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  1. Personalized Management Approach for OSA.

    PubMed

    Carberry, Jayne C; Amatoury, Jason; Eckert, Danny J

    2017-06-16

    OSA is a heterogeneous disorder. If left untreated, it has major health, safety, and economic consequences. In addition to varying levels of impairment in pharyngeal anatomy (narrow/collapsible airway), nonanatomical "phenotypic traits" are also important contributors to OSA for most patients. However, the majority of existing therapies (eg, CPAP, oral appliances, weight loss, positional therapy, upper airway surgery) target only the anatomical cause. These are typically administered as monotherapy according to a trial and error management approach in which the majority of patients are first prescribed CPAP. Despite its high efficacy, CPAP adherence remains unacceptably low, and second-line therapies have variable and unpredictable efficacies. Recent advances in knowledge regarding the multiple causes of OSA using respiratory phenotyping techniques have identified new targets or "treatable traits" to direct therapy. Identification of the traits and development of therapies that selectively target one or more of the treatable traits has the potential to personalize the management of this chronic health condition to optimize patient outcomes according to precision medicine principles. This brief review highlights the latest developments and emerging therapies for personalized management approaches for OSA. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  2. Intraoperative BiPAP in OSA Patients

    PubMed Central

    Singh, Bhavna P

    2015-01-01

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

  3. Intermittent hypoxemia and OSA: implications for comorbidities.

    PubMed

    Dewan, Naresh A; Nieto, F Javier; Somers, Virend K

    2015-01-01

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

  4. Back to sleep or not: the effect of the supine position on pediatric OSA: Sleeping position in children with OSA.

    PubMed

    Walter, Lisa M; Dassanayake, Daranagama U N; Weichard, Aidan J; Davey, Margot J; Nixon, Gillian M; Horne, Rosemary S C

    2017-09-01

    In both adults and children, obstructive sleep apnea (OSA) has significant adverse cardiovascular consequences. In adults, sleeping position has a marked effect on the severity of OSA; however, the limited number of studies conducted in children have reported conflicting findings. We aimed to evaluate the effect of sleeping position on OSA severity and the cardiovascular consequences in preschool-aged children. This was a retrospective analysis of children (3-5 years of age) diagnosed with OSA (n = 75) and nonsnoring controls (n = 25). Sleeping position was classified as supine, semi-supine, left lateral, right lateral, prone, and semi-prone by using video recordings during one night of attended polysomnography. OSA severity and cardiovascular parameters were compared between the positions. All children spent significantly more sleep time in the supine position than in any other position. The obstructive apnea-hypopnea index was higher in the supine position than in the other sleeping positions during NREM (p < 0.05), higher in the moderate/severe OSA group when sleeping in the supine position than when sleeping in the left and right lateral positions (p < 0.05 for both) and prone position (p = 0.007) during REM. Sympathovagal balance was decreased in children with OSA in the supine and lateral positions (p < 0.05). This study identified that preschool-aged children, whether nonsnoring controls or children with OSA, predominately sleep in the supine position, and OSA was more severe in the supine position. We suggest that to avoid the supine sleep position, positional therapy has the potential to ameliorate OSA severity, and the known cardiovascular consequences. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Obstructive Sleep Apnea Syndrome (OSAS) and Cardiovascular System.

    PubMed

    Lombardi, Carolina; Tobaldini, Eleonora; Montano, Nicola; Losurdo, Anna; Parati, Gianfranco

    2017-08-28

    There is increasing evidence of a relationship between Obstructive Sleep Apnea (OSA) and cardiovascular diseases. The strong association between OSA and arterial hypertension, in particular in patients with resistant hypertension and/or a non-dipping profile, has been extensively reported. The relationship between OSA and high blood pressure (BP) has been found independent from a number of confounders, but several factors may affect this relationship, including age and sex. It is thus important to better assess pathophysiologic and clinical interactions between OSA and arterial hypertension, also aimed at optimizing treatment approaches in OSA and hypertensive patients with co-morbidities. Among possible mechanisms, cardiovascular autonomic control alterations, altered mechanics of ventilation, inflammation, endothelial dysfunction, and renin-angiotensin-aldosterone system should be considered with particular attention. Additionally, available studies also support the occurrence of a bidirectional association between OSA and cardiovascular alterations, in particular heart failure, stroke and cardiac arrhythmias, emphasizing that greater attention is needed to both identify and treat sleep apneas in patients with cardiovascular diseases. However, a number of aspects of such a relationship are still to be clarified, in particular with regard to gender differences, effect of sleep-related breathing disorders in childhood, and influence of OSA treatment on cardiovascular risk, and they may represent important targets for future studies.

  6. Digital Morphometrics: A New Upper Airway Phenotyping Paradigm in OSA.

    PubMed

    Schwab, Richard J; Leinwand, Sarah E; Bearn, Cary B; Maislin, Greg; Rao, Ramya Bhat; Nagaraja, Adithya; Wang, Stephen; Keenan, Brendan T

    2017-08-01

    OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA. Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour). The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P < .001) and controlling for age, sex, race, and BMI (P = .015 and P = .018, respectively). Measures of tongue size were larger in subjects with OSA vs control subjects in unadjusted models and controlling for age, sex, and race but nonsignificant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA. Measures of tongue size, airway visibility, and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  7. Obstructive sleep apnea (OSA) in preadolescent girls is associated with delayed breast development compared to girls without OSA.

    PubMed

    Shaw, Natalie D; Goodwin, James L; Silva, Graciela E; Hall, Janet E; Quan, Stuart F; Malhotra, Atul

    2013-08-15

    Adults with obstructive sleep apnea (OSA) have lower sex steroid levels than controls. We sought to determine whether OSA also interferes with reproductive hormones in adolescence by tracking the pace of pubertal development. One hundred seventy-two children in the Tucson Children's Assessment of Sleep Apnea study (TuCASA) underwent two home polysomnographic studies, spaced 4-5 years apart. Height and weight were measured at both visits, and Tanner staging of breasts/genitals and pubic hair were self-assessed by a pictorial questionnaire at follow-up. Eighty-seven girls and 85 boys, age 8.9 ± 1.6 years (mean ± SD) at baseline and 13.4 ± 1.6 years at follow-up, participated. Twenty-seven percent of participants were over-weight or obese at baseline, and the majority remained so at follow-up. Twenty-six percent of girls and 28% of boys met criteria for OSA, defined as a respiratory disturbance index (RDI) ≥ 1/h associated with a 3% desaturation (RDI 3%), at baseline. There was an inverse relationship between baseline log RDI 3% and Tanner breast stage at follow-up (coefficient -1.3, p = 0.02) in girls after adjusting for age (p < 0.001), body mass index (p < 0.005), and ethnicity. Girls with OSA at baseline were more than 1 Tanner breast stage behind girls without OSA at follow-up. OSA did not affect genital development in boys or pubic hair development in either sex. OSA in preadolescent girls predicts delayed breast development relative to girls without OSA. Sleep fragmentation and/or hypoxia seen in OSA may interfere with reproductive development in girls.

  8. Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient

    PubMed Central

    2016-01-01

    A case report is presented which demonstrates the effectiveness of comprehensive orthodontic treatment combined with orthognathic surgery in the correction of malocclusion and reduction in the sequelae of Obstructive Sleep Apnea (OSA). The patient's severe OSA was improved to very mild as evaluated by full overnight polysomnogram. The orthodontic treatment included the expansion of both dental arches and mandibular advancement surgery. There was significant improvement in the patient's sleep continuity and architecture with the elimination of obstructive apneas. PMID:27668098

  9. Obstructive Sleep Apnea (OSA) in Preadolescent Girls is Associated with Delayed Breast Development Compared to Girls without OSA

    PubMed Central

    Shaw, Natalie D.; Goodwin, James L.; Silva, Graciela E.; Hall, Janet E.; Quan, Stuart F.; Malhotra, Atul

    2013-01-01

    Study Objective: Adults with obstructive sleep apnea (OSA) have lower sex steroid levels than controls. We sought to determine whether OSA also interferes with reproductive hormones in adolescence by tracking the pace of pubertal development. Methods: One hundred seventy-two children in the Tucson Children's Assessment of Sleep Apnea study (TuCASA) underwent two home polysomnographic studies, spaced 4-5 years apart. Height and weight were measured at both visits, and Tanner staging of breasts/genitals and pubic hair were self-assessed by a pictorial questionnaire at follow-up. Results: Eighty-seven girls and 85 boys, age 8.9 ± 1.6 years (mean ± SD) at baseline and 13.4 ± 1.6 years at follow-up, participated. Twenty-seven percent of participants were over-weight or obese at baseline, and the majority remained so at follow-up. Twenty-six percent of girls and 28% of boys met criteria for OSA, defined as a respiratory disturbance index (RDI) ≥ 1/h associated with a 3% desaturation (RDI 3%), at baseline. There was an inverse relationship between baseline log RDI 3% and Tanner breast stage at follow-up (coefficient -1.3, p = 0.02) in girls after adjusting for age (p < 0.001), body mass index (p < 0.005), and ethnicity. Girls with OSA at baseline were more than 1 Tanner breast stage behind girls without OSA at follow-up. OSA did not affect genital development in boys or pubic hair development in either sex. Conclusions: OSA in preadolescent girls predicts delayed breast development relative to girls without OSA. Sleep fragmentation and/or hypoxia seen in OSA may interfere with reproductive development in girls. Citation: Shaw ND; Goodwin JL; Silva GE; Hall JE; Quan SF; Malhotra A. Obstructive sleep apnea (OSA) in preadolescent girls is associated with delayed breast development compared to girls without OSA. J Clin Sleep Med 2013;9(8):813-818. PMID:23946712

  10. Obstructive sleep apnea syndrome (OSAS) in mouth breathing children.

    PubMed

    Izu, Suemy Cioffi; Itamoto, Caroline Harumi; Pradella-Hallinan, Márcia; Pizarro, Gilberto Ulson; Tufik, Sérgio; Pignatari, Shirley; Fujita, Reginaldo Raimundo

    2010-01-01

    It is well known that mouth breathing is associated with adenotonsillar hypertrophy - which is the main cause of obstructive sleep apnea among children. Despite the importance of this matter, there are only a handful of studies showing the relationship between OSAS and mouth breathing. to determine the prevalence of obstructive sleep disorders in mouth breathing children and study its correlation with otorhinolaryngological findings. Retrospective cohort study. Data analysis from 248 medical charts of mouth breathing children seen at the Pediatric Otolaryngologic Division of a large medical institution between the years of 2000 and 2006. All patients had nasofibroscopy and or Cavum radiographs and polysomnographic exams. According to the Apnea index, patients were classified as primary snorers (AI<1); and as OSAS (>1). From 248 patients included in the study, 144 (58%) were primary snorers and 104 (42%) had OSAS. The most prevalent otorhinolaryngological findings were adenotonsillar hypertrophy (n=152; 61.2%), tonsilar hypertrophy (n=17; 6.8%), adenoid hypertrophy (n=37; 14.9%), rhinitis (n=155; 62.5%) and secretory otitis (n=36; 14.5%). primary snoring and OSAS are frequent findings in mouth breathing children. The most frequent otorhinolaryngological disorder in children with OSAS is adenotonsillar hypertrophy with or without rhinitis.

  11. Prognosis for Spontaneous Resolution of OSA in Children

    PubMed Central

    Ellenberg, Susan S.; Hou, Xiaoling; Marcus, Carole L.; Garetz, Susan L.; Katz, Eliot S.; Hodges, Elise K.; Mitchell, Ron B.; Jones, Dwight T.; Arens, Raanan; Amin, Raouf; Redline, Susan; Rosen, Carol L.; Katz, Eliot; Ware, Janice; Jones, Dwight; Redline, Susan; Wang, Rui; Mitchell, Ron; Paruthi, Shalini; Snyder, Karen; Marcus, Carole; Thomas, Nina H.; Elden, Lisa; Amin, Raouf; Beebe, Dean; Willging, Paul; Arens, Raanan; Muzumdar, Hiren; Harris, Shelby; Rosen, Carol; Taylor, H. Gerry; Sprecher, Robert; Arnold, James; Gozal, David; Chervin, Ronald; Garetz, Susan; Giordani, Bruno; Hoban, Tim; Ellenberg, Susan; Moore, Reneé H.; Lacy, Kim

    2015-01-01

    BACKGROUND: Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment. METHODS: The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline. RESULTS: After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors. CONCLUSIONS: Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov. PMID:25811889

  12. Colloid Characteristics and Emulsifying Properties of OSA Starches

    NASA Astrophysics Data System (ADS)

    Dokić, Petar; Dokić, Ljubica; Dapčević, Tamara; Krstonošić, Veljko

    The objective of this paper was to characterize commercially available octenyl-succinate starches (OSA starches), Purity Gum 2000 and Hi-cap 100, by determining their viscous behaviour and characteristics and molecular mass, as well as to examine their emulsifying properties in corn oil-in-water emulsion system.

  13. [Quality of life in adult patient (Tunisian) with severe OSA].

    PubMed

    Kacem, I; Kalboussi, H; Ben Salem, H; Maoua, M; El Guedri, S; Laayouni, M; Abdelghani, A; Boughattas, W; Brahem, A; Debbabi, F; El Maalel, O; Chatti, S; Benzarti, M; Mrizak, N

    2017-09-01

    The negative impact of obstructive sleep apnea (OSA) on quality of life of affected individuals is a central consequence of this disease. The recognition of the quality of life as a therapeutic target is a relatively new concept. To evaluate the quality of life and its determinants in patients with OSA. We conducted a cross-sectional study during the period from 1st July 2012 to 30th June 2013. The target population was patients with OSA and in employment examined in consultations of pneumology in the teaching hospital Farhat-Hached in Sousse (Tunisia). This study was based on a generic questionnaire (SF-36) to assess the quality of life. The study population included 103 cases with a mean age of 55.15±11.4years and a sex ratio of 0.71. Our patients were obese in 95.1 % of cases with an average BMI of 39.13±7.19kg/m(2). The majority of our patients had an impaired quality of life with an average score of 44.76 (SF36) and extremes of 22 and 70. There was a positive linear relationship between physical and mental components of the SF-36 and gender, age, BMI, and anxiety and depressive disorders. The OSA is a demanding disease whose impact on the quality of life seems important and requires special attention. The management of this disease should not be limited to controlling the disease but aspire to overall patient satisfaction. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Advanced airway management strategies for severe OSAS and craniofacial anomalies.

    PubMed

    Gungor, Anil

    Pediatric OSAS and craniofacial malformations present challenges that require innovative approaches and comprehensive treatment strategies. Synchronous airway lesions, craniofacial malformations, obstructive anomalies of the tongue base, nasal vault and choanae are commonly addressed by subspecialists from various clinical and surgical academic traditions who practice variable levels of required communication. This is not a mere social requirement but an important requisite for intelligent and effective airway management. Membership of dedicated airway, aero digestive or craniofacial teams are desirable but not required. I expect this clinical brief to help many brilliant clinicians in their pursuit of perfection. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Ensuring a Future for Marine Corps Operational Support Airlift (OSA)

    DTIC Science & Technology

    2013-04-29

    purchase of the C-12 in the 1980’s. The C- 12, which is a military version of the Beech Craft ‘ King Air’ was subsequently used by the Marine Corps...MAGTF. The C-12 (Figure 2) is the military version of the Beechcraft King Air. It is often referred to as the ‘workhorse’ of OSA. There are...during major exercises such as Cobra Gold. 39 This would also allow the aircraft to 20 normalize operations in the region, which would better

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

    PubMed Central

    Zhang, Wang

    2012-01-01

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

  17. OSA Syndrome and Posttraumatic Stress Disorder: Clinical Outcomes and Impact of Positive Airway Pressure Therapy.

    PubMed

    Lettieri, Christopher J; Williams, Scott G; Collen, Jacob F

    2016-02-01

    We sought to determine the impact of OSA syndrome (OSAS) on symptoms and quality of life (QoL) among patients with posttraumatic stress disorder (PTSD). In addition, we assessed adherence and response to positive airway pressure (PAP) therapy in this population. This was a case-controlled observational cohort study at the Sleep Disorders Center of an academic military medical center. Two hundred consecutive patients with PTSD underwent sleep evaluations. Patients with PTSD with and without OSAS were compared with 50 consecutive age-matched patients with OSAS without PTSD and 50 age-matched normal control subjects. Polysomnographic data, sleep-related symptoms and QoL measures, and objective PAP usage were obtained. Among patients with PTSD, more than one-half (56.6%) received a diagnosis of OSAS. Patients with PTSD and OSAS had lower QoL and more somnolence compared with the other groups. Patients with PTSD demonstrated significantly lower adherence and response to PAP therapy. Resolution of sleepiness occurred in 82% of patients with OSAS alone, compared with 62.5% of PAP-adherent and 21.4% of nonadherent patients with PTSD and OSAS (P < .001). Similarly, posttreatment Functional Outcomes of Sleep Questionnaire ≥ 17.9 was achieved in 72% of patients with OSAS, compared with only 56.3% of patients with PTSD and OSA who were PAP adherent and 26.2% who were nonadherent (P < .03). In patients with PTSD, comorbid OSAS is associated with worsened symptoms, QoL, and adherence and response to PAP. Given the negative impact on outcomes, the possibility of OSAS should be considered carefully in patients with PTSD. Close follow-up is needed to optimize PAP adherence and efficacy in this at-risk population. Published by Elsevier Inc.

  18. 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".

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    PubMed Central

    Collins, Russell T.; Treisman, Jessica E.

    2000-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  5. Endothelial nitric oxide synthase uncoupling: a novel pathway in OSA induced vascular endothelial dysfunction.

    PubMed

    Varadharaj, Saradhadevi; Porter, Kyle; Pleister, Adam; Wannemacher, Jacob; Sow, Angela; Jarjoura, David; Zweier, Jay L; Khayat, Rami N

    2015-02-01

    The mechanism of vascular endothelial dysfunction (VED) and cardiovascular disease in obstructive sleep apnea (OSA) is unknown. We performed a comprehensive evaluation of endothelial nitric oxide synthase (eNOS) function directly in the microcirculatory endothelial tissue of OSA patients who have very low cardiovascular risk status. Nineteen OSA patients underwent gluteal biopsies before, and after effective treatment of OSA. We measured superoxide (O2(•-)) and nitric oxide (NO) in the microcirculatory endothelium using confocal microscopy. We evaluated the effect of the NOS inhibitor l-Nitroarginine-Methyl-Ester (l-NAME) and the NOS cofactor tetrahydrobiopterin (BH4) on endothelial O2(•-) and NO in patient endothelial tissue before and after treatment. We found that eNOS is dysfunctional in OSA patients pre-treatment, and is a source of endothelial O2(•-) overproduction. eNOS dysfunction was reversible with the addition of BH4. These findings provide a new mechanism of endothelial dysfunction in OSA patients and a potentially targetable pathway for treatment of cardiovascular risk in OSA. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Network science meets respiratory medicine for OSAS phenotyping and severity prediction

    PubMed Central

    Mihaicuta, Stefan; Topirceanu, Alexandru; Udrescu, Lucretia

    2017-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common clinical condition. The way that OSAS risk factors associate and converge is not a random process. As such, defining OSAS phenotypes fosters personalized patient management and population screening. In this paper, we present a network-based observational, retrospective study on a cohort of 1,371 consecutive OSAS patients and 611 non-OSAS control patients in order to explore the risk factor associations and their correlation with OSAS comorbidities. To this end, we construct the Apnea Patients Network (APN) using patient compatibility relationships according to six objective parameters: age, gender, body mass index (BMI), blood pressure (BP), neck circumference (NC) and the Epworth sleepiness score (ESS). By running targeted network clustering algorithms, we identify eight patient phenotypes and corroborate them with the co-morbidity types. Also, by employing machine learning on the uncovered phenotypes, we derive a classification tree and introduce a computational framework which render the Sleep Apnea Syndrome Score (SASScore); our OSAS score is implemented as an easy-to-use, web-based computer program which requires less than one minute for processing one individual. Our evaluation, performed on a distinct validation database with 231 consecutive patients, reveals that OSAS prediction with SASScore has a significant specificity improvement (an increase of 234%) for only 8.2% sensitivity decrease in comparison with the state-of-the-art score STOP-BANG. The fact that SASScore has bigger specificity makes it appropriate for OSAS screening and risk prediction in big, general populations. PMID:28503375

  7. Color opponency and scale uniformity in the OSA-UCS system: the geometrical structure

    NASA Astrophysics Data System (ADS)

    Oleari, Claudio

    2002-06-01

    Two different transformations between the (X10, Y10, Z10) coordinates and the (LOSA, g, j) ones of the Uniform Color System of the Optical Society of America (OSA- UCS) are given related to two possible different geometrical structures. Both transformations are logarithmic functions obtained by integration of Weber fractions of ratios of suitable color stimuli. The first structure is related to the color opponency proper of the (g, j) coordinates of the OSA-UCS) system and the second one to a mixing of the (g, j) coordinates. The second transformation has a simpler and highly symmetrical structure, and the regularity of the OSA- UCS lattice is higher.

  8. Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment

    PubMed Central

    Vakulin, Andrew; Baulk, Stuart D.; Catcheside, Peter G.; Antic, Nick A.; van den Heuvel, Cameron J.; Dorrian, Jillian; McEvoy, R. Doug

    2011-01-01

    Study Objectives: To assess the effectiveness of CPAP treatment in improving 90-minute driving simulator performance in severe OSA patients compared to age/gender matched controls. Design: Driving simulator performance was assessed at baseline and 3 months later, with OSA patients treated with CPAP during the interval. Setting: University Teaching Hospital. Participants: Patients with severe OSA (n = 11) and control subjects without OSA (n = 9). Interventions: CPAP Measurements and Results: Simulator driving parameters of steering deviation, braking reaction time and crashes were measured at baseline and ∼3 months follow-up. At baseline, OSA subjects demonstrated significantly greater steering deviation compared to controls (mean [95% CI], OSA group, 49.9 cm [43.7 to 56.0 cm] vs control group, 34.9 cm [28.1 to 41.7 cm], p = 0.003). Following ∼3 months of CPAP treatment (mean ± SD 6.0 ± 1.4 h/night), steering deviation in OSA subjects improved by an average of 3.1 cm (CI, 1.4 to 4.9), p < 0.001, while no significant steering changes were observed in the control group. Despite the improvement, steering deviation in the OSA group remained significantly higher than in controls (OSA group, 46.7 cm [CI, 40.6 to 52.8 cm] vs control group, 36.1 cm [CI, 29.3 to 42.9 cm], p = 0.025). Conclusions: While driving simulator performance improved after ∼3 months of CPAP treatment with high adherence in patients with severe OSA, performance remained impaired compared to control subjects. These results add to the growing body of evidence that some neurobehavioral deficits in patients with severe OSA are not fully reversed by treatment. Further studies are needed to assess causes of residual driving simulator impairment and to determine whether this is associated with persistent elevated real-life accident risk. Trial Registration: Data presented in this manuscript was collected as part of a clinical trial “Experimental Investigations of Driving Impairment in Obstructive

  9. Characterization of obstructive sleep apnea-hypopnea syndrome (OSA) population by means of cluster analysis.

    PubMed

    Lacedonia, Donato; Carpagnano, Giovanna Elisiana; Sabato, Roberto; Storto, Maria Maddalena Lo; Palmiotti, Giuseppe Antonio; Capozzi, Vito; Barbaro, Maria Pia Foschino; Gallo, Crescenzio

    2016-12-01

    Obstructive sleep apnea-hypopnea syndrome (OSA) is being identified increasingly as an important health issue. It is typified by repeated episodes of upper airway collapse during sleep leading to occasional hypoxaemia, sleep fragmentation and poor sleep quality. OSA is also being considered as an independent risk factor for hypertension, diabetes and cardiovascular diseases, leading to increased multi-morbidity and mortality. Cluster analysis, a powerful statistical set of techniques, may help in investigating and classifying homogeneous groups of patients with similar OSA characteristics. This study aims to investigate the (possible) different groups of patients in an OSA population, and to analyse the relationships among the main clinical variables in each group to better understand the impact of OSA on patients. Starting from a well-characterized OSA population of 198 subjects afferent to our sleep centre, we identified three different communities of OSA patients. The first has a very severe disease [apnea-hypopnea index (AHI) = 65.91 ± 22.47] and sleep disorder has a strong impact on daily life: a low level of diurnal partial pressure of oxygen (PaO2 ) (77.39 ± 11.64 mmHg) and a high prevalence of hypertension (64%); the second, with less severe disease (AHI = 28.88 ± 17.13), in which sleep disorders seem to be less important for diurnal PaO2 and have a minimum impact on comorbidity; and the last with very severe OSA (AHI = 57.26 ± 15.09) but with a low risk of nocturnal hypoxaemia (T90 = 11.58 ± 8.54) and less sleepy (Epworth Sleepiness Scale 10.00 ± 4.77).

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

    PubMed Central

    Olaithe, Michelle; Bucks, Romola S.

    2013-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  12. Is There a Relationship Between Snoring Sound Intensity and Frequency and OSAS Severity?

    PubMed

    Acar, Mustafa; Yazıcı, Demet; Bayar Muluk, Nuray; Hancı, Deniz; Seren, Erdal; Cingi, Cemal

    2016-01-01

    We investigated the relationship between snoring sounds and severity of obstructive sleep apnea syndrome (OSAS). A total number of 103 snoring patients (60 males and 43 females) were evaluated by means of polysomnographic findings and snoring sound recordings. Snoring sound intensity was assessed using fast Fourier transform (FFT) method by measuring maximal frequency (Fmax) and average snoring sound intensity level (SSIL). Maximal frequency and SSIL are correlated with apnea-hypopnea index (AHI), REM AHI, and severity of the OSAS. So, as the severity of the OSAS increased, so did the Fmax and SSIL of the snoring recordings, meaning patients started snoring louder with more frequency. In older patients, in females, in severe OSAS group, and in patients with higher body mass index (BMI), AHI and AHI REM values and SSIL and Fmax values increased. As mean oxygen (O2) saturation and lowest O2 saturation decreased, SSIL and Fmax values increased. Maximal frequency and SSIL analysis of the snoring sound increased in severe OSAS patients. People should be aware of the importance of snoring sounds. In particular, patients with snoring sounds increasing in intensity and of higher frequency should discuss with their physicians the possibility of OSAS. © The Author(s) 2015.

  13. Effect of CPAP Therapy in Improving Daytime Sleepiness in Indian Patients with Moderate and Severe OSA

    PubMed Central

    Battan, Gulshan; Panwar, Ajay; Atam, Virendra; Kumar, Pradeep; Gangwar, Anil; Roy, Ujjawal

    2016-01-01

    Introduction Obstructive Sleep Apnoea (OSA) is a highly prevalent disease and a major public health issue in India. Excessive daytime sleepiness is an almost ubiquitous symptom of OSA. Epworth Sleepiness Scale (ESS) score is a validated objective score to measure the degree of daytime sleepiness. Continuous Positive Airway Pressure (CPAP) therapy has been established as the gold standard treatment modality for OSA patients. A few Indian studies have reported the effectiveness of CPAP therapy in improving ESS scores after 1st month of CPAP use. Aim To observe both, short-term (one month) and long-term (three month) effects of CPAP therapy on ESS scores in moderate to severe OSA patients. Materials and Methods The patients complaining of excessive day-time sleepiness, snoring and choking episodes during sleep, consecutively presenting to medicine OPD over a period of 2 years, were subjected to Polysomnography (PSG). Seventy-three patients with apnoea-hypopnea index (AHI) ≥15 were categorised as having moderate to severe forms of OSA (moderate OSA with AHI=15-30 and severe OSA with AHI >30), and were scheduled for an initial trial of CPAP therapy. Forty-seven patients reported good tolerance to CPAP therapy after a trial period of 2 weeks and comprised the final study group. ESS scores in these patients were recorded at the baseline, and after 1st and 3rd month of CPAP therapy, and statistically analysed for significance. Results Mean ESS score at the baseline among moderate and severe OSA patients were 13.67±2.29 and 16.56 ±1.87, respectively. ESS score in both these subgroups improved significantly to 11.63±3.79, p=0.022, CI (0.3293-4.0106)} and 14.13 ±3.74, p < 0.001, CI (1.2991-4.5408), respectively after one month of CPAP therapy. Likewise, mean ESS scores among moderate and severe OSA patients improved significantly to 9.84 ±2.97, p = 0.022, CI (0.3293-4.0106) and 12.29 ±3.97, p <0.001, CI (2.9414-6.1385), respectively after three months of CPAP therapy

  14. Relationship between energy expenditure, physical activity and weight loss during CPAP treatment in obese OSA subjects.

    PubMed

    Bamberga, Michele; Rizzi, Maurizio; Gadaleta, Felice; Grechi, Attilio; Baiardini, Renata; Fanfulla, Francesco

    2015-04-01

    Increased energy expenditure (EE) has been reported in patients with obstructive sleep apnea (OSA). It has been postulated that CPAP treatment may induce weight reduction in obese patients, even if it has not been confirmed by recent studies. In the present study we investigated the effect of OSA on EE and the effect of CPAP on body weight and physical activity. One hundred and seven obese OSA patients and 25 healthy obese volunteers, as control group, matched for age, sex and BMI, were enrolled. The following evaluation was performed only in OSA patients after 6 months of CPAP treatment. Baseline total EE was similar in the two groups, but OSA patients showed higher EE during the night, while control group during daytime. In patients, EE correlates with OSA severity, degree of daytime sleepiness or obesity. At follow-up evaluation, BMI and total EE were unchanged. However, daytime EE increased (1066 ± 131.5 vs 1104 ± 133 Kcal/die, p < 0.001, respectively) and night EE decreased (694 ± 69 vs 595 ± 73, p < 0.0001, respectively). Statistically significant changes in BMI, sleepiness scale, blood gases and EE were found only in patients who were compliant to CPAP. Obese OSA patients showed an increased night EE that was normalized only in those patients compliant to CPAP. Body weight and daily physical activity did not change in statistically significant way. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    2016-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  17. Reviewing the relationship between OSA and cognition: Where do we go from here?

    PubMed

    Bucks, Romola S; Olaithe, Michelle; Rosenzweig, Ivana; Morrell, Mary J

    2017-10-01

    Obstructive sleep apnoea (OSA) is a disorder of breathing during sleep resulting in temporary reduction in cerebral oxygenation and sleep disruption. A growing body of research reveals a relatively consistent pattern of deficits in cognition, particularly in attention, episodic memory, and executive function, which are partially remediated by treatment. This is where the consensus ends. Despite a number of competing explanations regarding how OSA affects cognition, reliable evidence is hard to find, which may relate to the many, common conditions co-morbid with OSA or to the methodological challenges in this field. This paper reviews the evidence for cognitive impairment in OSA, the proposed models of cognitive harm, the impact of co-morbidities and the many methodological and theoretical challenges of exploring the effect of OSA on cognition. To overcome some of these challenges, we end by proposing a number of future directions for the field, including suggesting some core design elements for future studies. © 2017 Asian Pacific Society of Respirology.

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

    PubMed Central

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

    2015-01-01

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

  19. Performance analysis and overload control of an open service access (OSA) architecture

    NASA Astrophysics Data System (ADS)

    Andersson, Jens K.; Nyberg, Christian; Kihl, Maria

    2003-08-01

    The trend of the service architectures developed in telecommunications today is that they should be open in the sense that they can communicate over the borders of different networks. Instead of each network having their own service architecture with their own applications, all networks should be able to use the same applications. 3GPP, the organization developing specifications for the 3G networks has specified the standard Open Service Access (OSA), as a part of the 3G specification. OSA offers different Application Protocol Interfaces that enable an application that resides outside a network to use the capabilities of the network. This paper analyses the performance of an OSA gateway. It is examined how the overload control can be dealt with in a way to best satisfy the operators and the 3'rd parties. There are some guiding principles in the specifications, but a lot of decisions have to be made by the implementors of application servers and OSA gateways. Proposals of different requirements for an OSA architecture exist such as, minimum amount of accepted calls per second and time constraint for the maximal total delay for an application. Maximal and fair throughput have to be prioritized from the 3'rd parties view, but profit is the main interest from the operators point of view. Therefore this paper examines a priority based proposal of an overload control mechanism taking these aspects and requirements into account.

  20. Can sleep microstructure improve diagnosis of OSAS? Integrative information from CAP parameters.

    PubMed

    Milioli, Giulia; Bosi, Marcello; Grassi, Andrea; Riccardi, Silvia; Terzano, Mario Giovanni; Cortelli, Pietro; Poletti, Venerino; Parrino, Liborio

    2015-01-01

    The scoring of American Academy of Sleep Medicine (AASM) arousal is mandatory for the definition of respiratory event-related arousal (RERA). However there are other EEG activation phenomena, such as A phases of cyclic alternating pattern (CAP) which are associated with respiratory events in non rapid eye movements (NREM) sleep. This study aims at quantifying the additional value of CAP for the definition of respiratory events and sleep alterations in OSAS. Analysis of polysomnographic recordings from nineteen OSAS patients was carried out. Scoring was focused on investigation of the cerebral response to flow limitation (FL) events. For this purpose we used both CAP rules and AASM arousal criteria. While no difference was demonstrated in the arousal index between mild and moderate-severe OSAS patients, CAP time showed a progressive enhancement from normal subjects (152.5±20.76) to mild (180.64±34.76) and moderate-severe (282.27±58.02) OSAS patients. In NREM sleep, only 41.1% of FL events met the criteria for the definition of RERA, while, 75.5% of FL events ended with a CAP A phase and most FL CAP (69.1%) terminated with a CAP phase A3 subtype. Our data indicate that the RERA scoring has a limited accuracy in the detection of FL events. In NREM sleep, CAP rules provided more information than AASM arousal for the definition of respiratory events and sleep alterations in OSAS.

  1. OSAS-related inflammatory mechanisms of liver injury in nonalcoholic fatty liver disease.

    PubMed

    Paschetta, Elena; Belci, Paola; Alisi, Anna; Liccardo, Daniela; Cutrera, Renato; Musso, Giovanni; Nobili, Valerio

    2015-01-01

    Obstructive sleep apnoea syndrome (OSAS) is a common sleep disorder, affecting over 4% of the general population, and is associated with metabolic syndrome and cardiovascular disease, independent of obesity and traditional risk factors. OSAS has been recently connected to nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease in the world, which can be found in 30% of the general adult population. Several studies suggest that the chronic intermittent hypoxia (CIH) of OSAS patients may per se trigger liver injury, inflammation, and fibrogenesis, promoting NAFLD development and the progression from steatosis to steatohepatitis, cirrhosis, and hepatocellular carcinoma. In NAFLD patients, liver disease may be caused by hypoxia both indirectly by promoting inflammation and insulin resistance and directly by enhancing proinflammatory cytokine production and metabolic dysregulation in liver cells. In this review, we focus on molecular mechanisms linking OSAS to NAFLD, including hypoxia inducible factor (HIF), nuclear factor kappa B (NF-κB), YKL-40, unfolded protein response, and hypoxic adipose tissue inflammation, which all could provide novel potential therapeutic approaches for the management of NAFLD patients with OSAS.

  2. 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

  3. Effects of hydrothermal pretreatment on subsequent octenylsuccinic anhydride (OSA) modification of cornstarch.

    PubMed

    Chen, Xu; He, Xiaowei; Huang, Qiang

    2014-01-30

    Cornstarch granules were hydrothermally pretreated and then esterified with octenylsuccinic anhydride (OSA). The physicochemical properties of cornstarch and hydrothermally pretreated OS-starch (H-OS-starch) were investigated. Results showed that hydrothermal pretreatments significantly increased the degree of substitution (DS) and reaction efficiency (RE) of H-OS-starch compared with the control. The higher the pretreatment temperature was, the more the OSA could go deep into the internal starch granules. The optimal pretreatment temperature for the OSA modification was 60°C. In addition, the OS groups appeared to be distributed throughout the OS-starch granules, especially on the surface, as shown by confocal laser scanning microscopy (CLSM). H-OS-starch had a slightly higher peak viscosity (Pv) and break down (BD) values, but lower pasting temperature (Tp) compared with the control OS-starch.

  4. Applying time, frequency and nonlinear features from nocturnal oximetry to OSA diagnosis.

    PubMed

    Alvarez, Daniel; Hornero, Roberto; Victor Marcos, J; Del Campo, Felix; Zamarron, Carlos; Lopez, Miguel

    2008-01-01

    This study is aimed to improve the diagnostic ability of blood oxygen saturation (SaO(2)) in obstructive sleep apnea (OSA) detection. We studied 74 patients suspected of suffering from OSA. Ten characteristics were derived from each SaO2 recording: arithmetic mean, variance, skewness and kurtosis from both time and frequency domains, central tendency measure and Lempel-Ziv complexity. The diagnostic ability of each feature was assessed by means of a receiver operating characteristics (ROC) analysis. Additionally, forward stepwise logistic regression (LR) was applied. The kurtosis in the time domain and the nonlinear measure of complexity were automatically selected. This methodology reached 93.2% sensitivity, 80.0% specificity and 87.8% accuracy, improving the results from each feature individually. Our study showed that common statistics in the time and frequency domains and nonlinear features could provide additional and complementary information to help in OSA diagnosis.

  5. Evidence of perceptive impairment in OSA patients investigated by means of a visual search task.

    PubMed

    Giora, Enrico; Galbiati, Andrea; Marelli, Sara; Zucconi, Marco; Ferini-Strambi, Luigi

    2017-10-01

    Obstructive Sleep Apnoea (OSA) is a common sleep disorder characterized by episodes of complete or partial obstruction of respiratory airways during sleep that leads to hypoxaemia and sleep fragmentation. One relevant daytime consequence of OSA is a negative impact on neurocognitive domain, ranging from psychomotor performance to executive function. In spite of a huge amount of evidence regarding cognitive impairment, little is known about perceptual processing in these patients. The aim of this research is to investigate the effects of OSA on visual mechanisms by employing a visual search paradigm. 19 OSA patients and 19 age-matched healthy controls (HC) participated in a case-control study. After a nocturnal cardiorespiratory monitoring, patients performed a visual search task in which they had to detect the presence/absence of a target (letter T) embedded in the 50% of trials into a set of distractors (letters Os, Xs, or Ls). Target's salience and distractors' numerosity were manipulated as independent variables, whereas accuracy and reaction times (RT) were recorded as dependent variables. HC, after the exclusion of any sleep disorder or sleepiness, performed the same experiments. Results generally confirmed the typical effects of visual search. OSA patients reported significantly slower RT in comparison with HC, indicating an overall perceptual deficit consisting in a harder extraction of relevant information from noise. Neither patients' age nor the objective clinical indices were associated with RT. This study indicates the presence of an impairment in OSA patients involving basic mechanisms of visual processing and likely ascribable to the disorder per se. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Genetic analysis of candidate SNPs for metabolic syndrome in obstructive sleep apnea (OSA)

    PubMed Central

    Grilo, Antonio; Ruiz-Granados, Elena S.; Moreno-Rey, Concha; Rivera, Jose M.; Ruiz, Agustin; Real, Luis M.; Sáez, Maria E.

    2014-01-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by the reduction or complete cessation in airflow resulting from an obstruction of the upper airway. Several studies have observed an increased risk for cardiovascular morbidity and mortality among OSA patients. Metabolic syndrome (MetS), a cluster of cardiovascular risk factors characterized by the presence of insulin resistance, is often found in patients with OSA, but the complex interplay between these two syndromes is not well understood. In this study, we present the results of a genetic association analysis of 373 candidate SNPs for MetS selected in a previous genome wide association analysis (GWAS). The 384 selected SNPs were genotyped using the Illumina VeraCode Technology in 387 subjects retrospectively assessed at the Internal Medicine Unit of the “Virgen de Valme” University Hospital (Seville, Spain). In order to increase the power of this study and to validate our findings in an independent population, we used data from the Framingham Sleep study which comprises 368 individuals. Only the rs11211631 polymorphism was associated with OSA in both populations, with an estimated OR=0.57 (0.42-0.79) in the joint analysis (p=7.21 × 10-4). This SNP was selected in the previous GWAS for MetS components using a digenic approach, but was not significant in the monogenic study. We have also identified two SNPs (rs2687855 and rs4299396) with a protective effect from OSA only in the abdominal obese subpopulation. As a whole, our study does not support that OSA and MetS share major genetic determinants, although both syndromes share common epidemiological and clinical features. PMID:23524009

  7. OSA screening with the pediatric sleep questionnaire for adolescents undergoing bariatric surgery in teen-LABS.

    PubMed

    Ishman, Stacey; Heubi, Christine; Jenkins, Todd; Michalsky, Marc; Simakajornboon, Narong; Inge, Thomas

    2016-11-01

    Obstructive sleep apnea (OSA) is reported in 70% of adolescents who present for bariatric surgery. The Pediatric Sleep Questionnaire (PSQ) was developed to identify children at risk for OSA but is not validated in adolescents with obesity. The aims of this study were: (1) to assess validity of the PSQ to detect OSA and (2) to determine the correlation between anthropometric and polysomnography measurements. A cross-sectional assessment of Teen-Longitudinal Assessment of Bariatric Surgery participants at high risk for OSA was performed. Participants completed an overnight polysomnography, and caregivers completed the PSQ. Forty-five participants (84% female, 78% Caucasian, mean age = 16.7 ± 1.5 years) were evaluated. Mean BMI was 51.3 ± 7.7 kg/m(2) and mean obstructive apnea-hypopnea index (oAHI) was 6.1 ± 5.9 events/h. For diagnosis of OSA (oAHI ≥5), the total PSQ score sensitivity, specificity, and positive predictive value (PPV) were 86%, 38%, and 55%, respectively. For snoring >50% of the time, PPV was 84%, sensitivity was 64%, and specificity was 43%. Sagittal abdominal diameter correlated with oAHI and oxygen saturation nadir (ρ = 0.34, P = 0.027), whereas BMI, neck, and waist circumference correlated with neither. The PSQ demonstrated low specificity, and PPV and the question regarding snoring >50% of the time did not effectively identify OSA. Sagittal abdominal diameter correlated with oAHI and oxygen saturation nadir. © 2016 The Obesity Society.

  8. Resting energy expenditure in OSAS: the impact of a single CPAP application.

    PubMed

    Fekete, Katalin; Boutou, Afroditi K; Pitsiou, Georgia; Chavouzis, Nikolaos; Pataka, Athanasia; Athanasiou, Ioanna; Ilonidis, Georgios; Kontakiotis, Theodoros; Argyropoulou, Paraskevi; Kioumis, Ioannis

    2016-03-01

    Data on the impact of obstructive sleep apnea syndrome (OSAS) and its treatment on resting energy expenditure (REE) are currently few and conflicting. The purpose of the present study was to investigate the impact of OSAS on REE, as measured before and after sleep, and the changes in REE after a single continuous positive airway pressure (CPAP) application, for the first time in literature. This is a nested case-control study. From the initial study population, two groups were formed, based on the results of nocturnal polysomnography: a group of male OSAS patients and a group of male, age-matched non-OSAS controls. REE was measured in both groups before and after sleep by indirect calorimetry, while patients repeated REE measurements before and after a single nasal CPAP application. Ninety-two male OSAS patients (45.3 ± 12.8 years old) and 19 male non-OSAS controls (50.8 ± 11.7 years old) were studied. REE/lean body mass (LBM) was higher among patients compared to controls both pre- (29.6 ± 12 vs 22.9 ± 7.9 kcal/kg; p = 0.022, correspondingly) and post-sleep (26.4 ± 9.6 vs 21.6 ± 9 kcal/kg; p = 0.047 correspondingly). REE/LBM decreased significantly after sleep in OSAS patients (p = 0.002), but not in controls; this difference was most evident among patients with more severe disease and higher desaturation. A single nasal CPAP application diminished the pre-post REE/LBM difference (30.3 ± 8.2 vs 28.3 ± 10.3 kcal/kg; p = 0.265), but only among responders. In OSAS patients, REE values are high and vary significantly before and after sleep. A single nasal CPAP application diminishes this difference among responders, possibly through reversal of nocturnal desaturation.

  9. Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea (OSA) in moderate to severe chronic obstructive pulmonary disease (COPD): The challenge to predict OSA in advanced COPD.

    PubMed

    Soler, Xavier; Liao, Shu-Yi; Marin, Jose Maria; Lorenzi-Filho, Geraldo; Jen, Rachel; DeYoung, Pamela; Owens, Robert L; Ries, Andrew L; Malhotra, Atul

    2017-01-01

    The combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is associated with substantial morbidity and mortality. We hypothesized that predictors of OSA among patients with COPD may be distinct from OSA in the general population. Therefore, we investigated associations between traditional OSA risk factors (e.g. age), and sleep questionnaires [e.g. Epworth Sleepiness Scale] in 44 patients with advanced COPD. As a second aim we proposed a pilot, simplified screening test for OSA in patients with COPD. In a prospective, observational study of patients enrolled in the UCSD Pulmonary Rehabilitation Program we collected baseline characteristics, cardiovascular events (e.g. atrial fibrillation), and sleep questionnaires [e.g. Pittsburgh Sleep Quality Index (PSQI)]. For the pilot questionnaire, a BMI ≥25 kg/m2 and the presence of cardiovascular disease were used to construct the pilot screening test. Male: 59%; OSA 66%. FEV1 (mean ± SD) = 41.0±18.2% pred., FEV1/FVC = 41.5±12.7%]. Male gender, older age, and large neck circumference were not associated with OSA. Also, Epworth Sleepiness Scale and the STOP-Bang questionnaire were not associated with OSA in univariate logistic regression. In contrast, BMI ≥25 kg/m2 (OR = 3.94, p = 0.04) and diagnosis of cardiovascular disease (OR = 5.06, p = 0.03) were significantly associated with OSA [area under curve (AUC) = 0.74]. The pilot COPD-OSA test (OR = 5.28, p = 0.05) and STOP-Bang questionnaire (OR = 5.13, p = 0.03) were both associated with OSA in Receiver Operating Characteristics (ROC) analysis. The COPD-OSA test had the best AUC (0.74), sensitivity (92%), and specificity (83%). A ten-fold cross-validation validated our results. We found that traditional OSA predictors (e.g. gender, Epworth score) did not perform well in patients with more advanced COPD. Our pilot test may be an easy to implement instrument to screen for OSA. However, a larger validation study is necessary before

  10. Obstructive sleep apnea syndrome (OSAS) and social support in elder patients.

    PubMed

    Tutuncu, Recep; Karabulut, Hayriye; Acar, Baran; Babademen, Mehmet Ali; Ciftçi, Bülent; Karaşen, Riza Murat

    2012-01-01

    Social support is a very important aspect in debilitating diseases. OSAS is a disabling disease that impairs social functioning and accounts for a large socio-economic burden for the community. In this study our aim is to investigate social support levels among OSAS patients: 85 of them with the diagnosis of OSAS were enrolled in the study. Multidimensional scale of perceived social support (MSPSS) is used to measure the perception of individuals' social support sufficiency. In contrast to many studies, we found that social support levels of elder patients were higher than the young ones and family subscale was significantly higher. It might be both due to Turkish family structure that the grands are in close relationship with the other family members and the adverse effects of the disease which have more negative impact on young patients' life. In conclusion, social support is an important aspect in OSAS patients. The interventions for the enhancement of social support could lead to substantial cost-savings, reduce morbidity, and increase well-being. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Evaluation of a biological wastewater treatment system combining an OSA process with ultrasound for sludge reduction.

    PubMed

    Romero-Pareja, P M; Aragon, C A; Quiroga, J M; Coello, M D

    2017-05-01

    Sludge production is an undesirable by-product of biological wastewater treatment. The oxic-settling-anaerobic (OSA) process constitutes one of the most promising techniques for reducing the sludge produced at the treatment plant without negative consequences for its overall performance. In the present study, the OSA process is applied in combination with ultrasound treatment, a lysis technique, in a lab-scale wastewater treatment plant to assess whether sludge reduction is enhanced as a result of mechanical treatment. Reported sludge reductions of 45.72% and 78.56% were obtained for the two regimes of combined treatment tested in this study during two respective stages: UO1 and UO2. During the UO1 stage, the general performance and nutrient removal improved, obtaining 47.28% TN removal versus 21.95% in the conventional stage. However, the performance of the system was seriously damaged during the UO2 stage. Increases in dehydrogenase and protease activities were observed during both stages. The advantages of the combined process are not necessarily economic, but operational, as US treatment acts as contributing factor in the OSA process, inducing mechanisms that lead to sludge reduction in the OSA process and improving performance parameters. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Transcriptional regulation of the Drosophila moira and osa genes by the DREF pathway.

    PubMed

    Nakamura, Kumi; Ida, Hiroyuki; Yamaguchi, Masamitsu

    2008-07-01

    The DNA replication-related element binding factor (DREF) plays an important role in regulation of cell proliferation in Drosophila, binding to DRE and activating transcription of genes carrying this element in their promoter regions. Overexpression of DREF in eye imaginal discs induces a rough eye phenotype in adults, which can be suppressed by half dose reduction of the osa or moira (mor) genes encoding subunits of the BRM complex. This ATP-dependent chromatin remodeling complex is known to control gene expression and the cell cycle. In the 5' flanking regions of the osa and mor genes, DRE and DRE-like sequences exist which contribute to their promoter activities. Expression levels and promoter activities of osa and mor are decreased in DREF knockdown cells and our results in vitro and in cultured cells indicate that transcription of osa and mor is regulated by the DRE/DREF regulatory pathway. In addition, mRNA levels of other BRM complex subunits and a target gene, string/cdc25, were found to be decreased by knockdown of DREF. These results indicate that DREF is involved in regulation of the BRM complex and thereby the cell cycle.

  13. Cognition and nocturnal disturbance in OSA: the importance of accounting for age and premorbid intelligence.

    PubMed

    Olaithe, Michelle; Skinner, Timothy C; Hillman, David; Eastwood, Peter E; Bucks, Romola S

    2015-03-01

    Obstructive sleep apnea (OSA) is a common disorder that is associated with impaired attention, memory and executive function. However, the mechanisms underlying such dysfunction are unclear. To determine the influence of sleep fragmentation and hypoxia, this study examined the effect of sleep fragmentation and hypoxia on cognition in OSA, while controlling for potentially confounding variables including sleepiness, age and premorbid intelligence. Participants with and without OSA (N = 150) were recruited from the general community and a tertiary hospital sleep clinic. All underwent comprehensive, laboratory-based polysomnography (PSG) and completed assessments of cognition including attention, short- and long-term memory and executive function. Structural equation modelling (SEM) was used to construct a theoretically-driven model to examine the relationships between hypoxia and sleep fragmentation, and cognitive function. Although after controlling for IQ, increased sleep disturbance was a significant predictor of decreased attention (p = 0.04) and decreased executive function (p = 0.05), controlling for age removes these significant relationships. No significant predictors of memory function were found. The mechanisms underlying the effects of OSA on cognition remain to be defined. Implications are discussed in light of these findings.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Feldstein, Carlos A

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-07-01

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

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

    PubMed

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

    2015-08-01

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

  19. The effectiveness of combined tonsillectomy and anterior palatoplasty in the treatment of snoring and obstructive sleep apnoea (OSA).

    PubMed

    Adzreil, Bakri; Wong, Eugene Hung Chih; Saraiza, Abu Bakar; Raman, Rajagopalan; Amin, Jalaludin

    2017-04-01

    The prevalence of obstructive sleep apnoea (OSA) is increasing due to a rising rate of obesity. Multiple surgical techniques used to address obstruction at the palatal level have been associated with significant morbidities. Few studies have reported good outcomes of anterior palatoplasty (AP) in mild-to-moderate OSA. The aim of this study is to investigate the effectiveness of combining tonsillectomy and anterior palatoplasty in the treatment of snoring and OSA. All patients with snoring and OSA treated with tonsillectomy and anterior palatoplasty were analyzed. The primary outcome was reduction of the apnoea hypopnoea index (AHI) with surgical success criteria; reduction of AHI by ≥50% and AHI ≤10. The secondary outcomes measured were patients' Epworth Sleepiness Scale (ESS) and snoring visual analogue scale (VAS) scores. Thirty one patients completed the study, where 19% had mild, 42% moderate, and 39% had severe OSA. The mean surgical success rate was 45% at 3 months and 32% at 1-year post-operatively. There was a significant reduction of ESS and VAS at 3 months and 1-year post-operatively (p < 0.05). Combination of tonsillectomy and anterior palatoplasty could be considered as a treatment option for snoring and OSA in selected groups of patients (mild-to-moderate OSA with mainly retropalatal obstruction). The surgical success was found to reduce with time, and BMI optimization should be emphasized as part of post-operative care.

  20. [Specific features of wounds with a self-defense traumatic weapon "Osa"].

    PubMed

    Khodov, A M; Zolotov, A S; Filipchenkov, L S

    2012-01-01

    Specific features and outcomes of wounds with a traumatic weapon of self-defense "Osa" were analyzed in 24 patients. Mean age of the wounded was from 21 to76 years. In 20 patients there was a single wound, in 4 patients it was multiple, in 7--blunt, in 12--perforating and 5 patients had gutter wounds. All the patients were treated according to the principles of field military surgery. Five patients had severe wounds: penetrating fracture of the skull (2 of them died), fracture of the shoulder (1 case), injury of the main artery (1 case), of the pleura (1 case). The wounds were closed up by primary intention in 19 patients, by second intention in 4 patients. The authors' experience shows that a traumatic weapon of self-defense "Osa" rather often caused permanent harm to health and can be mortal. Active surgical strategy in treatment of such patients prevents the development of serious infectious complications.

  1. Effects of simultaneous palatal expansion and mandibular advancement in a child suffering from OSA.

    PubMed

    Galeotti, A; Festa, P; Pavone, M; De Vincentiis, G C

    2016-08-01

    This clinical report describes a child suffering from obstructive sleep apnoea (OSA) and class II skeletal malocclusion with maxillary contraction and anterior open bite. He presented moderate obstructive sleep apnoea with large impact on quality of life of patient and parents. He was treated using an innovative orthodontic device (Sleep Apnea Twin Expander) to simultaneously carry out palatal expansion and mandibular advancement. After orthodontic therapy, the OSA-18 questionnaire demonstrated an improvement of the main respiratory symptoms, while cardiorespiratory sleep study revealed a reduction in obstructive sleep apnoea events. Post-treatment, clinical assessment and cephalometric analysis showed a reduction of sagittal maxillary discrepancy and an extension of upper airway space. In conclusion, this case report suggests that orthodontic treatment might be a valuable alternative treatment in children with obstructive sleep apnoea related to craniofacial anomalies.

  2. Corresponding color datasets and a chromatic adaptation model based on the OSA-UCS system.

    PubMed

    Oleari, Claudio

    2014-07-01

    Today chromatic adaptation transforms (CATs) are reconsidered, since their mathematical inconsistency has been shown in Color Res. Appl.38, 188 (2013) and by the CIE technical committee TC 8-11: CIECAM02 Mathematics. In 2004-2005 the author proposed an adaptation transform based on the uniform color scale system of the Optical Society of America (OSA-UCS) [J. Opt. Soc. Am. A21, 677 (2004); Color Res. Appl. 30, 31 (2005)] that transforms the cone-activation stimuli into adapted stimuli. The present work considers all the 37 available corresponding color (CC) datasets selected by CIE and (1) shows that the adapted stimuli obtained from CC data are defined up to an unknown transformation, and an unambiguous definition of the adapted stimuli requires additional hypotheses or suitable experimental data (as it is in the OSA-UCS system); (2) produces a CAT, represented by a linear transformation between CCs, associated with any CC dataset, whose high quality measured in ΔE units discards the possibility of nonlinear transformations; (3) analyzes these color-conversion matrices in a heuristic way with a reference adaptation that is approximately that of the OSA-UCS adapted colors for the D65 illuminant and particularly shows accordance with the Hunt effect and the Bezold-Brücke hue shift; (4) proposes the measurements of CC stimuli with a reference adaptation equal to that of the visual situation of the OSA-UCS system for defining adapted colors for any considered illumination adaptation and therefore for defining a general CAT formula.

  3. Upper Airway Stimulation for OSA: Early Adherence and Outcome Results of One Center.

    PubMed

    Kent, David T; Lee, Jake J; Strollo, Patrick J; Soose, Ryan J

    2016-07-01

    To review outcome measures and objective adherence data for patients treated with hypoglossal nerve stimulation (HNS) therapy for moderate to severe obstructive sleep apnea (OSA). Case series with chart review. Academic sleep medicine center. The first 20 implanted patients to complete postoperative sleep laboratory testing were assessed. All patients had moderate to severe OSA, were unable to adhere to positive pressure therapy, and met previously published inclusion criteria for the commercially available implantable HNS system. Data included demographics, body mass index (BMI), apnea-hypopnea index (AHI), Epworth Sleepiness Score (ESS), nightly hours of device usage, and procedure- and therapy-related complications. Mean age was 64.8 ± 12.0 years, with 50% female. Mean BMI was unchanged postoperatively (26.5 ± 4.2 to 26.8 ± 4.5 kg/m(2); P > .05). Mean AHI (33.3 ± 13.0 to 5.1 ± 4.3; P < .0001) and mean ESS (10.3 ± 5.2 to 6.0 ± 4.4; P < .01) decreased significantly. Seventy percent (14/20) of patients achieved a treatment AHI <5, 85% (17/20) an AHI <10, and 95% (19/20) an AHI <15. Average stimulation amplitude was 1.89 ± 0.50 V after titration. Adherence monitoring via device interrogation showed high rates of voluntary device use (mean 7.0 ± 2.2 h/night). For a clinical and anatomical subset of patients with OSA, HNS therapy is associated with good objective adherence, low morbidity, and improved OSA outcome measures. Early results at one institution suggest that HNS therapy can be implemented successfully into routine clinical practice, outside of a trial setting. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  4. A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA.

    PubMed

    Ng, Susanna S S; Chan, Ruth S M; Woo, Jean; Chan, Tat-On; Cheung, Bernice H K; Sea, Mandy M M; To, Kin-Wang; Chan, Ken K P; Ngai, Jenny; Yip, Wing-Ho; Ko, Fanny W S; Hui, David S C

    2015-11-01

    Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA. This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring. In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (-1.8 kg/m2, 6.0% of the initial BMI; -0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (-3.5 in the LMP group vs -1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months. LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months. ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov.

  5. Effect of oxygen desaturation threshold on determination of OSA severity during weight loss.

    PubMed

    Myllymaa, Katja; Myllymaa, Sami; Leppänen, Timo; Kulkas, Antti; Kupari, Salla; Tiihonen, Pekka; Mervaala, Esa; Seppä, Juha; Tuomilehto, Henri; Töyräs, Juha

    2016-03-01

    Weight loss leads to improvement of obstructive sleep apnea (OSA), based on frequency of respiratory events (apnea-hypopnea index, AHI). However, AHI does not incorporate the severity of individual obstruction events. The American Academy of Sleep Medicine suggests two alternative oxygen desaturation thresholds (ODT) for scoring of hypopneas. We hypothesize that lowering the ODT level increases the determined impact of weight loss on OSA severity. We investigate this during weight change with AHI and adjusted AHI. Adjusted AHI is a novel parameter incorporating both severity and number of the events. Ambulatory polygraphic data of 54 OSA patients (F 15/M 39, 51.7 ± 8.4 years), divided into weight loss (>5 %, n = 20), control (weight change 0-5 %, n = 26), and weight gain (>5 %, n = 8) groups, were evaluated at baseline and after 5-year follow-up. Effect of ODT (ODT2%-ODT6%) on AHI and adjusted AHI was investigated. The greatest changes in AHI (decrease in weight loss group and increase in weight gain group) were observed with ODT2%. Changes in AHI diminished with increasing ODT. In weight loss group, adjusted AHI showed a similar but non-significant trend. In contrast, the higher ODT was used in weight gain group, the greater increase in adjusted AHI resulted. Using adjusted AHI instead of AHI, led to a smaller number of patients (20 vs. 55 %, ODT3%) whose OSA severity category improved along weight loss. Weight loss significantly reduced AHI. This reduction was highly dependent on selected ODT. The change in adjusted AHI did not occur in the same extent. This was expected as the more severe events which tend to remain during the weight loss have greater importance in adjusted AHI, while the event severity is neglected in AHI.

  6. OSA-18 survey in evaluation of sleep-disordered breathing in children with adenotonsillar hypertrophy.

    PubMed

    Hasukic, Begzada

    2013-01-01

    The aim of this study was to estimate the quality of life (QOL) in children with sleep-disordered breathing (SDB) before and after adenoidectomy and before and after adenotonsillectomy using the OSA-18 survey. The prospective study included sixty children with symptoms of SDB caused by enlarged adenoids or tonsils, of both sexes, aged 3-12 years, consecutively admitted into the ENT Clinic in Tuzla, for adenoidectomy or adenotonsillectomy. Patients were divided in two subgroups: thirty patients who underwent adenoidectomy and thirty patients who underwent adenotonsillectomy. Parents or caregivers completed the OSA-18 survey before surgery and 5 weeks after surgery. For statistical analysis was used Student's t-test of pared samples. The values p < 0.05 were accepted as significant. Mean total score before adenoidectomy was 3.44 (SD = 0.77) and after surgery was 1.30 (SD = 0.46).Mean total score before adenotonsillectomy was 3.69 (SD = 0.80), after surgery was 1.22 (SD = 0.27). The difference between preoperative and postoperative scores in both subgroups of patients was significant (p < 0.01). Adenoidectomy and adenotonsillectomy improve QOL in children with SDB, which is caused by adenotonsillar hypertrophy. The OSA-18 survey is a useful tool for the selection of children for surgery with SDB caused by adenotonsillar hypertrophy and to assess quality of life after surgery.

  7. Physiology of Arousal in OSA and Potential Impacts for Sedative Treatment.

    PubMed

    Jordan, Amy S; O'Donoghue, Fergal J; Cori, Jennifer M; Trinder, John

    2017-04-11

    Treatment options for patients with obstructive sleep apnea (OSA) intolerant of continuous positive airway pressure (CPAP) are limited. Thus, new therapies are sought. Recently, there has been interest in using sedatives to delay arousal from sleep, allowing upper airway dilator muscle recruitment sufficient to re-open the airway while maintaining sleep. In this review the rationale for sedative use and prior sedative studies in OSA are presented, along with a description of six factors that may determine sedative treatment success. It is proposed that in order for a sedative to treat OSA the patient must have each of the following three traits: 1) a mild to moderately collapsible upper airway, 2) responsive and effective upper airway dilator muscles and 3) a low to moderate arousal threshold. In addition (4), proponents of sedative treatment generally believe that to be effective the sedative must increase the arousal threshold. Finally (5), sedatives may have additional utility in patients with large ventilatory responses to arousal and (6) the metric used to define sedative success needs to be considered. To date, few of these factors have been evaluated in sedative trials. Further, it is likely only a relatively small percentage of patients will have all of the required traits. If sedative treatment is successful in appropriate patients, easily measured surrogate markers for the factors that determine sedative success will be critical for implementation in the clinic. Finally, sedatives may have detrimental outcomes for some patients and prospective identification of such patients will be required.

  8. Everyday life for the spouses of patients with untreated OSA syndrome.

    PubMed

    Stålkrantz, Anna; Broström, Anders; Wiberg, Jan; Svanborg, Eva; Malm, Dan

    2012-06-01

    The aim of this study was to generate a theoretical model describing concerns for spouses of patients with untreated obstructive sleep apnoea syndrome (OSAS) and how they manage these concerns in their everyday life. Twelve spouses were interviewed about their experiences and how they manage everyday life. The interviews were analysed according to the Grounded Theory method as described by Strauss and Corbin. Two main categories emerged from the data: 'Social adjustment' and 'New feelings'. 'Social adjustment' reveals how the spouses made adjustments in their daily lives, both according to their partners' tiredness and owing to their own fatigue. 'New feelings' reveals emotional reactions related to the effects of their partner's illness and the impact it had on the spouse's everyday life. These two main categories could be seen in relation to four dimensions describing how the spouses manage their everyday life: 'Sacrificing', 'Controlling', 'Changing' and 'Understanding'. The results show how the spouses made adjustments in everyday life and how their feelings were affected by their partner's OSAS. Healthcare personnel could use information from this study to gain a deeper understanding and knowledge of what spouses of untreated patients with OSAS experience as their main concerns and how they manage their everyday life. This knowledge can be used to improve the support to the spouses, as well as in the educational situation concerning the illness, as well as the treatment. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

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

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  10. Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

    PubMed

    Ozcelik, Hatice; Kayar, Yusuf; Danalioglu, Ahmet; Arabaci, Elif; Uysal, Omer; Yakar, Fatih; Kart, Levent

    2017-03-01

    Obstructive sleep apnea (OSA) leads to upper respiratory tract obstruction, causing increased abdominal-gastric pressure and decreased lower esophageal sphincter (LES) pressure and thus gastroesophageal reflux (GER). Continuous positive airway pressure (CPAP) is known to be an effective method for OSA treatment, but its effect on GER is still controversial. There are a very few studies investigating CPAP and GER relationship and performed based on pre- and post-treatment objective parameters of GER in patients with OSA. The study investigated the effect of CPAP treatment in patients with moderate and severe OSA without GER complaints on pre- and post-treatment objective GER parameters. The study included 25 patients with respiratory disturbance indices >15 without reflux symptoms who had undergone polysomnography at sleep laboratory. Age, sex, body mass index (BMI), waist, and neck circumference of the patients were documented. DeMeester score, LES pressure, and polysomnography parameters were evaluated pre- and post-CPAP. The results were statistically evaluated, and p value <0.05 is considered significant. Out of 25 patients, 21 were male (84 %) and mean age was 49.2 ± 8.6 (range 31-66). At the pre-CPAP phase, mean sphincter pressure was 22.2 ± 1.2 (range 8-73), and mean DeMeester score was 18 ± 15.5 (range 0.2-57). At the post-CPAP, mean sphincter pressure was 22.9 ± 1.6 (range 9-95), and mean DeMeester score was 16.3 ± 14.8 (range 0.2-55). No significant difference (p > 0.05) was found comparing pre-CPAP and post-CPAP measurements. Objective criteria show that CPAP treatment does not cause reflux in patients with OSA. Unlike studies reported in the literature, this conclusion has been reached by pre- and post-CPAP assessments.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2014-10-01

    Octenyl succinic anhydride (OSA)-modified starch functions as both an emulsifier and emulsion stabilizer in foods, and is intended for use in infant formula, follow-on formula, and formulae for special medical purposes. These formulae predominantly include extensively hydrolyzed protein or free amino acids, rather than intact protein, which otherwise would provide emulsifying functionality. The study objectives were to evaluate (1) the safety of OSA-modified starch after three weeks of administration to neonatal farm piglets, beginning 2 days after birth and (2) the impact of OSA-modified starch on piglet growth. OSA-modified starch was added to formula at concentrations of 2, 4, and 20 g/L. The vehicle control, low-dose, and mid-dose diets were supplemented with Amioca™ Powder to balance the nutritional profiles of all formulations. There were no test article-related effects of any diet containing OSA-modified starch on piglet growth and development (clinical observations, body weight, feed consumption), or clinical pathology parameters (hematology, clinical chemistry, coagulation, urinalysis). In addition, there were no adverse effects at terminal necropsy (macro- and microscopic pathology evaluations). Therefore, dietary exposure to OSA-modified starch at concentrations up to 20 g/L was well tolerated by neonatal farm piglets and did not result in adverse health effects or impact piglet growth. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Influence of Tonsillar Size on OSA Improvement in Children Undergoing Adenotonsillectomy.

    PubMed

    Tang, Alice; Benke, James R; Cohen, Aliza P; Ishman, Stacey L

    2015-08-01

    To determine if pediatric obstructive sleep apnea (OSA) improves after adenotonsillectomy (AT) regardless of tonsil size. Case series with chart review. Pediatric Otolaryngology Department, Johns Hopkins Hospital. Seventy children 1 to 18 years of age who underwent polysomnography (PSG) before and after AT. Tonsil size was evaluated using the Brodsky grading scale. Children were stratified by tonsil size as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). There was a significant improvement in obstructive apnea-hypopnea index (oAHI), apnea index (AI), and saturation nadir across all 3 groups after AT. Preoperative oAHI, AI, and hypopnea index (HI) were similar regardless of tonsil size (P > .05). Overall, oAHI improved from a median of 11.8 ± 21.7 to 2.0 ± 6.1 events/h, with 40% (28/70) of children having complete resolution. The oAHI (P < .0001-0.02), AI (P < .0001-0.017), HI (P < .0001-0.058), and saturation nadir (P < .0001-0.017) significantly improved for the 2+, 3+, and 4+ groups. Only the HI (P = .058) in the 2+ group did not. The median oAHI improvement was 3.4 ± 26.4 events/h in the 2+ group, 8.3 ± 16.6 events/h in the 3+ group, and 12.3 ± 19.5 events/h in the 4+ group, with 25% (5/20), 50% (18/36), and 36% (5/14), respectively, having complete resolution. There was no correlation between OSA severity and tonsil or adenoid size (P > .32). Tonsil size did not correlate with OSA severity. While a larger proportion of patients classified as 3+ and 4+ had complete resolution after surgery, significant improvement was seen in AI and saturation nadir even in those classified as 2+. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  14. The relationship between AHI, Epworth scores and sleep endoscopy in patients with OSAS.

    PubMed

    Belgü, Ayfer Ulçay; Erdoğan, Barış; San, Turhan; Gürkan, Emre

    2015-01-01

    This prospective study aimed to evaluate the relationship between sleep endoscopy findings, the apnea-hypopnea index (AHI) or the Epworth sleepiness scale in patients and obstructive sleep apnea syndrome (OSAS). Patients with symptoms of OSAS were searched, and their polysomnography findings, Epworth sleepiness scales and sleep endoscopy findings were recorded. Those who were diagnosed with mild, moderate or heavy OSAS were included in the study. Patients included in the study were observed under sedative-induced sleep in the operation room using flexible nasopharyngoscopy. The obstruction levels and degrees were recorded and compared with other variables. Of the 88 patients included in the study, 67 (76.1 %) were male, and 21 (23.9 %) were female. The mean age (±standard deviation) of all 88 patients was 43.77 ± 10.07 years (range 21-65 years). Sleep endoscopy findings were classified as uvulopalatal, lateral pharyngeal, tongue base and laryngeal collapses. The Epworth sleepiness scale showed no significant correlation with the sleep endoscopy findings. No significant relationship was found between the AHI and collapses in the uvulopalatal, lateral and laryngeal zones (p > 0.05). However, tongue base collapse was correlated with AHI (p < 0.05). AHI increased with the degree of collapse in the tongue base. No meaningful relationship was noted among the Epworth sleepiness scale, AHI, and number of involved zones (p > 0.05). The degree of collapse in the related zones was not meaningfully associated with AHI, which is accepted as the indicator of disease severity.

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

  16. Rapid maxillary expansion in children with Obstructive Sleep Apnoea Syndrome (OSAS).

    PubMed

    Marino, A; Ranieri, R; Chiarotti, F; Villa, M P; Malagola, C

    2012-03-01

    to evaluate the effects of rapid maxillary expansion (RME) in a group of OSAS preschool children. Lateral cephalograms of 15 OSAS children (8 boys and 7 girls, age mean ± SD: 5.94 ± 1.64 years) were analysed at the start of treatment with RME (T0). All subjects were revaluated after a mean period of 1.57 ± 0.58 years (T1). At this time the sample was divided into 2 groups according to the change in the respiratory disturbance index (RDI): an improved group (I: 8 subjects) and a stationary/worsened group (SW: 7 subjects). Differences between I and SW children with respect to values of cephalometric variables at T0 and to variations between T0 and T1 were evaluated using Mann-Whitney U test. Differences between T0 and T1 values in the overall group of children and separately in I and SW groups were assessed using Wilcoxon test. At the start of treatment, the I group was characterised by more retrognathic jaws with lower values of SNA (p=0.055) and SNB (p=0.020) and higher age values (p=0.093) when compared to SW group. After treatment, the I group showed an increase in SNA and SNB angle significantly higher than SW group (p=0.004 and p=0.003, respectively). On the contrary, I and SW groups did not differ as for variation in the skeletal divergency and in the total facial height. OSAS preschool children with retrognathic jaws could benefit from RME treatment.

  17. [Prevalence of obstructive sleep apnea syndrome (OSA) in patients with sudden hearing loss. A pilot study].

    PubMed

    Fischer, Y; Yakinthou, A; Mann, W J

    2003-06-01

    It is estimated that in patients with sleep-related breathing disorders the probability of a cerebral vascular infarction (CVI) is 3.1 times that in patients without sleep apnea and that 25-50% of all patients who have a stroke suffer from sleep apnea (OSA) and have a respiratory disturbance index (RDI) higher than 10. CVI may be caused by variations in intracranial pressure or in intracranial hemodynamics owing to decreasing pO(2) and increasing pCO(2) during cessation of airflow. It is suspected that the most common causes of sudden deafness are vasospasm, thrombosis, embolism, hypercoagulation and sludging. The present study analyzed the prevalence of sleep apnea in patients with sudden hearing loss. A 7-channel polygraph was used to test 33 subjects with normal hearing and 27 patients suffering from sudden hearing loss. Statistical analyses were performed with a Chi-square test and the Mann-Whitney test. We found that 29.6% of the patient group and 21.2% of those in the study control group were suffering from OSA and had RDI >10; this difference was not significant ( p=0.554). Sudden hearing loss may also be an indicator of arteriosclerosis secondary to such risk factors as hypertension ( p=0.005), diabetes ( p=0.003), and hyperlipidemia ( p=0.004), which were highly significant for the patient group. Patients who develop sudden hearing loss tend to have OSA more frequently than those in the control group owing to the similar risk factors for cerebral infarction and sudden hearing loss.

  18. Nasal and oral snoring endoscopy: novel and promising diagnostic tools in OSAS patients.

    PubMed

    Lovato, Andrea; Kotecha, Bhik; Vianello, Andrea; Giacomelli, Luciano; Staffieri, Alberto; Marchese-Ragona, Rosario

    2015-07-01

    The aim of the present study was to investigate if any of the three awake procedures [fiberoptic nasopharyngoscopy with modified Müller Maneuver (FNMM), nasal snoring endoscopy (NSE), or oral snoring endoscopy (OSE)] could efficiently predict the grade or pattern of upper airway (UA) collapse found with drug-induced sleep endoscopy (DISE), which is considered by many authors as the current gold standard in optimizing obstructive sleep apnea syndrome (OSAS) patient selection for UA surgery. Twenty consecutive patients (simple snorers and OSAS patients) were studied with FNMM, NSE, OSE, and DISE. The inter-test agreement was evaluated with Cohen's kappa coefficient (κ). In the current series, we found that NSE and OSE were better than FNMM in predicting the pattern of collapse found with DISE. A significant pattern agreement between NSE and DISE was present in all sub-sites, and the agreement was measured with a scale proposed by Landis and Koch as: moderate in velo- and oropharynx (κ = 0.52, p = 0.001, and κ = 0.47, p = 0.003, respectively), and substantial in hypopharynx (κ = 0.63, p < 0.00001). Comparing OSE with DISE, the pattern agreement was almost perfect at oropharyngeal level (κ = 0.82, p < 0.00001), and moderate at hypopharyngeal level (κ = 0.55, p = 0.0002); while a trend towards significance was found at velopharyngeal level (κ = 0.20, p = 0.07). FNMM showed a fair pattern agreement with DISE only at oropharyngeal level (κ = 0.31, p = 0.009); while in the other sub-sites, no significant agreement was found. NSE and OSE are new promising diagnostic tools in OSAS patients. Further investigations are needed to see if they could predict the effectiveness of UA surgery.

  19. Positional OSA part 2: retrospective cohort analysis with a new classification system (APOC).

    PubMed

    Ravesloot, M J L; Frank, M H; van Maanen, J P; Verhagen, E A; de Lange, J; de Vries, N

    2016-05-01

    In Part 1 of this two-part article, the Amsterdam Positional Obstructive Sleep Apnoea Classification (APOC) was recently introduced, a classification system aimed at facilitating the identification of suitable candidates for positional therapy (PT): patients who will benefit from a clinically significant improvement of their obstructive sleep apnoea (OSA) with PT. APOC was developed with new generation PT devices in mind rather than conventional PT (tennis ball technique). New generation PT can be defined as a well-tolerated device which prevents a patient from adopting the worst sleeping position (WSP) without negatively influencing sleep efficiency, as objectified by a full night polysomnography (PSG). PT is rapidly gaining momentum in the scope of OSA treatment. The objective of this manuscript is to measure the prevalence of position-dependent obstructive sleep apnoea (POSA) according to the APOC, in a consecutive series of patients referred for PSG as well as an investigation of associations between POSA and certain patient characteristics. We performed a retrospective, single-centre cohort study including a consecutive series of patients who underwent a PSG during the period of April 2010 until October 2010. Within this OSA-cohort (n = 253), a prevalence of POSA of 69 % when applying APOC is measured, compared to 64 % when applying Cartwright's classification. An inverse relation between POSA and BMI was observed, likewise between POSA and apnoea hypopnoea index (AHI). We are of opinion that APOC is a suitable tool to identify patients who will or will not benefit from PT, thus resulting in more cost-efficient treatment.

  20. Drug-induced sleep endoscopy: A new gold standard for evaluating OSAS? Part I: Technique.

    PubMed

    Blumen, M; Bequignon, E; Chabolle, F

    2017-04-01

    Surgical results in obstructive sleep apnea syndrome (OSAS) vary greatly, whatever the surgical technique or site treated. Most authors agree that rigorous patient selection is logical and mandatory. Drug-induced sleep endoscopy (DISE) was introduced in 1991 and has been rediscovered and used extensively since the 2000s. It mimics sleep in order to observe the upper airway on flexible endoscopy. A review of the DISE literature was performed, and is reported in two parts. The present first part describes the technique: drugs, practical anesthesiologic and ENT modalities, reproducibility, and limitations. Copyright © 2016. Published by Elsevier Masson SAS.

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

    PubMed Central

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

    2015-01-01

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

  2. An automatic rules extraction approach to support OSA events detection in an mHealth system.

    PubMed

    Sannino, Giovanna; De Falco, Ivanoe; De Pietro, Giuseppe

    2014-09-01

    Detection and real time monitoring of obstructive sleep apnea (OSA) episodes are very important tasks in healthcare. To suitably face them, this paper proposes an easy-to-use, cheap mobile-based approach relying on three steps. First, single-channel ECG data from a patient are collected by a wearable sensor and are recorded on a mobile device. Second, the automatic extraction of knowledge about that patient takes place offline, and a set of IF…THEN rules containing heart-rate variability (HRV) parameters is achieved. Third, these rules are used in our real-time mobile monitoring system: the same wearable sensor collects the single-channel ECG data and sends them to the same mobile device, which now processes those data online to compute HRV-related parameter values. If these values activate one of the rules found for that patient, an alarm is immediately produced. This approach has been tested on a literature database with 35 OSA patients. A comparison against five well-known classifiers has been carried out.

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

    PubMed Central

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

    2013-01-01

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

  4. Obstructive sleep apnea (OSA) does not affect ventilatory and perceptual responses to exercise in morbidly obese subjects.

    PubMed

    Innocenti Bruni, Giulia; Gigliotti, Francesco; Scano, Giorgio

    2012-09-30

    We have tested the hypothesis that high mass loading effects and obstructive sleep apnea (OSA) constrain the ventilatory response to exercise in morbidly obese subjects as compared to their counterparts without OSA. Fifteen obese patients with (8) and without OSA and 12 lean healthy subjects performed incremental cycle exercise. The functional evaluation included ventilation, oxygen uptake, carbon dioxide production, end-expiratory-lung-volumes (EELV), inspiratory capacity, heart rate, dyspnea and leg effort (by a modified Borg scale). Changes in ventilation and dyspnea per unit changes in work rate and metabolic variables were similar in the three groups. Breathing pattern and heart rate increased from rest to peak exercise similarly in the three groups. Leg effort was the prevailing symptom for stopping exercise in most subjects. In conclusion, OSA does not limit exercise capacity in morbidly obese subjects. Ventilation contributes to exertional dyspnea similarly as in lean subjects and in obese patients regardless of OSA. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    PubMed

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

    2016-06-01

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

  6. OsWS1 involved in cuticular wax biosynthesis is regulated by osa-miR1848.

    PubMed

    Xia, Kuaifei; Ou, Xiaojin; Gao, Chunzhi; Tang, Huadan; Jia, Yongxia; Deng, Rufang; Xu, Xinlan; Zhang, Mingyong

    2015-12-01

    Cuticular wax forms a hydrophobic layer covering aerial plant organs and acting as a protective barrier against biotic and abiotic stresses. Compared with well-known wax biosynthetic pathway, molecular regulation of wax biosynthesis is less known. Here, we show that rice OsWS1, a member of the membrane-bound O-acyl transferase gene family, involved in wax biosynthesis and was regulated by an osa-miR1848. OsWS1-tagged green fluorescent protein localized to the endoplasmic reticulum (ER). Compared with wild-type rice, OsWS1 overexpression plants displayed a 3% increase in total wax, especially a 35% increase in very long-chain fatty acids, denser wax papillae around the stoma, more cuticular wax crystals formed on leaf and stem surfaces, pollen coats were thicker and more seedlings survived after water-deficit treatment. In contrast, OsWS1-RNAi and osa-miR1848 overexpression plants exhibited opposing changes. Gene expression analysis showed that overexpression of osa-miR1848 down-regulated OsWS1 transcripts; furthermore, expression profiles of OsWS1 and osa-miR1848 were inversely correlated in the leaf, panicle and stem, and upon water-deficit treatment. These results suggest that OsWS1 is regulated by osa-miR1848 and participates in cuticular wax formation. © 2015 John Wiley & Sons Ltd.

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

    PubMed Central

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

    2016-01-01

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

  8. Enhancer-promoter communication mediated by Chip during Pannier-driven proneural patterning is regulated by Osa.

    PubMed

    Heitzler, Pascal; Vanolst, Luc; Biryukova, Inna; Ramain, Philippe

    2003-03-01

    The GATA factor Pannier activates proneural achaete/scute (ac/sc) expression during development of the sensory organs of Drosophila through enhancer binding. Chip bridges Pannier with the (Ac/Sc)-Daughterless heterodimers bound to the promoter and facilitates the enhancer-promoter communication required for proneural development. We show here that this communication is regulated by Osa, which is recruited by Pannier and Chip. Osa belongs to Brahma chromatin remodeling complexes and we show that Osa negatively regulates ac/sc. Consequently, Pannier and Chip also play an essential role during repression of proneural gene expression. Our study suggests that altering chromatin structure is essential for regulation of enhancer-promoter communication.

  9. Amsterdam positional OSA classification: the AASM 2012 recommended hypopnoea criteria increases the number of positional therapy candidates.

    PubMed

    Duce, Brett; Kulkas, Antti; Langton, Christian; Töyräs, Juha; Hukins, Craig

    2017-05-01

    This study examined the effect of hypopnoea criteria on the prevalence of positional obstructive sleep apnoea (pOSA) identified under the Amsterdam Positional OSA Classification (APOC) system. Three hundred three consecutive patients undertaking polysomnography (PSG) for the suspicion of OSA were included in this retrospective investigation. PSGs were scored using both the 2007 American Academy of Sleep Medicine (AASM) recommended hypopnoea criteria (AASM2007Rec) and the 2012 AASM recommended hypopnoea criteria (AASM2012Rec). For each hypopnoea criteria, OSA patients were grouped according to the APOC categories (I, II or II) or else deemed non-APOC if they did not meet the APOC criteria. Outcome measures, such as Functional Outcomes of Sleep Questionnaire (FOSQ), MOS 36-item short-form health survey (SF-36) and psychomotor vigilance task (PVT), were also compared between the groups. The AASM2012Rec increased the prevalence of OSA compared to AASM2007Rec. The AASM2012Rec trebled the number of APOC I patients compared to AASM2007Rec (297% increase) as well as increased the proportion of females in the APOC I group. AASM2012Rec did not change the number of APOC II and APOC III patients. In fact, the same patients were present in these categories irrespective of hypopnoea criteria. The proportion of non-APOC patients proportionally decreased with the AASM2012Rec criteria. There were no differences in outcome measures between the AASM2012Rec and AASM2007Rec groups. This study demonstrates that, compared to AASM2007Rec, AASM2012Rec increases the prevalence of who could be successfully treated with positional therapy. The proportion of females with pOSA also increases as a consequence of AASM2012Rec.

  10. Total analysis of clinical factors for surgical success of adenotonsillectomy in pediatric OSAS.

    PubMed

    Chang, Ting-So; Chiang, Rayleigh Ping-Ying

    2017-01-01

    The objective of this study is the total evaluation of most common clinical factors influencing the successful rate of adenotonsillectomy for pediatric obstructive sleep apnea syndrome (OSAS). Retrospectively, 63 pediatric patients ranged from 2 to 16 years old were included. Syndromics and patients who had received orthodontic treatment or orthognathic surgery were excluded. All patients received pre-operative and postoperative polysomnography and cephalometry. Each patient received adenotonsillectomy by single surgeon. Surgical success was defined as apneahypopnea index (AHI) decreased ≧50 % or post-operative AHI <5. Total evaluated clinical factors related to success of adenotonsillectomy for pediatric OSAS include age, gender, body mass index (BMI), tonsil size, adenoid/nasopharynx ratio (A/N Ratio), pre-operative data of polysomnography, including AHI, apnea index (AI), hypopnea index (HI), mean O2 saturation and nadir O2 saturation, and 18 cephalometry parameters. Mean age of the total 63 patients was 7.78 years old. Mean BMI of the patients was 19.02. The proportion of obese patients was 25.4% (16/63). Surgical success was achieved in 42 out of 63 patients (66.7%). The surgical success was not statistically significant related to all pre-operative cephalometric parameters, age, gender, BMI and adenoid size by multiple logistic regression model. However, the surgical success was significantly related to pre-operative AHI and tonsil size. In addition, all patients who received adenotonsillectomy showed improved polysomnography parameters, including AHI, AI, HI, mean O2 saturation and nadir O2 saturation which all reached statistically significant improvement. Although adenotonsillectomy cannot cure pediatric OSAS in our research, all patients showed significant improvement of polysomnography parameters after this procedure. Pre-operative cephalometry parameters, BMI and age did not show significant correlation with surgical success, however, pre-op AHI and

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

    PubMed Central

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

    2014-01-01

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

  12. Drug-induced sleep endoscopy: A new gold standard for evaluating OSAS? Part II: Results.

    PubMed

    Blumen, M; Bequignon, E; Chabolle, F

    2017-04-01

    Surgical results in obstructive sleep apnea syndrome (OSAS) vary greatly, whatever the surgical technique or site. Most authors agree that rigorous patient selection is logical and mandatory. Drug-induced sleep endoscopy (DISE) was introduced in 1991 and has been rediscovered and used extensively since the 2000s. It attempts to mimic natural sleep in order to observe the upper airway on flexible endoscopy in a situation in which obstruction may occur. A review of the DISE literature was performed, and is reported in two parts. The present second part reports DISE results concerning obstruction sites, impact on treatment efficacy and the consequent indications for this exploration. Copyright © 2016. Published by Elsevier Masson SAS.

  13. Epidemiological analysis of structural alterations of the nasal cavity associated with obstructive sleep apnea syndrome (OSA).

    PubMed

    Mekhitarian Neto, Levon; Fava, Antonio Sérgio; Lopes, Hugo Canhete; Stamm, Aldo

    2005-01-01

    The objective of this paper is to demonstrate that structural alterations of the nasal cavity, e.g. septal deviation and conchal hypertrophy have high incidence in patients with sleep apnea and hypopnea syndrome and must be addressed with associated specific procedures of the syndrome. Clinical retrospective. A retrospective study of 200 patients was performed, with 196 male and 4 female, attended at the otorhinolaryngology ambulatory of Hospital Prof. Edmundo Vasconcelos and Unidade Paulista de Otorrinolaringologia, all of them subjected to polysomnography, otorhinolaryngological physical exam, endoscopy exam, and surgical treatment with nasal and pharyngeal procedures. All of them were subjected to pharyngeal procedure: uvulopalatopharyngoplasty or uvulopalatoplasty and nose procedure: 176 septoplasty with partial turbinectomy (88%) and 24 isolated turbinectomy, with satisfactory results. We can see that structural alterations of the nasal cavity have high incidence in patients with OSA.

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

    PubMed Central

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

    2015-01-01

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

  15. 5-years APAP adherence in OSA patients--do first impressions matter?

    PubMed

    van Zeller, Mafalda; Severo, Milton; Santos, Ana Cristina; Drummond, Marta

    2013-12-01

    Although continuous positive airway pressure (CPAP) is effective in treating obstructive sleep apnoea (OSA), inadequate adherence remains a major cause of treatment failure. This study aimed to determine long term adherence to auto adjusting-CPAP (APAP) and its influencing factors including the role of initial compliance. Eighty-eight male patients with newly diagnosed moderate/severe OSA were included. After initiation of APAP treatment, patients had periodic follow-up appointments at 2 weeks, 6 months and then annually for at least 5 years. Patient's compliance to therapy was assessed in each appointment and predictors to treatment abandonment and poor compliance were evaluated. The studied population had a mean age of 53.8 years and mean apnoea-hypopnoea index of 52.71/h. The mean time of follow-up was 5.2 (± 1.6) years, during that time 22 (25%) patients abandoned APAP, those who maintained treatment had good compliance to it since 94% of them used it more than 4 h/day for at least 70% of days. A significant negative association was found between age, % of days and mean time of APAP use on 12th day and 6th month and the risk of abandoning. APAP use lower than 33% and 57% of days at 12th day and 6th month, respectively had high specificity (≈ 100%) to detect treatment abandonment. the majority of patients adheres to long term APAP treatment and has good compliance after 5-years of follow-up. Age and initial compliance (% days of use and mean hour/day) have the ability to predict future adherence, as soon as 12 days and 6 months after initiation. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Misclassification of OSA severity with automated scoring of home sleep recordings.

    PubMed

    Aurora, R Nisha; Swartz, Rachel; Punjabi, Naresh M

    2015-03-01

    The advent of home sleep testing has allowed for the development of an ambulatory care model for OSA that most health-care providers can easily deploy. Although automated algorithms that accompany home sleep monitors can identify and classify disordered breathing events, it is unclear whether manual scoring followed by expert review of home sleep recordings is of any value. Thus, this study examined the agreement between automated and manual scoring of home sleep recordings. Two type 3 monitors (ApneaLink Plus [ResMed] and Embletta [Embla Systems]) were examined in distinct study samples. Data from manual and automated scoring were available for 200 subjects. Two thresholds for oxygen desaturation (≥ 3% and ≥ 4%) were used to define disordered breathing events. Agreement between manual and automated scoring was examined using Pearson correlation coefficients and Bland-Altman analyses. Automated scoring consistently underscored disordered breathing events compared with manual scoring for both sleep monitors irrespective of whether a ≥ 3% or ≥ 4% oxygen desaturation threshold was used to define the apnea-hypopnea index (AHI). For the ApneaLink Plus monitor, Bland-Altman analyses revealed an average AHI difference between manual and automated scoring of 6.1 (95% CI, 4.9-7.3) and 4.6 (95% CI, 3.5-5.6) events/h for the ≥ 3% and ≥ 4% oxygen desaturation thresholds, respectively. Similarly for the Embletta monitor, the average difference between manual and automated scoring was 5.3 (95% CI, 3.2-7.3) and 8.4 (95% CI, 7.2-9.6) events/h, respectively. Although agreement between automated and manual scoring of home sleep recordings varies based on the device used, modest agreement was observed between the two approaches. However, manual review of home sleep test recordings can decrease the misclassification of OSA severity, particularly for those with mild disease. ClinicalTrials.gov; No.: NCT01503164; www.clinicaltrials.gov.

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

    PubMed

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

    2015-01-01

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

  18. Fate of trace organic contaminants in oxic-settling-anoxic (OSA) process applied for biosolids reduction during wastewater treatment.

    PubMed

    Semblante, Galilee U; Hai, Faisal I; McDonald, James; Khan, Stuart J; Nelson, Mark; Lee, Duu-Jong; Price, William E; Nghiem, Long D

    2017-09-01

    This study investigated the fate of trace organic contaminants (TrOCs) in an oxic-settling-anoxic (OSA) process consisting of a sequencing batch reactor (SBR) with external aerobic/anoxic and anoxic reactors. OSA did not negatively affect TrOC removal of the SBR. Generally, low TrOC removal was observed under anoxic and low substrate conditions, implicating the role of co-metabolism in TrOC biodegradation. Several TrOCs that were recalcitrant in the SBR (e.g., benzotriazole) were biodegraded in the external aerobic/anoxic reactor. Some hydrophobic TrOCs (e.g., triclosan) were desorbed in the anoxic reactor possibly due to loss of sorption sites through volatile solids destruction. In OSA, the sludge was discharged from the aerobic/anoxic reactor which contained lower concentration of TrOCs (e.g., triclosan and triclocarban) than that of the control aerobic digester, suggesting that OSA can also help to reduce TrOC concentration in residual biosolids. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2016-08-20

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

  20. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial.

    PubMed

    Mendelson, Monique; Vivodtzev, Isabelle; Tamisier, Renaud; Laplaud, David; Dias-Domingos, Sonia; Baguet, Jean-Philippe; Moreau, Laurent; Koltes, Christian; Chavez, Léonidas; De Lamberterie, Gilles; Herengt, Frédéric; Levy, Patrick; Flore, Patrice; Pépin, Jean-Louis

    2014-11-01

    Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. Sleep clinics in France. 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. ClinicalTrials.gov identifier: NCT01226641.

  1. Misclassification of OSA Severity With Automated Scoring of Home Sleep Recordings

    PubMed Central

    Aurora, R. Nisha; Swartz, Rachel

    2015-01-01

    BACKGROUND: The advent of home sleep testing has allowed for the development of an ambulatory care model for OSA that most health-care providers can easily deploy. Although automated algorithms that accompany home sleep monitors can identify and classify disordered breathing events, it is unclear whether manual scoring followed by expert review of home sleep recordings is of any value. Thus, this study examined the agreement between automated and manual scoring of home sleep recordings. METHODS: Two type 3 monitors (ApneaLink Plus [ResMed] and Embletta [Embla Systems]) were examined in distinct study samples. Data from manual and automated scoring were available for 200 subjects. Two thresholds for oxygen desaturation (≥ 3% and ≥ 4%) were used to define disordered breathing events. Agreement between manual and automated scoring was examined using Pearson correlation coefficients and Bland-Altman analyses. RESULTS: Automated scoring consistently underscored disordered breathing events compared with manual scoring for both sleep monitors irrespective of whether a ≥ 3% or ≥ 4% oxygen desaturation threshold was used to define the apnea-hypopnea index (AHI). For the ApneaLink Plus monitor, Bland-Altman analyses revealed an average AHI difference between manual and automated scoring of 6.1 (95% CI, 4.9-7.3) and 4.6 (95% CI, 3.5-5.6) events/h for the ≥ 3% and ≥ 4% oxygen desaturation thresholds, respectively. Similarly for the Embletta monitor, the average difference between manual and automated scoring was 5.3 (95% CI, 3.2-7.3) and 8.4 (95% CI, 7.2-9.6) events/h, respectively. CONCLUSIONS: Although agreement between automated and manual scoring of home sleep recordings varies based on the device used, modest agreement was observed between the two approaches. However, manual review of home sleep test recordings can decrease the misclassification of OSA severity, particularly for those with mild disease. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01503164; www

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  3. Quantifying the dynamic of OSA brain using multifractal formalism: A novel measure for sleep fragmentation.

    PubMed

    Raiesdana, Somayeh

    2017-01-01

    It is thought that the critical brain dynamics in sleep is modulated during frequent periods of wakefulness. This paper utilizes the capacity of EEG based scaling analysis to quantify sleep fragmentation in patients with obstructive sleep apnea. The scale-free (fractal) behavior refers to a state where no characteristic scale dominates the dynamics of the underlying process which is evident as long range correlations in a time series. Here, Multiscaling (multifractal) spectrum is utilized to quantify the disturbed dynamic of an OSA brain with fragmented sleep. The whole night multichannel sleep EEG recordings of 18 subjects were employed to compute and quantify variable power-law long-range correlations and singularity spectra. Based on this characteristic, a new marker for sleep fragmentation named ``scaling based sleep fragmentation'' was introduced. This measure takes into account the sleep run length and stage transition quality within a fuzzy inference system to improve decisions made on sleep fragmentation. The proposed index was implemented, validated with sleepiness parameters and compared to some common indexes including sleep fragmentation index, arousal index, sleep diversity index, and sleep efficiency index. Correlations were almost significant suggesting that the sleep characterizing measure, based on singularity spectra range, could properly detect fragmentations and quantify their rate. This method can be an alternative for quantifying the sleep fragmentation in clinical practice after being approved experimentally. Control of sleep fragmentation and, subsequently, suppression of excessive daytime sleepiness will be a promising outlook of this kind of researches.

  4. Heart rate recovery post 6-minute walking test in obstructive sleep apnea: cycle ergometry versus 6-minute walking test in OSA patients.

    PubMed

    Cholidou, Kyriaki G; Manali, Effrosyni D; Kapsimalis, Fotis; Kostakis, Ioannis D; Vougas, Konstantinos; Simoes, Davina; Markozannes, Evaggelos; Vogiatzis, Ioannis; Bakakos, Petros; Koulouris, Nikolaos; Alchanatis, Manos

    2014-10-01

    To examine the clinical usefulness of heart rate recovery (HRR) post 6-minute walking test (6MWT) as a simple marker of cardiovascular risk in obstructive sleep apnea (OSA) patients in comparison to HRR post cycle ergometry, the validated and more sophisticated protocol. Seventy-four participants underwent full overnight polysomnography, cycle ergometry and 6MWT. The HRR at 1, 2 and 3 min (HRR-1, HRR-2 and HRR-3) 6MWT was compared to HRR at 1, 2, and 3 min post cycle ergometry in normal subjects and in moderate and severe OSA patients before and after 6-month CPAP treatment. The HRR-1, HRR-2 and HRR-3 in 6MWT were significantly different between normal, moderate and severe OSA patients with higher rates achieved in normal. The higher the severity of OSA the lower the HRR was. There were also no differences found between work rate and distance walked during cycle ergometry or 6MWT, respectively, concerning normal, moderate and severe OSA patients. Heart rate recovery was further associated with minimum saturation of oxygen during sleep independently of the duration of apnea episodes of BMI and ESS. The treatment with CPAP had a beneficial effect on HRR both post-6MWT and post cycle ergometry. Autonomic nervous system dysfunction in OSA can be found even with submaximal exertion. Heart rate recovery post-6MWT, such as HRR post cycle ergometry, was significantly impaired in OSA patients in comparison to normals and was favorably influenced from CPAP treatment. Furthermore, it was found to be more sensitive compared with distance walked in 6MWT in discriminating severity of OSA. The HRR post-6MWT was found to be an easily measured and reliable marker of OSA severity both before and after CPAP treatment.

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

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

    PubMed Central

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

    2015-01-01

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

  7. Effects of a lifestyle intervention on REM sleep-related OSA severity in obese individuals with type 2 diabetes.

    PubMed

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

    2017-05-31

    The aim of this study was to determine if an intensive lifestyle intervention (ILI) reduces the severity of obstructive sleep apnea (OSA) in rapid-eye movement (REM) sleep, and to determine if longitudinal changes in glycaemic control are related to changes in OSA severity during REM sleep over a 4-year follow-up. This was a randomized controlled trial including 264 overweight/obese adults with type 2 diabetes (T2D) and OSA. Participants were randomized to an ILI targeted to weight loss or a diabetes support and education (DSE) control group. Measures included anthropometry, apnea-hypopnea index (AHI) during REM sleep (REM-AHI) and non-REM sleep (NREM-AHI) and glycated haemoglobin (HbA1c) at baseline and year 1, year 2 and year 4 follow-ups. Mean baseline values of REM-AHI were significantly higher than NREM-AHI in both groups. Both REM-AHI and NREM-AHI were reduced significantly more in ILI versus DSE, but these differences were attenuated slightly after adjustment for weight changes. Repeated-measure mixed-model analyses including data to year 4 demonstrated that changes in HbA1c were related significantly to changes in weight, but not to changes in REM-AHI and NREM-AHI. Compared to control, the ILI reduced REM-AHI and NREM-AHI during the 4-year follow-up. Weight, as opposed to REM-AHI and NREM-AHI, was related to changes in HbA1c. The findings imply that weight loss from a lifestyle intervention is more important than reductions in AHI for improving glycaemic control in T2D patients with OSA. © 2017 European Sleep Research Society.

  8. Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD

    PubMed Central

    He, Bai-Ting; Lu, Gan; Xiao, Si-Chang; Chen, Rui; Steier, Joerg; Moxham, John; Polkey, Michael I; Luo, Yuan-Ming

    2017-01-01

    Background The mechanisms underlying sleep-related hypoventilation in patients with coexisting COPD and obstructive sleep apnoea (OSA), an overlap syndrome, are incompletely understood. We compared neural respiratory drive expressed as diaphragm electromyogram (EMGdi) and ventilation during stage 2 sleep in patients with COPD alone and patients with overlap syndrome. Methods EMGdi and airflow were recorded during full polysomnography in 14 healthy subjects, 14 patients with OSA and 39 consecutive patients with COPD. The ratio of tidal volume to EMGdi was measured to indirectly assess upper airway resistance. Results Thirty-five patients with COPD, 12 healthy subjects and 14 patients with OSA completed the study. Of 35 patients with COPD, 19 had COPD alone (FEV1 38.5%±16.3%) whereas 16 had an overlap syndrome (FEV1 47.5±16.2%, AHI 20.5±14.1 events/hour). Ventilation (VE) was lower during stage 2 sleep than wakefulness in both patients with COPD alone (8.6±2.0 to 6.5±1.5 L/min, p<0.001) and those with overlap syndrome (8.3±2.0 to 6.1±1.8 L/min). Neural respiratory drive from wakefulness to sleep decreased significantly for patients with COPD alone (29.5±13.3% to 23.0±8.9% of maximal, p<0.01) but it changed little in those with overlap syndrome. The ratio of tidal volume to EMGdi was unchanged from wakefulness to sleep in patients with COPD alone and healthy subjects but was significantly reduced in patients with OSA or overlap syndrome (p<0.05). Conclusions Stage 2 sleep-related hypoventilation in COPD alone is due to reduction of neural respiratory drive, but in overlap syndrome it is due to increased upper airway resistance. PMID:27807016

  9. Microencapsulation of white champaca (Michelia alba D.C.) extract using octenyl succinic anhydride (OSA) starch for controlled release aroma.

    PubMed

    Samakradhamrongthai, Rajnibhas; Thakeow, Prodpran; Kopermsub, Phikunthong; Utama-Ang, Niramon

    2016-12-01

    The objective of the study was to optimise the encapsulation of Michelia alba D.C. (MAD) extract using octenyl succinic anhydride (OSA) starch. The MAD extract (5-10 g/100 g of dry starch) and the OSA starch (25-100 g/100 ml of water) was used in microcapsule preparation and analysed for the physicochemical and encapsulation properties. The optimised formula using the MAD extract and the OSA starch were 15.00 g/100 g of dry starch and 96.32 g/100 g water, which provided the highest in yield recovery (40.65% ± 0.99) and encapsulation efficiency (68.91% ± 1.50), with the lowest moisture content (3.19% ± 0.06) and water activity (0.236 ± 0.004). The aroma release from the optimum encapsulated powder in simulated artificial saliva fluid (SSF) suggested that linalool retention in microcapsules was higher than verbenone and 2-methyl butanoic acid. This study shows that the optimised formulation of MAD encapsulated flavour powder was found to be effective for controlling the aroma release.

  10. What is known about the experiences of using CPAP for OSA from the users' perspective? A systematic integrative literature review.

    PubMed

    Ward, Kim; Hoare, Karen J; Gott, Merryn

    2014-08-01

    Economic, social and personal costs of untreated obstructive sleep apnoea (OSA) are high. Continuous positive airway pressure (CPAP) is recommended and cost effective. Increasing OSA prevalence may accompany predicted globally increasing obesity. To synthesise international evidence regarding personal experiences using CPAP for OSA. A systematic integrative literature review was conducted and quality assessment criteria applied. 22, of 538, identified papers met inclusion criteria. Thematic analysis identified three themes: 1) users' beliefs about CPAP influence users' experiences of CPAP; 2) CPAP users are primed to reflect negatively on experiences of CPAP; and 3) spouse and family influence users' experiences of CPAP. Personality and attitude impact expectations about CPAP prior to use, whilst engagement of spouse and family also influence experiences. Analysis highlighted that users' reporting of CPAP experiences is constrained by investigator defined assessment methods. Overall, research relating to experiences using CPAP is limited. Users' perspectives of CPAP are constrained by researchers' concern with non-compliance. Typically experiences are not defined by the user, but from an 'expert' healthcare perspective, using words which frame CPAP as problematic. Family and social support is a significant, but neglected area of experiencing CPAP warranting further investigation. More information from users is required to determine how CPAP can be managed successfully. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA).

    PubMed

    Faria, Ana Célia; da Silva-Junior, Savio Nogueira; Garcia, Luis Vicente; dos Santos, Antonio Carlos; Fernandes, Maria Regina França; de Mello-Filho, Francisco Veríssimo

    2013-03-01

    Maxillomandibular advancement (MMA) has been reported to be the most effective surgical treatment of obstructive sleep apnea (OSA). Most reports about MMA aim to confirm the efficiency of this treatment modality, but few describe the anatomical changes produced in the pharynx by the surgery. Thus, the objective of the present investigation was to quantify the anatomical changes of the pharynx that occur in patients with OSA after MMA surgery using magnetic resonance (MR). Twenty patients with a polysomnographic diagnosis of OSA participated in the study. All patients were submitted to image acquisition by MR performed during wakefulness. Polysomnography and MR were performed preoperatively and 6 months after MMA. Volume analysis (in cubic millimeters) was performed as the sum of the areas multiplied by their thickness, with no intervals between sections. The pharyngeal air space of the region between the hard palate and the base of the epiglottis was divided into a retropalatal (RP) region and a retrolingual (RL) region. Postoperative MR showed a mean volumetric increase of 26.72 % in the RP region and of 27.2 % in the RL region. MMA increases the air space of the pharynx by expanding the facial skeletal structure to which the soft tissues of the pharynx and tongue are fixed, with a consequent reduction of collapsibility in the presence of negative pressure during inspiration. This reduced possibility of pharyngeal collapse may contribute to the reduction of obstructive events.

  12. Investigation of resectability degree for adenoidal surgery in OSA children with the method of computational fluid dynamics.

    PubMed

    Hu, Changlong; Han, Demin; Zhou, Bing; Zhang, Luo; Li, Yunchuan; Zang, HongRui; Li, LiFeng

    2017-01-01

    From aspect of fluid dynamics, expanding patients' nasopharyngeal coronal-sectional area to 48.3-54.7% of normal area will bring the airflow velocity back to normal in adenoidal hypertrophy children. It might provide a suggestion for adenoidectomy range selection and whether total resection is necessary. To evaluate the nasopharyngeal airflow characteristics in pediatric OSA patients with adenoidal hypertrophy, and to explore the proper resection range for adenoidectomy Method: Nine OSA patients and four normal children were recruited. The CT scans of their upper airway were collected and used to construct three dimensional models for fluid dynamics analysis. Using computational fluid dynamics, indices such as velocity, pressure, and coronal-sectional area were calculated. Compared with the normal, the OSA children showed three characteristics in nasopharyngeal: the airflow velocity was significantly higher (p < 0.05), the coronal-sectional area was significantly smaller (p < 0.01), while pressure showed no difference (p > 0.05). In a study of the relationship between velocity and coronal-sectional area, this study investigates different coronal-sectional areas from 30-300 mm(2). It was found that, when patients' nasopharyngeal coronal-sectional area was expanded over 155-170 mm(2), namely 48.3-54.7% of normal area, airflow velocity in nasopharyngeal showed no difference than normal.

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

    PubMed Central

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

    2015-01-01

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

  14. Clinical analysis of drug-induced sleep endoscopy for the OSA patient.

    PubMed

    Golbin, Dina; Musgrave, Brandon; Succar, Eric; Yaremchuk, Kathleen

    2016-01-01

    To determine if the use of drug-induced sleep endoscopy (DISE) and transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA) is associated with improved outcomes and acceptable complication rates when compared to uvulopalatopharyngoplasty (UPPP) with or without tonsillectomy (± T). A retrospective cohort review was performed comparing 40 patients who had previously undergone UPPP ± T with 64 patients who had DISE, UPPP ± T, and possible TORS base-of-tongue resection and/or partial epiglottectomy. Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), body mass index, sex, hospital length of stay, hospital charges, hospital readmissions, emergency department visits, and major complications were compared for both groups. The 40 patients who underwent UPPP ± T without DISE showed a significant reduction in AHI of -20.1 (P = 0.001) and a complication rate of 3% (P = 0.001). There was no significant change in ESS (-2.2; P = 0.734). The 64 patients who underwent DISE and subsequent procedures showed a significant reduction in AHI of -21.4 (P = 0.001) and a complication rate of 34.7% (P = 0.001). There was no significant difference in the ESS (+0.1; P = 0.734) or AHI (P = 0.092) between the two groups. Patients who underwent UPPP ± T without DISE did not show a statistically significant difference in outcomes compared to the patients who underwent DISE with other procedures, including TORS. The TORS patients had increased total costs and length of stay that were statistically significant and had increased complications that were not statistically significant. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  16. [Forest and population at Península de Osa, Costa Rica].

    PubMed

    Rosero-Bixby, Luis; Maldonado-Ulloa, Tirso; Bonilla-Carrión, Roger

    2002-06-01

    The research is focused on the relationship between population growth and conservation of the forest on the Osa Peninsula. Data of the geo-referenced censuses and information on land-use, derived from satellite images and aerial photography, were integrated into a GIS. We undertook an historical inventory of the changes in the population and the forest coverage, and the key events in the land tenure and economy of the region. Deforestation, reforestation, and fragmentation of the forest during the period 1980-1995 were analyzed. Relationships with the population potential, derived from the 1984 Costa Rican censuses, were identified, and the effects of third variables were controlled such as distances to the roads, rain, distances to the forest frontier, level of protection, etc. Both strong and significant associations between 1984 population potential and the three processes were detected. The probability of deforestation is null in unpopulated areas, 35% in areas with 25-30 potential farmers and to 65% in areas with 50 farmers and over. The probability of reforestation decreases from 100% to 28% and to 18% in these three categories. This kind of relationship persists in the multivariable analysis. An increase of 0.63% in the number of household, results in an increment of 1% in the risk of deforestation (elasticity). The elasticity in the chances of reforestation is -0.37 and 1% in fragmentation of the forest. An evaluation in the risk of deforestation for the period 1995-2005 was done. The most recent population data were used and it identifies several geographic areas with high deforestation risk.

  17. High Adherence to CPAP Treatment Does Not Prevent the Continuation of Weight Gain among Severely Obese OSAS Patients

    PubMed Central

    Myllylä, Minna; Kurki, Samu; Anttalainen, Ulla; Saaresranta, Tarja; Laitinen, Tarja

    2016-01-01

    Study Objectives: Obstructive sleep apnea syndrome (OSAS) patients benefit from continuous positive airway pressure (CPAP) treatment in a dose-response manner. We determined adherence and weight control, as well as their predictors, among long-term CPAP users. Methods: Cohort of 1,023 OSAS patients had used CPAP on average of 6.6 ± 1.2 years. BMI was determined at baseline and at follow-up visits. There were 7.4 ± 1.7 BMI and 6.5 ± 1.8 CPAP usage measurements per patient on average. Using the Bayesian hierarchical model, we determined the patients' individual trends of BMI and adherence development. Patients with significantly increasing or decreasing trends were identified at the posterior probability level of > 90%. Results: The mean age in the cohort was 55.6 ± 9.8 years, BMI 33.5 ± 6.4 kg/m2, apnea-hypopnea index 33.7 ± 23.1, and CPAP usage 6.0 ± 1.8 h/day. The majority of patients had no significant change in BMI (mean annual weight gain 0.04 ± 0.29 kg/m2) or CPAP adherence (mean annual increase 11.4 ± 7.0 min/day). However, at the individual level, 10% of the patients showed significant annual weight gain (0.63 ± 0.35 kg/m2) during the 5-year follow-up period. At baseline these patients were already more severely obese (mean BMI 40.0 ± 5.9 kg/m2) despite being younger (mean 50.9 ± 9.5 years) than the rest of the cohort. Conclusions: In the majority of CPAP-treated OSAS patients, weight did not significantly change but gained slightly slower than in age-matched population in general. However, in 10% of patients, high adherence to CPAP treatment did not prevent the continuation of weight gain. These patients present a high-risk group for OSAS-related multimorbidity later in life. Citation: Myllylä M, Kurki S, Anttalainen U, Saaresranta T, Laitinen T. High adherence to CPAP treatment does not prevent the continuation of weight gain among severely obese OSAS patients. J Clin Sleep Med 2016;12(4):519–528. PMID:26888588

  18. Auto bi-level pressure relief-PAP is as effective as CPAP in OSA patients--a pilot study.

    PubMed

    Blau, Alexander; Minx, Mihaela; Peter, Jan Giso; Glos, Martin; Penzel, Thomas; Baumann, Gert; Fietze, Ingo

    2012-09-01

    Continuous positive airway pressure (CPAP) is the therapy of choice for the treatment of obstructive sleep apnea (OSA). Not all patients can use CPAP therapy with adequate compliance. There is a need to develop more comfortable modes. Auto bi-level Pressure Relief-Positive Airway Pressure (ABPR-PAP) can be an alternative. We conducted a prospective double-blind, randomised trial to evaluate the efficacy and compliance of ABPR-PAP compared with CPAP in OSA patients. We included 35 CPAP naive patients (age 53.3 ± 10.3 years, BMI 31.0 ± 5.0 kg/m(2), ESS 10.0 ± 4.2) diagnosed with moderate to severe OSA who underwent a successful CPAP titration. Patients were randomised into the CPAP or the ABPR-PAP treatment group. We used the same device (BIPAP® Auto, Philips Respironics) for CPAP or ABPR-PAP. Apnea-hypopnea index (AHI) was determined using polysomnography before (AHI 40.6 ± 18.3 per hour) and after treatment. Eighteen patients received CPAP and the remaining 17 received APBR-PAP. Groups were similar in terms of demographics and OSA severity. There were no serious adverse events during the trial. CPAP was fixed by a sleep expert and ABPR-PAP varied (range 5-15 cmH(2)O). AHI decreased in the CPAP group to 6.4 ± 5.7 per hour and in the ABPR-PAP group to 4.8 ± 3.6 per hour in the first night (N = 35). After 3 months, the AHI decreased in the CPAP group to 4.4 ± 5.3 per hour and in the ABPR-PAP group to 2.6 ± 3.8 per hour (N = 32). Differences between the groups were not statistically significant. There were no differences in compliance. ABPR-PAP is a promising new ventilation mode that enables effective treatment of OSA patients.

  19. A pilot validation study for the NOX T3(TM) portable monitor for the detection of OSA.

    PubMed

    Cairns, Alyssa; Wickwire, Emerson; Schaefer, Edward; Nyanjom, David

    2014-09-01

    The aim of the current pilot study is to compare the diagnostic accuracy of the NOX T3(TM) (T3) portable sleep monitor (PM) to that of simultaneously recorded in-lab polysomnogram (PSG). A total of 40 participants were recruited following face-to-face evaluation at a sleep disorders clinic. Each participant wore both PSG and PM equipment simultaneously during their in-lab PSG. PSG records were manually scored using the American Academy of Sleep Medicine (AASM) criteria, and PM records were double-scored using the device's autoscore algorithm as well as manual scoring. The final sample consisted of 32 participants (56% male, 50% black) with a mean ESS, BMI, and apnea-hypopnea index (AHI) of 10.4, 32.8, and 16.3, respectively. Three participants (7.5%) were excluded for poor PM signal quality. Mean AHI derived from the T3's autoscore algorithm was similar to that from manual scoring (19.6 ± 18.9 vs. 18.6 ± 19.1, respectively). Autoscore-derived T3 AHI and PSG-derived AHI were strongly related (r = .93). The T3 (autoscored AHI) demonstrated a high degree of sensitivity for the presence of obstructive sleep apnea syndrome (OSA; 100%) and acceptable specificity for the exclusion of OSA using an AHI cutoff of ≥5 events/h (70%). The unit (autoscored) had a high degree of both sensitivity (92%) and specificity (85%) when the presence of OSA was defined more conservatively (AHI > 15 events/h). For OSA defined as an AHI of ≥5, the T3 (autoscored) correctly identified 88% of positive cases and 100% of negative cases. In this small, clinic-based sample, the T3 demonstrated very good measurement agreement compared to PSG and a high degree of sensitivity for detecting even mild OSA. False positives appeared to be due to respiratory effort-related arousals (RERAs) being autoscored as obstructive apneas and may be due to inherent discrepancy in flow measurement sensitivity between PSG and portable monitors.

  20. Comparison of Cognitive Functions Between Obstructive Sleep Apnea Syndrome and Simple Snoring Patients: OSAS May Be a Modifiable Risk Factor for Cognitive Decline.

    PubMed

    Arli, Berna; Bilen, Sule; Titiz, Ayse Pinar; Ulusoy, Ersin Kasim; Mungan, Semra; Gurkas, Erdem; Oztekin, Zeynep Nese; Ozcan, Muge; Ak, Fikri

    2015-01-01

    By comparing neurocognitive test results from patients with obstructive sleep apnea syndrome (OSAS) and those from patients with simple snoring, we aimed to establish whether OSAS negatively influences cognition. Patients with mild-to-severe OSAS (n = 29) and nonhypoxic simple-snoring patients (n = 30) were admitted to the study. All participants in both groups were evaluated with polysomnography and neurocognitive tests, including the Stroop Test, Rey Auditory Verbal Learning Test, Judgment of Line Orientation, Trail-Making Test, and Symbol Digit Modalities Test (SDMT). Significant differences were identified between the groups for test scores on the Rey 1, SDMT, and Stroop tests. We propose that accurate OSAS diagnosis and treatment might help to prevent cognitive decline.

  1. Maxillary expansion and maxillomandibular expansion for adult OSA: A systematic review and meta-analysis.

    PubMed

    Abdullatif, Jose; Certal, Victor; Zaghi, Soroush; Song, Sungjin A; Chang, Edward T; Gillespie, M Boyd; Camacho, Macario

    2016-05-01

    This study sought to systematically review the international literature for articles evaluating maxillary expansion and maxillomandibular expansion as treatments for obstructive sleep apnea (OSA) in adults and to perform a meta-analysis. Nine databases (including MEDLINE/PubMed). Searches were performed through January 8, 2016. The PRISMA statement was followed. Eight adult studies (39 patients) reported polysomnography and/or sleepiness outcomes. Six studies reported outcomes for maxillary expansion (36 patients), and the apnea-hypopnea index (AHI) decreased from a mean (M) ± standard deviation (SD) of 24.3 ± 27.5 [95% CI 15.3, 33.3] to 9.9 ± 13.7 [95% CI 5.4, 14.4] events/hr (relative reduction: 59.3%). Maxillary expansion improved lowest oxygen saturation (LSAT) from a M ± SD of 84.3 ± 8.1% [95% CI 81.7, 87.0] to 86.9 ± 5.6% [95% CI 85.1, 88.7]. Maxillomandibular expansion was reported in two studies (3 patients) and AHI decreased from a M ± SD of 47.53 ± 29.81 [95% CI -26.5 to 121.5] to 10.7 ± 3.2 [95% CI 2.8, 18.6] events/hr (relative reduction: 77.5%). Maxillomandibular expansion improved LSAT from a M ± SD of 76.7 ± 14.5% [95% CI 40.7, 112.7] to 89.3 ± 3.1 [95% CI 81.6, 97]. The current literature demonstrates that maxillary expansion can improve and maxillomandibular expansion can possibly improve AHI and LSAT in adults; however, given the paucity of studies, these remain open for additional research efforts. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. All rights reserved.

  2. Summary of IODP Expedition 344, CRISP-A2, offshore the Osa Peninsula, Costa Rica

    NASA Astrophysics Data System (ADS)

    Harris, R. N.; Sakaguchi, A.; Petronotis, K. E.

    2013-12-01

    The Costa Rica Seismogenesis Project (CRISP) is designed to elucidate the processes that control nucleation and seismic rupture of large earthquakes at erosional subduction zones. The CRISP study area is located offshore the Osa Peninsula where the incoming Cocos Ridge has lifted the seismogenic zone to within reach of scientific drilling. The incoming plate is characterized by low sediment supply, a fast convergence rate, abundant plate interface seismicity, and a change in subducting plate relief along strike. In addition to elucidating processes at erosional convergent margins, this project is complementary to other IODP deep fault drilling projects (e.g., NanTroSEIZE and J-FAST). Expedition 344 (23 October - 11 December, 2012) is the second expedition of CRISP Program A (Integrated Ocean Drilling Program Proposal 537A-Full5) that focused on the shallow lithologic, hydrologic, stress, and thermal conditions that lead to unstable slip in the seismogenic zone. With the exception of not reaching the décollement and the underthrust sediment at the toe site (U1412), Expedition 344 exceeded expectations. Material was recovered from the incoming Cocos plate (Sites U1381 and U1414), the toe of the margin (Site U1412), the mid-slope region (Site U1380), and the upper-slope region (Site U1413). Input sites U1381 and U1414 are characterized by anomalously high heat flow and the flow of fluids. These sites contained abundant ash that will be used to assess the impact of Cocos Ridge subduction on the evolution of the Central American volcanic arc. Although toe Site U1412 did not cross the décollement we did penetrate terrigenous sediments interrupted by a Miocene ooze that may reflect accretion of a frontal prism sliver. Mid-slope Site U1380 yielded a major result in that the upper plate material is not a mélange of oceanic material or the offshore extension of the Caribbean large igneous complex, but forearc basin material consisting of lithic sedimentary units. Upper

  3. Do field walking tests produce similar cardiopulmonary demands to an incremental treadmill test in obese individuals with treated OSA?

    PubMed

    Evans, Rachael A; Dolmage, Thomas E; Robles, Priscila G; Goldstein, Roger S; Brooks, Dina

    2014-07-01

    Cardiorespiratory fitness, assessed during cardiopulmonary exercise tests by peak oxygen uptake (Vo2pk), is an independent predictor of mortality in obesity. We investigated whether Vo2pk and systemic responses measured during field walking tests were similar to those measured during an incremental treadmill test (ITMT) in obese individuals with treated OSA. Individuals with treated OSA and a BMI > 30 kg/m2 were recruited. Participants completed an ITMT, two 6-min walk tests (6MWTs), and two incremental shuttle walk tests (ISWTs) on three separate days in a randomized order. Expired gas analysis was performed during all tests. The study was completed by 16 patients (nine men) (mean [SD] age, 58 [12] y; BMI, 36.1 [7.6] kg/m2). There was no difference (P = .27) in Vo2pk assessed by the ITMT and the ISWT (2,266 [478] and 2,017 [561] mL/min, respectively). The Vo2pk measured by the 6MWT (1,778 [360] mL/min) was lower than that measured by the ITMT (P < .01). The limits of agreement for Vo2pk between the ISWT and the ITM were ± 730 mL/min. Cardiorespiratory responses during the ISWT and the ITMT reflected a graded response to a peak, whereas the 6MWT demonstrated a rapid rise to a plateau. The ISWT can be used instead of an ITMT and in preference to the 6MWT to assess cardiorespiratory fitness for a cohort of obese people with treated OSA. However, the imprecision of the agreement in Vo2pk between the ITMT and ISWT means they cannot be used interchangeably in an individual. ClinicalTrials.gov; No.: NCT01930513; www.clinicaltrials.gov.

  4. Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology.

    PubMed

    Pasquali, R; Colella, P; Cirignotta, F; Mondini, S; Gerardi, R; Buratti, P; Rinaldi Ceroni, A; Tartari, F; Schiavina, M; Melchionda, N

    1990-03-01

    The role of weight loss in the therapy of obstructive sleep apnea syndrome (OSAS) was investigated in 23 affected patients with various degrees of obesity (body mass index range 26.6-61.0) free of cranio-facial malformations. Weight loss resulted 18.5 +/- 14.7 (s.d.) kg and was significantly correlated with baseline BMI value (r = 0.94; P less than 0.0001). Weight loss significantly reduced the number of apneas + hypopneas per hour of sleep ((A + H)I) from 66.5 +/- 23.0 to 33.0 +/- 26.2 (P less than 0.0001) and improved the mean of oxygen desaturation peaks during apneas (mSaO2) from 81.9 +/- 6.9 to 87.6 +/- 3.9; P less than 0.001). A significant correlation was found between weight loss and changes in the (A + H)I (r = -0.55; P less than 0.01) and the mSaO2 (r = 0.46; P less than 0.05). The (A + H)I significantly improved in both patients who lost more than 10 kg (basal BMI: 42.3 +/- 10.0) and in those who lost less than 10 kg (basal BMI: 30.2 +/- 2.3), whereas the mSaO2 improved only in the former. Obese patients with moderate to heavy ORL pathological findings had worse pretreatment and final OSAS parameters than those with absent or mild ORL lesions. However, both groups showed a significant, although quantitatively different, improvement of the (A + H)I and mSaO2 after weight loss. Compared to those who were cured or improved after the treatment, patients who failed to obtain significant effects on OSAS clinical presentation also had a significantly higher prevalence of ORL pathology. It is concluded that: (1) weight loss improves parameters and clinical presentation of OSAS in the majority of affected obese patients; (2) a relationship exists between the entity of weight loss and that of improvement of the syndrome; (3) weight loss must be encouraged even in patients with mild to moderate overweight; (4) the presence of ORL pathology may represent a confusing factor in the interpretation of the results obtained after weight loss.

  5. Upper airway structural changes induced by CPAP in OSAS patients: a study using drug-induced sleep endoscopy.

    PubMed

    Jung, Sung Hoon; Koo, Soo Kweon; Choi, Jang Won; Moon, Ji Seung; Lee, Sang Hoon

    2017-01-01

    We studied upper airway structural changes induced by continuous positive airway pressure (CPAP) in obstructive sleep apnea syndrome (OSAS) patients using drug-induced sleep endoscopy (DISE). This prospective study was conducted at an academic secondary referral center. In total, 28 male OSAS patients (mean age 41.1 years) with only retropalatal level obstructions were enrolled. Measurements of the obstruction site were obtained in two steps: first a measurement was taken of the obstruction site in accordance with sleep apnea, then, a measurement was taken of the obstruction site in accordance with DISE-assisted CPAP titration, including quantitative changes in the occlusion site before and after CPAP in pixel format using an area calculation program. There was a tendency for persistent closing in cases of antero-posterior (AP) obstruction versus cases of lateral (Lat) obstruction in the CPAP titration. Lat obstructions showed a tendency to be wider than AP obstructions in the quantitative analysis. These results show that the pattern and degree of airway expansion after CPAP differ in accordance with the obstruction site.

  6. Michels syndrome, Carnevale syndrome, OSA syndrome, and Malpuech syndrome: variable expression of a single disorder (3MC syndrome)?

    PubMed

    Titomanlio, Luigi; Bennaceur, Selim; Bremond-Gignac, Dominique; Baumann, Clarisse; Dupuy, Olivier; Verloes, Alain

    2005-09-01

    We report on a 3-year-old girl with Michels syndrome, a rare condition characterized by craniosynostosis, blepharophimosis, ptosis, epicanthus inversus, cleft lip/palate, abnormal supra-umbilical abdominal wall, and mental deficiency. The phenotypic findings are compared with the six previously reported Michels cases, and with patients referred to as Carnevale, OSA, and Malpuech syndromes. Michels syndrome is characterized by cleft lip and palate, anterior chamber anomalies, blepharophimosis, epicanthus inversus, and craniosynostosis. Carnevale syndrome shows hypertelorism, downslanting palpebral fissures, ptosis, strabismus synophrys, large and fleshy ears, and lozenge-shaped diastasis around the umbilicus. OSA syndrome resembles Carnevale, with humeroradial synostoses, and spinal anomalies as extra features. Malpuech syndrome shows IUGR, hypertelorism, cleft lip and palate, micropenis, hypospadias, renal anomalies, and caudal appendage. All are autosomal recessive. Despite the presence of apparently distinctive key features, it appears that these four entities share multiple similarities in the facial Gestalt and the pattern of MCA. Those similarities lead us to postulate that they belong to the same spectrum, which could be referred to as "3MC syndrome" (Malpuech-Michels-Mingarelli-Carnevale syndrome).

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

    NASA Astrophysics Data System (ADS)

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

    2005-05-01

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

  8. Uniformities in OSA-UCS and in NCS tested by color difference prediction based on principal hue components

    NASA Astrophysics Data System (ADS)

    Indow, Tarow

    2002-06-01

    The OSA uniform color system is a 3-D collection of color samples according to the regular rhombohedral structure in which each color is surrounded by its 12 nearest neighbors, all perceptually equally different (local uniformity). The Swedish NCS system is a 3-D collection of color samples that vary gradually in each of the three perceptual attributes. It is not clear that this arrangement implies all neighboring pairs along the respective coordinates being perceptually equally different (local uniformity). Of pairs (j,k) of interest, predicted color differences djk were calculated that have the following property. Suppose an observer selects a pair of Munsell grays (Va, Vb) that matches in size with the color difference between (j,k), then djk=|Va-Vb| is predicted by djk, on the average, with error of 0.34 in Munsell V-unit. Variation of djk in this unit was in the order of 0.22V for nearest neighboring pairs (j,k) in various cleavage planes of OSA-UCS and in the order of 0.11V for neighboring pairs (j,k) along s-coordinate and c-coordinate in sheets with fixed hue of NCS. Both were well within the prediction error range, but some systematic trends in values of djk were found.

  9. One night's CPAP withdrawal in otherwise compliant OSA patients: marked driving impairment but good awareness of increased sleepiness.

    PubMed

    Filtness, Ashleigh J; Reyner, Louise A; Horne, James A

    2012-09-01

    Obstructive sleep apnoea (OSA) patients effectively treated by and compliant with continuous positive air pressure (CPAP) occasionally miss a night's treatment. The purpose of this study was to use a real car interactive driving simulator to assess the effects of such an occurrence on the next day's driving, including the extent to which these drivers are aware of increased sleepiness. Eleven long-term compliant CPAP-treated 50-75-year-old male OSA participants completed a 2-h afternoon, simulated, realistic monotonous drive in an instrumented car, twice, following one night: (1) normal sleep with CPAP and (2) nil CPAP. Drifting out of road lane ('incidents'), subjective sleepiness every 200 s and continuous electroencephalogram (EEG) activities indicative of sleepiness and compensatory effort were monitored. Withdrawal of CPAP markedly increased sleep disturbance and led to significantly more incidents, a shorter 'safe' driving duration, increased alpha and theta EEG power and greater subjective sleepiness. However, increased EEG beta activity indicated that more compensatory effort was being applied. Importantly, under both conditions, there was a highly significant correlation between subjective and EEG measures of sleepiness, to the extent that participants were well aware of the effects of nil CPAP. Patients should be aware that compliance with treatment every night is crucial for safe driving.

  10. Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

    PubMed Central

    Malu, Omojo O.; Kram, Yoseph A.; Song, Sungjin A.; Tolisano, Anthony M.; Kushida, Clete A.

    2016-01-01

    Objective. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for obstructive sleep apnea (OSA). Study Design. Systematic review with meta-analysis. Methods. Four databases, including PubMed/MEDLINE, were searched through September 29, 2016. Results. One-hundred twelve studies were screened, fifty-eight studies were reviewed, and fourteen studies met criteria. In 147 patients, the apnea-hypopnea index (AHI) was reported, and there was an improvement from a mean ± standard deviation (M ± SD) of 28.7 ± 24.0 to 27.4 ± 23.3 events/hr, p value 0.64. There was no significant change in AHI, lowest oxygen saturation, or snoring index in OSA patients when using nasal dilators. However, a subanalysis demonstrated a slight reduction in apnea index (AI) with internal nasal dilators (decrease by 4.87 events/hr) versus minimal change for external nasal dilators (increase by 0.64 events/hr). Conclusion. Although nasal dilators have demonstrated improved nasal breathing, they have not shown improvement in obstructive sleep apnea outcomes, with the exception of mild improvement in apnea index when internal nasal dilators were used. PMID:28070421

  11. [Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA): how many adhere to treatment?].

    PubMed

    Sarrell, E Michael; Chomsky, Ofer; Shechter, Dalia

    2013-03-01

    Obstructive sleep apnea syndrome (OSA) afflicts approximately 5% of the adult population and increases with age. The gold standard treatment is with the Continuous Positive Airways Pressure (CPAP) machine. Well-designed prospective trials to elucidate long term compliance with CPAP machine are rare. Assessing compliance and long-term use of CPAP machines among patients with OSA who were referred for treatment with this machine. A 4 years prospective cohort observational study was conducted using telephone interviews of 371 newly diagnosed patients with moderate to severe OSA, who received a specialist recommendation to use the CPAP machine which was bought and adjusted to their use. At the end of the first year, 126 (34%) of the OSA patients used the CPAP machine on a nightly basis (regular users), 120 (32.3%) had not used it at all, and 125 (33.7%) had used it only intermittently. The number of regular users increased between the 1st and 2nd year from 126 (34%), to 163 (44%) (p < 0.07) due to additions from the intermittent users group. The non-users group grew from 120 (32.3%) in the first year, and every year afterwards, up to 221 (59.6%) in the fourth year (p < 0.02). In contrast, there was a significant decrease in the intermittent users group, which declined from 125 (33.7%) in the first year to only 18 (4.8%) in the 4th year (p < 0.005). Most of the patients (92.9%) were males. The average age of the regular users was 59.6 years (+/- 11), which was higher in comparison to 55.9 years (+/- 10.3) for the non-users or 58.9 years (+/- 12.6) among the intermittent users (p = 0.064). There were no statistical differences in co-morbidities or demographics between the three groups. However, the regular users were found to have a higher score in the Epworth Sleepiness Scale (ESS) and a minimal arterial oxygen saturation (SaO2) level lower than the patients in the non-users and intermittent users groups (p = 0.019 and p = 0.03 respectively). Four years follow

  12. The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA).

    PubMed

    Tamanna, Sadeka; Parker, Jefferson D; Lyons, Judith; Ullah, M I

    2014-06-15

    Post-Traumatic Stress Disorder (PTSD) is increasingly prevalent among Veterans characterized by recurrent nightmare and disrupted sleep. Veterans with PTSD also have a high prevalence of obstructive sleep apnea (OSA) and untreated OSA worsens the sleep-related symptoms of PTSD. In our study, we hypothesized that among PTSD-afflicted Veterans with OSA, CPAP therapy may reduce the frequency of nightmares and a better CPAP compliance may be associated with increased symptom improvement. We retrospectively reviewed medical records to identify OSA patients treated in a VA medical center who also carried a diagnosis of PTSD (n = 69). Data about patient characteristics and polysomnographic findings were extracted. Repeated-measures t-tests were performed, comparing mean nightmare frequency and Epworth sleepiness score (ESS) before and after CPAP treatment. Multiple linear regressions were done to identify factors predicting CPAP compliance. A logistic regression analysis was also done to estimate the odds of subjective improvement in PTSD symptoms with CPAP. CPAP therapy reduced the mean ESS from 14.62 to 8.52 (p < 0.001) and the mean number of nightmares per week from 10.32 to 5.26 (p < 0.01). Reduced nightmare frequency after CPAP treatment was best predicted by CPAP compliance (p < 0.001). Every 10% increase in CPAP compliance almost doubled the odds of benefitting by CPAP (odds ratio = 1.92, 95% CI = 1.47-2.5). In Veterans with PTSD and OSA, CPAP therapy reduces PTSD-associated nightmares and improves overall PTSD symptoms. We recommend that all PTSD patients should be screened clinically for symptoms of OSA and receive CPAP treatment whenever possible to improve PTSD symptoms.

  13. PREVALENCE AND FACTORS ASSOCIATED WITH VITAMIN B12 DEFICIENCY IN ELDERLY FROM VIÇOSA/MG, BRASIL.

    PubMed

    Oliveira Martinho, Karina; Luiz Araújo Tinôco, Adelson; Queiroz Ribeiro, Andréia

    2015-11-01

    La prevalencia de deficiencia nutricional de vitamina B12 aumenta con la edad y es especialmente común en la población mayor. El objetivo de este estudio consistió en determinar su prevalencia y los factores asociados a esta carencia en mayores no institucionalizados de Viçosa, Estado de Minas Gerais, Brasil. Métodos: estudio poblacional interseccional, realizado para identificar la prevalencia y los factores asociados a deficiencia de vitamina B12 entre la población de mayores en Viçosa (MG). Los datos fueron recopilados desde agosto de 2011 hasta junio de 2012 mediante una encuesta en los hogares y pruebas hematológicas y bioquímicas realizadas en 340 mayores. Resultados: la prevalencia de deficiencia de vitamina B12 en este grupo fue del 17,4% (95% CI, 13,4% - 21,4%). La deficiencia cognitiva se presenta como un factor importante relacionado con la deficiencia de vitamina B12. Conclusiones: el informe actual contribuye a los estudios que destacan ciertos factores que podrían afectar al rendimiento de las personas mayores en su proceso de envejecimiento natural, especialmente cuando estos factores están asociados con deficiencia cognitiva y dan lugar a una discapacidad significativa así como pérdida de calidad de vida. Así, los resultados aquí presentados han servido para aportar un conocimiento más comprensivo sobre la relación entre deficiencia de B12 y su impacto sobre este grupo de población. También han demostrado su relevancia de cara a la planificación de programas e iniciativas de salud pública centrados en este grupo de población.

  14. Preservation of Oxygen Isotope Stage 3 Marine Terrace Deposits along the Southwest Coast of the Osa Peninsula, Corcovado National Park, Costa Rica

    NASA Astrophysics Data System (ADS)

    Hoffman, W. N.; Sak, P. B.

    2007-12-01

    Subduction of the aseismic Cocos Ridge at the Middle American Trench outboard of the Osa Peninsula results in rapid late Quaternary surface uplift. The distribution of surface uplift corresponds with the imaged bathymetric relief. On the Osa Peninsula, inboard of the northwest flank of the Cocos Ridge, exposures of the Late Pleistocene Puerto Armuelles Formation are recognized. The Puerto Armuelles Fm consists of poorly consolidated sands, silts, and muds from shallow marine, estuarine, and mangrove systems. Along the southwest coast, Puerto Armuelles Fm sediment infills paleo-topographic depressions. AMS radiocarbon dates obtained on 4 marine macrofossil samples yield ages ranging from 38.51 ka B.P. to 42.35 ka B.P. Dates obtained on multiple samples from individual sections are internally consistent, recording younger ages at higher stratigraphic levels within two fining upward deposits. The sections are displaced relative to one another across a northeast striking fault. The two measured stratigraphic sections are used to quantify a minimum Late Pleistocene to recent separation rate of 0.54 m ka-1. A suite of 15 radiocarbon dates on exposures of the Puerto Armuelles Fm from the eastern portion of the Osa Peninsula (Gardner et al., 1992) and 14 radiocarbon dates obtained from equivalent strata along the northwestern portions of the Osa Peninsula (Sak et al., 2004) clearly and consistently indicate a Late Pleistocene age of deposition during Oxygen Isotope Stage 3.

  15. Capability of Paraguaçu estuary (Todos os Santos Bay, Brazil) to form oil-SPM aggregates (OSA) and their ecotoxicological effects on pelagic and benthic organisms.

    PubMed

    Rios, Mariana C; Moreira, Ícaro T A; Oliveira, Olívia M C; Pereira, Taís S; de Almeida, Marcos; Trindade, Maria Clara L F; Menezes, Leonardo; Caldas, Alex S

    2017-01-15

    For experiments concerning the formation of oil-suspended particulate matter (SPM) aggregates (OSA), oil and sediment samples were collected from Campos Basin and six stations of Paraguaçu estuary, Todos os Santos Bay, Brazil, respectively. The sediments samples were analyzed for organic matter determined by the EMBRAPA method, nitrogen determined by the Kjeldahl method, and phosphorus determined by the method described by Aspila. The oil trapped in OSA was extracted following the method described by Moreira. The experiment showed a relationship between the amount of organic matter and OSA formation and consequently the dispersion of the studied oil. On the basis of the buoyancy of OSA and the ecotoxicological effects on pelagic and benthic community, the priority areas for application of remediation techniques are Cachoeira, Maragogipe, and Salinas da Margarida because of the large amount of oil that accumulated at the bottom of the experiment flask (5.85%, 27.95%, and 38,98%; 4.2%, 17.66%, and 32.64%; and 11.82%, 8.07%, and 10.91% respectively).

  16. [Application medical history indicators and goals for the diagnosis of OSAS in a cohort of workers of the private car transportation: results of a year of health surveillance].

    PubMed

    Romano, C; Ricco, G; Launaro, N; Ceccarelli, M; Cravero, A; Manassero, F

    2012-01-01

    Even though Obstructive Sleep Apnea Syndrome (OSAS) is one of the main causes of daytime sleepiness with high subsequent risk for causing vehicle accidents, its evaluation is not usually included among the criteria used for the certification of job fitness among professional drivers. In order to assess the feasibility of a screening method that allows the occupational physician to identify the subjects at risk for OSAS which should undergo second level tests (cardiorespiratory monitoring), we recorded and subsequently processed appropriate subjective and objective indicators among 455 professional drivers employed in private transportation companies. Only 17 subjects (47%) out of 36 tested positive underwent cardiorespiratory monitoring (due to technical and organizational difficulties and to the poor compliance of workers). OSAS was confirmed in 15 subjects out of 17 showing an excellent positive predictive value of the screening. Risk management for OSAS is currently unavoidable yet not formally provided by law. Our results show the possibility of completing the health surveillance program with feasible and valuable screening tests. Difficulties (hardly compliant with a timely certification of the job fitness) arise instead as far as second level confirmatory procedures are involved.

  17. Osa Protein Constitutes a Strong Oncogenic Suppression System That Can Block vir-Dependent Transfer of IncQ Plasmids between Agrobacterium Cells and the Establishment of IncQ Plasmids in Plant Cells

    PubMed Central

    Lee, Lan-Ying; Gelvin, Stanton B.

    2004-01-01

    The osa (oncogenic suppressive activity) gene of the IncW group plasmid pSa is sufficient to suppress tumorigenesis by Agrobacterium tumefaciens. osa confers oncogenic suppression by inhibiting VirE2 protein export. This result is similar, but not identical, to that of oncogenic suppression by the IncQ plasmid RSF1010. We conducted a series of experiments to compare oncogenic suppression by these two systems. Agrobacterium strains harboring plasmids containing osa are more able to effect oncogenic suppression than are similar strains containing various RSF1010 derivatives. When osa is present within a donor Agrobacterium strain that also carries a derivative of RSF1010, the transfer of RSF1010 derivatives to recipient bacteria and their establishment in plants are blocked. Oncogenic suppression is still effected when the osa gene is integrated into the Agrobacterium chromosome, suggesting that it is the osa gene product that is active in suppression and that suppression does not require a protein-nucleic acid intermediate like that described for IncQ plasmids. Extracellular complementation experiments with tobacco leaf disks indicated that Osa blocks stable transfer of RSF1010 to plant cells by inhibiting transfer of VirE2, which is essential for the transfer of RSF1010 into plant cells, and not by inhibiting the actual transfer of RSF1010 itself. Our results suggest that Osa and RSF1010 cause oncogenic suppression by using different mechanisms. PMID:15489437

  18. Cardiovascular and psychiatric morbidity in obstructive sleep apnea (OSA) with insomnia (sleep apnea plus) versus obstructive sleep apnea without insomnia: a case-control study from a Nationally Representative US sample.

    PubMed

    Gupta, Madhulika A; Knapp, Katie

    2014-01-01

    To evaluate cardiovascular and psychiatric morbidity in patient visits with obstructive sleep apnea (OSA) with insomnia (OSA+Insomnia) versus OSA without insomnia (OSA-Insomnia) in a nationally representative US sample. A retrospective case-control study of epidemiologic databases (National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey) representing an estimated ± standard error (SE) 62,253,910 ± 5,274,747 (unweighted count=7234) patient visits with diagnosis of OSA from 1995-2010, was conducted. An estimated 3,994,104 ± 791,386 (unweighted count=658) were classified as OSA+Insomnia and an estimated 58,259,806 ± 4,849,800 (unweighted count=6576) as OSA-Insomnia. Logistic regression analysis was carried out using OSA+Insomnia versus OSA-Insomnia as the dependent variable, and age (>50 years versus ≤ 50 years), sex, race ('White' versus 'non-White'), essential hypertension, heart failure, ischemic heart disease, cardiac dysrhythmia, cerebrovascular disease, diabetes, obesity, hyperlipidemia, depressive, anxiety, and adjustment disorders (includes PTSD), hypersomnia and all medications used as independent variables. All comorbidities were physician diagnosed using the ICD9-CM. Among patient visits with OSA, an estimated 6.4%± 0.9% also had insomnia. Logistic regression analysis revealed that the OSA+Insomnia group was significantly more likely to have essential hypertension (all ICD9-CM codes 401) (OR=1.83, 95% CI 1.27-2.65) and provisionally more likely to have cerebrovascular disease (ICD9-CM codes 430-438) (OR=6.58, 95% CI 1.66-26.08). The significant OR for cerebrovascular disease was considered provisional because the unweighted count was <30. In a nationally representative sample, OSA+Insomnia was associated significantly more frequently with essential hypertension than OSA-Insomnia, a finding that has not been previously reported. In contrast to studies that have considered patient self-reports of psychological

  19. Control of OSA during automatic positive airway pressure titration in a clinical case series: predictors and accuracy of device download data.

    PubMed

    Huang, Hsin-Chia Carol; Hillman, David R; McArdle, Nigel

    2012-09-01

    To investigate the factors associated with physiologic control of obstructive sleep apnea (OSA) during automatic positive airway pressure (APAP) titration in a clinical series. To also assess the usefulness of apnea-hypopnea index (AHI) data downloaded from the APAP device (Dev AHI). Retrospective review of a consecutive series of patients with OSA who underwent APAP titration (Autoset Spirit, ResMed, Bella Vista, New South Wales, Australia ) with simultaneous polysomnographic (PSG) monitoring in the sleep laboratory. Tertiary sleep clinic. There were 190 consecutive patients with OSA referred for APAP titration. There were 58% of patients who achieved optimal or good control of OSA (titration PSG AHI < 10, or at least 50% reduction in AHI if diagnostic AHI < 15/hr) during APAP titration. The independent predictors of titration PSG AHI were a history of cardiac disease and elevated central apnea and arousal indices during the diagnostic study. Although the median and interquartile range (IQR) AHI from the device (7.0, 3.9-11.6 events/hr) was only slightly less than the PSG AHI (7.8, 3.9-14.4 events/hr, P = 0.04) during titration, case-by-case agreement between the two measures was poor (chi-square < 0.001). In a clinical sample control of OSA during APAP titration is often poor, and close clinical follow-up is particularly needed in patients with a history of cardiac disease or with high arousal or central apnea indices on the diagnostic study. Device AHI does not reliably assess control during APAP titration, and PSG assessment may be required if clinical response to treatment is poor. The findings relate to the ResMed AutoSet device and may not apply to other devices.

  20. The Effect of CPAP in Normalizing Daytime Sleepiness, Quality of Life, and Neurocognitive Function in Patients with Moderate to Severe OSA

    PubMed Central

    Antic, Nick A.; Catcheside, Peter; Buchan, Catherine; Hensley, Michael; Naughton, Matthew T.; Rowland, Sharn; Williamson, Bernadette; Windler, Samantha; McEvoy, R. Doug

    2011-01-01

    Study Objectives: The study aimed to document the neurobehavioral outcomes of patients referred to and treated by a sleep medicine service for moderate to severe obstructive sleep apnea (OSA). In particular, we aimed to establish the proportion of patients who, while appearing to have optimal continuous positive airway pressure (CPAP) adherence, did not normalize their daytime sleepiness or neurocognitive function after 3 months of CPAP therapy despite effective control of OSA. Design: Multicenter clinical-effectiveness study. Setting: Three academic sleep centers in Australia. Participants: Patients referred to a sleep medicine service with moderate to severe OSA (n = 174). Intervention: CPAP. Measurements and Results: Participants were assessed pretreatment and again after 3 months of CPAP therapy. At the beginning and at the conclusion of the trial, participants completed a day of testing that included measures of objective and subjective daytime sleepiness, neurocognitive function, and quality of life. In patients with symptomatic moderate to severe OSA (i.e., apnea-hypopnea index > 30/h), we found a treatment dose-response effect for CPAP in terms of Epworth Sleepiness Scale scores (P < 0.001). Several key indexes of neurobehavior (e.g., Functional Outcomes of Sleep Questionnaire, Epworth Sleepiness Scale) currently used to assess treatment response failed to normalize in a substantial group of patients after 3 months of CPAP treatment, even in those who were maximally compliant with treatment. Forty percent of patients in this trial had an abnormal Epworth Sleepiness Scale score at the conclusion of the trial. In addition, we showed no dose-response effect with the Maintenance of Wakefulness Test, raising doubts as to the clinical utility of the Maintenance of Wakefulness Test in assessing treatment response to CPAP in patients with OSA. Conclusions: Our study suggests that a greater percentage of patients achieve normal functioning with longer nightly CPAP

  1. Control of OSA During Automatic Positive Airway Pressure Titration in a Clinical Case Series: Predictors and Accuracy of Device Download Data

    PubMed Central

    Huang, Hsin-Chia Carol; Hillman, David R.; McArdle, Nigel

    2012-01-01

    Study Objectives: To investigate the factors associated with physiologic control of obstructive sleep apnea (OSA) during automatic positive airway pressure (APAP) titration in a clinical series. To also assess the usefulness of apnea-hypopnea index (AHI) data downloaded from the APAP device (Dev AHI). Design: Retrospective review of a consecutive series of patients with OSA who underwent APAP titration (Autoset Spirit, ResMed, Bella Vista, New South Wales, Australia ) with simultaneous polysomnographic (PSG) monitoring in the sleep laboratory. Setting: Tertiary sleep clinic. Participants: There were 190 consecutive patients with OSA referred for APAP titration. Measurements and Results: There were 58% of patients who achieved optimal or good control of OSA (titration PSG AHI < 10, or at least 50% reduction in AHI if diagnostic AHI < 15/hr) during APAP titration. The independent predictors of titration PSG AHI were a history of cardiac disease and elevated central apnea and arousal indices during the diagnostic study. Although the median and interquartile range (IQR) AHI from the device (7.0, 3.9-11.6 events/hr) was only slightly less than the PSG AHI (7.8, 3.9-14.4 events/hr, P = 0.04) during titration, case-by-case agreement between the two measures was poor (chi-square < 0.001). Conclusion: In a clinical sample control of OSA during APAP titration is often poor, and close clinical follow-up is particularly needed in patients with a history of cardiac disease or with high arousal or central apnea indices on the diagnostic study. Device AHI does not reliably assess control during APAP titration, and PSG assessment may be required if clinical response to treatment is poor. The findings relate to the ResMed AutoSet device and may not apply to other devices. Citation: Huang HCC; Hillman DR; McArdle N. Control of OSA during automatic positive airway pressure titration in a clinical case series: predictors and accuracy of device download data. SLEEP 2012;35(9):1277

  2. Altered gut-liver axis and hepatic adiponectin expression in OSAS: novel mediators of liver injury in paediatric non-alcoholic fatty liver.

    PubMed

    Nobili, Valerio; Alisi, Anna; Cutrera, Renato; Carpino, Guido; De Stefanis, Cristiano; D'Oria, Valentina; De Vito, Rita; Cucchiara, Salvatore; Gaudio, Eugenio; Musso, Giovanni

    2015-08-01

    Mechanism(s) connecting obstructive sleep apnoea syndrome (OSAS) to liver injury in paediatric non-alcoholic fatty liver disease (NAFLD) are unknown. We hypothesised alterations in gut-liver axis and in the pool and phenotype of hepatic progenitor cells (HPCs) may be involved in OSAS-associated liver injury in NAFLD. Eighty biopsy-proven NAFLD children (age, mean±SD, 11.4±2.0 years, 56% males, body mass index z-score 1.95±0.57) underwent a clinical-biochemical assessment, with measurement of insulin sensitivity, plasma cytokines, lipopolysaccharide (LPS), an intestinal permeability test and a standard polysomnography. Hepatic toll-like receptor (TLR)-4 expression by liver-resident cells and overall number and expression of resistin and adiponectin by HPCs were assessed by immunofluorescence and immunohistochemistry. OSAS was defined by an apnoea/hypopnoea index ≥1. OSAS was characterised by an increased intestinal permeability and endotoxemia, coupled with TLR-4 upregulation in hepatocytes, Kupffer and hepatic stellate cells (HSCs) and by an expansion of an adiponectin-deficient HPC pool, key features of steatohepatitis and fibrosis.The duration of haemoglobin desaturation (SaO2 <90%) independently predicted intestinal permeability (β: 0.396; p=0.026), plasma LPS (β: 0.358; p=0.008) and TLR-4 expression by hepatocytes (β: 0.332; p=0.009), Kupffer cells (β: 0.357; p=0.006) and HSCs (β:0.445; p=0.002).SaO2 <90% predicted also HPC number (β: 0.471; p=0.001) and impaired adiponectin expression by HPC pool (β: -0.532; p=0.0009).These relationships were observed in obese and non-obese children. In paediatric NAFLD, OSAS is associated with increased endotoxemia coupled with impaired gut barrier function, with increased TLR-4-mediated hepatic susceptibility to endotoxemia and with an expansion of an adiponectin-deficient HPC pool. These alterations may represent a novel pathogenic link and a potential therapeutic target for OSAS-associated liver injury in

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

    PubMed

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

    2009-01-01

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

  4. MASP1 Mutations in Patients with Facial, Umbilical, Coccygeal, and Auditory Findings of Carnevale, Malpuech, OSA, and Michels Syndromes

    PubMed Central

    Sirmaci, Asli; Walsh, Tom; Akay, Hatice; Spiliopoulos, Michail; Şakalar, Yıldırım Bayezit; Hasanefendioğlu-Bayrak, Aylin; Duman, Duygu; Farooq, Amjad; King, Mary-Claire; Tekin, Mustafa

    2010-01-01

    Distinctive facial features consisting of hypertelorism, telecanthus, blepharophimosis, blepharoptosis, epicanthus inversus, periumbilical defects, and skeletal anomalies are seen in autosomal-recessive Carnevale, Malpuech, Michels, and oculo-skeletal-abdominal (OSA) syndromes. The gene or genes responsible for these syndromes were heretofore unknown. We report on three individuals from two consanguineous Turkish families with findings characteristic of these syndromes, including facial dysmorphism, periumbilical depression, mixed hearing loss, radioulnar synostosis, and coccygeal appendage. Homozygosity mapping yielded an autozygous region on chromosome 3q27 in both families. In one family, whole exome sequencing revealed a missense mutation, MASP1 c.2059G>A (p.G687R), that cosegregated with the phenotype. In the second family, Sanger sequencing of MASP1 revealed a nonsense mutation, MASP1 c.870G>A (p.W290X), that also cosegregated with the phenotype. Neither mutation was found in 192 Turkish controls or 1200 controls of various other ancestries. MASP1 encodes mannan-binding lectin serine protease 1. The two mutations occur in a MASP1 isoform that has been reported to process IGFBP-5, thereby playing a critical role in insulin growth factor availability during craniofacial and muscle development. These results implicate mutations of MASP1 as the cause of a human malformation syndrome and demonstrate the involvement of MASP1 in facial, umbilical, and ear development during the embryonic period. PMID:21035106

  5. Environmental service payments: evaluating biodiversity conservation trade-offs and cost-efficiency in the Osa Conservation Area, Costa Rica.

    PubMed

    Barton, D N; Faith, D P; Rusch, G M; Acevedo, H; Paniagua, L; Castro, M

    2009-02-01

    The cost-efficiency of payments for environmental services (PES) to private landowners in the Osa Conservation Area, Costa Rica, is evaluated in terms of the trade-off between biodiversity representation and opportunity costs of conservation to agricultural and forestry land-use. Using available GIS data and an 'off-the-shelf' software application called TARGET, we find that the PES allocation criteria applied by authorities in 2002-2003 were more than twice as cost-efficient as criteria applied during 1999-2001. Results show that a policy relevant assessment of the cost-effectiveness of PES relative to other conservation policies can be carried out at regional level using available studies and GIS data. However, there are a number of data and conceptual limitations to using heuristic optimisation algorithms in the analysis of the cost-efficiency of PES. Site specific data on probabilities of land-use change, and a detailed specification of opportunity costs of farm land, labour and capital are required to use algorithms such as TARGET for ranking individual sites based on cost-efficiency. Despite its conceptual soundness for regional conservation analysis, biodiversity complementarity presents a practical challenge as a criterion for PES eligibility at farm level because it varies depending on the set of areas under PES contracts at any one time.

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

    PubMed

    Oviedo, L; Solís, M

    2008-06-01

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

  7. Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA).

    PubMed

    Batool-Anwar, Salma; Goodwin, James L; Kushida, Clete A; Walsh, James A; Simon, Richard D; Nichols, Deborah A; Quan, Stuart F

    2016-12-01

    Obstructive sleep apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality of life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) versus sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. Overall we found no significant improvement in quality of life among sleep apnea patients after CPAP treatment. However, after stratifying by OSA severity, it was found that long-term improvement in quality of life might occur with the use of CPAP in people with severe and possibly moderate sleep apnea, and no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea. © 2016 European Sleep Research Society.

  8. Comparison between ozonation and the OSA process: analysis of excess sludge reduction and biomass activity in two different pilot plants.

    PubMed

    Torregrossa, Michele; Di Bella, Gaetano; Di Trapani, Daniele

    2012-01-01

    The excess biomass produced during biological treatment of municipal wastewater represents a major issue worldwide, as its disposal implies environmental, economic and social impacts. Therefore, there has been a growing interest in developing technologies to reduce sludge production. The main proposed strategies can be categorized according to the place inside the wastewater treatment plant (WWTP) where the reduction takes place. In particular, sludge minimization can be achieved in the wastewater line as well as in the sludge line. This paper presents the results of two pilot scale systems, to evaluate their feasibility for sludge reduction and to understand their effect on biomass activity: (1) a pilot plant with an ozone contactor in the return activated sludge (RAS) stream for the exposition of sludge to a low ozone dosage; and (2) an oxic-settling-anaerobic (OSA) process with high retention time in the anaerobic sludge holding tank have been studied. The results showed that both technologies enabled significant excess sludge reduction but produced a slight decrease of biomass respiratory activity.

  9. Terrestrial ecosystems of the Osa-Golfito region: one component of an integrative cross-disciplinary initiative for sustainability

    NASA Astrophysics Data System (ADS)

    Broadbent, E. N.; Dirzo, R.; Morales Barquero, L.

    2012-12-01

    Sustainability science seeks to develop approaches incorporating simultaneous human and environmental well-being. The Osa-Golfito Initiative (InOGo), as described in the previous presentation by Dr. Hunt et al. in this session, represents a cutting edge project seeking to develop both a fundamental framework for linking interdisciplinary components to address this objective with the creation of an applied approach for a sustainable future in this area of exceptional cultural and environmental diversity. In this presentation we describe the terrestrial ecosystems component of InOGo. This component incorporates four primary research approaches: (a) an extensive literature review; (b) spatial and non-spatial data aggregation; (c) change analysis via remote sensing; and (d) a questionnaire and participatory mapping survey with relevant experts. Integrating these approaches we seek to: (a) establish a detailed baseline understanding of the terrestrial ecosystems and their spatial distribution in the study region; (b) quantify temporal changes in their extent, connectivity, and ecosystem services; (c) identify the principal conservation priorities and threats in the region; and (d) isolate specific actions to address identified threats. We highlight both the overall approach developed for this component, which is broadly applicable throughout similar tropical regions, as well as results specific to the initiative.;

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

    PubMed

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

    2015-11-01

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

  11. Rice osa-miR171c Mediates Phase Change from Vegetative to Reproductive Development and Shoot Apical Meristem Maintenance by Repressing Four OsHAM Transcription Factors.

    PubMed

    Fan, Tian; Li, Xiumei; Yang, Wu; Xia, Kuaifei; Ouyang, Jie; Zhang, Mingyong

    2015-01-01

    Phase change from vegetative to reproductive development is one of the critical developmental steps in plants, and it is regulated by both environmental and endogenous factors. The maintenance of shoot apical meristem (SAM) identity, miRNAs and flowering integrators are involved in this phase change process. Here, we report that the miRNA osa-miR171c targets four GRAS (GAI-RGA-SCR) plant-specific transcription factors (OsHAM1, OsHAM2, OsHAM3, and OsHAM4) to control the floral transition and maintenance of SAM indeterminacy in rice (Oryza sativa). We characterized a rice T-DNA insertion delayed heading (dh) mutant, where the expression of OsMIR171c gene is up-regulated. This mutant showed pleiotropic phenotypic defects, including especially prolonged vegetative phase, delayed heading date, and bigger shoot apex. Parallel expression analysis showed that osa-miR171c controlled the expression change of four OsHAMs in the shoot apex during floral transition, and responded to light. In the dh mutant, the expression of the juvenile-adult phase change negative regulator osa-miR156 was up-regulated, expression of the flowering integrators Hd3a and RFT1 was inhibited, and expression of FON4 negative regulators involved in the maintenance of SAM indeterminacy was also inhibited. From these data, we propose that the inhibition of osa-miR171c-mediated OsHAM transcription factors regulates the phase transition from vegetative to reproductive development by maintaining SAM indeterminacy and inhibiting flowering integrators.

  12. Rice osa-miR171c Mediates Phase Change from Vegetative to Reproductive Development and Shoot Apical Meristem Maintenance by Repressing Four OsHAM Transcription Factors

    PubMed Central

    Yang, Wu; Xia, Kuaifei; Ouyang, Jie; Zhang, Mingyong

    2015-01-01

    Phase change from vegetative to reproductive development is one of the critical developmental steps in plants, and it is regulated by both environmental and endogenous factors. The maintenance of shoot apical meristem (SAM) identity, miRNAs and flowering integrators are involved in this phase change process. Here, we report that the miRNA osa-miR171c targets four GRAS (GAI-RGA-SCR) plant-specific transcription factors (OsHAM1, OsHAM2, OsHAM3, and OsHAM4) to control the floral transition and maintenance of SAM indeterminacy in rice (Oryza sativa). We characterized a rice T-DNA insertion delayed heading (dh) mutant, where the expression of OsMIR171c gene is up-regulated. This mutant showed pleiotropic phenotypic defects, including especially prolonged vegetative phase, delayed heading date, and bigger shoot apex. Parallel expression analysis showed that osa-miR171c controlled the expression change of four OsHAMs in the shoot apex during floral transition, and responded to light. In the dh mutant, the expression of the juvenile-adult phase change negative regulator osa-miR156 was up-regulated, expression of the flowering integrators Hd3a and RFT1 was inhibited, and expression of FON4 negative regulators involved in the maintenance of SAM indeterminacy was also inhibited. From these data, we propose that the inhibition of osa-miR171c-mediated OsHAM transcription factors regulates the phase transition from vegetative to reproductive development by maintaining SAM indeterminacy and inhibiting flowering integrators. PMID:26023934

  13. Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients.

    PubMed

    Chen, Hui; Lowe, Alan A; Strauss, Arthur M; de Almeida, Fernanda Riberiro; Ueda, Hiroshi; Fleetham, John A; Wang, Bangkang

    2008-05-01

    Oral appliances (OAs) have been used to treat obstructive sleep apnea (OSA) patients for decades. However, detailed dental side effects in long-term OA cases analyzed with an accurate three-dimensional (3D) measurement tool have seldom been reported. The purpose of this study is to evaluate dental side effects in five OSA patients, who had used a tongue retaining device (TRD) (with occasional other OA wear) for an average of 6 years and 4 months. The baseline and follow-up orthodontic study models were measured with a newly developed MicroScribe-3DX analysis system. High compliance of TRD wear was confirmed in all cases and different patterns and amounts of dental changes were observed. The most common appliance-induced dental changes included anterior and/or unilateral posterior open-bites and reduced anterior overjets. It was hypothesized that there might be two possible mechanisms for the TRD side effects--one is the forward pressure of the tongue upon the anterior dental arch and the other is the lateral pressure of the tongue upon the posterior arch. Considerations to correct the TRD dental side effects should be guided by these different mechanisms of the tongue on the dental arch. Possible solutions to minimize occlusal changes and maximize the benefits for OSA patients are also discussed.

  14. AtSIA1 AND AtOSA1: two Abc1 proteins involved in oxidative stress responses and iron distribution within chloroplasts.

    PubMed

    Manara, Anna; DalCorso, Giovanni; Leister, Dario; Jahns, Peter; Baldan, Barbara; Furini, Antonella

    2014-01-01

    The Abc1 protein kinases are a large family of functionally diverse proteins with multiple roles in the regulation of respiration and oxidative stress tolerance. A functional characterization was carried out for AtSIA1, an Arabidopsis thaliana Abc1-like protein, focusing on its potential redundancy with its homolog AtOSA1. Both proteins are located within chloroplasts, even if a different subplastidial localization seems probable. The comparison of atsia1 and atosa1 mutants, atsia1/atosa1 double mutant and wild-type plants revealed a reduction in plastidial iron-containing proteins of the Cytb6 f complex in the mutants. Iron uptake from soil is not hampered in mutant lines, suggesting that AtSIA1 and AtOSA1 affect iron distribution within the chloroplast. Mutants accumulated more ferritin and superoxide, and showed reduced tolerance to reactive oxygen species (ROS), potentially indicating a basal role in oxidative stress. The mutants produced higher concentrations of plastochromanol and plastoquinones than wild-type plants, but only atsia1 plants developed larger plastoglobules and contained higher concentrations of α- and γ-tocopherol and VTE1. Taken together, these data suggest that AtSIA1 and AtOSA1 probably act in signaling pathways that influence responses to ROS production and oxidative stress.

  15. Potential application of oil-suspended particulate matter aggregates (OSA) on the remediation of reflective beaches impacted by petroleum: a mesocosm simulation.

    PubMed

    Silva, Carine S; de Oliveira, Olivia M C; Moreira, Icaro T A; Queiroz, Antonio F S; de Almeida, Marcos; Silva, Jessica V L; da Silva Andrade, Igor Oliveira

    2015-08-28

    This paper presents the oil-suspended particulate matter aggregate (OSA) resulted from the interaction of droplets of dispersed oil in a water column and particulate matter. This structure reduces the adhesion of oil on solid surfaces, promotes dispersion, and may accelerate degradation processes. The effects of the addition of fine sediments (clay + silt) on the formation of OSA, their impact on the dispersion and degradation of the oil, and their potential use in recovering reflective sandy beaches were evaluated in a mesoscale simulation model. Two simulations were performed (21 days), in the absence and presence of fine sediments, with four units in each simulation using oil from the Recôncavo Basin. The results showed that the use of fine sediment increased the dispersion of the oil in the water column up to four times in relation to the sandy sediment. There was no evidence of the transport of hydrocarbons in bottom sediments associated with fine sediments that would have accelerated the dispersion and degradation rates of the oil. Most of the OSA that formed in this process remained in the water column, where the degradation processes were more effective. Over the 21 days of simulation, we observed a 40 % reduction on average of the levels of saturated hydrocarbons staining the surface oil.

  16. The geology, geochemistry and emplacement of the Cretaceous—Tertiary ophiolitic Nicoya Complex of the Osa Peninsula, southern Costa Rica

    NASA Astrophysics Data System (ADS)

    Berrangé, J. P.; Thorpe, R. S.

    1988-04-01

    The Nicoya Complex of the Osa Peninsula is essentially an obducted segment of oceanic crust comprising basaltic lavas and associated intrusive dolerite and gabbro, interstratified with lesser amounts of pelagic limestones, cherts and argillites. The sediments contain a minor clastic component and were deposited on an ocean floor of considerable relief and distant from a major landmass. The extrusive and intrusive basaltic rocks have geochemical affinities to large ion lithophile (LIL) element-enriched oceanic crust, and are interpreted to have formed in a back-arc basin analagous to the Mariana Trough, Lau Basin or Gulf of California. One sample has distinctly different geochemical characteristics and may represent a younger within-plate seamount. In the Late Cretaceous, an E-W-trending intra-oceanic trench/volcanic/back-arc system developed in association with an active southward-dipping subduction zone located south of the present-day southern Central American isthmus. Pelagic sediments and basaltic lavas accumulated in the back-arc over a period of at least 34 Ma spanning the Late Cretaceous and Early Tertiary. During this period there were three major volcanic events dated respectively as Santonian-Campanian (78.0 ± 2 Ma), Palaeocene (60.2 ± 7.6 Ma) and Middle Eocene (44.0 ± 4.4 Ma). Continuing northward movement of the southern plate caused overthrusting of the volcanic arc onto the northern plate and production of a thickened embryonic continental crust. Inferred reorganization of crustal stress in the Late Eocene caused fragmentation of the single ancestral plate into the Caribbean and "East Pacific" plates, with a flipping of the subduction zone accompanying development of the NE-dipping Middle America subduction zone and andesitic volcanism. During the Oligocene, the ancestral East Pacific plate split into the NE-moving Cocos plate and the eastward-moving Nazca plate, separated by the E-W-trending Colón spreading ridge and a series of N

  17. LIPID PROFILE AND ASSOCIATED FACTORS AMONG ELDERLY PEOPLE, ATTENDED AT THE FAMILY HEALTH STRATEGY, VIÇOSA/MG.

    PubMed

    Danésio de Souza, Jacqueline; Queiroz Ribeiro, Andréia; Oliveira Martinho, Karina; Silva Franco, Fernanda; Vidal Martins, Marcos; Gonçalves Rodrigues, Meirele; Wick, Jeannette Y; Araújo Tinôco, Adelson Luiz

    2015-08-01

    the aging population has been accompanied by epidemiological changes of the Brazilian population, with the highlight being the continued growth of the prevalence of non-communicable chronic diseases especially cardiovascular or artery-coronary, resulting from changes in the lipid profile of the elderly. this study had the aim to describe the behavioral, anthropometric, lifestyle and body composition factors and their association with changes in the lipid profile of elderly people. the sample included 402 participants attended at the Family Health Strategy, Viçosa (MG), to which a questionnaire with socio-demographic, behavioral and lifestyle information was applied. Blood sample was collected to obtain the lipid fractions, and the weight, height, waist circumference and body fat percentage were measured. Multiple linear regression was performed to identify independently associated factors with changes in each of the selected lipid fractions. the factors independently associated with increased levels of total cholesterol were the presence of sedentary behavior, high body fat percentage, greater waist height and greater waist circumference. The consumption of alcoholic beverages and a higher waist-hip ratio remained independently associated with decreased high-density lipoprotein levels. The increased waist circumference was independently associated with low values of the low-density lipoprotein levels. The value of increased triglyceride was independently associated with higher waist-hip ratio, higher body mass index and smoking. modifiable risk factors associated with a changed lipid profile should be prioritized among the actions to be considered in structuring health programs for the elderly. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  18. ROLE OF SPOUSAL INVOLVEMENT IN CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) ADHERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (OSA)

    PubMed Central

    Batool-Anwar, Salma; Baldwin, Carol M.; Fass, Shira; Quan, Stuart F.

    2017-01-01

    Introduction Little is known about the impact of spousal involvement on continuous positive airway pressure (CPAP) adherence. The aim of this study was to determine whether spouse involvement affects adherence with CPAP therapy, and how this association varies with gender. Methods 194 subjects recruited from Apnea Positive Pressure Long Term Efficacy Study (APPLES) completed the Dyadic Adjustment Scale (DAS). The majority of participants were Caucasian (83%), and males (73%), with mean age of 56 years, mean BMI of 31 kg/m2. & 62% had severe OSA. The DAS is a validated 32-item self-report instrument measuring dyadic consensus, satisfaction, cohesion, and affectional expression. A high score in the DAS is indicative of a person’s adjustment to the marriage. Additionally, questions related to spouse involvement with general health and CPAP use were asked. CPAP use was downloaded from the device and self-report, and compliance was defined as usage ≥ 4 h per night. Results There were no significant differences in overall marital quality between the compliant and noncompliant subjects. However, level of spousal involvement was associated with increased CPAP adherence at 6 months (p=0.01). After stratifying for gender these results were significant only among males (p=0.03). Three years after completing APPLES, level of spousal involvement was not associated with CPAP compliance even after gender stratification. Conclusion Spousal involvement is important in determining CPAP compliance in males in the 1st 6 months after initiation of therapy but is not predictive of longer-term adherence. Involvement of the spouse should be considered an integral part of CPAP initiation procedures. Support HL068060 PMID:28725492

  19. Neighborhood Walking Environment and Activity Level Are Associated With OSA: The Multi-Ethnic Study of Atherosclerosis.

    PubMed

    Billings, Martha E; Johnson, Dayna A; Simonelli, Guido; Moore, Kari; Patel, Sanjay R; Diez Roux, Ana V; Redline, Susan

    2016-11-01

    There has been growing interest in understanding how neighborhoods may be related to cardiovascular risk. Neighborhood effects on sleep apnea could be one contributing mechanism. We investigated whether neighborhood walking environment and personal activity levels are related to OSA. Data were analyzed from a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA), including subjects who participated in both the MESA Sleep and Neighborhood studies (N = 1,896). Perceived neighborhood walking environment and subjects' objective activity were evaluated in multivariate, multilevel models to determine any association with sleep apnea severity as defined by using the apnea-hypopnea index. Sex, race/ethnicity, and obesity were examined as moderators. Residing in the lowest quartile walking environment neighborhoods (score < 3.75) was associated with more severe sleep apnea (mean, 2.7 events/h greater AHI [95% CI, 0.7 to 4.6]), after adjusting for demographic characteristics, BMI, comorbidities, health behaviors, neighborhood socioeconomic status, and site. Associations were stronger among obese and male individuals. Approximately 1 SD greater objective activity in men was associated with a lower AHI (mean, -2.4 events/h [95% CI, -3.5 to -1.3]). This association was partially mediated by BMI (P < .001). Living in neighborhoods with a low walking environment score is associated with greater severity of sleep apnea, especially in male and obese individuals. In men, greater activity level is associated with less severe sleep apnea, independent of BMI, comorbidities, and socioeconomic status. Neighborhood-level interventions that increase walkability and enable increased physical activity may potentially reduce the severity of sleep apnea. Copyright © 2016 American College of Chest Physicians. All rights reserved.

  20. Mapping Tropical Forest Mosaics with C- and L-band SAR: First Results from Osa Peninsula, Costa Rica

    NASA Astrophysics Data System (ADS)

    Pinto, N.; Hensley, S.; Aguilar-Amuchastegui, N.; Broadbent, E. N.; Ahmed, R.

    2016-12-01

    In tropical countries, economic incentives and improved infrastructure are creating forest mosaics where small-scale farming and industrial plantations are embedded within and potentially replacing native ecosystems. Practices such as agroforestry, slash-and-burn cultivation, and oil palm monocultures bring widely different impacts on carbon stocks. Characterizing these production systems is not only critical to ascribe deforestation to particular drivers, but also essential to understand the impact of macroeconomic scenarios, national policies, and land tenure schemes on carbon fluxes. The last decade has experienced a dramatic improvement in the extent and consistency of tree cover and gross deforestation products from optical imagery. At the same time, recent work shows that Synthetic Aperture Radar (SAR) can complement optical data and reveal structural types that cannot be easily resolved with reflectance measurements alone. While these results demonstrate the validity of sensor fusion methodologies, they typically rely on local classifications or even manual delineation and as such they cannot support large-scale investigations. Furthermore, there have been few attempts to exploit PolInSAR or multiple wavelengths that can provide critical information to resolve natural and anthropogenic land cover types. We report results from our research at Costa Rica's Osa Peninsula. This site is ideal for algorithm development as it includes a highly diverse tropical forest within Corcovado National Park, as well as agroforestry zones, mangroves, and palm plantations. We first integrate SAR backscatter and coherence data from NASA's L-band UAVSAR, JAXA's ALOS/PALSAR, and ESA's Sentinel to produce a map of structural types. Second, we assess whether coherence measurements and PolInSAR retrievals can be used to resolve forest stand differences at 30m resolution and disitinguish between primary and secondary forest sites.

  1. In patients with minimally symptomatic OSA can baseline characteristics and early patterns of CPAP usage predict those who are likely to be longer-term users of CPAP

    PubMed Central

    Bratton, Daniel J.; Craig, Sonya E.; Kohler, Malcolm; Stradling, John R.

    2016-01-01

    Background Long-term continuous positive airway pressure (CPAP) usage varies between individuals. It would be of value to be able to identify those who are likely to benefit from CPAP (and use it long term), versus those who would not, and might therefore benefit from additional help early on. First, we explored whether baseline characteristics predicted CPAP usage in minimally symptomatic obstructive sleep apnoea (OSA) patients, a group who would be expected to have low usage. Second, we explored if early CPAP usage was predictive of longer-term usage, as has been shown in more symptomatic OSA patients. Methods The MOSAIC trial was a multi-centre randomised controlled trial where minimally symptomatic OSA patients were randomised to CPAP, or standard care, for 6 months. Here we have studied only those patients randomised to CPAP treatment. Baseline characteristics including symptoms, questionnaires [including the Epworth sleepiness score (ESS)] and sleep study parameters were recorded. CPAP usage was recorded at 2–4 weeks after initiation and after 6 months. The correlation and association between baseline characteristics and 6 months CPAP usage was assessed, as was the correlation between 2 and 4 weeks CPAP usage and 6 months CPAP usage. Results One hundred and ninety-five patients randomised to CPAP therapy had median [interquartile range (IQR)] CPAP usage of 2:49 (0:44, 5:13) h:min/night (h/n) at the 2–4 weeks visit, and 2:17 (0:08, 4:54) h/n at the 6 months follow-up visit. Only male gender was associated with increased long-term CPAP use (male usage 2:56 h/n, female 1:57 h/n; P=0.02). There was a moderate correlation between the usage of CPAP at 2–4 weeks and 6 months, with about 50% of the variability in long-term use being predicted by the short-term use. Conclusions In patients with minimally symptomatic OSA, our study has shown that male gender (and not OSA severity or symptom burden) is associated with increased long-term use of CPAP at 6 months

  2. Adaptation and Validation of the Spanish Version of OSA-18, a Quality of Life Questionnaire for Evaluation of Children with Sleep Apnea-Hypopnea Syndrome.

    PubMed

    Chiner, Eusebi; Landete, Pedro; Sancho-Chust, José Norberto; Martínez-García, Miguel Ángel; Pérez-Ferrer, Patricia; Pastor, Esther; Senent, Cristina; Arlandis, Mar; Navarro, Cristina; Selma, María José

    2016-11-01

    To analyze the reliability and validity of the Spanish version of the OSA-18 quality of life questionnaire in children with apnea-hypopnea syndrome (SAHS). Children with suspected SAHS were studied with polysomnography (PSG) before and after adenotonsillectomy (AA). Age, gender, clinical data, PSG, anthropometric data, and Mallampati and Brodsky scales were analyzed. OSA-18 was administered at baseline and 3-6months post AA. After translation and backtranslation by bilingual professionals, the internal consistency, reliability, construct validity, concurrent validity, predictive validity and sensitivity to change of the questionnaire was assessed. In total, 45 boys and 15 girls were evaluated, showing BMI 18±4, neck 28±5, Brodsky (0: 7%; <25%: 12%; 25-50%: 27%; >50 to <75%: 45%; >75%: 6%), AHI 12±7 pre AA. Global Cronbach alpha was 0.91. Correlations between domains were significant except for emotional aspects, although the total scores correlated with all domains (0.50 to 0.90). The factorial analysis was virtually identical to the original structure. The total scores showed good correlation for concurrent validity (0.2-0.45). With regard to predictive validity, the questionnaire adequately differentiated levels of severity according to Mallampati (ANOVA P=.002) and apnea-hypopnea index (ANOVA P=.006). Test-retest reliability was excellent, as was sensitivity to change, both in the total scores (P<.001) and in each domain (P<.001). The Spanish adaptation of the OSA-18 and its psychometric characteristics suggest that the Spanish version is equivalent to the original and can be used in Spanish-speaking countries. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Effect of Armodafinil on Cortical Activity and Working Memory in Patients with Residual Excessive Sleepiness Associated with CPAP-Treated OSA: A Multicenter fMRI Study

    PubMed Central

    Greve, Douglas N.; Duntley, Stephen P.; Larson-Prior, Linda; Krystal, Andrew D.; Diaz, Michele T.; Drummond, Sean P. A.; Thein, Stephen G.; Kushida, Clete A.; Yang, Ronghua; Thomas, Robert J.

    2014-01-01

    Study Objective: To assess the effect of armodafinil on task-related prefrontal cortex activation using functional magnetic resonance imaging (fMRI) in patients with obstructive sleep apnea (OSA) and excessive sleepiness despite continuous positive airway pressure (CPAP) therapy. Methods: This 2-week, multicenter, prospective, randomized, double-blind, placebo-controlled, parallel-group study was conducted at five neuroimaging sites and four collaborating clinical study centers in the United States. Patients were 40 right-handed or ambidextrous men and women aged between 18 and 60 years, with OSA and persistent sleepiness, as determined by multiple sleep latency and Epworth Sleepiness Scale scores, despite effective, stable use of CPAP. Treatment was randomized (1:1) to once-daily armodafinil 200 mg or placebo. The primary efficacy outcome was a change from baseline at week 2 in the volume of activation meeting the predefined threshold in the dorsolateral prefrontal cortex during a 2-back working memory task. The key secondary measure was the change in task response latency. Results: No significant differences were observed between treatment groups in the primary or key secondary outcomes. Armodafinil was generally well tolerated. The most common adverse events (occurring in more than one patient [5%]) were headache (19%), nasopharyngitis (14%), and diarrhea (10%). Conclusions: Armodafinil did not improve fMRI-measured functional brain activation in CPAP-treated patients with OSA and excessive sleepiness. Study Registration: Double-Blind, Placebo-Controlled, Functional Neuroimaging Study of Armodafinil (200 mg/Day) on Prefrontal Cortical Activation in Patients With Residual Excessive Sleepiness Associated With Obstructive Sleep Apnea/Hypopnea. ClinicalTrials.gov Identifier: NCT00711516. http://www.clinicaltrials.gov/ct2/show/study/NCT00711516 Citation: Greve DN; Duntley SP; Larson-Prior L; Krystal AD; Diaz MT; Drummond SP; Thein SG; Kushida CA; Yang R; Thomas RJ

  4. Effect of CPAP on Cardiac Function in Minimally Symptomatic Patients with OSA: Results from a Subset of the MOSAIC Randomized Trial

    PubMed Central

    Craig, Sonya; Kylintireas, Ilias; Kohler, Malcolm; Nicoll, Debby; Bratton, Daniel J.; Nunn, Andrew J.; Leeson, Paul; Neubauer, Stefan; Stradling, John R.

    2015-01-01

    Study Objectives: Minimally symptomatic obstructive sleep apnea (OSA) is highly prevalent, and the effects of continuous positive airway pressure (CPAP) on myocardial function in these patients are unknown. The MOSAIC randomized, controlled trial of CPAP for minimally symptomatic OSA assessed the effect of CPAP on myocardial function in a subset of patients. Methods: Two centers taking part in the MOSAIC trial randomized 238 patients in parallel to 6 months of CPAP (120) or standard care (118). Of these, 168 patients had echocardiograms, and 68 patients had a cardiac magnetic resonance scan (CMR). A larger group (314) from 4 centers had brain natriuretic peptide (BNP) measured. Results: Mean (SD) baseline oxygen desaturation index (ODI) and Epworth sleepiness score (ESS) were 13.5 (13.2), and 8.4 (4.0), respectively. CPAP significantly reduced ESS and ODI. Baseline LV ejection fraction (LVEF) was well preserved (60.4%). CPAP had no significant effect on echo-derived left atrial (LA) area (−1.0 cm2, 95% CI −2.6 to +0.6, p = 0.23) or early to late left ventricular filling velocity (E/A) ratio (−0.01, 95% CI −0.07 to +0.05, p = 0.79). There was a small change in echo-derived LV end diastolic volume (EDV) with CPAP (−5.9 mL, 95% CI −10.6 to −1.2, p = 0.015). No significant changes were detected by CMR on LV mass index (+1.1 g/m2, 95% CI −5.9 to +8.0, p = 0.76) or LVEF (+0.8%, 95% CI −1.2 to +2.8, p = 0.41). CPAP did not affect BNP levels (p = 0.16). Conclusions: Six months of CPAP therapy does not change cardiac functional or structural parameters measured by echocardiogram or CMR in patients with minimally symptomatic mild-to-moderate OSA. Clinical Trial Registration: ISRCTN 34164388 (http://isrctn.org). Citation: Craig S, Kylintireas I, Kohler M, Nicoll D, Bratton DJ, Nunn AJ, Leeson P, Neubauer S, Stradling JR. Effect of CPAP on cardiac function in minimally symptomatic patients with OSA: results from a subset of the MOSAIC randomized trial. J Clin

  5. Osa Creek gabbro-granite ring complex, Sierra Nevada, CA, by degassing-driven subsidence of mafic-magmatic sheets

    NASA Astrophysics Data System (ADS)

    Sisson, T. W.; Moore, J. G.

    2010-12-01

    Intrusive ring complexes commonly represent the shallow substrates of calderas, with arcuate intrusions forming as ring dikes engulfing subsiding caldera blocks, and as cone sheets injected during magmatic repressurization. The Osa Creek ring complex, southern Sierra Nevada batholith, differs in having formed by axial subsidence of solidifying gabbro-diorite sheets that injected a coeval mushy granitic magma body. The result is a remarkable nearly circular (6×10 km) steep-sided bimodal intrusive body, exposed 60 km east of Porterville and 30 km southwest of Owens Lake on the east side of the Kern Canyon. Zircon ages (SHRIMP) of both gabbro and granite are 146 ±1.5 Ma (1-sigma), slightly younger than, or concurrent with, the Independence Dike Swarm. Much of the structure is hornblende-biotite gabbro and diorite (SiO2, 47-51 wt %) emplaced as sheets 0.1-5 m thick, with each mafic sheet commonly chilled against and separated by thin (1-25 cm) septa of lighter colored and coarser rock ranging from granite to hornblende-plagioclase pegmatite. Mutually intrusive relations indicate that the septa were partly molten during sheet injection. In the outer portions of the complex the mafic sheets strike parallel to the margins and dip vertically-to-steeply radially inward. Dips of mafic sheets shallow toward the center of the complex, and are sub-horizontal in the center, defining a cup or basin structure. At least 28 thicker (5-250 m) conformable granitic sheets (SiO2, 70-77 wt. %) are spaced through the gabbroic layers and are increasingly thicker and abundant toward the higher elevation outer edges of the structure. Granite sheets also dip steeply inward, further defining the basin-shaped structure. Subsidence of the complex’s interior is indicated by rotation of igneous geopetal (way-up) indicators. These are in the form of small flames and pipes (to ~10 cm across) of the comagmatic inter-sheet septa granitoids that inject adjacent mafic sheets consistently toward the

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

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

  9. STEALTH liposome-encapsulated cisplatin (SPI-77) versus carboplatin as adjuvant therapy for spontaneously arising osteosarcoma (OSA) in the dog: a randomized multicenter clinical trial.

    PubMed

    Vail, David M; Kurzman, Ilene D; Glawe, Phyllis C; O'Brien, Maura G; Chun, Ruthanne; Garrett, Laura D; Obradovich, Joyce E; Fred, Rogers M; Khanna, Chand; Colbern, Gail T; Working, Peter K

    2002-08-01

    This trial was designed to compare the efficacy of adjuvant STEALH liposome-encapsulated cisplatin (SPI-77) to "standard-of-care" carboplatin therapy in dogs with osteosarcoma (OSA) in the context of a randomized study design. The study included 40 pet dogs with spontaneously arising OSA which were randomized to receive SPI-77 (350 mg/m(2) i.v. every 3 weeks for four treatments) or carboplatin (300 mg/m(2) i.v. every 3 weeks for four treatments) along with amputation of the affected limb. Median disease-free (DFS) and overall survival (OS) were compared using standard life-table analysis. The median follow-up was 693 days (range 321-730 days). Of 38 dogs eligible for follow-up, 25 were dead of their disease, 9 were alive and disease-free (8 receiving SPI-77, 1 receiving carboplatin; P=0.02), 2 were free of disease when they were lost to follow-up at 321 and 395 days, and 2 had died of an unrelated disease. The median DFS times for dogs treated with SPI-77 and carboplatin were 156 and 123 days, respectively ( P=0.19). The median OS times for dogs treated with SPI-77 and carboplatin were 333 and 207 days, respectively ( P=0.18). While STEALTH liposome encapsulation of cisplatin allowed the safe administration of five times the maximally tolerated dose of free cisplatin to dogs without concurrent hydration protocols, this did not translate into significantly prolonged DFS or OS. However, a larger proportion of dogs receiving SPI-77 enjoyed long-term DFS when compared with dogs receiving carboplatin.

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  11. The “DOC” screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics

    PubMed Central

    Swartz, Richard H.; Cayley, Megan L.; Lanctôt, Krista L.; Murray, Brian J.; Cohen, Ashley; Thorpe, Kevin E.; Sicard, Michelle N.; Lien, Karen; Sahlas, Demetrios J.; Herrmann, Nathan

    2017-01-01

    Background Post-stroke Depression, Obstructive sleep apnea (OSA) and Cognitive impairment (“DOC”) are associated with greater mortality, worse recovery and poorer quality of life. Best practice recommendations endorse routine screening for each condition; yet, all are under-assessed, diagnosed and treated. We seek to determine the feasibility and validity of an integrated tool (“DOC” screen) to identify stroke clinic patients at high-risk of depression, OSA, and cognitive impairment. Methods All consecutive new referrals to a regional Stroke Prevention Clinic who were English-speaking and non-aphasic were eligible to be screened. Time for screen completion was logged. DOC screen results were compared to the neuropsychological battery and polysomnogram assessments using a modified receiver operator characteristic and area under the curve analysis. Data is reported to conform to STARD guidelines. Findings 1503 people were screened over 2 years. 89% of eligible patients completed the screen in 5 minutes or less (mean 4.2 minutes), less than half the time it takes to complete the Montreal Cognitive Assessment (MoCA). 437 people consented to detailed testing. Of those, 421 completed the Structured Clinical Interview for Depression within 3 months of screening, 387 completed detailed neuropsychological testing within 3 months, and 88 had overnight polysomnograms. Screening scores combined with demographic variables (age, sex, education, body mass index), had excellent validity compared to gold standard diagnoses: DOC-Mood AUC 0.90; DOC-Apnea AUC 0.80; DOC-Cog AUC 0.81. DOC screen scores can reliably categorize patients in to low-, intermediate- or high-risk groups for further action and can do so with comparable accuracy to more time-consuming screens. Conclusions Systematic screening of depression, obstructive sleep apnea, and cognitive impairment in 5 minutes or less is feasible and valid in a high volume stroke clinic using the DOC screen. The DOC screen may

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

    NASA Astrophysics Data System (ADS)

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

    2007-10-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Bringhurst, K.; Jordan, P.

    2011-12-01

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

  15. Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial.

    PubMed

    de Ruiter, Maurits H T; Benoist, Linda B L; de Vries, Nico; de Lange, Jan

    2017-09-15

    The Sleep Position Trainer (SPT) is a new option for treating patients with positional obstructive sleep apnea (POSA). This study investigated long-term efficacy, adherence, and quality of life during use of the SPT device compared with oral appliance therapy (OAT) in patients with POSA. This prospective, multicenter trial randomized patients with mild to moderate POSA (apnea-hypopnea index [AHI] 5-30/h) to SPT or OAT. Polysomnography was performed at baseline and after 3 and 12 months' follow-up. The primary endpoint was OSA severity; adherence, quality of life, and adverse events were also assessed. Ninety-nine patients were randomized and 58 completed the study (29 in each group). Median AHI in the SPT group decreased from 13.2/h at baseline to 7.1/h after 12 months (P < 0.001); corresponding values in the OAT group were 13.4/h and 5.0/h (P < 0.001), with no significant between-group difference (P = 1.000). Improvements throughout the study were maintained at 12 months. Long-term median adherence was also similar in the two treatment groups; the proportion of patients who used their device for ≥ 4 h for 5 days in a week was 100% in the SPT group and 97.0% in the OAT group (P = 0.598). The efficacy of SPT therapy was maintained over 12 months and was comparable to that of OAT in patients with mild to moderate POSA. Adherence was relatively high, and similar in the two groups. www.clinicaltrials.gov (NCT02045576).

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

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

    PubMed

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

    2014-06-01

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

  18. Effects of CPAP-therapy on brain electrical activity in obstructive sleep apneic patients: a combined EEG study using LORETA and Omega complexity : reversible alterations of brain activity in OSAS.

    PubMed

    Toth, Marton; Faludi, Bela; Kondakor, Istvan

    2012-10-01

    Effects of initiation of continuous positive airway pressure (CPAP) therapy on EEG background activity were investigated in patients with obstructive sleep apnea syndrome (OSAS, N = 25) to test possible reversibility of alterations of brain electrical activity caused by chronic hypoxia. Normal control group (N = 14) was also examined. Two EEG examinations were done in each groups: at night and in the next morning. Global and regional (left vs. right, anterior vs. posterior) measures of spatial complexity (Omega complexity) were used to characterize the degree of spatial synchrony of EEG. Low resolution electromagnetic tomography (LORETA) was used to localize generators of EEG activity in separate frequency bands. Before CPAP-treatment, a significantly lower Omega complexity was found globally and over the right hemisphere. Due to CPAP-treatment, these significant differences vanished. Significantly decreased Omega complexity was found in the anterior region after treatment. LORETA showed a decreased activity in all of the beta bands after therapy in the right hippocampus, premotor and temporo-parietal cortex, and bilaterally in the precuneus, paracentral and posterior cingulate cortex. No significant changes were seen in control group. Comparing controls and patients before sleep, an increased alpha2 band activity was seen bilaterally in the precuneus, paracentral and posterior cingulate cortex, while in the morning an increased beta3 band activity in the left precentral and bilateral premotor cortex and a decreased delta band activity in the right temporo-parietal cortex and insula were observed. These findings indicate that effect of sleep on EEG background activity is different in OSAS patients and normal controls. In OSAS patients, significant changes lead to a more normal EEG after a night under CPAP-treatment. Compensatory alterations of brain electrical activity in regions associated with influencing sympathetic outflow, visuospatial abilities, long

  19. Generalization of color-difference formulas for any illuminant and any observer by assuming perfect color constancy in a color-vision model based on the OSA-UCS system.

    PubMed

    Oleari, Claudio; Melgosa, Manuel; Huertas, Rafael

    2011-11-01

    The most widely used color-difference formulas are based on color-difference data obtained under D65 illumination or similar and for a 10° visual field; i.e., these formulas hold true for the CIE 1964 observer adapted to D65 illuminant. This work considers the psychometric color-vision model based on the Optical Society of America-Uniform Color Scales (OSA-UCS) system previously published by the first author [J. Opt. Soc. Am. A 21, 677 (2004); Color Res. Appl. 30, 31 (2005)] with the additional hypothesis that complete illuminant adaptation with perfect color constancy exists in the visual evaluation of color differences. In this way a computational procedure is defined for color conversion between different illuminant adaptations, which is an alternative to the current chromatic adaptation transforms. This color conversion allows the passage between different observers, e.g., CIE 1964 and CIE 1931. An application of this color conversion is here made in the color-difference evaluation for any observer and in any illuminant adaptation: these transformations convert tristimulus values related to any observer and illuminant adaptation to those related to the observer and illuminant adaptation of the definition of the color-difference formulas, i.e., to the CIE 1964 observer adapted to the D65 illuminant, and then the known color-difference formulas can be applied. The adaptations to the illuminants A, C, F11, D50, Planckian and daylight at any color temperature and for CIE 1931 and CIE 1964 observers are considered as examples, and all the corresponding transformations are given for practical use.

  20. Constraining Source Locations of Shallow Subduction Megathrust Earthquakes in 1-D and 3-D Velocity Models - A Case Study of the 2002 Mw=6.4 Osa Earthquake, Costa Rica

    NASA Astrophysics Data System (ADS)

    Grevemeyer, I.; Arroyo, I. G.

    2015-12-01

    Earthquake source locations are generally routinely constrained using a global 1-D Earth model. However, the source location might be associated with large uncertainties. This is definitively the case for earthquakes occurring at active continental margins were thin oceanic crust subducts below thick continental crust and hence large lateral changes in crustal thickness occur as a function of distance to the deep-sea trench. Here, we conducted a case study of the 2002 Mw 6.4 Osa thrust earthquake in Costa Rica that was followed by an aftershock sequence. Initial relocations indicated that the main shock occurred fairly trenchward of most large earthquakes along the Middle America Trench off central Costa Rica. The earthquake sequence occurred while a temporary network of ocean-bottom-hydrophones and land stations 80 km to the northwest were deployed. By adding readings from permanent Costa Rican stations, we obtain uncommon P wave coverage of a large subduction zone earthquake. We relocated this catalog using a nonlinear probabilistic approach using a 1-D and two 3-D P-wave velocity models. The 3-D model was either derived from 3-D tomography based on onshore stations and a priori model based on seismic refraction data. All epicentres occurred close to the trench axis, but depth estimates vary by several tens of kilometres. Based on the epicentres and constraints from seismic reflection data the main shock occurred 25 km from the trench and probably along the plate interface at 5-10 km depth. The source location that agreed best with the geology was based on the 3-D velocity model derived from a priori data. Aftershocks propagated downdip to the area of a 1999 Mw 6.9 sequence and partially overlapped it. The results indicate that underthrusting of the young and buoyant Cocos Ridge has created conditions for interpolate seismogenesis shallower and closer to the trench axis than elsewhere along the central Costa Rica margin.

  1. OSA Imaging and Applied Optics Congress Support

    DTIC Science & Technology

    2017-02-16

    and Computational Optical Sensing and Imaging (COSI) .The meetings exposed attendees to in-depth learning of optical sensing and imaging and their...were supported by this grant. The meetings exposed attendees to in-depth learning of optical sensing and imaging and their applications from...Participants can hear about the latest products and services, but more importantly, learn about entrepreneurial opportunities and how scientific

  2. OR State Profile. Oregon: Oregon State Assessment System (OSAS)

    ERIC Educational Resources Information Center

    Center on Education Policy, 2010

    2010-01-01

    This paper provides information about Oregon State Assessment System. Its purpose is to assess proficiency in the Essential Skills for the purpose of earning a regular or modified high school diploma. Oregon Assessment of Knowledge and Skills is also used for federal accountability purposes under No Child Left Behind. [For the main report,…

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

    NASA Astrophysics Data System (ADS)

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

    2000-06-01

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

  4. OSA Proceedings on Picosecond Electronics and Optoelectronics. Volume 4

    DTIC Science & Technology

    1989-01-01

    3 shows PL decay time and the time integrated PL intensity of QWI and QW2 of three samples as a function of Va. The physical interpretations are...Picosecond Pulse Generation and Sampling with GaAs Monolithic Integrated Circuits .6........................................ R. A. Marsland, C. . Madden...73 K L. HaIl,_E.Jt?. Ippen, J. Mark, and G. Eisenstein rSpread-Spectrum- Integrated Optic Modulators ....................... 76 David W

  5. Gregor Mendel, OSA (1822-1884), founder of scientific genetics.

    PubMed

    Dunn, P M

    2003-11-01

    Gregor Mendel, an Augustinian monk and part-time school teacher, undertook a series of brilliant hybridisation experiments with garden peas between 1857 and 1864 in the monastery gardens and, using statistical methods for the first time in biology, established the laws of heredity, thereby establishing the discipline of genetics.

  6. Predicting sleep disordered breathing in outpatients with suspected OSA

    PubMed Central

    Cowan, Douglas C; Allardice, Gwen; MacFarlane, Duncan; Ramsay, Darren; Ambler, Heather; Banham, Stephen; Livingston, Eric; Carlin, Christopher

    2014-01-01

    Objective To validate the utilities of Berlin, STOP and STOP-BANG Questionnaires, other patient characteristics, comorbidities, Epworth Sleepiness Scale (ESS), fractional exhaled nitric oxide (FENO) and blood markers for the prediction of sleep disordered breathing (SDB) on limited polygraphy. Setting North Glasgow Sleep Service (a tertiary referral centre). Participants 129 consecutive patients, aged ≥16 years, referred to the sleep clinic for assessment of possible obstructive sleep apnoea. Interventions We selected cut-points of apnoea hypopnoea index (AHI) of ≥5 and ≥15/h from their home polygraphy and determined associations of these with individual symptoms, questionnaire scores and other results. Receiver operating characteristic analysis and univariate and multivariate logistic regression were used to explore these. Primary and secondary outcomes measures Primary: The utility of STOP, STOP-BANG and Berlin Questionnaires for prediction of SDB. Secondary: The utility of other measures for prediction of SDB. Results AHI was ≥5 in 97 patients and ≥15 in 56 patients. STOP and STOP-BANG scores were associated with both AHI cut-points but results with ESS and Berlin Questionnaire scores were negative. STOP-BANG had a negative predictive value 1.00 (0.77–1.00) for an AHI ≥15 with a score ≥3 predicting AHI ≥5 with sensitivity 0.93 (95% CI 0.84 to 0.98) and accuracy 79%, while a score ≥6 predicted AHI ≥15 with specificity 0.78 (0.65 to 0.88) and accuracy 72%. Neck circumference ≥17 inch and presence of witnessed apnoeas were independent predictors of SDB. Conclusions STOP and STOP-BANG Questionnaires have utility for the prediction of SDB in the sleep clinic population. Modification of the STOP-BANG Questionnaire merits further study in this and other patient groups. PMID:24736037

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

    PubMed

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

    2016-08-01

    Despite the undeniable medical advances achieved in recent decades, cancer remains one of the main causes of mortality. It is thus extremely important to make every effort to discover new risk factors for this disease, particularly ones that can be treated or modified. Various pathophysiologic pathways have been postulated as possible causes of cancer or its increased aggressiveness, and also of greater resistance to antitumoral treatment, in the presence of both intermittent hypoxia and sleep fragmentation (both inherent to sleep apnea). Thus far, these biological hypotheses have been supported by various experimental studies in animals. Meanwhile, recent human studies drawing on preexisting databases have observed an increase in cancer incidence and mortality in patients with a greater severity of sleep-disordered breathing. However, the methodologic limitations of these studies (which are mostly retrospective and lack any measurement of direct markers of intermittent hypoxia or sleep fragmentation) highlight the need for controlled, prospective studies that would provide stronger scientific evidence regarding the existence of this association and its main characteristics, as well as explore its nature and origin in greater depth. The great epidemiologic impact of both cancer and sleep apnea and the potential for clinical treatment make this field of research an exciting challenge. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  8. OSA Trends in Optics and Photonics Series, Volume 14 Spatial Light Modulators

    DTIC Science & Technology

    1998-05-26

    electroplated gold. The advantages of our new fabrication technology are as follows. The integration does not require any alignment before wafer bonding...circuit and the photonic circuit is electroplated gold. The gold electrode under the VCSEL is for reducing the thermal resistance. The device fabrication...form three-dimensional contacts between the p-type contact of the VCSELs and the bonding pads on the Si-CMOS wafer with electroplated gold

  9. OSA Trends in Optics and Photonics Series. Volume 13: Ultrafast Electronics and Optoelectronics

    DTIC Science & Technology

    1997-01-01

    Monolithically - Integrated Circuit for All Optical Generation of Millimeter-Wave Frequencies 91 G. Allen Vawter, Alan Mar, Vince Hietala, John Zolper...generation using hybrid mode-locking of a monolithic DBR laser," Electron. Lett., 1995, 31, pp. 733-734. [3] T. Hoshida, H. F. Liu, M. R. H. Daza, M...400 500 Time (ps) Figure 3. Pulse response of the RCE photodiode A Complete Monolithically - Integrated Circuit for All Optical Generation of

  10. Obesity and Obstructive Sleep Apnea: Or is it OSA and Obesity?

    DTIC Science & Technology

    2008-01-01

    xample, Tasali et al. [42] recently documented that selec- ive reduction of delta sleep compromises insulin sensitivity. 7 h / Path H s T s b a o p s F...treatment onset, and he same group recently demonstrated a 68% improvement n insulin sensitivity after ∼3 years of successful PAP treat- ent [71]. Kajaste et...association with, and ndependent of, reduction in body weight. In a retrospective tudy of questionnaire data from Quan et al. suggested that egular

  11. First Image Products from EcoSAR - Osa Peninsula, Costa Rica

    NASA Technical Reports Server (NTRS)

    Osmanoglu, Batuhan; Lee, SeungKuk; Rincon, Rafael; Fatuyinbo, Lola; Bollian, Tobias; Ranson, Jon

    2016-01-01

    Designed especially for forest ecosystem studies, EcoSAR employs state-of-the-art digital beamforming technology to generate wide-swath, high-resolution imagery. EcoSARs dual antenna single-pass imaging capability eliminates temporal decorrelation from polarimetric and interferometric analysis, increasing the signal strength and simplifying models used to invert forest structure parameters. Antennae are physically separated by 25 meters providing single pass interferometry. In this mode the radar is most sensitive to topography. With 32 active transmit and receive channels, EcoSARs digital beamforming is an order of magnitude more versatile than the digital beamforming employed on the upcoming NISAR mission. EcoSARs long wavelength (P-band, 435 MHz, 69 cm) measurements can be used to simulate data products for ESAs future BIOMASS mission, allowing scientists to develop algorithms before the launch of the satellite. EcoSAR can also be deployed to collect much needed data where BIOMASS satellite wont be allowed to collect data (North America, Europe and Arctic), filling in the gaps to keep a watchful eye on the global carbon cycle. EcoSAR can play a vital role in monitoring, reporting and verification schemes of internationals programs such as UN-REDD (United Nations Reducing Emissions from Deforestation and Degradation) benefiting global society. EcoSAR was developed and flown with support from NASA Earth Sciences Technology Offices Instrument Incubator Program.

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

    NASA Astrophysics Data System (ADS)

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

    2012-10-01

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

  13. Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy.

    PubMed

    Alves, Eduardo S; Lira, Fabio S; Santos, Ronaldo V T; Tufik, Sergio; de Mello, Marco T

    2011-08-23

    Sleep is an integral part of good health. Sleep disorders and variations in sleep habits are associated with a low-grade inflammatory status, which may be either a cause or consequence of other conditions, including obesity, diabetes and cardiovascular disease. Several strategies are available to counteract these conditions including continuous positive airway pressure (CPAP), pharmacological and nutritional interventions, and even surgery. At present, our group is investigating the effect of chronic endurance exercise on sleep alterations.

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

    NASA Astrophysics Data System (ADS)

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

    2015-09-01

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

  15. Process optimization of ultrasound-assisted curcumin nanoemulsions stabilized by OSA-modified starch.

    PubMed

    Abbas, Shabbar; Bashari, Mohanad; Akhtar, Waseem; Li, Wei Wei; Zhang, Xiaoming

    2014-07-01

    This study reports on the process optimization of ultrasound-assisted, food-grade oil-water nanoemulsions stabilized by modified starches. In this work, effects of major emulsification process variables including applied power in terms of power density and sonication time, and formulation parameters, that is, surfactant type and concentration, bioactive concentration and dispersed-phase volume fraction were investigated on the mean droplet diameter, polydispersity index and charge on the emulsion droplets. Emulsifying properties of octenyl succinic anhydride modified starches, that is, Purity Gum 2000, Hi-Cap 100 and Purity Gum Ultra, and the size stability of corresponding emulsion droplets during the 1 month storage period were also investigated. Results revealed that the smallest and more stable nanoemulsion droplets were obtained when coarse emulsions treated at 40% of applied power (power density: 1.36 W/mL) for 7 min, stabilized by 1.5% (w/v) Purity Gum Ultra. Optimum volume fraction of oil (medium chain triglycerides) and the concentration of bioactive compound (curcumin) dispersed were 0.05 and 6 mg/mL oil, respectively. These results indicated that the ultrasound-assisted emulsification could be successfully used for the preparation of starch-stabilized nanoemulsions at lower temperatures (40-45 °C) and reduced energy consumption.

  16. 'REM-related OSA': a forgotten diagnostic? Possible path to under-diagnosing sleep apnea.

    PubMed

    Beneto, A; Soler-Algarra, S; Salavert, V

    2016-12-01

    Introduccion. Recientemente se han propugnado criterios restrictivos para definir el sindrome de apnea/hipopnea obstructiva ligado al sueño REM y persisten interrogantes sobre su trascendencia nosologica y manejo clinico. Objetivo. Evaluar los criterios definitorios de la apnea del sueño REM, su relacion con la comorbilidad cardiometabolica y los aspectos relacionados con su diagnostico. Pacientes y metodos. Estudio observacional retrospectivo sobre datos clinicos y polisomnograficos de pacientes ambulatorios. Se incluyo a 525 pacientes mayores de 18 años que tenian un indice apnea/hipopnea (IAH) por hora de sueño = 5 (total, o parcial en REM o no REM). Resultados. Se han configurado subgrupos 'dependientes de la fase' utilizando un criterio basado en la 'proporcion = 2' y otro 'estricto' basado en uno de los IAH parciales = 5 frente al otro IAH < 5 (en REM o en no REM). En el subgrupo 'apnea del sueño REM estricto', la mitad de los pacientes muestra un IAH global < 5 y menos gravedad en los parametros respiratorios, pero sin menores porcentajes de comorbilidad. Con los criterios diagnosticos actuales quedarian excluidos del diagnostico de sindrome de apnea/hipopnea obstructiva del sueño (SAHOS). Conclusiones. Aplicar un criterio estricto para detectar apnea del sueño REM permite filtrar formas muy leves de SAHOS asociadas a comorbilidad cardiometabolica en porcentajes no diferentes significativamente de otras formas mas graves. Para evitar el infradiagnostico del SAHOS seria oportuno revisar los criterios diagnosticos actuales y las indicaciones de las tecnicas reducidas.

  17. Emerging applications: Screening OSA by Modified Pictorial Epworth Sleepiness Scale in Indian subjects.

    PubMed

    Karim, Azmat; Arora, V K; Gupta, M B

    2015-10-01

    The Epworth Sleepiness Scale (ESS) is a widely used scoring to measure excessive daytime sleepiness. This scale was designed to be self-completed by the subjects, but unfortunately in a developing country with low literacy this had affected its outcome interpretation. The Traditional ESS has been translated into a Modified Pictorial version for easy comprehension by the patients. Subjects were evaluated for their competence to self-complete the ESS (Conventional and Pictorial) in Sleep Clinic at Respiratory Department of Santosh Medical College and Hospital, Ghaziabad. Modified Pictorial representations were designed along with 5 newer questions incorporated as sub-questions in 8 original domains prepared and labelled as Pictorial Scale. The Traditional (ESS) and Pictorial (Modified) representations were compared for agreement by receiver operating curve and the area under curve. It was found that time taken to complete the Traditional ESS was significantly higher in comparison to Modified Pictorial Epworth Sleepiness Scale with reduced errors (Pictorial ESS 4.67min than Traditional ESS 14.43min). Modified pictures scale showed statistically significant improvements over ESS and hence can be used as an alternative for subjects with low literacy level. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  18. Osa-miR169 Negatively Regulates Rice Immunity against the Blast Fungus Magnaporthe oryzae

    PubMed Central

    Li, Yan; Zhao, Sheng-Li; Li, Jin-Lu; Hu, Xiao-Hong; Wang, He; Cao, Xiao-Long; Xu, Yong-Ju; Zhao, Zhi-Xue; Xiao, Zhi-Yuan; Yang, Nan; Fan, Jing; Huang, Fu; Wang, Wen-Ming

    2017-01-01

    miR169 is a conserved microRNA (miRNA) family involved in plant development and stress-induced responses. However, how miR169 functions in rice immunity remains unclear. Here, we show that miR169 acts as a negative regulator in rice immunity against the blast fungus Magnaporthe oryzae by repressing the expression of nuclear factor Y-A (NF-YA) genes. The accumulation of miR169 was significantly increased in a susceptible accession but slightly fluctuated in a resistant accession upon M. oryzae infection. Consistently, the transgenic lines overexpressing miR169a became hyper-susceptible to different M. oryzae strains associated with reduced expression of defense-related genes and lack of hydrogen peroxide accumulation at the infection site. Consequently, the expression of its target genes, the NF-YA family members, was down-regulated by the overexpression of miR169a at either transcriptional or translational level. On the contrary, overexpression of a target mimicry that acts as a sponge to trap miR169a led to enhanced resistance to M. oryzae. In addition, three of miR169’s target genes were also differentially up-regulated in the resistant accession upon M. oryzae infection. Taken together, our data indicate that miR169 negatively regulates rice immunity against M. oryzae by differentially repressing its target genes and provide the potential to engineer rice blast resistance via a miRNA. PMID:28144248

  19. Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients.

    PubMed

    Koo, Soo Kweon; Kwon, Soon Bok; Kim, Yang Jae; Moon, J I Seung; Kim, Young Jun; Jung, Sung Hoon

    2017-03-01

    Snoring is a sign of increased upper airway resistance and is the most common symptom suggestive of obstructive sleep apnea. Acoustic analysis of snoring sounds is a non-invasive diagnostic technique and may provide a screening test that can determine the location of obstruction sites. We recorded snoring sounds according to obstruction level, measured by DISE, using a smartphone and focused on the analysis of formant frequencies. The study group comprised 32 male patients (mean age 42.9 years). The spectrogram pattern, intensity (dB), fundamental frequencies (F 0), and formant frequencies (F 1, F 2, and F 3) of the snoring sounds were analyzed for each subject. On spectrographic analysis, retropalatal level obstruction tended to produce sharp and regular peaks, while retrolingual level obstruction tended to show peaks with a gradual onset and decay. On formant frequency analysis, F 1 (retropalatal level vs. retrolingual level: 488.1 ± 125.8 vs. 634.7 ± 196.6 Hz) and F 2 (retropalatal level vs. retrolingual level: 1267.3 ± 306.6 vs. 1723.7 ± 550.0 Hz) of retrolingual level obstructions showed significantly higher values than retropalatal level obstruction (p < 0.05). This suggests that the upper airway is more severely obstructed with retrolingual level obstruction and that there is a greater change in tongue position. Acoustic analysis of snoring is a non-invasive diagnostic technique that can be easily applied at a relatively low cost. The analysis of formant frequencies will be a useful screening test for the prediction of occlusion sites. Moreover, smartphone can be effective for recording snoring sounds.

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

    PubMed

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

    2016-08-01

    A 51-year-old woman with a personal history of vitiligo, normal thyroid hormone studies, a simple hysterectomy for multiple uterine myomas at age 35 years, and childhood adenotonsillectomy was seen for progressive hearing loss. She reported mild asthenia, cold intolerance, mild dysphagia with frequent choking while eating and drinking, and a progressive increase in inspiratory effort, especially in the supine position. Her partner described a progressively worsening history of snoring and witnessed apneic episodes, mostly in the supine position. Mild to moderate daytime sleepiness was also present. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. How the Navy Can Use Open Systems Architecture to Revolutionize Capability Acquisition: The Naval OSA Strategy Can Yield Multiple Benefits

    DTIC Science & Technology

    2015-04-30

    open the DoD market to a greater array of component innovators. Work products that establish payload architectures and platform integration services...infrastructure 7. Markets that are currently vendor locked to be opened (foreign and domestic) 8. The science and technology community to focus on...ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= tÉÇåÉëÇ~ó=pÉëëáçåë= sçäìãÉ=f= = How the Navy Can Use Open Systems Architecture to Revolutionize Capability

  2. IMPACT OF CONTINOUS POSITIVE AIRWAY PRESSURE (CPAP) ON QUALITY OF LIFE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (OSA)

    PubMed Central

    Batool-Anwar, Salma; Goodwin, James L.; Kushida, Clete A.; Walsh, James A.; Simon, Richard D.; Nichols, Deborah A.; Quan, Stuart F.

    2017-01-01

    Summary Obstructive Sleep Apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from a subset of the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) vs. sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. We found that long-term improvement in quality of life occurs with the use of CPAP in persons with severe and possibly moderate sleep apnea. However no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea. PMID:27242272

  3. Converting a Manned LCU into an Unmanned Surface Vehicle (USV): An Open Systems Architecture (OSA) Case Study

    DTIC Science & Technology

    2014-09-01

    through pier-like structure or perform stern- gate marriages to amphibious well deck ships. Welded steel hull construction...connecting USVs with other, dissimilar systems. The thesis goes on to recognize that open architecture (OA) is valuable to fielding a USV system, but

  4. OSA Proceedings on Ultrafast Electronics and Optoelectronics Held in San Francisco, California on January 25 -27, 1993. Volume 14,

    DTIC Science & Technology

    1993-01-27

    Gb/s NRZ signal. Since monolithic OEIC es such as bistable memory LDs, and ultra- devices have advantages of reduced cost and fast nonlinear-optical...4 T TB ( I - kT/2A + • • - ) ; (9a) tATz -- <(,,-_ )2> = B2 (kT/2 )2,& (9b) where gE =_ I/RE is the differential emitter where c, a- 4mW•mWNB/2A. It...Lett. 53, 373-375 (1988). InP High Electron Mobility Transistors: Status and Promise Loi D. Nguyen Hughes Research Laboratories, 3011 Malibu Canyon Roa4

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Gastauer, Markus; Leyh, Werner; Meira-Neto, João A A

    2015-01-01

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

  7. Validation of a new domiciliary diagnosis device for automatic diagnosis of patients with clinical suspicion of OSA.

    PubMed

    Durán-Cantolla, Joaquín; Zamora Almeida, Gabriela; Vegas Diaz de Guereñu, Odei; Saracho Rotaeche, Luis; Hamdan Alkhraisat, Mohammad; Durán Carro, Joaquín; Egea Santaolalla, Carlos; Anitua, Eduardo

    2017-02-01

    Obstructive sleep apnoea is a prevalent and considerably underdiagnosed disease. The development of cost-effective, home-based, automatic diagnostic devices to improve the diagnosis accessibility is therefore essential. In this study, a new portable polygraph (BTI-APNiA) was used to validate automatic scoring. This five-channel device records respiratory flow, oxygen saturation, heart rate, body position and snoring. The validation was performed in two phases. In the first phase, manual and automatic scorings of a new respiratory polygraphy (RP) device (BTI-APNiA) were compared. In the second phase, automatic analysis performed with BTI-APNiA was compared with manual scoring of a validated RP device (Embletta Gold). Phase I was completed by 424 patients (50.5% males, 52.2 ± 12.4 years, BMI of 25.4 ± 4.8 kg/m(2) and Epworth Sleepiness Scale score of 8.0 ± 4.0). Manual and automatic analysis resulted in an apnoea-hypopnoea index (AHI) of 13.7 ± 12.7 and 14.0 ± 12.5 (P > 0.05), respectively. The interclass correlation coefficient (ICC) was 0.99 (P < 0.001). During Phase II, 28 patients were evaluated (72.0% men, 49.1 ± 10.9 years, BMI of 27.1 ± 4.2 kg/m(2) and Epworth Sleepiness Scale score of 7.5 ± 4.2). Manual analysis of Embletta Gold recordings indicated an AHI of 12.3 ± 14.0, while automatic analysis of the BTI-APNiA was 13.4 ± 14.7 (P > 0.05). The ICC was 0.68 (P < 0.01). The automatic analysis of the BTI-APNiA is as accurate as manual analysis of AHI. This automatic analysis compared well with the manual analysis of a validated RP device (Embletta Gold). © 2016 Asian Pacific Society of Respirology.

  8. OSA Proceedings of the Topical Meeting on Nonlinear Guided-Wave Phenomena Held in Cambridge, England (United Kingdom) on 2-4 September 1991. Volume 15

    DTIC Science & Technology

    1992-05-22

    Michel Piche. U. Laval, Canada. The dynamical optical fiber communications due to stimulated Brillouin instabilities at the output of an all-fiber...38. 107 [T] .J. Leavitt t ’ilversit v of Arizonia. 1990. 278 / TuE5-1 Instabilities of a dispersive nonlinear all-fiber ring cavity Rdal Vallde Michel ...Pich6 Centre d’optique photonique et laser (COPL) Universitd Laval (Pav. Vachon ) G1 K 7P4 Canada TEL.: (418) 656-2454 FAX.: (418) 656-2623 Nonlinear

  9. Tracking Pulse Oximeter Findings Before, During and After Titration of Mandibular Advancement Devices (MAD) for Patients With Mild to Moderate Obstructive Sleep Apnea (OSA)

    DTIC Science & Technology

    2015-06-01

    medical 25 histmy and examination of extra- and intra-oral tissues. Soft tissue anatomy, periodontal status, dental caries, the TMJ, muscles of...8. Do not need any restorative, periodontal , or root canal dental treatment 9. Do not have evidence of intraoral soft tissue and bone pathology b...posterior teeth 5. Restricted jaw opening :<:: 25 mm 6. TMD symptoms that prevent MAD wear 7. Caries, periodontal disease, oral pathology 8. Previous

  10. Osa Topical Meeting Proceedings (4th) on Picosecond Electronics and Optoelectronics Held in Salt Lake City, Utah on 13-15 March 1991. Volume 9

    DTIC Science & Technology

    1992-05-22

    Greene, J. F. Federici, A. F. J. Levi, L N. Pfeifer, andRiZ F. Kopf Terahertz Absorption Between Split Subbands in Coupled Quantum Wells ...Measurements in GaAs Quantum Wells ........... 40 W H. Knox G. E. Doran, J. Cunninghan M. Ramaswamy, and S. M. Goodnick Propagation of Picosecond...and N. Newman Ultrafast Lasers Femtosecond Monolithic Colliding-Pulse Mode-Locked Quantum - Well Lasers ........ 176 M. C. Wu, Y. K. Chen, T Tanbun-Ek

  11. OSA Proceedings of the Topical Meeting on Soft-X-Ray Projection Lithography Held in Monterey, California on 10-12 April 1991. Volume 12

    DTIC Science & Technology

    1992-05-22

    Carbide because of its high thermal the mirror on its backside or edge. Shott Zerodur conductivity. Edge cooling causes a larger exceeded the limit by about...Characterization Angstrom-level noncontact profiling of mirrors for soft x-ray lithography............ 134 Paul Glenn Nonspecular Scattering from X-Ray...structed by patterning a Mo/Si Tropel Division of GCA Corporation. multilayer coated silicon wafer. The mirrors were coated at AT&T Bell The multilayer

  12. OSA Proceedings of the Topical Meeting on Optical Amplifiers and Their Applications, Held in Snowmass Village, Colorado on 24 - 26 July 1991. Volume 13

    DTIC Science & Technology

    1992-05-22

    Laboratories, USA E. Eichen S. Yamamoto GTE Laboratories, USA KDD Meguro R&D Laboratories, Japan TUESDAY, JULY 23,1991 WEDNESDAY, JULY 24, 1991-Continued CABARET ...Laboratories, Japan. A gain of 10 dB was obtained in a neodymium-doped fluoride fiber amplifier by using bidirec- CABARET LOBBY tional 25-mW pumping...and a 1.05-pm rejection filter. (p. 16) 7.00 am-5:00 pm REGISTRATIONISPEAKER CHECK-IN CABARET LOBBY 10:00 am-10-30 am COFFEE BREAKIEXHIBITSANDERSON

  13. OSA (Optical Society of America) Proceedings on Short Wavelength Coherent Radiation: Generation and Applications Held in North Falmouth, Massachusetts on 26-29 September 1988. Volume 2

    DTIC Science & Technology

    1988-09-01

    spectral region above about 170A. The spectra are complicated by a number of oxygen lines b) and some yet unclassified Cu lines. We Ib) , have been able to...presented intense spectral FVII, lines become broader. Also the lines of hydrogen and helium like ions forbidden transition 3p-2p of FVI, gets of oxygen ...Li-like oxygen 3p-2s line is the same in both the on- and off-axis spectra. This indicates that there isFigure 7. Schematic drawings of experimental

  14. OSA Proceedings of the International Topical Meeting on Photonic Switching, Held in Salt Lake City, Utah on 6 - 8 March, 1992. Volume 8

    DTIC Science & Technology

    1992-05-22

    Multiple Quantum-Well Modulator Arrays for Neural Network and Photonic Switching Applications ........................ 210 M. A. Z Rejman- Greene , E G. Scott...34. Kobe, Japan, April 12-14, 1990 16. OSCAR Annual Report, Part A2-CS5 2. N.F. Whitehead, OFC󈨞, January 22-26, 17. M. Gustavsson , A. Karlsson and L... Gustavsson and L. Thylen, Top. Meeting Topical Meetings on Photonic Switching, on Photonic Swithcing, Salt Lake City, 1-3 Kobe, Japan, April 12-14, 1990

  15. A Comparison of Official Transcripts and Operational Records for Fall, 1975 University of Minnesota Registered Students. OSA Research Bulletin, v17 n7.

    ERIC Educational Resources Information Center

    Lele, Kaustubh T.; Armstrong, Roberta A.

    This study was undertaken to provide data for a review of the University of Minnesota's two-transcript system, which maintains an operational record (including all work taken) and an official transcript (record of accomplishment only) for each student. The sample included all students registered in fall 1975. Actual differences between the two…

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

    SciTech Connect

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

    1991-01-01

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

  17. Piecing Together Phenotypes of Brain Injury and Dysfunction in Obstructive Sleep Apnea

    PubMed Central

    Veasey, Sigrid C.

    2012-01-01

    Obstructive sleep apnea (OSA) is a highly prevalent condition that is associated with significant neurobehavioral impairments. Cognitive abnormalities identified in individuals with OSA include impaired verbal memory, planning, reasoning, vigilance, and mood. Therapy for OSA improves some but not all neurobehavioral outcomes, supporting a direct role for OSA in brain dysfunction and raising the question of irreversible injury from OSA. Recent clinical studies have refined the neurobehavioral, brain imaging, and electrophysiological characteristics of OSA, highlighting findings shared with aging and some unique to OSA. This review summarizes the cognitive, brain metabolic and structural, and peripheral nerve conduction changes observed in OSA that collectively provide a distinct phenotype of OSA brain injury and dysfunction. Findings in animal models of OSA provide insight into molecular mechanisms underlying OSA neuronal injury that can be related back to human neural injury and dysfunction. A comprehensive phenotype of brain function and injury in OSA is essential for advancing diagnosis, prevention, and treatment of this common disorder. PMID:23087666

  18. Sleep Apnea Research in Animals. Past, Present, and Future

    PubMed Central

    Chopra, Swati; Polotsky, Vsevolod Y.

    2016-01-01

    Obstructive sleep apnea (OSA) is a common disorder that describes recurrent collapse of the upper airway during sleep. Animal models have been pivotal to the understanding of OSA pathogenesis, consequences, and treatment. In this review, we highlight the history of OSA research in animals and include the discovery of animals with spontaneous OSA, the induction of OSA in animals, and the emulation of OSA using exposures to intermittent hypoxia and sleep fragmentation. PMID:26448201

  19. OSA Proceedings of the Topical Meeting (5th) on Short-Wave Length Coherent Radiation: Generation and Applications Held in Monterey, California on 8-10 April 1991. Volume 11

    DTIC Science & Technology

    1992-05-22

    after passing through the chamber-was blocked, first by an HR mirror , followed by two IR. filters. The spectrum of the SHG in the forward direction was...counterpropaganng pulse (the "probe pulse") with this "moving mirror ", we shift to a reference frame moving at the velocity 3c with the ionization...factor f2 (1 + 13) 2 as the frequency upshift. This is exactly analogous to a mirror which is physically moving. However, in contrast to a real mirror

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

    PubMed

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

    2006-02-01

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

  1. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients

    PubMed Central

    Diaz, Karla; Faverio, Paola; Hospenthal, Angela; Restrepo, Marcos I.; Amuan, Megan E.; Pugh, Mary Jo V.

    2014-01-01

    BACKGROUND: Obstructive sleep apnea (OSA) is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA). MATERIALS AND METHODS: This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED) visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA. RESULTS: Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4%) were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF), pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05). The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05). CONCLUSION: Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA. Early OSA

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    1999-01-01

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

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

    PubMed

    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

    2015-09-01

    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. Case-control study. 147 stroke patients admitted to a neurorehabilitation unit. N/A. 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. 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. 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. © 2015 Associated Professional Sleep Societies, LLC.

  5. Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children.

    PubMed

    Imanguli, Matin; Ulualp, Seckin O

    2016-11-01

    To determine the prevalence of residual obstructive sleep apnea (OSA) in children who had adenotonsillectomy (AT) and to identify the risk factors for residual OSA after AT. Retrospective chart review. Children with OSA who had AT at a tertiary care children's hospital were reviewed. Data pertaining to demographics, past medical history, body mass index, tonsil and adenoid size, and polysomnography were obtained. Residual OSA was defined as apnea hypopnea index (AHI) greater than 2. The rate of residual OSA and risk factors for residual OSA were assessed. One hundred sixty-nine children with OSA underwent polysomnography before and after AT. The prevalence of residual OSA was 38%. The prevalence of residual OSA in obese patients (49%) was higher than that of nonobese patients (27%) (P = .02). Patients with neurological/developmental/craniofacial abnormalities had higher prevalence of residual OSA (44%) than patients without comorbidities (33%) (P < .05). The prevalence of residual OSA in patients with severe OSA (42%) was higher than patients with moderate (29%) or mild OSA (0%) (P = .03). Teenage patients (67%) had a higher prevalence of residual OSA than toddlers (27%), preschooler (33%), and middle childhood groups (29%) (P = .03). The majority of children had improvement in OSA after AT. The choice of AHI threshold used to define residual OSA influenced the prevalence of residual OSA. Teenagers and children with obesity, comorbidities including neurological/developmental/craniofacial abnormalities alone or in combination with asthma, or severe OSA have a high risk of residual OSA. 4 Laryngoscope, 126:2624-2629, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  6. A Comparative Analysis of Sleep Disordered Breathing in Active Duty Service Members with and without Combat-Related Posttraumatic Stress Disorder.

    PubMed

    Mysliwiec, Vincent; Matsangas, Panagiotis; Gill, Jessica; Baxter, Tristin; O'Reilly, Brian; Collen, Jacob F; Roth, Bernard J

    2015-12-15

    Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are frequently co-occurring illnesses. The purpose of this study was to determine whether comorbid PTSD/OSA is associated with increased PTSD symptoms or decreased OSA severity compared to PTSD or OSA alone in recently deployed Active Duty Service Members (ADSM). Cross-sectional observational study of ADSM who returned from combat within 24 months. Participants underwent an attended diagnostic polysomnogram and were assessed for PTSD, depression, combat exposure severity, sleepiness, and sleep quality with validated clinical instruments. Our study included 109 military personnel who returned from a combat deployment within 24 months with a mean age of 34.3 ± 8.23 and BMI of 30.8 ± 3.99. Twenty-four participants had PTSD/OSA, 68 had OSA, and 17 had PTSD. Mean PTSD Checklist- Military Version (PCL-M) scores were 62.0 ± 8.95, 60.5 ± 4.73, and 32.5 ± 8.95 in PTSD/OSA, PTSD, and OSA, respectively. The mean AHI was 16.9 ± 15.0, 18.9 ± 17.0, and 1.73 ± 1.3 for those with PTSD/OSA, OSA, and PTSD. PTSD symptoms and OSA severity in military personnel with comorbid PTSD/OSA were not significantly different from those with PTSD or OSA alone. On multivariate analysis, BMI was a significant predictor of OSA (OR, 1.21; 95% CI, 1.04-1.44) and age trended towards significance. Depression, but not OSA severity, was associated with PTSD symptoms. Following recent combat exposure, comorbid PTSD/OSA is not associated with increased PTSD symptoms or decreased severity of OSA. Early evaluation after traumatic exposure for comorbid OSA is indicated in PTSD patients with sleep complaints given the high co-occurrence and adverse clinical implications. © 2015 American Academy of Sleep Medicine.

  7. Prader Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population.

    PubMed

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

    2014-04-15

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

  8. 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.

  9. The Benefits of Perioperative Screening for Sleep Apnea in Surgical Patients.

    PubMed

    Subramani, Yamini; Wong, Jean; Nagappa, Mahesh; Chung, Frances

    2017-03-01

    Obstructive sleep apnea (OSA) is a chronic disease affecting millions of people worldwide. Untreated OSA can lead to about a 2-fold increase in medical expenses, mainly because of cardiovascular morbidity. OSA is highly prevalent in the surgical population, with an increased risk of perioperative complications. This article describes the perioperative and long-term social and economic benefits of preoperative screening for OSA. Screening patients to identify high-risk OSA is important to decrease the adverse outcomes and associated health care costs in the perioperative period. Screening for OSA is particularly relevant because most patients are undiagnosed at the time of surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Obstructive Sleep Apnea and Pathological Characteristics of Resected Pancreatic Ductal Adenocarcinoma

    PubMed Central

    Dal Molin, Marco; Brant, Aaron; Blackford, Amanda L.; Griffin, James F.; Shindo, Koji; Barkley, Thomas; Rezaee, Neda; Hruban, Ralph H.; Wolfgang, Christopher L.; Goggins, Michael

    2016-01-01

    Background Prospective studies have identified obstructive sleep apnea (OSA) as a risk factor for increased overall cancer incidence and mortality. The potential role of OSA in the risk or progression of specific cancers is not well known. We hypothesized that pathological differences in pancreatic cancers from OSA cases compared to non-OSA cases would implicate OSA in pancreatic cancer progression. Methods We reviewed the medical records of 1031 patients who underwent surgical resection without neoadjuvant therapy for pancreatic ductal adenocarcinoma (PDAC) at Johns Hopkins Hospital between 2003 and 2014 and compared the TNM classification of their cancer and their overall survival by patient OSA status. Results OSA cases were significantly more likely than non-OSA cases to have lymph node-negative tumors (37.7% vs. 21.8%, p = 0.004). Differences in the prevalence of nodal involvement of OSA vs. non-OSA cases were not associated with differences in other pathological characteristics such as tumor size, tumor location, resection margin status, vascular or perineural invasion, or other comorbidities more common to OSA cases (BMI, smoking, diabetes). A logistic regression model found that a diagnosis of OSA was an independent predictor of lymph node status (hazard ratio, 0.051, p = 0.038). Patients with OSA had similar overall survival compared to those without OSA (HR, 0.89, (0.65–1.24), p = 0.41). Conclusion The observed pathological differences between OSA-associated and non-OSA-associated pancreatic cancers supports the hypothesis that OSA can influence the pathologic features of pancreatic ductal adenocarcinoma. PMID:27732623

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

    PubMed Central

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

    2016-01-01

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

  12. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome.

    PubMed

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

    2013-08-13

    Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. The high dependency of supine position in obstructive sleep apnea.

    PubMed

    Guven, Selma F; Ciftci, Bulent; Lakadamyali, Huseyin; Ciftci, Tansu U

    2013-02-01

    To define the frequency of supine positional obstructive sleep apnea (OSA) in patients diagnosed with OSA and to describe the demographic associations with positional OSA (PO). A retrospective study was performed in a total of 3813 patients who underwent full-night polysomnography at the Sleep Disorders Center of the Ataturk Chest Diseases, Thoracic Surgery Education and Research Hospital, Ankara, Turkey between June 2007 and June 2010. A total of 3214 patients diagnosed with OSA were included in the study. Positional OSA was defined as a total AHI more than or equal to 5, and supine AHI/non-supine AHI more than or equal to 2. Characteristics of positional OSA and non-positional OSA groups were compared statistically. Patients classified as positional OSA composed 39.9% of all OSA patients. Positional OSA patients were younger with lower body mass index and their OSA was less severe. Positional OSA, which may require different treatment approaches, is not uncommon among OSA patients and should be understood as a different clinical entity.

  14. Chronic obstructive sleep apnea accelerates pulmonary remodeling via TGF-β/miR-185/CoLA1 signaling in a canine model.

    PubMed

    Ding, Xue; Yu, Chengyuan; Liu, Yang; Yan, Sen; Li, Wenpeng; Wang, Dingyu; Sun, Li; Han, Yu; Li, Minghui; Zhang, Song; Yun, Fengxiang; Zhao, Hongwei; Li, Yue

    2016-09-06

    Chronic obstructive sleep apnea syndrome (OSAS) is considered to be associated with pulmonary diseases. However, the roles and mechanisms of OSA in pulmonary remodeling remain ambiguous. Thus, this study was aimed to elucidate the morphological and mechanical action of OSA in lung remodeling. In the present study, we employed a novel OSA model to mimic the OSA patient and investigate the role of OSA in pulmonary remodeling. We showed that pulmonary artery pressure of OSA group has no significant increased compared with the sham group. Nevertheless, we found that fibrotic tissue was predominantly located around the bronchi and vascular in the lung. Additionally, inflammatory cell infiltration was also detected in the peribonchial and perivascular space. The morphological change in OSA canines was ascertained by ultrastructure variation characterized by mitochondrial swelling, lamellar bodies degeneration and vascular smooth muscle incrassation. Moreover, sympathetic nerve sprouting was markedly increased in OSA group. Mechanistically, we showed that several pivotal proteins including collagen type I(CoLA1), GAP-43, TH and NGF were highly expressed in OSA groups. Furthermore, we found OSA could activated the expression of TGF-β, which subsequently suppressed miR-185 and promoted CoL A1 expression. This signaling cascade leads to pulmonary remodeling. In conclusion, Our data demonstrates that OSA can accelerate the progression of pulmonary remodeling through TGF-β/miR-185/CoLA1 signaling, which would potentially provide therapeutic strategies for chronic OSAS.

  15. 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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2014-11-01

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

  18. Corrective Jaw Surgery

    MedlinePlus Videos and Cool Tools

    ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  19. Obstructive Sleep Apnea

    MedlinePlus

    ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  20. Obstructive Sleep Apnea: Role in the Risk and Severity of Diabetes

    PubMed Central

    Pamidi, Sushmita; Aronsohn, Renee S.; Tasali, Esra

    2010-01-01

    OSA is a treatable sleep disorder that is pervasive among overweight and obese individuals. Current evidence supports a robust association between OSA and insulin resistance, glucose intolerance and the risk of type 2 diabetes, independent of obesity. Up to 83% of patients with type 2 diabetes suffer from unrecognized OSA and increasing severity of OSA is independently associated with poorer glucose control. Evidence from animal and human models that mimic OSA supports a potential causal role for OSA in altered glucose metabolism. Robust prospective and randomized clinical trials are still needed to test the hypothesis that effective treatment of OSA may prevent the development of type 2 diabetes and its complications, or reduce its severity. Type 2 diabetes is occurring at alarming rates worldwide and despite available treatment options, the economic and public health burden of this epidemic remains enormous. OSA might represent a novel, modifiable risk factor for the development of prediabetes and type 2 diabetes. PMID:21112020

  1. Inflammation in Sleep Apnea: An Update

    PubMed Central

    Unnikrishnan, Dileep; Jun, Jonathan; Polotsky, Vsevolod

    2014-01-01

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

  2. Clinical manifestations of sleep apnea

    PubMed Central

    2015-01-01

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

  3. Clinical, polysomnographic, and CPAP titration features of obstructive sleep apnea: Mixed versus purely obstructive type.

    PubMed

    Lee, Sang-Ahm; Lee, Gha-Hyun; Chung, Yoo-Sam; Kim, Woo Sung

    2015-08-15

    To determine whether obstructive sleep apnea syndrome (OSAS) patients with mixed sleep apnea (MSA) have different clinical, polysomnographic, and continuous positive airway pressure (CPAP) titration findings compared to OSAS patients without MSA. We retrospectively reviewed the records of OSAS patients who had undergone CPAP titration and categorized them into pure-OSA and mixed-OSA groups. Demographic features, daytime sleepiness, and apnea severity were compared between the two groups using univariate and multivariate analyses. CPAP titration findings were also compared between the two groups. One hundred and ninety-five subjects (n=126 pure-OSA; n=69 mixed-OSA) were included in the analysis. Compared to the pure-OSA group, the mixed-OSA group had a higher percentage of males (p=0.003) and a higher body mass index (p=0.044), Epworth Sleepiness Scale score (p=0.028), and apnea-hypopnea index (AHI) (p<0.001). In logistic regression analysis, older age, male sex, and higher body mass index were independently associated with mixed-OSA before PSG study. When using AHI as a covariable, the higher AHI with older age, male sex, and daytime sleepiness was independently related to mixed-OSA. The mixed-OSA group had a higher percentage of patients with complex sleep apnea, a lower percentage of patients with optimal titration, and a higher titrated pressure than the pure-OSA group. Severe OSA, older age, male sex, obesity, and daytime sleepiness were related to mixed-OSA. Complex sleep apnea, less optimal titration, and a higher titrated CPAP were also associated with MSA in OSAS patients. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Prevalence and clinical significance of supine-dependent obstructive sleep apnea in patients using oral appliance therapy.

    PubMed

    Dieltjens, Marijke; Braem, Marc J; Van de Heyning, Paul H; Wouters, Kristien; Vanderveken, Olivier M

    2014-09-15

    The prevalence of supine-dependent obstructive sleep apnea (sdOSA) in a general population ranges from 20% to 60%, depending on the criteria used. Currently, the prevalence and evolution of sdOSA once oral appliance therapy with a mandibular advancement device (OAm) has started is unknown. In addition, literature on the correlation between sdOSA and treatment success with OAm is not unequivocal. The first purpose of this study was to assess the prevalence of sdOSA before and under OAm therapy. Second, the conversion rate from non-sdOSA to sdOSA during OAm therapy was evaluated. The third and final goal was to analyze the correlation between sdOSA and treatment success with OAm therapy in the patient population. Two hundred thirty-seven consecutive patients (age 48 ± 9 years; male/female ratio 173/64; AHI 20.1 ± 14.7 events/h; BMI 27.2 ± 4.3 kg/m(2)) starting OAm therapy were included. The prevalence of sdOSA before the start of OAm therapy, ranged from 27.0% to 67.5%. The prevalence of residual sdOSA under OAm therapy in this study ranged from 17.5% to 33.9%. Second, the conversion rate from non-sdOSA to sdOSA ranged from 23.0% to 37.5%. Third, the presence of sdOSA at baseline was not a significant factor for treatment success with OAm therapy. The results of this study indicate that the prevalence of sdOSA before and under OAm therapy is relatively high. One-third of patients shift from non-sdOSA to sdOSA. Finally, treatment success for OAm therapy was not significantly correlated with the presence of sdOSA at baseline. © 2014 American Academy of Sleep Medicine.

  5. Clinical manifestations of sleep apnea.

    PubMed

    Stansbury, Robert C; Strollo, Patrick J

    2015-09-01

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

  6. Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apnea.

    PubMed

    Bjorvatn, Bjørn; Lehmann, Sverre; Gulati, Shashi; Aurlien, Harald; Pallesen, Ståle; Saxvig, Ingvild W

    2015-12-01

    The objective of the present study was to investigate the prevalence of insomnia and excessive sleepiness in relation to the presence and severity of obstructive sleep apnea (OSA). The sample consisted of patients referred to a university hospital on suspicion of OSA. In total, 1115 patients with mean age of 48 years were studied. Insomnia (Bergen Insomnia Scale) and excessive sleepiness (Epworth Sleepiness Scale) were diagnosed using validated questionnaires. The insomnia scale permits diagnosing insomnia using both old and new (from 2014) criteria. OSA was diagnosed and categorized based on a standard respiratory polygraphic sleep study using a type 3 portable monitor. OSA was diagnosed in 59.4 % of the referred patients. The prevalence of excessive sleepiness was higher with greater severity of OSA: 40.5 % in the patients without OSA (apnea-hypopnea index (AHI) <5), 46.5 % in mild OSA (AHI 5-14.9), 52.0 % in moderate OSA (AHI 15-29.9), and 58.0 % in severe OSA (AHI 30 or above). In contrast, the prevalence of insomnia using the 2014 diagnostic criteria showed an opposing prevalence: 54.2 % no OSA, 54.9 % mild OSA, 48.5 % moderate OSA, and 44.6 % severe OSA. Logistic and linear regression analyses showed that sleepiness was positively associated whereas insomnia was negatively associated with OSA severity and AHI. Both excessive sleepiness and insomnia were seen in high proportions of the patients referred on suspicion of OSA. Excessive sleepiness was higher whereas insomnia was lower with greater OSA severity.

  7. Pediatric Home Sleep Studies: A Prospective Study

    DTIC Science & Technology

    Introduction: Obstructive sleep apnea (OSA) affects 1-5% of pediatric patients. Untreated pediatric OSA is associated with neurocognitive impairment...not always available, and is inconvenient for patients. Therefore, 90% of children undergo adenotonsillectomy without confirmatory diagnostic testing. Home sleep testing for OSA may alleviate these issues.

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

    PubMed

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

    2015-12-01

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

  9. Atrial fibrillation in obstructive sleep apnea

    PubMed Central

    Goyal, Sandeep K; Sharma, Abhishek

    2013-01-01

    Atrial fibrillation (AF) is a common arrhythmia with rising incidence. Obstructive sleep apnea (OSA) is prevalent among patients with AF. This observation has prompted significant research in understanding the relationship between OSA and AF. Multiple studies support a role of OSA in the initiation and progression of AF. This association has been independent of obesity, body mass index and hypertension. Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA. These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period, promoting pulmonary vein discharges and atrial dilation. OSA not only promotes initiation of AF but also makes management of AF difficult. Drug therapy and electrical cardioversion for AF are less successful in presence of OSA. There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA. Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF. However, additional studies are needed to establish a stronger relationship between OSA treatment and success of AF therapies. There should be heightened suspicion of OSA in patients with AF. There is a need for guidelines to screen for OSA as a part of AF management. PMID:23802045

  10. Snoring and obstructive sleep apnea.

    PubMed

    Krug, P

    1999-04-01

    The most common form of sleep apnea is obstructive sleep apnea (OSA). It is characterized by the cessation of nasal airflow with persistence of ventilatory effort, as shown by paradoxical chest and abdominal movement, and varying degrees of oxygen desaturation. This article describes current methods of diagnosing OSA and available treatment for OSA and snoring.

  11. Obstructive sleep apnea in patients with human immunodeficiency virus (HIV) disease.

    PubMed

    Epstein, L J; Strollo, P J; Donegan, R B; Delmar, J; Hendrix, C; Westbrook, P R

    1995-06-01

    Adenotonsillar hypertrophy has been identified as an early manifestation of human immunodeficiency virus (HIV) disease. Three patients with HIV disease were identified with obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy. In order to examine the relationship between HIV-induced adenotonsillar hypertrophy and OSA, 134 patients with asymptomatic HIV disease were screened with a self-administered sleep survey designed to detect OSA and excessive daytime somnolence. Patients meeting trigger score criteria were studied with overnight polysomnography and nine additional patients were identified with OSA. The only consistent risk factor for OSA in this young and primarily nonobese population was the presence of adenotonsillar hypertrophy, found in 11 of 12 patients with OSA. Three patients had tonsillar biopsy or tonsillectomy and all displayed benign follicular lymphoid hyperplasia. Scores on the Epworth Sleepiness Scale (ESS) were significantly higher for patients with OSA, indicating a greater degree of hypersomnolence (mean ESS scores: OSA+ = 11.4 +/- 3.6, OSA- = 7.8 +/- 4.6, p = 0.012). In our population, patients with HIV disease had a prevalence of OSA of 7%. HIV-induced adenotonsillar hypertrophy is a risk factor for the development of OSA. HIV patients with complaints of excessive daytime sleepiness and snoring who are found to have adenotonsillar hypertrophy on exam should undergo a sleep evaluation to rule out the presence of OSA.

  12. Clinical manifestations of pediatric obstructive sleep apnea syndrome: Clinical utility of the Chinese-version Obstructive Sleep Apnea Questionaire-18.

    PubMed

    Huang, Yu-Shu; Hwang, Fang-Ming; Lin, Cheng-Hui; Lee, Li-Ang; Huang, Po-Yu; Chiu, Szu-Tzu

    2015-12-01

    Childhood obstructive sleep apnea syndrome (OSA) affects not only the children's physical health, but also their mental development, behavioral problems and learning difficulties. Therefore, an early diagnosis is important. However, the assessment tools of polysomnography are demanding. The Obstructive Sleep Apnea Questionnaire-18 (OSA-18) is designed to screen OSA and has good reliability and validity. The goal of this study was to validate the Chinese version of the OSA-18, to analyze the frequency of symptoms and find the most common symptoms of OSA in Taiwanese children. We validated the OSA-18 in an ethnic Chinese group and compared the treatment outcomes to show the sensitivity of the questionnaire. The caregivers completed the questionnaire twice at an interval of 4 weeks to test reliability. In the validation study, we included 88 OSA children. The OSA-18 and follow-up polysomnography were performed before and 6 months after adenotonsillectomy. Results showed the excellent test-retest reliability (r = 0.84**) of the OSA-18. There was a statistically significant correlation between the OSA-18 and, respectively, the Apnea-Hypopnea Index (r = 0.29*), and the Hypopnea Index (r = 0.29*). Quality of life showed a significant correlation with the Apnea Index (r = 0.43**), central apnea count (r = 0.50***), and mixed apnea count (r = 0.36*). The cut-off point of the OSA-18 total scores for detecting pediatric OSA in children aged 6-12 years was 66. The common symptoms of pediatric OSA were poor attention span, loud snoring, caregiver worried about child's health, difficulty awakening, and mouth breathing. Our results show that the Chinese version of the OSA-18 is a reliable and valid instrument. The questionnaire also showed improvement in the quality of life of OSA children post-adenotonsillectomy. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

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

    PubMed

    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

    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. 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). Twenty-seven subjects with OSA-on-CPAP (age 49±7years, BMI 43±7 kg/m(2)) and 25 controls without OSA (age 52±9years, BMI 39±4 kg/m(2)) 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. 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.

  14. Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea

    PubMed Central

    Tajudeen, Bobby A.; Brooks, Steven G.; Yan, Carol H.; Kuan, Edward C.; Schwartz, Joseph S.; Suh, Jeffrey D.; Palmer, James N.

    2017-01-01

    Background: There is preliminary evidence that patients with chronic rhinosinusitis (CRS) and comorbid obstructive sleep apnea (OSA) have reduced quality-of-life (QOL) improvements after functional endoscopic sinus surgery (FESS) compared with patients without OSA. The effect of OSA severity on QOL improvement after FESS is unknown. Objectives: To better characterize the QOL improvement after FESS for patients with comorbid OSA and to assess whether QOL improvement is dependent on OSA severity. Methods: This multi-institution, retrospective cohort study evaluated adult patients with CRS who underwent FESS between 2007 and 2015. Preoperative, 1-month, 3-month, 6-month, and 1-year postoperative 22-Item Sino-Nasal Outcome Test scores were used to evaluate QOL. We compared patients without OSA with patients with stratified OSA based on the preoperative apnea-hypopnea index. A multilevel, mixed-effects linear regression model was used for the analysis. Results: Of 480 participants, 83 (17%) had OSA, and 47 of these patients had polysomnography results available for review. Both patients with OSA and patients without OSA reported significant QOL improvement after surgery (p < 0.0001) relative to baseline. In the unadjusted model, the subjects with OSA demonstrated a statistically worse outcome in 22-Item Sino-Nasal Outcome Test scores at each time point (2.4 points higher per time point, p = 0.006). When controlling for covariates, the adjusted model showed no difference in QOL outcome based on OSA status (p = 0.114). When stratified by OSA disease severity, the adjusted model showed no difference in the QOL outcome. Conclusions: Patients with CRS and comorbid OSA had worse QOL outcomes after FESS; however, when controlling for patient factors, there was no difference in QOL outcome. OSA disease severity did not seem to predict QOL improvement after FESS. PMID:28381324

  15. 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

  16. 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

  17. Obstructive Sleep Apnea and Atherosclerosis.

    PubMed

    Amin, Zulkifli; Amin, Hilman Z; Amin, Lukman Z

    2016-01-01

    Obstructive sleep apnea (OSA) is a sleep respiratory disorder characterized by recurrent episodes of complete or partial airway obstruction, resulting in apneas or hypopneas. OSA could contribute to atherosclerosis through direct and indirect mechanisms. Endothelial dysfunction, sympathetic stimulation, and proinflammatory cytokine modulation caused by OSA play significant role to an atherosclesrotic event. Other risk factors of atherosclerosis like hypertension and diabetes mellitus also associated with OSA. Animal and clinical studies recently showed promising data to prove association between OSA, atherosclerosis, and its risk factors. However, provided data has not showed consistent result. In the future, demand of further research both basic and clinical sciences need to be fulfilled.

  18. Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report.

    PubMed

    Ferraz, Otávio; Guimarães, Thais M; Rossi, Rowdley R; Cunali, Paulo A; Fabbro, Cibele Dal; Chaves, Cauby M; Maluly, Milton; Bittencourt, Lia; Tufik, Sergio

    2016-01-01

    Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).

  19. Sleep Endoscopy in the Evaluation of Pediatric Obstructive Sleep Apnea

    PubMed Central

    Lin, Aaron C.; Koltai, Peter J.

    2012-01-01

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

  20. Obstructive sleep apnoea in children: perioperative considerations.

    PubMed

    Patino, M; Sadhasivam, S; Mahmoud, M

    2013-12-01

    Obstructive sleep apnoea (OSA) has become a major public health concern as its incidence and severity have increased in tandem with the obesity epidemic. In children, OSA is now recognized as a common disorder and can be associated with significant morbidity. OSA belongs to a spectrum of diagnoses known as sleep-related breathing disorders in which the airway is completely (apnoea) or partially (hypopnoea) occluded during sleep despite continued respiratory efforts. This airway obstruction can cause abnormal gas exchange leading to hypoxaemia, hypercapnia, sleep fragmentation, and their attendant physiological and behavioural consequences. The degrees of hypercapnia, hypoxaemia, and upper airway airflow reduction are the primary factors determining the severity of OSA. In young children, adenotonsillar hypertrophy is the most common anatomical abnormality associated with OSA, and adenotonsillectomy is, therefore, the most common surgical intervention. Perioperative complications associated with adenotonsillectomy are more common in children with severe OSA. A thorough understanding of the pathophysiology of OSA, careful and complete preoperative assessment, meticulous intraoperative and postoperative management, and early recognition of potential perioperative complications are essential to optimization of outcomes. The safe anaesthetic management of a child with OSA requires an anaesthetic technique tailored to the underlying aetiology and severity of OSA and the surgical procedure. This review focuses on the epidemiology, pathogenesis, and diagnosis of OSA, and the state-of-the-art and future directions in the perioperative management of children with OSA.

  1. Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke.

    PubMed

    Stahl, Stephanie M; Yaggi, H Klar; Taylor, Stanley; Qin, Li; Ivan, Cristina S; Austin, Charles; Ferguson, Jared; Radulescu, Radu; Tobias, Lauren; Sico, Jason; Vaz Fragoso, Carlos A; Williams, Linda S; Lampert, Rachel; Miech, Edward J; Matthias, Marianne S; Kapoor, John; Bravata, Dawn M

    2015-10-01

    The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients. Published by Elsevier B.V.

  2. Self-control predicts attentional bias assessed by online shopping-related Stroop in high online shopping addiction tendency college students.

    PubMed

    Jiang, Zhaocai; Zhao, Xiuxin; Li, Cancan

    2017-05-01

    The aim of this study was to examine the relationships of personality types (i.e., self-control, BAS/BIS) and online shopping addiction (OSA) behavior and to investigate whether high-OSA tendency individuals display attentional biases toward online shopping-related (OS-related) stimuli as well as the links between attentional bias and personality types. The study included 98 college students divided into three groups (i.e., high-, medium- and low-OSA) according to their OSA behavior. The personality types (i.e., self-control, BAS/BIS) and OSA behavior were investigated by questionnaires. The attentional bias was evaluated by the OS-related Stroop and dot-probe task (DPT) paradigms. OSA was positively predicted by time spent on online shopping per day and average consumption for online shopping monthly, and negatively by self-control. High-OSA individuals displayed significant attentional biases toward OS-related stimuli in the Stroop, but not DPT paradigm. Moreover, the attentional bias toward OSA-related stimuli in high-OSA individuals was negatively correlated with self-control. These findings demonstrated the critical role of self-control in OSA behavior and attentional bias to OS-related stimuli in high-OSA individuals, indicating that more importance should be attached to self-control for the clinical intervention of online shopping addiction in future studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Assessment of the calcification of the nuchal ligament and osteophytes of the cervical spine in obstructive sleep apnoea subjects and snorers.

    PubMed

    Ando, E; Shigeta, Y; Nejima, J; Yamanaka, H; Hirai, S; Ogawa, T; Clark, G T; Enciso, R

    2016-02-01

    The previous reports suggest that obstructive sleep apnoea (OSA) is related to metabolic syndrome, mineral metabolism disorders and cardiovascular disease. In addition, a possible relationship between obesity and the calcification of ligaments has been implied. However, the potential link between OSA and the calcification of ligaments has not been directly studied. In this present study, to investigate the potential link between OSA and the calcification of ligaments, we examined the prevalence of the calcification of ligaments in OSA patients and the relationship between these findings and OSA severity. Eighty consecutive patients (60 males, 20 females) diagnosed as OSA or a heavy snorer based on full-night polyso-mnography were retrospectively recruited from May 2006 to July 2008. Each patient underwent cephalometric imaging examination before the arrangement of an oral appliance. One calibrated observer (YS) reviewed the cephalometric images for the presence of calcification of the nuchal ligament and osteophytes of the cervical spine. The prevalence of calcification of the nuchal ligament in OSA patients and snorers was 46.3% (males: 52%, females: 30%) There was a significant positive correlation between the severity of OSA (AHI) and the calcification of the nuchal ligament before and after adjusting for BMI. The prevalence of the calcification of the nuchal ligament in OSA subjects and snorers was higher than in previous studies with non-OSA subjects. In addition, it is suggested that the severity of OSA correlates with the presence of calcification of the nuchal ligament.

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

    PubMed Central

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

    2015-01-01

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

  5. Association of PPARγ2 (Pro12Ala) and neuropeptide Y (Leu7Pro) gene polymorphisms with obstructive sleep apnea in obese Asian Indians.

    PubMed

    Bhushan, Bharat; Guleria, Randeep; Misra, Anoop; Luthra, Kalpana; Kumar, Guresh

    2011-01-01

    Obstructive sleep apnea (OSA) is prevalent in 7.5% in urban Asian Indians. Peroxisome proliferator activated receptor gamma2 (PPARγ2) has been implicated in adipocyte differentiation. Neuropeptide Y (NPY) is also considered as a candidate gene for excess body fat accumulation. The association of PPARγ2 (Pro12Ala)} and NPY (Leu7Pro) gene polymorphisms with OSA has not been studied in Asian Indians. To study the distribution of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) polymorphism in Asian Indians with and without OSA. This study was carried out in 252 obese subjects [(body mass index (BMI > 25 kg/m2]; 142 with OSA and 110 without OSA. Measurements included anthropometric and biochemical parameters (fasting blood glucose, lipid profile, various circumferences and skin-fold thicknesses). PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene} polymorphisms were studied in all subjects. The frequency of the variant allele (Ala12) of PPARγ2 gene was significantly higher in subjects with OSA (14.4%) when compared with subjects without OSA (5.5%; χ2= 9.7; p = 0.001). The distribution of the variant allele (Pro7) of NPY gene was comparable in subjects with OSA (3.5%) and without OSA (3.6%; χ2= 0.001, p = 0.94). This study reveals a significantly higher frequency of PPARγ2 (Ala12) allele in obese Asian Indians with OSA when compared to obese Asian Indians without OSA.

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  7. An Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults.

    PubMed

    Chowdhuri, Susmita; Quan, Stuart F; Almeida, Fernanda; Ayappa, Indu; Batool-Anwar, Salma; Budhiraja, Rohit; Cruse, Peggy E; Drager, Luciano F; Griss, Barbara; Marshall, Nathaniel; Patel, Sanjay R; Patil, Susheel; Knight, Shandra L; Rowley, James A; Slyman, Alison

    2016-05-01

    Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults; however, whether mild OSA has significant neurocognitive and cardiovascular complications is uncertain. The specific goals of this Research Statement are to appraise the evidence regarding whether long-term adverse neurocognitive and cardiovascular outcomes are attributable to mild OSA in adults, evaluate whether or not treatment of mild OSA is effective at preventing or reducing these adverse neurocognitive and cardiovascular outcomes, delineate the key research gaps, and provide direction for future research agendas. Literature searches from multiple reference databases were performed using medical subject headings and text words for OSA in adults as well as by hand searches. Pragmatic systematic reviews of the relevant body of evidence were performed. Studies were incongruent in their definitions of "mild" OSA. Data were inconsistent regarding the relationship between mild OSA and daytime sleepiness. However, treatment of mild OSA may improve sleepiness in patients who are sleepy at baseline and improve quality of life. There is limited or inconsistent evidence pertaining to the impact of therapy of mild OSA on neurocognition, mood, vehicle accidents, cardiovascular events, stroke, and arrhythmias. There is evidence that treatment of mild OSA in individuals who demonstrate subjective sleepiness may be beneficial. Treatment may also improve quality of life. Future research agendas should focus on clarifying the effect of mild OSA and impact of effective treatment on other neurocognitive and cardiovascular endpoints as detailed in the document.

  8. Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature.

    PubMed

    Helvaci, Nafiye; Karabulut, Erdem; Demir, Ahmet Ugur; Yildiz, Bulent Okan

    2017-10-01

    Polycystic ovary syndrome (PCOS) has been reported to be associated with the development of obstructive sleep apnea (OSA). The objective of this meta-analysis is to assess the relationship between PCOS and OSA. A literature search was conducted to identify studies linking PCOS with the risk of OSA. Studies in which the presence of OSA was confirmed with overnight polysomnography were included. Random effects models were used to calculate pooled relative risks. Eight studies conducted in adults and five studies conducted in adolescents were identified. The pooled OSA prevalence was 0.22 (95% confidence interval (CI): 0.08-0.40) in PCOS patients. The pooled prevalence of OSA was higher in adults (0.32, 95% CI: 0.13-0.55) than adolescents (0.08, 95% CI: 0.00-0.30). Risk of OSA was significantly increased in adult patients with PCOS (odds ratio (OR) 9.74, 95% CI: 2.76-34.41). Risk of OSA was not significantly increased in adolescents (OR: 4.54, 95% CI:0.56-36.43). These findings demonstrate a significant association between PCOS and OSA in adult patients. Considering the increased risk for long-term cardiometabolic disorders associated with both PCOS and OSA, it is important to diagnose and treat OSA in patients with PCOS. © 2017 The authors.

  9. Neurocognitive dysfunction and grey matter density deficit in children with obstructive sleep apnoea.

    PubMed

    Chan, K C; Shi, L; So, H K; Wang, D; Liew, A W C; Rasalkar, D D; Chu, C W; Wing, Y K; Li, A M

    2014-09-01

    Cerebral structural changes related to obstructive sleep apnoea (OSA) have been reported in adult OSA patients; however, similar data and their associations with neurocognitive dysfunction are scarce in childhood OSA. To compare neurocognitive function, regional grey matter density and cerebral volume in children with and without OSA. Fifty OSA cases and 27 normal controls underwent a panel of neurocognitive tests. High resolution 3-dimensional magnetic resonance images of the brain were obtained from 23 OSA cases and 15 gender and age matched controls. Total cerebral volume and regional grey matter density were analyzed using voxel-based morphometry technique and compared between the two groups. Individuals with an obstructive apnoea hypopnoea index (OAHI) > 5 were defined as having moderate-to-severe OSA. Children with OSA showed significantly reduced attention and visual-fine motor coordination scores compared with controls. Grey matter volume deficit was observed in prefrontal and temporal regions of cases with moderate-to-severe OSA only. Significant negative correlations were found between the visual-fine motor coordination score and the ratio of grey matter volume over total brain volume. Children with OSA had impaired attention and visual-fine motor coordination. Regional grey matter reduction was evident in children with more severe OSA. Copyright © 2014 Elsevier B.V. All rights reserved.

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

    PubMed

    Lurie, Alain

    2011-01-01

    The relationship between metabolic disorders and obstructive sleep apnea (OSA) is multidirectional. Obesity is recognized as the strongest risk factor for OSA. It is unknown whether metabolic syndrome and insulin resistance/type 2 diabetes mellitus contribute to the development or aggravation of OSA, although this is likely. Conversely, OSA may be a risk factor for metabolic disorders. Strong evidence suggests that OSA may increase the risk of developing insulin resistance, glucose intolerance and type 2 diabetes mellitus. OSA has also been associated with the development and/or aggravation of obesity, dyslipidemia, metabolic syndrome and nonalcoholic fatty liver disease - a liver manifestation of metabolic syndrome. In addition, metabolic disorders are confounding factors in OSA. Metabolic disorders and OSA share common intermediate pathogenic pathways, including alterations in autonomic nervous system regulation, increased inflammatory activity, and alterations in adipokine levels and endothelial dysfunction, which may be involved in the interplay between these conditions. Overall, this complexity makes it especially difficult to reveal and understand the links between OSA and metabolic and cardiovascular disorders. The International Diabetes Federation has recently published clinical practice recommendations suggesting that OSA patients should be routinely screened for markers of metabolic disturbance and cardiovascular risk, such as waist circumference, blood pressure, and fasting lipid and glucose levels. It also recommends that the possibility of OSA should be considered in the assessment of all patients with type 2 diabetes mellitus and metabolic syndrome. Copyright © 2011 S. Karger AG, Basel.

  11. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms.

    PubMed

    Arnardottir, Erna S; Bjornsdottir, Erla; Olafsdottir, Kristin A; Benediktsdottir, Bryndis; Gislason, Thorarinn

    2016-01-01

    The aim was to assess the prevalence of obstructive sleep apnoea (OSA) as defined by an apnoea-hypopnea index (AHI) ≥15 in the middle-aged general population, and the interrelationship between OSA, sleep-related symptoms, sleepiness and vigilance.A general population sample of 40-65-year-old Icelanders was invited to participate in a study protocol that included a type 3 sleep study, questionnaire and a psychomotor vigilance test (PVT).Among the 415 subjects included in the study, 56.9% had no OSA (AHI <5), 24.1% had mild OSA (AHI 5-14.9), 12.5% had moderate OSA (AHI 15-29.9), 2.9% had severe OSA (AHI ≥30) and 3.6% were already diagnosed and receiving OSA treatment. However, no significant relationship was found between AHI and subjective sleepiness or clinical symptoms. A relationship with objective vigilance assessed by PVT was only found for those with AHI ≥30. Subjects already on OSA treatment and those accepting OSA treatment after participating in the study were more symptomatic and sleepier than others with similar OSA severity, as assessed by the AHI.In a middle-aged general population, approximately one in five subjects had moderate-to-severe OSA, but the majority of them were neither symptomatic nor sleepy and did not have impaired vigilance.

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

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

    PubMed

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

    2016-01-01

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

  14. Epidemiological aspects of obstructive sleep apnea.

    PubMed

    Garvey, John F; Pengo, Martino F; Drakatos, Panagis; Kent, Brian D

    2015-05-01

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

  15. An Integrative Model of Physiological Traits Can be Used to Predict Obstructive Sleep Apnea and Response to Non Positive Airway Pressure Therapy

    PubMed Central

    Owens, Robert L.; Edwards, Bradley A.; Eckert, Danny J.; Jordan, Amy S.; Sands, Scott A.; Malhotra, Atul; White, David P.; Loring, Stephen H.; Butler, James P.; Wellman, Andrew

    2015-01-01

    Study Objectives: Both anatomical and nonanatomical traits are important in obstructive sleep apnea (OSA) pathogenesis. We have previously described a model combining these traits, but have not determined its diagnostic accuracy to predict OSA. A valid model, and knowledge of the published effect sizes of trait manipulation, would also allow us to predict the number of patients with OSA who might be effectively treated without using positive airway pressure (PAP). Design, Participants and Intervention: Fifty-seven subjects with and without OSA underwent standard clinical and research sleep studies to measure OSA severity and the physiological traits important for OSA pathogenesis, respectively. The traits were incorporated into a physiological model to predict OSA. The model validity was determined by comparing the model prediction of OSA to the clinical diagnosis of OSA. The effect of various trait manipulations was then simulated to predict the proportion of patients treated by each intervention. Measurements and Results: The model had good sensitivity (80%) and specificity (100%) for predicting OSA. A single intervention on one trait would be predicted to treat OSA in approximately one quarter of all patients. Combination therapy with two interventions was predicted to treat OSA in ∼50% of patients. Conclusions: An integrative model of physiological traits can be used to predict population-wide and individual responses to non-PAP therapy. Many patients with OSA would be expected to be treated based on known trait manipulations, making a strong case for the importance of non-anatomical traits in OSA pathogenesis and the effectiveness of non-PAP therapies. Citation: Owens RL, Edwards BA, Eckert DJ, Jordan AS, Sands SA, Malhotra A, White DP, Loring SH, Butler JP, Wellman A. An integrative model of physiological traits can be used to predict obstructive sleep apnea and response to non positive airway pressure therapy. SLEEP 2015;38(6):961–970. PMID:25515107

  16. High Prevalence of Obstructive Sleep Apnea and Its Association with Renal Function among Nondialysis Chronic Kidney Disease Patients in Japan: A Cross-Sectional Study

    PubMed Central

    Shoji, Tatsuya; Kawabata, Hiroaki; Niihata, Kakuya; Suzuki, Akira; Kaneko, Tetsuya; Okada, Noriyuki; Isaka, Yoshitaka; Rakugi, Hiromi; Tsubakihara, Yoshiharu

    2011-01-01

    Summary Background and objectives Obstructive sleep apnea (OSA) affects one of five adults in the general population. Although a high prevalence of OSA has been reported among dialysis patients, the association between nondialysis chronic kidney disease (CKD) and OSA has not been fully investigated. This cross-sectional study aimed to investigate the prevalence of OSA among nondialysis CKD patients in Japan and the association between renal function and OSA. Design, setting, participants, & measurements Consecutive nondialysis CKD patients hospitalized mainly for CKD educational program, regardless of their sleep complaints, were enrolled. The diagnosis of OSA and its severity were measured using a type 3 portable monitor. Results Overall (n = 100, 68.0% male, median age 66.5 years, body mass index [BMI] 23.1 kg/m2, estimated GFR [eGFR] 28.5 ml/min per 1.73 m2), 65% were diagnosed as OSA: mild OSA (apnea-hypopnea index [AHI] 5.0 to 14.9) in 32%, moderate OSA (AHI 15.0 to 29.9) in 25%, and severe OSA (AHI ≥ 30.0) in 8%. Multivariate logistic regression analysis revealed that a 10-ml/min per 1.73 m2 decrease in eGFR was associated with a 42% increased odds of OSA after adjustment for age, BMI, and diabetes mellitus. Moreover, in a generalized linear model, eGFR was inversely correlated with AHI after adjustment for covariates. Conclusions This study demonstrated a high prevalence of OSA among nondialysis CKD patients in Japan and that the increased risk of OSA was significantly associated with decreased GFR among these patients. Further investigations are warranted to determine OSA's direct influence on cardiovascular disease. PMID:21415314

  17. Prevalence and correlates of obstructive sleep apnea among patients with and without HIV infection

    PubMed Central

    KUNISAKI, Ken M.; AKGÜN, Kathleen M.; FIELLIN, David A.; GIBERT, Cynthia L.; KIM, Joon W.; RIMLAND, David; RODRIGUEZ-BARRADAS, Maria C.; YAGGI, H. Klar; CROTHERS, Kristina

    2014-01-01

    Objectives In HIV-uninfected populations, obstructive sleep apnea (OSA) is commonly associated with cardiovascular disease, metabolic syndrome, and cognitive impairment. These comorbidities are common in HIV-infected patients, but there are scarce data regarding OSA in HIV-infected patients. Therefore, we examined the prevalence and correlates of OSA in a cohort of HIV-infected and uninfected patients. Design Observational cohort study. Methods Electronic medical record and self-report data were examined in patients enrolled in the Veterans Aging Cohort Study (VACS) between 2002-2008 and followed through 2010. The primary outcome was OSA diagnosis, determined using ICD-9 codes, in HIV-infected compared with uninfected. We used regression analyses to determine the association between OSA diagnosis, symptoms and comorbidities in adjusted models. Results Of 3,683 HIV-infected and 3,641 uninfected patients, 143 (3.9%) and 453 (12.4%) had a diagnosis of OSA (p<0.0001), respectively. HIV-infected patients were more likely to report symptoms associated with sleep and OSA such as tiredness and fatigue. Compared with uninfected patients with OSA, HIV-infected patients with OSA were younger, had lower BMIs, and were less likely to have hypertension. In models adjusting for these traditional OSA risk factors, HIV infection was associated with markedly reduced odds of OSA diagnosis (odds ratio=0.48; 95% confidence interval 0.39—0.60). Conclusions HIV-infected patients are less likely to receive a diagnosis of OSA. Future studies are needed to determine whether the lower prevalence of OSA diagnoses in HIV-infected patients is due to decreased screening and detection or due to a truly decreased likelihood of OSA in the setting of HIV. PMID:25230851

  18. Blunted heart rate recovery is improved following exercise training in overweight adults with obstructive sleep apnea.

    PubMed

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

    2013-08-20

    Obstructive sleep apnea (OSA) predisposes individuals to cardiovascular morbidity, and cardiopulmonary exercise test (CPET) markers prognostic for cardiovascular disease have been found to be abnormal in adults with OSA. Due to the persistence of OSA and its cardiovascular consequences, whether the cardiovascular adaptations normally conferred by exercise are blunted in adults not utilizing established OSA treatment is unknown. The aims of this study were to document whether OSA participants have abnormal CPET responses and determine whether exercise modifies these CPET markers in individuals with OSA. The CPET responses of 43 sedentary, overweight adults (body mass index [BMI]>25) with untreated OSA (apnea-hypopnea index [AHI]≥ 15) were compared against matched non-OSA controls (n=9). OSA participants were then randomized to a 12-week exercise training (n=27) or stretching control treatment (n=16), followed by a post-intervention CPET. Measures of resting, exercise, and post-exercise recovery heart rate (HRR), blood pressure, and ventilation, as well as peak oxygen consumption (VO(2peak)), were obtained. OSA participants had blunted HRR compared to non-OSA controls at 1 (P=.03), 3 (P=.02), and 5-min post-exercise (P=.03). For OSA participants, exercise training improved VO2 peak (P=.04) and HRR at 1 (P=.03), 3 (P<.01), and 5-min post-exercise (P<.001) compared to control. AHI change was associated with change in HRR at 5-min post-exercise (r=-.30, P<.05), but no other CPET markers. These results suggest that individuals with OSA have autonomic dysfunction, and that exercise training, by increasing HRR and VO2 peak, may attenuate autonomic imbalance and improve functional capacity independent of OSA severity reduction. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. The prevalence of REM-related obstructive sleep apnoea is reduced by the AASM 2012 hypopnoea criteria.

    PubMed

    Duce, Brett; Kulkas, Antti; Langton, Christian; Töyräs, Juha; Hukins, Craig

    2017-06-09

    The variations in reported prevalence of rapid eye movement-related obstructive sleep apnoea (REM-OSA) have been attributed to different definitions, although the effect of hypopnoea criteria has not been previously investigated. Within this retrospective study, 134 of 382 consecutive patients undertaking polysomnography (PSG) for the suspicion of OSA met the inclusion criteria. PSGs were scored using both the 2007 AASM recommended hypopnoea criteria (AASM2007Rec) and the 2012 AASM recommended hypopnoea criteria (AASM2012Rec). For each hypopnoea criteria, REM-OSA patients were grouped as REM-related [either as REM-predominant OSA (rpOSA) or REM-isolated OSA (riOSA)] or non-stage-specific OSA (nssOSA). Outcome measures (SF-36, FOSQ and DASS-21) were also compared between groups. Incorporation of the AASM2012Rec criteria compared to the AASM2007Rec criteria increased the apnoea-hypopnoea index (AHI) for NREM and REM sleep but decreased the AHIREM/AHINREM ratio from 1.9 to 1.3 (p < 0.001). It also decreased the prevalence of riOSA [15.7 vs 2.2% (p < 0.001) for AASM2007Rec and AASM2012Rec, respectively]. The prevalence of rpOSA remained the same for each hypopnoea criteria although the prevalence of nssOSA increased with the AASM2012Rec hypopnoea criteria [53.0 vs 66.4% (p < 0.006) for AASM2007Rec and AASM2012Rec, respectively]. There were no differences in clinical symptoms between the groups, irrespective of hypopnoea criteria used. This study demonstrates that in comparison with AASM2007Rec, the AASM2012Rec hypopnoea criteria reduce the prevalence of riOSA but not rpOSA by reducing the ratio of REM respiratory events and NREM respiratory events.

  20. Quality of life after adenotonsillectomy for children with sleep-disordered breathing: a linear mixed model analysis.

    PubMed

    Lee, Chia-Hsuan; Kang, Kun-Tai; Weng, Wen-Chin; Lee, Pei-Lin; Hsu, Wei-Chung

    2014-08-01

    To study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity. Children aged 2-18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI < 1), mild obstructive sleep apnea (OSA) (5 > AHI ≥ 1), and moderate-to-severe OSA (AHI ≥ 5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model. In total, 144 children were enrolled (mean age, 7.0 ± 3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥ 6 years vs. < 6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P = 0.004; mild OSA vs. moderate-to-severe OSA, P = 0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring. Children with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Obstructive sleep apnea is an important predictor of hepatic fibrosis in patients with nonalcoholic fatty liver disease in a tertiary care center.

    PubMed

    Agrawal, Swastik; Duseja, Ajay; Aggarwal, Ashutosh; Das, Ashim; Mehta, Manu; Dhiman, Radha K; Chawla, Yogesh

    2015-04-01

    The association of obstructive sleep apnea (OSA) with nonalcoholic fatty liver disease (NAFLD) has only been studied in selected subgroups such as the morbidly obese. We aimed to determine the prevalence and effect of OSA on NAFLD and vice versa in unselected patients attending the outpatient department. OSA was diagnosed by polysomnography, done in patients having symptoms of OSA, in patients with NAFLD attending the liver clinic. Polysomnography-proven patients with OSA attending the chest clinic were evaluated for NAFLD by ultrasonography. Anthropometry, liver function tests, metabolic syndrome evaluation and transient elastography were performed in all patients. Three (3%; 95% CI 1.03-8.45%) out of 100 patients with NAFLD (mean age 41 ± 11 years) had symptomatic OSA. Of 23 patients with OSA (mean age 46 ± 12 years,), 3 (13%) had mild, 5 (22%) moderate and 15 (65%) severe OSA. Twenty-one (91.3%; 95% CI 73.2-97.6%) patients with OSA had NAFLD, while raised hepatic transaminase levels were seen in seven (30.4%; 95% CI 15.6-50.9%). Body mass index (OR 1.21, 95% CI 1.02-1.44) and male gender (OR 4.79, 95% CI 1.12-20.48) were significant independent predictors of OSA in NAFLD. The apnea-hypopnea index (OR 1.084, 95% CI 1.002-1.172), a marker of OSA severity, was the only significant independent predictor of significant fibrosis in patients with NAFLD. Prevalence of symptomatic OSA in patients with NAFLD is low and is predicted by male gender and obesity. Prevalence of NAFLD in patients with OSA is very high. Significant hepatic fibrosis in patients with NAFLD is predicted by OSA independent of obesity and metabolic syndrome.

  2. Obstructive sleep apnea with excessive daytime sleepiness is associated with non-alcoholic fatty liver disease regardless of visceral fat.

    PubMed

    Yu, Ji Hee; Ahn, Jae Hee; Yoo, Hye Jin; Seo, Ji A; Kim, Sin Gon; Choi, Kyung Mook; Baik, Sei Hyun; Choi, Dong Seop; Shin, Chol; Kim, Nan Hee

    2015-11-01

    Obstructive sleep apnea (OSA) is associated with an increased risk of obesity and non-alcoholic fatty liver disease (NAFLD), but it remains unclear whether the risk of NAFLD is independently related to OSA regardless of visceral obesity. Thus, the aim of the present study was to examine whether OSA alone or in combination with excessive daytime sleepiness (EDS) or short sleep duration was associated with NAFLD independent of visceral fat in Korean adults. A total of 621 participants were selected from the Korean Genome and Epidemiology Study (KoGES). The abdominal visceral fat area (VFA) and hepatic fat components of the participants were assessed using computed tomography scans and they were then categorized into four groups depending on the presence of OSA and EDS. The proportions of NAFLD were 21.1%, 18.5%, 32.4%, and 46.7% in participants without OSA/EDS, with only EDS, with only OSA, and with both OSA and EDS, respectively. A combination of OSA and EDS increased the odds ratio (OR) for developing NAFLD (OR, 2.75; 95% confidence interval [CI], 1.21 to 6.28) compared to those without OSA/EDS, and this association remained significant (OR, 2.38; 95% CI, 1.01 to 5.59) even after adjusting for VFA. In short sleepers (< 5 hours) with OSA, the adjusted OR for NAFLD was 2.50 (95% CI, 1.08 to 5.75) compared to those sleeping longer than 5 hours without OSA. In the present study, OSA was closely associated with NAFLD in Korean adults. This association was particularly strong in those with EDS or short sleep duration regardless of VFA.

  3. Obesity and obstructive sleep apnea.

    PubMed

    Gami, Apoor S; Caples, Sean M; Somers, Virend K

    2003-12-01

    There is a very high prevalence of OSA in obese individuals and a high prevalence of obesity in patients with OSA. The pathophysiology of OSA is intimately linked to obesity. Anatomic and functional considerations of the pharyngeal airway, the CNS, central obesity, and leptin likely interact in the development of OSA in obese individuals. OSA may itself predispose individuals to worsening obesity because of sleep deprivation, daytime somnolence, and disrupted metabolism. The diagnosis of OSA requires the clinician's awareness of its potential to cause a spectrum of acute and chronic neurocognitive, psychiatric, and nonspecific symptoms in patients who may be unaware that their sleep is disturbed. Symptoms and examination findings help predict which obese individuals have OSA, and polysomnography is the gold standard by which to make the diagnosis and assess the effects of treatment. Numerous disease states are associated with both OSA and obesity, and it is becoming clear that the relationships are mediated by complex interrelated mechanisms. Common diseases and disease mechanisms in OSA and obesity suggest that conditions related to obesity may be better managed if patients, particularly those who are morbidly obese, are evaluated and treated for previously undiagnosed OSA. OSA is cured in only specific cases with craniofacial or upper airway surgery, and the general application of UVP is not efficacious. OSA also can be cured with sufficient lifestyle-mediated or surgical weight loss; however, in the absence of long-term weight maintenance, OSA returns with weight gain. Although not curative, nasal CPAP is the initial treatment of choice for most patients because of its noninvasive approach and technical efficacy. It is limited, however, by patient acceptance and long-term compliance. Advances in mask comfort and use of humidified air should increase its acceptance. Future management strategies include newer generations of positive airway devices that

  4. Obstructive Sleep Apnea and Lipid Abnormalities

    PubMed Central

    Karkinski, Dimitar; Georgievski, Oliver; Dzekova-Vidimliski, Pavlina; Milenkovic, Tatjana; Dokic, Dejan

    2017-01-01

    BACKGROUND: There has been a great interest in the interaction between obstructive sleep apnea (OSA) and metabolic dysfunction, but there is no consistent data suggesting that OSA is a risk factor for dyslipidemia. AIM: The aim of this cross-sectional study was to evaluate the prevalence of lipid abnormalities in patients suspected of OSA, referred to our sleep laboratory for polysomnography. MATERIAL AND METHODS: Two hundred patients referred to our hospital with suspected OSA, and all of them underwent for standard polysomnography. All patients with respiratory disturbance index (RDI) above 15 were diagnosed with OSA. In the morning after 12 hours fasting, the blood sample was collected from all patients. Blood levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL), were determined in all study patients. In the study, both OSA positive and OSA negative patients were divided according to the body mass index (BMI) in two groups. The first group with BMI ≤ 30 kg/m^2 and the second group with BMI > 30 kg/m^2. RESULTS: OSA positive patients with BMI ≤ 30 kg/m^2 had statistically significant higher levels of triglycerides and total cholesterol, and statistically significant lower level of HDL compared to OSA negative patients with BMI ≤ 30. There were no statistically significant differences in age and LDL levels between these groups. OSA positive patients with BMI > 30 kg/m^2 had higher levels of triglycerides, total cholesterol and LDL and lower levels of HDL versus OSA negative patients with BMI > 30 kg/m^2, but without statistically significant differences. CONCLUSION: OSA and obesity are potent risk factors for dyslipidemias. OSA could play a significant role in worsening of lipid metabolism in non-obese patients. But in obese patients, the extra weight makes the metabolic changes of lipid metabolism, and the role of OSA is not that very important like in non-obese patients. PMID

  5. Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study.

    PubMed

    Sánchez-de-la-Torre, Alicia; Soler, Xavier; Barbé, Ferran; Florés, Marina; Maisel, Alan; Malhotra, Atul; Rue, Montserrat; Bertran, Sandra; Aldomá, Albina; Worner, Fernando; Valls, Joan; Lee, Chi-Hang; Turino, Cecilia; Galera, Estefanía; de Batlle, Jordi; Sánchez-de-la-Torre, Manuel

    2017-07-20

    An analysis of cardiac injury markers in patients with OSA who sustain an episode of acute coronary syndrome (ACS) may contribute to a better understanding of the interactions and impact of OSA in subjects with ACS. We compared peak cardiac troponin I (cTnI) levels in patients with OSA and patients without OSA who were admitted for ACS. Blood samples were collected every 6 hours from the time of admission until two consecutive assays showed a downward trend in the cTnI assay. The highest value obtained defined the peak cTnI value, which provides an estimate of infarct size. We included 89 patients with OSA and 38 patients without OSA with an apnea-hypopnea index of a median of 32 (interquartile range [IQR], 20.8-46.6/h and 4.8 [IQR, 1.6-9.6]/h, respectively. The peak cTnI value was significantly higher in patients without OSA than in patients with OSA (median, 10.7 ng/mL [IQR, 1.78-40.1 ng/mL] vs 3.79 ng/mL [IQR, 0.37-24.3 ng/mL]; P = .04). The multivariable linear regression analysis of the relationship between peak cTnI value and patient group, age, sex, and type of ACS showed that the presence or absence of OSA significantly contributed to the peak cTnI level, which was 54% lower in patients with OSA than in those without OSA. The results of this study suggest that OSA has a protective effect in the context of myocardial infarction and that patients with OSA may experience less severe myocardial injury. The possible role of OSA in cardioprotection should be explored in future studies. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  6. An Integrative Model of Physiological Traits Can be Used to Predict Obstructive Sleep Apnea and Response to Non Positive Airway Pressure Therapy.

    PubMed

    Owens, Robert L; Edwards, Bradley A; Eckert, Danny J; Jordan, Amy S; Sands, Scott A; Malhotra, Atul; White, David P; Loring, Stephen H; Butler, James P; Wellman, Andrew

    2015-06-01

    Both anatomical and nonanatomical traits are important in obstructive sleep apnea (OSA) pathogenesis. We have previously described a model combining these traits, but have not determined its diagnostic accuracy to predict OSA. A valid model, and knowledge of the published effect sizes of trait manipulation, would also allow us to predict the number of patients with OSA who might be effectively treated without using positive airway pressure (PAP). Fifty-seven subjects with and without OSA underwent standard clinical and research sleep studies to measure OSA severity and the physiological traits important for OSA pathogenesis, respectively. The traits were incorporated into a physiological model to predict OSA. The model validity was determined by comparing the model prediction of OSA to the clinical diagnosis of OSA. The effect of various trait manipulations was then simulated to predict the proportion of patients treated by each intervention. The model had good sensitivity (80%) and specificity (100%) for predicting OSA. A single intervention on one trait would be predicted to treat OSA in approximately one quarter of all patients. Combination therapy with two interventions was predicted to treat OSA in ∼50% of patients. An integrative model of physiological traits can be used to predict population-wide and individual responses to non-PAP therapy. Many patients with OSA would be expected to be treated based on known trait manipulations, making a strong case for the importance of non-anatomical traits in OSA pathogenesis and the effectiveness of non-PAP therapies. © 2015 Associated Professional Sleep Societies, LLC.

  7. Obstructive sleep apnoea and related comorbidities in incident idiopathic pulmonary fibrosis.

    PubMed

    Gille, Thomas; Didier, Morgane; Boubaya, Marouane; Moya, Loris; Sutton, Angela; Carton, Zohra; Baran-Marszak, Fanny; Sadoun-Danino, Danielle; Israël-Biet, Dominique; Cottin, Vincent; Gagnadoux, Frederic; Crestani, Bruno; d'Ortho, Marie-Pia; Brillet, Pierre-Yves; Valeyre, Dominique; Nunes, Hilario; Planès, Carole

    2017-06-01

    The objectives of this prospective study were: 1) to determine the prevalence and determinants of obstructive sleep apnoea (OSA) in patients with newly diagnosed idiopathic pulmonary fibrosis (IPF); 2) to determine whether OSA was associated with cardiovascular disease (CVD) as well as increased oxidative stress and levels of IPF biomarkers in the blood.A group of 45 patients with newly diagnosed IPF attended polysomnography. The prevalence of CVD and the severity of coronary artery calcification were investigated by high-resolution computed tomography. The levels of 8-hydroxydeoxyguanosine (8-OH-DG) and various IPF biomarkers in the blood were compared between patients with no or mild OSA (apnoea-hypopnoea index (AHI) <15 events·h(-1)), with moderate OSA (15 ≤AHI <30 events·h(-1)) and with severe OSA (AHI ≥30 events·h(-1)).The prevalence of moderate-to-severe OSA and severe OSA was 62% and 40%, respectively. AHI did not correlate with demographic or physiological data. All patients with severe OSA had a medical history of CVD, versus 41.2% and 40% of those with no or mild OSA, or with moderate OSA, respectively (p<0.0001). Ischaemic heart disease (IHD) and moderate-to-severe coronary artery calcifications were strongly associated with severe OSA. The 8-OH-DG and matrix metalloproteinase-7 serum levels were significantly increased in the severe OSA group.Moderate-to-severe OSA is highly prevalent in incident IPF and severe OSA is strongly associated with the presence of CVD, particularly IHD. Copyright ©ERS 2017.

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

    PubMed Central

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

    2016-01-01

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

  9. A Comparative Analysis of Sleep Disordered Breathing in Active Duty Service Members with and without Combat-Related Posttraumatic Stress Disorder

    PubMed Central

    Mysliwiec, Vincent; Matsangas, Panagiotis; Gill, Jessica; Baxter, Tristin; O'Reilly, Brian; Collen, Jacob F.; Roth, Bernard J.

    2015-01-01

    Study Objectives: Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are frequently co-occurring illnesses. The purpose of this study was to determine whether comorbid PTSD/OSA is associated with increased PTSD symptoms or decreased OSA severity compared to PTSD or OSA alone in recently deployed Active Duty Service Members (ADSM). Methods: Cross-sectional observational study of ADSM who returned from combat within 24 months. Participants underwent an attended diagnostic polysomnogram and were assessed for PTSD, depression, combat exposure severity, sleepiness, and sleep quality with validated clinical instruments. Results: Our study included 109 military personnel who returned from a combat deployment within 24 months with a mean age of 34.3 ± 8.23 and BMI of 30.8 ± 3.99. Twenty-four participants had PTSD/OSA, 68 had OSA, and 17 had PTSD. Mean PTSD Checklist- Military Version (PCL-M) scores were 62.0 ± 8.95, 60.5 ± 4.73, and 32.5 ± 8.95 in PTSD/OSA, PTSD, and OSA, respectively. The mean AHI was 16.9 ± 15.0, 18.9 ± 17.0, and 1.73 ± 1.3 for those with PTSD/OSA, OSA, and PTSD. PTSD symptoms and OSA severity in military personnel with comorbid PTSD/OSA were not significantly different from those with PTSD or OSA alone. On multivariate analysis, BMI was a significant predictor of OSA (OR, 1.21; 95% CI, 1.04–1.44) and age trended towards significance. Depression, but not OSA severity, was associated with PTSD symptoms. Conclusions: Following recent combat exposure, comorbid PTSD/OSA is not associated with increased PTSD symptoms or decreased severity of OSA. Early evaluation after traumatic exposure for comorbid OSA is indicated in PTSD patients with sleep complaints given the high co-occurrence and adverse clinical implications. Citation: Mysliwiec V, Matsangas P, Gill J, Baxter T, O'Reilly B, Collen JF, Roth BJ. A comparative analysis of sleep disordered breathing in active duty service members with and without combat-related posttraumatic

  10. 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

  11. Transcriptomic Analysis Identifies Phosphatases as Novel Targets for Adenotonsillar Hypertrophy of Pediatric Obstructive Sleep Apnea

    PubMed Central

    Khalyfa, Abdelnaby; Gharib, Sina A.; Kim, Jinkwan; Dayyat, Ehab; Snow, Ayelet B.; Bhattacharjee, Rakesh; Kheirandish-Gozal, Leila; Goldman, Julie L.; Gozal, David

    2010-01-01

    Rationale: Obstructive sleep apnea (OSA) is a highly prevalent disorder in children, in which enlarged adenotonsillar tissues (AT) play a major pathophysiologic role. Mechanisms leading to the proliferation and hypertrophy of AT in children who subsequently develop OSA remain unknown, and surgical extirpation of AT is associated with potential morbidity and mortality. Objectives: We hypothesized that a computationally based analysis of gene expression in tonsils from children with OSA and children with recurrent tonsillitis without OSA can identify putative mechanistic pathways associated with tonsillar proliferation and hypertrophy in OSA. Methods: Palatine tonsils from children with either polysomnographically documented OSA or recurrent infectious tonsillitis were subjected to whole-genome microarray and functional enrichment analyses followed by significance score ranking based on gene interaction networks. The latter enabled identification and confirmation of a candidate list of tonsil-proliferative genes in OSA. Measurements and Main Results: In vitro studies using a mixed tonsil cell culture system targeting one of these candidates, phosphoserine phosphatase, revealed that it was more abundantly expressed in tonsils of children with OSA, and that pharmacological inhibition of phosphoserine phosphatase led to marked reductions in T- and B-lymphocyte cell proliferation and increased apoptosis. Conclusions: A systems biology approach revealed a restricted set of candidate genes potentially underlying the heightened proliferative properties of AT in children with OSA. Furthermore, functional studies confirm a novel role for protein phosphatases in AT hypertrophy, and may provide a promising strategy for discovery of novel, nonsurgical therapeutic targets in pediatric OSA. PMID:20093640

  12. Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment - A systematic review.

    PubMed

    Andersen, Ida Gillberg; Holm, Jens-Christian; Homøe, Preben

    2016-08-01

    To systematically review and discuss the outcome of treating obstructive sleep apnea (OSA) in obese children and adolescents. In February 2016 Pub Med was searched using a predetermined string to retrieve all relevant articles. The search identified 518 publications. In total 16 articles were included for review using the selected inclusion and exclusion criteria. The PRISMA guidelines was used. OSA was significantly more likely to persist in obese children after adenotonsillectomy. The prevalence of persistent OSA ranged from 33 to 76% in obese children and from 15 to 37% in non-obese children depending on the definition of OSA, the degree of obesity and the age of the study population. The few studies that investigated the effect of weight loss found that OSA improved significantly after intervention and that the prevalence of persistent OSA varied between 10 and 38%. Positive airway pressure was effective for treating OSA, but the mean nightly use was <4 h in two out of three available studies. Obese children benefit less from adenotonsillectomy than normal-weight children. Weight loss improve OSA significantly, but more research is needed to clarify the role of weight loss as treatment for OSA. Positive airway pressure is effective for treating OSA; however, adherence is a challenge. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. High levels of inflammation and insulin resistance in obstructive sleep apnea patients with hypertension.

    PubMed

    Qian, Xiaoshun; Yin, Tong; Li, Tianzhi; Kang, Chunyan; Guo, Ruibiao; Sun, Baojun; Liu, Changting

    2012-08-01

    Hypertension induced by obstructive sleep apnea (OSA) may be multifactorial in origin, and systemic inflammation is one of the major factors. However, OSA patients do not always have the identical probability with hypertension even in patients with the same history and degree of OSA. The aim of this study was to compare the levels of inflammation and insulin resistance in two groups of patients who had the same degree as well as the same long history of OSA, but with/without hypertension. OSA patients (Apnea Hyponea Index, AHI ≥ 40/h, n = 70) were examined by polysomnography and blood analysis for the measurements of fasting plasma glucose, serum insulin (FINS), high-sensitivity C-reactive protein (CRP), peptide C,TNF-α, IL-6, and IL-10. Patients with hypertension (n = 40) had higher level of LDL-C and lower HDL-C levels than patients without hypertension. Almost half (16/40) of OSA patients with hypertension had family history of hypertension. Moreover in OSA patients with hypertension, the levels of TNF-α, IL-6, and CRP were higher, but IL-10 was lower than those without hypertension. FINS, peptide C, HOMA-IR, and HOMA-islet were also higher in OSA patients with hypertension. OSA patients with hypertension have higher level of inflammation and insulin resistance. Systemic inflammation and insulin resistance are both important factors for the development of hypertension in OSA patients.

  14. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study

    PubMed Central

    Forni Ogna, Valentina; Ogna, Adam; Pruijm, Menno; Bassi, Isabelle; Zuercher, Emilie; Halabi, Georges; Phan, Olivier; Bullani, Roberto; Teta, Daniel; Gauthier, Thierry; Cherpillod, Anne; Mathieu, Claudine; Mihalache, Alexandra; Cornette, Francoise; Haba-Rubio, José; Burnier, Michel; Heinzer, Raphaël

    2015-01-01

    Background. Previous observations found a high prevalence of obstructive sleep apnea (OSA) in the hemodialysis population, but the best diagnostic approach remains undefined. We assessed OSA prevalence and performance of available screening tools to propose a specific diagnostic algorithm. Methods. 104 patients from 6 Swiss hemodialysis centers underwent polygraphy and completed 3 OSA screening scores: STOP-BANG, Berlin's Questionnaire, and Adjusted Neck Circumference. The OSA predictors were identified on a derivation population and used to develop the diagnostic algorithm, which was validated on an independent population. Results. We found 56% OSA prevalence (AHI ≥ 15/h), which was largely underdiagnosed. Screening scores showed poor performance for OSA screening (ROC areas 0.538 [SE 0.093] to 0.655 [SE 0.083]). Age, neck circumference, and time on renal replacement therapy were the best predictors of OSA and were used to develop a screening algorithm, with higher discriminatory performance than classical screening tools (ROC area 0.831 [0.066]). Conclusions. Our study confirms the high OSA prevalence and highlights the low diagnosis rate of this treatable cardiovascular risk factor in the hemodialysis population. Considering the poor performance of OSA screening tools, we propose and validate a specific algorithm to identify hemodialysis patients at risk for OSA for whom further sleep investigations should be considered. PMID:26229952

  15. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study.

    PubMed

    Forni Ogna, Valentina; Ogna, Adam; Pruijm, Menno; Bassi, Isabelle; Zuercher, Emilie; Halabi, Georges; Phan, Olivier; Bullani, Roberto; Teta, Daniel; Gauthier, Thierry; Cherpillod, Anne; Mathieu, Claudine; Mihalache, Alexandra; Cornette, Francoise; Haba-Rubio, José; Burnier, Michel; Heinzer, Raphaël

    2015-01-01

    Previous observations found a high prevalence of obstructive sleep apnea (OSA) in the hemodialysis population, but the best diagnostic approach remains undefined. We assessed OSA prevalence and performance of available screening tools to propose a specific diagnostic algorithm. 104 patients from 6 Swiss hemodialysis centers underwent polygraphy and completed 3 OSA screening scores: STOP-BANG, Berlin's Questionnaire, and Adjusted Neck Circumference. The OSA predictors were identified on a derivation population and used to develop the diagnostic algorithm, which was validated on an independent population. We found 56% OSA prevalence (AHI ≥ 15/h), which was largely underdiagnosed. Screening scores showed poor performance for OSA screening (ROC areas 0.538 [SE 0.093] to 0.655 [SE 0.083]). Age, neck circumference, and time on renal replacement therapy were the best predictors of OSA and were used to develop a screening algorithm, with higher discriminatory performance than classical screening tools (ROC area 0.831 [0.066]). Our study confirms the high OSA prevalence and highlights the low diagnosis rate of this treatable cardiovascular risk factor in the hemodialysis population. Considering the poor performance of OSA screening tools, we propose and validate a specific algorithm to identify hemodialysis patients at risk for OSA for whom further sleep investigations should be considered.

  16. Sleep apnoea and driving risk: the need for regulation.

    PubMed

    McNicholas, Walter T; Rodenstein, Daniel

    2015-12-01

    Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent chronic respiratory disorder with prevalence among adult males of ≥10%. The most common daytime symptom associated with OSAS is excessive sleepiness, which in more severe manifestations can result in sleepiness at the wheel while driving and probably contributes to the substantial increase in accident risk among patients with OSAS. Fortunately, current evidence indicates that successful therapy of OSAS, particularly with continuous positive airway pressure, can bring the accident risk down to levels similar to an equivalent general population. The recognition of the increased driving accident risk in OSAS prompted the Transport and Mobility Directorate of the European Commission to establish a working group on this topic in 2012, which ultimately led to a revision of Annex III of the EU Driving Licence Directive, which is subject to mandatory implementation by European Union member states by December 2015. This directive specifies that patients with moderate or severe OSAS associated with significant daytime sleepiness should be prohibited from driving until effective therapy is established. These new regulations are designed to balance the legitimate objective of public safety with not penalising OSAS patients who are complying with effective therapy. Successful implementation of regulations on driving in OSAS patients must also include measures to educate relevant stakeholders including patients, medical personnel, traffic police and employers in the transport industry. The key objective is to encourage patients with possible OSAS to seek diagnosis and treatment and not to inhibit OSAS patients from coming forward. Copyright ©ERS 2015.

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

    PubMed Central

    Madaeva, Irina; Polyakov, Vladimir; Kolesnikov, Sergey

    2016-01-01

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

  18. Obstructive sleep apnea: management considerations in psychiatric patients

    PubMed Central

    Heck, Taryn; Zolezzi, Monica

    2015-01-01

    Psychiatric disorders and obstructive sleep apnea (OSA) are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms. PMID:26508864

  19. Obstructive sleep apnea and type 2 diabetes: interacting epidemics.

    PubMed

    Tasali, Esra; Mokhlesi, Babak; Van Cauter, Eve

    2008-02-01

    Type 2 diabetes is a major public health concern with high morbidity, mortality, and health-care costs. Recent reports have indicated that the majority of patients with type 2 diabetes also have obstructive sleep apnea (OSA). There is compelling evidence that OSA is a significant risk factor for cardiovascular disease and mortality. Rapidly accumulating data from both epidemiologic and clinical studies suggest that OSA is also independently associated with alterations in glucose metabolism and places patients at an increased risk of the development of type 2 diabetes. Experimental studies in humans and animals have demonstrated that intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, exert adverse effects on glucose metabolism. Based on the current evidence, clinicians need to address the risk of OSA in patients with type 2 diabetes and, conversely, evaluate the presence of type 2 diabetes in patients with OSA. Clearly, there is a need for further research, using well-designed studies and long-term follow-up, to fully demonstrate a causal role for OSA in the development and severity of type 2 diabetes. In particular, future studies must carefully consider the confounding effects of central obesity in examining the link between OSA and alterations in glucose metabolism. The interactions among the rising epidemics of obesity, OSA, and type 2 diabetes are likely to be complex and involve multiple pathways. A better understanding of the relationship between OSA and type 2 diabetes may have important public health implications.

  20. Upper airway endoscopy to optimize obstructive sleep apnea treatment in Apert and Crouzon syndromes.

    PubMed

    Doerga, Priya N; Spruijt, Bart; Mathijssen, Irene M J; Wolvius, Eppo B; Joosten, Koen F M; van der Schroeff, Marc P

    2016-02-01

    Obstructive sleep apnea (OSA) is highly prevalent in children with Apert and Crouzon syndromes. Although often related to midface hypoplasia, it is a multi-level problem for which routine midface advancement might be a suboptimal treatment choice. We therefore wished to: 1.) use upper airway endoscopy to examine the level of obstruction in children with OSA; 2.) determine the relationship between endoscopic assessment and OSA severity; and 3.) evaluate the effect of surgery on endoscopic assessment and OSA severity. Prospective observational cohort study of patients considered for midface advancement, underwent upper airway endoscopy. Endoscopy findings were scored according to the system of Bachar, based on level (nose, uvulopalatine plane, tongue base, hypopharynx and larynx); and severity (no, partial or complete obstruction). Polysomnography was used to diagnose OSA. We included 22 children (Apert N = 10, Crouzon N = 12), 17 had OSA, 14 of whom had multilevel obstruction and 3 single-level obstruction. The endoscopy findings were correlated with OSA severity: R = 0.56, P = 0.01. Midface advancement (N = 8) reduced Bachar's severity index in 7 of 8 patients, and OSA in all patients. OSA in children with Apert or Crouzon syndrome is often a multi-level problem. Upper airway endoscopy is essential to optimizing OSA treatment. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  1. The relationship between depressive symptoms and obstructive sleep apnea in pediatric populations: a meta-analysis.

    PubMed

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

    2013-11-15

    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. 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. 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. 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). 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.

  2. Body Composition, Anthropometric Indices and Hydration Status of Obstructive Sleep Apnea Patients: Can Cachexia Coexist with Obesity?

    PubMed

    Kuźnar-Kamińska, Barbara; Grabicki, Marcin; Trafas, Tomasz; Szulińska, Monika; Cofta, Szczepan; Piorunek, Tomasz; Brajer-Luftmann, Beata; Nowicka, Agata; Bromińska, Barbara; Batura-Gabryel, Halina

    2017-03-03

    The aim of this study was to elucidate body composition, anthropometric indices, and hydration status in obstructive sleep apnea (OSA) patients, taking into account different disease stages, gender, and the possibility of the presence of cachexia. There were 98 OSA patients and 23 control subjects enrolled into the study. All study participants underwent polysomnography examination. Body mass index (BMI), fat mass index (FMI), fat free mass, muscle mass, body cell mass, total body water, and extracellular and intracellular water were evaluated. The neck, abdominal, and waist circumference was measured. We found that overweight and obesity were present in 96% of patients. Cachexia was present in one OSA individual with comorbidities. Apnea-hypopnea index correlated with the neck and waist circumference, and with BMI in OSA patients. All muscle indices and water contents above outlined were significantly higher in severe OSA compared with control subjects. BMI, FMI, neck circumference, and extracellular water were greater in a subset of severe OSA compared with a moderate OSA stage. The female OSA patients had a higher FMI than that present in males at a comparable BMI. We conclude that the most body composition indices differed significantly between severe OSA patients and control subjects. A higher FMI in females at a comparable BMI could be due to a discordance between BMI and FMI. Cachexia occurs rarely in OSA and seems to coexist with comorbidities.

  3. Obstructive sleep apnea is associated with fatty liver and abnormal liver enzymes: a meta-analysis.

    PubMed

    Sookoian, Silvia; Pirola, Carlos J

    2013-11-01

    Obstructive sleep apnea (OSA) is associated with the cluster of clinical conditions that comprise the metabolic syndrome, including nonalcoholic fatty liver disease (NAFLD). Our primary purpose was to estimate the effect of OSA on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Our secondary purpose was to investigate the potential influence of OSA on histological severity of NAFLD to explore whether chronic intermittent hypoxia is associated with inflammation and fibrosis. Our literature search identified 11 studies, from which we extracted information about numbers of control subjects and OSA patients, and ALT, AST, and NAFLD. From a total of 668 OSA patients and 404 controls, we found that the standardized difference in mean values of ALT and AST levels in patients with OSA was significantly different from that in the controls. Meta-regression showed that the association was independent of body mass index and type 2 diabetes. Fatty liver was associated with OSA in five studies with 400 subjects. OSA was significantly associated with liver fibrosis in 208 subjects, but not with lobular inflammation. Routine assessment of liver enzymes and liver damage should be implemented in OSA patients because they have an increase of 13.3% of ALT and 4.4% of AST levels, and a 2.6-fold higher risk of liver fibrosis when they have NAFLD, which is 2.6 times more frequent in OSA patients.

  4. Obstructive sleep apnea predisposes to nonalcoholic Fatty liver disease in patients with polycystic ovary syndrome.

    PubMed

    Tock, Luciana; Carneiro, Gláucia; Togeiro, Sônia M; Hachul, Helena; Pereira, Andrea Z; Tufik, Sérgio; Zanella, Maria T

    2014-03-01

    Some studies have shown a higher prevalence of nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) in patients with polycystic ovary syndrome (PCOS). The objective of this study was to assess NAFLD in PCOS women with and without OSA. A possible role of high serum androgen levels in the development of OSA in PCOS women was also investigated. Biochemical, hormonal, and polysomnography parameters were determined in 38 premenopausal PCOS patients. NAFLD was evaluated by ultrasound. Testosterone was measured by an immunoassay. Serum androgen levels and the prevalence of NAFLD (83.3% vs. 26.9%; P<.001) were higher in patients with OSA than those without OSA. The mean apnea-hypopnea index (AHI) was higher in patients with NAFLD than in those without NAFLD (16.87 events [ev]/h vs. 1.57 ev/h; P<.002). On multivariate logistic regression, where body mass index ≥30 kg/m2, homeostasis model assessment for insulin resistance ≥2.7, and OSA (AHI ≥5 ev/h) were independent variables, only OSA was an independent predictor of NAFLD (odds ratio [OR], 7.63; P = .044). Free testosterone levels ≥1.07 ng/dL were also independently associated with OSA (OR, 8.18; P = .023). In PCOS women, the occurrence of OSA strongly predisposes them to development of NAFLD and a worse metabolic profile; hence, treatment of OSA might be beneficial for NAFLD.

  5. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease in patients with severe obesity.

    PubMed

    Benotti, Peter; Wood, G Craig; Argyropoulos, George; Pack, Allan; Keenan, Brendan T; Gao, Xiang; Gerhard, Glenn; Still, Christopher

    2016-04-01

    Obstructive sleep apnea (OSA) is common among candidates for bariatric surgery. OSA and its associated intermittent hypoxia have been implicated in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis. A large cohort of bariatric surgery patients was studied in an effort to explore the relationship between OSA severity, hypoxia, metabolic syndrome, and the severity of NAFLD. Bariatric surgery candidates who underwent both polysomnography and liver biopsy were studied. The severity of OSA as determined by the apnea-hypopnea index (AHI) and parameters of hypoxia was studied in relation to extent of abnormalities of liver histology as measured by the presence of hepatic steatosis, inflammation, and fibrosis. The study cohort included 362 patients with a mean age of 46.2 years and BMI of 49.9 kg/m(2) . On the basis of AHI, 26% of the cohort had no OSA, 32% mild OSA, 22% moderate OSA, and 20% severe OSA. For the study subjects without metabolic syndrome, positive correlations were found between OSA severity, as measured by AHI, and parameters of hypoxia, with the severity of NAFLD. OSA severity and its accompanying hypoxia are associated with the severity of NAFLD. © 2016 The Obesity Society.

  6. Structure and physicochemical properties of octenyl succinic esters of sugary maize soluble starch and waxy maize starch.

    PubMed

    Miao, Ming; Li, Rong; Jiang, Bo; Cui, Steve W; Zhang, Tao; Jin, Zhengyu

    2014-05-15

    The structure and physicochemical properties of octenyl succinic anhydride (OSA) starches prepared from sugary maize (SMSS) and waxy maize (WMS) were studied and compared. The degree of substitution (DS) increased linearly with the amount of OSA, while the DS of OSA-SMSS was higher than that of OSA-WMS using equivalent modification conditions. FT-IR analysis indicated that two characteristic peaks, at 1725 and 1570 cm(-1), were observed for OSA-starch. The weight-average of the molar mass (Mw) and z-root mean square radius of gyration (Rz) of SMSS increased with increased OSA esterification substitutions, whereas Mw was reduced and Rz was nearly constant for WMS. The zeta-potential and emulsifying activity increased with DS for starch modified with OSA. OSA-SMSS (DS of 0.0192) was the best material for stable oil-in-water emulsion preparation. The increase of DS in OSA-starch resulted in a substantial reduction of RDS content with an accompanying increase of SDS and RS. This study revealed the potential application of OSA-SMSS as a particle stabilizer of oil-in-water emulsion, which would allow encapsulate and protect functional food components. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    2016-01-01

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

  8. Reaction of octenylsuccinic anhydride with a mixture of granular starch and soluble maltodextrin.

    PubMed

    Bai, Yanjie; Shi, Yong-Cheng

    2013-11-06

    The reaction of octenylsuccinic anhydride (OSA) with a mixture of granular waxy maize starch and soluble maltodextrin was investigated. OSA was reacted with a 1:1 (w/w) mixture of the granular starch and maltodextrin at OSA levels of 1.5, 3, 9, and 15% (wt% based on starch weight). After the first 0.5h of the reaction, degree of substitution (DS) on maltodextrin reached 0.021, 0.030, 0.080, and 0.10 for 1.5, 3, 9, and 15% OSA, respectively, whereas DS for granular starch was only 0.0020, 0.0087, 0.014, and 0.016. At 2h of the reaction, the bound OS ratio of maltodextrin to granular starch was 10.8 when OSA concentration was 1.5% and the ratio decreased to ca. 5 at higher OSA concentrations. OSA preferred to react with maltodextrin than semi-crystalline granular starch when both existed in the system. OSA reacted with maltodextrin at a much faster rate and to a greater extent than with granular starch, but a significant amount of OSA reacted with granular starch at 3-15% OSA concentrations.

  9. Obesity in children with different risk factors for obstructive sleep apnea: a community-based study.

    PubMed

    Su, Miao-Shang; Zhang, Hai-Lin; Cai, Xiao-Hong; Lin, Ying; Liu, Pei-Ning; Zhang, Yuan-Bo; Hu, Wen-Zhen; Li, Chang-Chong; Xiao, Yan-Feng

    2016-02-01

    This study investigated the association between obesity and obstructive sleep apnea (OSA) in preschool and school-age children. Parents of obese and randomly chosen normal weight children completed a questionnaire on sleep-related symptoms, demography, family, and medical history. All subjects were invited to undergo polysomnography (PSG). OSA cases were defined as obstructive apnea hypopnea index (OAHI) ≥1. A total of 5930 children were studied with 9.5% obese (11.9% boys/6.1% girls), 205/2680 preschool and 360/3250 school children. There were 1030 children (535 obese/495 normal weight) who underwent PSG. OSA was higher in obese children and obese school children had higher OAHI, arousal index, and shorter total sleep time. However, there was no positive correlation between OSA and body mass index (BMI). The main risk factors for OSA in preschool children were adenotonsillar hypertrophy and recurrent respiratory tract infection. The main cause for OSA in school children was a history of parental snoring and obesity. Mallampati scores and sleep-related symptoms were found to be associated with OSA in both preschool and school children. We demonstrated differential risk factors for OSA in obese children, which suggest that a different mechanism may be involved in OSA development in preschool and school-age children. Various risk factors have been reported in obese children with OSA owing to the different age and different study design. Obese children have a higher prevalence and severity of obstructive sleep apnea (OSA). OSA risk factors in obese children are affected by different ages and study designs. A differential prevalence and risk factors for obese preschool and school-age children with OSA has been demonstrated.

  10. 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

  11. Association of obstructive sleep apnea with homocystein, nitric oxide and total antioxidant capacity levels in patients with or without coronary artery disease.

    PubMed

    Ortaç Ersoy, Ebru; Fırat, Hikmet; Akaydın, Sevgi; Özkan, Yeşim; Durusu, Mine; Darılmaz Yüce, Gülbahar; Ergün, Recai; Topeli, Arzu; Ardıç, Sadık

    2014-01-01

    Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality. Deficiency of nitric oxide (NO) and plasma levels of homocystein have been implicated in the pathogenesis of cardiovascular disease. OSA results in oxygen desaturation and arousal from sleep. Free oxygen radicals can be produced by hypoxia-reoxygenation. To test for the hypothesis that OSA is associated with cardiovascular morbidity, we investigated levels of homocystein, NO and total antioxidant capacity in OSA patients with and without coronary artery disease (CAD) in comparison with normal subjects and patients with CAD without OSA. Polysomnography was performed in 27 patients who had a myocardial infarction and in 25 patients without evidence of CAD. Patients were grouped according their polysomnography results as OSA with CAD (group 1), OSA without CAD (group 2), CAD (group 3), and normal (group 4) . Levels of homocystein, NO and total antioxidant capacity were determined after an overnight fasting. Data were analysed with parametric and non parametric statistical tests. According to apnea-hypopnea index (AHI) 44.4% of CAD patients were OSA. After polysomnographic evaluation, the patients were re-distributed as follows: OSA with CAD (n= 12), OSA without CAD (n= 14), CAD (n= 15), and normal (n= 11). Homocystein levels were higher in 3 groups compared to controls. AHI, MDI and desaturation time was higher in three -vessel disease compared to one and two- vessel diseases (p< 0.05). NO levels were correlated with the period of oxygen desaturation (r: -0.45, p= 0.031). The antioxidant capacity did not differ between OSA and healthy groups. OSA is frequent in CAD. AHI, MDI and desaturation time are higher in patients with severe CAD. It is important to evaluate OSA patients for CAD.

  12. [Obstructive sleep-apnoea syndrome in adult and its perioperative management].

    PubMed

    Payen, J-F; Jaber, S; Levy, P; Pepin, J-L; Fischler, M

    2010-11-01

    Obstructive sleep apnoea (OSA) syndrome in adult is defined as an Apnoea-Hypopnoea Index (AHI) of 5 or more per hour of sleep in a context of excessive daytime sleepiness and snoring. OSA is considered as mild with an AHI of 5-15, moderate with an AHI of 15-30, and severe with an AHI greater than 30. OSA is a highly prevalent disease since it should affect 7-15% of the middle-aged population, but most patients are not yet diagnosed for OSA. Middle age, male gender, obesity and arterial hypertension are main risk factors for OSA in adults. OSA patients are exposed to higher neurological and cardiovascular morbidity, including stroke, depression, hypertension, coronary artery disease, heart failure, arrhythmias. Because OSA may lead to life-threatening problems if undiagnosed, anaesthesiologists should be aware of their screening role in the preoperative period. In that way, the STOP-BANG questionnaire is a well-adapted instrument to screen patients for OSA during the preoperative visit. OSA patients are exposed to higher preoperative morbidity in relation with OSA severity, particularly difficult manual ventilation with mask, difficult tracheal intubation and postoperative upper airway obstruction. The unknown diagnosis of OSA is one major contributor to facilitate the occurrence of those events. In the postoperative period, early resuming continuous positive airway pressure and installing the OSA patient in a nonsupine position could be effective in preventing pharyngeal obstruction. Considering the timing of postoperative complications, a careful monitoring in the post-anesthesia care unit for three hours is an appropriate strategy for a majority of OSA patients. Alternatives to opioids should be promoted for postoperative pain control.

  13. Self-reported obstructive sleep apnea is associated with nonresponse to antidepressant pharmacotherapy in late-life depression.

    PubMed

    Waterman, Lauren; Stahl, Sarah T; Buysse, Daniel J; Lenze, Eric J; Blumberger, Daniel; Mulsant, Benoit; Butters, Meryl; Gebara, Marie Anne; Reynolds, Charles F; Karp, Jordan F

    2016-12-01

    Obstructive sleep apnea (OSA) is frequently comorbid with late-life depression. The purpose of this project was to determine, using a sample of older adults with major depressive disorder, whether patient-reported diagnosis of OSA was associated with rate of response to venlafaxine. Participants from this multisite study were adults ≥60 years old (n = 468) with major depressive disorder and a Montgomery Asberg Depression Rating Scale (MADRS) score of ≥15. Depression response was the outcome variable, defined as a MADRS score of ≤10 for two consecutive assessments at the end of 12 weeks of open-label treatment with venlafaxine 300 mg/day. To assess OSA, participants were asked if they had been diagnosed with OSA using polysomnography. Eighty participants (17.1%) reported a diagnosis of OSA prior to baseline. Participants with OSA were more likely to be male, report greater impairment on measures of health, experience a longer duration of the index episode, and receive an adequate antidepressant trial prior to entering the study. During the 12 weeks of treatment, 40.8% responded to treatment with venlafaxine (43.6%, n = 169/388 of the no OSA group, and 27.5%, n = 22/80 of the OSA group). Participants without OSA were 1.79 times more likely to respond to treatment (HR: 1.79 [95%CI: 1.13-2.86], P < .05) compared to those with OSA. OSA may impair response to antidepressant pharmacotherapy in depressed older adults. Future studies of antidepressant response rates among depressed older adults with OSA should both prospectively diagnose OSA and monitor adherence to treatments such as continuous positive airway pressure. © 2016 Wiley Periodicals, Inc.

  14. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate.

    PubMed

    Liao, Yu-Fang; Chuang, Ming-Lung; Chen, Philip K T; Chen, Ning-Hung; Yun, Claudia; Huang, Chiung-Shing

    2002-05-01

    To investigate the incidence and severity of obstructive sleep apnea (OSA) associated with pharyngeal flap surgery in patients with cleft palate at least 6 months postoperatively and to determine whether age or the flap width had an effect on them. The hypothesis tested in this study was that the severity of OSA associated with pharyngeal flap surgery is greater in children than in adults. Ten adults, six men and four women, with a mean age of 28.0 years at pharyngeal flap (adult group). Twenty-eight children, 13 boys and 15 girls, with a mean age of 6.3 years at pharyngeal flap (child group). A prospective analysis. An overnight polysomnographic study was used to determine the incidence and severity of OSA 6 months after pharyngeal flap. The incidence of OSA following pharyngeal flap was high but not significantly different between these two groups (90% in adults and 93% in children, p = 1.000). When OSA was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups (p =.022). In the adult group, eight patients (89%) had mild OSA and 1 patient (11%) had moderate to severe OSA. In the child group, 11 patients (42%) were found to have mild OSA, and 15 patients (58%) had moderate to severe OSA. No relation was found between the flap width and the incidence (p =.435 in adults and.640 in children) or the severity (p =.325 in adults and.310 in children) of OSA in each group. Six months following pharyngeal flap surgery, more than 90% of the patients with cleft palate still had OSA. The severity of OSA associated with pharyngeal flap surgery tended to be greater in children than in adults. The flap width was unrelated to the incidence and severity of OSA, no matter in adults or in children.

  15. Factors Associated with Referrals for Obstructive Sleep Apnea Evaluation among Community Physicians

    PubMed Central

    Williams, Natasha J.; Nunes, João V.; Zizi, Ferdinand; Okuyemi, Kola; Airhihenbuwa, Collins O.; Ogedegbe, Gbenga; Jean-Louis, Girardin

    2015-01-01

    Study Objectives: This study assessed knowledge and attitudes toward obstructive sleep apnea (OSA) among community physicians and explored factors that are associated with referrals for OSA evaluation. Methods: Medical students and residents collected data from a convenience sample of 105 physicians practicing at community-based clinics in a large metropolitan area. Average age was 48 ± 14 years; 68% were male, 70% black, 24% white, and 6% identified as “other.” Physicians completed the Obstructive Sleep Apnea Knowledge and Attitudes questionnaire. Results: The average year in physician practice was 18 ± 19 years. Of the sample, 90% reported providing care to black patients. The overall OSA referral rate made by physicians was 75%. OSA knowledge and attitudes scores ranged from 5 to 18 (mean = 14 ± 2) and from 7 to 20 (mean = 13 ± 3), respectively. OSA knowledge was associated with white race/ ethnicity (rp = 0.26, p < 0.05), fewer years in practice (rp = -0.38, p < 0.01), patients inquiring about OSA (rp = 0.31, p < 0.01), and number of OSA referrals made for OSA evaluation (rp = 0.30, p < 0.01). Positive attitude toward OSA was associated with patients inquiring about OSA (rp = 0.20, p < 0.05). Adjusting for OSA knowledge and attitudes showed that physicians whose patients inquired about OSA were nearly 10 times as likely to make a referral for OSA evaluation (OR = 9.38, 95% CI: 2.32–38.01, p < 0.01). Conclusion: Independent of physicians' knowledge and attitudes toward obstructive sleep apnea, the likelihood of making a referral for obstructive sleep apnea evaluation was influenced by whether patients inquired about the condition. Citation: Williams NJ, Nunes JV, Zizi F, Okuyemi K, Airhihenbuwa CO, Ogedegbe G, Jean-Louis G. Factors associated with referrals for obstructive sleep apnea evaluation among community physicians. J Clin Sleep Med 2015;11(1):23–26. PMID:25325590

  16. Evaluation of the risk factors of depressive disorders comorbid with obstructive sleep apnea

    PubMed Central

    Cai, Liqiang; Xu, Luoyi; Wei, Lili; Sun, Yi; Chen, Wei

    2017-01-01

    Objective Overlap of obstructive sleep apnea (OSA) complicates diagnosis of depressive disorder and renders antidepressant treatment challenging. Previous studies have reported that the incidence of OSA is higher in patients with depression than in the general population. The purpose of this article was to investigate clinical risk factors to predict OSA in depression disorders. Methods A total of 115 patients diagnosed with major depressive disorder (MDD) and bipolar disorder (in a major depressive episode), who underwent overnight polysomnography, were studied retrospectively. They were divided into two groups: non-OSA and OSA. The patients who had apnea–hypopnea index (AHI) <5 were defined as the non-OSA group, whereas the OSA group was defined as those with an AHI ≥5. Logistic regression was used to analyze the association among AHI and clinical factors, including sex, age, body mass index (BMI), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale, Pittsburgh Sleep Quality Index (PSQI), and diagnosis (MDD or bipolar disorder [in a major depressive episode]). Results In 115 patients, 51.3% had OSA. Logistic regression analysis showed significant associations between AHI and diagnosis (MDD or bipolar disorder [in a major depressive episode]), BMI, HAMD, and PSQI (P<0.05). Conclusion The findings of our study suggested that the rate of depression being comorbid with OSA is remarkably high and revealed that there is a high rate of undetected OSA among depressive disorder patients and untreated OSA among mood disorder patients. The clinical risk factors (diagnosis [MDD or bipolar disorder {in a major depressive episode}], BMI, HAMD, and PSQI) could predict AHI or OSA diagnosis and contribute to OSA screening in depressive disorder patients. PMID:28144146

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

    PubMed Central

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

    2016-01-01

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

  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. Increased plasma YKL-40/chitinase-3-like-protein-1 is associated with endothelial dysfunction in obstructive sleep apnea.

    PubMed

    Jafari, Behrouz; Elias, Jack A; Mohsenin, Vahid

    2014-01-01

    Obstructive sleep apnea (OSA) is a common disorder affecting 15-24% of the adults and is associated with increased risk of hypertension and atherosclerosis. The exact mechanisms underlying hypertension in OSA are not entirely clear. YKL-40/Chitinase-3-like protein-1 is a circulating moiety with roles in injury, repair and angiogenesis that is dysregulated in atherosclerosis and a number of other diseases. We sought to determine the role of YKL-40 in endothelial dysfunction and hypertension in OSA. We studies 23 normotensive OSA (N-OSA) and 14 hypertensive OSA (H-OSA) without diabetes and apparent cardiovascular disease. Endothelial-dependent nitric oxide-mediated vasodilatory capacity was assessed by flow-mediated vasodilation (FMD). YKL-40, vascular endothelial growth factor (VEGF) and the soluble form of VEGF receptor-1 or sFlt-1 were measured in plasma using ELISA methodology. N-OSA subjects aged 49.1 ± 2.3 years and H-OSA aged 51.3 ± 1.9 years with BMI 36.1 ± 1.6 and 37.6 ± 1.9 kg/m(2), respectively. The apnea-hypopnea index (AHI) was 41 ± 5 events/hr in N-OSA and 46 ± 6 in H-OSA with comparable degree of oxygen desaturations during sleep. FMD was markedly impaired in H-OSA (8.3% ± 0.8) compared to N-OSA (13.2% ± 0.6, P<0.0001). Plasma YKL-40 was significantly elevated in H-OSA (55.2 ± 7.9 ng/ml vs. 35.6 ± 4.2 ng/ml in N-OSA, P = 0.02) and had an inverse relationship with FMD (r = -0.52, P = 0.013). There was a significant positive correlation between sFlt-1/VEGF, a measure of decreased VEGF availability, and YKL-40 (r = 0.42, P = 0.04). The levels of plasma YKL-40 were elevated in H-OSA group and inversely correlated with the endothelial-dependent vasodilatory capacity whereas there was a positive correlation between sFlt-1/VEGF and YKL-40. These findings suggest that YKL-40 is dysregulated, in part, due to perturbation of VEGF signaling, and may contribute to endothelial dysfunction and hypertension in OSA.

  20. Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-analysis of Prospective and Retrospective Cohort Studies.

    PubMed

    Nagappa, Mahesh; Patra, Jayadeep; Wong, Jean; Subramani, Yamini; Singh, Mandeep; Ho, George; Wong, David T; Chung, Frances

    2017-08-21

    The risk of postoperative complications increases with undiagnosed obstructive sleep apnea (OSA). The high-risk OSA (HR-OSA) patients can be easily identified using the STOP-Bang screening tool. The aim of this systematic review and meta-analysis is to determine the association of postoperative complications in patients screened as HR-OSA versus low-risk OSA (LR-OSA). The following data bases were searched from January 1, 2008, to October 31, 2016, to identify the eligible articles: Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Cochrane Databases of Systematic Reviews, Medline-in-Process & other nonindexed citations, Google Scholar, Embase, Web of Sciences and Scopus. The search included studies with adult surgical patients screened for OSA with STOP-Bang questionnaire that reported at least 1 cardiopulmonary or any other complication requiring intensive care unit admission as diagnosis of outcome. We used a Bayesian random-effects analysis to evaluate the existing evidence of STOP-Bang in relation to OSA and to assess the association of postoperative complications with the identified HR-OSA patients by study design and methodologies. This systematic review and meta-analysis was conducted using 10 cohort studies: 23,609 patients (HR-OSA, 7877; LR-OSA, 15,732). The pooled odds of perioperative complications were higher in the HR-OSA versus LR-OSA patients (odds ratio 3.93, 95% credible interval, 1.85-7.77, P= .003; 6.86% vs 4.62%). The length of hospital stay was longer in HR-OSA by 2 days when compared with LR-OSA (5.0 ± 4.2 vs 3.4 ± 2.8 days; mean difference 2.01; 95% credible interval, 0.77-3.24; P= .005). Meta-regression to adjust for baseline confounding factors and subgroup analysis did not materially change the results. This systematic review and meta-analysis suggests that HR-OSA is related with higher risk of postoperative adverse events and longer length of hospital stay when compared with LR-OSA patients. Our findings support the

  1. Coexistence of obstructive sleep apnea worsens the overall outcome of intracranial aneurysm: a pioneer study.

    PubMed

    Bir, Shyamal C; Nanda, Anil; Cuellar, Hugo; Sun, Hai; Guthikonda, Bharat; Liendo, Cesar; Minagar, Alireza; Chernyshev, Oleg Y

    2017-03-24

    OBJECTIVE Obstructive sleep apnea (OSA) is associated with the progression of abdominal and thoracic aortic aneurysms. However, the role of OSA in the overall outcome of intracranial aneurysms (IAs) has not yet been established. Authors of this report investigated the role of OSA in the overall outcome of IAs. METHODS Radiological and clinical data on patients (from 2010 through 2015) with confirmed IA were retrospectively reviewed. Significant differences between the OSA and non-OSA groups were determined using a chi-square test. Logistic regression analysis was performed to identify the predictors of an unfavorable IA outcome. RESULTS Among the 283 patients with confirmed IAs, 45 patients (16%) were positively screened for OSA, a proportion that was significantly higher than the prevalence of OSA in nonaneurysmal neurosurgical patients (4%, p = 0.008). The percentage of patients with hypertension (p = 0.018), a body mass index ≥ 30 kg/m(2) (p < 0.0001), hyperlipidemia (p = 0.034), diabetes mellitus (p = 0.005), chronic heart disease (CHD; p = 0.024), or prior stroke (p = 0.03) was significantly higher in the OSA group than in the non-OSA group. Similarly, the percentage of wide-necked aneurysms (p = 0.00001) and patients with a poor Hunt and Hess Grade IV-V (p = 0.01) was significantly higher in the OSA group than in the non-OSA group. In addition, the percentage of ruptured aneurysms (p = 0.03) and vasospasms (p = 0.03) was significantly higher in the OSA group. The percentage of patients with poor modified Rankin Scale (mRS) scores (3-6) was significantly higher in the OSA group (p = 0.03). A separate cohort of patients with ruptured IAs showed similar results. In both univariate (p = 0.01) and multivariate (p = 0.04) regression analyses, OSA was identified as an individual predictor of an unfavorable outcome. In addition, hypertension and prior stroke were revealed as predictors of a poor IA outcome. CONCLUSIONS Complications of IA such as rupture and

  2. Obstructive sleep apnea in children: a critical update

    PubMed Central

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

    2013-01-01

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

  3. Effects of concurrent ball milling and octenyl succinylation on structure and physicochemical properties of starch.

    PubMed

    Li, Nannan; Niu, Meng; Zhang, Binjia; Zhao, Siming; Xiong, Shanbai; Xie, Fengwei

    2017-01-02

    This work concerns the effects of concurrent ball milling (BM) and octenyl succinic anhydride (OSA) modification on the starch microstructure and physicochemical properties (swelling, emulsifying, and rheological). Unlike normal OSA-modified starches, the BM/OSA-modified starch displayed new features such as reduced viscosity and rigidity but increased paste stability during shearing, heating and cooling, regardless of the substitution degree. More interestingly, while the physicochemical properties could be regulated by simply altering the BM treatment time, BM/OSA was more efficient and effective at modulating starch properties during the initial period (approx. 10h), as seen by the rapid evolutions in starch structural disruption and OSA esterification. Thus, the BM/OSA modification can serve as a viable and cost-effective approach for producing octenyl succinate starches where low viscosity (at relatively high concentrations) and high paste stability are desired.

  4. [Acute aortic syndromes and sleep apnea].

    PubMed

    Baguet, Jean-Philippe

    2016-10-01

    Obstructive sleep apnea (OSA) is a common disease, often present in "cardiovascular or metabolic patients". OSA favours the occurrence of arterial lesions, all the more if severe. There is a strong relationship between OSA and acute aortic syndromes (AAS). This relationship is in part explained by aortic dilatation linked to OSA. The presence of repeated episodes of sudden variation of transmural pressure applied on aortic wall seems to play a major role in this dilatation. All OSA patients should have a search of aortic dilatation by ultrasound (at a thoracic and abdominal level). Also, screening of OSA should be systematically performed in patients with aortic disease. The effect of continuous positive airway pressure in apneic patients with AAS has not been studied.

  5. 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. Copyright © 2016. Published by Elsevier Masson SAS.

  6. Predictive abilities of the STOP-Bang and Epworth Sleepiness Scale in identifying sleep clinic patients at high risk for obstructive sleep apnea.

    PubMed

    Vana, Kimberly D; Silva, Graciela E; Goldberg, Rochelle

    2013-02-01

    This study compared the predictive abilities of the STOP-Bang and Epworth Sleepiness Scale (ESS) for screening sleep clinic patients for obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB). Forty-seven new adult patients without previous diagnoses of OSA or SDB were administered the STOP-Bang and ESS and were assigned to OSA or SDB risk groups based on their scores. STOP-Bang responses were scored with two Body Mass Index cut points of 35 and 30 kg/m(2) (SB35 and SB30). The tools' predictive abilities were determined by comparing patients' predicted OSA and SDB risks to their polysomnographic results. The SB30 correctly identified more patients with OSA and SDB than the ESS alone. The ESS had the highest specificity for OSA and SDB.

  7. Obstructive sleep apnea as a risk factor for type 2 diabetes mellitus

    PubMed Central

    Rajan, Preethi; Greenberg, Harly

    2015-01-01

    Obstructive sleep apnea (OSA) is independently associated with cardiovascular and cardiometabolic risk in several large epidemiologic studies. OSA leads to several physiologic disturbances such as intermittent hypoxia, sleep fragmentation, and increase in autonomic tone. These disturbances have been associated with insulin resistance and type 2 diabetes mellitus (T2DM) in animal and human studies. Studies also suggest a bidirectional relationship between OSA and T2DM whereby T2DM itself might contribute to the features of OSA. Moreover, successful treatment of OSA may reduce these risks, although this is controversial. The purpose of this article is to review 1) the links and bidirectional associations between OSA and T2DM; 2) the pathogenic mechanisms that might link these two disease states; 3) the role of continuous positive airway pressure therapy in improving glucose tolerance, sensitivity, and resistance; and 4) the implications for clinical practice. PMID:26491377

  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.

  9. Sleep-Disordered Breathing and Excessive Daytime Sleepiness.

    PubMed

    He, Ken; Kapur, Vishesh K

    2017-09-01

    Sleep-related breathing disorders include obstructive sleep apnea (OSA), central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia. Excessive daytime sleepiness (EDS) is frequently reported by patients with OSA but is not invariably present. The efficacy of positive airway pressure therapy in improving EDS is well established for OSA, but effectiveness is limited by suboptimal adherence. Non-OSA causes of sleepiness should be identified and treated before initiating pharmacotherapy for persistent sleepiness despite adequately treated OSA. Further research on the identification of factors that promote EDS in the setting of OSA is needed to aid in the development of better treatment options. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. A Novel Class of Plant Type III Polyketide Synthase Involved in Orsellinic Acid Biosynthesis from Rhododendron dauricum

    PubMed Central

    Taura, Futoshi; Iijima, Miu; Yamanaka, Eriko; Takahashi, Hironobu; Kenmoku, Hiromichi; Saeki, Haruna; Morimoto, Satoshi; Asakawa, Yoshinori; Kurosaki, Fumiya; Morita, Hiroyuki

    2016-01-01

    Rhododendron dauricum L. produces daurichromenic acid, the anti-HIV meroterpenoid consisting of sesquiterpene and orsellinic acid (OSA) moieties. To characterize the enzyme responsible for OSA biosynthesis, a cDNA encoding a novel polyketide synthase (PKS), orcinol synthase (ORS), was cloned from young leaves of R. dauricum. The primary structure of ORS shared relatively low identities to those of PKSs from other plants, and the active site of ORS had a unique amino acid composition. The bacterially expressed, recombinant ORS accepted acetyl-CoA as the preferable starter substrate, and produced orcinol as the major reaction product, along with four minor products including OSA. The ORS identified in this study is the first plant PKS that generates acetate-derived aromatic tetraketides, such as orcinol and OSA. Interestingly, OSA production was clearly enhanced in the presence of Cannabis sativa olivetolic acid cyclase, suggesting that the ORS is involved in OSA biosynthesis together with an unidentified cyclase in R. dauricum. PMID:27729920

  11. Obstructive sleep apnea-hypopnea syndrome and nonalcoholic fatty liver disease: emerging evidence and mechanisms.

    PubMed

    Musso, Giovanni; Olivetti, Carla; Cassader, Maurizio; Gambino, Roberto

    2012-02-01

    Obstructive sleep apnea syndrome (OSAS) and nonalcoholic fatty liver disease (NAFLD) are common conditions, frequently encountered in patients with metabolic disorders. OSAS has been associated with an increased risk of cardiovascular and metabolic complications. It has been recently suggested that the chronic intermittent hypoxia of OSAS may also affect the presence and severity of NAFLD. We will critically review experimental and human evidence connecting OSAS to NAFLD pathogenesis, trying to dissect the effect of intermittent hypoxia from that of obesity and associated comorbidities, and examine molecular mechanisms connecting OSAS to liver and metabolic disease in NAFLD, including hypoxia inducible factor (HIF), nuclear factor-kappa B, unfolded protein response, hypoxic adipose tissue inflammation, and their therapeutic potential for NAFLD and its complications, including cirrhosis and hepatocellular carcinoma. Finally, we will provide suggestions for the management of NAFLD patients with suspected OSAS and recommendations for future research. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Evaluation of optimal water fluoridation on the incidence and skeletal distribution of naturally arising osteosarcoma in pet dogs.

    PubMed

    Rebhun, R B; Kass, P H; Kent, M S; Watson, K D; Withers, S S; Culp, W T N; King, A M

    2016-01-14

    Experimental toxicological studies in laboratory animals and epidemiological human studies have reported a possible association between water fluoridation and osteosarcoma (OSA). To further explore this possibility, a case-control study of individual dogs evaluated by the UC Davis Veterinary Medical Teaching Hospital was conducted using ecologic data on water fluoridation based on the owner's residence. The case group included 161 dogs with OSA diagnosed between 2008-2012. Two cancer control groups included dogs diagnosed with lymphoma (LSA) or hemangiosarcoma (HSA) during the same period (n = 134 and n = 145, respectively). Dogs with OSA were not significantly more likely to live in an area with optimized fluoride in the water than dogs with LSA or HSA. Additional analyses within OSA patients also revealed no significant differences in age, or skeletal distribution of OSA cases relative to fluoride status. Taken together, these analyses do not support the hypothesis that optimal fluoridation of drinking water contributes to naturally occurring OSA in dogs.

  13. Preparation and characterization of octenylsuccinylated plantain starch.

    PubMed

    Bello-Flores, Christopher A; Nuñez-Santiago, Maria C; San Martín-Gonzalez, María F; BeMiller, James N; Bello-Pérez, Luis A

    2014-09-01

    Plantain starch was esterified with octenylsuccinic anhydride (OSA) at two concentrations (3 and 15% w/w) of OSA. The morphology, granule size distribution, pasting, gelatinization, swelling, and solubility of granules and structural features of the starch polymers were evaluated. Granules of the OSA-modified starches increased in size during cooking more than did the granules of the native starch, and the effect was greater at the higher OSA concentration. Pasting viscosities also increased, but gelatinization and pasting temperatures and enthalpy of gelatinization decreased in the OSA-modified starches. It was concluded that insertion of OS groups effected disorder in the granular structure. Solubility, weight average molar mass, Mw¯, and z-average radius of gyration, RGz, of the amylopectin decreased as the OSA concentration increased, indicating a decrease in molecular size.

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

    PubMed

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

    2015-09-09

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

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-09-01

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

  17. Obstructive sleep apnea pretreatment and posttreatment in symptomatic children with congenital craniofacial malformations.

    PubMed

    Moraleda-Cibrián, Marta; Edwards, Sean P; Kasten, Steven J; Buchman, Steven R; Berger, Mary; O'Brien, Louise M

    2015-01-15

    Obstructive sleep symptoms are common in children with craniofacial malformations (CFM). However objective data about obstructive sleep apnea (OSA) is still limited. The aims of this study were to investigate the frequency of OSA in symptomatic children with CFM and to determine improvement in severity of OSA after treatment. Symptomatic children with CFM referred for a diagnostic polysomnogram (PSG) were identified. Obstructive sleep apnea was defined as an apnea/hypopnea index (AHI) ≥ 1, with moderate/severe OSA as an AHI ≥ 5. Overall, 151 symptomatic children were identified; 87% were diagnosed with OSA, of whom 24% had moderate-to-severe OSA. Children with syndromic CFM, compared to non-syndromic CFM, were more likely to have an AHI ≥ 5 (syndromic 33% vs. non-syndromic 15%, p = 0.02). Of the 131 children with OSA, 64 were treated and 32 returned for a posttreatment PSG, with 22 treated with either positive airway pressure (PAP) or adenotonsillectomy (AT). Children treated with PAP demonstrated a decrease in AHI from 6.2 to 3.5 (p = 0.057) and an increase in SpO2 from 89.1% to 91.1% (p = 0.091). There were no significant improvements for those in the AT group for either AHI (2.5 to 1.8, p = 0.19) or SpO2 (90.4% to 91.3%, p = 0.46). Normalization of the AHI (AHI < 1) occurred in only one child in each group (7% and 14% of the PAP and AT groups, respectively). The vast majority of children with CFM referred for OSA evaluation are found to have objective evidence of OSA and a quarter of children have moderate-to-severe OSA. It is likely that many children with underlying OSA are not identified and referred for evaluation. Residual OSA after treatment is common in children with CFM. © 2015 American Academy of Sleep Medicine.

  18. 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

  19. Facial appearance following surgical treatment for obstructive sleep apnea syndrome.

    PubMed

    Goodday, Reginald; Gregoire, Curtis

    2008-05-01

    Obstructive sleep apnea syndrome (OSAS) is a serious medical condition that is associated with numerous negative health side effects. The general dentist plays an invaluable role in identifying patients with this condition. Certain OSAS patients receive significant medical and social benefits from orthognathic surgery to advance the maxilla, mandible, and chin. Anterior positioning of the maxilla and mandible is not only highly successful for curing OSAS but also results in favorable facial esthetic changes.

  20. Increased eustachian tube dysfunction in infants with obstructive sleep apnea.

    PubMed

    Robison, Jacob G; Wilson, Caleb; Otteson, Todd D; Chakravorty, Sangeeta S; Mehta, Deepak K

    2012-05-01

    To investigate the prevalence of eustachian tube dysfunction (ETD) in infants with obstructive sleep apnea (OSA). Retrospective medical record review of infants (3-24 months old) diagnosed with OSA and ETD. There were 94 infants diagnosed with OSA by polysomnography and ETD as determined by performance of myringotomy and ventilation tube placement (MT). The main outcome measures were demographic data, apnea-hypopnea index, dates and number of MTs, interventions for treatment of OSA, and medical comorbidities. Of 295 infants diagnosed with OSA, 94 (31.9%) had concomitant ETD. A total of 135 MT procedures were performed, with 30 (31.9%) patients undergoing two or more procedures. The average age of first MT was 16.3 months for those undergoing MT only once, and 11.1 months for those undergoing at least two MT procedures. There was no difference in average age of first MT when analyzed by OSA severity (15.6 months, 14.2 months, and 14.6 months for mild, moderate, and severe OSA, respectively). The first MT procedure was performed before or concurrent with the first treatment for OSA in 75 (80%) patients. Of the 137 interventions for treatment of OSA, 10 (45.5%) nonsurgical and 75 (65.2%) surgical interventions did not require further MT procedures afterward. The ETD prevalence of 32% in infants with OSA is increased compared to the general pediatric prevalence of 4% to 7%. Patients presenting for evaluation of OSA should also be evaluated for ETD. Surgical interventions for treatment of OSA led to decreased need for further MT procedures. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  1. Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea

    PubMed Central

    Aurora, R. Nisha; Collop, Nancy A.; Jacobowitz, Ofer; Thomas, Sherene M.; Quan, Stuart F.; Aronsky, Amy J.

    2015-01-01

    Obstructive sleep apnea (OSA) is a prevalent disorder associated with a multitude of adverse outcomes when left untreated. There is significant heterogeneity in the evaluation and management of OSA resulting in variation in cost and outcomes. Thus, the goal for developing these measures was to have a way to evaluate the outcomes and reliability of the processes involved with the standard care approaches used in the diagnosis and management of OSA. The OSA quality care measures presented here focus on both outcomes and processes. The AASM commissioned the Adult OSA Quality Measures Workgroup to develop quality care measures aimed at optimizing care for adult patients with OSA. These quality care measures developed by the Adult OSA Quality Measures Workgroup are an extension of the original Centers for Medicare & Medicaid Services (CMS) approved Physician Quality Reporting System (PQRS) measures group for OSA. The measures are based on the available scientific evidence, focus on public safety, and strive to improve quality of life and cardiovascular outcomes for individual OSA patients. The three outcomes that were selected were as follows: (1) improve disease detection and categorization; (2) improve quality of life; and (3) reduce cardiovascular risk. After selecting these relevant outcomes, a total of ten process measures were chosen that could be applied and assessed for the purpose of accomplishing these outcomes. In the future, the measures described in this document may be reported through the PQRS in addition to, or as a replacement for, the current OSA measures group. The overall objective for the development of these measures is that implementation of these quality measures will result in improved patient outcomes, reduce the public health burden of OSA, and provide a measurable standard for evaluating and managing OSA. Citation: Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with

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

    PubMed Central

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

    2014-01-01

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

  3. 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

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

    PubMed Central

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

    2016-01-01

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

  5. Risk Assessment of Obstructive Sleep Apnea in a Population of Patients Undergoing Ambulatory Surgery

    PubMed Central

    Stierer, Tracey L.; Wright, Christopher; George, Anu; Thompson, Richard E.; Wu, Christopher L.; Collop, Nancy

    2010-01-01

    Study Objectives: The aims of this study were to: (a) assess the prevalence of diagnosed OSA and symptoms of undiagnosed OSA in a cohort of ambulatory surgical patients, and (b) characterize the frequency of postoperative complications in outpatients with a diagnosis of or a propensity to OSA. Methods: Patients presenting for ambulatory surgery completed a self-administered questionnaire. Using a previously validated prediction model, the probability for OSA was determined. Patients with ≥ 70% propensities were considered to be at high risk of having the disorder. Relevant perioperative data and complications were tracked and recorded, and differences in median estimated propensities for OSA were considered by these data. Results: Three-thousand five hundred fifty-three patients completed the preoperative survey. A total of 2139 patients had perioperative data and estimated propensity scores. Ninety-four of the 2139 (4.4%) patients gave a self-reported prior diagnosis of OSA. One hundred three (4.8%) patients were found to be at high risk of OSA based on the survey and prediction model. Seventy-five percent of the patients with > 70% propensity for OSA had not yet been diagnosed. There was no association between OSA propensity scores and unplanned hospital admission, however there was an association of increased propensity with difficult intubation, intraoperative use of pressors, and postoperative oxygen saturation in the PACU. Conclusion: The results of this study suggest that undiagnosed OSA may be relatively common in an ambulatory surgical population. There was no relationship between unplanned hospital admission and diagnosis of or increased risk of OSA. However, there was an association of increased perioperative events requiring additional anesthetic management in patients with a diagnosis of, or with a higher propensity to OSA. Citation: Stierer TL; Wright C; George A; Thompson RE; Wu CL; Collop N. Risk assessment of obstructive sleep apnea in a

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

    PubMed Central

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

    2014-01-01

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

  7. Assessment of the role of serum ischemia-modified albumin in obstructive sleep apnea in comparison with interleukin-6.

    PubMed

    Dogan, Deniz; Ocal, Nesrin; Aydogan, Mehmet; Tasci, Canturk; Arslan, Yakup; Tapan, Serkan; Yetkin, Sinan; Bilgic, Hayati

    2016-08-01

    There is limited and contradictory information regarding the role of serum ischemia-modified albumin (IMA) in obstructive sleep apnea (OSA). In this study we examine the effects of OSA and obesity on IMA and interleukin-6 (IL-6), and detect whether IMA and IL-6 may be potential biomarkers in OSA. Fifty-one males who underwent all night polysomnography test were included into the study. Body-mass index (BMI) and apnea-hypopnea index (AHI) of all patients were determined. Serum IMA and IL-6 levels, erythrocyte sedimentation rate (ESR), complete blood count, routine blood biochemistry and thyroid function tests were performed. Mean IMA [0.36 (± 0.04) U/ml, 0.89 (± 0.15) U/ml], mean IL-6 [1.01 (± 0.19) pg/ml, 2.02 (± 1.19) pg/ml] and mean ESR [4.14 (± 2.5) mm/h, 14.35 (± 13.7) mm/h] levels showed significant difference between non-OSA and OSA groups (P = 0.005, P < 0.001, P < 0.001, respectively). Sensitivity of IMA in distinction of non-OSA/OSA was equal to IL-6 and higher than ESR. IMA was also a stronger predictive factor than IL-6 and ESR in the evaluation of OSA groups (severe/mild/moderate OSA and non-OSA). IMA was the sole distinctive biomarker in assessment of obese and non-obese cases. IMA correlated with IL-6, AHI and ESR. Serum IMA may be a valuable oxidative stress indicator for OSA and could act as a better biomarker than IL-6 for reflecting the presence and the severity of OSA.

  8. The influence of the oscillation angle and the neck anteversion of the prosthesis on the cup safe-zone that fulfills the criteria for range of motion in total hip replacements. The required oscillation angle for an acceptable cup safe-zone.

    PubMed

    Yoshimine, Fumihiro

    2005-01-01

    A normal hip joint has more than 120 degrees flexion. The reduced range of motion (ROM) of total hip arthroplast leads to frequent prosthetic impingement, subluxation and dislocation. Prosthetic impingement may be more serious for metal-on-metal and ceramic-on-ceramic total hip prosthesis (THP). A larger oscillation angle of THP (OsA) and proper cup and neck positions make a larger theoretical ROM of a patient's artificial hip joint. But what OsA is required and what range of cup positions is kinetically accepted are not clearly understood. A ROM of more than 120 degrees flexion, 45 degrees internal-rotation at 90 degrees flexion, 30 degrees extension and 40 degrees external-rotation was defined as severe criteria for an acceptable ROM. Theoretical cup safe-zones were created that fulfill the severe criteria of ROM for (OsA=110 degrees , 120 degrees , 135 degrees ) by the mathematical formulas. The size of the cup safe-zone mainly depends on the size of the OsA. There is no cup safe-zone for 110 degrees OsA, an extremely small safe-zone for 120 degrees OsA and an acceptable safe-zone for 135 degrees OsA. Each THP has its own OsA, because OsA is the function of head and neck diameter and cup design. More than 135 degrees OsA enlarges the safe-zone of the prosthetic position, so it extends the acceptable range of error that surgeons cannot avoid completely. However, few THPs with more than 135 degrees OsA are currently clinically available. Both surgeons and manufacturers must realize that OsA is as essential as cup and neck orientations for ROM.

  9. 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

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

    PubMed Central

    Lindberg, Eva

    2015-01-01

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

  11. Obesity and craniofacial structure as risk factors for obstructive sleep apnoea: impact of ethnicity.

    PubMed

    Sutherland, Kate; Lee, Richard W W; Cistulli, Peter A

    2012-02-01

    OSA is the result of structural and functional abnormalities that promote the repetitive collapse of the upper airway during sleep. This common disorder is estimated to occur in approximately 4% of men and 2% of women, with prevalence studies from North America, Australia, Europe and Asia indicating that occurrence is relatively similar across the globe. Anatomical factors, such as obesity and craniofacial morphology, are key determinants of the predisposition to airway collapse; however, their relative importance for OSA risk likely varies between ethnicities. Direct inter-ethnic studies comparing craniofacial phenotypes in OSA are limited. However, available data suggest that Asian OSA populations primarily display features of craniofacial skeletal restriction, African Americans display more obesity and enlarged upper airway soft tissues, while Caucasians show evidence of both bony and soft tissue abnormalities. Our recent comparison of Chinese and Caucasian OSA patients found for the same degree of OSA severity. Caucasians were more obese, and Chinese had more skeletal restriction. However, the ratio of obesity to craniofacial bony size (or anatomical balance, an important determinant of upper airway volume and OSA risk) was similar between Caucasians and Chinese OSA patients. Ethnicity appears to influence OSA craniofacial phenotype but furthermore the relative contribution of the anatomical factors underlying OSA risk. The skeletal restriction craniofacial phenotype may be particularly vulnerable to increasing obesity rates. Better understanding of craniofacial phenotypes encompassing ethnicity may help improve OSA recognition and treatment; however, further studies are needed to elucidate ethnic differences in OSA anatomical risk factors. © 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

  12. Gender-related changes of the epicardial fat thickness and leptin in obstructive sleep apnea.

    PubMed

    Akilli, Hakan; Kayrak, Mehmet; Bekci, Taha Tahir; Erdogan, Halil İbrahim; Aribas, Alpay; Yildirim, Oguzhan; Taner, Alpaslan; Erer, Murat; Unlu, Ali

    2014-04-01

    Epicardial fat thickness (EFT), an indicator of visceral obesity, and leptin are 2 novel markers for studying the obstructive sleep apnea (OSA) population. This study aimed to investigate the effects of gender on leptin levels and EFT, and the relation with OSA severity. A total of 149 patients with OSA (female/male 55/94 and mean age 50.8 ± 9.2 years) and 50 control patients (female/male 24/26 and mean age 48.9 ± 8.8 years) were included in the study. The study population was divided into 4 groups according to apnea/hypopnea index (AHI) as control (AHI <5), the mild OSA (AHI 5-14), the moderate OSA (AHI 15-29), and the severe OSA (AHI ≥30). EFT was obtained from parasternal long-axis and parasternal short-axis echocardiographic images. Leptin levels among females were significantly higher than among males (10.5 [7.8] vs. 5.4 [4.5] ng/mL, P = 0.001, respectively). Among women, leptin levels were significantly higher in the severe OSA group compared to the control group (9.8 [9.0] vs. 15.5 [10.1] ng/mL, P = 0.05, respectively). Conversely, no relation was observed between OSA severity and the leptin levels among men. EFT was not significantly different between the 2 genders (P > 0.05). EFT was thicker in the severe OSA group than in the control and mild OSA groups among women, whereas EFT was not changed according to OSA severity among males (P > 0.05). Leptin and EFT may be a valuable parameter in the evaluation of OSA severity in women than in men. © 2013, Wiley Periodicals, Inc.

  13. Advanced Optical Fiber Development for kW Fiber Lasers with Sub-GHz Linewidth

    DTIC Science & Technology

    2016-01-12

    Advanced Optical Fiber Development for kW Fiber Lasers with Sub-GHz Linewidth The project is for acquiring an optical spectrum analyzer (OSA) covering...Report Title The project is for acquiring an optical spectrum analyzer (OSA) covering wavelength range from 1900nm to 3400nm (Yokogawa AQ6375- Z-D/FC/RFC...STATEMENT 13. SUPPLEMENTARY NOTES 14. ABSTRACT The project is for acquiring an optical spectrum analyzer (OSA) covering wavelength range

  14. Obstructive sleep apnea and heart rate asymmetry microstructure during sleep.

    PubMed

    Guzik, Przemyslaw; Piskorski, Jaroslaw; Awan, Kokab; Krauze, Tomasz; Fitzpatrick, Michael; Baranchuk, Adrian

    2013-04-01

    Heart rate decelerations and accelerations have unequal input to heart rate variability (HRV) and patterns created by consecutive cardiac cycles-this phenomenon is known as heart rate asymmetry (HRA). The analysis of monotonic runs of heart rate decelerations and accelerations provides a detailed insight into the HRA microstructure and thus of HRV. To evaluate the relation between the severity of obstructive sleep apnea (OSA) and the HRA microstructure during sleep. Seventy-eight patients with suspected OSA underwent overnight polysomnography. The 300-min ECGs from the polysomnography were selected and analyzed. The HRA microstructure was quantified by measuring (1) the contribution of monotonic runs of decelerations or accelerations of different lengths to the number of all sinus beats, and (2) the length of the longest deceleration and acceleration runs. There were 19 patients with no/mild OSA (Apnea/Hypopnea Index (AHI) 5.1 ± 2.5/h), 18 with moderate OSA (AHI 21.8 ± 4.0/h) and 41 with severe OSA (AHI 42.8 ± 17.4/h). Patients with severe OSA had significantly reduced deceleration and acceleration runs of length 1 compared to the moderate OSA group, and compared to patients with no/mild OSA they had an increased number of longer runs (from 5 to 10 for accelerations and from 5 to 8 for decelerations; p < 0.05 for all comparisons). The longest acceleration runs were significantly longer in severe OSA group (p < 0.05) than in subjects with no/mild OSA. HRA microstructure is related with OSA severity. An increased number of longer deceleration and acceleration runs is more common in severe OSA patients.

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

    PubMed Central

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

    2016-01-01

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

  16. Prevalence of metabolic syndrome in a north Indian hospital-based population with obstructive sleep apnoea

    PubMed Central

    Agrawal, Swastik; Sharma, Surendra K.; Sreenivas, Vishnubhatla; Lakshmy, Ramakrishnan

    2011-01-01

    Background & objectives: Obstructive sleep apnoea (OSA) is known to be associated with cardiovascular risk factors and metabolic syndrome (MS). The burden of MS in patients with OSA in India is unknown. We investigated the prevalence of MS and its components in a cross-sectional study in patients with and without OSA in a hospital-based population of a tertiary health care centre in New Delhi, India. Methods: Consecutive patients undergoing overnight polysomnography in the Sleep Laboratory of the Department of Internal Medicine of All India Institute of Medical Sciences (AIIMS) hospital, New Delhi, were studied. Anthropometry and body composition analysis, blood pressure (BP), fasting blood glucose, insulin resistance by homeostasis model assessment (HOMA-IR) and fasting blood lipid profile were measured. MS was defined using the National Cholesterol Education Program Adult treatment panel III criteria, with Asian cut-off values for abdominal obesity. Results: Of the 272 subjects recruited, 187 (82%) had OSA [apnoea-hypopnoea index (AHI)>5 events/h] while 40 (18%) had a normal sleep study. Prevalence of MS in OSA patients was 79 per cent compared to 48 per cent in non-OSA individuals [OR 4.15, (2.05-8.56), P<0.001]. Prevalence of OSA in mild, moderate and severe OSA was 66, 72 and 86 per cent, respectively (P<0.001). Patients with OSA were more likely to have higher BP [OR: 1.06 (1.02-1.11)], fasting insulin [OR: 1.18 (1.05-1.32)], HOMA-IR [OR: 1.61 (1.11-2.33)] and waist circumference [OR: 1.20 (1.13-1.27)]. Interpretation & conclusions: Our findings suggest that OSA is associated with a 4-fold higher occurrence of MS than patients without OSA. The prevalence of MS increases with increasing severity of OSA, therefore, early detection will be beneficial. PMID:22199102

  17. Evaluation of Ocular Surface Health in Patients with Obstructive Sleep Apnea Syndrome

    PubMed Central

    Karaca, Emine Esra; Akçam, Hanife Tuba; Uzun, Feyzahan; Özdek, Şengül; Ulukavak Çiftçi, Tansu

    2016-01-01

    Objectives: To evaluate ocular surface health in obstructive sleep apnea syndrome (OSAS) and to investigate the tendency of these patients toward dry eyes. Materials and Methods: Fifty patients who underwent polysomnography and were diagnosed with OSAS and 50 normal control subjects were compared with respect to ocular surface disease index (OSDI), Schirmer I test and tear film break-up time (TBUT) values. Results: Patients were grouped as mild (n=15, 30%), moderate (n=15, 30%) and severe (n=20, 40%) according to apnea-hypopnea index values. The right eyes of patients were included in both groups. OSDI values were as follows: control group, 18.7±8.5; mild OSAS group, 40.2±2.8; moderate OSAS group, 48.5±2.2 and severe OSAS group, 62.7±2.3 (p<0.001). TBUT values were as follows: control group, 12.3±4.9; mild OSAS group, 8.2±4.7; moderate OSAS group, 5.8±2.1 and severe OSAS group, 4.2±3.7 (p<0.001). Schirmer values were as follows: control group, 18±6.1 mm; mild OSAS group, 12.9±6.7 mm; moderate OSAS group, 8.5±5.2 mm and severe OSAS group, 7.9±4.7 mm (p<0.001). Conclusion: Patients with OSAS seem to have a tendency toward dry eyes. Clinicians should be aware of dry eye development in these patients. PMID:27800271

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2013-01-01

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

  20. Acoustic-integrated dynamic MR imaging for a patient with obstructive sleep apnea.

    PubMed

    Chen, Yunn-Jy; Shih, Tiffany Ting-Fang; Chang, Yi-Chung; Hsu, Ying-Chieh; Huon, Leh-Kiong; Lo, Men-Tzung; Pham, Van-Truong; Lin, Chen; Wang, Pa-Chun

    2015-12-01

    Obstructive sleep apnea syndrome (OSAS) is caused by multi-level upper airway obstruction. Anatomic changes at the sites of obstruction may modify the physical or acoustic properties of snores. The surgical success of OSA depends upon precise localization of obstructed levels. We present a case of OSAS who received simultaneous dynamic MRI and snore acoustic recordings. The synchronized image and acoustic information successfully characterize the sites of temporal obstruction during sleep-disordered breathing events.

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

    PubMed

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

    2015-01-01

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

  2. Obstructive sleep apnea and acute respiratory failure: An analysis of mortality risk in patients with pneumonia requiring invasive mechanical ventilation.

    PubMed

    Jean, Raymonde E; Gibson, Charlisa D; Jean, Raymond A; Ochieng, Pius

    2015-08-01

    Although obstructive sleep apnea (OSA) is common and pneumonia is a frequent cause of acute respiratory failure requiring admission to the intensive care unit, little is known about the effect of OSA on this patient population. This study examined outcomes associated with OSA in patients with pneumonia requiring invasive mechanical ventilation. The Nationwide Inpatient Sample was investigated for discharges with a primary diagnosis of pneumonia requiring invasive mechanical ventilation between 2009 and 2011. Persons aged 18 to 75 years with OSA were compared with patients without OSA. Outcomes included in-hospital mortality and nonroutine discharges. Among 74032 hospitalizations, 13.8% (10227) were obese, and 10.3% (7610) had OSA. Obstructive sleep apnea patients had decreased in-hospital mortality (17.0% vs 25.8%; P < .01) and nonroutine discharge (74.4% vs 79.4%; P < .01) when compared with non-OSA patients. In adjusted logistic models, OSA was associated with a 27% decreased risk of in-hospital mortality (odds ratio, 0.73; 95% confidence interval, 0.68-0.79; P < .01) and a 21% decreased risk of nonroutine discharge (odds ratio, 0.79; 95% confidence interval, 0.74-0.84; P < .01). In mechanically ventilated patients with pneumonia, OSA was associated decreased in-hospital mortality and nonroutine discharge. It is possible that differences in treatment pattern may partially explain improved survival. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. The incremental effect of obstructive sleep apnea syndrome on right and left ventricular myocardial performance in newly diagnosed essential hypertensive subjects.

    PubMed

    Gao, Jing; Hua, Qi; Li, Jing; Wang, Cai-Rong

    2009-03-01

    Obstructive sleep apnea syndrome (OSAS) may predispose patients to congestive heart failure, suggesting a deleterious effect of OSAS on myocardial contractility. We investigated whether essential hypertensive individuals with OSAS are characterized by decreased right and left ventricular myocardial performance. Our study population consisted of 45 consecutive patients with newly diagnosed untreated stage I-II essential hypertension suffering from OSAS (35 men, aged 49+/-8 years) and 48 hypertensives without OSAS, matched for age, sex, level of blood pressure, heart rate, body mass index and smoking status. All subjects underwent polysomnography and echocardiography. Right and left ventricular functions were evaluated using the myocardial performance index (MPI). Right and left ventricular functions were altered in hypertensives with OSAS. The mean right MPI was 0.26+/-0.11 in hypertensives without OSAS and 0.51+/-0.16 in hypertensives with OSAS (P<0.01). The mean left MPI values were 0.29+/-0.07 and 0.44+/-0.13, respectively (P<0.01). Right and left MPI correlated positively and significantly with apnea-hypopnea index (rho=0.40, P=0.002).OSAS is associated with impaired right and left ventricular function. These phenomena were independent of hypertension.

  4. A review of oil-suspended particulate matter aggregation--a natural process of cleansing spilled oil in the aquatic environment.

    PubMed

    Sun, Juan; Zheng, Xilai

    2009-10-01

    It has been acknowledged that following an oil spill in coastal areas where suspended particulate matter (SPM) is rich, aggregation between oil and SPM can be naturally formed. This kind of aggregation product is termed as oil-SPM aggregates (OSAs). Because OSAs are not as sticky to the shorelines as crude oil and the oil-water contact area is greatly increased due to the formation of OSAs, both oil dispersion into the water body and oil biodegration would be significantly enhanced. In this review article, the authors (1) describe in detail the mechanism of OSA formation and controlling parameters which can influence OSA formation (the parameters discussed include the oil nature and properties, sediment types and concentrations, and the environmental factors such as salinity, temperature and mixing energy); (2) briefly review qualitative and quantitative methods used for characterization of OSA formation (two main methods used for the OSA characterization are the UV epi-fluorescence microscopy and gas chromatography equipped with flame ionization detector (GC-FID); (3) elucidate the applications of OSA formation in oil spill response strategies including natural attenuation, sediment relocation, and sediment mixing; and (4) discuss research needs in the future which would further improve our understanding of OSA formation and move towards the development of adequate oil behaviour models.

  5. Relationship of oxidative stress and endothelial dysfunction in sleep apnoea.

    PubMed

    Jurado-Gámez, B; Fernandez-Marin, M C; Gómez-Chaparro, J L; Muñoz-Cabrera, L; Lopez-Barea, J; Perez-Jimenez, F; Lopez-Miranda, J

    2011-04-01

    The aim of the present study was to evaluate ischaemic reactive hyperaemia (IRH) in obstructive sleep apnoea (OSA) and its relationship with oxidative stress. We studied 69 consecutive patients referred to our Sleep Unit (Reina Sofia University Hospital, Cordoba, Spain). Patients with chronic diseases or those taking medication were excluded. IRH was assessed before and after polysomnography. Morning IRH and oxidative stress markers were compared between patients with (apnoea-hypopnoea index (AHI) ≥ 5) and without (AHI < 5) OSA. Measurements were repeated in 25 severe OSA patients after continuous positive airway pressure (CPAP) therapy. We included 46 OSA patients (mean ± sd AHI 49 ± 32.1) and 23 non-OSA subjects (AHI 3 ± 0.9). The OSA patients showed a significant worsening of morning IRH, and a significant increase in malondialdehyde and 8-hydroxydeoxyguanosine levels. Only the oxygen desaturation index independently explained morning IRH, while malondialdehyde levels showed a weak effect on IRH. In severe OSA patients, IRH improved significantly after CPAP treatment, as did malondialdehyde, 8-hydroxydeoxyguanosine and protein carbonyl levels. In OSA patients, endothelial dysfunction and oxidative stress were observed, and IRH worsened after sleep. The increase in oxidative stress was not associated with IRH, while intermittent hypoxia was strongly associated with IRH. In severe OSA patients, CPAP treatment improved oxidative stress and endothelial function.

  6. Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

    PubMed Central

    Gildeh, Nadia; Drakatos, Panagis; Higgins, Sean; Rosenzweig, Ivana

    2016-01-01

    Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation. PMID:27747026

  7. [Relationship between symptoms of obstructive sleep apnea syndrome and traffic accidents in the city drivers].

    PubMed

    Akkoyunlu, Muhammed Emin; Kart, Levent; Uludağ, Murat; Bayram, Mehmet; Alisha, Gersi; Özçelik, Hatice; Karaköse, Fatmanur; Sezer, Murat

    2013-01-01

    There is a high tendency for traffic accidents in patients with obstructive sleep apnea syndrome (OSAS). Thus it's recommended to investigate OSAS symptoms before certification of professional drivers. However, to what degree OSAS symptoms predict traffic accidents is not clear. We aimed to investigate the relationship between OSAS symptoms and traffic accidents. Five hundred twenty bus drivers working at Istanbul Electricity, Tramway and Tunnel (IETT) general management were randomly selected. Berlin questionnaire was applied which included demographic data, accident ratios, total duration in profession, duration of working in a day and OSAS symptoms. Epworth sleepiness score (ESS) test was applied to assess day time slepiness. All drivers were male. Snoring were present in 324 (65.7%) of participants. Traffic accident history were present in 259 (49.7%) of drivers. Significant relationship was present between traffic accident and only daytime sleepiness among the OSAS symptoms. The mean of accident/year ratio of all participants were 0.092. Mean of ESS was 7.3 ± 3.2 for all participants. There is a positive correlation between ESS and accident/year ratio (r= 0.57, p= 0.012). Only daytime sleepiness among OSAS symptoms is related with traffic accident. The questioning of OSAS symptoms alone is inadequate to estimate traffic accident risk. Thus further consideration more than symptom questioning is needed at phase of authorization of professional drivers to detect OSAS.

  8. Prevalence of M75 Streptococcus pyogenes Strains Harboring slaA Gene in Patients Affected by Pediatric Obstructive Sleep Apnea Syndrome in Central Italy

    PubMed Central

    Viciani, Elisa; Montagnani, Francesca; Tordini, Giacinta; Romano, Antonio; Salerni, Lorenzo; De Luca, Andrea; Ruggiero, Paolo; Manetti, Andrea G. O.

    2017-01-01

    Recently we reported an association between pediatric obstructive sleep apnea syndrome (OSAS) and Group A streptococcus (GAS) sub-acute chronic tonsil colonization. We showed that GAS may contribute to tonsil hyperplasia via a streptolysin O (SLO)-dependent cysteinyl leukotrienes (CysLTs) production, which can trigger T and B cell proliferation. In the present study, we characterized the GAS strains isolated from pediatric OSAS patients in comparison with a panel of age and sex matched GAS strains unrelated to OSAS, but isolated in the same area and during the same period ranging from 2009 to 2013. We found that slaA gene, previously reported to be associated to CysLTs production pathway, was significantly associated to GAS OSAS strains. Moreover, the most numerous group (32%) of the GAS OSAS strains belonged to M75 type, and 6 out of 7 of these strains harbored the slaA gene. Multilocus Sequence Typing (MLST) experiments demonstrated that the clone emm75/ST49/ smeZ, slaA was associated to OSAS cases. In conclusion, we found an association between slaA gene and the GAS OSAS strains, and we showed that the clone emm75/ST49 harboring genes smeZ and slaA was exclusively isolated from patients affected by OSAS, thus suggesting that this genotype might be associated to the pathogenesis of OSAS, although further studies are needed to elucidate the possible role of SlaA in tonsil hypertrophy development. PMID:28293224

  9. Atrial electrophysiological and molecular remodelling induced by obstructive sleep apnoea.

    PubMed

    Channaveerappa, Devika; Lux, Jacob C; Wormwood, Kelly L; Heintz, Timothy A; McLerie, Meredith; Treat, Jacqueline A; King, Hannah; Alnasser, Donia; Goodrow, Robert J; Ballard, Glenn; Decker, Robert; Darie, Costel C; Panama, Brian K

    2017-09-01

    Obstructive sleep apnoea (OSA) affects 9-24% of the adult population. OSA is associated with atrial disease, including atrial enlargement, fibrosis and arrhythmias. Despite the link between OSA and cardiac disease, the molecular changes in the heart which occur with OSA remain elusive. To study OSA-induced cardiac changes, we utilized a recently developed rat model which closely recapitulates the characteristics of OSA. Male Sprague Dawley rats, aged 50-70 days, received surgically implanted tracheal balloons which were inflated to cause transient airway obstructions. Rats were given 60 apnoeas per hour of either 13 sec. (moderate apnoea) or 23 sec. (severe apnoea), 8 hrs per day for 2 weeks. Controls received implants, but no inflations were made. Pulse oximetry measurements were taken at regular intervals, and post-apnoea ECGs were recorded. Rats had longer P wave durations and increased T wave amplitudes following chronic OSA. Proteomic analysis of the atrial tissue homogenates revealed that three of the nine enzymes in glycolysis, and two proteins related to oxidative phosphorylation, were down regulated in the severe apnoea group. Several sarcomeric and pro-hypertrophic proteins were also up regulated with OSA. Chronic OSA causes proteins changes in the atria which suggest impairment of energy metabolism and enhancement of hypertrophy. © 2017 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

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

    PubMed Central

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

    2016-01-01

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

  11. Serum sLOX-1 Levels Are Correlated with the Presence and Severity of Obstructive Sleep Apnea

    PubMed Central

    Xu, Chun-Yan; Li, Da-Ju; Wu, Chun-Ling; Lou, Han-Jian; Jiang, Hong-Wei

    2015-01-01

    Context: Inflammation plays a critical role in the development and progression of obstructive sleep apnea (OSA). Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) activation is involved in the pathophysiology of inflammatory process-related disorders. Objective: This study aims to investigate whether serum soluble LOX-1 (sLOX-1) levels are associated with the presence and severity of OSA. Materials and Methods: A total of 137 OSA patients and 78 controls were recruited in this study. Serum sLOX-1 levels were measured by enzyme-linked immunosorbent assay. The severity of OSA was assessed by the apnea–hypopnea index (AHI). Results: OSA patients had significantly higher serum sLOX-1 levels compared with controls. Serum sLOX-1 levels elevated with the increment of OSA severity. sLOX-1 was the independent predictor of OSA. Serum sLOX-1 levels were significantly correlated with AHI and high-sensitivity C-reactive protein levels. Conclusions: Serum sLOX-1 levels were independently correlated with the presence and severity of OSA. These findings revealed that sLOX-1 might function as a potential biomarker for monitoring the development and progression of OSA. PMID:25825846

  12. Obstructive sleep apnea promotes cancer development and progression: a concise review.

    PubMed

    Cao, Jie; Feng, Jing; Li, Lian; Chen, Baoyuan

    2015-05-01

    Obstructive sleep apnoea-hypopnoea (OSA) is an increasingly common sleep disorder which is widely accepted to be associated with high rates of morbidity and mortality. OSA is an independent risk factor for cardiovascular diseases, cerebrovascular disease, and metabolic disease. Recently, several studies have demonstrated that patients with OSA have a higher prevalence of cancer and cancer-related mortality. The epidemiological surveys suggest that patients with OSA had a higher incidence of cancer and cancer-related mortality than patients without OSA. Animal studies indicate that the activation of HIF-1 and VEGF pathways in response to intermittent hypoxia may promote the blood supply which supports tumor growth. In addition, tumor-associated macrophages may be altered by intermittent hypoxia (or sleep fragmentation) to a tumor-promoting phenotype yielding more aggressive cancer behavior. The relationship between OSA and cancer has been confirmed, in which patients with OSA have a relative high prevalence of cancer and cancer-related mortality. The mechanism of OSA promoting cancer development and progression may be related with intermittent hypoxia and possibly sleep fragmentation. The activation of several cancer-related pathways may play an important role in tumor growth and metastasis. More clinical data and basic studies are needed to explain and confirm the relationship between OSA and cancer.

  13. Breathing sounds spectral and higher order statistics changes from wakefulness to sleep in apneic and non-apneic people.

    PubMed

    Soltanzadeh, R; Moussavi, Z

    2014-01-01

    Breathing sounds analysis conveys valuable information in relation to obstructive sleep apnea (OSA) during both sleep and wakefulness. In this study, we investigated whether the breathings sounds spectral and higher order statistics characteristics (HOS) change from wakefulness to sleep, and more importantly whether this change is associated with severity of OSA. Tracheal breathing sounds of 6 individuals with severe OSA and 6 non-OSA individuals during wakefulness and stage 2 of sleep, both in supine position, were used in this study. The sounds were recorded simultaneously with full overnight polysomnography (PSG) assessment. First, the sounds of 5 noise-free breathing cycles were extracted and sequestered into inspiratory and expiratory phase segments manually for each study subject. After normalizing each sound segment to its energy, spectral and HOS features were calculated. Several features including the median bispectral frequency (MBF), spectral bandwidth (BW) and bispectrum Harmonic Mean (HM) were found to change statistically significantly from wakefulness to sleep mostly in severe OSA group but not as much in non-OSA group. The most prominent and consistent change between the two groups of OSA and non-OSA was observed in MBF; it changed from wakefulness to sleep in the two groups in an opposite manner; this observation is congruent with the hypothesis that the upper airway in OSA population has an increased non-homogeneity.

  14. 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

  15. Diagnosis of Obstructive Sleep Apnea Syndrome in Adults: A Brief Review of Existing Data for Practice in Iran

    PubMed Central

    Foroughi, Moein; Razavi, Hossein; Malekmohammad, Majid; Jamaati, Hamidreza

    2016-01-01

    Obstructive sleep apnea (OSA) is a common disorder associated with major comorbidities. It is estimated that 5–35% of the adult population in Iran are at high risk for OSA. This review article is designed to assist sleep medicine specialists as well as general practitioners in Iran to screen for OSA. It summarizes empirical data for diagnosing OSA including history taking, physical examination, diagnostic testing, and diagnostic criteria with regards to existing sleep medicine centers and availability of diagnostic tests in Iran. PMID:27904537

  16. Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

    PubMed Central

    Ozoh, Obianuju Beatrice; Okubadejo, Njideka Ulunma; Akinkugbe, Ayesha Omolara; Ojo, Oluwadamilola Omolara; Asoegwu, Chinyere Nkiru; Amadi, Casmir; Odeniyi, Ifedayo; Mbakwem, Amam Chinyere

    2014-01-01

    Introduction The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting. Methods The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ2 test. Independent risk predictors for OSA were assessed in multivariate logistic regression analysis. Results A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p). Conclusion A significant proportion of patients attending our tertiary care center are at high risk of OSA. PMID:25328598

  17. Pediatric Sleep Apnea

    PubMed Central

    Ievers-Landis, Carolyn E.; Redline, Susan

    2007-01-01

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

  18. Sleep-disordered breathing in patients with decompensated heart failure

    PubMed Central

    Valdivia-Arenas, Martin A.; Powers, Michael

    2009-01-01

    Sleep-disordered breathing (SDB) has a higher prevalence in patients with heart failure than in the general middle-aged population. Obstructive sleep apnea (OSA), one of the forms of SBD, promotes poorly controlled hypertension, coronary events, and atrial fibrillation events that can lead to acutely decompensated heart failure (ADHF), and evidence suggests that untreated OSA increases mortality in patients with heart failure. Cheyne–Stokes respiration and central sleep apnea (CSA) have long been associated with heart failure and, in many patients, can coexist with OSA. In this article, we propose a systematic approach to diagnose and treat OSA in patients with ADHF based on current evidence. PMID:18758944

  19. Emerging drugs for common conditions of sleepiness: obstructive sleep apnea and narcolepsy.

    PubMed

    Sullivan, Shannon S; Guilleminault, Christian

    2015-01-01

    Obstructive sleep apnea (OSA) and narcolepsy are sleep disorders associated with high prevalence and high symptomatic burden including prominent sleepiness, daytime dysfunction and poor nocturnal sleep. Both have elevated risk of poor health outcomes. Current therapies are often underutilized, cumbersome, costly or associated with residual symptoms. This review covers current available therapies for OSA and narcolepsy as well as discusses areas for potential drug development, and agents in the therapeutic pipeline, including the cannabinoid dronabinol (OSA), the histamine inverse agonist/ antagonist pitolisant (narcolepsy), and stimulants with uncertain and/or multiple activities such as JZP-110 and JZP-386 (narcolepsy, possibly OSA). Finally it addresses new approaches and uses for therapies currently on the market such as the carbonic anhydrase inhibitor acetazolamide (OSA). Both OSA and narcolepsy are conditions of sleepiness for which lifelong treatments are likely to be required. In OSA, while continuous positive airway pressure will likely remain the gold standard therapy for the foreseeable future, there is plenty of room for integrating phenotypes and variants of OSA into therapeutic strategies to lead to better, more personalized disease modification. In narcolepsy, unlike OSA, drug therapy is the current mainstay of treatment. Advances using novel mechanisms to treat targeted symptoms such as sleepiness and/or novel agents that can treat more than one symptom of narcolepsy, hold promise. However, cost, convenience and side effects remain challenges.

  20. Screening of Obstructive Sleep Apnea Syndrome by Electronic-Nose Analysis of Volatile Organic Compounds.

    PubMed

    Scarlata, Simone; Pennazza, Giorgio; Santonico, Marco; Santangelo, Simona; Rossi Bartoli, Isaura; Rivera, Chiara; Vernile, Chiara; De Vincentis, Antonio; Antonelli Incalzi, Raffaele

    2017-09-20

    Obstructive Sleep Apnea Syndrome (OSAS) carries important social and economic implications. Once the suspicion of OSAS has arisen, Polysomnography (PSG) represents the diagnostic gold standard. However, about 45% of people who have undergone PSG are free from OSAS. Thus, efforts should be made to improve the selection of subjects. We verified whether the pattern of Volatile Organic Compounds (VOCs) helps to select patients amenable to PSG. We studied 136 subjects (20 obese non-OSAS, 20 hypoxic OSAS, 20 non-hypoxic OSAS, and 20 non-hypoxic Chronic Obstructive Pulmonary Disease (COPD) vs 56 healthy controls) without any criteria of exclusion for comorbidity to deal with a real-life population. VOCs patterns were analyzed using electronic-nose (e-nose) technology. A Discriminant Analysis (Partial Least Square-Discriminant Analysis) was performed to predict respiratory functions and PSG parameters. E-nose distinguished controls (100% correct classification) from others and identified 60% of hypoxic, and 35% of non-hypoxic OSAS patients. Similarly, it identified 60% of COPD patients. One-by-one group comparison yielded optimal discrimination of OSAS vs controls and of COPD vs controls (100% correct classification). In conclusion, e-nose technology applied to breath-analysis can discriminate non-respiratory from respiratory diseased populations in real-life multimorbid populations and exclude OSAS. If confirmed, this evidence may become pivotal for screening purposes.

  1. Prevalence and Clinical Significance of Supine-Dependent Obstructive Sleep Apnea in Patients Using Oral Appliance Therapy

    PubMed Central

    Dieltjens, Marijke; Braem, Marc J.; Van de Heyning, Paul H.; Wouters, Kristien; Vanderveken, Olivier M.

    2014-01-01

    Study Objective: The prevalence of supine-dependent obstructive sleep apnea (sdOSA) in a general population ranges from 20% to 60%, depending on the criteria used. Currently, the prevalence and evolution of sdOSA once oral appliance therapy with a mandibular advancement device (OAm) has started is unknown. In addition, literature on the correlation between sdOSA and treatment success with OAm is not unequivocal. The first purpose of this study was to assess the prevalence of sdOSA before and under OAm therapy. Second, the conversion rate from non-sdOSA to sdOSA during OAm therapy was evaluated. The third and final goal was to analyze the correlation between sdOSA and treatment success with OAm therapy in the patient population. Methods: Two hundred thirty-seven consecutive patients (age 48 ± 9 years; male/female ratio 173/64; AHI 20.1 ± 14.7 events/h; BMI 27.2 ± 4.3 kg/m2) starting OAm therapy were included. Results: The prevalence of sdOSA before the start of OAm therapy, ranged from 27.0% to 67.5%. The prevalence of residual sdOSA under OAm therapy in this study ranged from 17.5% to 33.9%. Second, the conversion rate from non-sdOSA to sdOSA ranged from 23.0% to 37.5%. Third, the presence of sdOSA at baseline was not a significant factor for treatment success with OAm therapy. Conclusions: The results of this study indicate that the prevalence of sdOSA before and under OAm therapy is relatively high. One-third of patients shift from non-sdOSA to sdOSA. Finally, treatment success for OAm therapy was not significantly correlated with the presence of sdOSA at baseline. Citation: Dieltjens M, Braem MJ, Van de Heyning PH, Wouters K, Vanderveken OM. Prevalence and clinical significance of supine-dependent obstructive sleep apnea in patients using oral appliance therapy. J Clin Sleep Med 2014;10(9):959-964. PMID:25142766

  2. Induced sputum inflammatory measures correlate with disease severity in children with obstructive sleep apnoea.

    PubMed

    Li, A M; Hung, E; Tsang, T; Yin, J; So, H K; Wong, E; Fok, T F; Ng, P C

    2007-01-01

    To establish the association between airway inflammation and severity of obstructive sleep apnoea (OSA) in children. Consecutive children presenting with symptoms suggestive of OSA were recruited. They completed a sleep apnoea symptom questionnaire, underwent physical examination, spirometry, sputum induction and an overnight polysomnography. Adequate sputum contained <50% squamous epithelial cells, and OSA was diagnosed if the obstructive apnoea index was >1. 73 children with a median (interquartile range (IQR)) age of 11.3 (10.0-13.2) years were recruited. There were 21 girls and the median body mass index of the group was 24.0 (18.0-27.0) kg/m2. The most common presenting symptoms were habitual snoring, mouth breathing and prone sleeping position. Sputum induction was successful in 43 (59%) children, of whom 14 were found to have OSA. Children with OSA had significantly greater percentage sputum neutrophil than those without OSA (18.5 (IQR 8.0-42.0) v 4 (IQR 3.0-11.3), p = 0.006). On multiple regression analysis, percentage sputum neutrophil was significantly associated with OSA (odds ratio = 1.1, p = 0.013). Children with OSA had airway inflammation characterised by a marked increase in neutrophils. Further studies are needed to confirm these findings and to better define the downstream cellular interactions and molecular pathogenesis in childhood OSA.

  3. Evaluation of obstructive sleep apnea in obese patients scheduled for bariactric surgery.

    PubMed

    Lopes Neto, José Maurício; Brandão, Leandro Ortega; Loli, Alessandra; Leite, Celso Vieira de Souza; Weber, Silke Anna Theresa

    2013-04-01

    To evaluate the frequency of obstructive sleep apnea (OSA) in obese patients scheduled for bariatric surgery and their identification for risk of OSA by Berlin Questionnaire (BQ) and excessive daytime sleepiness by Epworth Sleepiness Scale (ESS). Fifty nine patients were evaluated by BQ and ESS. Out of these individuals, 35 performed a full-night sleep study using a type 3 portable monitoring (PM). The questionnaire results were compared for gender and BMI. The presence and severity of OSA was correlated with gender and both questionnaires. 94.75% of the respondents presented high risk for OSA by BQ and 59.65% presented positivity by ESS. Taking into account the AHI> 5 per hour for OSA diagnosis, all of them presented OSA, average AHI of 45.31 ± 26.3 per hour and 68.6% have severe OSA (AHI>30). The male patients had a higher AHI (p<0.05). There was a positive correlation between the positivity in both questionnaires as well as the severity of OSA measured by AHI (p<0.05). The frequency and severe obstructive sleep apnea in the studied group is high. The Berlin Questionnaire and Epworth Sleepiness Scale had a positive correlation with the diagnosis of OSA in the group studied.

  4. 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

  5. Obstructive Sleep Apnea in Obese Adolescents and Cardiometabolic Risk Markers

    PubMed Central

    Watson, Sara E.; Li, Zhuokai; Tu, Wanzhu; Jalou, Hasnaa; Brubaker, Jamie L.; Gupta, Sandeep; Huber, Jordan N.; Carroll, Aaron; Hannon, Tamara S.

    2013-01-01

    Background Pediatric studies examining the association between obstructive sleep apnea (OSA) and insulin sensitivity/cardiometabolic risk are limited and conflicting. Objective To determine if cardiometabolic risk markers are increased among obese youth with obstructive sleep apnea as compared with their equally obese peers without OSA. Methods We performed a retrospective analysis of 96 patients (age 14.2 ± 1.4 years) who underwent polysomnography for suspected OSA. Fasting lipids, glucose, insulin, and hemoglobin A1c (HbA1c) were performed as part of routine clinical evaluation. Patients were categorized into two groups by degree of OSA as measured by the apnea hypopnea index (AHI): none or mild OSA (AHI < 5) and moderate or severe OSA (AHI ≥ 5). Results Despite similar degrees of obesity, patients with moderate or severe OSA had higher fasting insulin (p = 0.037) and homeostasis model assessment-insulin resistance [HOMA-IR (p = 0.0497)], as compared with those with mild or no OSA. After controlling for body mass index, there was a positive association between the AHI and log HOMA-IR (p = 0.005). There was a positive relationship between arousals plus awakenings during the polysomnography and fasting triglycerides. Conclusions OSA is linked with greater cardiometabolic risk markers in obese youth. PMID:24106092

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

    PubMed Central

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

    2015-01-01

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

  7. Association of serum irisin concentrations with the presence and severity of obstructive sleep apnea syndrome.

    PubMed

    Li, Yanli; Li, Xueqin; Sun, Dejun; Cai, Shaoxi

    2016-10-11

    Obesity is involved in the pathogenesis of obstructive sleep apnea syndrome (OSAS). Irisin, a recently discovered myokine, protects the mice from obesity. This study aims to determine the association of serum irisin concentrations with the presence and severity of OSAS. This cross-sectional investigation was performed in 165 male OSAS patients and 98 healthy male subjects. Serum irisin concentrations were assessed using an enzyme-linked immunosorbent assay kit. The serum irisin concentrations of OSAS patients significantly decreased compared with the healthy controls (P<.001). Multivariable logistic regression analysis indicated that serum irisin concentrations were an independent determinant of OSAS (OR .971, 95% CI .960 to .981; P<.001). Serum irisin concentrations were significantly reduced among patients with severe OSAS compared with patients with mild and moderate OSAS (P<.001 and P=.010, respectively). Spearman correlation analysis revealed that serum irisin concentrations were inversely correlated with OSAS severity (r=-.327, P<.001). Decreased serum irisin concentrations are associated with the presence and severity of OSAS. © 2016 Wiley Periodicals, Inc.

  8. Pediatric Home Sleep Studies: A Prospective Study

    DTIC Science & Technology

    2016-04-30

    available, and is inconvenient for patients. Therefore, 90 % of children undergo adenotonsillectomy without confirmatory diagnostic testing. Ambulatory sleep monitoring for OSA may alleviate these issues.

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

    PubMed

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

    2014-07-01

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

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

    PubMed Central

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

    2015-01-01

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

  11. Sleep apnea syndrome in endocrine clinics.

    PubMed

    Ceccato, F; Bernkopf, E; Scaroni, C

    2015-08-01

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

  12. Polymorphisms in nitric oxide synthase and endothelin genes among children with obstructive sleep apnea.

    PubMed

    Chatsuriyawong, Siriporn; Gozal, David; Kheirandish-Gozal, Leila; Bhattacharjee, Rakesh; Khalyfa, Ahamed A; Wang, Yang; Sukhumsirichart, Wasana; Khalyfa, Abdelnaby

    2013-09-06

    Obstructive sleep apnea (OSA) is associated with adverse and interdependent cognitive and cardiovascular consequences. Increasing evidence suggests that nitric oxide synthase (NOS) and endothelin family (EDN) genes underlie mechanistic aspects of OSA-associated morbidities. We aimed to identify single nucleotide polymorphisms (SNPs) in the NOS family (3 isoforms), and EDN family (3 isoforms) to identify potential associations of these SNPs in children with OSA. A pediatric community cohort (ages 5-10 years) enriched for snoring underwent overnight polysomnographic (NPSG) and a fasting morning blood draw. The diagnostic criteria for OSA were an obstructive apnea-hypopnea Index (AHI) >2/h total sleep time (TST), snoring during the night, and a nadir oxyhemoglobin saturation <92%. Control children were defined as non-snoring children with AHI <2/h TST (NOSA). Endothelial function was assessed using a modified post-occlusive hyperemic test. The time to peak reperfusion (Tmax) was considered as the indicator for normal endothelial function (NEF; Tmax<45 sec), or ED (Tmax ≥ 45 sec). Genomic DNA from peripheral blood was extracted and allelic frequencies were assessed for, NOS1 (209 SNPs), NOS2 (122 SNPs), NOS3 (50 SNPs), EDN1 (43 SNPs), EDN2 (48 SNPs), EDN3 (14 SNPs), endothelin receptor A, EDNRA, (27 SNPs), and endothelin receptor B, EDNRB (23 SNPs) using a custom SNPs array. The relative frequencies of NOS-1,-2, and -3, and EDN-1,-2,-3,-EDNRA, and-EDNRB genotypes were evaluated in 608 subjects [128 with OSA, and 480 without OSA (NOSA)]. Furthermore, subjects with OSA were divided into 2 subgroups: OSA with normal endothelial function (OSA-NEF), and OSA with endothelial dysfunction (OSA-ED). Linkage disequilibrium was analyzed using Haploview version 4.2 software. For NOSA vs. OSA groups, 15 differentially distributed SNPs for NOS1 gene, and 1 SNP for NOS3 emerged, while 4 SNPs for EDN1 and 1 SNP for both EDN2 and EDN3 were identified. However, in the smaller sub

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

    PubMed Central

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

    2015-01-01

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

  14. Th17/Treg balance in children with obstructive sleep apnea syndrome and the relationship with allergic rhinitis.

    PubMed

    Ni, Kun; Zhao, Limin; Wu, Jiali; Chen, Wei; HongyaYang; Li, Xiaoyan

    2015-09-01

    This study aims to explore the role of the Th17 to Treg cell ratio in children with OSA and its relationship with allergic rhinitis. The study included 127 children diagnosed with OSA by polysomnography (PSG) testing and 29 children without OSA. The 127 children with OSA were divided into the following groups: OSA with moderate adenoidal hypertrophy (n=47), OSA with severe adenoidal hypertrophy (n=49), and OSA complicated by allergic rhinitis (AR) (n=31). The adenoids of the 29 children without OSA were mildly hypertrophic. We measured the number of Th17 and Treg cells, the levels of related serum cytokines in cellular secretions, and the expression of key transcription factors in both the peripheral blood and adenoid tissue. The Th17/Treg ratio was calculated and analyzed between groups. The numbers of Th17 and Treg cells were measured by flow cytometry; the secreted IL-17, IL-10, and TGF-β were measured by ELISA; and the expression levels of RORγt and Foxp3 were measured by RT-PCR. Compared with the control group, OSA children exhibited a significant increase in the number of peripheral Th17 cells, Th17-related cytokine secretion (IL-17), and RORγt mRNA levels, whereas they exhibited a decrease in the number of Treg cells, Treg-related cytokine secretions (IL-10, TGF-β) and Foxp3 mRNA levels. The Th17/Treg ratio was higher (p<0.05) in the OSA groups than in the control group. The Th17/Treg ratio was correlated with the size of the adenoids. We also found that the Th17/Treg balance in OSA patients was complicated by allergic rhinitis; the increase was significantly larger in the AR group (p<0.05, p=0.021) than in OSA groups without AR. These results were observed in both the peripheral blood and local adenoid tissue. The Th17/Treg imbalance may increase the risk of developing OSA, and AR may promote the development of the disease. These results provide an alternative explanation for OSA pathogenesis that warrants additional research and presents new directions

  15. Obstructive sleep apnea in normal weight patients: characteristics and comparison with overweight and obese patients.

    PubMed

    Dacal Quintas, Raquel; Tumbeiro Novoa, Manuel; Alves Pérez, María Teresa; Santalla Martínez, Mari Luz; Acuña Fernández, Adela; Marcos Velázquez, Pedro

    2013-12-01

    To determine the frequency of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) in normal weight patients and their characteristics, and to compare these with overweight and obese patients. We studied all patients with suspected OSA referred to the sleep laboratory from January to December 2009. OSA was diagnosed when the apnoea-hypopnoea index (AHI) was >5 and symptoms were present. MS was diagnosed according to International Diabetes Federation (IDF) criteria. The patients were distributed into 3 groups according to body mass index (BMI): normal weight (<25kg/m(2)), overweight (25-29.9kg/m(2)) and obese (≥30kg/m(2)). We studied 475 patients: 7.60% normal weight and 56.4% obese. Most patients in the normal weight group were women, snorers, non-smokers, non-drinkers and were significantly younger and with a smaller neck and waist circumference than obese and overweight patients. OSA was diagnosed in 90.10%: 77.70% normal weight. OSA in these patients was mostly mild, and there were differences between the diagnosis of OSA and the BMI classified. MS was diagnosed in 64.40%: 33.33% normal weight. There was a higher probability of MS as the BMI increased. OSA and MS frequency in normal weight patients was 22% and in obese patients was 70.52%. OSA in normal weight patients was related with gender and age. There was no relationship between OSA and MS, or between otorhinolaryngological malformations and OSA in normal weight patients. Eight normal weight patients with OSA were treated with continuous positive airway pressure (CPAP) therapy. The frequency of OSA in normal weight patients was lower than in overweight and obese patients. The frequency of concomitant OSA and MS was lower in normal weight patients than in obese subjects. Normal weight patients were mostly women, younger and had no toxic habits. In normal weight patients, age and gender were predictive factors for OSA, but OSA and MS were not related. Copyright © 2013 SEPAR. Published by Elsevier

  16. Correlation of salivary cortisol level with obstructive sleep apnea syndrome in pediatric subjects.

    PubMed

    Park, Chan-Soon; Guilleminault, Christian; Hwang, Se-Hwan; Jeong, Jong-Hyun; Park, Dong-Sun; Maeng, Jae-Hwan

    2013-10-01

    Obstructive sleep apnea syndrome (OSAS) is associated with stress system activation involving the hypothalamic-pituitary-adrenocortical (HPA) axis. The relationships among salivary cortisol, a measure of the HPA axis, and objective parameters of polysomnography (PSG) and subjective sleep symptoms were examined. Our prospective study enrolled 80 children who had a physical examination, underwent overnight PSG, and completed the Korean version of the modified pediatric Epworth sleepiness scale (KMPESS) and OSA-18 (KOSA-18) questionnaires. Saliva was collected at night before PSG and in the early morning after PSG. Subjects (N=80) were divided into control (n=32, apnea-hypopnea index [AHI]<1) and OSAS (n=48, AHI > or =1) groups; the OSAS group was subdivided into mild (1< or = AHI < 5) and moderate to severe (AHI > or =5) groups. Although salivary cortisol before PSG (n-sCor) did not show a significant change with OSAS severity, salivary cortisol after PSG (m-sCor) significantly decreased with OSAS severity. This decrease resulted in a salivary cortisol ratio (r-sCor) that was significantly different between the control group and the two OSAS subgroups. The m-sCor and sub-sCor of the total group as well as the m-sCor, sub-sCor, and r-sCor of the OSAS group were negatively related to the oxygen desaturation index (ODI). The m-sCor and r-sCor in the OSAS group also were related to subjective sleep symptoms (quality of life [QOL] by KOSA-18). Among the four salivary cortisol parameters, r-sCor was negatively associated with OSAS severity, ODI, and QOL (KOSA-18), which may indicate a chronically stressed HPA axis. These results demonstrate that salivary cortisol may be a useful biomarker of OSAS. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. 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

  18. 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

  19. 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

  20. Vaspin and lipocalin-2 levels in severe obsructive sleep apnea

    PubMed Central

    Zorlu, Mehmet; Akkoyunlu, Muhammed Emin; Kilic, Elif; Karatoprak, Cumali; Cakirca, Mustafa; Yavuz, Erdinc; Ardic, Cuneyt; Camli, Ahmet Adil; Cikrikcioglu, Mehmetali; Kart, Levent

    2014-01-01

    Background Vaspin and lipocalin-2 are less-known recent members of adipocytokine family. There are ongoing studies investigating the role of vaspin ve lipocalin-2 in metabolic syndrome (MS). Obstructive sleep apnea syndrome (OSAS) is independently associated with an increased prevalence of MS. We aimed to measure the levels of vaspin and lipocalin-2 which are secreted from adipocytes in patients with severe OSAS and examine the relationship between these two adipocytokines and OSAS. Methods The study consisted of two groups: severe OSAS patients with an apnea-hypopnea index (AHI) of >30/h (OSAS group, 34 subjects) and age-matched healthy volunteers with a AHI <5/h (control group, 25 subjects) Serum levels of vaspin and lipocalin-2 in these two groups were compared. Results Serum levels of vaspin were significantly lower in OSAS group; patients with severe OSAS compared with control group; healthy volunteers (OSAS group: 0.69±0.5 vs. control group: 1.24±1.13; P=0.034). The difference between the two groups in terms of serum levels of lipocalin-2 has not reached statistical significance (OSAS group: 61.6±18.2 vs. control group: 68.5±20.1; P=0.17). Conclusions We found that serum vaspin levels were significantly lower in patients with severe OSAS compared with healthy controls. Lipocalin-2 levels were similar. The decrease in serum vaspin levels in severe OSAS patients may be important in diagnosis and follow-up of these patients. PMID:24976995

  1. Oxidative Stress-induced Telomere Length Shortening of Circulating Leukocyte in Patients with Obstructive Sleep Apnea

    PubMed Central

    Kim, Kyung Soo; Kwak, Jin Wook; Lim, Su Jin; Park, Yong Kyun; Yang, Hoon Shik; Kim, Hyun Jik

    2016-01-01

    The main mechanism of pathogenesis which causes systemic complications in obstructive sleep apnea (OSA) patients is believed to be intermittent hypoxia-induced intermediary effect and it depends on the burden of oxidative stress during sleep. We aimed to search the predictive markers which reflect the burden of systemic oxidative stress in patients with OSA and whether excessive telomere length shortening is a characteristic feature that can assess oxidative stress levels. We used quantitative PCR to measure telomere length using peripheral blood genomic DNA. Telomere lengths were compared in an age- and body mass index (BMI)-dependent manner in 34 healthy volunteers and 43 OSA subjects. We also performed reactive oxygen species assay to measure the concentration of hydrogen peroxide in the peripheral blood of healthy volunteers and OSA subjects. We found that the serum concentration of hydrogen peroxide was considerably higher in OSA patients, and that this was closely related with the severity of OSA. Significantly shortened telomere length was observed in the circulating leukocytes of the peripheral blood of OSA patients, and telomere length shortening was aggravated more acutely in an age- and BMI-dependent manner. An inverse correlation was observed between the concentration of hydrogen peroxide and the telomere length of OSA patients and excessive telomere length shortening was also linked to severity of OSA. The results provided evidence that telomere length shortening or excessive cellular aging might be distinctive in circulating leukocyte of OSA patients and may be an predictive biomarker for reflect the burden of oxidative stress in the peripheral blood of OSA patients. PMID:27699083

  2. Neural Alterations and Depressive Symptoms in Obstructive Sleep Apnea Patients

    PubMed Central

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

    2008-01-01

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

  3. Left ventricular geometry in patients with obstructive sleep apnea coexisting with treated systemic hypertension.

    PubMed

    Myslinski, Wojciech; Duchna, Hans-Werner; Rasche, Kurt; Dichmann, Manuel; Mosiewicz, Jerzy; Schultze-Werninghaus, Gerhard

    2007-01-01

    Left ventricular (LV) hypertrophy is a common consequence of systemic hypertension (SH) and obstructive sleep apnea (OSA). However, little is known about the degree of LV involvement in patients with OSA coexisting with treated SH. Our study was designed in order to assess the prevalence of distinct types of LV geometry in treated hypertensive OSA patients. 183 patients with treated SH were enrolled to the study. Group 1 consisted of 38 patients with newly-diagnosed OSA and ineffectively treated SH. The remaining 145 patients with effectively treated SH were divided into three groups: group 2 - 70 patients with newly-diagnosed OSA, group 3 - 31 patients with OSA treated with continuous positive airway pressure (CPAP), and group 4 - 44 patients without OSA. Overnight sleep studies and M-mode echocardiography were performed. LV mass index did not differ between the study groups. Mean values of LV end-diastolic diameter (LVED) were 55.4 +/- 6.8 mm in group 1 and 53.6 +/- 6.9 mm in group 2 and were significantly increased in comparison to subjects treated with CPAP and controls (49.8 +/- 6.8 mm and 50.1 +/- 64.7 mm, respectively; p = 0.001). LVED correlated positively with the apnea-hypopnea index and desaturation index. LV eccentric hypertrophy was the commonest type of LV geometry in newly-diagnosed OSA patients. The major finding of our study is the predominance of LV eccentric hypertrophy in newly-diagnosed OSA patients. We suggest that a relatively moderate degree of LV involvement in hypertensive OSA patients may depend on the cardioprotective effect of concomitant antihypertensive therapy, ameliorating OSA-dependent neurohumoral abnormalities.

  4. 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

  5. Association of estradiol with sleep apnea in depressed perimenopausal and postmenopausal women: a preliminary study.

    PubMed

    Galvan, Thania; Camuso, Julia; Sullivan, Kathryn; Kim, Semmie; White, David; Redline, Susan; Joffe, Hadine

    2017-01-01

    Women's risk of obstructive sleep apnea (OSA) increases substantially during and after the menopausal transition, when depression risk is also elevated, raising the possibility that estrogen withdrawal contributes to OSA vulnerability, in turn contributing to mood disturbance. We examined the association between estradiol levels and OSA in depressed peri- and postmenopausal women. Thirty depressed peri-/postmenopausal women (mean body mass index [BMI] 30.82 kg/m) without known OSA completed routine polysomnography concurrent with serum estradiol levels. Estradiol in women with apnea-hypopnea indices (AHI) ≥15 indicating moderate-to-severe OSA was compared against those with AHI less than 15 using logistic regression adjusting for age and BMI. Thirteen women (43%) had AHI ≥15 (median AHI 21.6). Estradiol levels were lower (P = 0.02) in those with OSA (median 19, interquartile range 9-25 pg/mL) than without OSA (median 29, interquartile range 19-66 pg/mL). On univariate analysis, higher estradiol was associated with reduced odds of OSA (odds ratio 0.95, 95% CI 0.90-0.99, P = 0.04). After adjusting for age and BMI, estradiol levels remained associated with lower odds of OSA (odds ratio 0.90), but the association was no longer statistically significant (95% CI 0.76-1.05, P = 0.18). Montgomery Åsberg Depression Rating Scale scores did not differ between those with and without OSA. These preliminary results suggest that, in addition to higher BMI and age, lower estradiol may be associated with increased OSA risk in depressed women during the peri- and postmenopause, raising the possibility that estradiol withdrawal associated with menopause influences upper-airway patency in women.

  6. Airway and alveolar nitric oxide measurements in obstructive sleep apnea syndrome.

    PubMed

    Fortuna, A M; Miralda, R; Calaf, N; González, M; Casan, P; Mayos, M

    2011-04-01

    The process of intermittent hypoxia-reoxygenation produces airway inflammation and endothelial dysfunction that favors the development of cardiovascular disorders in obstructive sleep apnea syndrome (OSAS). Nitric oxide (NO) is an important mediator in airway inflammation and the regulation of endothelium-dependent vasodilation. This study compared airway NO (FE(NO)) and alveolar NO (CA(NO)) measurements in exhaled breath in 30 OSAS patients to those of 30 healthy (non-OSAS) individuals and determined the relationship between NO levels and OSAS severity. Additionally, NO measurements were analyzed after 3 months of CPAP treatment. The mean (±SD) FE(NO) level in the OSAS group (27.2 ± 18 ppb) was higher than in the healthy non-OSAS group (p = 0.006). The mean CA(NO) level was 1.65 ± 0.90 ppb, lower than in the non-OSAS group (p = 0.001). A significant correlation was found between FE(NO) and CA(NO) levels and the apnea-hypopnea index (AHI) in the OSAS group (r = 0.8, p < 0.05; r = -0.9, p = 0.01, respectively). FE(NO) levels decreased and CA(NO) levels increased significantly after CPAP treatment. Severe OSAS patients have higher FE(NO) and lower CA(NO) levels and these are restored to normal after CPAP treatment, reflecting the correction of local upper airway inflammation and endothelial dysfunction present in OSAS patients. Exhaled breath techniques can be useful to identify airway inflammation and endothelial dysfunction in severe OSAS patients. Copyright © 2010 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2014-05-28

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

  8. A Nomogram for Predicting the Likelihood of Obstructive Sleep Apnea to Reduce the Unnecessary Polysomnography Examinations

    PubMed Central

    Luo, Miao; Zheng, Hai-Yan; Zhang, Ying; Feng, Yuan; Li, Dan-Qing; Li, Xiao-Lin; Han, Jian-Fang; Li, Tao-Ping

    2015-01-01

    Background: The currently available polysomnography (PSG) equipments and operating personnel are facing increasing pressure, such situation may result in the problem that a large number of obstructive sleep apnea (OSA) patients cannot receive timely diagnosis and treatment, we sought to develop a nomogram quantifying the risk of OSA for a better decision of using PSG, based on the clinical syndromes and the demographic and anthropometric characteristics. Methods: The nomogram was constructed through an ordinal logistic regression procedure. Predictive accuracy and performance characteristics were assessed with the area under the curve (AUC) of the receiver operating characteristics and calibration plots, respectively. Decision curve analyses were applied to assess the net benefit of the nomogram. Results: Among the 401 patients, 73 (18.2%) were diagnosed and grouped as the none OSA (apnea-hypopnea index [AHI] <5), 67 (16.7%) the mild OSA (5 ≤ AHI < 15), 82 (20.4%) the moderate OSA (15 ≤ AHI < 30), and 179 (44.6%) the severe OSA (AHI ≥ 30). The multivariable analysis suggested the significant factors were duration of disease, smoking status, difficulty of falling asleep, lack of energy, and waist circumference. A nomogram was created for the prediction of OSA using these clinical parameters and was internally validated using bootstrapping method. The discrimination accuracies of the nomogram for any OSA, moderate-severe OSA, and severe OSA were 83.8%, 79.9%, and 80.5%, respectively, which indicated good calibration. Decision curve analysis showed that using nomogram could reduce the unnecessary polysomnography (PSG) by 10% without increasing the false negatives. Conclusions: The established clinical nomogram provides high accuracy in predicting the individual risk of OSA. This tool may help physicians better make decisions on PSG arrangement for the patients referred to sleep centers. PMID:26265604

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

    PubMed Central

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

    2016-01-01

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

  10. Obstructive Sleep Apnea in Young Infants with Down Syndrome Evaluated in a Down Syndrome Specialty Clinic

    PubMed Central

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

    2015-01-01

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

  11. Association of PPARγ2 (Pro12Ala) and Neuropeptide Y (Leu7Pro) Gene Polymorphisms with Obstructive Sleep Apnea in Obese Asian Indians

    PubMed Central

    Bhushan, Bharat; Guleria, Randeep; Misra, Anoop; Luthra, Kalpana; Kumar, Guresh

    2011-01-01

    Background: Obstructive sleep apnea (OSA) is prevalent in 7.5% in urban Asian Indians. Peroxisome proliferator activated receptor gamma2 (PPARγ2) has been implicated in adipocyte differentiation. Neuropeptide Y (NPY) is also considered as a candidate gene for excess body fat accumulation. The association of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene polymorphisms with OSA has not been studied in Asian Indians. Objective: To study the distribution of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) polymorphism in Asian Indians with and without OSA. Methods and results: This study was carried out in 252 obese subjects [(body mass index (BMI > 25 kg/m2)]; 142 with OSA and 110 without OSA. Measurements included anthropometric and biochemical parameters (fasting blood glucose, lipid profile, various circumferences and skin-fold thicknesses). PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene polymorphisms were studied in all subjects. The frequency of the variant allele (Ala12) of PPARγ2 gene was significantly higher in subjects with OSA (14.4%) when compared with subjects without OSA (5.5%; χ2 = 9.7; p = 0.001). The distribution of the variant allele (Pro7) of NPY gene was comparable in subjects with OSA (3.5%) and without OSA (3.6%; χ 2 = 0.001, p = 0.94). Conclusion: This study reveals a significantly higher frequency of PPARγ2 (Ala12) allele in obese Asian Indians with OSA when compared to obese Asian Indians without OSA. PMID:21508507

  12. Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder.

    PubMed

    Murata, Emi; Mohri, Ikuko; Kato-Nishimura, Kumi; Iimura, Jiro; Ogawa, Makoto; Tachibana, Masaya; Ohno, Yuko; Taniike, Masako

    2017-06-01

    Obstructive sleep apnea (OSA) may affect daily cognitive functioning in children. The aims of our study were two-fold. The first aim was to detect, using the Child Behavior Checklist (CBCL), whether adenotonsillectomy (AT) for the treatment of OSA improved the behavior of children with autism spectrum disorder (ASD). The second aim was to identify characteristics for behavioral improvement following the treatment of OSA in these children with ASD. The behaviors of ASD children aged 5-14 years diagnosed as having OSA (n=30) were evaluated using CBCL before and after AT. CBCL evaluation of ASD children without OSA at two time points with the same interval served as a control (n=24). We statistically examined the two groups. In addition, we conducted a paired t-test to assess changes in CBCL Tscores between the improved group and unchanged/deteriorated group to identify characteristics that may affect behavioral changes following OSA treatment. After AT, T-scores of the CBCL scales were significantly improved in the OSA group, but no change was observed in the control. A paired t-test revealed that the improved group had significantly higher scores on the CBCL pre-AT than the unchanged/deteriorated group in ASD children with OSA after OSA treatment. Behavioral problems were significantly improved following AT in ASD children with OSA. Early detection and treatment of children with OSA is essential to prevent behavioral problems and to support mental development. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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

    PubMed

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

    2016-02-01

    Individuals suffering from obstructive sleep apnea (OSA) are at increased risk for systemic hypertension. The importance of a healthy gut microbiota, and detriment of a dysbiotic microbiota, on host physiology is becoming increasingly evident. We tested the hypothesis that gut dysbiosis contributes to hypertension observed with OSA. OSA was modeled in rats by inflating a tracheal balloon during the sleep cycle (10-s inflations, 60 per hour). On normal chow diet, OSA had no effect on blood pressure; however, in rats fed a high-fat diet, blood pressure increased 24 and 29 mm Hg after 7 and 14 days of OSA, respectively (P<0.05 each). Bacterial community characterization was performed on fecal pellets isolated before and after 14 days of OSA in chow and high-fat fed rats. High-fat diet and OSA led to significant alterations of the gut microbiota, including decreases in bacterial taxa known to produce the short chain fatty acid butyrate (P<0.05). Finally, transplant of dysbiotic cecal contents from hypertensive OSA rats on high-fat diet into OSA recipient rats on normal chow diet (shown to be normotensive) resulted in hypertension similar to that of the donor (increased 14 and 32 mm Hg after 7 and 14 days of OSA, respectively; P<0.05). These studies demonstrate a causal relationship between gut dysbiosis and hypertension, and suggest that manipulation of the microbiota may be a viable treatment for OSA-induced, and possibly other forms of, hypertension. © 2015 American Heart Association, Inc.

  14. Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan.

    PubMed

    Chen, Wei-Sheng; Chang, Yu-Sheng; Chang, Chi-Ching; Chang, Deh-Ming; Chen, Yi-Hsuan; Tsai, Chang-Youh; Chen, Jin-Hua

    2016-10-01

    To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time-dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Behçet disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively). Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA.

  15. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome.

    PubMed

    Inonu Koseoglu, Handan; Pazarli, Ahmet Cemal; Kanbay, Asiye; Demir, Osman

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease (CVD). Although monocyte to high-density lipoprotein cholesterol ratio (MHR) is increasingly being implicated in cardiovascular morbidity and mortality, no study has attempted to determine the role of MHR in cardiovascular morbidity of patients with OSAS. We aimed to investigate the association between MHR and CVD in patients with OSAS and the relationship between severity of OSAS, polysomnographic parameters, and MHR. In this cohort study, patients who had undergone a full-night polysomnography for the diagnosis of OSAS were recruited. Included patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-15), moderate (15-30), and severe (>30) OSAS. Patients with AHI < 5 served as the control group. The presence of heart failure, coronary artery disease, or arrhythmia was defined as CVD. A total of 1050 patients were included (131 controls, 222 mild, 228 moderate, and 469 severe OSAS). The severe group had higher MHR compared with the control and other OSAS groups (9.99, 12.11, 13.65, and 20.67 in control, mild, moderate, and severe OSAS groups, respectively, P < .001). The MHRs were significantly correlated with AHI, oxygen desaturation index, and minimum O2 saturation values ( P < .001). Values of MHR were significantly higher in patients with CVD compared with those without ( P < .001). Multiple regression analysis demonstrated that MHR is an independent predictor of CVD. The MHR is strongly associated with CVD and the severity of OSAS and might be used as a biomarker to predict CVD in patients with OSAS.

  16. Clinical assessment and polysomnographic study of sleep apnea in a Chinese population of snorers*

    PubMed Central

    Shao, Chuan; Jiang, Jing-bo; Wu, Hong-cheng; Wu, Shi-bo; Yu, Bi-yun; Tang, Yao-dong

    2015-01-01

    Background and objectives: While an increasing number of people who snore are seeking medical consultations, the clinical characteristics of snorers are rarely reported. The aim of this study is to characterize the clinical and polysomnographic features in a population of snorers. Methods: A total of 490 subjects were examined retrospectively. The clinical history, Epworth Sleepiness Scale (ESS) scores, physical examination, and full-night polysomnography (PSG) data were obtained for all the subjects. The correlations between the neck circumference, waist circumference, ESS scores, body mass index (BMI), and apnea-hypopnea index (AHI) of obstructive sleep apnea (OSA) patients were explored. The gender and age differences in OSA patients were analyzed. Results: OSA was diagnosed in 84.7% of the sample, with 21.2% of the patients having a mild form, 15.4% having a moderate form, and 63.4% having a severe form of OSA. The ESS scores, neck circumference, waist circumference, and BMI were positively correlated with AHI in OSA patients. The ESS scores and BMI were negatively correlated with nadir oxygen saturation (SaO2). A greater number of men than women exhibited moderate to severe forms of the disease. OSA affects the work of males more commonly compared with females. Nocturia was a more common complaint in elderly OSA patients. Heart diseases coexisted more frequently with OSA in elderly patients. Conclusions: In a population of snorers, OSA is the most common condition identified. The ESS scores and BMI were well correlated with the severity of the disease. Men had a more severe form of OSA than women. Nocturia frequently occurred in elderly OSA patients, as did the coexistence of heart disease. PMID:25743123

  17. Morphometric analysis of the uvula in patients with sleep-related breathing disorders.

    PubMed

    Hamans, E P; Van Marck, E A; De Backer, W A; Creten, W; Van de Heyning, P H

    2000-01-01

    The upper-airway mucosa in obstructive sleep apnea (OSA) patients and snorers is often described as edematous and hyperplastic. The morphologic aspects of the pharyngeal mucosa, and in particular the mucosa of the uvula and soft palate, in OSA patients are, however, not well described. The aim of the present retrospective study therefore was to perform histologic examination of the pharyngeal mucosa obtained from patients with various forms of sleep-related breathing disorders, including primary snoring. A midsagittal section of uvulas obtained by uvulopalatopharyngoplasty (UPPP) was investigated in 34 OSA patients and 9 non-apneic snorers. Control tissues were taken by autopsy in 19 patients not known to have OSA or snoring. A morphometric point counting technique was used to determine the tissue composition. The data showed that OSA patients and non-apneic snorers had a significantly greater percentage of intercellular space than controls (65.7% vs 54.0%; P = 0.006). Control uvulas contained more muscle than OSA and snorers (14.0% vs 7.8%; P = 0.006). Moreover, the covering epithelium was significantly thicker in OSA and snorers than in controls (variance ratio = 7.64; P = 0.008). When taking body mass index (BMI) into account, no correlation was found between fat deposition and BMI. Findings showed that an increased clinical severity of OSA did not affect the tissue composition. Indeed, uvula morphology was similar in OSA patients with respect to non-apneic snorers. Since the increased amount of intercellular space is the expression of edema, we hypothesize that these mucosal changes together with hyperplasia of the covering epithelium are secondary effects to snoring. They presumably play a minor role in the etiopathogenesis of OSA, but may increase the severity of OSA by further narrowing the pharyngeal lumen.

  18. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion.

    PubMed

    Manfredini, Daniele; Guarda-Nardini, Luca; Marchese-Ragona, Rosario; Lobbezoo, Frank

    2015-12-01

    Sleep bruxism (SB) is a term covering different motor phenomena with various risk and etiological factors and potentially different clinical relevance, especially as far as its possible protective role against obstructive sleep apnea (OSA) is concerned. The present expert opinion discusses the possible temporal relationships between the two phenomena. Four hypothetical scenarios for a temporal relationship may be identified: (1) the two phenomena are unrelated; (2) the onset of the OSA event precedes the onset of the SB event within a limited time span, with SB having a potential OSA-protective role; (3) the onset of the SB event precedes the onset of the OSA event within a limited time span, with SB having an OSA-inducing effect; and (4) the onset of the OSA and SB event occurs at the same moment. Literature findings on the SB-OSA temporal relationship are inconclusive. The most plausible hypothesis is that the above scenarios are all actually possible and that the relative predominance of one specific sequence of events varies at the individual level. SB activity may be protective against OSA by protruding the mandible and restoring airway patency in those subjects who benefit from mandibular advancement strategies or may even be related to OSA induction, as a consequence of airways' mucosae swelling resulting from a SB-induced trigeminal cardiac reflex. Clinicians should keep in mind that the SB-OSA relationship is complex and that interindividual differences may explain the possible different SB-OSA relationships, with particular regard to the anatomical site of obstruction.

  19. Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature.

    PubMed

    Mirrakhimov, Aibek E; Sooronbaev, Talant; Mirrakhimov, Erkin M

    2013-02-23

    Obstructive sleep apnea (OSA) is a common disease, affecting approximately 2% of women and 4% of men residing in Western communities. No systematically reviewed data are available about the prevalence of this disease in Asia, the most heavily populated continent. PubMed/Medline, Scopus and Google Scholar were searched for articles published from 1993 to May 2012 that reported the prevalence of OSA diagnosed via sleep monitoring and the prevalence of patients at risk for OSA as assessed by symptomatology and/or sleep questionnaires. We have also searched abstract database of major pulmonary and sleep scientific societies for relevant abstracts presented from 2010 to 2012. The following inclusion criteria were used: articles published in English, age ≥ 18 years, ≥ 100 participants in studies using sleep monitoring for the diagnosis of OSA, ≥ 300 participants in studies using questionnaires to detect patients at high risk for OSA. duplicate publications, studies reporting the prevalence of central sleep apnea only, hospital based studies as well as studies assessing OSA prevalence among patients with resistant arterial hypertension, chronic kidney disease, heart failure and in patients with concomitant neurological disease. Twenty four articles were found to meet the inclusion criteria, covering 47,957 subjects (26,042 men and 21,915 women) and four relevant abstracts were noted. OSA prevalence ranged from 3.7% to 97.3%. Male gender, older age, a higher BMI and waist to hip ratio, greater neck circumference, arterial hypertension, smoking, snoring and daytime sleepiness were associated with OSA. Sample size, difference between the populations studied and the fact that some works included patients with a high pre-test probability of OSA explain the difference in prevalence rates. This systematic review highlights the lack of data regarding the prevalence of OSA in Asians. Only a few studies provide an approximate estimate of the OSA burden in some Asian

  20. Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based follow-up study.

    PubMed

    Chen, Yi-Hua; Keller, Joseph K; Kang, Jiunn-Horng; Hsieh, Heng-Ju; Lin, Herng-Ching

    2013-05-15

    Empirical findings on the prospective link between obstructive sleep apnea (OSA) and subsequent depression are mixed. This nationwide, population-based study thus aimed at assessing the risk of depressive disorder within the first year following a diagnosis with OSA. Gender effects were further examined. Cohort study. Taiwan. This study used data from the Longitudinal Health Insurance Database 2000. A total of 2,818 patients diagnosed with OSA between 2002 and 2008 were evaluated, and 14,090 matched non-OSA enrollees used as a comparison cohort. Each patient was followed for one year to identify subsequent depressive disorder. We found that during the one-year follow-up, the incidence of depressive disorder per thousand person-years was about twice as high among patients with OSA (18.10, 95% CI = 13.62-23.61) as those without OSA (8.23, 95% CI = 6.83-9.84). The Cox proportional hazards model revealed that patients with OSA were independently associated with a 2.18 times (95% CI = 1.55-3.08) increased risk of subsequent depressive disorder within a year, compared to those without OSA. As epidemiological studies have consistently documented an increased risk for depression in women, we hypothesized and confirmed higher risks of depressive disorder among female patients with OSA (2.72, 95% CI = 1.68-4.40) than their male counterparts (1.81, 95% CI = 1.09-3.01). A prospective link between OSA and subsequent depressive disorder within one year was confirmed by the current study. The risk was particularly evident among women. Regular psychiatric screening among patients with OSA is suggested to prompt the timely detection of depression. A commentary on this article appears in this issue on page 425.

  1. Invariant Natural Killer T Cell Deficiency and Functional Impairment in Sleep Apnea: Links to Cancer Comorbidity.

    PubMed

    Gaoatswe, Gadintshware; Kent, Brian D; Corrigan, Michelle A; Nolan, Geraldine; Hogan, Andrew E; McNicholas, Walter T; O'Shea, Donal

    2015-10-01

    Emerging evidence links obstructive sleep apnea (OSA) with increased cancer incidence and mortality. Invariant natural killer T (iNKT) cells play an important role in cancer immunity. We hypothesized that patients with OSA have low number of circulating invariant natural killer T (iNKT) cells, which may also be functionally impaired. This study aims to evaluate the frequency of circulating iNKT cells in OSA. We evaluated the frequency of circulating iNKT cells by flow cytometry in 33 snorers being assessed for possible OSA. Using iNKT cell lines, we also evaluated the effect of exposure to hypoxia over 24 hours on apoptosis, cytotoxicity, and cytokine production. Teaching hospital based sleep unit and research laboratory. Thirty-three snorers were evaluated: 9 with no OSA (apnea-hypopnea frequency [AHI] < 5/h), 12 with mild-moderate OSA (AHI 5-30) and 12 with severe OSA (AHI > 30). Patients with severe OSA had considerably fewer iNKT cells (0.18%) compared to patients with mild-moderate (0.24%) or no OSA (0.35%), P = 0.0026. The frequency of iNKT cells correlated negatively with apnea-hypopnea index (r = -0.58, P = 0.001), oxygen desaturation index (r = -0.58, P = 0.0003), and SpO2% < 90% (r = -0.5407, P = 0.005). The frequency of iNKT cells increased following 12 months of nCPAP therapy (P = 0.015). Hypoxia resulted in increased apoptosis (P = 0.016) and impaired cytotoxicity (P = 0.035). Patients with obstructive sleep apnea (OSA) have significantly reduced levels of circulating invariant natural killer T (iNKT) cells and hypoxia leads to impaired iNKT cell function. These observations may partly explain the increased cancer risk reported in patients with OSA. © 2015 Associated Professional Sleep Societies, LLC.

  2. Neural alterations and depressive symptoms in obstructive sleep apnea patients.

    PubMed

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

    2008-08-01

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

  3. Vascular dysfunction in obstructive sleep apnea and type 2 diabetes mellitus.

    PubMed

    Yim-Yeh, Susie; Rahangdale, Shilpa; Nguyen, Anh Tu Duy; Stevenson, Karen E; Novack, Victor; Veves, Aristidis; Malhotra, Atul

    2011-01-01

    Despite the high prevalence of obstructive sleep apnea (OSA) in type 2 diabetes mellitus (DM), the attributable vascular risk from each condition is unknown. We hypothesize that OSA may have a similar effect on vascular function as type 2 diabetes does. Healthy normal-weight subjects, healthy obese subjects, subjects with type 2 diabetes, and obese subjects with OSA were enrolled. Vascular function was assessed with brachial artery ultrasound for flow-mediated dilatation (FMD) and in skin microcirculation by laser Doppler flowmetry. One hundred fifty-three subjects were studied: healthy normal-weight controls (NCs) (n = 14), healthy obese controls (OCs) (n = 33), subjects with DM (n = 68), and obese subjects with OSA (n = 38). The DM group did not undergo sleep study and thus may have had subclinical OSA. The OSA and type 2 diabetes groups had impaired FMD as compared to both the normal-weight and OC groups (5.8 ± 3.8%, 5.4 ± 1.6% vs. 9.1 ± 2.5%, 8.3 ± 5.1%, respectively, P < 0.001, post hoc Fischer test). When referenced to the NC group, a multiple linear regression model adjusting for covariates found that baseline brachial artery diameter (β = -3.75, P < 0.001), OSA (β = -2.45, P = 0.02) and type 2 diabetes status (β = -2.31, P = 0.02), negatively predicted % FMD. OSA status did not seem to affect nitroglycerin-induced vasodilation (endothelium-independent) of the brachial artery or vascular function in the skin microcirculation. OSA impairs endothelial function in the brachial artery to a similar degree as type 2 diabetes does. OSA, however, does not appear to affect brachial endothelium-independent vasodilation or skin microcirculatory function. Treatment of OSA in patients with concomitant type 2 diabetes, therefore, may be a potential therapeutic option to improve macro-, but not microvascular outcomes.

  4. Neurobehavioral functioning in adolescents with and without obesity and obstructive sleep apnea.

    PubMed

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

    2015-03-01

    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. Cross-sectional, case control. Sleep Center and community. Obese adolescents with OSAS compared to (1) nonsnoring, obese controls without OSAS, and (2) nonobese, nonsnoring controls. Neurobehavioral evaluation. 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. 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. © 2015 Associated Professional Sleep Societies, LLC.

  5. Understanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents

    PubMed Central

    Kim, Christopher; Bagchi, Sheila; Keenan, Brendan T.; Comyn, François-Louis; Wang, Stephen; Tapia, Ignacio E.; Huang, Shirley; Traylor, Joel; Torigian, Drew A.; Bradford, Ruth M.; Marcus, Carole L.

    2015-01-01

    Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children. Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI). Methods: Three groups of adolescents (age range: 12–16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50). Measurements and Main Results: We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation. Conclusions: Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss. PMID:25835282

  6. Perinatal Risk Factors Associated with the Obstructive Sleep Apnea Syndrome in School-Aged Children Born Preterm.

    PubMed

    Tapia, Ignacio E; Shults, Justine; Doyle, Lex W; Nixon, Gillian M; Cielo, Christopher M; Traylor, Joel; Marcus, Carole L

    2016-04-01

    The obstructive sleep apnea syndrome (OSAS) is more prevalent in ex-preterm children compared to the general pediatric population. However, it is unknown whether OSAS in ex-preterm children is associated with specific perinatal risk factors. This multicenter cohort study aimed to determine perinatal factors associated with OSAS at school age. 197 ex-preterm (500-1,250 g) children aged 5-12 y who participated as neonates in a double-blind, randomized clinical trial of caffeine versus placebo (Caffeine for Apnea of Prematurity) underwent comprehensive ambulatory polysomnography. A negative binomial regression model was used to identify perinatal risk factors associated with OSAS. 19 children had OSAS (9.6%). Chorioamnionitis and multiple gestation were positively associated with OSAS with P values of 0.014 and 0.03, respectively. Maternal white race (P = 0.047) and maternal age (P = 0.002) were negatively associated with OSAS. Other risk factors, such as birth weight, Apgar score at 5 min, antenatal corticosteroids, delivery route, and sex were not significant. OSAS is very frequent, and is associated with chorioamnionitis and multiple gestation in ex-preterm children. Those born to older white mothers appear to be protected. We speculate that the former may be due to systemic inflammation and the latter to a higher socio-economic status. A commentary on this article appears in this issue on page 721. © 2016 Associated Professional Sleep Societies, LLC.

  7. Usefulness of sleep endoscopy in predicting positional obstructive sleep apnea.

    PubMed

    Victores, Andrew J; Hamblin, John; Gilbert, Janet; Switzer, Christi; Takashima, Masayoshi

    2014-03-01

    The aim of the study was to (1) evaluate whether position affects drug-induced sleep endoscopy (DISE) findings in positional and nonpositional patients and (2) determine which areas of the upper airway obstruct in different body positions. Prospective, case-controlled study. Academic tertiary care center. Twenty-two patients with obstructive sleep apnea (OSA) were enrolled. Two groups were individually recruited to make 11 consecutive patients with positional OSA and 11 consecutive patients with nonpositional OSA. Positional OSA was defined by nonsupine 50% reduction in apnea-hypopnea index. DISE was performed with patients in both lateral and supine sleep positions. Upper airway collapse was compared between the sleep positions and between the 2 groups. Most patients (77%) demonstrated multilevel obstruction on DISE. Nearly all patients with positional OSA (91%) had at least a partial improvement in collapse while in the lateral sleep position. Most of the reduction in collapse involved the tongue base and epiglottis (P < .05). Sleep position did not significantly alter the upper airway morphology of patients with nonpositional OSA. Apnea-hypopnea index and body mass index were not significantly different between the 2 groups. Sleep position can change upper airway morphology on DISE, particularly positional OSA patients. Hypopharyngeal collapse was the primary site that improved with change in position. DISE in multiple sleep positions should be considered as part of a minimally invasive approach to surgical therapy of OSA.

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

    PubMed

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

    2014-02-01

    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.

  9. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment.

    PubMed

    Joosten, Simon A; O'Driscoll, Denise M; Berger, Philip J; Hamilton, Garun S

    2014-02-01

    The most striking feature of obstructive respiratory events is that they are at their most severe and frequent in the supine sleeping position: indeed, more than half of all obstructive sleep apnea (OSA) patients can be classified as supine related OSA. Existing evidence points to supine related OSA being attributable to unfavorable airway geometry, reduced lung volume, and an inability of airway dilator muscles to adequately compensate as the airway collapses. The role of arousal threshold and ventilatory control instability in the supine position has however yet to be defined. Crucially, few physiological studies have examined patients in the lateral and supine positions, so there is little information to elucidate how breathing stability is affected by sleep posture. The mechanisms of supine related OSA can be overcome by the use of continuous positive airway pressure. There are conflicting data on the utility of oral appliances, while the effectiveness of weight loss and nasal expiratory resistance remains unclear. Avoidance of the supine posture is efficacious, but long term compliance data and well powered randomized controlled trials are lacking. The treatment of supine related OSA remains largely ignored in major clinical guidelines. Supine OSA is the dominant phenotype of the OSA syndrome. This review explains why the supine position so favors upper airway collapse and presents the available data on the management of patients with supine related OSA. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Prevalence and Predictors of Atherogenic Serum Lipoprotein Dyslipidemia in Women with Obstructive Sleep Apnea

    PubMed Central

    Xia, Yunyan; Fu, Yiqun; Wang, Yuyu; Qian, Yingjun; Li, Xinyi; Xu, Huajun; Zou, Jianyin; Guan, Jian; Yi, Hongliang; Meng, Lili; Tang, Xulan; Zhu, Huaming; Yu, Dongzhen; Zhou, Huiqun; Su, Kaiming; Yin, Shankai

    2017-01-01

    Obstructive sleep apnea (OSA) is associated with dyslipidemia. However, no study has focused on dyslipidemia in women with OSA. The aim of this study was to determine the prevalence and risk factors for dyslipidemia in women with OSA. Between 2007 and 2013, 570 eligible female patients with suspected OSA were consecutively recruited. The analyzed data consisted of polysomnography parameters, biochemical indicators, and anthropometric measurements. Serum lipid levels and dyslipidemia were compared. Binary logistic regression and multivariate linear regression models were used to determine the independent risk factors influencing serum lipids. After multivariate adjustment, there were essentially no major differences in serum lipid levels among patients with no to mild, moderate, and severe OSA nor did serum lipid levels change with OSA severity. Dyslipidemia in total cholesterol, triglycerides, low-density lipoprotein cholesterol, apolipoproteins(apo) B and apoE increased with OSA severity, but only in non-obese subjects and those <55 years of age. Age, body mass index, waist to hip ratio, glucose and insulin were major risk factors for most serum lipids after multivariate adjustments. Our results indicate that, in women with OSA, age, obesity/central obesity, and insulin resistance are major determinants of dyslipidemia. PMID:28134311

  11. 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.

  12. Self-appraisals of arousal-oriented online sexual activities in university and community samples.

    PubMed

    Shaughnessy, Krystelle; Byers, E Sandra; Clowater, Sarah L; Kalinowski, Alana

    2014-08-01

    Arousal-oriented online sexual activities (OSAs) are any activities on the Internet that involve sexually explicit and/or sexually arousing stimuli. These can be solitary-arousal activities, requiring only one person be involved. They can also be partnered-arousal activities that involve at least two people interacting (Shaughnessy, Byers, & Walsh, 2011). Most researchers have focused on the negative outcomes of arousal-oriented OSAs on users' sexual life and life in general. Yet, these activities can also have positive outcomes. In two separate studies, we examined men's and women's perceptions of the positive and negative outcomes of their solitary- and partnered-arousal OSA experience. Study 1 included heterosexual university students (N = 191); Study 2 consisted of heterosexual and sexual minority individuals from the community (N = 316). Participants completed a background questionnaire and measures of their solitary- and partnered-arousal OSA experience and outcomes of these experiences. Overall, solitary- and partnered-arousal OSA was common among study participants. In both studies, participants reported significantly greater positive than negative outcomes of their solitary- and partnered-arousal OSAs, albeit the overall impact was small. We did not find significant gender differences or differences by sexual orientation in positive or negative outcomes of arousal-oriented OSAs. Our results suggest that, for most people, participating in solitary- and partnered-arousal OSAs has little impact on them.

  13. 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

  14. Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

    PubMed Central

    Bouloukaki, Izolde; Mermigkis, Charalampos; Kallergis, Eleftherios M; Moniaki, Violeta; Mauroudi, Eleni; Schiza, Sophia E

    2015-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease (CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein (CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS. PMID:25992322

  15. Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein.

    PubMed

    Bouloukaki, Izolde; Mermigkis, Charalampos; Kallergis, Eleftherios M; Moniaki, Violeta; Mauroudi, Eleni; Schiza, Sophia E

    2015-05-20

    Obstructive sleep apnea syndrome (OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease (CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein (CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.

  16. 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