleep was available. Citation: Floyd JA; Janisse JJ; Jenuwine ES et al. Changes in REM-sleep percentage over the adult lifespan. SLEEP 2007;30(7):829-836. PMID:17682652

  12. Has adult sleep duration declined over the last 50+ years?

    PubMed

    Youngstedt, Shawn D; Goff, Eric E; Reynolds, Alexandria M; Kripke, Daniel F; Irwin, Michael R; Bootzin, Richard R; Khan, Nidha; Jean-Louis, Girardin

    2016-08-01

    The common assumption that population sleep duration has declined in the past few decades has not been supported by recent reviews, which have been limited to self-reported data. The aim of this review was to assess whether there has been a reduction in objectively recorded sleep duration over the last 50+ years. The literature was searched for studies published from 1960 to 2013, which assessed objective sleep duration (total sleep time (TST)) in healthy normal-sleeping adults. The search found 168 studies that met inclusion criteria, with 257 data points representing 6052 individuals ages 18-88 y. Data were assessed by comparing the regression lines of age vs. TST in studies conducted between 1960 and 1989 vs. 1990-2013. Weighted regression analyses assessed the association of year of study with age-adjusted TST across all data points. Regression analyses also assessed the association of year of study with TST separately for 10-y age categories (e.g., ages 18-27 y), and separately for polysomnographic and actigraphic data, and for studies involving a fixed sleep schedule and participants' customary sleep schedules. Analyses revealed no significant association of sleep duration with study year. The results are consistent with recent reviews of subjective data, which have challenged the notion of a modern epidemic of insufficient sleep. PMID:26478985

  13. Numerical analysis for the efficacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

    NASA Astrophysics Data System (ADS)

    Yu, Shen; Liu, Ying-Xi; Sun, Xiu-Zhen; Su, Ying-Feng; Wang, Ying; Gai, Yin-Zhe

    2014-04-01

    In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea—hypopnea syndrome (OSAHS) patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The efficacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram (PSG) test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further, provide a theoretical basis to solve relevant clinical problems. [Figure not available: see fulltext.

  14. Utility of portable monitoring in the diagnosis of obstructive sleep apnea

    PubMed Central

    Krishnaswamy, U; Aneja, A; Kumar, R Mohan; Kumar, T Prasanna

    2015-01-01

    Obstructive sleep apnea (OSA) is a common but underdiagnosed sleep disorder, which is associated with systemic consequences such as hypertension, stroke, metabolic syndrome, and ischemic heart disease. Nocturnal laboratory-based polysomnography (PSG) is the gold standard test for diagnosis of OSA. PSG consists of a simultaneous recording of multiple physiologic parameters related to sleep and wakefulness including electroencephalography (EEG), electrooculography (EOG), surface electromyography (EMG), airflow measurement using thermistor and nasal pressure transducer, pulse oximetry and respiratory effort (thoracic and abdominal). Multiple alternative and simpler methods that record respiratory parameters alone for diagnosing OSA have been developed in the past two decades. These devices are called portable monitors (PMs) and enable performing sleep studies at a lower cost with shorter waiting times. It has been observed and reported that comprehensive sleep evaluation coupled with the use of PMs can fulfill the unmet need for diagnostic testing in various out-of-hospital settings in patients with suspected OSA. This article reviews the available medical literature on PMs in order to justify the utility of PMs in the diagnosis of OSA, especially in resource-poor, high-disease burden settings. The published practice parameters for the use of these devices have also been reviewed with respect to their relevance in the Indian setting. PMID:26440391

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

    PubMed Central

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

    2014-01-01

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

  16. Portable obstructive sleep apnea screening system using overnight ECG and a PDA-based wireless transmission system.

    PubMed

    Chang, Kang-Ming

    2009-05-01

    Sleep disorders such as obstructive sleep apnea (OSA) are now regarded as an important risk factor for cardiovascular diseases. The increasing demands for home-based sleep monitoring have prompted studies to develop devices that monitor sleep using fewer sensors. This paper proposes an electrocardiogram (ECG)-based sleep monitoring system that uses a personal digital assistant to display signals and a wireless transmission system. An OSA detection algorithm based only on the overnight-ECG-derived heart-rate-variability low-frequency component (0.02-0.04 Hz) exhibited detection sensitivity of 68.97% and specificity of 100%. This system could meet the future demands of home-based sleep monitoring and thereby reduce the current considerable burdens on hospital sleep centers. PMID:19441954

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

    PubMed Central

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

    2013-01-01

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

  18. Zolpidem Induced Sleep-related Eating and Complex Behaviors in a Patient with Obstructive Sleep Apnea and Restless Legs Syndrome.

    PubMed

    Park, Young-Min; Shin, Hyun-Woo

    2016-08-31

    Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA. PMID:27489385

  19. Zolpidem Induced Sleep-related Eating and Complex Behaviors in a Patient with Obstructive Sleep Apnea and Restless Legs Syndrome

    PubMed Central

    Park, Young-Min; Shin, Hyun-Woo

    2016-01-01

    Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA). His baseline serum iron level was low at admission. Zolpidem discontinuation resulted in the immediate disappearance of his SRED, but did not affect his RLS symptoms. These symptoms rapidly improved after adding a single i.v. iron injection once daily, and so he was discharged to day-clinic treatment. These findings indicate that zolpidem can induce SRCB. Although the pathophysiology of zolpidem-induced SRED and other SRCB remains unclear, clinicians should carefully monitor for the potential induction of complex behaviors associated with zolpidem in patients with comorbid RLS or OSA. PMID:27489385

  20. [Acute correction of nocturnal hypoxemia and sleep pattern using continuous nasal positive pressure in patients with obstructive sleep apnea syndrome].

    PubMed

    Díaz, M; Rendón, A; Cano, M E

    1998-01-01

    In order to find out the effectiveness of the nasal CPAP in the treatment of obstructive sleep apnea (OSA), we studied 30 patients with this diagnosis corroborated by nocturnal polysomnography. The average age was 46.37 +/- 11.58 years, 97% were males and 90% were overweight, with a weight of 101.24 +/- 15.57 Kg. All the patients were evaluated before and after the application of nasal CPAP with a pressure of 12.9 +/- 4.35 cm of H2O with a FIO2 of 21%. The sleep efficiency index improved from 0.62 +/- 0.03 to 0.84 +/- 0.02 (p < 0.0001). The maximum duration of the apneas diminished from 65.5 +/- 6.5 seconds to 19 +/- 3.7 seconds (p < 0.0001), and the minimum level of O2 saturation of the hemoglobin increased from 56.8 +/- 3.2% to 84.9 +/- 1.9% (p < 00.0001). These findings showed a clear improvement in the majority of the evaluated parameters in all of the patients, and, in many of them, a normalization. We conclude that the nasal CPAP is effective for the acute improvement of the disorders observed during the sleep in patients with OSA, which supports its therapeutic use in this illness. PMID:9927773

  1. Restoring the salivary cortisol awakening response through nasal continuous positive airway pressure therapy in obstructive sleep apnea.

    PubMed

    Ghiciuc, Cristina Mihaela; Dima Cozma, Lucia Corina; Bercea, Raluca Mihaela; Lupusoru, Catalina Elena; Mihaescu, Traian; Szalontay, Andreea; Gianfreda, Angela; Patacchioli, Francesca Romana

    2013-10-01

    Partial and largely conflicting data are currently available on the interplay between obstructive sleep apnea (OSA) and hypothalamus-pituitary-adrenal axis (HPA) activity in adult obese men. This study was performed to evaluate the daily trajectories of salivary cortisol, specifically with respect to the salivary cortisol awakening response (CAR), a common method used to assess HPA axis activity. The main findings of this study were that adult male obese subjects who were newly diagnosed with severe OSA showed the following: (1) a flattening of the CAR; (2) levels of cortisol at awakening that were lower than those of the controls; and (3) maintenance of the physiological circadian activity of the HPA axis, with the highest hormone concentrations produced in the morning and the lowest in the evening. This study was also designed to investigate the effects of 3 and 6 mos of treatment with continuous airways positive pressure (CPAP). CPAP use resulted in a significant recovery of the sleep patterns disrupted by OSA; moreover, mild neuropsychological signs of depression and anxiety in severe OSA patients were concomitantly progressively improved by CPAP treatment. Furthermore, this study reports that 3 and 6 mos of CPAP therapy restored the presence of CAR and was able to significantly reduce the difference in the morning cortisol levels between the OSA and control groups. In conclusion, we report here that compared with obese nonapneic matched controls, OSA patients present a dysregulation of HPA axis activity, as shown by the flattening of the diurnal pattern of cortisol production in response to repeated challenge due to hypoxia and sleep fragmentation. This dysregulation was especially detectable in the first hour after awakening and restored after 3 and 6 mos of treatment with CPAP. PMID:23859257

  2. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances

    PubMed Central

    Black, David S.; O’Reilly, Gillian A.; Olmstead, Richard; Breen, Elizabeth C.; Irwin, Michael R.

    2015-01-01

    IMPORTANCE Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep. OBJECTIVE To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5). INTERVENTIONS A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework. MAIN OUTCOMES AND MEASURES The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)–κB. RESULTS Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95%CI, 0.6–2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P

  3. Clinical Effect of Surgical Correction for Nasal Pathology on the Treatment of Obstructive Sleep Apnea Syndrome

    PubMed Central

    Park, Chong Yoon; Hong, Joon Hyeong; Lee, Jae Heon; Lee, Kyu Eun; Cho, Hyun Sang; Lim, Su Jin; Kwak, Jin Wook; Kim, Kyung Soo; Kim, Hyun Jik

    2014-01-01

    Objectives This study aimed to evaluate the hypothesis that relief of nasal obstruction in subjects with obstructive sleep apnea (OSA) would lead to reduce OSA severity and to discuss the available evidence on the clinical efficacy of nasal surgery as a treatment modality for OSA. Study Design Twenty-five subjects who had reduced patency of nasal cavity and narrowing of retroglossal or retropalatal airways were diagnosed with OSA and underwent nasal surgery, such as septoplasty or turbinoplasty to correct nasal pathologies. The effect of the surgery on nasal patency was quantified by measuring minimal cross-sectional area (MCA) using acoustic rhinometry. The watch-PAT-derived respiratory disturbance index (RDI), apnea and hypopnea index (AHI), lowest oxygen saturation, and valid sleep time were measured before and after nasal surgery. Results The present study shows that the AHI and RDI decreased significantly and the lowest oxygen saturation and valid sleep time rose after nasal surgery in 25 OSA subjects. In addition, a reduction in subjective symptoms was observed in subjects and mean MCA increased after nasal surgery. Fourteen subjects were classified as responders and 11 subjects as non-responders. Responders showed considerable improvement of their subjective symptoms and the AHI and RDI were significantly lower after surgery. We found that the changes between pre- and post-operative AHI and RDI values were minimal in 11 non-responders. However, daytime somnolence and REM sleep time improved after nasal surgery in non-responders. Conclusions Our study provides evidence that the surgical treatment of nasal pathology improves nasal airway patency and reduces OSA severity in 56% subjects. Furthermore, correction of nasal pathology appears to result in improved sleep quality in both responder and non-responders OSA subjects. PMID:24896824

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

    PubMed Central

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

    2013-01-01

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

  5. A systematic review of pharmacists performing obstructive sleep apnea screening services.

    PubMed

    Cawley, Michael J; Warning, William J

    2016-08-01

    Background Obstructive sleep apnea (OSA) is a chronic sleep disorder associated with a varying degree of upper airway collapse during sleep. Left untreated, OSA can lead to the development of cardiovascular disease including risk of stroke and increased mortality. Pharmacists are the most accessible and underutilized healthcare resource in the community and can have a significant role in screening patients for OSA. The result may include an expedited referral to the patient's general practitioners or sleep disorder specialists for further diagnostic assessment and therapeutic intervention. Aim of the review The primary aim of this review was to identify the current published evidence of pharmacists providing OSA screening services in a community pharmacy setting. Methods A literature search was conducted to identify evidence of pharmacists providing OSA screening services. The literature search including five databases [PubMed, (1946-January 2015), Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts (1970 to January 2015), Cochrane Database of Systematic Reviews and Google Scholar] with search terms of ("pharmacist or pharmacy") AND ("obstructive sleep apnea") AND ("sleep disorders") AND ("continuous positive airway pressure-CPAP") were used. Articles were limited to English and reported in humans. Results A total of seven publications (four Australia, two Switzerland and one France) were selected and evaluated. Pharmacists utilized validated screening tools in 6/7 (86 %) of clinical studies to assist in the identification of patients with sleep disorders in community pharmacies. A total of 1701 pharmacies encompassing 9177 patients were screened in the clinical studies. Pharmacists were able to identify between 21.4 and 67 % of patients that were at risk for developing OSA or required a referral to a general practitioner or sleep disorder specialist for further diagnostic testing. Conclusion Studies assessing the role

  6. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

    PubMed Central

    Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

    2015-01-01

    The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. SLEEP 2015;38(8):1161–1183. PMID:26194576

  7. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

    PubMed Central

    Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

    2015-01-01

    The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med 2015;11(8):931–952. PMID:26235159

  8. 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

  9. 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

  10. Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches.

    PubMed

    Yaggi, Henry Klar; Mittleman, Murray A; Bravata, Dawn M; Concato, John; Ware, James; Stoney, Catherine M; Redline, Susan

    2016-02-01

    Obstructive sleep apnea (OSA) significantly impacts cardiovascular health, demonstrated by observational investigations showing an independently increased risk of ischemic heart disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, cardiovascular mortality, and all-cause mortality. Positive airway pressure (PAP), a medical therapy for sleep apnea, reverses airway obstruction and may help reduce cardiovascular risk. Prior to planning large phase III randomized controlled trials to test the impact of PAP on cardiovascular outcomes, several gaps in knowledge need to be addressed. This article describes 2 independent studies that worked collaboratively to fill these gaps. The populations, design features, and relative benefits/challenges of the 2 studies (SleepTight and BestAIR) are described. Both studies were encouraged to have multidisciplinary teams with expertise in behavioral interventions to improve PAP compliance. Both studies provide key information that will be useful to the research community in future large-scale, event-driven, randomized trials to evaluate the efficacy and/or effectiveness of strategies to identify and treat significant OSA for decreasing risk of major adverse cardiovascular events in high-risk patients. PMID:26856225

  11. An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea

    PubMed Central

    Kim, Richard D.; Kapur, Vishesh K.; Redline-Bruch, Julie; Rueschman, Michael; Auckley, Dennis H.; Benca, Ruth M.; Foldvary-Schafer, Nancy R.; Iber, Conrad; Zee, Phyllis C.; Rosen, Carol L.; Redline, Susan; Ramsey, Scott D.

    2015-01-01

    Study Objectives: We conducted an economic analysis of the HomePAP study, a multicenter randomized clinical trial that compared home-based versus laboratory-based testing for the diagnosis and management of obstructive sleep apnea (OSA). Design: A cost-minimization analysis from the payer and provider perspectives was performed, given that 3-mo clinical outcomes were equivalent. Setting: Seven academic sleep centers. Participants: There were 373 subjects at high risk for moderate to severe OSA. Interventions: Subjects were randomized to either home-based limited channel portable monitoring followed by unattended autotitration with continuous positive airway pressure (CPAP), versus a traditional pathway of in-laboratory sleep study and CPAP titration. Measurements and Results: From the payer perspective, per subject costs for the laboratory-based pathway were $1,840 (95% confidence interval [CI] $1,660, $2,015) compared to $1,575 (95% CI $1,439, $1,716) for the home-based pathway under the base case. Costs were $264 (95% CI $39, $496, P = 0.02) in favor of the home arm. From the provider perspective, per subject costs for the laboratory arm were $1,697 (95% CI $1,566, $1,826) compared to $1,736 (95% CI $1,621, $1,857) in the home arm, for a difference of $40 (95% CI −$213, $142, P = 0.66) in favor of the laboratory arm under the base case. The provider operating margin was $142 (95% CI $85, $202,P < 0.01) in the laboratory arm, compared to a loss of −$161 (95% CI −$202, −$120, P < 0.01) in the home arm. Conclusions: For payers, a home-based diagnostic pathway for obstructive sleep apnea with robust patient support incurs fewer costs than a laboratory-based pathway. For providers, costs are comparable if not higher, resulting in a negative operating margin. Clinicaltrials.gov Identifier: NCT00642486. Citation: Kim RD, Kapur VK, Redline-Bruch J, Rueschman M, Auckley DH, Benca RM, Foldvary-Schafer NR, Iber C, Zee PC, Rosen CL, Redline S, Ramsey SD. An economic

  12. Study of a Novel APAP Algorithm for the Treatment of Obstructive Sleep Apnea in Women

    PubMed Central

    McArdle, Nigel; King, Stuart; Shepherd, Kelly; Baker, Vanessa; Ramanan, Dinesh; Ketheeswaran, Sahisha; Bateman, Peter; Wimms, Alison; Armitstead, Jeff; Richards, Glenn; Hillman, David; Eastwood, Peter

    2015-01-01

    Study Objectives: To assess the efficacy of a novel female-specific autotitrating continuous positive airway pressure (CPAP) algorithm (AutoSet for her, AfH) in premenopausal women relative to a standard autotitrating algorithm (AutoSet, S9) (ResMed Ltd., Bella Vista, New South Wales, Australia). Design: Prospective randomised crossover noninferiority trial. Setting: Tertiary hospital sleep clinic and university research sleep laboratory. Participants: 20 female patients with obstructive sleep apnea (OSA) established on long-term CPAP treatment. Interventions: Treatment with 1 night each of AfH and AutoSet while monitored with overnight laboratory-based polysomnography (PSG); order randomly allocated. Measurements and Results: The primary outcome variables were the apnea-hypopnea index (AHI) and 3% oxygen desaturation index (ODI 3%) determined from PSG. Treatment efficacy on the AfH night was noninferior to the AutoSet night as assessed by median (IQR) AHI (1.2 [0.60–1.85]/h versus 1.15 [0.40–2.85]/h, respectively, P = 0.51) and 3% ODI (0.85 [0.25–1.5]/h versus 0.5 [0.25–2.55]/h, respectively, P = 0.83). Other PSG measures were similar, except for the percentage of the night spent in flow limitation, which was lower on the AfH (0.14%) than the AutoSet night (0.19%, P = 0.007). The device-downloaded 95th centile pressure on the AfH night was also lower than on the AutoSet night (10.6 ± 1.7 versus 11.6 ± 2.6 cmH2O, respectively; mean difference [95% confidence interval]: −1.1 [−2.13 to −0.01] cm H2O). Conclusion: Among premenopausal women a novel female-specific autotitrating algorithm (AfH) is as effective as the standard AutoSet algorithm in controlling obstructive sleep apnea (OSA). The new algorithm may reduce flow limitation more than the standard algorithm and achieve control of OSA at a lower (95th centile) pressure. Citation: McArdle N, King S, Shepherd K, Baker V, Ramanan D, Ketheeswaran S, Bateman P, Wimms A, Armitstead J, Richards G

  13. Cerebral Blood Flow Response to Hypercapnia in Children with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Busch, David R.; Lynch, Jennifer M.; Winters, Madeline E.; McCarthy, Ann L.; Newland, John J.; Ko, Tiffany; Cornaglia, Mary Anne; Radcliffe, Jerilynn; McDonough, Joseph M.; Samuel, John; Matthews, Edward; Xiao, Rui; Yodh, Arjun G.; Marcus, Carole L.; Licht, Daniel J.; Tapia, Ignacio E.

    2016-01-01

    Study Objectives: Children with obstructive sleep apnea syndrome (OSAS) often experience periods of hypercapnia during sleep, a potent stimulator of cerebral blood flow (CBF). Considering this hypercapnia exposure during sleep, it is possible that children with OSAS have abnormal CBF responses to hypercapnia even during wakefulness. Therefore, we hypothesized that children with OSAS have blunted CBF response to hypercapnia during wakefulness, compared to snorers and controls. Methods: CBF changes during hypercapnic ventilatory response (HCVR) were tested in children with OSAS, snorers, and healthy controls using diffuse correlation spectroscopy (DCS). Peak CBF changes with respect to pre-hypercapnic baseline were measured for each group. The study was conducted at an academic pediatric sleep center. Results: Twelve children with OSAS (aged 10.1 ± 2.5 [mean ± standard deviation] y, obstructive apnea hypopnea index [AHI] = 9.4 [5.1–15.4] [median, interquartile range] events/hour), eight snorers (11 ± 3 y, 0.5 [0–1.3] events/hour), and 10 controls (11.4 ± 2.6 y, 0.3 [0.2–0.4] events/hour) were studied. The fractional CBF change during hypercapnia, normalized to the change in end-tidal carbon dioxide, was significantly higher in controls (9 ± 1.8 %/mmHg) compared to OSAS (7.1 ± 1.5, P = 0.023) and snorers (6.7 ± 1.9, P = 0.025). Conclusions: Children with OSAS and snorers have blunted CBF response to hypercapnia during wakefulness compared to controls. Noninvasive DCS blood flow measurements of hypercapnic reactivity offer insights into physiopathology of OSAS in children, which could lead to further understanding about the central nervous system complications of OSAS. Citation: Busch DR, Lynch JM, Winters ME, McCarthy AL, Newland JJ, Ko T, Cornaglia MA, Radcliffe J, McDonough JM, Samuel J, Matthews E, Xiao R, Yodh AG, Marcus CL, Licht DJ, Tapia IE. Cerebral blood flow response to hypercapnia in children with obstructive sleep apnea syndrome. SLEEP 2016

  14. Circadian Sleep-Wake Rhythm of Older Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Maaskant, Marijke; van de Wouw, Ellen; van Wijck, Ruud; Evenhuis, Heleen M.; Echteld, Michael A.

    2013-01-01

    The circadian sleep-wake rhythm changes with aging, resulting in a more fragmented sleep-wake pattern. In individuals with intellectual disabilities (ID), brain structures regulating the sleep-wake rhythm might be affected. The aims of this study were to compare the sleep-wake rhythm of older adults with ID to that of older adults in the general…

  15. 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

  16. The Effect of Sleep Continuity on Pain in Adults with Sickle Cell Disease

    PubMed Central

    Moscou-Jackson, Gyasi; Finan, Patrick H.; Campbell, Claudia M.; Smyth, Joshua M.; Haythornthwaite, Jennifer A.

    2015-01-01

    This analysis examined the influence of quantifiable parameters of daily sleep continuity, primarily sleep duration and sleep fragmentation, on daily pain in adults with Sickle Cell Disease (SCD). Seventy-five adults with SCD completed baseline psychosocial measures and daily morning (sleep) and evening (pain) diaries over a three-month period. Mixed-effect modeling was used to examine daily between- and within-subjects effects of sleep continuity parameters on pain, as well as the synergistic effect of sleep fragmentation and sleep duration on pain. Results revealed nights of shorter sleep duration and time in bed, increased fragmentation, and less efficient sleep (relative to one’s own mean) were followed by days of greater pain severity. Further, the analgesic benefit of longer sleep duration was attenuated when sleep fragmentation was elevated. These results suggest that both the separate and combined effects of sleep duration and fragmentation should be considered in evaluating pain in adults with SCD. PMID:25842346

  17. Sleep in older adults: normative changes, sleep disorders, and treatment options.

    PubMed

    Gooneratne, Nalaka S; Vitiello, Michael V

    2014-08-01

    Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. It is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter having associated daytime impairments. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective with sustained benefit. Pharmacologic therapies are also available, but may be associated with psychomotor effects. A high index of suspicion is crucial for effective diagnosis of sleep apnea because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients. PMID:25037297

  18. Sleep-Dependent Consolidation of Procedural Motor Memories in Children and Adults: The Pre-Sleep Level of Performance Matters

    ERIC Educational Resources Information Center

    Wilhelm, Ines; Metzkow-Meszaros, Maila; Knapp, Susanne; Born, Jan

    2012-01-01

    In striking contrast to adults, in children sleep following training a motor task did not induce the expected (offline) gain in motor skill performance in previous studies. Children normally perform at distinctly lower levels than adults. Moreover, evidence in adults suggests that sleep dependent offline gains in skill essentially depend on the…

  19. Adult midgut malrotation presented with acute bowel obstruction and ischemia

    PubMed Central

    Zengin, Akile; Uçar, Bercis İmge; Düzgün, Şükrü Aydın; Bayhan, Zülfü; Zeren, Sezgin; Yaylak, Faik; Şanal, Bekir; Bayhan, Nilüfer Araz

    2016-01-01

    Introduction Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Presentation of case 40 years old female patient admitted to emergency service with acute abdomen and computerized tomography scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating “whirpool sign”. Discussion Malrotation in adults is a rare cause of midgut volvulus as though it should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Even though clinical symptoms are obscure, adult patients usually present with vomiting and recurrent abdominal pain due to chronic partial obstruction. Contrast enhanced radiograph has been shown to be the most accurate method. Typical radiological signs are corkscrew sign, which is caused by the dilatation of various duodenal segments at different levels and the relocation of duodenojejunal junction due to jejunum folding. As malrotation commonly causes intestinal obstruction, patients deserve an elective laparotomy. Conclusion Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality. PMID:27015011

  20. Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea

    PubMed Central

    2013-01-01

    Background Exercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea. Methods Forty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment. Results After two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564). Conclusion Nocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome. Trial registration NCT00914264 PMID:23782492

  1. Assessment of Surgical Effects on Patients with Obstructive Sleep Apnea Syndrome Using Computational Fluid Dynamics Simulations

    PubMed Central

    Cheng, Gary C.; Koomullil, Roy P.; Ito, Yasushi; Shih, Alan M.; Sittitavornwong, Somsak; Waite, Peter D.

    2013-01-01

    Obstructive sleep apnea syndrome is one of the most common sleep disorders. To treat patients with this health problem, it is important to detect the severity of this syndrome and occlusion sites in each patient. The goal of this study is to test the hypothesis that the cure of obstructive sleep apnea syndrome by maxillomandibular advancement surgery can be predicted by analyzing the effect of anatomical airway changes on the pressure effort required for normal breathing using a high-fidelity, 3-D numerical model. The employed numerical model consists of: 1) 3-D upper airway geometry construction from patient-specific computed tomographic scans using an image segmentation technique, 2) mixed-element mesh generation of the numerically constructed airway geometry for discretizing the domain of interest, and 3) computational fluid dynamics simulations for predicting the flow field within the airway and the degree of severity of breathing obstruction. In the present study, both laminar and turbulent flow simulations were performed to predict the flow field in the upper airway of the selected patients before and after maxillomandibular advancement surgery. Patients of different body mass indices were also studied to assess their effects. The numerical results were analyzed to evaluate the pressure gradient along the upper airway. The magnitude of the pressure gradient is regarded as the pressure effort required for breathing, and the extent of reduction of the pressure effort is taken to measure the success of the surgery. The description of the employed numerical model, numerical results from simulations of various patients, and suggestion for future work are detailed in this paper. PMID:25530663

  2. 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

  3. High altitude, continuous positive airway pressure, and obstructive sleep apnea: subjective observations and objective data.

    PubMed

    Ginosar, Yehuda; Malhotra, Atul; Schwartz, Eli

    2013-06-01

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

  4. [Effect of CPAP and BIPAP on stroke volume in patients with obstructive sleep apnea syndrome].

    PubMed

    Weber, U; Kellner, C; Burbach, R; Kirchheiner, T; Rühle, K H

    1995-03-01

    We studied the effect of CPAP and BIPAP on cardiac output (CO) in 23 male obstructive sleep apnea (OSAS) patients with cardiac history but without congestive heart failure (CHF) during wakefulness using the thermodilution method. CPAP was applied at 10 cm H2O and 15 cm H2O, BIPAP at 10/0 cm H2O and 15/10 cm H2O. CO only decreased significantly by 14.6 +/- 11.8% at 15 cm H2O CPAP and by 13.4 +/- 10.0% at 15/10 cm H2O BIPAP. CPAP and BIPAP did not differ in altering hemodynamics. So sleep apnea patients without CHF develop no severe decrease of CO during nasal positive pressure ventilation up to 15 cm 2O. PMID:7753770

  5. 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

  6. Obstructive sleep apnea syndrome: An important piece in the puzzle of cardiovascular risk factors.

    PubMed

    Costa, Cátia; Santos, Beatriz; Severino, Davide; Cabanelas, Nuno; Peres, Marisa; Monteiro, Isabel; Leal, Margarida

    2015-01-01

    The obstructive sleep apnea syndrome (OSA) is a clinical entity characterized by recurring episodes of apnea and/or hypopnea during sleep, due to a total or partial collapse, respectively, of the upper airway. This collapse originates a set of pathophysiological changes that determine the appearance of several cardiovascular complications. OSA contributes for the development of hypertension, heart failure, arrhythmias and coronary heart disease. Nowadays it is recognized to be an important public health problem, taking into account not just its repercussions but also its prevalence, since the main risk factor for the disease is obesity, a growing problem worldwide, both in developed and developing countries. The present review summarizes the current knowledge about OSA, as regards its definition, pathophysiology, clinical manifestations, diagnosis, cardiovascular effects and treatment. PMID:25496654

  7. The importance of nasal resistance in obstructive sleep apnea syndrome: a study with positional rhinomanometry.

    PubMed

    De Vito, A; Berrettini, S; Carabelli, A; Sellari-Franceschini, S; Bonanni, E; Gori, S; Pasquali, L; Murri, L

    2001-01-01

    The importance of nasal obstruction in the pathogenesis of obstructive sleep apnea syndrome (OSAS) has not yet been totally defined. Numerous studies have reported an association between nasal obstruction and OSAS, but the precise nature of this relationship remains to be clarified. This study was undertaken to evaluate the prevalence of nasal obstruction disorders in a group of OSAS patients. For this purpose, we analyzed the nasal resistance of 36 OSAS patients by performing a traditional basal anterior active rhinomanometry test (AAR) and a positional AAR, with the patient in a supine position. Seven patients had a pathologic nasal resistance in the seated position that increased further in the supine position; 9 patients had normal resistance in the seated position but a pathologic resistance in the supine position. In 20 patients, nasal resistance was normal in both positions. No statistically significant differences in the degree of apnea/hypopnea index (AHI) was found between the 20 patients with normal positional AAR and the 16 with pathologic positional AAR (p = 0.13). Moreover, no statistically significant differences in the degree of AHI was found between the 7 patients with pathologic basal and positional AAR and the 9 patients with normal basal AAR and pathologic positional AAR (p = 0.38). PMID:11868135

  8. Eclampsia as a cause of secondary non-obstructive central sleep hypoventilation.

    PubMed

    Štourač, P; Hradilová, T; Straževská, E; Turčáni, P; Štouračová, A; Janků, P; Skřičková, J; Gál, R

    2015-01-01

    The central alveolar hypoventilation of Ondine's curse is a disorder characterized by absent or diminished ventilatory response to hypercapnia, hypoxia or both, with parallel decrease in saturation to 50%. The secondary form may begin mainly after insult that affects the brain stem. We present a case of a 24-years old primipara in the 41st gestational week with an uncomplicated course of pregnancy and with secondary non-obstructive sleeping hypoventilation which occurred after eclamptic seizure. This obstetric case provides evidence for the benefit of home BiPAP use for patients with secondary Ondine's curse. PMID:25723073

  9. Treatment of obstructive sleep apnea with mandibular advancement appliance over prostheses: A case report

    PubMed Central

    Guimarães, Thais Moura; Colen, Sâmia; Cunali, Paulo Afonso; Rossi, Rowdley; Dal-Fabbro, Cibele; Ferraz, Otávio; Tufik, Sergio; Bittencourt, Lia

    2015-01-01

    Treatment with a mandibular advancement device (MAD) is recommended for mild obstructive sleep apnea (OSA), primary snoring and as a secondary option for Continuous Positive Airway Pressure, because it has better adherence and acceptance. However, edentulous patients do not have supports to hold the MAD. This study aimed to present a possible to OSA treatment with MAD in over complete upper and partial lower dentures. The patient, a 38-year-old female with mild OSA, was treated with a MAD. The respiratory parameter, such as apnea–hypopnea index, arousal index and oxyhemoglobin saturation was improved after treatment. PMID:26483952

  10. Exhaled breath analysis, a simple tool to study the pathophysiology of obstructive sleep apnoea.

    PubMed

    Bikov, Andras; Hull, James H; Kunos, Laszlo

    2016-06-01

    Accelerated airway inflammation may play a crucial role in the pathophysiology of obstructive sleep apnoea (OSA); however this phenomenon has been investigated only in a limited number of studies. The analysis of exhaled breath represents a promising, non-invasive tool to evaluate airway inflammation in this context. The knowledge on exhaled biomarkers in OSA has been growing with an emerging number of methodological studies which help to interpret exhaled breath data. This article not only summarises the results of studies on exhaled breath condensate (EBC) biomarkers, exhaled volatile compounds and exhaled monoxides in OSA, but also aims to critically review methodological limitations and provide some guideline for further research. PMID:26426372

  11. Obstructive sleep apnea syndrome in children: controversies in diagnosis and treatment.

    PubMed

    Rosen, Carol L

    2004-02-01

    Obstructive sleep apnea syndrome (OSAS) is a common, under-recognized condition in childhood with significant morbidities if undiagnosed and untreated. The American Academy of Pediatrics recently issued a clinical practice guideline for the diagnosis and management of childhood OSAS. It was accompanied by a comprehensive evidence-based technical report that summarized the available literature supporting the guideline. The current review highlights areas of controversy and uncertainty that limit the development of more definitive standards of practice, updates the reader to several newer publications relevant to diagnosis and treatment of childhood OSAS, and identifies future directions for clinical research. PMID:15008587

  12. 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

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

    PubMed Central

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

    2014-01-01

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

  14. Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization: Causes and Management.

    PubMed

    Chapman, Julia L; Serinel, Yasmina; Marshall, Nathaniel S; Grunstein, Ronald R

    2016-09-01

    Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. Individual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness. Modafinil and armodafinil are the only pharmacologic agents indicated for residual sleepiness in these patients. PMID:27542881

  15. Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge

    PubMed Central

    Redhu, Shruti; Prakash, Prabhakar Suman; Jain, Virendra; Dash, Hari Hara

    2016-01-01

    Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery. PMID:27330205

  16. Speech Signal and Facial Image Processing for Obstructive Sleep Apnea Assessment

    PubMed Central

    Espinoza-Cuadros, Fernando; Fernández-Pozo, Rubén; Toledano, Doroteo T.; Alcázar-Ramírez, José D.; López-Gonzalo, Eduardo; Hernández-Gómez, Luis A.

    2015-01-01

    Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients' facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI. PMID:26664493

  17. Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea

    PubMed Central

    White, Laura H; Bradley, T Douglas

    2013-01-01

    Obstructive sleep apnoea (OSA) is common in the general population and increases the risk of motor vehicle accidents due to hypersomnolence from sleep disruption, and risk of cardiovascular diseases owing to repetitive hypoxia, sympathetic nervous system activation, and systemic inflammation. In contrast, central sleep apnoea (CSA) is rare in the general population. Although their pathogenesis is multifactorial, the prevalence of both OSA and CSA is increased in patients with fluid retaining states, especially heart failure, where they are associated with increased mortality risk. This observation suggests that fluid retention may contribute to the pathogenesis of both OSA and CSA. According to this hypothesis, during the day fluid accumulates in the intravascular and interstitial spaces of the legs due to gravity, and upon lying down at night redistributes rostrally, again owing to gravity. Some of this fluid may accumulate in the neck, increasing tissue pressure and causing the upper airway to narrow, thereby increasing its collapsibility and predisposing to OSA. In heart failure patients, with increased rostral fluid shift, fluid may additionally accumulate in the lungs, provoking hyperventilation and hypocapnia, driving below the apnoea threshold, leading to CSA. This review article will explore mechanisms by which overnight rostral fluid shift, and its prevention, can contribute to the pathogenesis and therapy of sleep apnoea. PMID:23230237

  18. Contesting medicalisation, doubting the diagnosis: patients' ambivalence towards the diagnosis of Obstructive Sleep Apnoea.

    PubMed

    Zarhin, Dana

    2015-06-01

    Whereas social scientific studies have investigated the emergence of the category Obstructive Sleep Apnoea (OSA), the most commonly diagnosed sleep disorder, no study has examined whether and how the ways in which OSA emerged affect patients' reception of the diagnosis. This article fills this gap by drawing upon in-depth interviews with 65 Israelis who received a laboratory diagnosis of OSA. This study finds that many patients doubt the accuracy of their diagnosis, and argues that this scepticism derives from contested macro-level medicalisation processes that preceed and surround the development of OSA as a diagnostic category. Specifically, past and present controversies over the definitions of OSA and its precursor the 'Pickwickian syndrome' created images of 'OSA patients' as sleepy and obese. Consequently, patients whose self-perception conflicted with this image questioned their diagnosis. Other patients argued that one night of sleep at a laboratory could not reflect their quality of sleep at home, thereby implicitly criticising the ways in which OSA was medicalised. This study enhances our understanding of the underexplored dynamics between the macro and micro levels of medicalisation. PMID:25683493

  19. Obstructive sleep apnea syndrome and non-arteritic anterior ischemic optic neuropathy: a case control study

    PubMed Central

    Ghaleh Bandi, Mir Farhad; Naserbakht, Morteza; Tabasi, Abdolreza; Marghaiezadeh, Azin; Riazee Esfahani, Mohammad; Golzarian, Zohre

    2015-01-01

    Background: Sleep apnea is temporary cessation or absence of breathing during sleep. Significant increase in blood pressure is clinically seen in apneic episodes. The aim of this study was to examine sleep apnea syndrome as a risk factor for non- arthritic anterior ischemic optic neuropathy (NAION) in a case control study. Methods: Nineteen NAION patients (9 men and 10 women) and 31 age and sex matched control participants (18 men and 13 women) were evaluated for obstructive sleep apnea syndrome (OSAS). Full night polysomnography was performed and proportion of OSAS was compared between the NAION patients and the control group. Other risk factors for NAION such as hypertension, diabetes, hyperlipidemia, ischemic heart disease and tobacco consumption were also evaluated. Chi square test and independent samples t-test were used for statistical analysis. Results: OF the 19 NAION patients, 18 (95%) had OSAS, and of the control group 13 (41.9%) had OSAS. The frequency of OSAS was significantly higher among NAION patients compared to the controls (p< 0.001). The Mean Respiratory Disturbance Index (RDI) was 37.65/h SD= 37.61/h in NAION patients and it was 15.05/h SD= 11.97/h (p= 0.018) in controls. The frequency of diabetes and hypertension was significantly higher in the NAION patients than in controls. Conclusion: based on the results of this study, it seems that there is an association between NAION and OSAS. PMID:26913263

  20. Speech Signal and Facial Image Processing for Obstructive Sleep Apnea Assessment.

    PubMed

    Espinoza-Cuadros, Fernando; Fernández-Pozo, Rubén; Toledano, Doroteo T; Alcázar-Ramírez, José D; López-Gonzalo, Eduardo; Hernández-Gómez, Luis A

    2015-01-01

    Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients' facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI. PMID:26664493

  1. Sleep hypoventilation and daytime hypercapnia in stable chronic obstructive pulmonary disease

    PubMed Central

    Holmedahl, Nils Henrik; Øverland, Britt; Fondenes, Ove; Ellingsen, Ivar; Hardie, Jon Andrew

    2014-01-01

    Purpose To explore the associations between sleep hypoventilation (SH) and daytime arterial pressures of carbon dioxide (PaCO2), sleep stages, and sleep apneas/hypopneas (AHI) in subjects with chronic obstructive pulmonary disease (COPD). SH has previously been found in COPD-subjects with chronic hypercapnic respiratory failure (CHRF) using supplementary oxygen (LTOT), and has been proposed as a possible predictor for CHRF. Patients and methods A prospectively designed observational study in a pulmonary rehabilitation hospital of 100 (39 male) stable COPD inpatients with a mean forced expiratory volume in 1 second (FEV1) of 1.1 L (42% of predicted) and a mean age of 64 years, using polysomnography with transcutaneous measurement of carbon dioxide pressure increase (ΔPtcCO2). Results SH as defined by the American Academy of Sleep Medicine (AASM) was found in 15 of the subjects, seven of whom used LTOT. However, six had SH despite being normocapnic during the daytime (only one on LTOT). Subjects with SH had a greater ΔPtcCO2 increase from nonrapid eye movement (NREM) to rapid eye movement (REM) sleep stages compared to non-SH subjects (mean [standard deviation] between-groups difference =0.23(0.20) kPa, P<0.0005). Subjects with apnea/hypopnea index ≥15 (overlap, N=27) did not differ from those with COPD alone (AHI <5, N=25) in sleep ΔPtcCO2 or daytime PaCO2. A regression model with the variables FEV1, LTOT, and sleep maximum ΔPtcCO2 explained 56% of the variance in daytime PaCO2 (F(3, 94) =40.37, P<0.001). Conclusion In stable COPD, SH as defined by the AASM was found both in normocapnic, non-LTOT subjects and in hypercapnic, LTOT-using subjects. Between-sleep-stage increase in ΔPtcCO2 was higher in subjects with SH. Overlap subjects did not differ from simple COPD subjects in sleep ΔPtcCO2 or daytime PaCO2. PMID:24600219

  2. A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea

    PubMed Central

    Colrain, Ian M.; Black, Jed; Siegel, Lawrence C.; Bogan, Richard K.; Becker, Philip M.; Farid-Moayer, Mehran; Goldberg, Rochelle; Lankford, D. Alan; Goldberg, Andrew N.; Malhotra, Atul

    2013-01-01

    Objective We aimed to evaluate the impact of a novel noninvasive oral pressure therapy (OPT) (Winx®, ApniCure) system on polysomnographic measures of sleep-disordered breathing, sleep architecture, and sleep stability in obstructive sleep apnea (OSA). Subjects and methods A 4-week, multicenter, prospective, open-label, randomized, crossover, first-night order of control vs treatment, single-arm trial was conducted in five American Academy of Sleep Medicine (AASM) – accredited sleep clinics and one research laboratory. Sixty-three subjects (analysis cohort) were studied from a screening cohort of 367 subjects. The analysis cohort was 69.8% men, ages 53.6 ± 8.9 years (mean ± SD), body mass index of 32.3 ± 4.5 kg/m2, with mild to severe OSA. At treatment initiation, subjects received random assignment to one night with and one without (control) treatment, and they were assessed again following 28 nights of treatment. Breathing and sleep architecture were assessed each night based on blind scoring by a single centralized scorer using AASM criteria. Results Average nightly usage across the take-home period was 6.0 ± 1.4 h. There were no severe or serious device-related adverse events (AEs). Median apnea–hypopnea index (AHI) was 27.5 events per hour on the control night, 13.4 events per hour on the first treatment night, and 14.8 events per hour after 28 days of treatment. A clinically significant response (treatment AHI ≤10/h and ≤50% of control values) was seen in 20 of the 63 subjects evaluated. Rapid eye movement percentage (REM%) was significantly increased, and N1%, stage shifts to N1 sleep, overall stage shifts, total awakenings, and arousals per hour were all significantly reduced at both treatment nights compared to controls. Mean Epworth sleepiness scale (ESS) was significantly reduced from 12.1 to 8.6 (Cohen d effect size, 0.68) in those untreated for two or more weeks prior to OPT study participation and remained unchanged in subjects who

  3. [Airway rescue in a patient with severe obstructive sleep apnea syndrome and impossible ventilation after induction of general anesthesia].

    PubMed

    Komasawa, Nobuyasu; Kusunoki, Tomohiro; Soen, Masako; Minami, Toshiaki

    2014-06-01

    We report the successful rescue ventilation of a patient with severe obstructive sleep apnea syndrome after induction of general anesthesia using the i-gel supraglottic airway device. A 55-year-old man was scheduled for resection of a cerebellopontine angle tumor. He suffered from severe obstructive sleep apnea syndrome and routinely used continuous positive airway pressure. His apnea hypopnea index was 57.8. Manual assisted ventilation following propofol and fentanyl administration was successful. On rocuronium administration, manual ventilation became impossible and oropharyngeal airway could not release this condition. We immediately inserted the i-gel device to provide sufficient ventilation. As tracheal intubation with the i-gel device was difficult, we intubated a spiral tube (internal diameter, 8.0 mm) using the Pentax-AWS Airwayscope. Our findings suggest that the i-gel device may be useful for emergent airway rescue in the event of impossible ventilation for patients with severe obstructive sleep apnea syndrome. PMID:24979854

  4. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients.

    PubMed

    Riley, R W; Powell, N B; Guilleminault, C

    1993-02-01

    Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two-phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy-suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary-mandibular advancement osteotomy. One hundred twenty-one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and sleep architecture parameters. Surgery was considered a success if it was equivalent to nasal CPAP or the postoperative RDI was less than 20 with normal oxygenation. The overall success rate, which included patients that dropped from the protocol, was 76.5%, with a mean followup of 9.3 months (SD, 6.7). The preoperative RDI, nasal CPAP RDI, and postoperative RDI were 55.8 (SD, 26.7), 7.2 (SD, 5.4), and 9.2 (SD, 7.5), respectively.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8441535

  5. Choroidal Blood-Flow Responses to Hyperoxia and Hypercapnia in Men with Obstructive Sleep Apnea

    PubMed Central

    Tonini, Matthieu; Khayi, Hafid; Pepin, Jean-Louis; Renard, Elisabeth; Baguet, Jean-Philippe; Lévy, Patrick; Romanet, Jean-Paul; Geiser, Martial H.; Chiquet, Christophe

    2010-01-01

    Study Objectives: Obstructive sleep apnea (OSA) impacts on macrovasculature and autonomic function and may therefore interfere with ocular microvascular regulation. We hypothesized that choroidal vascular reactivity to hyperoxia and hypercapnia was altered in patients with OSA compared with matched control subjects and would improve after treatment with continuous positive airway pressure (CPAP). Methods: Sixteen healthy men were matched 1:1 for body mass index, sex, and age with 16 men with newly diagnosed OSA without comorbidities. Subjects underwent sleep studies, 24-hour blood pressure monitoring, arterial stiffness measurements, and cardiac and carotid echography. Overall, patients were middle-aged, lean, and otherwise healthy except for having OSA with a limited amount of desaturation, with, at most, subclinical lesions of the cardiovascular system, stage 1 hypertension, or both. Choroidal laser Doppler flowmetry provides a unique opportunity to assess microvascular function by measuring velocity, (ChBVel), volume (ChBVol), and relative subfoveal choroidal blood flow (ChBF). Vascular choroidal reactivity was studied during hyperoxia and hypercapnia (8% CO2) challenges before and after treatment with nasal CPAP. Results: Patients with OSA and control subjects exhibited similar choroidal reactivity during hyperoxia (stability of choroidal blood flow) and hypercapnia (significant increases in ChBVel of 13.5% and in ChBF of 16%). Choroidal vasoreactivity to CO2 was positively associated with arterial stiffness in patients with OSA. Gas choroidal vasoreactivity was unchanged after 6 to 9 months of CPAP treatment. Conclusion: This study showed unimpaired choroidal vascular reactivity in otherwise healthy men with OSA. This suggests that patients with OSA, without comorbidities, have long-term adaptive mechanisms active in ocular microcirculation. Citation: Tonini M; Khayi H; Pepin JL; Renard E; Baguet JP; Lévy P; Romanet JP; Geiser MH; Chiquet C. Choroidal blood

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2009-01-01

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

  8. Screening for obstructive sleep apnea in children treated at a major craniofacial center.

    PubMed

    Paliga, J Thomas; Tahiri, Youssef; Silvestre, Jason; Taylor, Jesse A

    2014-09-01

    Timely diagnosis of obstructive sleep apnea (OSA) in patients with craniofacial disorders may help prevent long-term adverse sequelae of upper airway obstruction, namely pulmonary hypertension, failure to thrive, and impaired neurocognitive development. Currently, little is known about the incidence of OSA in this high-risk population. A prospective study examining the incidence of positive screening for OSA in patients cared for by the craniofacial team at a large, urban referral center was performed. From January 2011 to August 2013, all patient families were asked to complete the Pediatric Sleep Questionnaire. This validated tool has a sensitivity of 85% and specificity of 87% in predicting a positive sleep study when the ratio of positive-total responses is 0.33 or greater. Screening results were evaluated via Chi-squared and Fisher tests according to demographic and clinical variables. A total of 234 children seen in our craniofacial clinic completed the Pediatric Sleep Questionnaire. The mean screening age was 8.38 years, and 47% were male (110/234). Total incidence of positive OSA screening was 28.2% (66/234). Of the total population, 128 patients had an underlying syndrome (54.7%), whereas 106 patients were nonsyndromic (45.3%). Both groups were at equivalent risk for screening positive for OSA (28.1% versus 28.3%, P = 1.0). Among children with a craniofacial diagnosis, patients with a cleft lip and/or palate were at equivalent risk for screening positive for OSA as patients without a cleft (25.5% versus 32.6%, P = 0.24). The OSA symptoms affect almost one third of patients seen by our craniofacial team. Syndromic and nonsyndromic patients seem to be at equivalent risk as those patients with and without an oropharyngeal cleft. Future work will correlate these findings with formal polysomnography and may serve to heighten awareness of OSA in this at-risk population. PMID:25162551

  9. Sleep EEG Characteristics in Young and Elderly Patients with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Lee, Yu Jin; Kim, Jong Won; Lee, Yu-Jin G.

    2016-01-01

    Objective In the present study, it was hypothesized that the sleep electroencephalogram (EEG) characteristics of young (<30 yrs) and elderly (>55 yrs) OSAS patients would differ. Methods We analyzed 76 sleep EEG recordings from OSAS patients (young group: n=40, mean age: 24.3±4.9 yrs; elderly group: n=36, mean age: 59.1±4.9 yrs), which were obtained during nocturnal polysomnography. The recordings were assessed via spectral analysis in the delta (0.5–4.5 Hz), theta (4.5–8 Hz), alpha (8–12 Hz), beta (12–32 Hz), slow sigma (11–13 Hz), and fast sigma (13–17 Hz) frequency bands. Results Apnea Hypopnea Index (AHI) and sleep efficiency (%) did not differ significantly between the two groups (19.8±14.4 vs. 25.9±16.0, p=0.085; 84.4±12.6 vs. 80.9±11.0, p=0.198, respectively). After adjusting for gender, the slow/fast sigma ratio was not significantly correlated with AHI in the elderly group (r=-0.047, p=0.790) but AHI was inversely correlated with the slow/fast sigma ratio in the young group (r=-0.423, p=0.007). A multiple linear regression analysis revealed that a higher AHI was related with a lower slow/fast sigma ratio in the young group (β=-0.392, p=0.028) but not the elderly. Conclusion In the present study, sleep EEG activity differed between young and elderly OSAS patients. The slow/fast sigma ratio was associated with OSAS severity only in young patients, suggesting that young OSAS patients may have a distinctive brain plasticity compared with elderly patients. PMID:27081383

  10. The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients.

    PubMed

    Denolf, Petra L; Vanderveken, Olivier M; Marklund, Marie E; Braem, Marc J

    2016-06-01

    Obstructive sleep apnea syndrome (OSAS) is the most common sleep disordered breathing disorder (SDB) in adults and is characterized by a recurrent partial or complete collapse of the upper airway during sleep. This can be caused by many factors, sometimes interacting, such as skeletal malformations, soft tissue crowding, respiratory instability and the various effects of aging, obesity and gender that dictate craniofacial and upper airway anatomy. Research has demonstrated that the majority of patients exhibit at least one anatomical component such as retrognathia or a narrow posterior airway space that predisposes to the development of OSAS. Within the predisposing elements for OSAS many seem to point to anatomical characteristics. A standardized and relatively simple radiologic technique to evaluate anatomical craniofacial relationships is cephalometry. This has been used already for a long time in orthodontics, but is now gradually being introduced in OSAS treatment to envisage optimal treatment selection as well as to predict treatment outcomes. The purpose of the present review is to evaluate the contribution of cephalometry in the prediction of outcomes from OSAS treatments that depend on the upper airway morphology in their mechanisms of action such as oral appliances that advance the mandible as well as various surgical methods. In addition, an overview of imaging modalities and methods that currently are being used in cephalometric analysis in OSAS patients is provided. The findings indicate that isolated cephalometric parameters cannot be used to reliably predict treatment outcomes from mandibular advancement devices and surgical methods for OSAS. Extreme or outlying values of cephalometric parameters may rather be used as contra-indicators or 'red flags' instead of predictors. PMID:26452001

  11. The Management of Iatrogenic Obstructive Sleep Apnoea Syndrome Following Bimaxillary Surgery in a Patient with Cleft Lip and Palate.

    PubMed

    Gerbino, Giovanni; Gervasio, Fernando Carmine; Blythe, John; Bianchi, Francesca Antonella

    2016-07-01

    A 26-year-old man presented with a 6-year history of severe obstructive sleep apnoea syndrome followed a bimaxillary osteotomy procedure for a class III skeletal pattern. The patient was born with a unilateral cleft lip and palate and underwent primary lip and palate repair and later a pharyngeal flap for severe velopharyngeal insufficiency. Surgical management of obstructive sleep apnoea syndrome with conventional osteotomy, in cleft lip and palate patients, is a difficult problem. Distraction osteogenesis may provide a safer alternative. The authors describe and discuss the indications and the technical challenge of a multistage treatment protocol with distraction osteogenesis. PMID:27391499

  12. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: A systematic review and meta-analysis.

    PubMed

    Huynh, Nelly T; Desplats, Eve; Almeida, Fernanda R

    2016-02-01

    A small maxilla and/or mandible may predispose children to sleep-disordered breathing, which is a continuum of severity from snoring to obstructive sleep apnea. Preliminary studies have suggested that orthodontic treatments, such as orthopedic mandibular advancement or rapid maxillary expansion, may be effective treatments. The aim is to investigate the efficacy of orthopedic mandibular advancement and/or rapid maxillary expansion in the treatment of pediatric obstructive sleep apnea. Pubmed, Medline, Embase, and Internet were searched for eligible studies published until April 2014. Articles with adequate data were selected for the meta-analysis; other articles were reported in the qualitative assessment. Data extraction was conducted by two independent authors. A total of 58 studies were identified. Only eight studies were included in the review; of these, six were included in the meta-analysis. The research yielded only a small number of studies. Consequently, any conclusions from the pooled diagnostic parameters and their interpretation should be treated carefully. Although the included studies were limited, these orthodontic treatments may be effective in managing pediatric snoring and obstructive sleep apnea. Other related health outcomes, such as neurocognitive and cardiovascular functions have not yet been systematically addressed. More studies are needed with larger sample size, specific inclusion and exclusion criteria and standardized data reporting to help establish guidelines for the orthodontic treatment of pediatric obstructive sleep apnea. PMID:26164371

  13. Upper Airway Stimulation for Obstructive Sleep Apnea: Self-Reported Outcomes at 24 Months

    PubMed Central

    Soose, Ryan J.; Woodson, B. Tucker; Gillespie, M. Boyd; Maurer, Joachim T.; de Vries, Nico; Steward, David L.; Strohl, Kingman P.; Baskin, Jonathan Z.; Padhya, Tapan A.; Badr, M. Safwan; Lin, Ho-sheng; Vanderveken, Olivier M.; Mickelson, Sam; Chasens, Eileen; Strollo, Patrick J.

    2016-01-01

    Objectives: To evaluate the long-term (24-mo) effect of cranial nerve upper airway stimulation (UAS) therapy on patient-centered obstructive sleep apnea (OSA) outcome measures. Methods: Prospective, multicenter, cohort study of 126 patients with moderate to severe OSA who had difficulty adhering to positive pressure therapy and received the surgically implanted UAS system. Outcomes were measured at baseline and postoperatively at 12 mo and 24 mo, and included self- and bedpartner-report of snoring intensity, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ). Additional analysis included FOSQ subscales, FOSQ-10, and treatment effect size. Results: Significant improvement in mean FOSQ score was observed from baseline (14.3) to 12 mo (17.3), and the effect was maintained at 24 mo (17.2). Similar improvements and maintenance of effect were seen with all FOSQ subscales and FOSQ-10. Subjective daytime sleepiness, as measured by mean ESS, improved significantly from baseline (11.6) to 12 mo (7.0) and 24 mo (7.1). Self-reported snoring severity showed increased percentage of “no” or “soft” snoring from 22% at baseline to 88% at 12 mo and 91% at 24 mo. UAS demonstrated large effect size (> 0.8) at 12 and 24 mo for overall ESS and FOSQ measures, and the effect size compared favorably to previously published effect size with other sleep apnea treatments. Conclusions: In a selected group of patients with moderate to severe OSA and body mass index ≤ 32 kg/m2, hypoglossal cranial nerve stimulation therapy can provide significant improvement in important sleep related quality-of-life outcome measures and the effect is maintained across a 2-y follow-up period. Citation: Soose RJ, Woodson BT, Gillespie MB, Maurer JT, de Vries N, Steward DL, Strohl KP, Baskin JZ, Padhya TA, Badr MS, Lin H, Vanderveken OM, Mickelson S, Chasens E, Strollo Jr PJ, STAR Trial Investigators. Upper airway stimulation for obstructive sleep apnea: self

  14. Excessive Daytime Sleepiness Increases the Risk of Motor Vehicle Crash in Obstructive Sleep Apnea

    PubMed Central

    Ward, Kim L.; Hillman, David R.; James, Alan; Bremner, Alexandra P.; Simpson, Laila; Cooper, Matthew N.; Palmer, Lyle J.; Fedson, Annette C.; Mukherjee, Sutapa

    2013-01-01

    Study Objectives: (1) To describe the incidence rate of motor vehicle crashes (MVCs) in patients with obstructive sleep apnea (OSA); and (2) to investigate MVC risk factors in OSA patients. Methods: A retrospective case-series observational study was conducted using data from the West Australian Sleep Health Study at a tertiary hospital-based sleep clinic. Participants were patients (N = 2,673) referred for assessment of suspected sleep disordered breathing. Questionnaire data were collected including age, sex, years of driving, near-misses and MVCs, sleepiness, and consumption of alcohol and caffeinated drinks. Overnight laboratory-based polysomnography was performed using standard methodology.1 Poisson univariate and negative binomial multivariable regression models were used to investigate associations between risk factors and MVC and near-miss risk in patients with untreated OSA. Results: In patients with untreated OSA, the crash rate was 0.06 MVC/person-year compared with the general community crash rate of 0.02 MVC/person-year. The rate ratio comparing very sleepy men with normal men was 4.68 (95% CI 3.07, 7.14) for near-misses and 1.27 (95% CI 1.00, 1.61) for crashes, after adjusting for confounders. In women there was a significant association with sleepiness score (p = 0.02) but no dose effect across quartiles. Conclusions: Untreated OSA is associated with an increased risk of near-misses in men and women and an increased risk of MVCs in very sleepy men. There is a strong association between excessive daytime sleepiness and increased report of near-misses. Our data support the observation that it is those patients with increased sleepiness regardless of OSA severity who are most at risk. Citation: Ward KL; Hillman DR; James A; Bremner AP; Simpson L; Cooper MN; Palmer LJ; Fedson AC; Mukherjee S. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med 2013;9(10):1013-1021. PMID:24127145

  15. Descriptive Assessment of Sleep Patterns among Community-Living Adults with Mental Retardation

    ERIC Educational Resources Information Center

    Luiselli, James K.; Magee, Christine; Sperry, James M.; Parker, Shawn

    2005-01-01

    There is little information about the sleep patterns of adults who have mental retardation and are supported in the community. In the present study, direct-care staff recorded sleep behaviors of 59 adults residing in 16 suburban group homes. Based on direct observation and measurement procedures, the adults averaged 7.9 hours of sleep each evening…

  16. Does Race-Ethnicity Moderate the Relationship between CPAP Adherence and Functional Outcomes of Sleep in US Veterans with Obstructive Sleep Apnea Syndrome?

    PubMed Central

    Wallace, Douglas M.; Wohlgemuth, William K.

    2014-01-01

    Background: Little is known about the association of race-ethnicity and the relationship of continuous positive airway pressure (CPAP) adherence with functional outcomes of sleep in American samples with obstructive sleep apnea syndrome (OSAS). This retrospective study examines whether race-ethnicity moderates the relationship between CPAP adherence and functional outcomes of sleep in OSAS. Methods: Over 4 months, consecutive OSAS patients had CPAP data downloads and completed questionnaires (demographics, Functional Outcomes of Sleep Questionnaire [FOSQ], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]) at the Miami VA sleep center. Medical diagnoses and polysomnography data were obtained from medical record. CPAP adherence was measured as mean daily hours of use. Hierarchical regression modeling was used to explore the differential impact of race-ethnicity and CPAP adherence on functional outcomes of sleep. Results: Two hundred twenty-seven veterans (93% male, age 59 ± 11 years) were included; 142 (63%) participants self-reported as white or Hispanic, and 85 participants (37%) as black. Hierarchical regression analyses failed to show main effects for race-ethnicity or CPAP use and FOSQ scores; however, the interaction of race-ethnicity with CPAP adherence was significantly associated with the total FOSQ (p = 0.04), Social (p = 0.02), and Intimacy (p = 0.01) subscale scores. For blacks, in adjusted analyses, CPAP adherence was positively associated with Social and Intimacy FOSQ subscales; however, no significant relationship was noted between CPAP use and FOSQ scores in whites/Hispanics. Conclusions: Race-ethnicity may moderate the relationship between CPAP adherence and some functional outcomes of sleep; however, further studies are needed. Citation: Wallace DM, Wohlgemuth WK. Does race-ethnicity moderate the relationship between CPAP adherence and functional outcomes of sleep in US veterans with obstructive sleep apnea syndrome? J Clin Sleep Med

  17. Complimentary and Alternative Medicine for Sleep Disturbances in Older Adults

    PubMed Central

    Gooneratne, Nalaka S.

    2008-01-01

    Synopsis Complimentary and alternative medicines (CAM) are frequently used for the treatment of sleep disorders, but in many cases, patients do not discuss these therapies directly with their health care provider. There is a growing body of well-designed clinical trials using CAM that have shown the following: 1) Melatonin is an effective agent for the treatment of circadian phase disorders that affect sleep, however, the role of melatonin in the treatment of primary or secondary insomnia is less well established. 2) Valerian has shown a benefit in some, but not all clinical trials. 3) Several other modalities, such as Tai Chi, acupuncture, acupressure, yoga and meditation have improved sleep parameters in a limited number of early trials. Future work examining CAM has the potential to significantly add to our treatment options for sleep disorders in older adults. PMID:18035236

  18. Upper Airway Stimulation for Obstructive Sleep Apnea: Durability of the Treatment Effect at 18 Months

    PubMed Central

    Strollo, Patrick J.; Gillespie, M. Boyd; Soose, Ryan J.; Maurer, Joachim T.; de Vries, Nico; Cornelius, Jason; Hanson, Ronald D.; Padhya, Tapan A.; Steward, David L.; Woodson, B. Tucker; Verbraecken, Johan; Vanderveken, Olivier M.; Goetting, Mark G.; Feldman, Neil; Chabolle, Frédéric; Badr, M. Safwan; Randerath, Winfried; Strohl, Kingman P.

    2015-01-01

    , Strohl KP, Stimulation Therapy for Apnea Reduction Trial Group. Upper airway stimulation for obstructive sleep apnea: durability of the treatment effect at 18 months. SLEEP 2015;38(10):1593–1598. PMID:26158895

  19. Sleep

    MedlinePlus

    ... sleep deprivation? What are sleep myths? What are sleep disorders? Can certain diseases/conditions disrupt sleep? What is ... sleep deprivation? What are sleep myths? What are sleep disorders? Can certain diseases/conditions disrupt sleep? What is ...

  20. Sleep In Older Adults: Normative Changes, Sleep Disorders, and Treatment Options

    PubMed Central

    Gooneratne, Nalaka S.; Vitiello, Michael V.

    2014-01-01

    1 Synopsis Sleep disorders are common in older adults: Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. When considering insomnia symptoms, it is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter distinguished by the presence of significant daytime symptoms such as fatigue. Evaluation with a sleep diary and screening for comorbid conditions, especially mood disorders, is essential. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective and have sustained benefit. A broad range of pharmacologic therapies are also available but can have unwanted psychomotor effects. If left untreated, insomnia can be associated with increased risk of depression and significant impairments in quality of life. In regards to sleep apnea, a high index of suspicion is crucial for effective diagnosis because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients. Diagnosis and management is fairly similar across age groups, except that a more nuanced approach to weight loss is warranted in older adults. The increasing use of home-based portable polysomnography and auto-titrating positive-airway pressure therapy can reduce barriers to treatment. PMID:25037297

  1. The Prevalence of Depression among Untreated Obstructive Sleep Apnea Patients Using a Standardized Psychiatric Interview

    PubMed Central

    Björnsdóttir, Erla; Benediktsdóttir, Bryndís; Pack, Allan I.; Arnardottir, Erna Sif; Kuna, Samuel T.; Gíslason, Thorarinn; Keenan, Brendan T.; Maislin, Greg; Sigurdsson, Jón Fridrik

    2016-01-01

    Study Objectives: The aims of this study were: (1) to use a standardized psychiatric interview, conducted by a trained psychologist to assess the prevalence of depression among patients with untreated OSA, and (2) to identify if OSA severity or other comorbid disorders (insomnia, hypertension, and diabetes) are related to depression among patients with untreated OSA. Methods: Participants were newly diagnosed patients with OSA (n = 284) waiting to start positive airway pressure (PAP) treatment. The Mini International Neuropsychiatric Interview (MINI) was used to assess depression. Results: Overall, 15.5% of the sample met the diagnosis for dysthymia. Women had a significantly higher prevalence (29.5% versus 11.7% among men, p < 0.001). The prevalence of major depression was 6% in the overall sample and there was no difference in the prevalence among sexes (5.8% among men versus 6.6 % among women). Obesity, daytime sleepiness, low physical activity, initial and late insomnia, low quality of life, and sleep medication and antidepressant use were all related to depression, whereas OSA severity, as measured by apnea-hypopnea index or oxygen desaturation index, was not. Daytime sleepiness, initial insomnia, and sleep medication use were the strongest predictors of depression in multivariable analyses. Conclusions: Sleep medication use, daytime sleepiness, and symptoms of initial insomnia were independently related to depression but OSA severity was not. Increased awareness of the relationship between depression and OSA and the appropriate use of assessment tools might substantially improve diagnostic accuracy as well as treatment outcome for both disorders. Citation: Björnsdóttir E, Benediktsdóttir B, Pack AI, Arnardottir ES, Kuna ST, Gíslason T, Keenan BT, Maislin G, Sigurdsson JF. The prevalence of depression among untreated obstructive sleep apnea patients using a standardized psychiatric interview. J Clin Sleep Med 2016;12(1):105–112. PMID:26350608

  2. Evaluation of a Decision Support System for Obstructive Sleep Apnea with Nonlinear Analysis of Respiratory Signals

    PubMed Central

    Kaimakamis, Evangelos; Tsara, Venetia; Bratsas, Charalambos; Sichletidis, Lazaros; Karvounis, Charalambos; Maglaveras, Nikolaos

    2016-01-01

    Introduction Obstructive Sleep Apnea (OSA) is a common sleep disorder requiring the time/money consuming polysomnography for diagnosis. Alternative methods for initial evaluation are sought. Our aim was the prediction of Apnea-Hypopnea Index (AHI) in patients potentially suffering from OSA based on nonlinear analysis of respiratory biosignals during sleep, a method that is related to the pathophysiology of the disorder. Materials and Methods Patients referred to a Sleep Unit (135) underwent full polysomnography. Three nonlinear indices (Largest Lyapunov Exponent, Detrended Fluctuation Analysis and Approximate Entropy) extracted from two biosignals (airflow from a nasal cannula, thoracic movement) and one linear derived from Oxygen saturation provided input to a data mining application with contemporary classification algorithms for the creation of predictive models for AHI. Results A linear regression model presented a correlation coefficient of 0.77 in predicting AHI. With a cutoff value of AHI = 8, the sensitivity and specificity were 93% and 71.4% in discrimination between patients and normal subjects. The decision tree for the discrimination between patients and normal had sensitivity and specificity of 91% and 60%, respectively. Certain obtained nonlinear values correlated significantly with commonly accepted physiological parameters of people suffering from OSA. Discussion We developed a predictive model for the presence/severity of OSA using a simple linear equation and additional decision trees with nonlinear features extracted from 3 respiratory recordings. The accuracy of the methodology is high and the findings provide insight to the underlying pathophysiology of the syndrome. Conclusions Reliable predictions of OSA are possible using linear and nonlinear indices from only 3 respiratory signals during sleep. The proposed models could lead to a better study of the pathophysiology of OSA and facilitate initial evaluation/follow up of suspected patients OSA

  3. Percutaneous biphasic electrical stimulation for treatment of obstructive sleep apnea syndrome.

    PubMed

    Hu, Lianggang; Xu, Xiaomei; Gong, Yongsheng; Fan, Xiaofang; Wang, Liangxing; Zhang, Jianhua; Zeng, Yanjun

    2008-01-01

    In this paper, we study the effect of stimulation of the genioglossus with percutaneous biphasic electrical pulses on patients with the obstructive sleep apnea syndrome (OSAS). The experiment was conducted in 22 patients clinically diagnosed with OSAS. The patients were monitored with polysomnography (PSG) in the trial. When the sleep apnea was detected, the genioglossus was stimulated with percutaneous biphasic electrical pulses that were automatically regulated by a microcontroller to achieve the optimal effect. The percutaneous biphasic electrical stimulation caused contraction of the genioglossus, forward movement of the tongue, and relieving of the glossopharyngeal airway obstruction. The SaO2, apnea time, hypoxemia time, and change of respiratory disturbance index (RDI) were compared in patients with treatment and without treatment. With percutaneous biphasic electrical stimulation of the genioglossus, the OSAS patients showed apnea time decreased (P < 0.01), RDI decreased (P < 0.01), and SaO2 increased (P < 0.01). No tissue injury or major discomfort was noticed during the trial. The stimulation of genioglossus with percutaneous biphasic electrical current pulse is an effective method for treating OSAS. PMID:18232360

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

    PubMed Central

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

    2012-01-01

    Background The purpose of this study was to evaluate the relationship between facial morphology using cephalometry and chronologic age in preschool children with obstructive sleep apnea (OSA). Materials and Methods From a group of lateral cephalometric radiographs taken of 35 children with OSA for diagnostic purposes, 15 were selected for the present investigation based on head position. The subjects consisted of preschool children with both OSA and primary dentition, all of them with a lowest documented SpO2 <90% and a lowest 0 Obstructive sleep apnea in children may be associated with growth disturbances of the nasal floor and corpus length. PMID:25756027

  5. Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system

    PubMed Central

    Jin, Ze-Ning; Wei, Yong-Xiang

    2016-01-01

    Background Obstructive sleep apnea (OSA) is the most common cause of resistant hypertension, which has been proposed to result from activation of the renin–angiotensin–aldosterone system (RAAS). We meta-analyzed the effects of OSA on plasma levels of RAAS components. Methods Full-text studies published on MEDLINE and EMBASE analyzing fasting plasma levels of at least one RAAS component in adults with OSA with or without hypertension. OSA was diagnosed as an apnea-hypopnea index or respiratory disturbance index ≥ 5. Study quality was evaluated using the Newcastle-Ottawa Scale, and heterogeneity was assessed using the I2 statistic. Results from individual studies were synthesized using inverse variance and pooled using a random-effects model. Subgroup analysis, sensitivity analysis, and meta-regression were performed, and risk of publication bias was assessed. Results The meta-analysis included 13 studies, of which 10 reported results on renin (n = 470 cases and controls), 7 on angiotensin II (AngII, n = 384), and 9 on aldosterone (n = 439). AngII levels were significantly higher in OSA than in controls [mean differences = 3.39 ng/L, 95% CI: 2.00–4.79, P < 0.00001], while aldosterone levels were significantly higher in OSA with hypertension than OSA but not with hypertension (mean differences = 1.32 ng/dL, 95% CI: 0.58–2.07, P = 0.0005). Meta-analysis of all studies suggested no significant differences in aldosterone between OSA and controls, but a significant pooled mean difference of 1.35 ng/mL (95% CI: 0.88–1.82, P < 0.00001) emerged after excluding one small-sample study. No significant risk of publication bias was detected among all included studies. Conclusions OSA is associated with higher AngII and aldosterone levels, especially in hypertensive patients. OSA may cause hypertension, at least in part, by stimulating RAAS activity. PMID:27403143

  6. Evaluation of an oral appliance in patients with mild to moderate obstructive sleep apnea syndrome intolerant to continuous positive airway pressure use: Preliminary results.

    PubMed

    Cantore, S; Ballini, A; Farronato, D; Malcangi, G; Dipalma, G; Assandri, F; Garagiola, U; Inchingolo, F; De Vito, D; Cirulli, N

    2016-06-01

    Obstructive sleep apnea syndrome (OSAS) is a phenomenon of repeated, episodic reduction, or cessation of airflow (hypopnea/apnea) as a result of upper airways obstruction. First-line treatment in younger children is adenotonsillectomy, although other available treatment options in middle-aged adults include continuous positive airways pressure (CPAP) and airway adjuncts. Oral appliances (OA) are a viable treatment alternative in patients with OSAS.The objective of this study was to assess, in a 1-year follow-up study, an OA in OSAS patients. The participants were subjected to polysomnographic examination with a validated device (MicroMESAM). Eight participants were fitted with a Thornton Adjustable Positioner (TAP). The participants were asked to wear the test appliance for 7 nights, and in case of compliance, for 6 months. The selected patients record their usage of the appliance and any adverse effects in a treatment journal. The research focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index) and the effect of oral appliances on daytime function.In conclusion, the results suggest that OA have a definite role in the treatment of snoring and sleep apnea. PMID:26684627

  7. Adenotonsillectomy in Obese Children with Obstructive Sleep Apnea Syndrome: Magnetic Resonance Imaging Findings and Considerations

    PubMed Central

    Nandalike, Kiran; Shifteh, Keivan; Sin, Sanghun; Strauss, Temima; Stakofsky, Allison; Gonik, Nathan; Bent, John; Parikh, Sanjay R.; Bassila, Maha; Nikova, Margarita; Muzumdar, Hiren; Arens, Raanan

    2013-01-01

    Objective: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. Methods: Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®). Results: Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm3, P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm3, P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm3, P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm3, P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm3, P = 0.005, respectively). Conclusions: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children. Citation: Nandalike K; Shifteh K; Sin S; Strauss T; Stakofsky A; Gonik N; Bent J; Parikh SR; Bassila M; Nikova M; Muzumdar H; Arens R. Adenotonsillectomy in obese children with

  8. 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

  9. Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

    PubMed Central

    Pliska, Benjamin T.; Nam, Hyejin; Chen, Hui; Lowe, Alan A.; Almeida, Fernanda R.

    2014-01-01

    Study Objectives: To evaluate the magnitude and progression of dental changes associated with long-term mandibular advancement splint (MAS) treatment of obstructive sleep apnea (OSA). Methods: Retrospective study of adults treated for primary snoring or mild to severe OSA with MAS for a minimum of 8 years. The series of dental casts of patients were analyzed with a digital caliper for changes in overbite, overjet, dental arch crowding and width, and inter-arch relationships. The progression of these changes over time was determined and initial patient and dental characteristics were evaluated as predictors of the observed dental side effects of treatment. Results: A total of 77 patients (average age at start of treatment: 47.5 ± 10.2 years, 62 males) were included in this study. The average treatment length was 11.1 ± 2.8 years. Over the total treatment interval evaluated there was a significant (p < 0.001) reduction in the overbite (2.3 ± 1.6 mm), overjet (1.9 ± 1.9 mm), and mandibular crowding (1.3 ± 1.8 mm). A corresponding significant (p < 0.001) increase of mandibular intercanine (0.7 ± 1.5 mm) and intermolar (1.1 ± 1.4 mm) width as well as incidence of anterior crossbite and posterior open bite was observed. Overbite and mandibular intermolar distance were observed to decrease less with time, while overjet, mandibular intercanine distance, and lower arch crowding all decreased continuously at a constant rate. Conclusions: After an average observation period of over 11 years, clinically significant changes in occlusion were observed and were progressive in nature. Rather than reaching a discernible end-point, the dental side effects of MAS therapy continue with ongoing MAS use. Commentary: A commentary on this article appears in this issue on page 1293. Citation: Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J

  10. Evaluation of Bone Mineral Density by Computed Tomography in Patients with Obstructive Sleep Apnea

    PubMed Central

    Hamada, Satoshi; Ikezoe, Kohei; Hirai, Toyohiro; Oguma, Tsuyoshi; Tanizawa, Kiminobu; Inouchi, Morito; Handa, Tomohiro; Oga, Toru; Mishima, Michiaki; Chin, Kazuo

    2016-01-01

    Study Objectives: Clinical studies have investigated whether obstructive sleep apnea (OSA) can modulate bone metabolism but data are conflicting. Bone mineral density (BMD) measured by dual-energy x-ray absorptiometry is the standard technique for quantifying bone strength but has limitations in overweight patients (body mass index [BMI] ≥ 25 kg/m2). The aim of this study was to examine the association between OSA and BMD by examining CT images that allow true volumetric measurements of the bone regardless of BMI. Methods: Lumbar vertebrae BMD was evaluated in 234 persons (180 males and 54 females) by CT scan. The method was calibrated by a phantom containing a known concentration of hydroxyapatite. Results: BMD was lower in male patients with severe OSA (apnea-hypopnea index [AHI] ≥ 30/h) than non OSA (AHI < 5; p < 0.05), while OSA and BMD had no association in females. Linear and multiple regression analyses revealed that age (p < 0.0001, β = −0.52), hypertension (p = 0.0068, β = −0.17), and the alveolar-arterial oxygen pressure difference (A-aDO2) (p = 0.012, β = −0.15) in males were associated with BMD, while only age (p < 0.0001, β = −0.68) was associated with BMD in females. Conclusion: Males with severe OSA had a significantly lower BMD than non OSA participants. Age, hypertension, and elevation of A-aDO2 were significant factors for BMD by CT imaging. The usefulness of measuring BMD in OSA patients by CT scanning should be studied in future. Citation: Hamada S, Ikezoe K, Hirai T, Oguma T, Tanizawa K, Inouchi M, Handa T, Oga T, Mishima M, Chin K. Evaluation of bone mineral density by computed tomography in patients with obstructive sleep apnea. J Clin Sleep Med 2016;12(1):25–34. PMID:26235157

  11. Evidence Supports No Relationship between Obstructive Sleep Apnea and Premolar Extraction: An Electronic Health Records Review

    PubMed Central

    Larsen, Ann J.; Rindal, D. Brad; Hatch, John P.; Kane, Sheryl; Asche, Stephen E.; Carvalho, Chris; Rugh, John

    2015-01-01

    Objective: A controversy exists concerning the relationship, if any, between obstructive sleep apnea (OSA) and the anatomical position of the anterior teeth. Specifically, there has been speculation that extraction orthodontics and retraction of the anterior teeth contributes to OSA by crowding the tongue and decreasing airway space. This retrospective study utilized electronic medical and dental health records to examine the association between missing premolars and OSA. Methods: The sample (n = 5,584) was obtained from the electronic medical and dental health records of HealthPartners in Minnesota. Half of the subjects (n = 2,792) had one missing premolar in each quadrant. The other half had no missing premolars. Cases and controls were paired in a 1:1 match on age range, gender, and body mass index (BMI) range. The outcome was the presence or absence of a diagnosis of OSA confirmed by polysomnography. Results: Of the subjects without missing premolars, 267 (9.56%) had received a diagnosis of OSA. Of the subjects with four missing premolars, 299 (10.71%) had received a diagnosis of OSA. The prevalence of OSA was not significantly different between the groups (OR = 1.14, p = 0.144). Conclusion: The absence of four premolars (one from each quadrant), and therefore a presumed indicator of past “extraction orthodontic treatment,” is not supported as a significant factor in the cause of OSA. Citation: Larsen AJ, Rindal DB, Hatch JP, Kane S, Asche SE, Carvalho C, Rugh J. Evidence supports no relationship between obstructive sleep apnea and premolar extraction: an electronic health records review. J Clin Sleep Med 2015;11(12):1443–1448. PMID:26235151

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

    PubMed Central

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

    2013-01-01

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

  13. 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

  14. Treatment of Obstructive Sleep Apnea Alters Cancer-associated Transcriptional Signatures in Circulating Leukocytes

    PubMed Central

    Gharib, Sina A.; Seiger, Ashley N.; Hayes, Amanda L.; Mehra, Reena; Patel, Sanjay R.

    2014-01-01

    Rationale: Obstructive sleep apnea (OSA) has been associated with a number of chronic disorders that may improve with effective therapy. However, the molecular pathways affected by continuous positive airway pressure (CPAP) treatment are largely unknown. We sought to assess the system-wide consequences of CPAP therapy by transcriptionally profiling peripheral blood leukocytes (PBLs). Methods: Subjects in whom severe OSA was diagnosed were treated with CPAP, and whole-genome expression measurement of PBLs was performed at baseline and following therapy. We used gene set enrichment analysis (GSEA) to identify pathways that were differentially enriched. Network analysis was then applied to highlight key drivers of processes influenced by CPAP. Results: Eighteen subjects with significant OSA underwent CPAP therapy and microarray analysis of their PBLs. Treatment with CPAP improved apnea-hypopnea index (AHI), daytime sleepiness, and blood pressure, but did not affect anthropometric measures. GSEA revealed a number of enriched gene sets, many of which were involved in neoplastic processes and displayed downregulated expression patterns in response to CPAP. Network analysis identified several densely connected genes that are important modulators of cancer and tumor growth. Conclusions: Effective therapy of OSA with CPAP is associated with alterations in circulating leukocyte gene expression. Functional enrichment and network analyses highlighted transcriptional suppression in cancer-related pathways, suggesting potentially novel mechanisms linking OSA with neoplastic signatures. Citation: Gharib SA; Seiger AN; Hayes AL; Mehra R; Patel SR. Treatment of obstructive sleep apnea alters cancer-associated transcriptional signatures in circulating leukocytes. SLEEP 2014;37(4):709-714. PMID:24688164

  15. Obstructive Sleep Apnea and Posttraumatic Stress Disorder among OEF/OIF/OND Veterans

    PubMed Central

    Colvonen, Peter J.; Masino, Tonya; Drummond, Sean P.A.; Myers, Ursula S.; Angkaw, Abigail C.; Norman, Sonya B.

    2015-01-01

    Objectives: This study examined: (a) the relationship between self-reported posttraumatic stress disorder (PTSD) symptoms and risk of obstructive sleep apnea (OSA) in a younger, Iraq and Afghanistan (OEF/OIF/OND) veteran sample seeking treatment for PTSD; and (b) the relationships between PTSD symptom scores and each risk factor of OSA (snoring, fatigue, high blood pressure/BMI). Methods: Participants were 195 Iraq and Afghanistan veterans presenting to a VA outpatient PTSD clinic for evaluation. Veterans were 21 to 59 years old (mean 33.40, SD 8.35) and 93.3% male (n = 182). Logistic regressions were run to examine whether veterans with greater PTSD symptom severity had an increased probability of screening as high risk for OSA, even after controlling for known risk factors (older age, positive smoking status, and use of CNS depressants). Results: Of 159 veterans screened, 69.2% were assessed as being at high risk for OSA. PTSD symptom severity increased the risk of screening positive for OSA. PTSD symptom severity increased risk of screening positive for snoring and fatigue, but not high blood pressure/BMI. Conclusions: OEF/OIF/OND veterans with PTSD screen as high risk for OSA at much higher rates than those seen in community studies and may not show all classic predictors of OSA (i.e., older and higher BMI). This study is the first to suggest that the Berlin may be a useful screener for OSA in a younger OEF/OIF/OND veteran population with PTSD. Screening of younger veterans with PTSD for OSA should be standard care, and polysomnography and OSA interventions should be readily available to younger veterans. Citation: Colvonen PJ, Mosino T, Drummond SP, Myers US, Angkaw AC, Norman SB. Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND veterans. J Clin Sleep Med 2015;11(5):513–518. PMID:25665698

  16. Oral Appliance Treatment Response and Polysomnographic Phenotypes of Obstructive Sleep Apnea

    PubMed Central

    Sutherland, Kate; Takaya, Hisashi; Qian, Jin; Petocz, Peter; Ng, Andrew T.; Cistulli, Peter A.

    2015-01-01

    Study Objectives: Mandibular advancement splints (MAS) are an effective treatment for obstructive sleep apnea (OSA); however, therapeutic response is variable. Younger age, female gender, less obesity, and milder and supine-dependent OSA have variably been associated with treatment success in relatively small samples. Our objective was to utilize a large cohort of MAS treated patients (1) to compare efficacy across patients with different phenotypes of OSA and (2) to assess demographic, anthropometric, and polysomnography variables as treatment response predictors. Methods: Retrospective analysis of MAS-treated patients participating in clinical trials in sleep centers in Sydney, Australia between years 2000–2013. All studies used equivalent customized two-piece MAS devices and treatment protocols. Treatment response was defined as (1) apnea-hypopnea index (AHI) < 5/h, (2) AHI < 10/h and ≥ 50% reduction, and (3) ≥ 50% AHI reduction. Results: A total of 425 patients (109 female) were included (age 51.2 ± 10.9 years, BMI 29.2 ± 5.0 kg/m2). MAS reduced AHI by 50.3% ± 50.7% across the group. Supine-predominant OSA patients had lower treatment response rates than non-positional OSA (e.g., 36% vs. 59% for AHI < 10/h). REM-predominant OSA showed a lower response rate than either NREM or non-stage dependent OSA. In prediction modelling, age, baseline AHI, and anthropometric variables were predictive of MAS treatment outcome but not OSA phenotype. Gender was not associated with treatment outcome. Conclusions: Lower MAS treatment response rates were observed in supine and REM sleep. In a large sample, we confirm that demographic, anthropometric, and polysomnographic data only weakly inform about MAS efficacy, supporting the need for alternative objective prediction methods to reliably select patients for MAS treatment. Citation: Sutherland K, Takaya H, Qian J, Petocz P, Ng AT, Cistulli PA. Oral appliance treatment response and polysomnographic phenotypes of

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

    PubMed Central

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

    2014-01-01

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

  18. Insulin resistance, glucose intolerance and diabetes mellitus in obstructive sleep ap