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Sample records for sleep apnea hypopnea

  1. Sleep apnea hypopnea syndrome and liver injury.

    PubMed

    Tian, Jian-li; Zhang, Yun; Chen, Bao-yuan

    2010-01-05

    A general review was made of studies involving: (1) the relationship between sleep apnea hypopnea syndrome/sleep apnea style intermittent hypoxia and liver injury and (2) the mechanism that causes the liver injury. The data used in this review were mainly from Medline and PubMed published in English from 1993 to February 2009. The search term was "sleep apnea hypopnea syndrome". (1) Clinical and laboratory evidence that sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia leads to liver injury; (2) the mechanism that causes the liver injury. The effect of sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia on the liver function is characterized by serum aminotransferase elevation. The liver histological injury includes hepatic steatosis, hepatocyte ballooning, lobular inflammation, lobular necrosis, and liver fibrosis. Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can cause insulin resistance and oxidative stress. Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can lead to chronic liver injury, which, in most cases, is shown as nonalcoholic fatty liver disease. Insulin resistance and oxidative stress caused by sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia play an important role in the mechanism of chronic liver disease development.

  2. [The sleep obstructive apnea and hypopnea syndromes].

    PubMed

    Cambron, L; Roelants, F; Deflandre, E; Raskin, S; Poirrier, R

    2004-01-01

    Since two decades, sleep breathing disorders are more wisely recognized by the Belgian medical community. Among these, the Obstructive Sleep Apnea Syndrome (OSA) is the best known but its frontiers with others syndromes such as the Upper Airway Resistance Syndrome (UARS), the Central Sleep Apnea Syndrome (CSAS) or the Overlap Syndrome are still matter of discussion. Its causes are plurifactorial, and many recent publications draw the attention to its long term effects in the cardiovascular and neuropsychiatric fields. This article summarizes the present definitions and features associated with OSA, from clinical and neurophysiological perspectives, and the different consequences to which untreated or underdiagnosed patients are exposed.

  3. Predominant obstructive or central sleep apnea in patients with atrial fibrillation: influence of characterizing apneas versus apneas and hypopneas.

    PubMed

    Strotmann, Johanna; Fox, Henrik; Bitter, Thomas; Schindhelm, Florian; Gutleben, Klaus-Jürgen; Horstkotte, Dieter; Oldenburg, Olaf

    2017-09-01

    Sleep-disordered breathing (SDB) is common in patients with atrial fibrillation (Afib). Although a high proportion of respiratory events are hypopneas, previous studies have only used apneas to differentiate obstructive (OSA) from central (CSA) sleep apnea. This study investigated the impact of using apneas and hypopneas versus apneas only to define the predominant type of SDB in Afib patients with preserved ejection fraction. This retrospective analysis was based on high-quality cardiorespiratory polygraphy (PG) recordings (07/2007-03/2016) that were re-analyzed using 2012 American Academy of Sleep Medicine criteria, with differentiation of apneas and hypopneas as obstructive or central. Classification of predominant (>50% of events) OSA and CSA was defined based on apneas only (OSAAI and CSAAI) or apneas and hypopneas (OSAAHI and CSAAHI). SDB was defined as an apnea-hypopnea index ≥5/h. A total of 211 patients were included (146 male, age 68.7 ± 8.5 y). Hypopneas accounted for >50% of all respiratory events. Based on apneas only, 46% of patients had predominant OSA and 44% had predominant CSA. Based on apneas and hypopneas, the proportion of patients with OSA was higher (56%) and that with CSA was lower (36%). In the subgroup of patients with moderate to severe SDB (AHI ≥ 15/h), the proportion with predominant CSA was 55.2% based on apneas only versus 42.1% with apneas and hypopneas. In hospitalized patients with Afib and SDB, use of apneas and hypopneas versus apneas alone had an important influence on the proportion of patients classified as having predominant OSA or CSA. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Sleep apnea diagnosis varies with the hypopnea criteria applied.

    PubMed

    Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul

    2016-03-01

    We aimed to evaluate the three hypopnea criteria, A and B from 2007 and the revised from 2012, proposed by the American Academy of Sleep Medicine (AASM) for scoring sleep-related breathing disorders (SRBDs) in patients with acute stroke or transient ischemic attack (TIA). Polysomnographies (PSGs) in patients with TIA or stroke were scored according to the A-, B-, and 2012-hypopnea criteria. Sixty-three PSGs were eligible for hypopnea scoring. There was no difference in the number of patients diagnosed with the B- and 2012-criteria. Therefore, they are mentioned as one. Forty-seven patients (75 %) were diagnosed with SRBD using the A-criteria versus 57 patients (90 %) using the B/2012-criteria (p < 0.0016). In 30 cases, a change from A- to B/2012-criteria resulted in a change in diagnosis. Ten cases of "no SRBD" changed to mild/moderate/severe SRBD. An apnea hypopnea index (AHI) >15 is a typical indication of treatment. With the B/2012-criteria, we found an additional indication of treatment in 18 patients, compared to when the A-criteria were applied (p < 0.0001). Two of these patients were labeled as no SRBD with the A-criteria. The difference is significant between the AHIs achieved by the A- and the B-/2012-hypopnea criteria, with much lower AHIs achieved with the A-criteria. As SRBD treatment lessens the risk of complications, correct identification of SRBD patients is of the utmost importance.

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

    PubMed

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

    2014-12-01

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

  6. Sleep-related deglutition in patients with sleep apnea-hypopnea syndrome.

    PubMed

    Sato, Kiminori; Nakashima, Tadashi

    2009-01-01

    We investigated sleep-related deglutition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Deglutition during sleep was examined in 10 patients with a mean (+/- SD) age of 48 +/- 11 years who had severe OSAHS (apnea-hypopnea index, 66.6 +/- 17.6) via time-matched recordings of polysomnography and surface electromyography of the thyrohyoid and suprahyoid muscles. During sleep, deglutition was episodic, and was absent for long periods. Deglutition did not occur during apnea or hypopnea periods. The mean number of swallows per hour during the total sleep time was 5.4 +/- 3.1. The mean period of the longest absence of deglutition was 43.5 +/- 14.7 minutes. Most deglutition occurred in association with respiratory electroencephalographic arousal after apnea or hypopnea. Approximately 70% of swallows were followed by inspiration. Deglutition was related to the sleep stage. The mean number of swallows per hour was 6.2 +/- 6.1 during stage 1 sleep, 6.0 +/- 3.4 during stage 2 sleep, 3.0 +/- 5.2 during stage 3 sleep, and 0 during stage 4 sleep. The deeper the sleep stage, the lower the mean deglutition frequency. The mean number of swallows per hour was 4.5 +/- 3.0 during rapid eye movement sleep. Deglutition was infrequent and displayed a unique pattern in patients with OSAHS during sleep.

  7. Automated scoring of obstructive sleep apnea and hypopnea events using short-term electrocardiogram recordings.

    PubMed

    Khandoker, Ahsan H; Gubbi, Jayavardhana; Palaniswami, Marimuthu

    2009-11-01

    Obstructive sleep apnea or hypopnea causes a pause or reduction in airflow with continuous breathing effort. The aim of this study is to identify individual apnea and hypopnea events from normal breathing events using wavelet-based features of 5-s ECG signals (sampling rate = 250 Hz) and estimate the surrogate apnea index (AI)/hypopnea index (HI) (AHI). Total 82,535 ECG epochs (each of 5-s duration) from normal breathing during sleep, 1638 ECG epochs from 689 hypopnea events, and 3151 ECG epochs from 1862 apnea events were collected from 17 patients in the training set. Two-staged feedforward neural network model was trained using features from ECG signals with leave-one-patient-out cross-validation technique. At the first stage of classification, events (apnea and hypopnea) were classified from normal breathing events, and at the second stage, hypopneas were identified from apnea. Independent test was performed on 16 subjects' ECGs containing 483 hypopnea and 1352 apnea events. The cross-validation and independent test accuracies of apnea and hypopnea detection were found to be 94.84% and 76.82%, respectively, for training set, and 94.72% and 79.77%, respectively, for test set. The Bland-Altman plots showed unbiased estimations with standard deviations of +/- 2.19, +/- 2.16, and +/- 3.64 events/h for AI, HI, and AHI, respectively. Results indicate the possibility of recognizing apnea/hypopnea events based on shorter segments of ECG signals.

  8. Three components of obstructive sleep apnea/hypopnea syndrome.

    PubMed

    Kumano-go, Takayuki; Mikami, Akira; Suganuma, Nakamori; Adachi, Hiroyoshi; Watanabe, Takuya; Shigedo, Yoshihisa; Sugita, Yoshiro; Takeda, Masatoshi

    2003-04-01

    The aims of this study were to calculate the apnea-hypopnea index (AHI), which represented as the number of apnea-hypopnea occurrences per hour, the 4% oxygen desaturation index (ODI4) and the breathing-related arousal index (B-ArI) in polysomnographic studies of obstructive sleep apnea/hypopnea syndrome (OSAHS) patients and to investigate whether there was any relationship between each pair of scoring schemes. Thirty-four cases of OSAHS were studied. Total OSAHS patients were subdivided into those with a high AHI (> 25), and those with a low AHI (< 25). The correlation between each pair of scoring schemes for OSAHS with a high AHI showed high value. The correlation between AHI and ODI4 for OSAHS with a low AHI was 0.18 and that between AHI and B-ArI showed a weak correlation of 0.59, while that between ODI4 and B-ArI was only -0.078. Our results mean that oxygen desaturation and arousal occur separately in mild or moderate OSAHS patients, even though they are diagnosed with the same level of OSAHS by means of AHI. Breathing-related arousal without oxygen desaturation often occurs in mild or moderate OSAHS patients. We previously reported that AHI does not accurately reflect the severity of the increase in negativity of esophageal pressure manifested as respiratory efforts. We consider that the comprehension and assessment of OSAHS can be improved by the systematic differentiations among the three components: oxygen desaturation, arousals and respiratory efforts.

  9. The Nightmares of Sleep Apnea: Nightmare Frequency Declines with Increasing Apnea Hypopnea Index

    PubMed Central

    Pagel, J. F.; Kwiatkowski, Carol

    2010-01-01

    Objective: To clarify the association of reported nightmare recall with polysomnographically defined obstructive sleep apnea (OSA) in a sleep laboratory population. Methods: This study included 393 individuals undergoing clinical polysomnography including a general intake questionnaire with questions on dream and nightmare recall frequency. Mean age was 50.5 and a range of 13 to 82 years, with 33% of the sample female and 67% male. Reported dream and nightmare recall were classified as infrequent when reported at less than once a month, or frequent when reported at a frequency greater than once per week. Results: Mean Apnea-hypopnea Index AHI was 34.9 (std. 32.0) indicating a high frequency of severe (AHI > 30) OSA in this clinical study population. Both AHI and Apnea Index (AI) were significantly higher (p = 0.000) for the grouping reporting infrequent nightmare recall. As the AHI score increased, the percent of participants with frequent nightmare recall decreased linearly. Conclusion: Patients with higher AHI report a lower nightmare frequency, indicating that significant OSA suppresses the cognitive experience of nightmare recall. Depressed nightmare recall may occur secondary to the REMS suppression know to occur in patients with significant OSA. Citation: Pagel JF; Kwiatkowski C. The nightmares of sleep apnea: nightmare frequency declines with increasing apnea hypopnea index. J Clin Sleep Med 2010;6(1):69-73. PMID:20191941

  10. Potential inflammatory markers in obstructive sleep apnea-hypopnea syndrome

    PubMed Central

    Lu, Dongmei; Li, Nanfang; Yao, Xiaoguang; Zhou, Ling

    2017-01-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a complex chronic inflammatory respiratory disease with multiple pathogenic factors and high morbidity and mortality. Serum levels of nuclear factor-κB (NF-κB), hypoxia-inducible factor-1 alpha (HIF-1α), and surfactant protein D (SPD) were investigated in OSAHS patients, to determine their clinical significance and correlation with the pathogenesis. Patients were classified into a mild and moderate OSAHS group (n = 25) and severe OSAHS group (n = 33). Twenty healthy patients served as a control group. Peripheral blood levels of NF-κB, HIF-1α, and SPD were determined by Western blot, and a correlation analysis was performed. Severe OSAHS patients received nasal continuous positive airway pressure (nCPAP) therapy and were followed up after 2 months. NF-κB p65, HIF-1α, and SPD expression levels were determined after valid nCPAP therapy. NF-κB p65 and HIF-1α expression was significantly higher in severe OSAHS group than in the other two groups (p < 0.01), and was positively correlated with the apnea-hypopnea index (AHI) (r = 0.696, p < 0.001; r = 0.634, p < 0.001). SPD expression was significantly lower in severe OSAHS group than in the control group (p < 0.01) and mild and moderate OSAHS group (p < 0.01), and was negatively correlated with AHI (r = −0.569, p < 0.001). OSAHS pathogenesis was associated with changes in NF-κB, HIF-1α, and SPD protein expression levels. nCPAP therapy could improve the clinical characteristics of the patients, lower serum NF-κB and HIF-1α levels, and increase serum SPD levels. We conclude that OSAHS is related to the expression of NF-κB, HIF-1, and SPD. PMID:27754829

  11. Utility of ApneaLink for the diagnosis of sleep apnea-hypopnea syndrome.

    PubMed

    Nigro, Carlos A; Serrano, Fernando; Aimaretti, Silvia; González, Sergio; Codinardo, Carlos; Rhodius, Edgardo

    2010-01-01

    Portable sleep studies may play an important role to take decisions on patients referred for suspicion of Sleep Apnea-Hypopnea Syndrome (SAHS). The aim of this study was to evaluate the diagnostic accuracy of automated analysis of ApneaLink in patients with suspicion of SAHS. All participants (75) performed the ApneaLink and polysomnography (PSG) simultaneously in the sleep laboratory. The two recordings were interpreted blindly. The ApneaLink software calculated: (1) risk indicator (RI)-a combination of apnea/hypopnea index (AHI) plus inspiratory flow limitation events and (2) the AHI. ApneaLink and SAHS were defined in three ways: AHI or respiratory disturbance index (RDI) >or= 5, 10 and 15 respectively. ROC curves analysis was performed. The sensitivity (S), specificity (E) and positive and negative likelihood ratio (LR+, LR-) for the different thresholds for RI or AHI were calculated; 66 patients were included (47 men, mean age 51, median RDI 10.6, mean BMI 29.3 kg/m2). The best cut off points of RI were: SAHS = RDI >or= 5: RI > 9 (S 80%, E 100%, LR- 0.20); SAHS =RDI >or= 10: RI > 13 (S 92%, E 93%, LR+ 13.7 LR- 0.089); SAHS = RDI >or= 15 =: RI > 16 (S 93.5%, E 91%, LR+10.9, LR- 0.071). The AHI had a similar diagnostic accuracy to RI for the different definitions of SAHS. The RI and AHI obtained from automated analysis of ApneaLink were highly sensitive and specific to diagnose moderate to severe SAHS.

  12. Obstructive Sleep Apnea Resolution in Hypopnea- versus Apnea-Predominant Children after Adenotonsillectomy.

    PubMed

    Tang, Alice L; Cohen, Aliza P; Benke, James R; Stierer, Kevin D; Stanley, James; Ishman, Stacey L

    2016-10-01

    Given that 30% to 40% of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we evaluated whether children with hypopnea-predominant OSA were more likely to have complete disease resolution after adenotonsillectomy than those with apnea-predominant disease. We also identified risk factors that might modify the relationship between disease resolution and polysomnographic event type (ie, hypopnea vs apnea). Case series with chart review. Tertiary pediatric hospital. Consecutive 1- to 18-year-old typically developing children diagnosed with OSA from March 2011 to December 2012 underwent adenotonsillectomy and completed pre- and postoperative polysomnography within 1 year of surgery. Fifty-eight children were included (27 female; mean ± SD: age, 5.6 ± 3.1 years; body mass index z score, 1.1 ± 1.7). Overall, adenotonsillectomy resulted in significant improvement in obstructive apnea-hypopnea index (oAHI) from 23.3 ± 40.0 to 4.3 ± 8.2 events per hour (P < .001), obstructive apnea index (5.1 ± 7.4 to 0.4 ± 0.8, P < .001), and obstructive hypopnea index (oHI; 18.1 ± 37.5 to 3.7 ± 8.1, P < .001). There was complete response (oAHI <1.0 event/h) in 24 of 58 patients (41%) but no difference by event type (P = .11). On univariate analysis, only race, sex, oxygen saturation nadir, and oHI were predictive of response to adenotonsillectomy, while multivariate analysis found that prematurity, age, oxygen saturation nadir, oHI, obstructive apnea index, and oAHI were predictive. Event type was not significant, even in a model controlling for age, race, sex, prematurity, asthma, body mass index, and baseline polysomnographic variables. This small study demonstrated no difference in disease resolution between children with hypopnea- and apnea-predominant OSA who underwent adenotonsillectomy. Additionally, adenotonsillectomy significantly improved OSA in most children, and high preoperative oAHI was associated with persistent postoperative OSA.

  13. Comparison of hypopnea definitions in lean patients with known obstructive sleep apnea hypopnea syndrome (OSAHS).

    PubMed

    Guilleminault, C; Hagen, C C; Huynh, N T

    2009-11-01

    In the interest of improving inter-rater reliability and standardization between sleep laboratories, hypopnea definitions were recently changed to place less emphasis on arousal scoring and more emphasis on oxygen desaturations. We sought to determine whether these changes would affect detection and treatment of OSAHS in lean patients-a group known to desaturate less-than-obese patients. Thirty-five lean subjects (15 male, 20 women, five post-menopausal) diagnosed OSAHS and a documented benefit from treatment had diagnostic polysomnograms (PSG) originally scored using the American Academy of Sleep Medicine (AASM) rule from 1999 (referred to as "Rule C"). These patients had appropriate clinical care based on those results. PSG records were then re-scored in a randomized and blinded fashion utilizing hypopnea Rule A and B of the 2007 AASM guidelines. Baseline mean (SD) apnea hypopnea indices (AHI) for rules A, B, and C were 6.4 (3.1), 20.6 (8.2), and 26.9 (7.3), respectively (p < 0.0001). Mean (SD) BMI was 24.4 (1.0). By design, all subjects were treatment responders. Eighty-six percent with CPAP, 83% with oral appliance, and 100% with surgical intervention reported resolution of their initial daytime or sleep complaint. Post-treatment AHIs for rules A, B, and C were 0.8 (0.9), 1.8 (1.2) and 2.3 (1.6; p < 0.001). In all three scoring conditions, the AHI was reduced significantly with treatment (p < 0.001). A repeated measures ANOVA of the difference between scoring methods indicated statistically significant differences between all three strategies at both pre- and post-treatment (p < 0.001). Sleepiness on the Epworth sleepiness scale decreased from a mean of 10.9 (2.3) to 5.7 (1.3) with treatment (p < 0.001). This change in subjective rating of sleepiness was more strongly correlated with rules B and C (r = 0.6) and more modestly correlated with Rule A scoring (r = 0.4). Response to treatment was more tightly correlated with arousal based scoring rules B and C in

  14. Neural Respiratory Drive and Arousal in Patients with Obstructive Sleep Apnea Hypopnea

    PubMed Central

    Xiao, Si-Chang; He, Bai-Ting; Steier, Joerg; Moxham, John; Polkey, Michael I.; Luo, Yuan-Ming

    2015-01-01

    Study Objectives: It has been hypothesized that arousals after apnea and hypopnea events in patients with obstructive sleep apnea are triggered when neural respiratory drive exceeds a certain level, but this hypothesis is based on esophageal pressure data, which are dependent on flow and lung volume. We aimed to determine whether a fixed threshold of respiratory drive is responsible for arousal at the termination of apnea and hypopnea using a flow independent technique (esophageal diaphragm electromyography, EMGdi) in patients with obstructive sleep apnea. Setting: Sleep center of state Key Laboratory of Respiratory Disease. Patients: Seventeen subjects (two women, mean age 53 ± 11 years) with obstructive sleep apnea/hypopnea syndrome were studied Methods: We recorded esophageal pressure and EMGdi simultaneously during overnight full polysomnography in all the subjects. Measurements and Results: A total of 709 hypopnea events and 986 apnea events were analyzed. There was wide variation in both esophageal pressure and EMGdi at the end of both apnea and hypopnea events within a subject and stage 2 sleep. The EMGdi at the end of events that terminated with arousal was similar to those which terminated without arousal for both hypopnea events (27.6% ± 13.9%max vs 29.9% ± 15.9%max, P = ns) and apnea events (22.9% ± 11.5%max vs 22.1% ± 12.6%max, P = ns). The Pes at the end of respiratory events terminated with arousal was also similar to those terminated without arousal. There was a small but significant difference in EMGdi at the end of respiratory events between hypopnea and apnea (25.3% ± 14.2%max vs 21.7% ± 13.2%max, P < 0.05]. Conclusions: Our data do not support the concept that there is threshold of neural respiratory drive that is responsible for arousal in patients with obstructive sleep apnea. Citation: Xiao SC, He BT, Steier J, Moxham J, Polkey MI, Luo YM. Neural respiratory drive and arousal in patients with obstructive sleep apnea hypopnea. SLEEP 2015

  15. [Arterial hypertension and sleep apnea hypopnea syndrome in primary care].

    PubMed

    Bayó Llibre, J; Riel Cabrera, R; Mellado Breña, E; Filomena Paci, J; Priego Artero, M; García Alfaro, F J; Grau Granero, J M; Vázquez González, D; López Solana, J; Fernández San Martín, M I

    2015-01-01

    Sleep apnea hypopnea syndrome (SAHS) is frequent in hypertensive patients and plays a role in a greater incidence of cardiovascular morbidity-mortality. This study aims to know the clinical profile of hypertensive patients with SAHS compared to hypertensive patients without SAHS to know which variables should be used to orient their screening from primary care. An observational, descriptive, retrospective study of cases (hypertensive patients with SAHS) and controls (hypertensive patients without) was performed in an urban health care center. Based on a computerized registry of the site, patients diagnosed of SAHS and hypertension over 30 years of age were selected. For each case, one control case of hypertensive patients without SAHS paired by age and gender was randomly obtained. A total of 64 cases and 64 controls were selected. Standing out in the bivariate analysis were greater BMI (34.3±12.8 vs. 28.6±3.6), predominance of obesity (70.3 vs. 35.9%), metabolic syndrome (77.3 vs. 42.2%), consumption of psychopharmaceuticals (19.7 vs. 7.8%) and anithypertensive drugs (26.5 vs. 14.0%), ischemic heart disease (20.3 vs. 9.4%) in the case group versus control group (P<.05 for all the variables). The multivariate analysis showed that only the presence of metabolic syndrome was related with the presence of SAHS in hypertensive patients (OR 4.65; 95% CI: 2.03-10.64; P<.001). Screening for SAHS should be performed in hypertensive patients seen in primary care if they have metabolic syndrome criteria. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

  16. Quantitative Effects of Trunk and Head Position on the Apnea Hypopnea Index in Obstructive Sleep Apnea

    PubMed Central

    van Kesteren, Ellen R.; van Maanen, J. Peter; Hilgevoord, Anthony A.J.; Laman, D. Martin; de Vries, Nico

    2011-01-01

    Study Objectives: To test the hypothesis that head position, separately from trunk position, is an additionally important factor for the occurrence of apnea in obstructive sleep apnea (OSA) patients. Design: Prospective cohort study. Setting: St. Lucas Andreas Hospital, Amsterdam, the Netherlands. Patients and Participants: Three hundred patients referred to our department because of clinically suspected OSA. Interventions: N/A Measurements and Results: Patients underwent overnight polysomnography with 2 position sensors: one on the trunk, and one in the mid-forehead. Of the 300 subjects, 241 were diagnosed with OSA, based on an AHI > 5. Of these patients, 199 could be analyzed for position-dependent OSA based on head and trunk position sensors (AHI in supine position twice as high as AHI in non-supine positions): 41.2% of the cases were not position dependent, 52.3% were supine position dependent based on the trunk sensor, 6.5% were supine position dependent based on the head sensor alone. In 46.2% of the trunk supine position-dependent group, head position was of considerable influence on the AHI (AHI was > 5 higher when the head was also in supine position compared to when the head was turned to the side). Conclusions: The results of this study confirm our hypothesis that the occurrence of OSA may also be dependent on the position of the head. Therefore in patients with a suspicion of position-dependent OSA, sleep recording with dual position sensors placed on both trunk and head should be considered. Citation: van Kesteren ER; van Maanen JP; Hilgevoord AAJ; Laman DM; de Vries N. Quantitative effects of trunk and head position on the apnea hypopnea index in obstructive sleep apnea. SLEEP 2011;34(8):1075-1081. PMID:21804669

  17. Facial phenotype in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis.

    PubMed

    Agha, Bahn; Johal, Ama

    2017-04-01

    This systematic review and meta-analysis explores the association between facial phenotype and obstructive sleep apnea-hypopnea syndrome in adults. A comprehensive electronic (Medline via Ovid, Scopus, and Embase) database and reference search were undertaken in relation to imaging modalities for surface craniofacial assessments in subjects with sleep apnea. The outcome measures were surface facial dimensions, morphology and profile. The quality of studies was assessed and a meta-analysis conducted. The studies were weighted using the inverse variance method, and the random effects model was used to analyse data. This systematic review identified eight case-control studies. In five studies (906 participants), adults with sleep apnea showed increased weighted mean differences in neck circumference by 1.26 mm (P = 0.0001) with extensive heterogeneity between studies (I² = 93%). Only two studies (467 participants) shared the following outcomes: mandible length, lower facial height, mandible width and anterior mandible height parameters. The pooled results demonstrated obstructive sleep apnea syndrome was associated with larger parameters than controls. In conclusion, the surface facial assessment was able to demonstrate some characteristic morphological features, facilitating a meta-analysis, in adults with obstructive sleep apnea-hypopnea syndrome. The strength of these findings, however, was limited by the heterogeneity of the studies precluding the identification of a clear phenotype.

  18. Incremental shuttle walk test in the assessment of patients with obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Billings, Catherine G; Aung, Thida; Renshaw, Stephen A; Bianchi, Stephen M

    2013-08-01

    Obstructive sleep apnea-hypopnea syndrome is associated independently with an increase in cardiovascular risk factors and is associated with self-reported lack of exercise. We aimed to investigate the utility of the incremental shuttle walk test in routine clinical practice to monitor physical capacity of patients with obstructive sleep apnea-hypopnea syndrome and explore whether continuous positive airway pressure therapy alters exercise capacity. Participants with symptomatic moderate/severe obstructive sleep apnea-hypopnea syndrome attending for a trial of continuous positive airway pressure therapy completed questionnaires assessing sleepiness and physical activity and underwent an incremental shuttle walk test. Subjects compliant or partially compliant with continuous positive airway pressure therapy underwent reassessment at 2 weeks, 3 months and 6 months post-initiation of therapy. Participants unable to tolerate continuous positive airway pressure therapy completed a single reassessment 6 months after their initial visit. Continuous positive airway pressure therapy resulted in an increased distance walked during the incremental shuttle walk test. Improvements in cardiovascular responses to exercise were identified. Compliant patients reported increased daily activity. The incremental shuttle walk test is a simple, reproducible and safe test that is responsive to continuous positive airway pressure treatment. Our findings support the use of the incremental shuttle walk test for monitoring the effects of continuous positive airway pressure treatment and may suggest its use in rehabilitation programmes designed to reduce obesity and cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome. © 2013 European Sleep Research Society.

  19. Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep.

    PubMed

    Zhou, X S; Shahabuddin, S; Zahn, B R; Babcock, M A; Badr, M S

    2000-07-01

    We hypothesized that a decreased susceptibility to the development of hypocapnic central apnea during non-rapid eye movement (NREM) sleep in women compared with men could be an explanation for the gender difference in the sleep apnea/hypopnea syndrome. We studied eight men (age 25-35 yr) and eight women in the midluteal phase of the menstrual cycle (age 21-43 yr); we repeated studies in six women during the midfollicular phase. Hypocapnia was induced via nasal mechanical ventilation for 3 min, with respiratory frequency matched to eupneic frequency. Tidal volume (VT) was increased between 110 and 200% of eupneic control. Cessation of mechanical ventilation resulted in hypocapnic central apnea or hypopnea, depending on the magnitude of hypocapnia. Nadir minute ventilation in the recovery period was plotted against the change in end-tidal PCO(2) (PET(CO(2))) per trial; minute ventilation was given a value of 0 during central apnea. The apneic threshold was defined as the x-intercept of the linear regression line. In women, induction of a central apnea required an increase in VT to 155 +/- 29% (mean +/- SD) and a reduction of PET(CO(2)) by -4.72 +/- 0.57 Torr. In men, induction of a central apnea required an increase in VT to 142 +/- 13% and a reduction of PET(CO(2)) by -3.54 +/- 0.31 Torr (P = 0.002). There was no difference in the apneic threshold between the follicular and the luteal phase in women. Premenopausal women are less susceptible to hypocapnic disfacilitation during NREM sleep than men. This effect was not explained by progesterone. Preservation of ventilatory motor output during hypocapnia may explain the gender difference in sleep apnea.

  20. Glycated hemoglobin and sleep apnea syndrome in children: beyond the apnea-hypopnea index.

    PubMed

    Peña-Zarza, J A; De la Peña, M; Yañez, A; Bauça, J M; Morell-Garcia, D; Caimari, M; Barceló, A; Figuerola, J

    2017-05-29

    Snoring and obstructive sleep apnea syndrome (OSA) are frequent conditions in pediatrics. Glycated hemoglobin (HbA1C) is a useful homeostatic biomarker of glycemia and may reflect alterations deriving from sleep breathing disorders. The aim of this study was to relate the severity of OSA with blood HbA1C levels in children. A descriptive observational study in snoring patients was performed. All patients underwent a sleep study and classified either as simple snorers (apnea-hypopnea index; AHI ≤ 1 episodies/h) or as OSA patients (AHI > 1 episodes/h). In the following morning, a blood glycemic profile (fasting glucose, insulin, HbA1C, and the HOMA index) was performed to every individual. A total of 48 patients were included. HbA1C levels were shown to be increased in the moderate OSA (AHI > 5 episodes/h) group (5.05 ± 0.25 vs. 5.24 ± 0.29%; p = 0.019). Significant correlations were found between HbA1C values and AHI (r = 0.345; p = 0.016) and also with oxygen desaturation index (r = 0.40; p = 0.005). Correlations remained significant after adjusting by age and body mass index. The AHI-associated change in HbA1C was 13.4% (p = 0.011). In the pediatric population, HbA1C is a biomarker associated with OSA severity, and this relationship is age- and obesity-independent. The fact that this association was observed in snoring patients could help the physician in the distinction between those patients affected with OSA and those with simple snoring. Therefore, HbA1C measurement could play a major role in the diagnosis and the management of the syndrome.

  1. New Rule-Based Algorithm for Real-Time Detecting Sleep Apnea and Hypopnea Events Using a Nasal Pressure Signal.

    PubMed

    Lee, Hyoki; Park, Jonguk; Kim, Hojoong; Lee, Kyoung-Joung

    2016-12-01

    We developed a rule-based algorithm for automatic real-time detection of sleep apnea and hypopnea events using a nasal pressure signal. Our basic premise was that the performance of our new algorithm using the nasal pressure signal would be comparable to that using other sensors as well as manual annotation labeled by a technician on polysomnography study. We investigated fifty patients with sleep apnea-hypopnea syndrome (age: 56.8 ± 10.5 years, apnea-hypopnea index (AHI): 36.2 ± 18.1/h) during full night PSG recordings at the sleep center. The algorithm was comprised of pre-processing with a median filter, amplitude computation and apnea-hypopnea detection parts. We evaluated the performance of the algorithm a confusion matric for each event and statistical analyses for AHI. Our evaluation achieved a good performance, with a sensitivity of 86.4 %, and a positive predictive value of 84.5 % for detection of apnea and hypopnea regardless of AHI severity. Our results indicated a high correlation with the manually labeled apnea-hypopnea events during PSG, with a correlation coefficient of r = 0.94 (p < 0.0001) and a mean difference of -2.9 ± 11.6 per hour. The proposed new algorithm could provide significant clinical and computational insights to design a PSG analysis system and a continuous positive airway pressure (CPAP) device for screening sleep quality related in patients with sleep apnea-hypopnea syndrome.

  2. Measurement techniques predicting the effectiveness of an oral appliance for obstructive sleep apnea hypopnea syndrome.

    PubMed

    Horiuchi, Atsushi; Suzuki, Masaaki; Ookubo, Mau; Ikeda, Katsuhisa; Mitani, Hideo; Sugawara, Junji

    2005-11-01

    The purpose of this study is to determine the measurement techniques that can predict the effectiveness of an oral appliance (OA) for the treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Split-night polysomnography and esophageal pressure (Pes) were recorded, and cephalometric tracings were superimposed for 25 OSAHS patients. The patients were classified into good and poor responders according to their apnea hypopnea index (AHI) and mean nadir Pes. When the degree of anterior displacement of the mandible was expressed by vector resolution, it was significantly different between the good and poor responders, whereas there was no significant difference in downward and total mandibular displacement between the two groups. Among the good responders evaluated on the basis of mean nadir Pes, their apnea index, hypopnea index, and mean nadir Pes were significantly different. However, AHI alone cannot predict the effectiveness of OA treatment. Good responders defined by mean nadir Pes also had short soft palates and a wide pharyngeal airway space. Conversely, no significant differences were observed in these parameters when good responders and poor responders are defined by AHI. Logistic regression analysis revealed that the degree of anterior displacement of the mandible showed a significant odds ratio of 1.97. In conclusion, evaluations based on Pes and analyses of the mandibular displacement expressed by vector resolution using a cephalometric superimposition technique can provide important clinical information in evaluation measurements and may be useful for the prediction of the efficacy of OA treatment for patients with OSAHS.

  3. [Compliance with nasal continuous positive airway pressure (CPAP) treatment in sleep apnea-hypopnea syndrome].

    PubMed

    Alarcón, A; León, C; Maimó, A; Barbé, F; Agustí, A G; Rodríguez-Roisin, R; Granados, A; Montserrat, J M

    1995-02-01

    Ever since Sullivan introduced nighttime nasal continuous pressure on the upper airway (CPAP) in 1981 it has been the standard treatment for sleep-hypopnea syndrome (SAHS). However, CPAP is carried out at great expense and is not tolerated by all patients. Moreover, its efficacy is dependent on the degree of compliance. In this study we set out to analyze the degree of compliance with CPAP over the first 3 months of treatment in a group of 142 consecutive patients with moderate to severe SAHS (apnea-hypopnea index: 48.9 +/- 20). Diagnosis and measurement of the level of CPAP needed (9.6 +/- 2.5 cm H2O) were based on polysomnography. Eighteen (13%) patients did not return for follow-up evaluation. In the remaining 124 patients (age 54 +/- 11 years) compliance with treatment was evaluated by way of a sleep diary in which the patient recorded the hours CPAP was used at night; this record was compared with readings from the CPAP generator's counter. All subjects were asked about their degree of sleepiness before treatment by way of a standard questionnaire. Although most patients reported regular use of CPAP in diaries, only about 60% actually used it for longer than a mean 4.5 hours daily. The most compliant patients could not be differentiated from the least compliant with respect to degree of initial sleepiness, apnea-hypopnea-per-hour index or level of CPAP required.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Non-contact screening system with two microwave radars in the diagnosis of sleep apnea-hypopnea syndrome.

    PubMed

    Kagawa, Masayuki; Ueki, Katsuhiko; Kurita, Akira; Tojima, Hirokazu; Matsui, Takemi

    2013-01-01

    There are two key problems in applying Doppler radar to a diagnosis system for sleep apnea-hypopnea syndrome. The first is noise associated with body movement and the second is the body position in bed and the change of the sleeping posture. We propose a new automatic gain control and a real-time radar-output channel selection method which is based on a spectrum shape analysis. There are three types of sleep apnea: central sleep apnea, obstructive sleep apnea and mixed sleep apnea. In this paper we paid attention to the obstructive sleep apnea and attempted to detect the disorder of corrugated shape compared with usual breathing or the paradoxical movement of the reversed phase with chest and abdominal radar signals. A prototype of the system was set up at a sleep disorder center in a hospital and field tests were carried out with eight subjects. Despite the subjects engaging in frequent body movements while sleeping, the system was quite effective in the diagnosis of sleep apnea-hypopnea syndrome (r=0.98).

  5. The price of obstructive sleep apnea-hypopnea: hypertension and other ill effects.

    PubMed

    Friedman, Oded; Logan, Alexander G

    2009-05-01

    This review addresses the cardiovascular, cerebrovascular, and metabolic consequences that accompany obstructive sleep apnea-hypopnea (OSAH) in conjunction with the mechanistic pathways implicated in mediating these effects. Particular emphasis is placed on the association with hypertension (HTN). Varying levels of evidence support a role of OSAH in perpetuating sustained HTN, nocturnal HTN, and difficult to control HTN as well as in contributing to the occurrences of nondipping of blood pressure (BP) and increased BP variability. In this context, the emergence of matched designs, adjusted analyses, meta-analyses as well as longitudinal and interventional studies strengthens causal inferences drawn from older observational studies, which suffered from such limitations as confounding.

  6. 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).

  7. Automated detection of sleep apnea and hypopnea events based on robust airflow envelope tracking in the presence of breathing artifacts.

    PubMed

    Ciołek, Marcin; Niedźwiecki, Maciej; Sieklicki, Stefan; Drozdowski, Jacek; Siebert, Janusz

    2015-03-01

    The paper presents a new approach to detection of apnea/hypopnea events, in the presence of artifacts and breathing irregularities, from a single-channel airflow record. The proposed algorithm, based on a robust envelope detector, identifies segments of signal affected by a high amplitude modulation corresponding to apnea/hypopnea events. It is shown that a robust airflow envelope-free of breathing artifacts-improves effectiveness of the diagnostic process and allows one to localize the beginning and the end of each episode more accurately. The performance of the proposed approach, evaluated on 30 overnight polysomnographic recordings, was assessed using diagnostic measures such as accuracy, sensitivity, specificity, and Cohen's coefficient of agreement; the achieved levels were equal to 95%, 90%, 96%, and 0.82, respectively. The results suggest that the algorithm may be implemented successfully in portable monitoring devices, as well as in software-packages used in sleep laboratories for automated evaluation of sleep apnea/hypopnea syndrome.

  8. A review of the surgical treatment options for the obstructive sleep apnea/hypopnea syndrome patient.

    PubMed

    Powers, David B; Allan, Patrick F; Hayes, Curtis J; Michaelson, Peter G

    2010-09-01

    Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a medical condition that has received significant attention within the medical community and mainstream media due to its potentially serious physiological consequences and relatively frequent occurrence within the general population. From the military perspective, the impact on individual readiness for deployment, and the potential degradation of performance in critically important military duties, often results in tremendous expenditures of training resources, time, and expertise to replace the military member with a suitable substitute or release of the individual from active duty. This article reviews common surgical techniques for clinical management of OSAHS patients in a presentation format for primary care and sleep medicine specialists, as well as surgeons interested in the philosophies of surgical management of sleep disordered breathing. Presentation of risks and benefits of surgical treatment are discussed in a manner to facilitate communication between patient and health care provider.

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

    PubMed

    Esteller, Eduard

    2015-01-01

    The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  10. [Therapeutic effects of oral appliance combined with uvulopalatopharyngoplasty on obstructive sleep apnea hypopnea syndrome].

    PubMed

    Han, Jianxing; Wang, Bei; An, Yunfang; Ma, Yuan; Liu, Yan; Ma, Yufeng

    2014-02-01

    To explore the long-term effects of the uvulopalatopharyngoplasty (UPPP) combined with oral appliance (OA) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Thirty patients with severe OSAHS confirmed by polysomnography (PSG) according to their apnea hypopnea index (AHI) and lowest SaO2 during sleep were selected using random permutation table and divided into only UPPP group(U group, n = 15) and UPPP with OA group (UA group, n = 15). The follow-up period was 2 years. PSG was performed in 0.5 year and 2 years after operation. AHI, lowest SaO2 and Tmax were tested and evaluated. The effectiveness of two groups was the same after 0.5 year. Two years after operation, the values [AHI: (18.06 ± 2.24) times/h; lowest SaO2: (88.64 ± 10.37)% and Tmax: (20.5 ± 17.6) s] in UA group were better than that [AHI: (49.73 ± 3.35) times/h; lowest SaO2: (79.56 ± 4.87)% and Tmax: (41.3 ± 19.7) s] in U group. The number of effectiveness was 9 and the number of ineffectiveness was 6 in U group, while in UA group, the number of effectiveness was 14 and the number of ineffectiveness was 1(P < 0.05). Long-term result of combined treatment was better than that of UPPP only.

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

    PubMed Central

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

    2016-01-01

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

  12. Impact of treatment of gastroesophageal reflux on obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Friedman, Michael; Gurpinar, Berk; Lin, Hsin-Ching; Schalch, Paul; Joseph, Ninos J

    2007-11-01

    We test the hypothesis that treatment of gastroesophageal reflux disease (GERD) can improve obstructive sleep apnea-hypopnea syndrome (OSAHS). One hundred forty-six patients with OSAHS underwent a complete history-taking, physical examination, and laboratory testing, including questions related to GERD symptoms. Full-night attended polysomnography, 24-hour wireless pH study at the upper esophagus, snoring level evaluation, Epworth Sleepiness Scale, and quality-of-life surveys were completed for each patient. Patients who tested positive for GERD were treated with esomeprazole magnesium 40 mg once daily for 2 to 12 months. The 24-hour pH study was repeated, and those patients with elimination of GERD were reevaluated by polysomnography, snoring level evaluation, Epworth Sleepiness Scale, quality-of-life surveys, and subjective data collection. Forty-one patients completed single-dose treatment with esomeprazole, but the repeat 24-hour pH study showed that 9 patients had persistent GERD. In the 29 patients who completed phase 2 with normal pH study findings, the snoring level decreased from 9.7 +/- 0.5 to 7.9 +/- 1.3 (p < .0001), the Epworth Sleepiness Scale score decreased from 14.2 +/- 2.5 to 11.1 +/- 2.4 (p < .0001), the apnea-hypopnea index decreased from 37.9 +/- 19.1 to 28.8 +/- 11.5 (p = .006), and the minimum saturation of oxygen increased from 84.1% +/- 7.8% to 86.9% +/- 5.0% (p = .055). Treatment of GERD had a significant impact on the reduction of the apnea-hypopnea index, snoring, and daytime sleepiness. Elimination of GERD should be part of a comprehensive treatment plan for patients with OSAHS.

  13. Short-Term Memory Performances during Sustained Wakefulness in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

    ERIC Educational Resources Information Center

    Greneche, Jerome; Krieger, Jean; Bertrand, Frederic; Erhardt, Christine; Maumy, Myriam; Tassi, Patricia

    2011-01-01

    Both working and immediate memories were assessed every 4 h by specific short-term memory tasks over sustained wakefulness in 12 patients with obstructive sleep apnea and hypopnea syndrome (OSAHS) and 10 healthy controls. Results indicated that OSAHS patients exhibited lower working memory performances than controls on both backward digit span and…

  14. Short-Term Memory Performances during Sustained Wakefulness in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

    ERIC Educational Resources Information Center

    Greneche, Jerome; Krieger, Jean; Bertrand, Frederic; Erhardt, Christine; Maumy, Myriam; Tassi, Patricia

    2011-01-01

    Both working and immediate memories were assessed every 4 h by specific short-term memory tasks over sustained wakefulness in 12 patients with obstructive sleep apnea and hypopnea syndrome (OSAHS) and 10 healthy controls. Results indicated that OSAHS patients exhibited lower working memory performances than controls on both backward digit span and…

  15. Computer-Assisted Diagnosis of the Sleep Apnea-Hypopnea Syndrome: A Review

    PubMed Central

    Alvarez-Estevez, Diego; Moret-Bonillo, Vicente

    2015-01-01

    Automatic diagnosis of the Sleep Apnea-Hypopnea Syndrome (SAHS) has become an important area of research due to the growing interest in the field of sleep medicine and the costs associated with its manual diagnosis. The increment and heterogeneity of the different techniques, however, make it somewhat difficult to adequately follow the recent developments. A literature review within the area of computer-assisted diagnosis of SAHS has been performed comprising the last 15 years of research in the field. Screening approaches, methods for the detection and classification of respiratory events, comprehensive diagnostic systems, and an outline of current commercial approaches are reviewed. An overview of the different methods is presented together with validation analysis and critical discussion of the current state of the art. PMID:26266052

  16. [Relationship between adult craniofacial structures and development of obstructive sleep apnea-hypopnea syndrome].

    PubMed

    Fan, Yuqin; Liu, Lizhong

    2010-06-01

    To explore the influence of adult craniofacial structures on obstructive sleep apnea hypopnea syndrome (OSAHS). This study compared the measurements of the height, body weight,neck circumference, the mallampati oropharyngeal score grading, thyromental distance, thyromental angle, lobule-mental distance, mental-lower lip distance of 50 patients with OSAHS with those of 50 controls. Statistical findings showed that OSAHS patients were different from controls in the following ways: (1) higher neck circumference; (2) larger thyromental angle; (3) higher Mallampati scores; (4) higher body mass index; (5) shorter mental-lower lip distance. A crowded posterior oropharynx and a steep thyromental plane are associated with OSAHS. The adult craniofacial structures of bony and soft tissue determine the dimension of upper airway during sleep andpaly an important role in the development of OSAHS.

  17. Serum Angiotensin Converting Enzyme and the Obstructive Sleep Apnea Hypopnea Syndrome

    PubMed Central

    Benjamin, John Amit; Moller, Maria; Ebden, Philip; Bartle, Ionah; Lewis, Keir E.

    2008-01-01

    Study Objectives: We wanted to see if the obstructive sleep apnea hypopnea syndrome (OSAHS) causes hypertension and endothelial dysfunction through activation of the angiotensin-converting enzyme (ACE). Methods: A cross-sectional followed by a prospective, interventional study in a sleep disordered breathing clinic in a UK Hospital. We measured baseline serum ACE activity and ACE allele frequencies in 26 consecutive (untreated) OSAHS patients, 26 consecutive Sleepy Snorers, and 26 healthy (non-sleepy) controls. The OSAHS and Sleepy Snorers had serum ACE repeated after 6 months, with the OSAHS group receiving CPAP in the interim. Results: There was no difference in baseline mean serum ACE among OSAHS (33 IU/L), sleepy snorers (36 IU/L), and healthy controls (32 IU/L), p = 0.63. There was no difference in serum ACE activity between OSAHS and sleepy snorers after 6 months (p = 0.9) and no change in serum ACE from baseline in either group. In particular, there was no change in ACE activity in the OSAHS group on an intention to treat basis or when limiting analysis was limited to only “good” CPAP users (n = 16, p = 0.68), despite significant improvements in their Epworth scores and blood pressure and normalization of the 4% dip-rate. Conclusions: Changes in serum ACE activity do not occur in OSAHS; therefore it is unlikely to be associated with the hypertension and other cardiovascular dysfunction often reported in OSAHS. Citation: Benjamin JA; Moller M; Ebden P; Bartle I; Lewis KE. Serum angiotensin converting enzyme and the obstructive sleep apnea hypopnea syndrome. J Clin Sleep Med 2008;4(4):325–331. PMID:18763423

  18. Elevated Serum Liver Enzymes in Patients with Obstructive Sleep Apnea-hypopnea Syndrome.

    PubMed

    Li, Jie; Zhang, Yan-Lin; Chen, Rui; Wang, Yi; Xiong, Kang-Ping; Huang, Jun-Ying; Han, Fei; Liu, Chun-Feng

    2015-11-20

    Obstructive sleep apnea-hypopnea syndrome (OSAS) is associated with elevated liver enzymes and fatty liver. The purpose of this study was to measure serum liver enzyme levels in patients evaluated by polysomnography (PSG) and the factors associated with liver injury in OSAS patients. All patients referred to PSG for evaluation of sleep apnea symptoms between June 2011 and November 2014 were included in this study. Demographic data and PSG parameters were recorded. Serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels were systematically measured. OSAS patients were divided into mild, moderate, and severe groups according to the apnea-hypopnea index (AHI) values of 5-14 events/h, 15-29 events/h, and ≥30 events/h. A total of 540 patients were enrolled in this study; among these patients, 386 were male. Elevated liver enzymes were present in 42.3% of OSAS patients (32.4% in mild/moderate group; 51.0% in severe group) and 28.1% patients without OSAS. Patients with OSAS had higher body mass index (BMI) (P < 0.01). In the bivariate correlation, the liver enzymes level was negatively correlated with age and the lowest arterial oxygen saturation (SaO 2 ), and was positively correlated with BMI, oxygen desaturation index, percent of total time with oxygen saturation level <90% (TS90%), AHI, total cholesterol (TC), and triglyceride (TG). In logistic regression analysis, Age, BMI, TS90%, TC, and TG were included in the regression equation. Our data suggest that OSAS is a risk factor for elevated liver enzymes. The severity of OSAS is correlated with liver enzyme levels; we hypothesize that hypoxia is one of main causes of liver damage in patients with OSAS.

  19. Cephalometric assessment of craniofacial morphology in Japanese male patients with obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Takai, Yujiro; Yamashiro, Yoshihiro; Satoh, Daisuke; Isobe, Kazutoshi; Sakamoto, Susumu; Homma, Sakae

    2012-07-01

    CRANIOFACIAL MORPHOLOGICAL ANOMALIES CAN BE DIVIDED INTO TWO PRINCIPAL CATEGORIES: skeletal anomalies and soft tissue anomalies. This study examined the hypothesis that the assessment of indices representing both skeletal and soft tissue can be used to appropriately identify the risk factor of obstructive sleep apnea-hypopnea syndrome (OSAHS). 232 suspected OSAHS male patients were examined with polysomnography and divided into two groups (202 males with OSAHS and 30 male controls without OSAHS). Cephalometric analysis was performed on all patients to evaluate craniofacial morphological anomalies. The measurement sites were as follows: skeletal morphology; soft tissue morphology; mixed morphology including mandibular plane to hyoid bone (MP-H); and jaw soft tissue (JS) ratio; a novel ratio we defined, between the area of jaw and area of tongue with soft palate. JS ratio increased with AHI as well as MP-H. MP-H and JS ratio showed significant but weak correlation with apnea-hypopnea index. JS ratio was significantly associated with an increased risk for severe OSAHS, even after adjusting age and BMI, its odds ratio was the greatest among these variables. These results showed that mixed craniofacial, skeletal and soft tissue morphology are correlated with AHI, and JS ratio may be a useful parameters to explain the characteristics of OSAHS in male patients.

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

    PubMed Central

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

    2013-01-01

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

  1. Stability of oxyhemoglobin affinity in patients with obstructive sleep apnea-hypopnea syndrome without daytime hypoxemia.

    PubMed

    Clause, Didier; Detry, Bruno; Rodenstein, Daniel; Liistro, Giuseppe

    2008-12-01

    A decrease in hemoglobin affinity for oxygen is considered an adaptive mechanism against tissue hypoxia. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by recurrent episodes of apnea and hypopnea resulting in arterial oxygen desaturations during sleep. Maillard et al. (10) observed a right shift of the oxyhemoglobin dissociation curve (ODC) and an increase in 2,3-diphosphoglycerate (2,3-DPG) concentration ([2,3-DPG]) in 15 patients with severe OSAHS, but some had slight daytime arterial hypoxemia while breathing room air. The aim of our study was to measure the ODC and 2,3-DPG concentrations in a group of subjects normoxemic during daytime referred to our sleep laboratory for suspicion of snoring or OSAHS. The patients were recruited during a period of 6 mo. All arterial and venous blood samples were taken early in the morning within 1 h of awakening following a full-night polysomnography. ODC and 2,3-DPG were analyzed in 88 patients: 56 OSAHS (oxygen desaturation index: 27.5 +/- 24.5) and 32 non-OSAHS. We found a significant correlation between the P50 and 2,3-DPG levels in the 88 patients: r = 0.502, P < 0.001. We observed no difference between OSAHS and non-OSAHS for the P50 and for [2,3-DPG]. There was no correlation between the severity of OSAHS and either P50 or [2,3-DPG]. Finally, there was no change in these parameters measured at baseline, after 3 days and after 1 mo of treatment by nasal continuous positive airway pressure in 7 patients with OSAHS. We conclude that patients with OSAHS who are normoxemic during daytime have comparable oxyhemoglobin affinity than nonapneic subjects.

  2. Airway resistance and allergic sensitization in children with obstructive sleep apnea hypopnea syndrome.

    PubMed

    Zhang, Jie; Zhao, Jing; Chen, Min; Liu, Shilin; Zhang, Xuexi; Zhang, Fengzhen; Zhang, Yamei; Chen, Hui; Ni, Xin

    2016-04-01

    The purpose of this study was to determine the airway resistance in Chinese children with obstructive sleep apnea hypopnea syndrome (OSAHS) by impulse oscilloetry (IOS) and investigate the association of the severity of OSAHS with the airway resistance and allergic sensitization. A total of 120 children (92 boys) treated for snoring in Beijing Children's Hospital between October 2010 and March 2011 were included in this study. Ninety-three children were diagnosed with OSAHS and 27 did not show OSAHS. Total airway resistance (R5), proximal airway resistance (R20), and peripheral airway resistance (X5) were determined by IOS. Serum levels of total IgE and allergen-specific IgE (sIgE) were also determined. R5 in the OSAHS group was significantly higher than that in the non-OSAHS group (P = 0.0025), whereas R20 and X5 were similar in the two groups. R5 was positively correlated with apnea hypopnea index and obstructive apnea index and negatively correlated with the lowest arterial oxygen saturation significantly (all P < 0.05). The percentage of children with abnormal serum levels of total IgE or abnormal allergen-specific IgEs was comparable in OSAHS and non-OSAHS groups. The proportions of abnormal R5 and of abnormal serum levels of total IgE were significantly higher in children with severe OSAHS compared with children with mild or moderate OSAHS (all P < 0.05). Total airway resistance was significantly increased in Children with OSAHS. Allergic sensitization might contribute to the exacerbation of existing OSAHS in children. Large scale studies are required to further validate these findings. © 2015 Wiley Periodicals, Inc.

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

    PubMed Central

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

    2014-01-01

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

  4. [Comparison of different continuous positive airway pressure titration methods for obstructive sleep apnea hypopnea syndrome].

    PubMed

    Li, Jingjing; Ye, Jingying; Zhang, Peng; Kang, Dan; Cao, Xin; Zhang, Yuhuan; Ding, Xiu; Zheng, Li; Li, Hongguang; Bian, Qiuli

    2014-10-01

    To explore whether there were differences between the results of automatic titration and the results of manual titration for positive airway pressure treatment in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and its influencing factors, the results might provide a theoretical basis for the rational use of two pressure titration methods. Sixty one patients with OSAHS were included in this study. All patients underwent a manual titration and an automatic titration within one week. The clinical informations, polysomnography data, and the results of both two titration of all patients were obtained for analysis. The overall apnea/hypopnea index was (63.1 ± 17.7)/h, with a range of 14.9/h to 110.4/h. The treatment pressure of manual titration was (8.4 ± 2.1) cmH(2)O, which was significantly lower than the treatment pressure of automatic titration, (11.5 ± 2.7) cmH(2)O (t = -9.797, P < 0.001). After using a ΔP of 3 cmH(2)O for the cutoff value (ΔP was defined as the difference of automatic titration and manual titration), it was found that the pressure of automatic titration was significantly higher in patients with a ΔP > 3 cmH(2)O than in patients with a ΔP ≤ 3 cmH(2)O, which was (13.3 ± 2.3) cmH(2)O vs (10.0 ± 2.0) cmH(2)O (t = -6.159, P < 0.001). However, there were no differences for the pressure of manual titration between these two groups, which was (8.6 ± 2.4) cmH(2)O vs (8.3 ± 2.0)cmH(2)O (P > 0.05). There was no significant difference in age, body mass index, neck circumference, abdomen circumference, apnea hypopnea index, and arterial oxygen saturation between these two groups. The treatment pressure of automatic titration is usually higher than that of manual titration. For patients with a high treatment pressure which is derived from automatic titration, a suggestion about manual titration could be given to decrease the potential treatment pressure of continuous positive airway pressure, which may be helpful in improving the

  5. Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy.

    PubMed

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

    2013-02-01

    Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals. We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal. We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations. Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal. Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).

  6. Efficacy of uvulopalatopharyngoplasty combined with oral appliance in treatment of obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Yang, D; Zhou, H-F; Xie, Y

    2015-06-01

    This study aimed to investigate the efficacy of UPPP combined with an oral appliance (OA) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). Forty patients diagnosed with severe OSAHS were randomly divided into two groups: 20 patients in the pure surgery group treated by uvulopalatopharyngoplasty (UPPP) surgery and the remaining 20 patients in the combined treatment group for the combined application of UPPP and OA. Nocturnal PSG monitoring was performed in postoperative 0.5 and 3.0a. AHI, SaO₂, and sleep structure improvement were calculated to compare the treatment efficiency of the two groups. The AHI of the combined treatment group in the postoperative 3 was lower than that of the pure surgery group, whereas the lowest SaO₂ value was higher than that of the pure surgery group (P < 0.05). The sleep structure improvement of the combined treatment group in the postoperative 3a was possibly more normal than that of the pure surgery group. The long-term efficacy of the combined UPPP and OA for the treatment of OSAHS was higher than that of pure UPPP treatment.

  7. Midsagittal jaw movement analysis for the scoring of sleep apneas and hypopneas.

    PubMed

    Senny, Frédéric; Destiné, Jacques; Poirrier, Robert

    2008-01-01

    Given the importance of the detection and classification of sleep apneas and hypopneas (SAHs) in the diagnosis and the characterization of the SAH syndrome, there is a need for a reliable noninvasive technique measuring respiratory effort. This paper proposes a new method for the scoring of SAHs based on the recording of the midsagittal jaw motion (MJM, mouth opening) and on a dedicated automatic analysis of this signal. Continuous wavelet transform is used to quantize respiratory effort from the jaw motion, to detect salient mandibular movements related to SAHs and to delineate events which are likely to contain the respiratory events. The classification of the delimited events is performed using multilayer perceptrons which were trained and tested on sleep data from 34 recordings. Compared with SAHs scored manually by an expert, the sensitivity and specificity of the detection were 86.1% and 87.4%, respectively. Moreover, the overall classification agreement in the recognition of obstructive, central, and mixed respiratory events between the manual and automatic scorings was 73.1%. The MJM signal is hence a reliable marker of respiratory effort and allows an accurate detection and classification of SAHs.

  8. [Role and mechanism of Th17/Treg in obstructive sleep apnea hypopnea syndrome].

    PubMed

    Liu, Y; Gu, Y C; Tang, Y; Lü, X L; Chen, H; Wu, Q Z

    2016-11-29

    Objective: To explore the role and the mechanism of Th17/Treg in obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: A total of 100 patients who completed polysomnography (PSG) in the sleep lab of Affiliated Wujiang Hospital of Nantong University from Mar. 2015 to Apr. 2016 were enrolled and divided into four groups (primary snoring as the control group, mild OSAHS, moderate OSAHS and severe OSAHS) according apnea hypopnea index (AHI). The proportion of Th17, Treg (of CD4(+) T cells) and the expression of interleukin (IL)-17A, IL-6 were detected and the relevant data were analyzed by the correlation analysis and the multiple stepwise regression analysis. Results: Compared with the control group, the OSAHS patients had higher Th17% [(1.36±0.46)%, (1.68±0.30)%, (2.23±0.03)% vs (1.02±0.22)%], Th17/Treg [(0.22±0.07), (0.28±0.10), (0.29±0.00) vs (0.13±0.03)], IL-17A [(2.53±0.89), (2.99±1.96), (7.77±1.63) vs (1.45±0.78) ng/L], IL-6 [(6.14±4.37), (9.41±4.66), (12.58±6.65) vs (5.44±3.13) ng/L] and lower Treg% [(7.57±0.16)%, (6.46±1.57)%, (6.10±1.19)% vs (8.02±1.45)%] (all P<0.05). A positive correlation could be seen between Th17%, Th17/Treg, IL-17A, IL-6 and AHI, oxygen desaturation index (ODI) respectively, there was a negative correlation between Th17%, Th17/Treg, IL-17A, IL-6 and the lowest oxygen saturation (SpO2) (all P<0.05). The proportion of Treg had a negative correlation with AHI or ODI and a positive correlation with the lowest SpO2 (all P<0.05). The lowest SpO2 was the most important factor which could influence Th17%, Treg% and the radio of Th17/Treg. Conclusions: There is an imbalance of Th17/Treg in OSAHS. Therefore, Th17 and the relevant inflammatory cytokines may be involved in the occurrence and development of OSAHS.

  9. Sleep architecture following a weight loss intervention in overweight and obese patients with obstructive sleep apnea and type 2 diabetes: relationship to apnea-hypopnea index.

    PubMed

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

    2014-11-15

    To determine if weight loss and/ or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/ obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). This was a randomized controlled trial including 264 overweight/ obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a significant positive association between AHI and stage 1 sleep (p < 0.001), and a significant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a significant positive association with change in body weight (p = 0.009). Compared to control, the ILI did not induce significant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/ obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more influenced by weight than AHI. NCT00194259. © 2014 American Academy of Sleep Medicine.

  10. Advanced age and apnea-hypopnea index predict subclinical atherosclerosis in patients with obstructive sleep apnea syndrome.

    PubMed

    Arik, Bilal; Inci, Mehmet Fatih; Gumus, Cesur; Varol, Kenan; Ege, Meltem Refiker; Dogan, Omer Tamer; Zorlu, Ali

    2013-02-06

    Both obstructive sleep apnea syndrome (OSAS) and coronary artery calcification (CAC) are considered to be related with the presence of coronary artery disease (CAD). In this study we evaluate the association between OSAS and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in patients who had OSAS but no history of known CAD. Seventy-three patients who were asymptomatic for CAD and had suspected OSAS were referred to overnight attended polysomnography. Patients were classified into 4 groups according to the Apnea-Hypopnea Index (AHI). All patients underwent computed tomographic examination for tomographic coronary calcification scoring. Physical examination, sleep study recordings, complete blood count and serum biochemistry were obtained from all patients. In the whole group, AHI levels were weakly correlated with coronary calcium score (r = 0.342, p = 0.003) and body mass index (r = 0.337, p = 0.004), moderately correlated with basal oxygen saturation (r = -0.734, p < 0.001), and strongly correlated with oxygen desaturation index (r = 0.844, p < 0.001). In an univariate analysis, age, AHI, basal oxygen saturation, and oxygen desaturation index were associated with CAC in patients with OSAS. In a multiple logistic regression model, age (OR 1.108,%95 CI 1.031-1.191, p = 0.005) and AHI (OR 1.036,% 95 CI 1.003-1.070, p = 0.033) were only independent predictors of CAC in patients with OSAS with a sensitivity of 88.9% and 77.8% and a specificity of 54.3% and 56.5% respectively. Our findings suggest that in patients with moderate or severe OSAS and advanced age, physicians should be alert for the presence of subclinical atherosclerosis.

  11. Hypoxia and inflammation indicate significant differences in the severity of obstructive sleep apnea within similar apnea-hypopnea index groups.

    PubMed

    Yilmaz Avci, Aynur; Avci, Suat; Lakadamyali, Huseyin; Can, Ufuk

    2017-03-07

    We determined whether hypoxia parameters are associated with C-reactive protein (CRP), mean platelet volume (MPV), white matter hyperintensity (WMH), and the severity of obstructive sleep apnea (OSA), and also evaluated whether hypoxia parameters, CRP, MPV, and WMH differ in patients with similar apnea-hypopnea index (AHI) scores. A total of 297 patients, who were evaluated using polysomnography, were assessed retrospectively. The measured hypoxia parameters included total sleep time with oxygen saturation <90% (ST90), percentage of cumulative time with oxygen saturation <90% (CT90), and lowest oxygen saturation (min SaO2). The patients were divided into subgroups according to their CT90 values, and patients with different AHI severities were divided into subgroups according to their ST90 and min SaO2 levels. Hypoxia parameters are associated with CRP, MPV, WMH, and the severity of OSA (P < 0.05). The hypoxia parameters differed in all subgroup analyses of similar AHI groups (P < 0.001), and CRP differed only in severe OSA (P < 0.008, P < 0.001). In subgroup analyses of similar AHI groups, MPV and WMH were not significantly different (P > 0.05). Above the hypoxia threshold (CT90 ≥ 10%) of CRP, MPV increased significantly and the presence of WMH increased twofold. These data suggest that increased hypoxia severity may mediate increased inflammation and activation of platelets and contribute to the pathogenesis of WMH in patients with OSA. In addition, patients with severe OSA may show significant variability in inflammation and vascular risk. Further prospective data are needed.

  12. Accuracy of a novel auto-CPAP device to evaluate the residual apnea-hypopnea index in patients with obstructive sleep apnea.

    PubMed

    Nigro, Carlos Alberto; González, Sergio; Arce, Anabella; Aragone, María Rosario; Nigro, Luciana

    2015-05-01

    Patients under treatment with continuous positive airway pressure (CPAP) may have residual sleep apnea (RSA). The main objective of our study was to evaluate a novel auto-CPAP for the diagnosis of RSA. All patients referred to the sleep laboratory to undergo CPAP polysomnography were evaluated. Patients treated with oxygen or noninvasive ventilation and split-night polysomnography (PSG), PSG with artifacts, or total sleep time less than 180 min were excluded. The PSG was manually analyzed before generating the automatic report from auto-CPAP. PSG variables (respiratory disturbance index (RDI), obstructive apnea index, hypopnea index, and central apnea index) were compared with their counterparts from auto-CPAP through Bland-Altman plots and intraclass correlation coefficient. The diagnostic accuracy of autoscoring from auto-CPAP using different cutoff points of RDI (≥5 and 10) was evaluated by the receiver operating characteristics (ROCs) curve. The study included 114 patients (24 women; mean age and BMI, 59 years old and 33 kg/m(2); RDI and apnea/hypopnea index (AHI)-auto median, 5 and 2, respectively). The average difference between the AHI-auto and the RDI was -3.5 ± 3.9. The intraclass correlation coefficient (ICC) between the total number of central apneas, obstructive, and hypopneas between the PSG and the auto-CPAP were 0.69, 0.16, and 0.15, respectively. An AHI-auto >2 (RDI ≥ 5) or >4 (RDI ≥ 10) had an area under the ROC curve, sensitivity, specificity, positive likelihood ratio, and negative for diagnosis of residual sleep apnea of 0.84/0.89, 84/81%, 82/91%, 4.5/9.5, and 0.22/0.2, respectively. The automatic analysis from auto-CPAP (S9 Autoset) showed a good diagnostic accuracy to identify residual sleep apnea. The absolute agreement between PSG and auto-CPAP to classify the respiratory events correctly varied from very low (obstructive apneas, hypopneas) to moderate (central apneas).

  13. [The relationship between upper airway curvature and obstructive sleep apnea and hypopnea syndrome].

    PubMed

    Zhu, Min; Lu, Xiao-feng; Shi, Hui-min

    2007-08-01

    The fluid flow through curved tubes has characteristics that an increase in the curvature induces pressure losses as well as higher resistance in the same region. The purpose of this study is to analyze the relationship between upper airway curvature and obstructive sleep apnea and hypopnea syndrome(OSAHS). 18 male OSAHS patients were paired by age with 18 males with no snoring. The mean AHI was 58.8. The supine lateral cephalometric films were obtained from CT and analysed using curvature software. Data were presented as mean and paired t test was conducted using SPSS10.0 software package. Correlative analysis was performed to indicate the relationship between BMI and AHI, curvature and BMI, respectively. The airway curvature was significantly different between the two groups(P<0.01). The curvature radius was significantly correlative with BMI (P<0.01), but not with AHI(P>0.05). Upper airway curvature was related significantly to the pathogenesis of OSAHS. An increase of curvature on anterior wall of velopharynx in OSAHS patients can change the pressure and resistance distribution in upper airway.

  14. [Sleep apnea-hypopnea syndrome: risk factors in children and adolescents; a systematic review].

    PubMed

    Aguilar Cordero, M J; Sánchez López, A M; Mur Villar, N; García García, I; Guisado Barrilao, R

    2013-11-01

    The sleep apnea-hypopnea syndrome (SAHS) is a disorder that currently affects a large number of children and adolescents. The aim of this review is to assess the factors causing this condition and the risk of suffering another disease associated with SAHS. The 50 articles selected for inclusion in this review were identified through GOOGLE SCHOLAR. The validity of the items was established by the degree of evidence obtained, by recommendations made in this respect and by the applicability to the situation observed. The review considers studies of SAHS in children and adolescents, taking into account those relating this disorder with obesity, hypertension, physical activity and other variables. The studies reviewed show that SAHS is associated with childhood obesity and that it increases the risk of cerebro-cardiovascular disease. It is also shown that SAHS decreases children's and adolescents' physical capacity and quality of life. Psychological aspects are also affected, impacting on academic performance, which is poorer than in healthy children. Therefore, early paediatric diagnosis of SAHS is important in order to prevent associated disorders.

  15. Diurnal changes in retinal nerve fiber layer thickness with obstructive sleep apnea/hypopnea syndrome

    PubMed Central

    Chirapapaisan, Niphon; Likitgorn, Techawit; Pleumchitchom, Mintra; Sakiyalak, Darin; Banhiran, Wish; Saiman, Manatsawin; Chuenkongkaew, Wanicha

    2016-01-01

    AIM To compare the retinal nerve fiber layer (RNFL) thickness in the morning and evening in Thai patients with varying degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS In this cross-sectional study, potential OSAHS patients at Siriraj Hospital underwent polysomnography to determine the severity of OSAHS and an eye examination (including best corrected visual acuity, slit-lamp examination, and Goldmann applanation tonometry). RNFL thickness was recorded once in the morning and once in the evening, using spectral domain optical coherence tomography. Thickness was expressed as an average and given for each quadrant. Patients with ocular or systemic diseases that might affect RNFL thickness were excluded. RESULTS Forty-one eyes of 41 patients were classified into 4 OSAHS groups. The average and mean RNFL thickness in most of the four quadrants of the severe OSAHS group trended toward being less than those in the comparable quadrants of the other groups in both the morning and evening. In the moderate OSAHS group, the average RNFL thickness and temporal and superior quadrant thickness in the morning were significantly higher than in the evening (P=0.01, P=0.01, and P=0.03, respectively). In the severe OSAHS group, the inferior quadrant thickness in the morning was significantly higher than in the evening (P=0.03). CONCLUSION The RNFL thickness in the morning was higher than in the evening in moderate OSAHS. PMID:27500104

  16. [Research progress on the treatment of obstructive sleep apnea and hypopnea syndrome with mandibular advancement device].

    PubMed

    Li, De-hong; Yang, Xiang-hong; Guo, Tian-wen

    2010-04-01

    Obstructive sleep apnea and hypopnea syndrome (OSAHS) is characterized by obstruction of upper airway and respiratory disturbance, excessive daytime sleepiness and tiredness.The possible causes are obesity, hypertension, and upper airway malformations,etc. The location and degree of upper airway structure narrowing in patients have been investigated in many ways, such as X-ray, multi-slices spiral computed tomography, etc. With multi-planar reconstruction technique,3-dimensional construction of upper airway can be established which shows the delicate changes of the upper airway structure. Mandibular advancement device is known as an effective treatment on mild and moderate OSAHS. By advancing the mandible forward, it can increase the space of upper airway, especially the oropharyngeal space. This paper reviewed the methods of investigating on OSAHS and the change of upper airway structure in OSAHS patients treated with mandibular advancement device. Supported by Combined Research Fund of Bureau of Health, Yunan Province and Kunming Medical College(Grant No.2009CD205).

  17. Pharyngeal aerodynamic characteristics of obstructive sleep apnea/hypopnea syndrome patients.

    PubMed

    Zang, Hong-Rui; Li, Li-Feng; Zhou, Bing; Li, Yun-Chuan; Wang, Tong; Han, De-Min

    2012-09-01

    The role of nasal obstruction in the pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) has been debated for decades. In this prospective study, we compared the pharyngeal aerodynamic characteristics of OSAHS patients and normal people, and investigated the contribution of total nasal airway resistance to the pathophysiology of OSAHS. Computational fluid dynamics (CFD) was used to extract the average pressure and average airflow velocity in three transverse cross-sectional planes of the pharynx for statistical analysis, and the correlation between nasal resistance and the average pressure in the pharyngeal cavity was investigated. The negative pressure within the pharyngeal cavity was significantly higher in OSAHS patients than in normal subjects, and total nasal airway resistance correlated well with the average pressure in three consecutive transverse cross-sections of the pharyngeal cavity. Greater negative pressure within the pharyngeal cavity contributed to the increased collapsibility of the pharynx in OSAHS patients, and the strong correlation between nasal resistance and pharyngeal pressure suggests that the nose plays a role in the pathogenesis of OSAHS.

  18. Clinical analysis of pharyngeal musculature and genioglossus exercising to treat obstructive sleep apnea and hypopnea syndrome*#

    PubMed Central

    TANG, Shi-xiong; QING, Jing; WANG, Yao-wen; CHAI, Liang; ZHANG, Wei-min; Ye, Xian-wang; Zhang, Jie; Huang, Yi-qin; Cheng, Peng

    2015-01-01

    Objective: To evaluate the effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea and hypopnea syndrome (OSAHS). Methods: We conducted a non-randomized retrospective clinical trial of 75 patients with OSAHS. Fifty-four patients were managed by exercising of the pharyngeal musculature and genioglossus (exercising group). Twenty-one patients, who refused to undertake any treatment, were defined as the control group. We took the Epworth Sleepiness Scale (ESS), checked patients’ polysomnography, and took 320 detector computed tomography (CT) before treatment. Six and twelve months later, we made records of apnea hypopnea index (AHI), lowest arterial oxygen saturation (LSaO2), body mass index (BMI), the shortest sagittal diameter, and transverse diameter, and the effective rates of exercising were calculated and compared with the 21 patients without any treatment (control group) at the same time. SPSS 10.0 was used to analyze the data. Results: Before treatment, the ESS value was 7.67; 6 and 12 months later, the values were 3.54 and 3.25, respectively in the exercising group. AHI was decreased to 15.36 after 6 months and 13.79 after 12 months from 22.84 at the beginning. LSaO2 values were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. There were significant differences in ESS scores, AHI, and LSaO2 between pre-treatment and post-treatment in the exercising group (P<0.05). However, there was no statistical difference in all the parameters between 6 and 12 months of exercising. The effective rates were 70.37% and 74.07% after 6- and 12-month exercising, respectively. There were significant differences between the exercising and control groups (P<0.0001). There was no statistical difference in the effective rate of the exercising group between 6 and 12 months of exercising (P>0.05). At 12 months of exercising, the compliance of the anteroposterior pharyngeal wall of the retropalatal area was lower (P

  19. [Chronic snoring and obstructive sleep apnea-hypopnea syndrome in children].

    PubMed

    de Carlos Villafranca, F; Cobo Plana, J; Díaz-Esnal, B; Fernández-Mondragón, P; Macías Escalada, E; Puente Rodríguez, M

    2003-09-01

    The problems children have in sleeping are manifold; the gamut of disorders that have been described ranges from simple, occasional snoring with no accompanying complications, through the syndrome of increased blockage of the upper airways to the obstructive sleep apnea-hypopnea syndrome (OSAHS) where respiratory difficulties accompanied by hypoxemia, hypercapnia and structural sleep difficulties. Mouth breathing and chronic snoring occur frequently in children, with the incidence of snoring, identical for both sexes, varying between 3.2 and 27%. Difficulties in sleeping begin between the ages of the 3 and 9, peaking between 3 and 6. These results demonstrate, in a general way, the disparity between growth of the adenoids and tonsils, and upper airway growth. A differential diagnosis between the various pathological possibilities is based on the observed clinical signs and symptoms, analysis of cephalometric radiographs, polysomnography, a nocturnal cardio-respiratory polygraph and a video film taken during sleep. Snoring is the most characteristic sign of OSAHS in children. We do not yet have available any synthetic study that would sum up results of studies of sleep disorders in children. Nevertheless, we can define obstructive sleep apnea in children as the partial or total cessation of nose and mouth breathing for a period double that of the normal respiratory cycle. Classical treatment of children who suffer from severe respiratory difficulties during sleep, after identification of the etiology of the problem, consists of surgical removal of the adenoids or tonsils and, in certain, continuous positive pressure to assist breathing. The authors of this article have worked with 137 patients between the ages of 6 and 9, 77 of whom were chronic snorers with an average age of 7 years 6 months. The average age of the control group of 60 children was 7 years 2 months. We collected clinical data, medical histories, and distributed a questionnaire to determine

  20. Apnea–hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea

    PubMed Central

    Wu, Jun; Zhao, Guoqiang; Li, Yunchuan; Zang, Hongrui; Wang, Tong; Wang, Dongbo; Han, Demin

    2017-01-01

    Abstract Background: Nasal surgeries have been applied to obstructive sleep apnea (OSA) patients with nasal obstruction for decades. However, the efficiency of nasal surgery in improving OSA remains controversial. The aim of this study was to identify whether isolated nasal surgery can improve apnea–hypopnea index (AHI). Methods: Computerized searches were performed in MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2000 to April 30, 2016. A total of 18 articles and 587 participants were included. There were 1 randomized controlled trials, 2 nonrandomized trials, 11 prospective studies, and 4 retrospective studies. Data regarding study design (prospective/retrospective clinical trial, randomized, and controlled), population size, participant characteristics (age, gender, and body mass index), surgical intervention, and outcomes (AHI, Epworth sleep scale [ESS]) was collected. Results: Statistically significant improvement in AHI (subgroup 1: weighted mean difference [WMD] [95%confidence interval (CI)], −4.17 [−7.62, −0.73]; subgroup 2: WMD [95%CI], −4.19 [−7.51, −0.88]; overall: WMD [95%CI], −4.15 [−6.48, −1.82]) and ESS (subgroup 1: WMD [95%CI], −2.14 [−3.08, −1.19]; subgroup 2: WMD [95%CI], −4.70 [−5.95, −3.44]; overall: WMD [95%CI], −4.08 [−5.27, −2.88]) was revealed. Conclusion: Both AHI and ESS improved significantly after isolated nasal surgery, but the improvement of AHI is slightly significant. Future randomized controlled trials are needed to confirm the long-term benefits of nasal surgery on OSA. PMID:28151900

  1. The STOP-Bang Equivalent Model and Prediction of Severity of Obstructive Sleep Apnea: Relation to Polysomnographic Measurements of the Apnea/Hypopnea Index

    PubMed Central

    Farney, Robert J.; Walker, Brandon S.; Farney, Robert M.; Snow, Gregory L.; Walker, James M.

    2011-01-01

    Background: Various models and questionnaires have been developed for screening specific populations for obstructive sleep apnea (OSA) as defined by the apnea/hypopnea index (AHI); however, almost every method is based upon dichotomizing a population, and none function ideally. We evaluated the possibility of using the STOP-Bang model (SBM) to classify severity of OSA into 4 categories ranging from none to severe. Methods: Anthropomorphic data and the presence of snoring, tiredness/sleepiness, observed apneas, and hypertension were collected from 1426 patients who underwent diagnostic polysomnography. Questionnaire data for each patient was converted to the STOP-Bang equivalent with an ordinal rating of 0 to 8. Proportional odds logistic regression analysis was conducted to predict severity of sleep apnea based upon the AHI: none (AHI < 5/h), mild (AHI ≥ 5 to < 15/h), moderate (≥ 15 to < 30/h), and severe (AHI ≥ 30/h). Results: Linear, curvilinear, and weighted models (R2 = 0.245, 0.251, and 0.269, respectively) were developed that predicted AHI severity. The linear model showed a progressive increase in the probability of severe (4.4% to 81.9%) and progressive decrease in the probability of none (52.5% to 1.1%). The probability of mild or moderate OSA initially increased from 32.9% and 10.3% respectively (SBM score 0) to 39.3% (SBM score 2) and 31.8% (SBM score 4), after which there was a progressive decrease in probabilities as more patients fell into the severe category. Conclusions: The STOP-Bang model may be useful to categorize OSA severity, triage patients for diagnostic evaluation or exclude from harm. Citation: Farney RJ; Walker BS; Farney RM; Snow GL; Walker JM. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med 2011;7(5):459-465. PMID:22003340

  2. Obstructive Sleep Apnea Hypopnea and Poor Response to Antidepressant Medication in Patients with Coronary Heart Disease

    PubMed Central

    Roest, Annelieke M.; Carney, Robert M.; Stein, Phyllis K.; Freedland, Kenneth E.; Meyer, Hilary; Steinmeyer, Brian C.; de Jonge, Peter; Rubin, Eugene H.

    2012-01-01

    Objective Evidence from several clinical trials in patients with coronary heart disease (CHD) suggests that depression that does not respond to treatment is associated with a particularly high risk of adverse cardiac outcomes. The purpose of this study was to determine whether obstructive sleep apnea/hypopnea (OSAH) is associated with a poor response to antidepressant medication in patients with CHD. Method This was an ancillary study of a clinical trial of omega-3 fatty acid augmentation of sertraline for depression in patients with CHD. Cyclical heart rate (HR) patterns associated with OSAH were detected via ambulatory electrocardiography prior to treatment. Symptoms of depression were measured at baseline and follow-up with the Beck Depression Inventory-II (BDI-II) and the Hamilton Rating Scale for Depression (HAM-D-17). The primary endpoint was the BDI-II score at 10 weeks. Results Thirty (29%) of the 105 patients were classified as having moderate to severe OSAH, based on HR patterns. Patients with OSAH had significantly higher scores on both the BDI-II (p=0.01) and the HAM-D-17 (p=0.02) at follow-up as compared to the reference group. Adjustment for the baseline depression score, treatment arm (omega-3 versus placebo), body mass index, and inflammatory markers did not change the results. Conclusion OSAH is associated with a relatively poor response to sertraline for depression. Future research should determine the contribution of OSAH to the increased risk of adverse cardiac outcome associated with treatment resistant depression. PMID:21903027

  3. Immune status of children with obstructive sleep apnea/hypopnea syndrome

    PubMed Central

    Zhang, Zihe; Wang, Chunguang

    2017-01-01

    Objective: We aimed to evaluate the immune status of children with obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods: Fifty children with OSAHS having the symptoms of “snoring, mouth breathing and suffocating during sleep”, who were admitted in our hospital from May 2014 to May 2016, were randomly selected. Another 52 healthy, age- and gender-matched children were enrolled as control subjects after taking informed consent. After admission, the peripheral venous blood was collected. T cell subsets and cytokines were analyzed by flow cytometry. Immunoglobulin and complement levels were detected by immunoassay analyzer. Results: The percentage of CD8+ T lymphocytes in children with OSAHS was (26.47 ± 1.52)% which was significantly higher than that of control group ((21.94 ± 1.92)%) (P<0.05). OSAHS group had a significantly lower CD4+/CD8+ ratio (1.24 ± 0.12) than that of control group (1.45 ± 0.11) (P<0.05). The two groups had similar percentages of CD3+ and CD4+ T lymphocytes (P>0.05). OSAHS group had significantly higher serum levels of IL-4, IL-6, IL-10 and IFN-γ than those of control group (P<0.05), but their IL-2 and TNF-α levels were similar (P>0.05). The serum IgA and C3 levels of OSAHS group significantly exceeded those of control group (P<0.05), but their IgG, IgM and C4 levels were similar (P>0.05). Conclusion: Children with OSAHS had increased percentage of CD8+ T lymphocytes and decreased CD4+/CD8+ ratio, suggesting this group had poor immune function. Increase in humoral immune-related indices IL-4, IL-6, IL-10 and IFN-γ indicated the occurrence of oxidative stress and systemic inflammatory status. PMID:28367199

  4. [The effect of chronic intermittent hypoxia caused by obstructive sleep apnea hypopnea syndrome on blood pressure].

    PubMed

    Mo, Li; Gai, Jun; He, Quan-Ying

    2007-12-01

    To explore the effect of chronic intermittent hypoxia caused by obstructive sleep apnea hypopnea syndrome (OSAHS) and chronic continuous hypoxia caused by chronic obstructive pulmonary disease (COPD) on blood pressure and levels of nitric oxide (NO)/endothelin (ET). A total of 85 cases were selected, including OSAHS patients over 18 years old visited this hospital from June to August 2006, stable COPD patients and healthy volunteers. According to the results of clinical questionnaire, pulmonary function test and polysomography (PSG), they were divided into 4 groups: non-smoking OSAHS patients (n = 26), smoking OSAHS patients (n = 22), patients with stable COPD (n = 17) and healthy control subjects (n = 20). Blood pressure measurement was performed before and after the PSG examination while the subjects were resting. The levels of ET and NO in blood samples and exhaled breath condensates (EBC) were measured by radioimmunoassay and nitrate reductase, respectively. Measurement data were analyzed by ANOVA, numeration data were analyzed by chi-square test, data of normal distribution were analyzed by Pearson correlation analysis, and non-normal data were analyzed by Spearman correlation analysis. Multiple linear regression analysis was also performed. Regardless of the smoking status, the difference of morning-evening diastolic blood pressure (DBP) in the morning of patients with OSAHS [non-smoking OSAHS: (88 +/- 10) mm Hg, 1 mm Hg = 0.133 kPa; smoking OSAHS: (95 +/- 17) mm Hg] was higher than that of patients with COPD [(76 +/- 7) mm Hg] and healthy subjects [(70 +/- 6) mm Hg]. The difference of morning-evening NO level in EBC of patients with OSAHS [non-smoking OSAHS: (-4.5 +/- 7.9) micromol/L; smoking OSAHS: (-3.4 +/- 5.5) micromol/L] was lower than that of patients with COPD [(1.4 +/- 6.1) micromol/L] and healthy subjects [(3.1 +/- 4.0) micromol/L]. The ratio of NO to ET in serum of the smoking OSAHS group (1.0 +/- 0.5) was lower than that of the COPD group (1

  5. Can we discriminate between apnea and hypopnea using audio signals?

    PubMed

    Halevi, M; Dafna, E; Tarasiuk, A; Zigel, Y

    2016-08-01

    Obstructive sleep apnea (OSA) affects up to 14% of the population. OSA is characterized by recurrent apneas and hypopneas during sleep. The apnea-hypopnea index (AHI) is frequently used as a measure of OSA severity. In the current study, we explored the acoustic characteristics of hypopnea in order to distinguish it from apnea. We hypothesize that we can find audio-based features that can discriminate between apnea, hypopnea and normal breathing events. Whole night audio recordings were performed using a non-contact microphone on 44 subjects, simultaneously with the polysomnography study (PSG). Recordings were segmented into 2015 apnea, hypopnea, and normal breath events and were divided to design and validation groups. A classification system was built using a 3-class cubic-kernelled support vector machine (SVM) classifier. Its input is a 36-dimensional audio-based feature vector that was extracted from each event. Three-class accuracy rate using the hold-out method was 84.7%. A two-class model to separate apneic events (apneas and hypopneas) from normal breath exhibited accuracy rate of 94.7%. Here we show that it is possible to detect apneas or hypopneas from whole night audio signals. This might provide more insight about a patient's level of upper airway obstruction during sleep. This approach may be used for OSA severity screening and AHI estimation.

  6. [Symptom prevalence of obstructive sleep apnea-hypopnea syndrome in health-care providers in central Sivas].

    PubMed

    Doğan, Omer Tamer; Berk, Serdar; Ozşahin, Sefa Levent; Arslan, Sülhattin; Düzenli, Hasan; Akkurt, Ibrahim

    2008-01-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most common sleep disorder that can lead to serious complications. Polysomnography (PSG) is the gold standard for the diagnosis of OSAHS. Unfortunately, PSG studies are expensive, time-consuming, requiring special team and equipment. Therefore, it is possible to determine the cases likely to have OSAHS requiring at least PSG by type A studies. There isn't enough data about the prevalence of OSAHS in Turkey. The aim of this study was to estimate the symptom prevalence of OSAHS in health-care providers in central Sivas. The questionnaire asking demographic features, additional diseases, habits, the symptoms related with OSAHS was performed in total of 1202 health care providers. We also performed Epworth sleepiness scale (ESS) to determine excessive daytime sleepiness. Snoring was detected in 267 participants. Snoring rates were 38% and 10.9% in men and in women, respectively. The rate of witnessed sleep apnea in all cases was 4.4% (n=53). Witnessed sleep apnea was reported by 42 of men (8.4%) and 11 of women (1.6%). A total of 338 participants had excessive daytime sleepiness. There was a significant relation between three major symptoms of OSAHS and excessive sleepiness while driving. All three major symptoms were detected in 22 cases (1.8%), of which 21 were males. This study suggested that OSAHS symptom prevalence is quite high helth-care provides in our region and, therefore expanded usage of PSG studies is required.

  7. Evaluation of the Apnea-Hypopnea Index Determined by the S8 Auto-CPAP, a Continuous Positive Airway Pressure Device, in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

    PubMed Central

    Ueno, Kanako; Kasai, Takatoshi; Brewer, Gregory; Takaya, Hisashi; Maeno, Ken-ichi; Kasagi, Satoshi; Kawana, Fusae; Ishiwata, Sugao; Narui, Koji

    2010-01-01

    Objective: Continuous positive airway pressure (CPAP) has been established as an effective treatment for obstructive sleep apnea-hypopnea syndrome (OSAHS). Recently, several auto-CPAP devices that can detect upper airway obstructive events and provide information about residual events while patients are on CPAP have come into clinical use. The purpose of this study was to compare the apnea-hypopnea index (AHI) determined by the S8 auto-CPAP device with the AHI derived by polysomnography in patients with OSAHS. Method: Consecutive patients with OSAHS titrated on S8 auto-CPAP were included. The correlation between AHI determined by manual scoring (AHI-PSG) and by S8 (AHI-S8) during an overnight in-hospital polysomnogram with the patient on CPAP was assessed. Furthermore, the apnea index (AI) and the hypopnea index (HI) were evaluated separately. Results: Seventy patients with OSAHS (94% men) were enrolled. The mean AHI on the diagnostic study was 51.9 ± 2.4. During the titration, this device markedly suppressed the respiratory events (AHI-PSG, 4.2 ± 0.4; AI, 1.9 ± 0.3; HI, 2.3 ± 0.3). On the other hand, the AHI-S8 was 9.9 ± 0.6 (AI-S8, 2.4 ± 0.3; HI-S8, 7.5 ± 0.4). There was a strong correlation between the overall AHI-PSG and the AHI-S8 (r = 0.85, p < 0.001), with a stronger correlation in the apnea component AI-PSG and the AI-S8 (r = 0.93, p < 0.001), whereas there was a weaker correlation between the HI-PSG and the HI-S8 (r = 0.67, p < 0.001). Conclusions: Using the same airflow signals as those of the CPAP device, a strong correlation between the AHI-PSG and the AHI-S8 was observed. However, the correlation was weakened when the analysis was limited to the HI. Citation: Ueno K; Kasai T; Brewer G; Takaya H; Maeno K; Kasagi S; Kawana F; Ishiwata S; Narui K. Evaluation of the apnea-hypopnea index determined by the S8 auto-CPAP, a continuous positive airway pressure device, in patients with obstructive sleep apnea-hypopnea syndrome. J Clin Sleep Med 2010

  8. Effect of different oxygen desaturation threshold levels on hypopnea scoring and classification of severity of sleep apnea.

    PubMed

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

    2015-09-01

    Recently, there has been a debate about the rules used to score hypopnea events. The purpose of this study was to examine the effect of different oxygen desaturation threshold (ODT) levels on the apnea-hypopnea index (AHI) and on a recently introduced parameter, adjusted AHI. Adjusted AHI incorporates the severity of individual breathing cessation events. We also aimed to clarify the impact of the different ODT levels on the current classification of obstructive sleep apnea (OSA) severity. Ambulatory polygraphic recordings of 68 patients (19 F/49 M, median age 53.2 years, AHI ≥5) were analyzed retrospectively. Hypopneas were defined as ≥30% drop in airflow for ≥10 s associated with ≥2% oxygen desaturation (ODT2%), and after that, using stricter ODT criteria (ODT3%-ODT8%). Compared to ODT4%, the ODT3% resulted in 5.6 events/h higher median conventional AHI, but only 1.5 events/h higher median adjusted AHI. A significant rearrangement of patients between the clinical severity categories took place when using different ODTs. When assessing with ODT3% instead of ODT4%, the portion of the patients with moderate or severe OSA (AHI ≥15) raised from 29.4 to 73.5% using conventional AHI, but only marginally, i.e., from 73.5 to 77.9%, using the adjusted AHI. The conventional AHI was found to be susceptible even to minor changes in ODT level which may lead to substantial variability in AHI-based classification of disease severity. Since the adjusted AHI comprises information on severity of individual breathing cessations, it reduces the variability related to ODT levels used in hypopnea scoring and can increase the accuracy of estimation of OSA severity.

  9. [The role of maxillofacial surgery in obstructive sleep hypopnea and apnea syndrome].

    PubMed

    Gilon, Yves; Raskin, Sylviane; Heymans, Olivier; Poirrier, Robert

    2002-01-01

    One of the most common symptoms of obstructive sleep apnea syndrome (OSAS) is daytime drowsiness. It is associated with a high cardiovascular morbidity and mortality, and an elevated incidence of car crashes. In general, young patients don't want conservative treatment because symptomatic and to prevent secondary effects. In this article, we briefly define sleep disorders and the interest of cephalometric examination. We describe the different treatment possibilities and stress the important role of orthognathic surgery in this syndrome.

  10. Impact of different hypopnea definitions on obstructive sleep apnea severity and cardiovascular mortality risk in women and elderly individuals.

    PubMed

    Campos-Rodriguez, Francisco; Martínez-García, Miguel A; Reyes-Nuñez, Nuria; Selma-Ferrer, Maria J; Punjabi, Naresh M; Farre, Ramon

    To assess the impact of three hypopnea definitions on the severity classification of obstructive sleep apnea (OSA) and its association with cardiovascular mortality risk in women and elderly individuals. We analyzed two Spanish clinical cohorts (1116 women and 939 elderly individuals) who were studied for suspicion of OSA between 1998 and 2007. A calibration model was used to apply different definitions of hypopnea to our two cohorts. Hypopnea was defined as a 30-90% reduction in oronasal flow for ≥10 s followed by (1) ≥4% fall in oxyhemoglobin saturation-AHI4%; (2) ≥3% fall in oxyhemoglobin saturation-AHI3%; or (3) ≥3% fall in oxyhemoglobin saturation or an event-related arousal-AHI3%a. In both cohorts, the prevalence of an AHI ≥30 events/h increased by 14% with AHI3%a, compared to AHI4% criteria. The percentage of women with an AHI <5 events/h decreased from 13.9% with AHI4% to 1.1% with the AHI3%a definition. In fully adjusted multivariable analyses, AHI ≥30 events/h was associated with increased cardiovascular mortality risk in women, regardless of the hypopnea definition, and in elderly individuals diagnosed using the AHI4% and AHI3% but not the AHI3%a definition. Our findings suggest that hypopnea definitions substantially influence OSA prevalence and severity classification, and also affect the association with cardiovascular outcomes. With the currently recommended criterion (AHI3%a), a threshold of 30 events/h is appropriate to identify women, but not elderly individuals with increased risk of cardiovascular death. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Magnetic resonance imaging in simple snoring and obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Fusco, Giovanni; Macina, Francesco; Macarini, Luca; Garribba, Angela Patrizia; Ettorre, Giovanni Carlo

    2004-09-01

    Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a condition characterised by periodic cessation of breathing during sleep, associated with Upper Air-Digestive Ways (UADW) morphologic abnormalities that can be detected, in awake patients, by using various imaging techniques. The purpose of this study is to determine the usefulness of MR imaging and new original morphometrical measurements that we are proposing in patients with Sleep Obstructive Breathing Disordered (SOBD). We studied 70 patients (52 with OSAHS and 18 snoring without OSAHS) using 1.5T and 0.5T MR imagers with neck and head coils and T1-DP-T2-weighted SE sequences. During the procedure, the patients were awake and with tidal breathing. We also evaluated sagittal pharyngeal diameters at different levels; the length and maximum width of soft palate; the distance between the hyoid bone and the C2C3-Me line (ideally joining the geometrical centre of the C2-C3 intervertebral space to the lower point of mandibular symphysis) measured on the perpendicular; the angle resulting from the longitudinal axis of the cervical spine and the epiglottis axis (alpha); the slope angle of the tongue -- resulting from the longitudinal axis of the cervical spine and the longitudinal axis of the tongue (beta). We used sagittal, coronal and axial sections of the head and neck. In OSAHS patients, pharynx calibre medium sizes were reduced compared with simple snoring patients. Only in OSAHS patients (not in simple snorers without OSAHS) we observed: 16 patients with narrowing sites = or <3 mm. On axial images we observed three different narrowing patterns: rounded, with greater anterior-posterior axis; with greater axis in lateral direction. In OSAHS patients we also observed, on average, increase of the distance between the hyoid bone (Hmr point) and the line C2C3-Me; increase in the angle resulting between cervical rachis and epiglottis (alpha); reduction of sloping angle of the tongue (beta). MR imaging, together with

  12. Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers.

    PubMed Central

    Sériès, F; Côté, C; Simoneau, J A; Gélinas, Y; St Pierre, S; Leclerc, J; Ferland, R; Marc, I

    1995-01-01

    Upper airway dilator muscles play an important role in the pathophysiology of sleep apnea hypopnea syndrome (SAHS). The mechanical and structural characteristics of these muscles remain unknown. The aim of this study was to compare the physiologic, metabolic, and fiber type characteristics of one upper airway dilator muscle (musculus uvulae, MU) in 11 SAHS and in seven nonapneic snorers. The different analyses were done on MU obtained during uvulo-palato-pharyngoplasty. Snorers and SAHS differed only in their apnea + hypopnea indices (11.5 +/- 5.9 and 34.2 +/- 14.6/h, respectively, mean +/- SD). Absolute twitch and tetanic tension production of MU was significantly greater in SAHS than in snorers while the fatigability index was similar in the two groups. Protein content and anaerobic enzyme activities of MU were significantly greater in SAHS than in snorers; no difference was observed for aerobic enzyme activities. The total muscle fiber cross-sectional area of MU was significantly higher in SAHS (2.2 +/- 0.9 mm2) than in snorers (1.1 +/- 0.7 mm2). The surface occupied by type IIA muscle fibers of MU was larger in SAHS (2.00 +/- 0.96) than in snorers (0.84 +/- 0.63 mm2). We conclude that the capacity for tension production and the anaerobic metabolic activity of MU are greater in SAHS than in snorers. PMID:7814616

  13. [Prevalence of obstructive sleep apnea-hypopnea syndrome in adults aged over 20 years in Fuzhou city].

    PubMed

    Lin, Qi-Chang; Huang, Jian-Chai; Ding, Hai-Bo; Huang, Hong-Bo; Zeng, Chun-Yan; Li, Shu-Qi

    2009-03-01

    To investigate the prevalence and risk factors of obstructive sleep apnea-hypopnea syndrome (OSAHS) in adults aged over 20 years in Fuzhou city, there fore to provide epidemiological data for prevention and treatment of the disease, and establishing a data base for prospective study. A total of 5500 subjects were derived from a random and cluster sampling of the population in 5 districts of Fuzhou city. They were asked to answer the questions from a questionnaire at home. According to the degree of snoring, 315 subjects with a snoring score > or = 3 degree and 100 subjects with a snoring score = 2 degree were selected at random to undergo polysomnography for a whole night. The prevalence of the disease was estimated and the risk factors for OSAHS were analyzed. 4595 subjects (83.55%) responded, and validated questionnaires were obtained from 4286 subjects (effective power 93.28%); of whom 606 (14.14%) subjects had habitual snoring. The estimated prevalence of OSAHS defined by apnea-hypopnea index (AHI) > or = 5 and Epworth sleepiness scale (ESS) > or = 9 was 4.78%. Multivariate analysis revealed that age, smoking, family snoring, neck-circumference, waist circumference, and abnormality of the upper airway were significant risk factors for OSAHS. The estimated prevalences of snoring and OSAHS in adults aged over 20 years in Fuzhou city was high. Strategies based on the epidemiological data in Fuzhou city are needed to cut down the prevalence and harm of OSAHS by controlling modifiable risk factors.

  14. Localization of glossopharyngeal obstruction using nasopharyngeal tube versus Friedman tongue position classification in obstructive sleep apnea hypopnea syndrome.

    PubMed

    Li, Shuhua; Hei, Renyi; Wu, Dahai; Shi, Hongjin

    2014-08-01

    Assessing the severity of glossopharyngeal obstruction is important for the diagnosis and therapy of obstructive sleep apnea hypopnea syndrome (OSAHS). The polysomnography (PSG) with nasopharyngeal tube insertion (NPT-PSG) has shown good results in assessing glossopharyngeal obstruction. The objective of this study was to compare NPT-PSG with Friedman tongue position (FTP) classification which was also used to evaluate the glossopharyngeal obstruction. One hundred and five patients with OSAHS diagnosed by PSG were included in the study. All the patients were successfully examined by NPT-PSG. Based on the grade of FTP classification, 105 patients were divided into four groups. The differences of the general clinical data, PSG and NPT-PSG results were analyzed among the four groups. And the coincidence of diagnosing glossopharyngeal obstruction of two methods was calculated. There was no significant difference among the four groups in general clinical data and PSG results. However, NPT-PSG results were significantly different among the four groups. Following with the increasing FTP, apnea hypopnea index increased and lowest saturation of blood oxygen decreased. There were 38 patients with and other 38 patients without glossopharyngeal obstruction diagnosed by both methods. The coincidence of two methods was 72.4 %. NPT-PSG is an easy and effective method in assessing the severity of glossopharyngeal obstruction. The coincidence between the NPT-PSG and FTP classification is good. But in some special OSAHS patients such as glossoptosis, unsuccessful uvulopalatopharyngoplasty or suspicious pachyglossia, NPT-PSG is better than FTP classification.

  15. Non-contact diagnostic system for sleep apnea-hypopnea syndrome based on amplitude and phase analysis of thoracic and abdominal Doppler radars.

    PubMed

    Kagawa, Masayuki; Tojima, Hirokazu; Matsui, Takemi

    2016-05-01

    Full-night polysomnography (PSG) has been recognized as the gold standard test for sleep apnea-hypopnea syndrome (SAHS). However, PSG examinees are physically restrained for the full night by many contact sensors and obtrusive connecting cables, inducing mental stress. We developed a non-contact SAHS diagnostic system that can detect apneic events without inducing stress in monitored individuals. Two Doppler radars were installed beneath the mattress to measure the vibrations of the chest and abdomen, respectively. Our system determines apnea and hypopnea events when the radar output amplitude decreases by <20 and 70 %, respectively, of the amplitude of a normal breath (without SAHS events). Additionally, we proposed a technique that detects paradoxical movements by focusing on phase differences between thoracic and abdominal movements, and were able to identify three types of sleep apnea: obstructive, central, and mixed. Respiratory disturbance indexes obtained showed a higher correlation (r = 94 %) with PSG than with pulse oximetry (r = 89 %). When predicting the severity of SAHS with an apnea-hypopnea index (AHI) of >15/h or >30/h using PSG as a reference, the radar system achieved a sensitivity of 96 and 90 %, and a specificity of 100 and 79 % with an AHI of >15/h and >30/h, respectively. The proposed radar system can be used as an alternative to the current airflow sensor, and to chest and abdomen belts for apnea-hypopnea evaluation.

  16. 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 ...

  17. Association of sleep time in supine position with apnea-hypopnea index as evidenced by successive polysomnography.

    PubMed

    Yalciner, Gokhan; Babademez, Mehmet Ali; Gul, Fatih

    2017-05-01

    The purpose of this study is to evaluate the impact of body position during sleep on apnea-hypopnea index (AHI) and night-to-night variability in polysomnography (PSG) parameters. Totally, 30 patients with obstructive sleep apnea syndrome (OSAS) were assessed prospectively with successive PSGs performed. The patients were categorized as increased (group A), decreased (group B), and unchanged (group C) AHI between the first and second PSG evaluations performed at least 1-week interval. The mean AHI values were significantly higher in the second night (p = 0.02). A change in AHI was found in almost 85 % of the patients between two successive measurements. According to multivariate and correlation analyses and differences in total AHI in supine position (r = 0.897), it was found that the influence of the supine position was the primary factor contributing to the night-to-night variability. Supine AHI, non-supine AHI, and non-supine time findings did not add any significance on total AHI. The variability observed in the AHI seems related to amount of sleeping time spent in supine position, suggesting that mean AHI alone is not that reliable in the accurate diagnosis of OSAS severity. A thorough evaluation of AHI in supine and non-supine positions is needed in order to understand better the severity of OSAS.

  18. [Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome].

    PubMed

    Shen, Ling; Lin, Zongtong; Xu, Yangyang; Yang, Zhongjie

    2014-07-01

    To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months. The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ² were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was

  19. Intelligent Approach for Analysis of Respiratory Signals and Oxygen Saturation in the Sleep Apnea/Hypopnea Syndrome

    PubMed Central

    Moret-Bonillo, Vicente; Alvarez-Estévez, Diego; Fernández-Leal, Angel; Hernández-Pereira, Elena

    2014-01-01

    This work deals with the development of an intelligent approach for clinical decision making in the diagnosis of the Sleep Apnea/Hypopnea Syndrome, SAHS, from the analysis of respiratory signals and oxygen saturation in arterial blood, SaO2. In order to accomplish the task the proposed approach makes use of different artificial intelligence techniques and reasoning processes being able to deal with imprecise data. These reasoning processes are based on fuzzy logic and on temporal analysis of the information. The developed approach also takes into account the possibility of artifacts in the monitored signals. Detection and characterization of signal artifacts allows detection of false positives. Identification of relevant diagnostic patterns and temporal correlation of events is performed through the implementation of temporal constraints. PMID:25035712

  20. [Evaluate the effect of Nd:YAG laser in treatment of obstructive sleep apnea-hypopnea syndrome].

    PubMed

    Zhang, Chao; Zhang, Xianzhong; Li, Yongping; Lu, Eryong

    2004-06-01

    To observe the effect of laser in treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). Eighty-nine cases of OSAHS were treated by Laser assisted uvulopalptoplasty (LAUP). Among the cases, the soft palate and uvula were partly resected. The cureiform incise was made into the soft palate along the each side of uvula. The follow-up period was six months, 76 cases received the detection of polysomnography. Eight cases were cured; 36 cases had notable effects; 25 cases had effects; 7 cases had no effects. The total ratio of validity was 90.8%. It has clinical value to use LAUP in treatment of OSAHS, and its advantage include hemostasia, solidfication, penetrability, clear visual threshold, lower complication and shortening the surgery time.

  1. Sleep Apnea

    MedlinePlus

    Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing ... an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or ...

  2. Distinguishing obstructive from central sleep apneas and hypopneas using linear SVM and acoustic features.

    PubMed

    Hummel, Richard; Bradley, T Douglas; Packer, Devin; Alshaer, Hisham

    2016-08-01

    Sleep Apnea (SA) is a very common but underdiagnosed respiratory disorder. SA has 2 main types, obstructive and central sleep apnea (OSA and CSA, respectively). The distinction between the 2 types is important for proper clinical management. Our aim in this study was to deploy acoustic analysis of breath sounds to distinguish central from obstructive events. We recorded breath sounds from 29 patients from which 45 segments with obstructive only and 40 segments with central only respiratory events were isolated. Subsequently, 10 acoustic features were extracted and used to identify basic breath sounds: inspiration, expiration, and snoring. A 2nd set of 6 sound-specific features were extracted from the basic sounds, designed based on SA pathophysiology. These 6 features were used to train and test a linear SVM classifier using a leave-one-out cross validation scheme. We achieved an excellent accuracy of 91.8%. In conclusion, this is the first study to demonstrate the ability to distinguish CSA from OSA with high reliability from breath sound recordings during sleep.

  3. [Prevalence of obstructive sleep apnea-hypopnea syndrome in adults aged over 60 yeaes in dongying city].

    PubMed

    Su, Yi; Xu, Weiwei; Wang, Xiangyun; Zhang, Zhili; Cao, Yingchun; Yu, Qiuhong; Li, Jiandong

    2016-02-01

    To survey the prevalence of obstructive sleep apnea-hypopnea syndrome(OSAHS) in adults aged over 60 years in Dongying city,and analyze the risk factors and the extent of damage to the quality of life for the elderly to provide the basis for prevention and treatment of OSAHS people. One thousand subjects were derived from a random cluster sampling in seven districts of Dongying city:they were asked to answer the questions from questionnaires. According to the questionnaire scoring, 100 subjects in high-risk group were selected randomly to make polysomnography monitoring for a whole night,so that the prevalence of the disease was calculated and the related risk factors were analyzed; elderly patients diagnosed with OSAHS were asked to assess the quality of life assessment questionnaire by face to face to understand the quality of life dimensions injury. The actual number of completed surveys was 934, and the efficiency was 93.4%. The estimated prevalence of OSARS in elder people defined by apnea-hypopnea index (AHI ≥ 5) was 32.5%; Multivariate analysis revealed that age smoking, family snoring,neck circumference, waist circumference, and abnormality of the upper airway were respectively independent risk factors of OSAHS,and the abnormalities of the upper airway had the most obvious impact on AHI. The damage caused by OSAHS to the quality of life for elderly people followed their daily work life, social relationships, symptoms, alertness, emotional, general health, symptoms. The estimated prevalences of OSAHS in elder people were high. Actively promoting good habits to older people, weight loss, early detection and correct upper airway abnormalities may reduce the estimated prevalence of OSAHS. In the treatment process, the patient's physician should pay attention to their emotional and groom their psychological problems to improve the quality of life in elder people.

  4. [Predictors of Electrical Myocardial Instability in Men With Arterial Hypertension and Obstructive Sleep Apnea-Hypopnea Syndrome].

    PubMed

    Lyshova, O V; Borodin, N V; Kostenko, I I

    2017-05-01

    To access the detectability of corrected QT interval (QTc) prolongation ( more or equal 450 ms) and increased QT dispersion (QTd more or equal 60 ms) in men with obstructive sleep apnea-hypopnea syndrome (OSAS) and newly diagnosed arterial hypertension (AH). We included in this study 138 men (mean age 40.5+/-6.9 years, body mass index 34.5+/-4.7 kg/m2, all with more or equal 3 risk factors of AH development, 34% with subclinical target organs damage). According to office systolic and diastolic blood pressure level (SBP and DBP), AH of 1st degree was diagnosed in 103 (74.6%), 2nd - in 26 (18.9%) and 3rd - in 9 (6.5%) patients. All patients underwent 24-h multifunctional monitoring. According to the apnea-hypopnea index (AHI) patients were divided into 4 groups: I (control, n=34) with AHI less than 5/h, II (n=36) with AHI 5-14/h, III (n=32) with AHI 15-29/h, IV (n=36) with AHI more or equal 30/h. There were no significant intergroup differences in age, body mass index, sleep duration, mean daytime SBP, QT and JT dispersion in the diurnal, daytime and nighttime periods. However, in group IV values of mean heart rate (in normal range), daytime DBP, nighttime SBP and DBP, QTc and JTc intervals were higher than in other groups. Portions of patients with prolonged QTc and increased QTd were 38.2 and 35.3%, 44.4 and 33.3%, 34.4 and 40.6%; 50.0 and 38.9% in groups I, II, III, IV, respectively. Multiple regression analysis revealed associations between mean diurnal QTc interval prolongation and reduction of mean oxygen saturation (SpO2) during sleep, and between mean diurnal JTc interval prolongation and increase of AHI. Rates of detection of QTc interval prolongation and QTd increase in men with newly diagnosed AH and OSAS of different severity were almost similar. However, there was a trend to higher detectability of QTc interval prolongation (50.0%) among patients with AHI more or equal 30/h. Reduction of mean SpO2 and AHI increase during sleep were found to be predictors

  5. Sleep Apnea

    MedlinePlus

    ... that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is ... obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. CPAP may eliminate snoring and prevent sleep apnea. ...

  6. Emotional Content of Dreams in Obstructive Sleep Apnea Hypopnea Syndrome Patients and Sleepy Snorers attending a Sleep-Disordered Breathing Clinic

    PubMed Central

    Fisher, Samantha; Lewis, Keir E.; Bartle, Iona; Ghosal, Robin; Davies, Lois; Blagrove, Mark

    2011-01-01

    Study Objectives: To assess prospectively the emotional content of dreams in individuals with the obstructive sleep apnea hypopnea syndrome (OSAHS) and sleepy snorers. Methods: Prospective observational study. Forty-seven patients with sleepiness and snoring attending a sleep-disordered breathing clinic, completed a morning diary concerning pleasantness/unpleasantness of their dreams for 10 days, and then had AHI assessed by a limited-channel home sleep study. Participants and groups: Sleepy snorers, AHI < 5: n = 12 (mean age = 51.00 years [SD 7.01], 7 males); AHI 5 −14.9, n = 14 (mean age = 49.71 y [9.73], 12 males); AHI ≥ 15, n = 21 (mean age = 56.33 [11.24], 16 males). Results: All groups reported similar numbers of dreams and nightmares during the diary period. The AHI ≥ 15 group were significantly higher on dream unpleasantness than were the sleepy snorers (p < 0.05); and when only males were analyzed, this difference was also significant (p = 0.01). As AHI increased across the 3 groups, there was a significant decrease in variability of dream emotions (Levene test for homogeneity of variance between the 3 groups, p = 0.018). Mean daytime anxiety and daytime depression were significantly correlated with mean dream unpleasantness and with mean number of nightmares over the diary period. Conclusions: Patients with AHI ≥ 15 had more emotionally negative dreams than patients with AHI < 5. The variation in mean dream emotion decreased with increasing AHI, possibly because sleep fragmentation with increasing AHI results in fewer and shorter dreams, in which emotions are rarer. Citation: Fisher S; Lewis KE; Bartle I; Ghosal R; Davies L Blagrove M. Emotional content of dreams in obstructive sleep apnea hypopnea syndrome patients and sleepy snorers attending a sleep-disordered breathing clinic. J Clin Sleep Med 2011;7(1):69-74. PMID:21344048

  7. Airway Obstruction during Drug-Induced Sleep Endoscopy Correlates with Apnea-Hypopnea Index and Oxygen Nadir in Children.

    PubMed

    Dahl, John P; Miller, Craig; Purcell, Patricia L; Zopf, David A; Johnson, Kaalan; Horn, David L; Chen, Maida L; Chan, Dylan K; Parikh, Sanjay R

    2016-10-01

    To determine if standardized intraoperative scoring of anatomic obstruction in children with obstructive sleep apnea correlates with the apnea-hypopnea index (AHI) and lowest oxygen saturation on preprocedural polysomnogram (PSG). A secondary objective was to determine if age, presence of a syndrome, or previous adenotonsillectomy affect this correlation. Case series with chart review. Two tertiary care children's hospitals. Patients with a preprocedural PSG who underwent drug-induced sleep endoscopy (DISE) over a 4-year period. All DISEs were graded in a systematic manner with the Chan-Parikh (C-P) scoring system. AHI and nadir oxygen saturations were extracted from preprocedural PSG. Data were analyzed with a multivariate linear regression model that controlled for age at time of sleep endoscopy, syndrome diagnosis, and previous adenotonsillectomy. A total of 127 children underwent PSG prior to DISE: 56 were syndromic, and 21 had a previous adenotonsillectomy. Mean AHI was 13.6 ± 19.6 (± SD), and mean oxygen nadir was 85.4% ± 9.4%. Mean C-P score was 5.9 ± 2.7. DISE score positively correlated with preoperative AHI (r = 0.36, P < .0001) and negatively correlated with oxygen nadir (r = -0.26, P = .004). The multivariate linear regression models estimated that for every 1-point increase in C-P score, there is a 2.6-point increase in AHI (95% confidence interval: 1.4-3.8, P < .001) and a 1.1% decrease in the lowest oxygen saturation (95% confidence interval: -1.7 to -0.6, P < .001). The C-P scoring system for pediatric DISE correlates with both AHI and lowest oxygen saturation on preprocedural PSG. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  8. Big Endothelin-1 and Nitric Oxide in Hypertensive Elderly Patients with and without Obstructive Sleep Apnea-Hypopnea Syndrome

    PubMed Central

    Anunciato, Iara Felicio; Lobo, Rômulo Rebouças; Coelho, Eduardo Barbosa; Verri, Waldiceu Aparecido; Eckeli, Alan Luiz; Évora, Paulo Roberto Barbosa; Nobre, Fernando; Moriguti, Júlio César; Ferriolli, Eduardo; Lima, Nereida Kilza da Costa

    2013-01-01

    Background The role of oxidative stress in hypertensive elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is unknown. Objective The purpose was to evaluate the levels of big endothelin-1 (Big ET-1) and nitric oxide (NO) in elderly hypertensive patients with and without moderate to severe OSAHS. Methods Volunteers were hospitalized for 24 h. We obtained the following data: body mass index (BMI); 24-ambulatory blood pressure monitoring; and current medication. Arterial blood was collected at 7pm and 7am for determining plasma NO and Big ET-1 levels. Pulse oximetry was performed during sleep. Pearson's or Spearman's correlation and univariate analysis of variance were used for statistical analysis. Results We studied 25 subjects with OSAHS (group 1) and 12 without OSAHS (group 2) aged 67.0 ± 6.5 years and 67.8 ± 6.8 years, respectively. No significant differences were observed between the groups in BMI; number of hours of sleep; 24-h systolic and diastolic BPs; awake BP, sleep BP and medications to control BP between groups. No differences were detected in plasma Big ET-1 and NO levels at 19:00 h, but plasma Big ET-1 levels at 7:00 h were higher in group 1 (p = 0.03). In group 1, a negative correlation was also observed between the mean arterial oxyhemoglobin saturation level, 24-h systolic BP (p = 0.03, r = −0.44), and Big ET-1 (p = 0.04, r = −0.41). Conclusions On comparing elderly hypertensive patients with and without OSAHS having similar BP and BMI, we observed higher Big ET-1 levels After sleep in the OSAHS group. NO levels did not differ between the hypertensive patients with or without OSAHS. PMID:23979778

  9. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2014-04-01

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

  11. [Severe obstructive sleep apnea-hypopnea syndrome with dilated cardiomyopathy leading to pulmonary hypertension: case report and literature review].

    PubMed

    Chen, R K; Hong, C; Zhou, Y M; Kuang, A L; Zhang, Y T; Qing, S M; Liu, C L; Zhang, N F

    2017-01-12

    Objective: To study the relationship between dilated cardiomyopathy and obstructive sleep apnea-hypopnea syndrome (OSAHS) and to evaluate the curative effects of continuous positive airway pressure (CPAP) in OSAHS complicated with dilated cardiomyopathy. Methods: We reported one case with the symptom of exertional dyspnea for 1 year and aggravating for 1 month. The patient finally was diagnosed with severe OSAHS complicated with dilated cardiomyopathy leading to pulmonary hypertension. A systematic literature review was performed for similar published cases in Pubmed, Wanfang and CNKI database, using the keywords (obstructive sleep apnea) OR(OSA) OR(OSAHS) AND(dilated cardiomyopathy OR DCM)from January 1990 to May 2016. Results: Our patient had no significant improvement after receiving initial treatments, including reducing cardiac preload, improving myocardial metabolism, increasing myocardial contractility, and anticoagulants. After the patient was diagnosed as having severe OSAHS by polysomnography(PSG) and treated with CPAP, his symptoms improved remarkably. The enlarged heart became smaller and the patient had no repeated dyspnea at follow-up examination. By literature review, we found 4 English original articles and 6 Chinese articles (1 review article, 1 expert note, 1 original article and 3 case reports) on OSAHS complicated by DCM.Four Chinese and 1 English articles reported that the symptoms and parameters of OSAHS with DCM was improved remarkably after treatment with CPAP. Conclusion: For patients with dilated cardiomyopathy which fails to conventional therapy, especially those accompanied by obesity, snoring, daytime sleepiness, morning dry mouth and other related symptoms, PSG should be carried out. Early CPAP therapy could improve symptoms and prognosis of OSAHS associated with DCM.

  12. Mean apnea–hypopnea duration (but not apnea–hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea

    PubMed Central

    Wu, Hao; Zhan, Xiaojun; Zhao, Mengneng; Wei, Yongxiang

    2016-01-01

    Abstract To determine which polysomnography parameters are associated with severity of hypertension. This retrospective study collected data on all patients admitted to our urban, academic center in Beijing with hypertension who had undergone polysomnograms (PSG) and were diagnosed with obstructive sleep apnea (OSA) (apnea–hyponea index [AHI] ≥5/hour). We then compared polysomnographic parameters (AHI, oxygen desaturation index [ODI], lowest oxygen saturation [LOS], and mean apnea–hypopnea duration [MAD]) by hypertension severity in this cohort. There were 596 subjects who met entry criteria. Age, sex distribution, body mass index (BMI), history of current smoking and alcohol were similar among groups. Subjects with longer MAD suffered from more severe hypertension (P = 0.011). There were no relationship between AHI, ODI, and LOS and hypertension in our cohort. There were no significant differences in age, sex, BMI, history of current smoking and alcohol use between hypertension groups. MAD had a small but significant independent association (odds ratio [OR] = 1.072, 95% confidence interval [CI] 1.019–1.128, P = 0.007) with moderate to severe hypertension, using logistic regression analysis that accounted for age, sex, BMI, history of current smoking and alcohol, AHI, and LOS. Chinese inpatients with longer MAD by PSG face higher odds of moderate to severe hypertension. The mechanism of these effects may be due to aggravated nocturnal hypoxaemia and hypercapnia, as well as disturbed sleep architecture. These results suggest that additional information available in the polysomnogram, such as MAD, should be considered when evaluating OSA patients. PMID:27902610

  13. The relationship between structural/MHC changes in upper airway palatopharyngeal muscle morphology and obstructive sleep apnea/hypopnea syndrome.

    PubMed

    Shi, Song; Xia, Yanghui; Chen, Shicai; Li, Meng; Chen, Donghui; Liu, Fei; Zheng, Hongliang

    2014-01-01

    The aim of this study is to explore the relationship between structural/MHC changes in upper airway palatopharyngeal muscle morphology and obstructive sleep apnea/hypopnea syndrome. Palatopharyngeal muscle specimens were taken from 51 patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent uvulopalatopharyngoplasty (UPPP) resection. Patients were divided into light, medium and severe in terms of the severity of their OSAHS. There were 17 patients in each severity group. Palatopharyngeal muscle specimens were also taken from 17 patients suffering from chronic tonsillitis for comparison as the control group. All specimens were stained using Masson and observed for structural changes, especially in muscle fiber morphology, density and arrangement, as well as intermuscular connective tissues, under light microscopy. All specimens were also analyzed for MHC-I, MHC-IIa and MHC-IIb phenotype and protein expression differences using mRNA quantitative reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence staining. The results from each group were then statistically analyzed using semi-quantitative analysis. Light microscopy with Masson staining revealed that in the control group, the muscle fibers are closely connected and arranged neatly. In specimens from patients suffering from OSAHS, the palatopharyngeal muscle fibers are larger with obvious hypertrophy and there was an increase in elastic fibers. The mucosal lamina propria was thickened, and the density of muscle fibers was reduced. Muscle fibers are not neatly arranged and degeneration was observed. The amount of muscular pathology and fibrosis corresponds to the severity of disease in the patients. In patients with severe OSAHS, the proportion of collagen to muscle fibers was increased significantly. Immunofluorescence results reveal that there were significantly more fast muscle fibers and less slow muscle fibers in the study group than the control group. m

  14. Evaluation of the apnea-hypopnea index determined by the S8 auto-CPAP, a continuous positive airway pressure device, in patients with obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Ueno, Kanako; Kasai, Takatoshi; Brewer, Gregory; Takaya, Hisashi; Maeno, Ken-ichi; Kasagi, Satoshi; Kawana, Fusae; Ishiwata, Sugao; Narui, Koji

    2010-04-15

    Continuous positive airway pressure (CPAP) has been established as an effective treatment for obstructive sleep apnea-hypopnea syndrome (OSAHS). Recently, several auto-CPAP devices that can detect upper airway obstructive events and provide information about residual events while patients are on CPAP have come into clinical use. The purpose of this study was to compare the apnea-hypopnea index (AHI) determined by the S8 auto-CPAP device with the AHI derived by polysomnography in patients with OSAHS. Consecutive patients with OSAHS titrated on S8 auto-CPAP were included. The correlation between AHI determined by manual scoring (AHI-PSG) and by S8 (AHIS8) during an overnight in-hospital polysomnogram with the patient on CPAP was assessed. Furthermore, the apnea index (Al) and the hypopnea index (HI) were evaluated separately. Seventy patients with OSAHS (94% men) were enrolled. The mean AHI on the diagnostic study was 51.9 +/- 2.4. During the titration, this device markedly suppressed the respiratory events (AHI-PSG, 4.2 +/- 0.4; AI, 1.9 +/- 0.3; HI, 2.3 +/- 0.3). On the other hand, the AHI-S8 was 9.9 +/- 0.6 (AI-S8, 2.4 +/- 0.3; HI-S8, 7.5 +/- 0.4). There was a strong correlation between the overall AHI-PSG and the AHI-S8 (r = 0.85, p < 0.001), with a stronger correlation in the apnea component AI-PSG and the AI-S8 (r = 0.93, p < 0.001), whereas there was a weaker correlation between the HI-PSG and the HI-S8 (r = 0.67, p <0.001). Using the same airflow signals as those of the CPAP device, a strong correlation between the AHI-PSG and the AHI-S8 was observed. However, the correlation was weakened when the analysis was limited to the HI.

  15. [Efficacies of using modified oral appliance after uvulopalatopharyngoplasty in the treatment of moderate to severe obstructive sleep apnea hypopnea syndrome].

    PubMed

    Xu, Chao; Xie, Yuping; Kang, Hong; Ma, Wei; Hui, Peilin; Wang, Jinfeng; Zhao, Lijun; Qin, Meng; He, Jianmin; Yang, Qian; Zhou, Liya

    2015-03-17

    To evaluate the efficacies of a modified oral appliance (MOA) for residual obstruction after uvulopalatopharyngoplasty (UPPP) in the treatment of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS). The patients with residual airway obstruction on polysomnography (PSG) at four weeks post-UPPP were selected from the Sleep Medicine Center, Gansu Provincial People's Hospital from October 2013 to February 2014. As of week 5 post-UPPP, all subjects wore MOA for 4 weeks. Before and 4 weeks after treatment, questionnaires were distributed to evaluated the improvement of subjective and objective sleep. The average apnea hyponea index (AHI) and sleep patterns were examined by PSG. The sagittal diameter in minimal region of retropalatal and retroglossal patency and the volume of orophary were measured by cone beam computed tomography (CBCT) scans. And the correlation between the outcomes of CBCT and AHI were analyzed. A total of 10 male OSAHS patients were enrolled. The average age was (42.4 ± 9.2) (31-55) years, body mass index (BMI) (25.0 ± 4.8) (22.8-29.4) kg/m² and AHI was (26.0 ± 7.5) (15.8-35.9)/h. After wearing MOA for 4 weeks, the symptoms of snoring, daytime somnolence and suffocated waking during sleep improved as compared with that pre-treatment. All adapted to sleep with MOA. Average AHI decreased from (26.0 ± 7.5)/h to (6.0 ± 0.7)/h (P < 0.001). And the lowest average oxygen saturation value (SaO₂) increased from (79.6 ± 3.9)% to (87.6 ± 1.6)% (P < 0.001). PSG indicated that the percentage of awakening time and sleep time in nonrapid eye movement (NREM) stage 1 decreased from (11.0 ± 2.3)% and (26.1 ± 4.3)% to (6.8 ± 1.6)% and (11.1 ± 1.5)% respectively in total sleep time (TST). The percentage of NREM stage3 sleep time and rapid eye movement (REM) sleep time in TST increased on average from (10.2 ± 2.2)% and (11.6 ± 1.4)% to (17.7 ± 3.1)% and (21.3 ± 3.1)% respectively (all P < 0.001). CBCT measurements showed that the

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

    PubMed

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

    2016-01-01

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

  17. Spectral Heart Rate Variability analysis using the heart timing signal for the screening of the Sleep Apnea-Hypopnea Syndrome.

    PubMed

    Alvarez-Estevez, Diego; Moret-Bonillo, Vicente

    2016-04-01

    Some approaches have been published in the past using Heart Rate Variability (HRV) spectral features for the screening of Sleep Apnea-Hypopnea Syndrome (SAHS) patients. However there is a big variability among these methods regarding the selection of the source signal and the specific spectral components relevant to the analysis. In this study we investigate the use of the Heart Timing (HT) as the source signal in comparison to the classical approaches of Heart Rate (HR) and Heart Period (HP). This signal has the theoretical advantage of being optimal under the Integral Pulse Frequency Modulation (IPFM) model assumption. Only spectral bands defined as standard for the study of HRV are considered, and for each method the so-called LF/HF and VLFn features are derived. A comparative statistical analysis between the different resulting methods is performed, and subject classification is investigated by means of ROC analysis and a Naïve-Bayes classifier. The standard Apnea-ECG database is used for validation purposes. Our results show statistical differences between SAHS patients and controls for all the derived features. In the subject classification task the best performance in the testing set was obtained using the LF/HF ratio derived from the HR signal (Area under ROC curve=0.88). Only slight differences are obtained due to the effect of changing the source signal. The impact of using the HT signal in this domain is therefore limited, and has not shown relevant differences with respect to the use of the classical approaches of HR or HP.

  18. The New AASM Criteria for Scoring Hypopneas: Impact on the Apnea Hypopnea Index

    PubMed Central

    Ruehland, Warren R.; Rochford, Peter D.; O'Donoghue, Fergal J.; Pierce, Robert J.; Singh, Parmjit; Thornton, Andrew T.

    2009-01-01

    Study Objectives: To compare apnea-hypopnea indices (AHIs) derived using 3 standard hypopnea definitions published by the American Academy of Sleep Medicine (AASM); and to examine the impact of hypopnea definition differences on the measured prevalence of obstructive sleep apnea (OSA). Design: Retrospective review of previously scored in-laboratory polysomnography (PSG). Setting: Two tertiary-hospital clinical sleep laboratories. Patients or Participants: 328 consecutive patients investigated for OSA during a 3-month period. Interventions: N/A Measurements and Results: AHIs were originally calculated using previous AASM hypopnea scoring criteria (AHIChicago), requiring either > 50% airflow reduction or a lesser airflow reduction with associated > 3% oxygen desaturation or arousal. AHIs using the “recommended” (AHIRec) and the “alternative” (AHIAlt) hypopnea definitions of the AASM Manual for Scoring of Sleep and Associated Events were then derived in separate passes of the previously scored data. In this process, hypopneas that did not satisfy the stricter hypopnea definition criteria were removed. For AHIRec, hypopneas were required to have ≥ 30% airflow reduction and ≥ 4% desaturation; and for AHIAlt, hypopneas were required to have ≥ 50% airflow reduction and ≥ 3% desaturation or arousal. The median AHIRec was approximately 30% of the median AHIChicago, whereas the median AHIAlt was approximately 60% of the AHIChicago, with large, AHI-dependent, patient-specific differences observed. Equivalent cut-points for AHIRec and AHIAlt compared to AHIChicago cut-points of 5, 15, and 30/h were established with receiver operator curves (ROC). These cut-points were also approximately 30% of AHIChicago using AHIRec and 60% of AHIChicago using AHIAlt. Failure to adjust cut-points for the new criteria would result in approximately 40% of patients previously classified as positive for OSA using AHIChicago being negative using AHIRec and 25% being negative using

  19. Calibration Model for Apnea-Hypopnea Indices: Impact of Alternative Criteria for Hypopneas

    PubMed Central

    Ho, Vu; Crainiceanu, Ciprian M.; Punjabi, Naresh M.; Redline, Susan; Gottlieb, Daniel J.

    2015-01-01

    Study Objective: To characterize the association among apnea-hypopnea indices (AHIs) determined using three common metrics for defining hypopnea, and to develop a model to calibrate between these AHIs. Design: Cross-sectional analysis of Sleep Heart Health Study Data. Setting: Community-based. Participants: There were 6,441 men and women age 40 y or older. Measurement and Results: Three separate AHIs have been calculated, using all apneas (defined as a decrease in airflow greater than 90% from baseline for ≥ 10 sec) plus hypopneas (defined as a decrease in airflow or chest wall or abdominal excursion greater than 30% from baseline, but not meeting apnea definitions) associated with either: (1) a 4% or greater fall in oxyhemoglobin saturation—AHI4; (2) a 3% or greater fall in oxyhemoglobin saturation—AHI3; or (3) a 3% or greater fall in oxyhemoglobin saturation or an event-related arousal—AHI3a. Median values were 5.4, 9.7, and 13.4 for AHI4, AHI3, and AHI3a, respectively (P < 0.0001). Penalized spline regression models were used to compare AHI values across the three metrics and to calculate prediction intervals. Comparison of regression models demonstrates divergence in AHI scores among the three methods at low AHI values and gradual convergence at higher levels of AHI. Conclusions: The three methods of scoring hypopneas yielded significantly different estimates of the apnea-hypopnea index (AHI), although the relative difference is reduced in severe disease. The regression models presented will enable clinicians and researchers to more appropriately compare AHI values obtained using differing metrics for hypopnea. Citation: Ho V, Crainiceanu CM, Punjabi NM, Redline S, Gottlieb DJ. Calibration model for apnea-hypopnea indices: impact of alternative criteria for hypopneas. SLEEP 2015;38(12):1887–1892. PMID:26564122

  20. Sleep Apnea (For Parents)

    MedlinePlus

    ... for TV, Video Games, and the Internet Obstructive Sleep Apnea KidsHealth > For Parents > Obstructive Sleep Apnea Print ... kids and teens can develop it, too. About Sleep Apnea Sleep apnea happens when a person stops ...

  1. [Association of obstructive sleep apnea hypopnea syndrome with carotid atherosclerosis and the efficacy of continuous positive airway pressure treatment].

    PubMed

    Chen, Bi; Zhang, Wenhui; Chen, Yuling; Hu, Chen; Bian, Hong; He, Jun; Ji, Lei; Zhu, Shuyang

    2015-09-08

    To evaluate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) with carotid atherosclerosis and the efficacy of continuous positive airway pressure (CPAP) treatment. A total of 93 OSAHS patients diagnosed by polysomnography (PSG) were selected from Sleep Disorders Center at Affiliated Hospital of Xuzhou Medical College between March 2013 and December 2014. Based on the results of apnea-hypopnea index (AHI), they were divided into mild (n=22), moderate (n=37), and severe OSAHS group (n=34). Meanwhile, 28 healthy adult individuals matched for age and body mass index (BMI) were enrolled as the control group. The carotid intima-mesa thickness (IMT) was measured by color Doppler uhrasonography, and plasma levels of tumor necrosis factor-α (TNF-α), endothelin-1 (ET-1) and nitric oxide (NO) were determined by Enzyme-Linked Immunosorbent Assay (ELISA). The correlations between carotid IMT and plasma levels of TNF-α, ET-1 and NO were analyzed. A total of 24 patients with moderate to severe OSAHS underwent CPAP treatment and the carotid IMT, plasma levels of TNF-α, ET-1 and NO were compared before and after CPAP treatment. OSAHS patients had significant increase of carotid IMT with the increasing disease severity, and the carotid IMT in mild, moderate and severe OSAHS groups were all significantly higher than that in the control group ((0.73 ± 0.31), (0.86 ± 0.07), (1.07 ± 0.14) vs (0.65 ± 0.10) mm, all P<0.05). The plasma levels of TNF-α and ET-1 in mild to severe OSAHS group were significantly higher than those in controls ((17.45 ± 3.02), (23.81 ± 2.91), (35.16 ± 3.43) vs (12.53 ± 3.48) ng/L and (0.81 ± 0.13), (1.06 ± 0.21), (1.66 ± 0.30) vs (0.64 ± 0.12) ng/L, all P<0.05 ), whereas plasma levels of NO in the three OSAHS groups were significantly decreased compared with the control group ((35.46 ± 10.12), (29.32 ± 9.47), (20.16 ± 7.41) vs (45.43 ± 7.92) µmol/L, all P<0.05). Furthermore, there were significant differences in plasma

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

    PubMed Central

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

    2010-01-01

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

  3. Clinical application of the forced oscillation technique for CPAP titration in the sleep apnea/hypopnea syndrome.

    PubMed

    Badia, J R; Farré, R O; John Kimoff, R; Ballester, E; Hernández, L; Rotger, M; Navajas, D; Montserrat, J M

    1999-11-01

    We have previously demonstrated that upper airway obstruction in sleep apnea/hypopnea syndrome (SAHS) can be accurately assessed in real-time by measuring respiratory impedance (|Z|) with the forced oscillation technique (FOT). The aims of the present study were: (1) to determine the feasibility of identifying the optimal continuous positive airway pressure (CPAP) for patients with SAHS based on analysis of the |Z| signal during conventional polysomnographic CPAP titration studies; and (2) to evaluate practical issues involved in the application of FOT during CPAP titration. We performed CPAP titration in 28 patients with SAHS during polysomnography (PSG) (14 nap and 14 full overnight studies) using a FOT system applied continuously to obtain an on-line measurement of |Z|. FOT was easily implemented and was well-tolerated by the patients. Optimal CPAP levels were determined both in the conventional manner from the standard PSG titration record and during a separate blinded analysis using the FOT signal alone. The mean conventional versus FOT-based optimal CPAP values were similar for both nap studies (10.6 +/- 0.6 [mean +/- SEM] versus 11.1 +/- 0.6 cm H(2)O, respectively, p = 0. 054) and overnight studies (9.9 +/- 0.7 versus 9.9 +/- 0.6 cm H(2)O, respectively, p = 1.00). Subsequent analysis of the PSG record with the FOT signal incorporated demonstrated that artefacts in the |Z| tracing occurred during mask leak, mouth breathing, and movement during arousal. Such abnormalities were readily identified from the flow tracing. These results indicate that, for adequate interpretation, the tracing and values of respiratory impedance obtained by FOT should be evaluated in conjunction with the flow signal. Continuous FOT-guided CPAP titration is feasible and may be a useful adjunct during manual titration. FOT could also potentially serve as the basis for automated CPAP in SAHS.

  4. Severe sleep apnea-hypopnea syndrome is related to left ventricle dysfunction and hypertrophy in acromegalic patients.

    PubMed

    Sanchez-Ortiga, Ruth; Climent, Vicente; Sanchez-Tejada, Laura; Candela, Alfredo; Pico, Antonio

    2015-10-01

    To assess whether sleep apnea-hypopnea syndrome (SAHS) is a risk factor for development of acromegalic cardiomyopathy. A descriptive, cross-sectional study of 32 patients with acromegaly (15 categorized as non-controlled-NCA and 17 as controlled-CA) compared to 20 matched controls (by sex, age, and BMI) referred to the pulmonology department for suspected SAHS. Polysomnography, echocardiography (M-mode, 2-dimensional, and Doppler), and 12-lead electrocardiography were performed in all participants. Development of cardiac morbidity (ischemia heart disease or heart failure) was evaluated after 7 years. SAHS was diagnosed in 81.3% of patients with acromegaly and 85% of controls. Mild SAHS was more common in CA than in NCA patients (31.3% vs. 0%, p=0.048). There was a trend to greater prevalence of left ventricular diastolic dysfunction (LVDD) in acromegalic patients as compared to controls (58.1% vs. 30%, p=0.05). Presence of severe SAHS in patients with acromegaly was related to greater risk of LVDD (90.9% vs. 40%, p=0.008; OR 2.3 [1.3-4.0]), LV hypertrophy (55.6% vs. 10.5%, p=0.02; OR 5.3 [1.3-22.2]), and cardiac events (87.5% vs. 35.6%; p=0.01; OR 7.53 [1.07-53.24]). SAHS is highly prevalent in patients with acromegaly. Only in these patients was severe SAHS associated to hypertrophy, LV diastolic dysfunction, and cardiac events. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  5. Estrogen-mimicking isoflavone genistein prevents bone loss in a rat model of obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Song, Lige; Liang, Xiao; Zhou, Yun

    2014-01-01

    Intermittent hypoxia was introduced to mimic obstructive sleep apnea-hypopnea syndrome (OSAHS) in rats. Then, bone mass, bone strength and bone turnover were evaluated, and the influence of genistein on bone mass reduction was investigated in these rats. OSAHS animal model was established via chronic intermittent hypoxia, and genistein (2.5 mg/kg/day) was used to treat OSAHS rats. The bone mineral density (BMD), bone Histomorphometric indicators, bone biomechanics and expressions of genes related to bone formation and resorption (Runx2, Col I, ALP, Osteocalcin, OPG, RANKL and TRAP-5b) were measured after treatment. The BMD in OSAHS+OVX group was significantly lower than that in OVX group (P<0.05). The BMD in OSAHS+OVX+Genistein group was markedly increased when compared with OSAHS+OVX group (P<0.05), accompanied by partial improvement of the OSAHS induced damage to the lumbar biomechanics. In OSAHS+OVX group, the expressions of Runx2, Col I, ALP and Osteocalcin were significantly reduced when compared with OVX group, and rats in OSAHS+OVX+Genistein group had significantly higher expressions of Runx2, Col I, ALP and Osteocalcin and reduced TRAP-5b expression as compared to OSAHS+OVX group (P<0.05). Genistein can improve the reduction in bone mass and bone strength due to OSAHS in OVX rats, which may be attributed to the increase in bone formation and inhibition of bone resorption. Our findings suggest that genistein may be used to treat and prevent osteoporosis in postmenopausal women with OSAHS.

  6. Incidence of Obstructive Sleep Apnea in Elderly Edentulous Patients and the Possible Correlation of Serum Serotonin and Apnea-Hypopnea Index.

    PubMed

    Tripathi, Arvind; Bagchi, Soumyojeet; Singh, Juhi; Tripathi, Suryakant; Gupta, Narendra Kumar; Arora, Varun

    2017-08-21

    To estimate the incidence of obstructive sleep apnea (OSA) in elderly edentulous patients (aged 60-65 years) and investigate a correlation of serum serotonin levels with the apnea-hypopnea index (AHI), respiratory effort-related arousal (RERA), and respiratory disturbance index (RDI). 381 elderly completely edentulous patients (307 male, 74 female) aged 60 to 65 years with a history of edentulism of 12 to 15 months, seeking oral rehabilitation at the prosthodontic clinic at Saraswati Dental College & Hospital, Lucknow, India, between January 2014 and January 2016 were enrolled for the present study. After application of the inclusion and exclusion criteria of this study, 183 patients (162 male, 21 female) who were found susceptible, were subjected to the BERLIN questionnaire and Epworth Sleepiness Scale (ESS) to assess sleep disordered breathing (SDB) and then put through all-night polysomnography (PSG). On the basis of AHI, RERA, and RDI scores, 156 patients (143 male, 13 female) who tested positive for OSA were classified according to its intensity. All 156 patients underwent body-mass index (BMI) estimation, cephalometry, and intraoral examination for skeletal and soft tissue profile record. Serum serotonin was estimated from whole blood samples for the 156 OSA and the 27 normal patients. The 156 (147 nonobese, 9 obese) OSA-positive patients were provided with complete dentures and were trained to use the same as a modified mandibular advancement device (MAD) during sleep at night. These patients were kept on a quarterly follow-up for 9 months. Data collected was subjected to statistical analysis, and inferences drawn. The incidence of OSA in elderly edentulous subjects was found to be 32.03% in males and 8.91% in females. A mere 9 out of 156 (5.76%) elderly edentulous OSA patients were found to be obese (Class I) on the basis of BMI estimation. Cephalometry of the patients showed that they had a skeletal class I maxillomandibular relationship. AHI scores of

  7. [Effect of the obstructive sleep apnea hypopnea syndrome treatment on blood pressure in patients with resistant hypertension].

    PubMed

    Wang, H W; Liu, H M; Zheng, Z Y; Jia, Y Z; Li, H R

    2017-01-07

    Objective: To investigate the effect of the treatments for obstructive sleep apnea hypopnea syndrome (OSAHS) on the resistant hypertension (RH) of patients. Methods: Eighty patients with OSAHS and RH (blood pressure could not be controlled under 140/90 mmHg (1 mmHg=0.133 kPa) even with more than three kinds of antihypertensive drugs including diuretics) received surgery or continuous positive airway pressure (CPAP) treatment. The results of polysomnography monitoring, ambulatory blood pressure monitoring, and the dosage of antihypertensive medication were recorded before and six months after the treatment. Results: Apnea hypopnea index (AHI) decreased from (32.9±10.8) before treatment to (9.4±6.5) after treatment, while the lowest oxygen saturation (SaO(2)) increased from (0.682±0.062) to (0.884±0.056), with significant differences (t value was 18.863 and 26.614, respectively; both P<0.001). Twenty-four hours systolic blood pressure (SBP)/diastolic blood pressure (DBP) decreased respectively from ((150.5±9.8)/(97.8±7.3)) mmHg to ((140.7±6.8)/(88.6±6.3)) mmHg, daytime SBP/DBP decreased from ((154.3±8.9)/(100.6±7.4)) mmHg to ((144.8±5.8)/(91.3±5.5)) mmHg, and nighttime SBP/DBP decreased from ((145.5±8.8)/(93.8±6.4)) mmHg to ((135.8±5.7)/(84.6±5.9)) mmHg, with significant differences (t value was 7.832, 6.903, 7.005, 6.848, 8.025, 7.554, respectively; all P<0.001). The reduction of nighttime SBP /DBP was ((11.5±2.2)/(10.2±3.1)) mmHg, and the reduction of daytime SBP/DBP was ((9.0±2.8)/(7.9±3.5)) mmHg. The reduction of nighttime SBP/DBP was more obvious than daytime SBP/DBP, with significant differences (t value was 9.732 and 6.936, respectively; both P<0.001). Before treatment, nighttime blood pressure decrease rate below 10% was showed in 75 percent of patients, and after treatment, this rate only in 37.5 percent of patients (χ(2)=22.857, P<0.01). The numbers of required antihypertensive drugs decreased in 45 (56.3%) cases, the average numbers of

  8. [Obstructive sleep apnea syndrome].

    PubMed

    Alvarez-Sala Walther, José Luis

    2002-01-01

    The obstructive sleep apnea syndrome (OSAS) is caused by an intermittent and repetitive obstruction of the upper respiratory tract during sleep, which leads to a complete (apnea) or partial (hypopnea) block of air flow. It is quite prevalent, being seen in 4-6% of males and 2% of females. Structural abnormalities present in the upper respiratory tract and obesity are the fundamental etiological factors. Clinical manifestations are due to sleep fragmentation and oxygen desaturation which cause the apnea. Day hypersomnia, snoring and episodes of apnea described by the spouse are the three basic symptoms. The diagnosis is based on polysomnography, which can be substituted for a night cardiorespiratory polygraphy. It has an important morbimortality rate, mainly due to traffic and labor accidents, ischemic heart disease and chronic respiratory failure. The treatment is multifactorial. First, eliminating alcohol and hypnotic drugs. Obesity, which is almost always present, must also be corrected. Structural abnormalities of the upper respiratory tract may require a surgical solution. The treatment preferred nowadays is the application of a nasal continuous positive airway pressure (CPAP) while the patient is asleep. It should be considered for those symptomatic patients with an apnea-hypopnea index over 30, or if the index is below 30, than when a respiratory insufficiency or cardiovascular risk factors are present. In some cases surgical procedures may be considered, such as uvulopalatopharyngoplasty.

  9. Follow-up study of dental and skeletal changes in patients with obstructive sleep apnea and hypopnea syndrome with long-term treatment with the Silensor appliance.

    PubMed

    Wang, Xiaoyu; Gong, Xu; Yu, Zhe; Gao, Xuemei; Zhao, Ying

    2015-05-01

    In this study, we aimed to investigate the dental and skeletal changes associated with long-term use of the Silensor appliance (Erkodent, Cologne, Germany) in patients with obstructive sleep apnea and hypopnea syndrome. The sample included 42 patients with mild-to-severe obstructive sleep apnea and hypopnea syndrome (mean apnea-hypopnea index, 27; range, 5-74) who had been treated with the Silensor appliance for an average of 4 years (range, 1-11 years). A questionnaire was used to assess of the side effects subjectively; the cephalometric analysis was conducted to identify the dental and skeletal changes of different treatment times objectively. The Silensor appliance was associated with few subjective side effects. Most subjective side effects decreased after long-term use of the Silensor appliance. Significant changes after long-term use of the Silensor appliance were observed in incisor angulation, overbite, overjet, mandibular plane angle, anterior lower facial height, and anterior facial height. Overbite and skeletal changes at treatment times between 1 year and 3 years were a decrease in overbite and increases in the mandibular plane angle, anterior lower facial height, and anterior facial height. Overjet and other dental changes at treatment times longer than 3 years were a decrease in overjet, retroclination of the maxillary incisors, and proclination of the mandibular incisors. The Silensor appliance was well tolerated and preferred by most subjects. Common but mild dental and skeletal changes resulted from using the appliance over a long period of time. The changes after 1 to 3 years of use were skeletal changes predominantly. Both dental and skeletal changes were observed simultaneously at treatment times longer than 3 years. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  10. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index.

    PubMed

    Ruehland, Warren R; Rochford, Peter D; O'Donoghue, Fergal J; Pierce, Robert J; Singh, Parmjit; Thornton, Andrew T

    2009-02-01

    To compare apnea-hypopnea indices (AHIs) derived using 3 standard hypopnea definitions published by the American Academy of Sleep Medicine (AASM); and to examine the impact of hypopnea definition differences on the measured prevalence of obstructive sleep apnea (OSA). Retrospective review of previously scored in-laboratory polysomnography (PSG). Two tertiary-hospital clinical sleep laboratories. 328 consecutive patients investigated for OSA during a 3-month period. N/A. AHIs were originally calculated using previous AASM hypopnea scoring criteria (AHI(Chicago)), requiring either >50% airflow reduction or a lesser airflow reduction with associated >3% oxygen desaturation or arousal. AHIs using the "recommended" (AHI(Rec)) and the "alternative" (AHI(Alt)) hypopnea definitions of the AASM Manual for Scoring of Sleep and Associated Events were then derived in separate passes of the previously scored data. In this process, hypopneas that did not satisfy the stricter hypopnea definition criteria were removed. For AHI(Rec), hypopneas were required to have > or =30% airflow reduction and > or =4% desaturation; and for AHI(Alt), hypopneas were required to have > or =50% airflow reduction and > or =3% desaturation or arousal. The median AHI(Rec) was approximately 30% of the median AHI(Chicago), whereas the median AHI(Alt), was approximately 60% of the AHI(Chicago), with large, AHI-dependent, patient-specific differences observed. Equivalent cut-points for AHI(Rec) and AHI(Alt), compared to AHI(Chicago) cut-points of 5, 15, and 30/h were established with receiver operator curves (ROC). These cut-points were also approximately 30% of AHI(Chicago) using AHI(Rec) and 60% of AHI(Chicago) using AHI(Alt). Failure to adjust cut-points for the new criteria would result in approximately 40% of patients previously classifled as positive for OSA using AHI(Chicago) being negative using AHI(Rec) and 25% being negative using AHI(Alt). This study demonstrates that using different published

  11. Calibration Model for Apnea-Hypopnea Indices: Impact of Alternative Criteria for Hypopneas.

    PubMed

    Ho, Vu; Crainiceanu, Ciprian M; Punjabi, Naresh M; Redline, Susan; Gottlieb, Daniel J

    2015-12-01

    To characterize the association among apnea-hypopnea indices (AHIs) determined using three common metrics for defining hypopnea, and to develop a model to calibrate between these AHIs. Cross-sectional analysis of Sleep Heart Health Study Data. Community-based. There were 6,441 men and women age 40 y or older. Three separate AHIs have been calculated, using all apneas (defined as a decrease in airflow greater than 90% from baseline for ≥ 10 sec) plus hypopneas (defined as a decrease in airflow or chest wall or abdominal excursion greater than 30% from baseline, but not meeting apnea definitions) associated with either: (1) a 4% or greater fall in oxyhemoglobin saturation-AHI4; (2) a 3% or greater fall in oxyhemoglobin saturation-AHI3; or (3) a 3% or greater fall in oxyhemoglobin saturation or an event-related arousal-AHI3a. Median values were 5.4, 9.7, and 13.4 for AHI4, AHI3, and AHI3a, respectively (P < 0.0001). Penalized spline regression models were used to compare AHI values across the three metrics and to calculate prediction intervals. Comparison of regression models demonstrates divergence in AHI scores among the three methods at low AHI values and gradual convergence at higher levels of AHI. The three methods of scoring hypopneas yielded significantly different estimates of the apnea-hypopnea index (AHI), although the relative difference is reduced in severe disease. The regression models presented will enable clinicians and researchers to more appropriately compare AHI values obtained using differing metrics for hypopnea. © 2015 Associated Professional Sleep Societies, LLC.

  12. Post-operative complications following adenotonsillectomy in children with severe sleep apnea-hypopnea syndrome. Do they need to be admitted to an intensive care unit?

    PubMed

    del-Río Camacho, G; Martínez González, M; Sanabria Brossart, J; Gutiérrez Moreno, E; Gómez García, T; Troncoso Acevedo, F

    2014-01-01

    In recent years, with the rise of sleep-disordered breathing, we have been seeing more articles related to post-operative complications after adenotonsillectomy in children with sleep apnea-hypopnea syndrome (OSAS), especially in those with severe sleep apnea. The objective of this study was to evaluate post-operative complications in children with severe OSAS compared to children who had adenotonsillectomy for a different reason, and establish whether they needed admission to an intensive care unit or not. All children undergoing adenotonsillectomy in our hospital in the last 5 years were initially included in this study. Complications were analysed with a retrospective review. Two hundred and twenty nine children admitted for adenotonsillectomy were finally included. In the whole group, complications occurred in 3.5% of children, 2.2% corresponding to respiratory complications. Children with sleep apnea (3.23% vs 1.47%, P=.39) or severe sleep apnea (3.77% vs 1.70%, P=.32) presented a higher incidence of respiratory complications, which was not statistically significant and was far below those published by other authors. All respiratory complications took place in the immediate post-operative period (operating theatre or anaesthesia recovery), with none in the paediatric ward. In our population, children who undergo adenotonsillectomy, without any other comorbidities, malformation syndrome or neuromuscular disease, are more than 2 years old and have an immediate postoperative period without incidence, do not need to be systematically admitted to an intensive care unit, even if they present with severe OSAS. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  13. [Primary evaluation of the simplified Chinese version of STOP-Bang scoring model in predicting obstructive sleep apnea hypopnea syndrome].

    PubMed

    Yu, Yang; Mei, Wei; Cui, Yonghua

    2012-03-01

    To evaluate the predictive significance of the simplified Chinese STOP-Bang (S-B) scoring model in predicting obstructive sleep apnea hypopnea syndrome(OSAHS). A total of 114 cases with suspected OSAHS were included in this study. S-B questionnaire was filled before polysomnography (PSG) monitoring. According to the PSG monitoring results the patients were divided into simple snoring, mild, moderate and severe OSAHS groups. The average S-B scores and the ratio of patients with S-B score > or = 3 were compared among the four groups respectively. The accuracy of S-B scoring model was analyzed and predictive significance was evaluated. Eighty nine of 114 (78.1%) patients were classified as being at high risk of OSAHS by S-B scoring. The S-B scores showed an accrescent tendency as the severity of OSAHS increased. The scores in the four groups were 2.74 +/- 1.39, 3.25 +/- 1.16, 4.30 +/- 1.20, 4.79 +/- 1.41 respectively. Significant difference in S-B scores was found between severe OSAHS group and the other three groups respectively (P < 0.01), and also between moderate OSAHS group and mild OSAHS/simple snoring group (P < 0 01). The ratio of patients with high risk of OSAHS predicted by S-B scoring in OSAHS group (85.7%) was significantly higher than that in simple snoring group (47.8%) (P < 0.01). The sensitivities of S-B scoring model for AHI > or = 5 > or = > 15 and > or = 30 were 85.7%, 92 5% and 100%, respectively; the negative predictive values were 48.0% ,80.0% and 100%. The coincidence rate of S-B scoring model with golden standard to diagnose OSAHS was 78 9 . The area under the ROC curve at AHI cutoff of greater than or equal to 5 was 0 774. S-B scoring model can be used to evaluate patients with high risk of OSAHS. It is a concise and easy-to-use tool to screen and predict moderate and severe OSAHS with relative high sensitivity and negative predictive value.

  14. [The effects of pressure level in veil on upper airway in patients with obstructive sleep apnea hypopnea syndrome].

    PubMed

    Li, Shuhua; Gao, Li; Zou, Mingyu; Qu, Sheng; Shi, Hongjin; Dong, Weidong; Zou, Liangui

    2008-08-01

    To observe the effects of pressure level in veil on upper airway in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and normal adults. We scanned the upper airway from roof of nasopharynx to glottis with SIMENS 16 layer spiral CT scanner. The area and the dimensions of palate, uvula, and the region after lingua and epiglottis were measured by application of image work station. Forty-six patients with OSAHS and 35 normal adults were scanned by CT at 0 kPa water column and 0.784 kPa water column pressures in face mask, respectively. The area and inner diameter of OSAHS patients upper airways were less than those of normal adults at the same pressure in face mask. The area and inner diameter of upper airway at the pressure of 0.784 kPa water column were more than those at 0 kPa water column in both OSAHS patients and normal adults, and the increased extent of normal adults were more than those of OSAHS patients. We measured the minimum increased normal Cross sectional area of palate, uvula, and the region after lingua and epiglottis when the pressure in the mask increased from 0 kPa to 0.784 kPa, and we made it as the standard. The 46 OSAHS patients were sorted into 17 cases (group 1) with normal dilation and 29 cases (group 2) with less dilation in such standard. There was not significant difference between the two groups at 0 kPa pressures in area and inner diameter, but the area and inner diameter of group 1 were more than those of group 2 at 0.784 kPa pressure. The increased pressure in face mask would lead to upper airway dilation both in OSAHS patients and normal adults, and the dilated extents of normal adults were significant more than those of OSAHS patients. The less dilation of OSAHS may be duo to anatomic constriction and some pharynx wall pathological changes.

  15. Sleep Apnea Detection

    MedlinePlus

    ... Young Adult Healthy Children > Ages & Stages > Baby > Sleep > Sleep Apnea Detection Ages & Stages Listen Español Text Size Email Print Share Sleep Apnea Detection Page Content Article Body Sleep apnea ...

  16. Obstructive sleep apnea - adults

    MedlinePlus

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

  17. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  18. Emotional content of dreams in obstructive sleep apnea hypopnea syndrome patients and sleepy snorers attending a sleep-disordered breathing clinic.

    PubMed

    Fisher, Samantha; Lewis, Keir E; Bartle, Iona; Ghosal, Robin; Davies, Lois; Blagrove, Mark

    2011-02-15

    To assess prospectively the emotional content of dreams in individuals with the obstructive sleep apnea hypopnea syndrome (OSAHS) and sleepy snorers. Prospective observational study. Forty-seven patients with sleepiness and snoring attending a sleep-disordered breathing clinic, completed a morning diary concerning pleasantness/unpleasantness of their dreams for 10 days, and then had AHI assessed by a limited-channel home sleep study. Participants and groups: Sleepy snorers, AHI < 5: n = 12 (mean age = 51.00 years [SD 7.01], 7 males); AHI 5 -14.9, n = 14 (mean age = 49.71 y [9.73], 12 males); AHI ≥ 15, n = 21 (mean age = 56.33 [11.24], 16 males). All groups reported similar numbers of dreams and nightmares during the diary period. The AHI ≥ 15 group were significantly higher on dream unpleasantness than were the sleepy snorers (p < 0.05); and when only males were analyzed, this difference was also significant (p = 0.01). As AHI increased across the 3 groups, there was a significant decrease in variability of dream emotions (Levene test for homogeneity of variance between the 3 groups, p = 0.018). Mean daytime anxiety and daytime depression were significantly correlated with mean dream unpleasantness and with mean number of nightmares over the diary period. Patients with AHI ≥ 15 had more emotionally negative dreams than patients with AHI < 5. The variation in mean dream emotion decreased with increasing AHI, possibly because sleep fragmentation with increasing AHI results in fewer and shorter dreams, in which emotions are rarer.

  19. Analysis of the dynamic changes in the soft palate and uvula in obstructive sleep apnea-hypopnea using ultrafast magnetic resonance imaging.

    PubMed

    Wang, Y L; Mcdonald, J P; Liu, Y H; Pan, K F; Zhang, X H; Hu, R D

    2014-01-24

    Apnea and the respiratory cycle are dynamic processes in obstructive sleep apnea-hypopnea (OSAH), which occur only during sleep. Our study aimed to observe the dynamic changes in the soft palate and the uvula during wakefulness and sleep using ultrafast magnetic resonance imaging (UMRI) to provide reference data for the pathogenesis and treatment of OSAH. The dynamic changes in the soft palate and uvular tip of 15 male patients (average age: 50.43 ± 9.82 years) with OSAH were evaluated using UMRI of the upper airway while asleep and awake after 1 night of sleep deprivation. A series of midline sagittal images of the upper airway were obtained. The distance from the center of the soft palate to the x-axis (an extended line from the anterior nasal spine to the posterior nasal spine), from the uvular tip to the x-axis, from the center of the soft palate to the y-axis (a perpendicular line from the center of the pituitary to the x-axis), and from the uvular tip to the y-axis (designated as PX, UX, PY, and UY, respectively) were measured during sleep and wakefulness. The minimum PX, PY, UX, and UY were shorter during sleep than during wakefulness, whereas the maxima were longer during sleep (P < 0.01), the differences between the maximum and minimum PX, PY, UX, and UY were larger during sleep (P < 0.01). The upward, downward, forward, and backward ranges of movement of the soft palate and the uvular tip were larger during sleep in OSAH patients. This increased compliance may trigger each airway obstructive event.

  20. Obstructive Sleep Apnea

    MedlinePlus

    ... sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease. The more severe the obstructive sleep apnea, the ...

  1. Dynamic data analysis in obstructive sleep apnea.

    PubMed

    Karunajeewa, Asela S; Abeyratne, Udantha R; Rathnayake, Suren I; Swarnkar, V

    2006-01-01

    Obstructive Sleep Apnea (OSA) is a serious disease caused by the collapse of upper airways during sleep. The present method of measuring the severity of OSA is the Apnea Hypopnea Index (AHI). The AHI is defined as the average number of Obstructive events (Apnea and Hypopnea, OAH-events) during the total sleep period. The number of occurrence of OAH events during each hour of sleep is a random variable with an unknown probability density function. Thus the measure AHI alone is insufficient to describe its true nature. We propose a new measure Dynamic Apnea Hypopnea Index Time Series (DAHI), which captures the temporal density of Apnea event over shorter time intervals, and use its higher moments to obtain a dynamic characterization of OSA.

  2. [Usefulness of the basic exploration of the upper airways and neighbor structures in patients with adult obstructive sleep apnea-hypopnea syndrome].

    PubMed

    Ferré, Alex; Vila, Javier; Arcalís, Núria

    2014-04-07

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent disease in the general population, associated with an increase in the cardiovascular morbimortality. A basic and/or standardized otolaryngologic exploration could help us to detect the structural abnormalities that alter the upper airway collapsibility and offer a high pre-test risk factor, improve the CPAP adherence or even the possibility of offering alternative treatments. This article offers a revision of the exploration in OSAHS patients. We describe a guideline to identify the main structural abnormalities related to OSAHS. We also include a short algorithm for the diagnosis of OSAHS, when is suspected by primary care physicians. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  3. [Comparison of manual versus automatic titration in pressure determination for long-term therapy of continuous positive airway pressure in patients with obstructive sleep apnea hypopnea syndrome].

    PubMed

    Lu, Dong-xiao; Wu, Hai-gui; Luo, Jia-ying; Wu, Ying-xin; Yan, Hui-chan; Hong, Jia-xu; Luo, Yuan-ming

    2013-09-24

    To compare the continuous positive airway pressure (CPAP) of automatic titration with that of manual titration. A total of 58 patients with obstructive sleep apnea and hypopnea syndrome (OSAHS) diagnosed by overnight polysomnography at sleep center of First Affiliated Hospital, Guangzhou Medical University were studied between December 2010 and December 2012. Manual titration was performed under full polysmnography and auto-titration at home for 3-7 nights. There were 52 males and 6 females with an age range of (48 ± 11) years. CPAP pressure titrated by automatic device (10.0 ± 2.2) cm H2O (1 cm H2O = 0.098 kPa) was significantly higher than that titrated manually (7.5 ± 1.5) cm H2O (P = 0.000). Apnea-hyponea index decreased significantly from (54.0 ± 21.0) events/h pre-treatment to (3.8 ± 2.5) events/h post-treatment under manual titration (P < 0.01). CPAP pressure titrated by automatic device is usually higher than that titrated manually. Manual titration should be performed if a patient can not tolerate the CPAP pressure titrated by an automatic device.

  4. American Sleep Apnea Association

    MedlinePlus

    American Sleep Apnea Association Learn About the CPAP Assistance Program About ASAA News about ASAA Who we are Leadership Team Supporting the ASAA Financials Learn Healthy sleep Sleep apnea Other sleep disorders Personal stories Treat Test Yourself ...

  5. Alternative Therapy for Patients With Obstructive Sleep Apnea/Hypopnea Syndrome: A 1-year, Single-blind, Randomized Trial of Tui Na.

    PubMed

    Lu, Cheng-Nan; Friedman, Michael; Lin, Hsin-Ching; Bi, Kuo-Wei; Hsueh, Tun-Pin; Chang, Hsueh-Wen; Su, Mao-Chang; Lin, Meng-Chih

    2017-07-01

    Context • Obstructive sleep apnea/hypopnea syndrome (OSAHS) is among the most prevalent of sleep-related breathing disorders. No long-term follow-up studies have documented the continued success of lifestyle changes in treatment; oral appliances have an approximate 50% success rate; compliance with continuous positive airway pressure is poor, ranging from 50% to 89%; and the success rate of upper-airway surgery is only 66.4%. Therefore, some OSAHS patients seek alternative treatments. Objectives • The study intended to examine the efficacy of traditional Chinese therapeutic massage (tui na) for patients with OSAHS. Design • The research team designed a prospective study. Setting • The study took place at the outpatient clinic of the sleep center at the Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan), an academic tertiary medical center. Participants • Participants were 31 patients with moderate to severe OSAHS. Intervention • Each participant received a tui na treatment at multiple acupoints 2 ×/wk for 10 wk for approximately 15 min/session. Outcome Measures • At baseline and 3 mo after treatment, participants completed subjective measures, including (1) quality of life using a 36-item, short-form health survey (SF-36); (2) subjective snoring intensity indicated by bed-partners using a 0-10 visual analog scale (VAS); and (3) excessive daytime sleepiness (EDS) status, using a Chinese version of the Epworth Sleepiness Scale (CESS). The research team completed objective measures, including (1) polysomnography, (2) body mass index, and (3) neck circumference. Results • Twenty patients completed the full course of treatment. The apnea/hypopnea index per hour decreased from 43.8 ± 26.9 to 37.8 ± 31.7 after the treatments, with P = .049 (paired t test). The arousal index and rapid eye movement stage of sleep improved significantly. Statistically significant improvements were observed for the SF-36 on the score for the physical component

  6. Treatment and prevention of inflammatory responses and oxidative stress in patients with obstructive sleep apnea hypopnea syndrome using Chinese herbal medicines

    PubMed Central

    Chen, Qin; Lin, Rong Jing; Hong, Xuchu; Ye, Lin; Lin, Qichang

    2016-01-01

    The present study aimed to investigate the therapeutic effects of Chinese herbal medicines for the treatment and prevention of inflammatory responses and oxidative stress in obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 60 patients with OSAHS were randomly divided into two groups (n=30/group): The experimental group, who received the conventional treatment + oral administration of the traditional Chinese herbal formula, Jiawei Di Tan Tang; and the control group, who received the conventional treatment only. OSAHS patients were included in the current study if they presented with snoring and had an apnea-hypopnea index (AHI) of >30 in a polysomnography study, without comorbidities. The therapeutic course lasted 12 weeks in both groups. Alterations to the mean clinical symptom score, Epworth sleepiness scale (ESS) and AHI scores, lowest nocturnal blood oxygen saturation (SaO2) and the serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin (IL)-6, tumor necrosis factor (TNF)-α and C-reactive protein (CRP) prior to and following treatment were observed. The mean clinical symptom score was significantly decreased in the experimental group post-treatment compared with the control group (P<0.05). In addition, the clinical symptoms in the experimental group were significantly improved following treatment compared with pre-treatment symptoms (P<0.05). Furthermore, the ESS and AHI scores, lowest nocturnal SaO2 and serum levels of SOD, MDA, IL-6, TNF-α and CRP were significantly improved in the experimental group post-treatment compared with the control group (P<0.05). These parameters in the experimental group were also significantly improved post-treatment compared with those pre-treatment (P<0.05). The results of the present study suggested that oral administration of the traditional Chinese herbal formula Jiawei Di Tan Tang was able to attenuate oxidative stress and inflammatory responses in patients with OSAHS, and thus may

  7. Impact of different criteria for defining hypopneas in the apnea-hypopnea index.

    PubMed

    Manser, R L; Rochford, P; Pierce, R J; Byrnes, G B; Campbell, D A

    2001-09-01

    To explore the effect of using different scoring criteria for hypopneas in the scoring of polysomnographic studies: (1) by estimating the level of agreement between apnea-hypopnea index (AHI) scores derived from different scoring methods, and (2) by examining the effect on the point prevalence of disease using different threshold values of the AHI. Retrospective analysis of 48 diagnostic polysomnographic records. Tertiary-hospital sleep-disorders clinic. AHIs were derived from three different methods for scoring hypopneas. The hypopnea definitions used incorporated different combinations and threshold values of respiratory signal changes in addition to differences in the requirement for associated oxygen desaturation or arousal. The level of agreement between different scoring methods was assessed by constructing Bland-Altman plots and calculating intraclass correlation coefficients (ICCs). kappa statistics were used to assess agreement between the different methods using varying thresholds of AHI to categorize sleep apnea (AHI > 5, AHI > 15, and AHI > 20). The random-effects ICC for the three methods was 0.89, suggesting that the different scoring methods tended to rank patients fairly consistently. However, the point prevalence of disease estimated by using different thresholds of AHI was found to vary depending on the method used to score sleep studies (kappa, 0.30 to 0.95). These findings have implications for case finding, population-prevalence estimates, and grading of disease severity for access to government-funded continuous positive airway pressure services. Guidelines for standardizing the measurement and reporting of sleep studies in clinical practice should be implemented.

  8. Effect of adherence on daytime sleepiness, fatigue, depression and sleep quality in the obstructive sleep apnea/hypopnea syndrome patients undertaking nasal continuous positive airway pressure therapy.

    PubMed

    Wang, Yeying; Ai, Li; Luo, Jiahong; Li, Ran; Chai, Yanlin; He, Xiaojie; Cao, Yu; Li, Yongxia

    2017-01-01

    The aims of this study were to describe changes in day- and nighttime symptoms and the adherence to nasal continuous positive airway pressure (nCPAP) during the first 3-month nCPAP therapy among newly diagnosed patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and to identify the effect of adherence on the changes in day- and nighttime symptoms during the first 3 months. Newly diagnosed OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures of the 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 the end of 3rd, 6th, 9th and 12th week of therapy were collected. Twelve weeks' adherence was calculated as the average of each 3-week period. Mixed model was used to explore the effect of adherence to nCPAP therapy on ESS, FSS, SDS and PSQI in each 3-week phase. Seventy-six patients completed the 12-week follow-up. The mixed-effects models showed that under the control of therapy phase adherence in the range of <4 hours per night, using nCPAP could independently improve daytime sleepiness, in terms of ESS (coefficient, [95% confidence interval] unit; -4.49 [-5.62, -3.36]). Adherence at 4-6 hours per night could independently improve all variables of day- and nighttime symptoms included in this study, namely ESS -6.69 (-7.40, -5.99), FSS -6.02 (-7.14, -4.91), SDS -2.40 (-2.95, -1.85) and PSQI -0.20 (-0.52, -0.12). Further improvement in symptoms could be achieved at ≥6 hours per night using nCPAP, which was ESS -8.35 (-9.26, -7.44), FSS -10.30 (-11.78, -8.83), SDS -4.42 (-5.15, -3.68) and PSQI -0.40 (-0.82, -0.02). The interaction between adherence level and therapy phase was not significant in day- and nighttime symptoms. The effect of adherence on the above-mentioned symptoms is stable through the first 3 months. Under the control of therapy phase, the nCPAP therapy effectively

  9. 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.

  10. Automated detection of apnea/hypopnea events in healthy children polysomnograms: preliminary results.

    PubMed

    Held, Claudio M; Causa, Leonardo; Jaillet, Fabrice; Chamorro, Rodrigo; Garrido, Marcelo; Algarin, Cecilia; Peirano, Patricio

    2013-01-01

    A methodology to detect sleep apnea/hypopnea events in the respiratory signals of polysomnographic recordings is presented. It applies empirical mode decomposition (EMD), Hilbert-Huang transform (HHT), fuzzy logic and signal preprocessing techniques for feature extraction, expert criteria and context analysis. EMD, HHT and fuzzy logic are used for artifact detection and preliminary detection of respiration signal zones with significant variations in the amplitude of the signal; feature extraction, expert criteria and context analysis are used to characterize and validate the respiratory events. An annotated database of 30 all-night polysomnographic recordings, acquired from 30 healthy ten-year-old children, was divided in a training set of 15 recordings (485 sleep apnea/hypopnea events), a validation set of five recordings (109 sleep apnea/hypopnea events), and a testing set of ten recordings (281 sleep apnea/hypopnea events). The overall detection performance on the testing data set was 89.7% sensitivity and 16.3% false-positive rate. The next step is to include discrimination among apneas, hypopneas and respiratory pauses.

  11. Effect of continuous positive airway pressure treatment on short-term memory performance over 24 h of sustained wakefulness in patients with obstructive sleep apnea-hypopnea syndrome.

    PubMed

    Grenèche, Jérôme; Krieger, Jean; Bertrand, Frédéric; Erhardt, Christine; Maumy, Myriam; Tassi, Patricia

    2013-10-01

    Few studies have examined the impact of continuous positive airway pressure (CPAP) therapy on short-term memory (STM) over sustained wakefulness in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). We have investigated if impaired STM can be reversed by CPAP treatment in a 24-h sustained wakefulness paradigm. Our follow-up study was conducted with repeated-memory tasks within 12 OSAHS patients and 10 healthy controls who underwent three 32-h sessions, one before CPAP (T0) and the second (T3) and the third (T6), after 3 and 6 months of treatment, respectively, for OSAHS patients. Each session included one night of sleep followed by 24h of sustained wakefulness, during which both groups performed STM tasks including both digit span (DS) and Sternberg tasks. Untreated OSAHS patients had no deficit in the forward DS task measuring immediate memory but were impaired in STM, especially working memory assessed by the complex Sternberg task and the backward DS. However, only performance in the latter was improved after 6 months of CPAP treatment. Because the high level of memory scanning required high speed in information processing, persistent impairment on the complex Sternberg task may be attributable to working memory slowing, possibly enhanced by sustained wakefulness. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

  12. Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

    PubMed Central

    Guo, Li-Xin; Zhao, Xin; Pan, Qi; Sun, Xue; Li, Hui; Wang, Xiao-Xia; Zhang, Li-Na; Wang, Yao

    2015-01-01

    Background: For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM), the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM. Methods: Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data. Results: After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P = 0.03, respectively). The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P = 0.002, respectively) compared to pretreatment levels. During the night, MAGE also significantly decreased (P = 0.049). The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P = 0.024, respectively). The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05, respectively) after the treatment. In addition, HbA1c levels were also lower than those before treatment (P < 0.05), and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P = 0.034). Conclusions: CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management. PMID:26315076

  13. A comparison of apnea-hypopnea indices derived from different definitions of hypopnea.

    PubMed

    Tsai, W H; Flemons, W W; Whitelaw, W A; Remmers, J E

    1999-01-01

    We examined the effects of arousal- and desaturation-based scoring criteria on the apnea-hypopnea index (AHI) and on the measured prevalence of obstructive sleep apnea (OSA). Ninety-four randomly selected patients underwent overnight polysomnography. Studies were scored according to three different criteria for hypopnea, as defined by a >= 10 s discernible reduction in thoracoabdominal movement associated with: (1) >= 4% decrease in oxygen saturation (SaO2) (Type A); (2) either a >= 4% decrease in SaO2 or an arousal (Type B); or (3) electroencephalographically based arousal alone (Type C). Excellent correlation existed between AHI-A, AHI-B, and the oxygen desaturation index (ODI) (r > 0.98). AHI-A and AHI-B differed by only 2.04 +/- 1.72/h (2 SD). AHI-A and AHI-B differed from the ODI by 1.04 +/- 4.07/h and 3.07 +/- 4.30/h, respectively. Despite these small differences, use of the Type B rather than Type A definition resulted in an extra case of OSA being diagnosed for every 14 to 31 patients tested, depending on the definition of OSA (AHI: >= 5, 10, 15, or 20/h). The addition of arousal-based scoring criteria for hypopnea causes only small changes in the AHI, but if OSA is defined solely by an AHI value, the measured prevalence of OSA will increase.

  14. Effect of transoral endoscopic adenoidectomy on peripheral blood T-lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome and its treatment strategy.

    PubMed

    Yang, Na; Ji, Yaofeng; Liu, Yin

    2017-10-01

    The objective of the present study was to investigate the effect of transoral endoscopic adenoidectomy on peripheral blood T lymphocyte subsets in pediatric patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its treatment strategy. Ninety-eight pediatric patients with adenoidal hypertrophy associated with OSAHS admitted to the Department of Otolaryngology, Xuzhou Children's Hospital were selected. After admission, patients received perfected 24 h polysomnogram monitoring, routine blood examination, fasting blood biochemistry examination, T-lymphocyte subset count, 24 h ambulatory blood pressure monitoring, and nasopharyngeal computed tomography. After patients were diagnosed with adenoidal hypertrophy associated with OSAHS, they underwent transoral endoscopic adenoidectomy with a power microdebrider. Patients were evaluated at 3-, 6- and 12-week follow-up visits. The CD3(+), CD4(+), and CD8(+) T-cell counts, CD4(+)/CD8(+) T lymphocyte ratio, and changes of 24 h ambulatory blood pressure before and after surgery were recorded. After the 6-week follow-up visit, the mean CD4(+) T lymphocyte count in patients was increased significantly compared with that before surgery, the CD4(+)/CD8(+) T lymphocyte ratio increased gradually, and the differences were statistically significant (P<0.05). The frequency of nocturnal awakening of patients was decreased significantly after surgery and the duration of nocturnal sleep was extended significantly (P<0.05). Through analysis of the preoperative and postoperative clinical data of pediatric patients, the CD4(+)/CD8(+) T lymphocyte ratio was negatively correlated with mean arterial pressure (MAP) (r=-1.06, P=0.003). In conclusion, adenoidectomy can significantly decrease the MAP in pediatric patients with OSAHS and increase the duration of nocturnal sleep. The peripheral blood CD4(+)/CD8(+) T lymphocyte ratio in pediatric patients was significantly negatively correlated with MAP.

  15. A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome.

    PubMed

    Khanna, Ritu; Kline, Lewis R

    2003-07-01

    To compare efficacy, compliance rates, and side effects of a new strapless oral interface, the Oracle, with available nasal masks over 8 weeks of use for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 38 patients with OSAHS (respiratory disturbance index (RDI) >/=15/h) were enrolled after the diagnostic polysomnogram for subsequent continuous positive airway pressure (CPAP) therapy. After randomization, therapeutic pressures during a titration study were determined for 21 patients in the oral group and 17 patients in the nasal group. Comparisons for nasal and oral interfaces were made for baseline patient characteristics, average hours of CPAP use, side effects from therapy, and among questionnaires evaluating patients' subjective responses to therapy at months 1 and 2. No significant difference was observed in the average hours of CPAP use between the oral (4.5+/-2.1; 5.5+/-2.6) and nasal groups (4.0+/-2.6; 4.8+/-2.5) for either month 1 or 2 (P>0.05). The dropout rates were similar for both groups after 8 weeks of therapy. However, patients in the nasal group had higher occurrences of side effects such as nasal congestion, dryness, and air leaks, whereas patients in the oral group experienced more oral dryness and gum pain. Oral delivery of CPAP with the Oracle is an effective and suitable alternative for patients with OSAHS.

  16. [Analysis and management of postoperative hemorrhage in surgery of obstructive sleep apnea hypopnea syndrome in children using plasma-mediated radio-frequency ablation at low temperature].

    PubMed

    Wang, Jun; Chen, Jie; Yang, Jun

    2013-09-01

    To analyze retrospectively cause, prevention and management of postoperative hemorrhage in surgery of obstructive sleep apnea hypopnea syndrome (OSAHS) in children using plasma-mediated radio-frequency (pmRF) ablation at low temperature. Tonsil and adenoid ablation were carried out in 4028 cases diagnosed with OSAHS, using ENTColator lI plasma system of Arthocare company under general anesthesia. Postoperative hemorrhage occurred in 37 cases of 4028 cases, among which 1 case occurred after tonsil ablation and other 36 cases occurred after adenoid ablation. Primary hemorrhage was in 7 cases, while secondary hemorrhage in other 30 cases. Cessation of bleeding was achieved by using different methods of hemostasis in all cases. Tonsil and adenoid ablation were performed by pmRF at low temperature with advantages of less trauma, less bleeding. However, postoperative hemorrhage might occur in a few cases (accounting for 0.92%). Postoperative hemorrhage in these patients was related with preoperatively incomplete control of inflammation of tonsil or adenoid, surgeon's experience, intraoperatively incomplete hemostasis, postoperative crying and restlessness, eating improperly in two weeks after surgery, coagulation factor deficiency. In case of postoperative hemorrhage, good outcome could be achieved by management of compression, pmRF at low temperature, bipolar coagulation.

  17. [The relationship between the abnormal behavior and serum C-reactive protein in children with obstructive sleep apnea-hypopnea syndrome].

    PubMed

    Wang, Yan; Li, Yanzhong; Wang, Xin

    2009-12-01

    To explore the pathogenesis of abnormal behavior in children with obstructive sleep apnea-hypopnea syndrome (OSAHS). The behavioral problems and C-reactive protein were measured in 40 children with OSAHS and 30 children with habitual snoring who underwent overnight Polysomnography, 40 cases of healthy children for the control group. The ratio of abnormal behavior in OSAHS and habitual snoring children was significantly higher than that of the healthy control group, while no significant difference between the two groups. The content of C-reactive protein in OSAHS children (4.24 mg/L) was significantly higher than habitual snoring (2.76 mg/L) and healthy control group (1.27 mg/L); in habitual snoring children C-reactive protein was higher than in healthy control group. The content of serum C-reactive protein in OSAHS children accompanied by abnormal behavior (4.63 mg/L) was significantly higher than that without abnormal behavior (3.23 mg/L). The content of serum C-reactive protein content in habitual snoring children accompanied by abnormal behavior (3.63 mg/L) was significantly higher than that without abnormal behavior (1.76 mg/L). OSAHS and habitual snoring children have more behavior problems. C-reactive protein levels are higher in children with OSAHS and habitual snoring, and the levels of C-reactive protein are related to the abnormal behavior in these children.

  18. Ambient Temperature and Obstructive Sleep Apnea: Effects on Sleep, Sleep Apnea, and Morning Alertness

    PubMed Central

    Valham, Fredrik; Sahlin, Carin; Stenlund, Hans; Franklin, Karl A.

    2012-01-01

    Study Objectives: The aim of the study was to investigate the effect of ambient temperature on sleep, sleep apnea, and morning alertness in patients with obstructive sleep apnea. Design: Randomized controlled trial. Setting: In-hospital investigations. Participants: Forty patients with obstructive sleep apnea naïve to treatment, with an apnea-hypopnea index of 10-30. Interventions: Three different nights in room temperatures of 16°C, 20°C, and 24°C. Measurements: Overnight polysomnography and Karolinska Sleepiness Scale. Results: The obstructive apnea-hypopnea index was 30 ± 17 at 16°C room temperature, 28 ± 17 at 20°C, and 24 ± 18 at 24°C. The obstructive apnea-hypopnea index was higher at 16°C room temperature versus 24°C (P = 0.001) and at 20°C room temperature versus 24°C (P = 0.033). Total sleep time was a mean of 30 min longer (P = 0.009), mean sleep efficiency was higher (77 ± 11% versus 71 ± 13% respectively, P = 0.012), and the patients were significantly more alert according to the Karolinska Sleepiness Scale (P < 0.028) in the morning at 16°C room temperature versus 24°C. The amount of sleep in different sleep stages was not affected by room temperature. Conclusions: Untreated patients with obstructive sleep apnea sleep longer, have better sleep efficiency, and are more alert in the morning after a night's sleep at 16°C room temperature compared with 24°C, but obstructive sleep apnea is more severe at 16°C and 20°C compared with 24°C. Clinical Trial Information: This study is registered in ClinicalTrials.gov number NCT00544752. Citation: Valham F; Sahlin C; Stenlund H; Franklin KA. Ambient temperature and obstructive sleep apnea: effects on sleep, sleep apnea, and morning alertness. SLEEP 2012;35(4):513-517. PMID:22467989

  19. Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

    PubMed

    Kljajić, Zlatko; Roje, Željka; Bečić, Kristijan; Čapkun, Vesna; Vilović, K; Ivanišević, Petar; Marušić, Eugenija

    2017-09-01

    The aim of the study was to propose "the risk formula" for obstructive sleep apnea in children according to the general and local clinical parameters and findings relevant for obstructive sleep apnea (OSA) severity. The unmet need for this formula arises from the economic burden of polysomnography (device, staff, training, special sleep centers, etc) as the golden standard for the diagnostics. The study was performed from January 2013 until January 2016 in the Sleep Center, Department for Neuroscience, School of Medicine of the University of Split, Department of Pediatrics, University Hospital Split, Croatia and ENT Dept. University Hospital in Split, Croatia. Inclusion criteria were: age > two years, AHI >1 diagnosed by polysomnography. Exclusion criteria were: chronic lung disease, active tonsillitis/pharyngitis at the time of the physical exam and syndromes that affect breathing. All polysomnograms were scored by a qualified sleep technologist and interpreted by two board certified sleep physicians independently. Age, sex, BMI, Mallampati score, tonsillar size and adenoids size were recorded. All statistical calculations were performed using SPSS 20. In total 60 children were included in the study. The median of age was 5 years (range 2-9). There were 19 (32%) girls and 41 (68%) boys. Of all evaluated predictors, there were statistically significant differences in the values of AHI among children with different modified Mallampati score (χ2 = 28.2; p < 0.001), different size of tonsils (χ2 = 25.3; p < 0.001) and different size of adenoids (z = 2.7; p = 0,006) in univariate regression analysis. Strong positive association of AHI with modified Mallampati score (standardized B = 0.51; partial correlation = 0.542, r = 0.631) was found, as well as positive correlation of AHI with tonsillar size (standardized B = 0.246; partial correlation = 0.295,R = 0.489) in the multivariate forward stepwise regression analysis. Even though we are aware

  20. [Correlation between urinary catecholamines dosage and apnea-hypopnea index in a hypertension population: pilot study].

    PubMed

    Lopez-Sublet, M; Le Jeune, S; Giroux-Leprieur, B; Agnoletti, D; Dhote, R; Mourad, J J

    2014-06-01

    Sleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients. In this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24h urinary catecholamine dosage were included. Mean age was 51±11 years (30-76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14±9 (2-32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24h urinary normetanephrine (1931±1285 vs 869±293nmol/24h; P<0.05). However, this difference was not significant when this parameter was adjusted to 24h urinary creatinine. We observed a significant positive correlation between AHI and 24h urinary normetanephine (r=0.486; P=0.035). This pilot study confirms an isolated elevation of 24h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  1. [Insomnia and sleep apnea].

    PubMed

    Bayon, V; Léger, D

    2014-02-01

    The presence of insomnia in patients with sleep apnea seems paradoxical as excessive sleepiness is one of the major symptoms of sleep apnea. However, recent research has shown that about half of patients with sleep disorder breathing experience insomnia. Moreover, patients complaining of insomnia or non-restorative sleep may also present with moderate to severe sleep apnea syndromes. Thus, in recent years, clinicians have become more aware of the possible association between insomnia and sleep apnea. This article reviews data published on different aspects of this co-occurrence. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  2. Combination of CO2 laser-assisted uvulopalatopharyngoplasty and nasal cavity expansion enhances treatment of obstructive sleep apnea-hypopnea syndrome

    PubMed Central

    Huai, De; Dai, Jun; Xu, Min; Cao, Ying; Song, Hongmao; Wang, Shoufeng; Wang, Haixu; Yin, Min; Cheng, Lei; Zhang, Yalong; Zhou, Xiaojian; Wang, Jianwu

    2015-01-01

    This study aimed to investigate the methods, effects, and application value of a combination of CO2 laser-assisted uvulopalatopharyngoplasty (UPPP) and selective nasal cavity expansion for the treatment of multiplanar narrowing-induced obstructive sleep apnea hypopnea syndrome (OSAHS). Ninety-three patients with OSAHS and multiplanar stenosis were treated with CO2 laser-assisted modified UPPP and selective surgical expansion of the nasal cavity, with 12 completing the operation in stages. Six months after the operation, 23 patients (24.7%) were effectively cured, 52 (55.9%) had excellent efficacy, and 18 (19.4%) were cured, and the total efficacy was 100%. One year after the surgery, the surgical outcomes of 65 patients were reviewed, and the surgeries were ineffective in four (6.2%), effective in 14 (21.5%), very effective in 36 (55.4%), and curative in 11 (16.9%), and the total efficacy was 93.8%. Another 93 cases were treated with the traditional UPPP method only. At the six-month postoperative review, 18 (19.4%) were effectively cured, 30 (32.3%) had excellent efficacy, and 10 (10.8%) were cured, while the surgery was ineffective in 35 (37.6%). The total efficacy was 62.4%. One year after the surgery, the surgical outcomes of 75 patients were reviewed, and the surgeries were ineffective in 29 (38.7%), effective in 14 (18.7%), very effective in 24 (32.0%), and curative in eight (10.7%), and the total efficacy was 61.3%. Compared to the traditional operative methods, the treatment with one operation involving CO2-laser-assisted UPPP and selective nasal cavity expansion was thoroughly effective on multiple stenosis sites, including nasal, nasopharyngeal, and oropharyngeal airways. However, potential complications must be carefully avoided. PMID:26770642

  3. Apnea-hypopnea index as a predictor of atrial fibrillation recurrence following initial pulmonary vein isolation: usefulness of type-3 portable monitor for sleep-disordered breathing.

    PubMed

    Kawakami, Hiroshi; Nagai, Takayuki; Fujii, Akira; Uetani, Teruyoshi; Nishimura, Kazuhisa; Inoue, Katsuji; Suzuki, Jun; Oka, Yasunori; Okura, Takafumi; Higaki, Jitsuo; Ogimoto, Akiyoshi; Ikeda, Shuntaro

    2016-11-01

    The relationship between atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) and sleep-disordered breathing (SDB) evaluated using type-3 portable monitoring (PM) is still unknown. We investigated high-risk patients with AF recurrence after initial PVI using the apnea-hypopnea index (AHI) measured by type-3 PM. One hundred twenty-four (85 males; age 62 ± 10 years) AF patients undergoing initial PVI were enrolled: 83, paroxysmal AF; 41, persistent AF. At baseline, all patients were subjected to in-hospital unattended overnight polygraphy using type-3 PM for SDB. During 13 ± 7 months following initial PVI, 47 patients (38 %) experienced AF recurrence. AHI and left atrial volume index (LAVI) were significantly greater in patients with than in those without AF recurrence (AHI P = 0.011; LAVI P < 0.001). LAVI was an independent predictor of AF recurrence following initial PVI in patients with both paroxysmal AF and persistent AF (paroxysmal AF P = 0.008; persistent AF P = 0.002). However, AHI was an independent predictor of AF recurrence following initial PVI in patients with paroxysmal AF (P = 0.034) but not in those with persistent AF. The optimal cutoff value was defined as AHI = 14.1. AF recurrence following PVI is three times higher in patients with AHI ≥14.1 than in patients with AHI < 14.1. AHI measured using type-3 PM is a useful predictor of outcome following initial PVI in patients with paroxysmal AF.

  4. Comparisons of thyroid hormone, intelligence, attention, and quality of life in children with obstructive sleep apnea hypopnea syndrome before and after endoscopic adenoidectomy.

    PubMed

    Feng, Hui-Wei; Jiang, Tao; Zhang, Hong-Ping; Wang, Zhe; Zhang, Hai-Ling; Zhang, Hui; Chen, Xue-Mei; Fan, Xian-Liang; Tian, Yu-Dong; Jia, Tao

    2015-01-01

    Objective. The aim of this study was to compare the differences in thyroid hormone, intelligence, attention, and quality of life (QoL) of children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after endoscopic adenoidectomy. Method. A total of 35 OSAHS children (21 males and 14 females with a mean age of 6.81 ± 1.08 years) were included in this study for analyzing the levels of thyroid hormone, intelligence, attention, and QoL. There were 22 children underwent endoscopic adenoidectomy with bilateral tonsillectomy (BT), while the other 13 children who underwent endoscopic adenoidectomy without bilateral tonsillectomy without BT. Results. Our results revealed no significant difference in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels in OSAHS children before and after endoscopic adenoidectomy (all P > 0.05). However, there were significant differences in full-scale intelligence quotient (FIQ) (92.45 ± 5.88 versus 106.23 ± 7.39, P < 0.001), verbal intelligence quotient (VIQ) (94.17 ± 15.01 versus 103.91 ± 9.74, P = 0.006), and performance intelligence quotient (PIQ) (94.12 ± 11.04 versus 104.31 ± 10.05, P = 0.001), attention (98.48 ± 8.74 versus 106.87 ± 8.58, P < 0.001), and total OSA-18 scores (87.62 ± 17.15 versus 46.61 ± 10.15, P < 0.001) between before and after endoscopic adenoidectomy in OSAHS children. Conclusion. Our findings provided evidence that the intelligence, attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.

  5. Benefits of Oxytocin Administration in Obstructive Sleep Apnea.

    PubMed

    Jain, Vivek; Marbach, Joseph; Kimbro, Shawn; Andrade, David C; Jain, Arad; Capozzi, Eleanor; Mele, Kyle; Del Rio, Rodrigo; Kay, Matthew W; Mendelowitz, David

    2017-08-10

    Activation of oxytocin receptors has shown benefits in animal models of Obstructive Sleep Apnea (OSA). We tested if nocturnal oxytocin administration could have beneficial effects in OSA patients. 8 patients diagnosed with OSA were administered intranasal oxytocin (40 i.u.). Changes in cardiorespiratory events during sleep, including apnea and hypopnea durations and frequency, risk of event-associated arousals, and heart rate variability were assessed. Oxytocin significantly increased indices of parasympathetic activity, including heart rate variability, total sleep time, and the Post-Polysommogram Sleep Assessment (PPSA) score, an index of self-reported sleep satisfaction. Although the Apnea-Hypopnea Index (AHI) was not significantly changed with oxytocin administration, when apnea and hypopnea events were compared independently, the frequency of hypopneas, but not apneas, were significantly (p<.005) decreased with oxytocin treatment. Both apneas and hypopneas were significantly shortened in duration with oxytocin treatment. Oxytocin treatment significantly decreased the percent of apnea and hypopnea events that were accompanied with an arousal. Oxytocin administration has the potential to restore cardiorespiratory homeostasis and reduce some clinically important (objective and patient-reported) adverse events that occur with OSA. Additional studies are needed to further understand the mechanisms by which oxytocin promotes these changes in cardiorespiratory and autonomic function in OSA patients. Copyright © 2017, American Journal of Physiology-Lung Cellular and Molecular Physiology.

  6. How Is Sleep Apnea Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Sleep Apnea Treated? Sleep apnea is treated with lifestyle ... children grow. Rate This Content: NEXT >> Featured Video Sleep Apnea Research: The HeartBeat Study 06/07/2012 ...

  7. Sleep apnea and panic attacks.

    PubMed

    Edlund, M J; McNamara, M E; Millman, R P

    1991-01-01

    A survey of 301 sleep apnea patients demonstrated that obstructive sleep apnea may cause nocturnal panic attack symptoms. Sleep apnea should be considered in the differential diagnosis of nocturnal panic disorder.

  8. [Acromegaly with the sleep apnea syndrome].

    PubMed

    Ferreira, A M; César, M H; Pissarra, C; dos Santos, F J; Moita, J; Coelho, I; Azevedo, M H

    1997-12-01

    The authors present the clinical of a male patient aged 45 years whose main complaints were loud snoring and excessive daytime sleepiness. Polysomnographic study revealed a sleep obstructive apnea syndrome with an apnea/hypopnea index of 86.5. After being treated with nasal continuous positive air pressure, (12 cm H2O), the apneas ended and sleep architecture was corrected. Physical examination also indicated the presence of an acromegaly, and therefore, the patient was subjected to endocrinological and cerebral imagiological studies; the diagnosis confirmed it as a predisposing factor to the sleep breathing disorder. A brief literature review about the incidence of sleep apnea syndrome in acromegaly is also made; the authors conclude that there is still the need for a systematic screening of sleep breathing disorders in acromegalic patients in order to optimise the treatment and prognosis of this disorders.

  9. Central sleep apnea in pregnant women with sleep disordered breathing.

    PubMed

    Bourjeily, Ghada; Sharkey, Katherine M; Mazer, Jeffrey; Moore, Robin; Martin, Susan; Millman, Richard

    2015-09-01

    Physiologic changes in the cardiac, respiratory, and renal systems in pregnancy likely impact ventilatory control. Though obstructive sleep apnea and snoring are common in the pregnant population, the predisposition to central respiratory events during sleep and the prevalence of such events is less well studied. The aim of this study was to assess the presence of central apneas during sleep in pregnant women and non-pregnant controls suspected of sleep disordered breathing. Twenty-five pregnant women referred for polysomnography for sleep disordered breathing were compared with non-pregnant controls matched for age, body mass index, gender, and apnea hypopnea index (AHI). Central apnea index was defined as the number of central apneas per hour of sleep, and mixed apnea index was defined as the number of mixed apneas per hour of sleep. Sixty-four percent of pregnant women had a respiratory disturbance index >5 events per hour of sleep. Mean body mass index was 44.1 ± 6.9 kg/m(2) pregnant compared to 44.0 ± 7.3 kg/m(2) in controls. The total number of central apneas observed during sleep in the pregnant group consisted of two central apneas in one patient, and of 98 central apneas in 11 patients in the control group (p = 0.05). Median central apnea index was low in both groups (pregnant 0, interquartile range (IQR) 0, 0 vs. non-pregnant 0, IQR 0, 0.2, p = 0.04). Mixed apnea index was similarly low in both groups. Despite some physiologic changes of pregnancy that impact ventilatory control, the prevalence of central sleep apnea was low in our sample of overweight pregnant women with sleep-disordered breathing.

  10. AB008. Assessment of cognitive impairment in patients with obstructive sleep apnea-hypopnea syndrome with the use of Addenbrooke, Montreal Cognitive Assessment and Mini-Mental State Examination scales

    PubMed Central

    Ntafouli, Maria; Economou, Nikolaos-Tiberios; Gourgoulianis, Konstantinos; Steiropoulos, Paschalis

    2016-01-01

    Background Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), may have cognitive impairment, which usually is not diagnosed, affecting negatively their daily functioning. Aim of this study was to assess the scores of Addenbrooke (ACE-R), Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE), three diagnostic tools for detecting neuropsychological deficits, in patients with OSAHS. Methods Included were 101 patients with OSAHS, diagnosed with polysomnography, who visited the outpatient Sleep Clinic of the University General Hospital of Larissa and General Hospital “Evangelismos” of Athens and 40 normal controls of the general population. All participants filled the ACE-R, MoCA and MMSE scales. Results The majority of patients were males (52.5%), between the ages of 51–71 years (52.4%), secondary school graduates (53.5%). Apnea hypopnea index (AHI) was not correlated with any of the scales: MMSE (P=0.657), ACE-R (P=0.773), MoCA (P=0.465), while these 3 scales correlated well with each other. Conclusions Further research is necessary to evaluate the utility of ACE-R, MoCA and MMSE neuropsychological scales in assessing cognitive impairment of OSAHS patients.

  11. Central sleep apnea

    MedlinePlus

    ... Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. SLEEP . 2012;35:17-40. Clodagh MR, Bradley TD. ...

  12. [Effects of allitridi capsules on endothelial function and clinical prognosis in coronary artery disease patients with obstructive sleep apnea hypopnea syndrome].

    PubMed

    Nie, Xiaomin; Su, Lixiao; Zhou, Yajing; Li, Xiping; Shang, Mingyu; Wei, Yongxiang

    2014-07-22

    To explore the effects of allitridi capsules on endothelial function and clinical prognosis in coronary artery disease (CAD) patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 80 CAD patients with OSAHS were randomly assigned to receive conventional treatment (control, n = 40) and additional allitridi treatment (120 mg/day, n = 40) for 6 months. Another 40 CAD patients without OSAHS and 30 healthy individuals were chosen as controls. Endothelial function was assessed by endothelium dependent flow-mediated dilation (FMD) with high-definition color Doppler ultrasound. Serum nitric oxide (NO) and plasma endothelin-1 (ET-1) levels were determined by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay. The duration of follow-up was 1 year. The baseline clinical characteristics were not different between control and allitridi groups (P > 0.05). Compared with CAD patients without OSAHS, FMD and serum NO level were significantly lower ((7.9 ± 1.5)% vs (11.2 ± 2.9)%, P = 0.011 and (71.11 ± 10.62) vs (86.28 ± 11.03) µmol/L, P = 0.007), plasma ET-1 level was markedly higher ((112.34 ± 17.22) vs (89.87 ± 11.56) ng/L, P = 0.025) in CAD patients with OSAHS. At Month 6 post-treatment, FMD and serum NO level were significantly higher ((12.1 ± 3.1)% vs (9.1 ± 1.6)%, P = 0.020 and (105.24 ± 17.01) vs (82.39 ± 11.12) µmol/L, P = 0.001) and plasma ET-1 level in the allitridi group was lower ((77.12 ± 9.65) vs (97.77 ± 11.04) ng/L, P = 0.001) than that in the control group. At Month 12 post-treatment, the incidence of MACE was lower in the allitridi group than that in the control group (8.3% vs 15.8%, P = 0.016). Allitridi capsules significantly improved endothelial function in CAD patients with OSAHS.

  13. 6-Min walk-test data in severe obstructive-sleep-apnea-hypopnea-syndrome (OSAHS) under continuous-positive-airway-pressure (CPAP) treatment.

    PubMed

    Ben Saad, Helmi; Ben Hassen, Ikram; Ghannouchi, Ines; Latiri, Imed; Rouatbi, Sonia; Escourrou, Pierre; Ben Salem, Halima; Benzarti, Mohamed; Abdelghani, Ahmed

    2015-05-01

    Few studies have evaluated the functional capacity of severe OSAHS. To assess their functional capacity, identify their 6-min walking-distance (6MWD) influencing factors and compare their data with those of two control-groups. Sixty (42 males) clinically consecutive stable patients with severe OSAHS under CPAP were included. Clinical, Epworth questionnaire, anthropometric, polysomnographic, plethysmographic and 6-min walk-test (6MWT) data were collected. Univariate and multivariate analyses were used to identify the 6MWD influencing factors. Data of a subgroup of severe OSAHS aged ≥40 Yrs (n = 49) were compared with those of non-obese (n = 174) and obese (n = 55) groups. The means ± SD of age and apnea-hypopnea-index were, respectively, 49 ± 10 Yr and 62 ± 18/h. The profile of OSAHS patients carrying the 6MWT, was as follows: at the end of the 6MWT, 31% and 25% had, respectively, a high dyspnea (>5/10, visual analogue scale) and a low heart-rate (<60% of-maximal-predicted), 13% had an abnormal 6MWD ( 5 points and 3% stopped the walk. The factors that significantly influenced the 6MWD, explaining 80% of its variability, are included in the following equation: 6MWD (m) = 29.66 × first-second-forced-expiratory-volume (L) - 4.19 × Body-mass-index (kg/m(2)) - 51.89 × arterial-hypertension (0. No; 1. Yes) + 263.53 × Height (m) + 2.63 × average oxy-sat during sleep (%) - 51.06 × Diuretic-use (0. No; 1. Yes) - 20.68 × Dyspnea (NYHA) (0. No; 1. Yes) - 38.09 × Anemia (0. No; 1. Yes) + 5.79 × Resting oxy-sat (%) - 586.25. Compared with non-obese and obese groups, the subgroup of OSAHS has a significantly lower 6MWD [100 ± 9%, 100 ± 8% and 83 ± 12%, respectively). Severe OSAHS may play a role in reducing the functional capacity. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Sleep Apnea Facts

    MedlinePlus

    ... as while talking on the phone or driving. Risk factors for sleep apnea include being overweight and having a large neck. Losing even 10 percent of body weight can help reduce the ... be at increased risk for sleep apnea. Smoking and alcohol use increase ...

  15. AASM Criteria for Scoring Respiratory Events: Interaction between Apnea Sensor and Hypopnea Definition

    PubMed Central

    Thornton, Andrew T.; Singh, Parmjit; Ruehland, Warren R.; Rochford, Peter D.

    2012-01-01

    Study Objectives: To examine the impact of using a nasal pressure sensor only vs the American Academy of Sleep Medicine (AASM) recommended combination of thermal and nasal pressure sensors on (1) the apnea index (AI), (2) the apnea-hypopnea index (AHI), where the AHI is calculated using both AASM definitions of hypopnea, and (3) the accuracy of a diagnosis of obstructive sleep apnea (OSA). Design: Retrospective review of previously scored in-laboratory polysomnography. Setting: A tertiary-hospital clinical sleep laboratory. Patients or Participants: One hundred sixty-four consecutive adult patients with a potential diagnosis of OSA, who were examined during a 3-month period. Interventions: N/A. Measurements and Results: Studies were scored with and without the use of the oronasal thermal sensor. AIs and AHIs, using the nasal pressure sensor alone (AInp and AHInp), were compared with those using both a thermal sensor for the detection of apnea and a nasal pressure transducer for the detection of hypopnea (AIth and AHIth). Comparisons were repeated using the AASM recommended (AASMrec) and alternative (AASMalt) hypopnea definitions. AI was significantly different when measured from the different sensors, with AInp being 51% higher on average. Using the AASMrec hypopnea definition, the mean AHInp was 15% larger than the AHIth; with large interindividual differences and an estimated 9.8% of patients having a false-positive OSA diagnosis at a cutpoint of 15 events and 4.3% at 30 events per hour. Using AASMalt hypopnea definition, the mean AHInp was 3% larger than the AHIth, with estimated false-positive rates of 4.6% and 2.4%, respectively. The false-negative rate was negligible at 0.1% for both hypopnea definitions. Conclusions: This study demonstrates that using only a nasal pressure sensor for the detection of apnea resulted in higher values of AI and AHI than when the AASM recommended thermal sensor was added to detect apnea. When the AASMalt hypopnea definition was

  16. Apnea-hypopnea index use among intensive care patients: a case series

    PubMed Central

    2014-01-01

    Introduction ApneaLink™ (RESMED-Munich, Germany) is a simple and inexpensive device that determines the apnea-hypopnea index. The sensitivity and specificity of the apnea-hypopnea index are 100 and 87.5%, respectively. Our hypothesis can be used to create a treatment plan using the apnea-hypopnea index for intensive care unit patients. Case presentation This treatment plan has been created by determining the apnea-hypopnea index of eight Caucasian patients with a variety of diagnoses. Case 1 is that of a 70-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 2 is that of a 65-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 3 is that of a 78-year-old woman diagnosed with chronic obstructive pulmonary disease-pneumonia. Case 4 is that of a 26-year-old man diagnosed with head trauma. Case 5 is that of an 80-year-old man diagnosed with cerebrovascular disease. Case 6 is that of a 79-year-old man diagnosed with cerebrovascular disease. Case 7 is that of an 8-year-old girl diagnosed with ventricular septal defect-epidural hemorragia. Case 8 is that of a 42-year-old man diagnosed with subarachnoid hemorrage. Conclusions The apnea-hypopnea index can be informative regarding prognosis and outcomes, and helps to take precautions and develop new treatment strategies among critical patients in intensive care. The integration of developments in sleep medicine to intensive care unit practices means that we can be more informed about critical patients. PMID:24906620

  17. Predicting CPAP Use and Treatment Outcomes Using Composite Indices of Sleep Apnea Severity

    PubMed Central

    Balakrishnan, Karthik; James, Kathryn T.; Weaver, Edward M.

    2016-01-01

    Study Objectives: Measures of baseline sleep apnea disease burden (apnea-hypopnea index, Epworth Sleepiness Scale) predict continuous positive airway pressure (CPAP) adherence, but composite indices of sleep apnea severity (Sleep Apnea Severity Index, Modified Sleep Apnea Severity Index) may be more robust measures of disease burden. We tested the relative prognostic ability of each measure of sleep apnea disease burden to predict subsequent CPAP adherence and subjective sleep outcomes. Methods: Prospective cohort study at a tertiary academic sleep center. Patients (n = 323) underwent initial diagnostic polysomnography for suspected obstructive sleep apnea and 6 mo of subsequent CPAP therapy Results: Baseline apnea-hypopnea index and both composite indices predicted adherence to CPAP therapy at 6 mo in multivariate analyses (all p ≤ 0.001). Baseline Epworth Sleepiness Scale did not predict CPAP adherence (p = 0.22). Both composite indices were statistically stronger predictors of CPAP adherence at 6 mo than apnea-hypopnea index (p < 0.001). In multivariate analyses, baseline apnea-hypopnea index (p < 0.05) and both composite indices (both p < 0.04) predicted change in Pittsburgh Sleep Quality Index, whereas only the composite indices predicted changes in Sleep Apnea Quality of Life Index (both p < 0.001). Adjustment for treatment adherence did not affect the relationship of the composite indices with change in Sleep Apnea Quality of Life Index (both p ≤ 0.005). Conclusions: Composite indices of baseline sleep apnea severity better predict objective CPAP adherence and subjective treatment outcomes than baseline apnea-hypopnea index and baseline Epworth Sleepiness Scale. Citation: Balakrishnan K, James KT, Weaver EM. Predicting CPAP use and treatment outcomes using composite indices of sleep apnea severity. J Clin Sleep Med 2016;12(6):849–854. PMID:26857052

  18. 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.

  19. Getting a Diagnosis for Sleep Apnea

    MedlinePlus

    ... a Sleep Apnea Diagnosis Getting a Sleep Apnea Diagnosis If you suspect that you have sleep apnea, ... policy offers limited or no coverage for the diagnosis and treatment of sleep apnea, in which case ...

  20. [Obstructive sleep apnea syndromes].

    PubMed

    Poirrier, R

    1993-01-01

    Snoring and excessive sleepiness are the hallmarks of obstructive sleep apnea syndrome but other clinical manifestations are present and a precise assessment of the disease involves clear definitions of the various kinds of apnea. Several pathogenetic factors (functional, anatomical, neurological, genetical) are still being discussed. However new insights of the pathophysiology of apneas allow more reliable treatments. Central nervous and cardiovascular complications as well as the traumatic morbidity, associated with excessive daytime sleepiness, make it a major public health problem.

  1. Complex Sleep Apnea Syndrome

    PubMed Central

    Khan, Muhammad Talha; Franco, Rose Amy

    2014-01-01

    Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour) persist or emerge when obstructive events are extinguished with positive airway pressure (PAP) and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous cositive airway pressure (CPAP) related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therap, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs. PMID:24693440

  2. AASM criteria for scoring respiratory events: interaction between apnea sensor and hypopnea definition.

    PubMed

    Thornton, Andrew T; Singh, Parmjit; Ruehland, Warren R; Rochford, Peter D

    2012-03-01

    To examine the impact of using a nasal pressure sensor only vs the American Academy of Sleep Medicine (AASM) recommended combination of thermal and nasal pressure sensors on (1) the apnea index (AI), (2) the apnea-hypopnea index (AHI), where the AHI is calculated using both AASM definitions of hypopnea, and (3) the accuracy of a diagnosis of obstructive sleep apnea (OSA). Retrospective review of previously scored in-laboratory polysomnography. A tertiary-hospital clinical sleep laboratory. One hundred sixty-four consecutive adult patients with a potential diagnosis of OSA, who were examined during a 3-month period. N/A. Studies were scored with and without the use of the oronasal thermal sensor. AIs and AHIs, using the nasal pressure sensor alone (AI(np) and AHI(np)), were compared with those using both a thermal sensor for the detection of apnea and a nasal pressure transducer for the detection of hypopnea (AI(th) and AHI(th)). Comparisons were repeated using the AASM recommended (AASM(rec)) and alternative (AASM(alt)) hypopnea definitions. AI was significantly different when measured from the different sensors, with AI(np) being 51% higher on average. Using the AASM(rec) hypopnea definition, the mean AHI(np) was 15% larger than the AHI(th); with large interindividual differences and an estimated 9.8% of patients having a false-positive OSA diagnosis at a cutpoint of 15 events and 4.3% at 30 events per hour. Using AASM(alt) hypopnea definition, the mean AHI(np) was 3% larger than the AHI(th), with estimated false-positive rates of 4.6% and 2.4%, respectively. The false-negative rate was negligible at 0.1% for both hypopnea definitions. This study demonstrates that using only a nasal pressure sensor for the detection of apnea resulted in higher values of AI and AHI than when the AASM recommended thermal sensor was added to detect apnea. When the AASM(alt) hypopnea definition was used, the differences in AHI and subsequent OSA diagnosis were small and less than when

  3. Effect of simulated obstructive hypopnea and apnea on thoracic aortic wall transmural pressures

    PubMed Central

    Clarenbach, Christian F.; Camen, Giovanni; Sievi, Noriane A.; Wyss, Christophe; Stradling, John R.

    2013-01-01

    Preliminary evidence supports an association between obstructive sleep apnea (OSA) and thoracic aortic dilatation, although potential causative mechanisms are incompletely understood; these may include an increase in aortic wall transmural pressures, induced by obstructive apneas and hypopneas. In patients undergoing cardiac catheterization, mean blood pressure (MBP) in the thoracic aorta and esophageal pressure was simultaneously recorded by an indwelling aortic pigtail catheter and a balloon-tipped esophageal catheter in randomized order during: normal breathing, simulated obstructive hypopnea (inspiration through a threshold load), simulated obstructive apnea (Mueller maneuver), and end-expiratory central apnea. Aortic transmural pressure (aortic MBP minus esophageal pressure) was calculated. Ten patients with a median age (range) of 64 (46–75) yr were studied. Inspiration through a threshold load, Mueller maneuver, and end-expiratory central apnea was successfully performed and recorded in 10, 7, and 9 patients, respectively. The difference between aortic MBP and esophageal pressure (and thus the extra aortic dilatory force) was median (quartiles) +9.3 (5.4, 18.6) mmHg, P = 0.02 during inspiration through a threshold load, +16.3 (12.8, 19.4) mmHg, P = 0.02 during the Mueller maneuver, and +0.4 (−4.5, 4.8) mmHg, P = 0.80 during end-expiratory central apnea. Simulated obstructive apnea and hypopnea increase aortic wall dilatory transmural pressures because intra-aortic pressures fall less than esophageal pressures. Thus OSA may mechanically promote thoracic aortic dilatation and should be further investigated as a risk factor for the development or accelerated progression of thoracic aortic aneurysms. PMID:23766507

  4. Sleep Apnea (For Parents)

    MedlinePlus

    ... Because OSA makes it hard to get a good night's sleep, kids might have a hard time waking in the morning, be tired throughout the day, and have attention or other behavior problems. As a result, sleep apnea can hurt school performance. Teachers and others may think a child has attention ...

  5. 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.

  6. Adenoidectomy for Obstructive Sleep Apnea in Children

    PubMed Central

    Domany, Keren Armoni; Dana, Elad; Tauman, Riva; Gut, Guy; Greenfeld, Michal; Yakir, Bat-El; Sivan, Yakov

    2016-01-01

    Study Objective: Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Methods: Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17–73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Results: Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). Conclusions: We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed. Citation: Domany KA, Dana E, Tauman R, Gut G, Greenfeld M, Yakir BE, Sivan Y. Adenoidectomy for obstructive sleep apnea in children. J Clin Sleep Med 2016;12(9):1285–1291. PMID:27448429

  7. Sleep apnea syndrome in endocrine diseases.

    PubMed

    Bottini, Paolo; Tantucci, Claudio

    2003-01-01

    It is increasingly recognized that sleep-disordered breathing (SDB) - from snoring to apnea-hypopnea syndrome (SAHS) - can affect patients with various endocrine diseases (ED). Different mechanisms are implied in SDB, promoting either central or, more frequently, obstructive apnea in different ED. In the past, acromegaly and hypothyroidism were first associated with both central and obstructive SAHS. Today, great attention is placed on the complex cause-effect relationship between diabetes mellitus and obstructive SAHS (and vice versa). Symptoms and signs of SAHS may complicate the clinical course of these diseases and should be promptly suspected to detect and possibly treat the accompanying SDB. Copyright 2003 S. Karger AG, Basel

  8. Treatments for Obstructive Sleep Apnea

    PubMed Central

    Calik, Michael W.

    2016-01-01

    Objective To review the efficacy of current treatment options for adults with obstructive sleep apnea (OSA). Methods Review of the literature. Results OSA, characterized by repetitive ≥ 10-second interruptions (apnea) or reductions (hypopnea) in airflow, is initiated by partial or complete collapse in the upper airway despite respiratory effort. When left untreated, OSA is associated with comorbid conditions, such as cardiovascular and metabolic diseases. The current “gold standard” treatment for OSA is continuous positive air pressure (CPAP), which pneumatically stabilizes the upper airways. CPAP has proven efficacy and potential cost savings via decreases in health comorbidities and/or motor-vehicle crashes. However, CPAP treatment is not well-tolerated due to various side effects, and adherence among OSA subjects can be as low as 50% in certain populations. Other treatment options for OSA include improving CPAP tolerability, increasing CPAP adherence through patient interventions, weight loss/exercise, positional therapy, nasal expiratory positive airway pressure, oral pressure therapy, oral appliances, surgery, hypoglossal nerve stimulation, drug treatment, and combining 2 or more of the aforementioned treatments. Despite the many options available to treat OSA, none of them are as efficacious as CPAP. However, many of these treatments are tolerable, and adherence rates are higher than those of the CPAP, making them a more viable treatment option for long-term use. Conclusion Patients need to weigh the benefits and risks of available treatments for OSA. More large randomized controlled studies on treatments or combination of treatments for OSA are needed that measure parameters such as treatment adherence, apnea-hypopnea index, oxygen desaturation, subjective sleepiness, quality of life, and adverse events. PMID:27134515

  9. Accuracy of residual apnea-hypopnea index obtained using the continuous positive airway pressure device: application of new version 2.0 scoring rules for respiratory events during sleep.

    PubMed

    Kim, Doh-Eui; Hwangbo, Young; Bae, Ji Hyun; Yang, Kwang Ik

    2015-12-01

    Continuous positive airway pressure (CPAP) devices can estimate apnea-hypopnea index (AHI) using respiratory event detection algorithms. In 2012, rules for manually scoring respiratory events during sleep were updated to version 2.0. The purpose of the present study was to compare residual AHI determined using the Sleepstyle HC608 CPAP device (HC) with those determined by the new manual scoring (NM) rules during CPAP titration in patients with obstructive sleep apnea (OSA). Fifty-seven patients underwent CPAP titration with HC. Correlations were assessed between AHI determined by NM and HC. The AHI, the apnea index (AI), and the hypopnea index (HI) were evaluated separately. The mean AHI as assessed using diagnostic polysomnography (PSG) was 53.9 ± 22.4. During CPAP titration, respiratory events were effectively suppressed (HC-AHI, 4.2 ± 6.0; NM-AHI, 6.0 ± 5.8). Lower HI and AHI were obtained using HC compared to NM (HC-HI, 2.9 ± 3.6 and NM-HI, 5.2 ± 4.2, p < 0.001; HC-AHI, 4.2 ± 6.0 and NM-AHI, 6.0 ± 5.8, p < 0.001). Additionally, HC reported higher AI compared to NM (HC-AI, 1.3 ± 2.8; NM-AI, 0.9 ± 2.2, p = 0.002). NM-AI (ß = 1.017, p < 0.001), NM-HI (ß = -0.599, p < 0.001), and NM-arousal index (ß = -0.058, p = 0.042) were associated with greater differences between HC-AHI and NM-AHI in multivariate regression analysis. Our findings indicate differences in scoring respiratory events between our CPAP device and new version 2.0 manual scoring and suggest that residual AHI values should be carefully interpreted.

  10. CPAP therapy induces favorable short-term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS).

    PubMed

    Kostopoulos, Konstantinos; Alhanatis, Emmanouil; Pampoukas, Konstantinos; Georgiopoulos, Georgios; Zourla, Andromahi; Panoutsopoulos, Athanasios; Kallianos, Anastasios; Velentza, Lemonia; Zarogoulidis, Paul; Trakada, Georgia

    2016-05-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for hypertension, coronary artery disease, and diabetes mellitus. Epicardial fat has been recently recognized as a new risk factor and active participant on cardiometabolic risk. The aim of this study was to assess an independent relationship between sleep apnea severity, metabolic and vascular markers, and epicardial fat, at baseline and after 3 months of continuous positive airway pressure (CPAP) therapy. Our study group consisted of 48 patients with suspected OSAHS and no prior history of cardiovascular disease or diabetes mellitus. All patients underwent full overnight polysomnography. Thickness of epicardial and visceral adipose tissue, brachial artery flow-mediated dilation (FMD), carotid intima media thickness (cIMT), pulse wave velocity (PWV), plasma C-reactive protein (CRP) levels, fasting glucose levels, HbA1c, homeostatic model assessment of insulin resistance index (HOMA), and lipid profile were measured at baseline and after 3 months of CPAP use in patients with moderate to severe OSAHS. In OSAHS patients (Apnea-hypopnea index (AHI) ≥15/h, N = 28), epicardial fat correlated with fasting glucose (rho = 0.406, p = 0.04) and HOMA (rho = 0.525, p = 0.049) but was not associated with visceral fat (rho = 0.126, p = 0.595). Epicardial adipose tissue (EAT) (p = 0.022) increased across AHI severity along with PWV (p = 0.045) and carotid intima media thickness (IMT) (p = 0.034) while FMD (p = 0.017) decreased. Therapy with CPAP reduced both epicardial (p < 0.001) and visceral fat (p = 0.001). Alterations in epicardial fat across the follow-up were associated with changes in PWV (p = 0.026) and HOMA (p = 0.037) independently of major confounders. Epicardial fat thickness was associated with OSA severity and may be an additional marker of cardiovascular risk as well as of future diabetes in these patients. CPAP therapy

  11. Acromegaly and sleep apnea: cephalometric evaluations.

    PubMed

    Bruwier, A; Albert, A; Beckers, A; Limme, M; Poirrier, R

    2011-06-01

    Lateral teleradiography is a standard and quick examination. It has enabled us to define differences as regards to the craniofacial morphology between 20 acromegalic patients and 20 control subjects. The height of the mandibular ramus (from the posterior condyle point to the gonion point) increases significantly with the acromegalic patient and the cranial base angle (basion-superior tuberculum sellae-M point) is more extended. As acromegalic patients are more subject to sleep apnea (30% prevailing), the relationship between the amount of sleep apnea and hypopnea (AHI) in an acromegalic patient and his bone, tissue and hormone factors has been researched, in order to act on the causes of sleep apnea. It has emerged that confronting craniofacial bones and soft tissues factors enables a good prediction of the apnea and hypopnea index. Of course, we can find again the potential action of growth hormone (GH) but only in fifth place in importance order. The tongue, which increases in volume with the GH impact, is in a too short "lingual enclosure" (reduced length of the mandibular horizontal branch).

  12. Rodent models of sleep apnea.

    PubMed

    Davis, Eric M; O'Donnell, Christopher P

    2013-09-15

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

  13. Obstructive Sleep Apnea in Children

    PubMed Central

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

    2009-01-01

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

  14. The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea.

    PubMed

    Pıhtılı, Aylin; Bingöl, Züleyha; Kıyan, Esen

    2017-01-01

    As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Retrospective clinical study. Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001), oxygen desaturation index (p<0.001) and sleep time with SpO2<90% (p<0.001) were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001) and lowest SpO2 (p<0.001) were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high.

  15. The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea

    PubMed Central

    Pıhtılı, Aylin; Bingöl, Züleyha; Kıyan, Esen

    2017-01-01

    Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study. Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001), oxygen desaturation index (p<0.001) and sleep time with SpO2<90% (p<0.001) were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001) and lowest SpO2 (p<0.001) were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high. PMID:28251022

  16. Current hypopnea scoring criteria underscore pediatric sleep disordered breathing.

    PubMed

    Lin, Cheng-Hui; Guilleminault, Christian

    2011-08-01

    This is a retrospective study comparing 2007 American Academy of Sleep Medicine (AASM) pediatric scoring criteria and Stanford scoring criteria of pediatric polysomnograms to characterize the impact different scoring systems have upon the diagnosis of sleep disordered breathing in children. The diagnostic and post-treatment nocturnal polysomnograms (PSGs) of children (age 2-18 years) consecutively referred to an academic sleep clinic for evaluation of suspected sleep disordered breathing (SDB) for 1 year were independently analyzed by a single researcher using AASM and Stanford scoring criteria in a blinded fashion. A total of 209 (83 girls) children with suspected SDB underwent clinical evaluation and diagnostic PSG. Analysis of the diagnostic PSGs using the Stanford and AASM criteria classified 207 and 39 studies as abnormal, respectively. The AASM scoring criteria classified 19% of subjects as having obstructive sleep apnea (OSA) while the Stanford criteria diagnosed 99% of the subjects with OSA who were referred for evaluation of suspected sleep disordered breathing. There was a positive correlation between SDB-related clinical symptoms and anatomic risk factors for SDB. Scatter-plot analyses showed that the AASM apnea hypopnea index (AHI) was not only significantly lower compared to the Stanford AHI but also skewed in distribution. Ninety-nine children were restudied with PSG (9 were initially diagnosed with SDB with AASM criteria, whereas all 99 were diagnosed with SDB with Stanford criteria). All 99 children had been treated and had a post-treatment clinical evaluation and post-treatment PSG during the study period. All 99 children evaluated after treatment showed improvement in clinical presentation, Stanford AHI, and oxygen saturation during sleep. The AASM scoring criteria classified 19% of subjects as having OSA while the Stanford criteria diagnosed 99% of the subjects with OSA who were referred for evaluation of suspected sleep disordered breathing. The

  17. Obstructive sleep apnea.

    PubMed

    Ho, Matthew L; Brass, Steven D

    2011-11-29

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  18. Obstructive sleep apnea

    PubMed Central

    Ho, Matthew L.; Brass, Steven D.

    2011-01-01

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances. PMID:22368774

  19. Validation of a New System Using Tracheal Body Sound and Movement Data for Automated Apnea-Hypopnea Index Estimation.

    PubMed

    Kalkbrenner, Christoph; Eichenlaub, Manuel; Rüdiger, Stefan; Kropf-Sanchen, Cornelia; Brucher, Rainer; Rottbauer, Wolfgang

    2017-08-29

    The current gold standard for assessment of obstructive sleep apnea is the in-laboratory polysomnography. This approach has high costs and inconveniences the patient, whereas alternative ambulatory systems are limited by reduced diagnostic abilities (type 4 monitors, 1 or 2 channels) or extensive setup (type 3 monitors, at least 4 channels). The current study therefore aims to validate a simplified automated type 4 monitoring system using tracheal body sound and movement data. Data from 60 subjects were recorded at the University Hospital Ulm. All subjects have been regular patients referred to the sleep center with suspicion of sleep-related breathing disorders. Four recordings were excluded because of faulty data. The study was of prospective design. Subjects underwent a full-night screening using diagnostic in-laboratory polysomnography and the new monitoring system concurrently. The apnea-hypopnea index (AHI) was scored blindly by a medical technician using in-laboratory polysomnography (AHIPSG). A unique algorithm was developed to estimate the apnea-hypopnea index (AHIest) using the new sleep monitor. AHIest strongly correlates with AHIPSG (r2 = .9871). A mean ± 1.96 standard deviation difference between AHIest and AHIPSG of 1.2 ± 5.14 was achieved. In terms of classifying subjects into groups of mild, moderate, and severe sleep apnea, the evaluated new sleep monitor shows a strong correlation with the results obtained by polysomnography (Cohen kappa > 0.81). These results outperform previously introduced similar approaches. The proposed sleep monitor accurately estimates AHI and diagnoses sleep apnea and its severity. This minimalistic approach may address the need for a simple yet reliable diagnosis of sleep apnea in an ambulatory setting. Validation of a new method for ambulant diagnosis of sleep related breathing disorders using body sound; URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011195

  20. Impact of intermittent hypoxia and exercise on blood pressure and metabolic features from obese subjects suffering sleep apnea-hypopnea syndrome.

    PubMed

    González-Muniesa, P; Lopez-Pascual, A; de Andrés, J; Lasa, A; Portillo, M P; Arós, F; Durán, J; Egea, C J; Martinez, J A

    2015-09-01

    Strategies designed to reduce adiposity and cardiovascular-accompanying manifestations have been based on nutritional interventions conjointly with physical activity programs. The aim of this 13-week study was to investigate the putative benefits associated to hypoxia plus exercise on weight loss and relevant metabolic and cardiorespiratory variables, when prescribed to obese subjects with sleep apnea syndrome following dietary advice. The participants were randomly distributed in the following three groups: control, normoxia, and hypoxia. All the subjects received dietary advice while, additionally, normoxia group was trained under normal oxygen concentration and Hypoxia group under hypoxic conditions. There was a statistically significant decrease in fat-free mass (Kg) and water (%) on the control compared to normoxia group (p < 0.05 and p < 0.01, respectively). Body weight, body mass index, and waist circumference decreased in all the groups after the study. Moreover, leukocyte count was increased after the intervention in hypoxia compared to control group (p < 0.05). There were no statistically significant variations within groups in other variables, although changes in appetite were found after the 13-week period. In addition, associations between the variations in the leukocyte count and fat mass have been found. The hypoxia group showed some specific benefits concerning appetite and cardiometabolic-related measurements as exertion time and diastolic blood pressure, with a therapeutical potential.

  1. Relationship Between Sleep Apnea and Cancer.

    PubMed

    Martínez-García, Miguel Ángel; Campos-Rodríguez, Francisco; Almendros, Isaac; Farré, Ramón

    2015-09-01

    In the light of relationships reported between hypoxemia (tissue hypoxia) and cancer, Abrams et al. concluded in 2008 that sleep apnea-hypopnea syndrome (SAHS) and its main consequence, intermittent hypoxia, could be related with increased susceptibility to cancer or poorer prognosis of a pre-existing tumor. This pathophysiological association was confirmed in animal studies. Two large independent historical cohort studies subsequently found that the degree of nocturnal hypoxia in patients with SAHS was associated with higher cancer incidence and mortality. This finding has been confirmed in almost all subsequent studies, although the retrospective nature of some requires that they be considered as hypothesis-generating only. The relationship between sleep apnea and cancer, and the pathophysiological mechanisms governing it, could be clarified in the near future in a currently on-going study in a large group of melanoma patients.

  2. Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients.

    PubMed

    Rodrigues, Marcos Marques; Pereira Filho, Valfrido Antonio; Gabrielli, Mário Francisco Real; Oliveira, Talles Fernando Medeiros de; Batatinha, Júlio Américo Pereira; Passeri, Luis Augusto

    2017-01-30

    Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: -0.415 (p=0.025), 0.186 (p=0.334) and -0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: -0.206 (p=0.304), -0.155 (p=0.439) and 0.242 (p=0.284). There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

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

    PubMed

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

    2016-09-01

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

  4. Obstructive Sleep Apnea Severity and Overnight Body Fluid Shift before and after Hemodialysis.

    PubMed

    Ogna, Adam; Forni Ogna, Valentina; Mihalache, Alexandra; Pruijm, Menno; Halabi, Georges; Phan, Olivier; Cornette, Françoise; Bassi, Isabelle; Haba Rubio, José; Burnier, Michel; Heinzer, Raphaël

    2015-06-05

    Obstructive sleep apnea is associated with significantly increased cardiovascular morbidity and mortality. Fluid overload may promote obstructive sleep apnea in patients with ESRD through an overnight fluid shift from the legs to the neck soft tissues. Body fluid shift and severity of obstructive sleep apnea before and after hemodialysis were compared in patients with ESRD. Seventeen patients with hemodialysis and moderate to severe obstructive sleep apnea were included. Polysomnographies were performed the night before and after hemodialysis to assess obstructive sleep apnea, and bioimpedance was used to measure fluid overload and leg fluid volume. The mean overnight rostral fluid shift was 1.27±0.41 L prehemodialysis; it correlated positively with fluid overload volume (r=0.39; P=0.02) and was significantly lower posthemodialysis (0.78±0.38 L; P<0.001). There was no significant difference in the mean obstructive apnea-hypopnea index before and after hemodialysis (46.8±22.0 versus 42.1±18.6 per hour; P=0.21), but obstructive apnea-hypopnea index was significantly lower posthemodialysis (-10.1±10.8 per hour) in the group of 12 patients, with a concomitant reduction of fluid overload compared with participants without change in fluid overload (obstructive apnea-hypopnea index +8.2±16.1 per hour; P<0.01). A lower fluid overload after hemodialysis was significantly correlated (r=0.49; P=0.04) with a lower obstructive apnea-hypopnea index. Fluid overload-assessed by bioimpedance-was the best predictor of the change in obstructive apnea-hypopnea index observed after hemodialysis (standardized r=-0.68; P=0.01) in multivariate regression analysis. Fluid overload influences overnight rostral fluid shift and obstructive sleep apnea severity in patients with ESRD undergoing intermittent hemodialysis. Although no benefit of hemodialysis on obstructive sleep apnea severity was observed in the whole group, the change in obstructive apnea-hypopnea index was significantly

  5. Obstructive Sleep Apnea Severity and Overnight Body Fluid Shift before and after Hemodialysis

    PubMed Central

    Forni Ogna, Valentina; Mihalache, Alexandra; Pruijm, Menno; Halabi, Georges; Phan, Olivier; Cornette, Françoise; Bassi, Isabelle; Haba Rubio, José; Burnier, Michel; Heinzer, Raphaël

    2015-01-01

    Background and objectives Obstructive sleep apnea is associated with significantly increased cardiovascular morbidity and mortality. Fluid overload may promote obstructive sleep apnea in patients with ESRD through an overnight fluid shift from the legs to the neck soft tissues. Body fluid shift and severity of obstructive sleep apnea before and after hemodialysis were compared in patients with ESRD. Design, setting, participants, & measurements Seventeen patients with hemodialysis and moderate to severe obstructive sleep apnea were included. Polysomnographies were performed the night before and after hemodialysis to assess obstructive sleep apnea, and bioimpedance was used to measure fluid overload and leg fluid volume. Results The mean overnight rostral fluid shift was 1.27±0.41 L prehemodialysis; it correlated positively with fluid overload volume (r=0.39; P=0.02) and was significantly lower posthemodialysis (0.78±0.38 L; P<0.001). There was no significant difference in the mean obstructive apnea-hypopnea index before and after hemodialysis (46.8±22.0 versus 42.1±18.6 per hour; P=0.21), but obstructive apnea-hypopnea index was significantly lower posthemodialysis (−10.1±10.8 per hour) in the group of 12 patients, with a concomitant reduction of fluid overload compared with participants without change in fluid overload (obstructive apnea-hypopnea index +8.2±16.1 per hour; P<0.01). A lower fluid overload after hemodialysis was significantly correlated (r=0.49; P=0.04) with a lower obstructive apnea-hypopnea index. Fluid overload—assessed by bioimpedance—was the best predictor of the change in obstructive apnea-hypopnea index observed after hemodialysis (standardized r=−0.68; P=0.01) in multivariate regression analysis. Conclusions Fluid overload influences overnight rostral fluid shift and obstructive sleep apnea severity in patients with ESRD undergoing intermittent hemodialysis. Although no benefit of hemodialysis on obstructive sleep apnea severity

  6. Strength training and light physical activity reduces the apnea-hypopnea index in institutionalized older adults.

    PubMed

    Herrick, Jeffrey E; Bliwise, Donald L; Puri, Shipra; Rogers, Sandy; Richards, Kathy C

    2014-01-01

    To determine the effect of 7 weeks of resistance training and walking on the apnea-hypopnea index (AHI) in institutionalized older adults compared with a usual care control group. Secondary analysis of data from a randomized controlled trial. Ten nursing and 3 assisted living facilities in Arkansas. Institutionalized older adults. Exercise group (EG) performed supervised resistance training to arm and hip extensors on 3 days a week with additional 2 days a week of light walking. Usual care group (UC) participated in the usual activities provided within their living facility. Two nights of polysomnography before and following 7-week intervention. Adjusted means in the EG group showed a decrease in AHI from 20.2 (SD ±1.3) at baseline to 16.7 (SD ±0.9) at 7 weeks. Absolute strength gains were not associated with improved AHI. Supervised resistance training and light walking reduced the severity of obstructive sleep apnea in institutionalized older adults.

  7. Clinical Considerations of Obstructive Sleep Apnea with Little REM Sleep.

    PubMed

    Koo, Dae Lim; Nam, Hyunwoo

    2016-10-01

    Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20-25% of TST), and excessive REM sleep (>25% of TST). Multiple logistic regression analyses were applied to the data. The success rate of continuous positive airway pressure (CPAP) titration was estimated in these groups. The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m², respectively. The 902 patients comprised 684 (76%) men and 218 (24%) women. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple logistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence interval, 1.020-1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). The AHI is higher and the success rate of CPAP titration is lower in OSA patients with little REM sleep than those with normal REM sleep.

  8. 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.

  9. Always Tired? You May Have Sleep Apnea

    MedlinePlus

    ... Consumers Consumer Updates Always Tired? You May Have Sleep Apnea Share Tweet Linkedin Pin it More sharing ... Stimulation (UAS) System. back to top What is Sleep Apnea? The Greek word "apnea" literally means "without ...

  10. [Arrhythmia and sleep apnea syndrome].

    PubMed

    Marrakchi, S; Kammoun, I; Kachboura, S

    2015-10-01

    Arrhythmia is a major cause of morbidity and mortality in Europe and in the United States. The aim of this review article was to assess the results of the prospective studies that evaluated the risk of arrhythmia in patients with sleep apnea syndrome and discuss the management of this arrhythmia. Reports published with the following search terms were searched: sleep apnea syndrome, atrial flutter, supraventricular arrhythmia, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation, torsade de pointe, atrial fibrillation and sudden death. The investigation was restricted to reports published in English and French. The outcome of this analysis suggests that patients with untreated overt sleep apnea syndrome are at increased risk of arrhythmia. The timely recognition and effective treatment of sleep apnea syndrome in patients with arrhythmia are mandatory because the prognosis of arrhythmia may be improved with the appropriate treatment of sleep apnea syndrome. Copyright © 2015. Published by Elsevier Masson SAS.

  11. Pathophysiology of Sleep Apnea

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2014-02-01

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

  13. [Differentiation of arousal in sleep before and after CPAP therapy in patients with pronounced sleep apnea syndrome].

    PubMed

    Fietze, I; Warmuth, R; Waschke, K; Witt, C; Baumann, G

    1995-03-01

    The sleep apnea syndrome is often associated with the syndromes of daytime exhaustion and involuntary daytime sleeping fits. The cause is assumed to be fragmentary sleep resulting from night-time arousal. The central nervous activation reactions caused by apnea or hypopnea, respectively, and not the movement arousal determine the sleep structure. We have examined 10 male patients in the age range 40-55 years (48 +/- 6 SD) before and during the first 3 nights of CPAP therapy. Cardiorespiratory polysomnography was performed in all four nights. Sleep way analyzed visually and differentiation was made between respiratory (RA) and movement arousal (MA). All 10 patients had a pronounced sleep apnea syndrome. Deep and dream sleep were reduced, significantly more respiratory arousals occurred than movement arousals. The SWS latency was shortened in the first therapy night, the deep and dream sleep proportions increased and the RA decreased significantly. No further significant changes in the sleep parameters occurred during the second and third nights. We found that the number of apnea/hypopnea was not equal to the number of RA. When less arousal was recognized it was suggestive of a deficit of the diversion function while more RA was indicative of additional respiratory events, e.g. pharyngeal obstructions and hyperventilations which were not recognized as apnea or hypopnea. In addition to its role in the differential diagnosis of sleeping disorders, in particular sleep apnea, arousal differentiation is also an important criterion for estimating the efficiency of CPAP therapy.

  14. Obstructive Sleep Apnea and Sickle Cell Anemia

    PubMed Central

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

    2014-01-01

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

  15. Low leptin concentration may identify heart failure patients with central sleep apnea.

    PubMed

    Cundrle, Ivan; Somers, Virend K; Singh, Prachi; Johnson, Bruce D; Scott, Christopher G; Olson, Lyle J

    2017-06-23

    Low leptin concentration has been shown to be associated with central sleep apnea in heart failure patients. We hypothesized that low leptin concentration predicts central sleep apnea. Consecutive ambulatory New York Heart Association (NYHA) classes I-IV heart failure patients were studied prospectively, including measurement of serum leptin, echocardiography and polysomnography. Sleep apnea was defined by type (central/mixed/obstructive) and by apnea-hypopnea index ≥5 by polysomnography. Subjects were divided into four groups by polysomnography: (1) central sleep apnea, (2) mixed apnea, (3) no apnea and (4) obstructive sleep apnea. Fifty-six subjects were included. Eighteen subjects were diagnosed with central sleep apnea, 15 with mixed apnea, 12 with obstructive apnea and 11 with no sleep apnea. Leptin concentration was significantly lower in central sleep apnea compared to obstructive apnea (8 ± 10.7 ng mL(-1) versus 19.7 ± 14.7 ng mL(-1) , P ˂ 0.01) or no sleep apnea (8 ± 10.7 ng mL(-1) versus 17.1 ± 8.4 ng mL(-1) , P ˂ 0.01). Logistic regression showed leptin to be associated independently with central sleep apnea [odds ratio (OR): 0.19; 95% confidence interval (CI): 0.06-0.62; area under the curve (AUC): 0.80, P < 0.01]. For the detection of central sleep apnea, a cut-off value for leptin concentration 5 ng mL(-1) yielded a sensitivity of 50% and specificity of 89%. In conclusion, a low leptin concentration may have utility for the screening of heart failure patients for central sleep apnea. © 2017 European Sleep Research Society.

  16. Automated sleep scoring and sleep apnea detection in children

    NASA Astrophysics Data System (ADS)

    Baraglia, David P.; Berryman, Matthew J.; Coussens, Scott W.; Pamula, Yvonne; Kennedy, Declan; Martin, A. James; Abbott, Derek

    2005-12-01

    This paper investigates the automated detection of a patient's breathing rate and heart rate from their skin conductivity as well as sleep stage scoring and breathing event detection from their EEG. The software developed for these tasks is tested on data sets obtained from the sleep disorders unit at the Adelaide Women's and Children's Hospital. The sleep scoring and breathing event detection tasks used neural networks to achieve signal classification. The Fourier transform and the Higuchi fractal dimension were used to extract features for input to the neural network. The filtered skin conductivity appeared visually to bear a similarity to the breathing and heart rate signal, but a more detailed evaluation showed the relation was not consistent. Sleep stage classification was achieved with and accuracy of around 65% with some stages being accurately scored and others poorly scored. The two breathing events hypopnea and apnea were scored with varying degrees of accuracy with the highest scores being around 75% and 30%.

  17. The association between continuous positive airway pressure therapy and liver disease development in obstructive sleep apnea/hypopnea syndrome patients: a nationwide population-based cohort study in Taiwan.

    PubMed

    Hang, Liang-Wen; Chen, Chi-Fung; Wang, Chang-Bi; Wu, Trong-Neng; Liang, Wen-Miin; Chou, Tzu-Chieh

    2017-05-01

    Studies on the association between continuous positive airway pressure (CPAP) treatment and liver diseases such as non-alcoholic fatty liver disease (NAFLD) and cirrhosis in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) are limited. To the best of our knowledge, none exists that makes use of a national database in an Asian population. This study aims to evaluate the effects of CPAP treatment on patients with these two disorders in a retrospective, population-based study in Taiwan. Using the Taiwan National Health Insurance claims database, this study collected the data of OSAHS patients diagnosed between 2000 and 2008 and divided them into CPAP treatment and non-CPAP treatment groups. All subjects were followed up until 2010. Liver disease incidence and risk were calculated. The CPAP group had a lower cumulative incidence rate of developing liver disease than the non-CPAP group within the observation periods (p < 0.001). After adjusting for age, gender, urbanization level, and comorbidities, the CPAP treatment group showed a lower risk of developing liver disease compared with the non-CPAP treatment group (sub-aHR of 0.66 (95% CI 0.55-0.80), p < 0.001). Our observations suggest that CPAP treatment may play an important role to delay the progression of liver disease in OSAHS patients and decreases the incidence of liver disease among OSAHS patients. Thus, CPAP therapy may be a feasible way to decrease the risk of liver disease among patients with OSAHS.

  18. Obstructive Apnea Hypopnea Index Estimation by Analysis of Nocturnal Snoring Signals in Adults

    PubMed Central

    Ben-Israel, Nir; Tarasiuk, Ariel; Zigel, Yaniv

    2012-01-01

    Study Objective: To develop a whole-night snore sounds analysis algorithm enabling estimation of obstructive apnea hypopnea index (AHIEST) among adult subjects. Design: Snore sounds were recorded using a directional condenser microphone placed 1 m above the bed. Acoustic features exploring intra-(mel- cepstability, pitch density) and inter-(running variance, apnea phase ratio, inter-event silence) snore properties were extracted and integrated to assess AHIEST. Setting: University-affiliated sleep-wake disorder center and biomedical signal processing laboratory. Patients: Ninety subjects (age 53 ± 13 years, BMI 31 ± 5 kg/m2) referred for polysomnography (PSG) diagnosis of OSA were prospectively and consecutively recruited. The system was trained and tested on 60 subjects. Validation was blindly performed on the additional 30 consecutive subjects. Measurements and Results: AHIEST correlated with AHI (AHIPSG; r2 = 0.81, P < 0.001). Area under the receiver operating characteristic curve of 85% and 92% for thresholds of 10 and 20 events/h, respectively, were obtained for OSA detection. Both Altman-Bland analysis and diagnostic agreement criteria revealed 80% and 83% agreements of AHIEST with AHIPSG, respectively. Conclusions: Acoustic analysis based on intra- and inter-snore properties can differentiate subjects according to AHI. An acoustic-based screening system may address the growing needs for reliable OSA screening tool. Further studies are needed to support these findings. Citation: Ben-Israel N; Tarasiuk A; Zigel Y. Obstructive apnea hypopnea index estimation by analysis of nocturnal snoring signals in adults. SLEEP 2012;35(9):1299–1305. PMID:22942509

  19. 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).

  20. Sodium oxybate and sleep apnea: a clinical case.

    PubMed

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

    2011-12-15

    Sodium oxybate (GHB, Xyrem, Jazz Pharmaceuticals) is used to treat cataplexy in patients with narcolepsy. We report the case of a middle aged, normo-ponderal narcoleptic woman without risk factors who developed reversible sleep apnea and objective sleepiness when treated by sodium oxybate, with an apnea-hypopnea index (AHI) of 19.7 on sodium oxybate and AHI 4.8 without treatment. Despite a subjective improvement in vigilance, mean sleep latency on MWT decreased from 21 minutes to 8 minutes on sodium oxybate.

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

    NASA Astrophysics Data System (ADS)

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

    2009-10-01

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

  2. Loss of sleep spindle frequency deceleration in Obstructive Sleep Apnea.

    PubMed

    Carvalho, Diego Z; Gerhardt, Günther J L; Dellagustin, Guilherme; de Santa-Helena, Emerson L; Lemke, Ney; Segal, Alan Z; Schönwald, Suzana V

    2014-02-01

    Sleep spindles have been suggested as surrogates of thalamo-cortical activity. Internal frequency modulation within a spindle's time frame has been demonstrated in healthy subjects, showing that spindles tend to decelerate their frequency before termination. We investigated internal frequency modulation of slow and fast spindles according to Obstructive Sleep Apnea (OSA) severity and brain topography. Seven non-OSA subjects and 21 patients with OSA contributed with 30min of Non-REM sleep stage 2, subjected to a Matching pursuit procedure with Gabor chirplet functions for automatic detection of sleep spindles and quantification of sleep spindle internal frequency modulation (chirp rate). Moderate OSA patients showed an inferior percentage of slow spindles with deceleration when compared to Mild and Non-OSA groups in frontal and parietal regions. In parietal regions, the percentage of slow spindles with deceleration was negatively correlated with global apnea-hypopnea index (rs=-0.519, p=0.005). Loss of physiological sleep spindle deceleration may either represent a disruption of thalamo-cortical loops generating spindle oscillations or some compensatory mechanism, an interesting venue for future research in the context of cognitive dysfunction in OSA. Quantification of internal frequency modulation (chirp rate) is proposed as a promising approach to advance description of sleep spindle dynamics in brain pathology. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

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

    PubMed

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

    2015-10-01

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

  4. Leptin levels in children with obstructive sleep apnea syndrome.

    PubMed

    Söğüt, Ayhan; Açıkgöz, Şerefden; Uzun, Lokman; Uğur, Mehmet Birol; Altın, Remzi; Dağlı, Elif; Kaditis, Athanasios; Ersu, Refika

    2016-12-01

    The aim of this study is to assess the effect of obstructive sleep apnea syndrome (OSAS) severity on leptin levels in children. Children with habitual snoring underwent overnight polysomnography. Fasting venous blood samples were obtained between 8 AM and 9 AM, following the night of the sleep study. Children with an apnea-hypopnea index of ≥ 5/h were included in the moderate-to-severe OSAS group while those with an apnea-hypopnea index of < 5/h formed the mild OSAS/primary snoring group. 47 children (51% male and 49% female; mean age 7.8 ± 2.6 years) were recruited. Twenty seven participants were diagnosed with moderate-to-severe OSAS, and twenty children who had AHI < 5 were included in the mild OSAS/primary snoring. The two groups did not differ regarding age, gender and body mass index z score (p> 0.05). Furthermore there were no differences in log serum leptin levels (p= 0.749). Log serum leptin levels correlated with the BMI z score in the whole study group (p= 0.001; r= 0.499) but they were not associated with apnea-hypopnea index, mean and lowest oxygen saturation during sleep. Serum leptin levels are affected by adiposity but not by OSAS severity among children with habitual snoring.

  5. Complementary roles of gasotransmitters CO and H2S in sleep apnea.

    PubMed

    Peng, Ying-Jie; Zhang, Xiuli; Gridina, Anna; Chupikova, Irina; McCormick, David L; Thomas, Robert J; Scammell, Thomas E; Kim, Gene; Vasavda, Chirag; Nanduri, Jayasri; Kumar, Ganesh K; Semenza, Gregg L; Snyder, Solomon H; Prabhakar, Nanduri R

    2017-02-07

    Sleep apnea, which is the periodic cessation of breathing during sleep, is a major health problem affecting over 10 million people in the United States and is associated with several sequelae, including hypertension and stroke. Clinical studies suggest that abnormal carotid body (CB) activity may be a driver of sleep apnea. Because gaseous molecules are important determinants of CB activity, aberrations in their signaling could lead to sleep apnea. Here, we report that mice deficient in heme oxygenase-2 (HO-2), which generates the gaseous molecule carbon monoxide (CO), exhibit sleep apnea characterized by high apnea and hypopnea indices during rapid eye movement (REM) sleep. Similar high apnea and hypopnea indices were also noted in prehypertensive spontaneously hypertensive (SH) rats, which are known to exhibit CB hyperactivity. We identified the gaseous molecule hydrogen sulfide (H2S) as the major effector molecule driving apneas. Genetic ablation of the H2S-synthesizing enzyme cystathionine-γ-lyase (CSE) normalized breathing in HO-2(-/-) mice. Pharmacologic inhibition of CSE with l-propargyl glycine prevented apneas in both HO-2(-/-) mice and SH rats. These observations demonstrate that dysregulated CO and H2S signaling in the CB leads to apneas and suggest that CSE inhibition may be a useful therapeutic intervention for preventing CB-driven sleep apnea.

  6. An accelerometer-based device for sleep apnea screening.

    PubMed

    Morillo, Daniel Sánchez; Rojas Ojeda, Juan Luis; Crespo Foix, Luis Felipe; Jiménez, Antonio Léon

    2010-03-01

    This paper presents a body-fixed-sensor-based approach to assess potential sleep apnea patients. A trial involving 15 patients at a sleep unit was undertaken. Vibration sounds were acquired from an accelerometer sensor fixed with a noninvasive mounting on the suprasternal notch of subjects resting in supine position. Respiratory, cardiac, and snoring components were extracted by means of digital signal processing techniques. Mainly, the following biomedical parameters used in new sleep apnea diagnosis strategies were calculated: heart rate, heart rate variability, sympathetic and parasympathetic activity, respiratory rate, snoring rate, pitch associated with snores, and airflow indirect quantification. These parameters were compared to those obtained by means of polysomnography and an accurate microphone. Results demonstrated the feasibility of implementing an accelerometry-based portable device as a simple and cost-effective solution for contributing to the screening of sleep apnea-hypopnea syndrome and other breathing disorders.

  7. [Evaluation of sleep apnea syndromes].

    PubMed

    Poirrier, R

    1993-01-01

    The evaluation of sleep apnea syndrome is based on polysomnography. Different sensor and recording techniques are reported. Some widely used neurophysiological and cardiorespiratory analysis criteria are proposed. Many sleep laboratories develop ambulatory and automatized methods for screening breathing disorders associated with sleep. The main principles of these approaches are briefly reviewed.

  8. Effects of Sleep Apnea on Nocturnal Free Fatty Acids in Subjects with Heart Failure

    PubMed Central

    Jun, Jonathan C.; Drager, Luciano F.; Najjar, Samer S.; Gottlieb, Stephen S.; Brown, Cynthia D.; Smith, Philip L.; Schwartz, Alan R.; Polotsky, Vsevolod Y.

    2011-01-01

    Study Objectives: Sleep apnea is common in patients with congestive heart failure, and may contribute to the progression of underlying heart disease. Cardiovascular and metabolic complications of sleep apnea have been attributed to intermittent hypoxia. Elevated free fatty acids (FFA) are also associated with the progression of metabolic, vascular, and cardiac dysfunction. The objective of this study was to determine the effect of intermittent hypoxia on FFA levels during sleep in patients with heart failure. Design and Interventions: During sleep, frequent blood samples were examined for FFA in patients with stable heart failure (ejection fraction < 40%). In patients with severe sleep apnea (apnea-hypopnea index = 65.5 ± 9.1 events/h; average low SpO2 = 88.9%), FFA levels were compared to controls with milder sleep apnea (apnea-hypopnea index = 15.4 ± 3.7 events/h; average low SpO2 = 93.6%). In patients with severe sleep apnea, supplemental oxygen at 2-4 liters/min was administered on a subsequent night to eliminate hypoxemia. Measurements and Results: Prior to sleep onset, controls and patients with severe apnea exhibited a similar FFA level. After sleep onset, patients with severe sleep apnea exhibited a marked and rapid increase in FFA relative to control subjects. This increase persisted throughout NREM and REM sleep exceeding serum FFA levels in control subjects by 0.134 mmol/L (P = 0.0038). Supplemental oxygen normalized the FFA profile without affecting sleep architecture or respiratory arousal frequency. Conclusion: In patients with heart failure, severe sleep apnea causes surges in nocturnal FFA that may contribute to the accelerated progression of underlying heart disease. Supplemental oxygen prevents the FFA elevation. Citation: Jun JC; Drager LF; Najjar SS; Gottlieb SS; Brown CD; Smith PL; Schwartz AR; Polotsky VY. Effects of sleep apnea on nocturnal free fatty acids in subjects with heart failure. SLEEP 2011;34(9):1207-1213. PMID:21886358

  9. Sleep apnea and cardiovascular disease.

    PubMed

    Logan, Alexander G; Bradley, T Douglas

    2010-06-01

    Cardiovascular disease is still the leading cause of death in North America. To improve outcomes, it will likely be necessary to identify new potentially treatable conditions. Sleep apnea affects approximately 50% of patients with cardiovascular disease and is associated with increased cardiovascular risk. Continuous positive airway pressure is currently the treatment of choice and has many short-term favorable effects. The long-term benefits, however, remain elusive. Further, it may not be the ideal treatment for central sleep apnea, and the benefits of alternatives such adaptive servo-ventilation are currently being tested. Randomized controlled trials are now needed to determine whether treating sleep apnea will improve survival and reduce cardiovascular disease risk. Until better evidence becomes available, testing for sleep apnea cannot be recommended as part of the routine cardiovascular disease risk assessment, nor can its treatment be recommended for the prevention or management of cardiovascular disease in asymptomatic patients.

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

    PubMed

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

    2012-02-01

    Identifying predictors of subjective sleepiness and severity of sleep apnea are important yet challenging goals in sleep medicine. Classification algorithms may provide insights, especially when large data sets are available. We analyzed polysomnography and clinical features available from the Sleep Heart Health Study. The Epworth Sleepiness Scale and the apnea-hypopnea index were the targets of three classifiers: k-nearest neighbor, naive Bayes and support vector machine algorithms. Classification was based on up to 26 features including demographics, polysomnogram, and electrocardiogram (spectrogram). Naive Bayes was best for predicting abnormal Epworth class (0-10 versus 11-24), although prediction was weak: polysomnogram features had 16.7% sensitivity and 88.8% specificity; spectrogram features had 5.3% sensitivity and 96.5% specificity. The support vector machine performed similarly to naive Bayes for predicting sleep apnea class (0-5 versus >5): 59.0% sensitivity and 74.5% specificity using clinical features and 43.4% sensitivity and 83.5% specificity using spectrographic features compared with the naive Bayes classifier, which had 57.5% sensitivity and 73.7% specificity (clinical), and 39.0% sensitivity and 82.7% specificity (spectrogram). Mutual information analysis confirmed the minimal dependency of the Epworth score on any feature, while the apnea-hypopnea index showed modest dependency on body mass index, arousal index, oxygenation and spectrogram features. Apnea classification was modestly accurate, using either clinical or spectrogram features, and showed lower sensitivity and higher specificity than common sleep apnea screening tools. Thus, clinical prediction of sleep apnea may be feasible with easily obtained demographic and electrocardiographic analysis, but the utility of the Epworth is questioned by its minimal relation to clinical, electrocardiographic, or polysomnographic features.

  11. The effect of altitude descent on obstructive sleep apnea.

    PubMed

    Patz, David; Spoon, Mark; Corbin, Richard; Patz, Michael; Dover, Louise; Swihart, Bruce; White, David

    2006-12-01

    The present requirement for "at facility" polysomnograms requires many residents in mountain communities to descend in elevation for sleep testing, which may cause misleading results regarding the severity of obstructive sleep apnea (OSA). Eleven patients with previously undiagnosed sleep apnea living at an altitude > 2,400 m (7,900 feet) in Colorado underwent diagnostic sleep studies at their home elevation and at 1,370 m (4,500 feet), and 5 of the 11 patients were also studied at sea level. The mean (SE) apnea-hypopnea index (AHI) fell from 49.1 (10.5)/h to 37.0 (11.2)/h on descent to 1,370 m (p = 0.022). In the five patients who traveled to sea level, the AHI dropped from 53.8 (13.2)/h at home elevation to 47.1 (14.8)/h at 1,370 m, and to 33.1 (12.6)/h at sea level (p = 0.018). The reduction in AHI was predominantly a reduction in hypopneas and central apneas, with little change in the frequency of obstructive apneas. Duration of the obstructive apneas lengthened with descent. Of eight patients with an AHI < 50/h at their home elevation, two patients had their AHI fall to < 5/h at 1,370 m, and a third patient dropped to < 5/h at sea level, ie, below many physicians' threshold for providing therapy. Patients with the most severe OSA had the least improvement with descent. Because AHI decreases significantly with descent in altitude, polysomnography is most accurately done at the home elevation of the patient. Descent to a sleep laboratory at a lower elevation may yield false-negative results in patients with mild or moderate sleep apnea.

  12. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome.

    PubMed

    Koutsourelakis, Ioannis; Safiruddin, Faiza; Ravesloot, Madeline; Zakynthinos, Spyros; de Vries, Nico

    2012-11-01

    Although drug-induced sleep endoscopy is often employed to determine the site of obstruction in patients with obstructive sleep apnea (OSA) who will undergo upper airway surgery, it remains unknown whether its findings are associated with surgical outcome. This study tested the hypothesis that drug-induced sleep endoscopy variables can predict the outcome of upper airway surgery in OSA patients. Case series retrospective analysis. Forty-nine OSA patients (41 male; mean apnea-hypopnea index [AHI] 30.9 ± 18.5 events/hour) underwent propofol-induced sleep endoscopy followed by upper airway surgery (palatal surgery, and/or radiofrequency ablation of the tongue base, and/or hyoid suspension) and subsequently a follow-up polysomnography to assess surgical outcome. Twenty-three patients (47%) were responders, and twenty-nine were nonresponders (53%). Nonresponders had a higher occurrence of complete or partial circumferential collapse at velum and complete antero-posterior collapse at tongue base or epiglottis in comparison with responders. Multivariate logistic regression analysis revealed that among baseline clinical and polysomnographic characteristics (e.g., AHI, body mass index) and sleep endoscopy findings, the presence of complete circumferential collapse at velum, and of complete antero-posterior collapse at tongue base were the only independent predictors of upper airway surgery failure. Drug-induced sleep endoscopy can be used to predict higher likelihood of response to upper airway surgery in OSA. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  13. Elimination of Drifts in Long-Duration Monitoring for Apnea-Hypopnea of Human Respiration

    PubMed Central

    Jiang, Peng; Zhu, Rong

    2016-01-01

    This paper reports a methodology to eliminate an uncertain baseline drift in respiratory monitoring using a thermal airflow sensor exposed in a high humidity environment. Human respiratory airflow usually contains a large amount of moisture (relative humidity, RH > 85%). Water vapors in breathing air condense gradually on the surface of the sensor so as to form a thin water film that leads to a significant sensor drift in long-duration respiratory monitoring. The water film is formed by a combination of condensation and evaporation, and therefore the behavior of the humidity drift is complicated. Fortunately, the exhale and inhale responses of the sensor exhibit distinguishing features that are different from the humidity drift. Using a wavelet analysis method, we removed the baseline drift of the sensor and successfully recovered the respiratory waveform. Finally, we extracted apnea-hypopnea events from the respiratory signals monitored in whole-night sleeps of patients and compared them with golden standard polysomnography (PSG) results. PMID:27792151

  14. Obstructive Sleep Apnea in Adults: The Role of Upper Airway and Facial Skeletal Surgery.

    PubMed

    Garg, Ravi K; Afifi, Ahmed M; Sanchez, Ruston; King, Timothy W

    2016-10-01

    Obstructive sleep apnea represents a large burden of disease to the general population and may compromise patient quality of life; workplace and automotive safety; and metabolic, cardiovascular, and neurocognitive health. The disease is characterized by repetitive cycles of upper airway collapse resulting from a lack of pharyngeal airway structural support and loss of muscle tone among upper airway dilators. Polysomnography serves as the gold standard for diagnosis of obstructive sleep apnea and the apnea-hypopnea index is the most commonly used metric for quantifying disease severity. Conservative treatments include lifestyle modification, continuous positive airway pressure treatment, and dental appliance therapy. Surgical treatment options include pharyngeal and facial skeletal surgery. Maxillomandibular advancement has been shown to be the most effective surgical approach for multilevel expansion of the upper airway and may significantly reduce an obstructive sleep apnea patient's apnea-hypopnea index. Patient age, obesity, and the degree of maxillary advancement may be key factors contributing to treatment success.

  15. Obstructive sleep apnea in patients with inflammatory myopathies.

    PubMed

    Selva-O'Callaghan, Albert; Sampol, Gabriel; Romero, Odile; Lloberes, Patricia; Trallero-Araguás, Ernesto; Vilardell-Tarrés, Miquel

    2009-02-01

    The purpose of this study was to determine the frequency of obstructive sleep apnea in patients with inflammatory myopathy. An observational and prospective study was performed on a cohort of adult patients with inflammatory myopathy followed at a specialized outpatient clinic. Sixteen consecutive adult patients were evaluated by the Epworth Sleepiness Scale (ESS) and by complete polysomnography study. Disease activity and severity were assessed using the Myositis Disease Activity Assessment Tool (MDAAT) and Myositis Damage Index (MDI), respectively. Associations between sleep parameters and other factors were calculated using the chi-square test, Fisher's exact test, Mann-Whitney U-test, and Wilcoxon's test. A serum autoantibody profile was determined for all patients. The mean apnea-hypopnea index was 28.7 (23.8), and 14 patients (87%) had an apnea-hypopnea index >5. The mean frequency of respiratory arousals was 20.1 (12.5). Eleven (68%) patients reported frequently-always snoring, and 3 (19%) had excessive daytime sleepiness (ESS >10). Seven patients were offered continuous positive airway pressure (CPAP) therapy; 4 tolerated the procedure well and reported a clear improvement in daytime sleepiness and/or sleep quality. No significant association was observed between the apnea-hypopnea index and clinical or immunological groups. Dysphagia, disease activity, and disease severity were not significantly associated with any sleep parameters. The frequency of obstructive sleep apnea in adult patients with inflammatory myopathy is high. The possibility that these alterations play a role in persistent fatigue in these patients cannot be ruled out.

  16. Mallampati Score and Pediatric Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

    Rationale: Pediatric obstructive sleep apnea (OSA) is common, and a delay in diagnosis can lead to significant morbidity. Polysomnography (PSG) is the gold standard for the diagnosis of OSA. However, difficulty accessing PSG due to the relative shortage of sleep centers with pediatric expertise can lead to a delay in the diagnosis and management of OSA. Objectives: To assess the utility of Mallampati score (sitting and supine) in predicting the presence and severity of OSA in children. Methods: A retrospective study of 158 children from a single pediatric sleep center. All patients had a PSG and a physical examination documenting Mallampati score. The Mallampati score, tonsillar size, age, sex, and apnea hypopnea index (AHI) were analyzed. Odds ratio of having pediatric OSA (AHI > 1) with increase in Mallampati score and tonsillar size were calculated. Measurements and Main Results: A significant correlation was found between Mallampati score, tonsillar size, and AHI. For every point increase in the Mallampati score, the odds ratio of having OSA increased by more than 6-fold. For every point increase in tonsillar size, the odds ratio of having OSA increased by more than 2-fold. Conclusions: Mallampati score and tonsillar size are independent predictors of OSA. Oral examination including Mallampati score and tonsillar size should be considered when evaluating a patient for OSA. They can be used to prioritize children who may need PSG. Citation: Kumar HVM, Schroeder JW Jr, Gang Z, Sheldon SH. Mallampati score and pediatric obstructive sleep apnea. J Clin Sleep Med 2014;10(9):985-990. PMID:25142764

  17. Obstructive sleep apnea syndrome accompanied by diabetes mellitus.

    PubMed

    Nagai, Takashi; Imamura, Makoto; Iwasaki, Yasuki; Mori, Masatomo

    2003-01-01

    A 66-year-old man with diabetes mellitus was hospitalized with sleeping and dyspnea. Polysomnography determined an apnea hypopneas index (AHI) of 56/hr and that the events occurred in association with continued diaphragm electromyogram activity and thoraco-abdominal wall movement. Obstructive sleep apnea syndrome was then diagnosed and nasal continuous positive airway pressure (nCPAP) (11cmH2O) was set. AHI subsequently became 21/hr. Six months' later, uvulopalatopharyngoplasty (UPPP) for the narrowing middle pharynx was performed and the AHI became 7/hr. After starting nCPAP and UPPP, body weight and insulin resistance had decreased. Treatment for sleep apnea may improve insulin resistance in diabetes mellitus.

  18. Improving Activity in Adults with Diabetes and Coexisting Obstructive Sleep Apnea

    PubMed Central

    Chasens, Eileen R.; Korytkowski, Mary; Sereika, Susan M.; Burke, Lora E.; Drumheller, Oliver J.; Strollo, Patrick J.

    2014-01-01

    This study in participants with type 2 diabetes and obstructive sleep apnea evaluated changes in activity, sleep quality and daytime sleepiness after 4 weeks of continuous positive airway pressure (CPAP). This pilot study was a double-blind, randomized, placebo-controlled trial. Sleep apnea was quantified with an overnight sleep study. Sleep quality was measured by the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, vigor and fatigue with the Profiles of Mood States, subjective activity with the Functional Outcomes of Sleep Questionnaire, and objective activity with the Bodymedia SenseWear Armband™. Subjects were randomized to either continuous positive airway pressure (n=12) or a sham-devices (n=11). The intervention group had reduced apneas and hypopneas, daytime sleepiness and fatigue; they also had improved sleep quality, increased objective activity, and vigor. The study suggested that treatment of obstructive sleep apnea results in a modest improvement of activity in persons with type 2 diabetes. PMID:23976778

  19. Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea.

    PubMed

    Chen, Hui; Lowe, Alan A; Bai, Yuxing; Hamilton, Peter; Fleetham, John A; Almeida, Fernanda R

    2009-08-01

    This study was designed to assess the sensitivity and specificity of a portable sleep apnea recording device (ApneaLink) using standard polysomnography (PSG) as a reference and to evaluate the possibility of using the ApneaLink as a case selection technique for patients with suspected obstructive sleep apnea (OSA). Fifty patients (mean age 48.7 +/- 12.6 years, 32 males) were recruited during a 4-week period. A simultaneous recording of both the standard in-laboratory PSG and an ambulatory level 4 sleep monitor (ApneaLink) was performed during an overnight study for each patient. PSG sleep and respiratory events were scored manually according to standard criteria. ApneaLink data were analyzed either with the automated computerized algorithm provided by the manufacturer following the American Academy of Sleep Medicine standards (default setting DFAL) or The University of British Columbia Hospital sleep laboratory standards (alternative setting, ATAL). The ApneaLink respiratory disturbance indices (RDI), PSG apnea-hypopnea indices (AHI), and PSG oxygen desaturation index (ODI) were compared. The mean PSG-AHI was 30.0 +/- 25.8 events per hour. The means of DFAL-RDI and ATAL-RDI were 23.8 +/- 21.9 events per hour and 29.5 +/- 22.2 events per hour, respectively. Intraclass correlation coefficients were 0.958 between PSG-AHI and DFAL-RDI and 0.966 between PSG-AHI and ATAL-RDI. Receiver operator characteristic curves were constructed using a variety of PSG-AHI cutoff values (5, 10, 15, 20, and 30 events per hour). Optimal combinations of sensitivity and specificity for the various cutoffs were 97.7/66.7, 95.0/90.0, 87.5/88.9, 88.0/88.0, and 88.2/93.9, respectively for the default setting. The ApneaLink demonstrated the best agreement with laboratory PSG data at cutoffs of AHI >or= 10. There were no significant differences among PSG-AHI, DFAL-RDI, and ATAL-RDI when all subjects were considered as one group. ODI at 2%, 3%, and 4% desaturation levels showed significant

  20. Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome.

    PubMed

    Iriarte, Jorge; Murie-Fernandez, Manuel; Toledo, Estefania; Urrestarazu, Elena; Alegre, Manuel; Viteri, Cesar; Salvador, Javier; Baptista, Peter; Alcaide, Belen; Artieda, Julio

    2009-08-01

    Periodic limb movements (PLM) and obstructive sleep apnea syndrome (OSAS) are two frequent sleep disorders which often occur in the same patient. The goal of this study was to know the influence of the presence of PLM in the sleep architecture in patients with and without OSAS. Two hundred twenty consecutive patients (69 women and 151 men) participated in this transversal study. They were patients with clinical suspicion of dysomnia, including snoring, OSAS, and PLM. All of them underwent a full polysomnography and were interviewed using questionnaires about the sleep quality. The sleep parameters (percentage of sleep stages, rapid eye movement latency, sleep efficiency, awakenings, PLM presence, apnea-hypopnea index) were calculated and compared between groups. Descriptive statistics and nonparametric distribution techniques were used for the analysis. Patients with PLM when compared with patients with OSAS had lower sleep efficiency and less rapid eye movement percentage. The presence of PLM in patients with sleep apnea was less relevant being responsible only for an increase in the rapid eye movement latency and a decrease in the duration of the three to four sleep stages. However, the presence of OSAS was related to a better sleep efficiency (patients with PLM plus OSAS had a better sleep efficiency than patients with only PLM). PLM alters the structure of sleep. In patients with sleep apnea, the presence of PLM is less relevant.

  1. [Sleep apnea syndrome in patients with cardiac disease].

    PubMed

    Fujita, Kazumi; Wada, Yuka; Aono, Takuya; Sugi, Gosuke; Ohta, Noriaki; Sueda, Shozo; Nomoto, Takahiko; Oshita, Akira

    2008-09-01

    We examined the incidence of sleep-apnea syndrome (SAS; 5 or more episodes of apnea/hypopnea in 1 hour) in 213 patients (152 male, 67.8 +/- 10.9 years) with various cardiac diseases by a modified sleep polygraph (morpheus; Teijin Pharma, Tokyo) from July 2005 to April 2007. Mild sleep disturbance was defined as 5< or = AHI<20, moderate sleep disturbance as 20< or = AHI<40, and severe sleep disturbance as 40< or = AHI. SAS was seen in 87.3% of the patients. This high incidence sharply contrasts with 7.5% reported in factory workers in Japan. Body mass index, though significant, was scarcely correlated with the severity of SAS (p<0.01). As sleep disturbance became severe, the proportion of an obstructive, central, and eventually mixed obstructive-central SAS increased. Although the overall severity was not different between different categories of cardiac diseases, obstructive-central SAS was seen far more frequent in congestive heart failure. Hypertension was closely associated with apnea/hypopnea. A tight correlation between SAS and various cardiac diseases was suggested.

  2. Tongue Fat and its Relationship to Obstructive Sleep Apnea

    PubMed Central

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

    2014-01-01

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

  3. The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea.

    PubMed

    Butler, Matthew P; Smales, Carolina; Wu, Huijuan; Hussain, Mohammad V; Mohamed, Yusef A; Morimoto, Miki; Shea, Steven A

    2015-11-01

    To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. Within-subject and between-subjects. Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital. Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males. Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period. Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night. The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea. © 2015 Associated Professional Sleep Societies, LLC.

  4. Sleep Apnea and Heart Disease, Stroke

    MedlinePlus

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Sleep Apnea and Heart Disease, Stroke Updated:Mar 14, ... be life-threatening. It’s a condition known as sleep apnea, in which the person may experience pauses ...

  5. HHT based cardiopulmonary coupling analysis for sleep apnea detection.

    PubMed

    Liu, Dongdong; Yang, Xiaochen; Wang, Guangfa; Ma, Jing; Liu, Yanhui; Peng, Chung-Kang; Zhang, Jue; Fang, Jing

    2012-05-01

    To validate the feasibility of the Hilbert-Huang transform (HHT) based cardiopulmonary coupling (CPC) technique in respiratory events detection and estimation of the severity of apnea/hypopnea. The HHT-CPC sleep spectrogram technique was applied to a total of 69 single-lead ECG signals downloaded from the Physionet Sleep Apnea Database. Sleep spectrograms generated by both the original and the improved CPC method were compared on the structure distribution and time-frequency resolution. The performance of respiratory events detection by using the power of low frequency coupling (pLFC) in the new method was estimated by receiver operating characteristic analysis. Furthermore, correlation between HHT-CPC index (temporal Variability of Dominant Frequency, TVDF) and conventional OSAHS scoring was computed. The HHT-CPC spectrum provides much finer temporal resolution and frequency resolution (8 s and 0.001 Hz) compared with the original CPC (8.5 min and 0.004 Hz). The area under the ROC curve of pLFC was 0.79 in distinguishing respiratory events from normal breathing. Significant differences were found in TVDF among groups with different severities of OSAHS (normal, mild, moderate, and severe, p<0.001). TVDF has a strong negative correlation with the apnea/hypopnea index (AHI, correlation coefficient -0.71). The HHT-CPC spectrum could exhibit more detailed temporal-frequency information about cardiopulmonary coupling during sleep. As two spectrographic markers, pLFC and TVDF can be used to identify respiratory events and represent the disruption extent of sleep architecture in patients with sleep apnea/hypopnea, respectively. The proposed technique might serve as a complementary approach to enhance diagnostic efforts. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Comparison of full-night and ambulatory polysomnography with ApneaGraph in the subjects with obstructive sleep apnea syndrome.

    PubMed

    Karaloğlu, Furkan; Kemaloğlu, Yusuf K; Yilmaz, Metin; Ulukavak Çiftçi, Tansu; Çiftçi, Bülent; Bakkal, Faruk K

    2017-01-01

    The localization of the obstruction is crucial in determining the appropriate surgical treatment for obstructive sleep apnea syndrome (OSAS); ApneaGraph has been introduced for diagnosis of OSAS and localization of airway obstruction level. This study aims to evaluate the diagnostic value of ApneaGraph for both clinical staging and site of obstruction. Thirty male OSAS patients were prospectively enrolled in this clinical trial. The following parameter were included to the study: Body mass indexes and neck circumferences of the subjects, Epworth sleepiness scale, site of obstruction detected by flexible endoscopy and ApneaGraph, apnea hypopnea index (AHI), apnea index, hypopnea index, maximal oxygen desaturation and average oxygen saturation which were detected by both polysomnography (PSG) and ApneaGraph devices. Our data presented that, although AHI measured by ApneaGraph and PSG were significantly correlated; severity stages of the subjects were different in 44 % of the subjects when based on AHI of ApneaGraph, compared to PSG. Majority of the changes were from severe OSAS to mild or moderate levels. Similar dominant collapse levels were detected in 64 % of the subjects by both devices. It was seen that transpalatal obstruction was better correlated between ApneaGraph and flexible endoscopy. As a conclusion, we might assume that ApneaGraph can be used as a screener for OSAS and it appears to be a more reliable device to confirm dominancy of palatal level obstruction.

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

    PubMed Central

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

    2012-01-01

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

  8. The prevalence and characteristics of obstructive sleep apnea in hospitalized patients with type 2 diabetes in China.

    PubMed

    Zhang, Puhong; Zhang, Rui; Zhao, Fang; Heeley, Emma; Chai-Coetzer, Ching L; Liu, Jing; Jing, Bo; Han, Ping; Li, Qifu; Sun, Liao; Li, Yufeng; Dong, Shengying; Jiang, Xiaozhen; Zhang, Chunhua; Lu, Jinhui; Guo, Xingduan; Guo, Lixin; Mcevoy, R Doug; Ji, Linong

    2016-02-01

    Data on the prevalence of obstructive sleep apnea in subjects with type 2 diabetes mellitus in China is scarce. We conducted a multi-centre, cross-sectional study involving 12 hospitals from six regional cities to investigate the prevalence of obstructive sleep apnea in hospitalized patients with type 2 diabetes mellitus and to explore the association between obstructive sleep apnea and related risk factors, diabetic complications and comorbidities in China. Each hospital recruited at least 70 consecutive patients with type 2 diabetes mellitus who were admitted to the endocrinology ward. A total of 880 participants were enrolled and administered overnight sleep monitoring with a portable monitor (ApneaLink™, ResMed, San Diego, CA, USA); other information was collected from medical charts and a standardized questionnaire. In this study, 60.0% (95% confidence interval: 56.8%, 63.2%) of hospitalized patients in China with type 2 diabetes mellitus had comorbid obstructive sleep apnea (apnea-hypopnea index ≥ 5). Only 1.5% (eight of 528) of the patients with both conditions had been diagnosed previously with obstructive sleep apnea. The prevalence of moderate-severe (apnea-hypopnea index ≥ 15) and severe obstructive sleep apnea (apnea-hypopnea index ≥ 30) was estimated to be 25.6% (22.7, 28.5%) and 10.3% (8.3, 12.4%), respectively. Age, sex, body mass index, snoring, reported breath-holding in sleep or gasping or choking arousal, sleepiness, diabetes duration, hypertension, diabetic nephropathy and cardiovascular diseases history were correlated significantly with the severity of obstructive sleep apnea. In China, the prevalence of obstructive sleep apnea in hospitalized patients with type 2 diabetes mellitus is high. Routine screening for and treatment of obstructive sleep apnea is an important, but often neglected, part of the management of diabetes.

  9. The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea

    PubMed Central

    Butler, Matthew P.; Smales, Carolina; Wu, Huijuan; Hussain, Mohammad V.; Mohamed, Yusef A.; Morimoto, Miki; Shea, Steven A.

    2015-01-01

    Study Objective: To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. Design: Within-subject and between-subjects. Settings: Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital. Participants: Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males. Interventions: Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period. Measurements and Results: Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night. Conclusions: The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea. Citation: Butler MP, Smales C, Wu H, Hussain MV, Mohamed YA, Morimoto M, Shea SA. The circadian system contributes to apnea lengthening across the night in obstructive sleep apnea. SLEEP 2015;38(11):1793–1801. PMID:26039970

  10. 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

  11. Upper-airway stimulation for obstructive sleep apnea.

    PubMed

    Strollo, Patrick J; Soose, Ryan J; Maurer, Joachim T; de Vries, Nico; Cornelius, Jason; Froymovich, Oleg; Hanson, Ronald D; Padhya, Tapan A; Steward, David L; Gillespie, M Boyd; Woodson, B Tucker; Van de Heyning, Paul H; Goetting, Mark G; Vanderveken, Oliver M; Feldman, Neil; Knaack, Lennart; Strohl, Kingman P

    2014-01-09

    Obstructive sleep apnea is associated with considerable health risks. Although continuous positive airway pressure (CPAP) can mitigate these risks, effectiveness can be reduced by inadequate adherence to treatment. We evaluated the clinical safety and effectiveness of upper-airway stimulation at 12 months for the treatment of moderate-to-severe obstructive sleep apnea. Using a multicenter, prospective, single-group, cohort design, we surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty either accepting or adhering to CPAP therapy. The primary outcome measures were the apnea-hypopnea index (AHI; the number of apnea or hypopnea events per hour, with a score of ≥15 indicating moderate-to-severe apnea) and the oxygen desaturation index (ODI; the number of times per hour of sleep that the blood oxygen level drops by ≥4 percentage points from baseline). Secondary outcome measures were the Epworth Sleepiness Scale, the Functional Outcomes of Sleep Questionnaire (FOSQ), and the percentage of sleep time with the oxygen saturation less than 90%. Consecutive participants with a response were included in a randomized, controlled therapy-withdrawal trial. The study included 126 participants; 83% were men. The mean age was 54.5 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 28.4. The median AHI score at 12 months decreased 68%, from 29.3 events per hour to 9.0 events per hour (P<0.001); the ODI score decreased 70%, from 25.4 events per hour to 7.4 events per hour (P<0.001). Secondary outcome measures showed a reduction in the effects of sleep apnea and improved quality of life. In the randomized phase, the mean AHI score did not differ significantly from the 12-month score in the nonrandomized phase among the 23 participants in the therapy-maintenance group (8.9 and 7.2 events per hour, respectively); the AHI score was significantly higher

  12. Utility of screening for obstructive sleep apnea syndrome in children with craniofacial disorders.

    PubMed

    Cielo, Christopher M; Silvestre, Jason; Paliga, J Thomas; Maguire, Meg; Gallagher, Paul R; Marcus, Carole L; Taylor, Jesse A

    2014-09-01

    Children with craniofacial disorders are at increased risk for obstructive sleep apnea syndrome. Methods for diagnosing obstructive sleep apnea syndrome in this population remain controversial. Sleep studies are the criterion standard but are impractical for all patients. The utility of obstructive sleep apnea syndrome questionnaires such as the Pediatric Sleep Questionnaire is unknown in children with craniofacial disorders. The authors hypothesized that the Pediatric Sleep Questionnaire would be a sensitive tool for detecting obstructive sleep apnea syndrome in children with craniofacial abnormalities. A retrospective review of consecutive children with diagnosed craniofacial disorders who both completed the Pediatric Sleep Questionnaire and underwent polysomnography was performed. Demographics, Pediatric Sleep Questionnaire score, and polysomnographic data were recorded. Statistical analysis included calculation of sensitivity, specificity, positive predictive value, and negative predictive value for the Pediatric Sleep Questionnaire. Eighty-three children aged 2 to 18 years were included in the study. Of these, 44 (53.0 percent) screened positive on the Pediatric Sleep Questionnaire and 23 (27.7 percent) had polysomnographic evidence of obstructive sleep apnea syndrome, but the sensitivity of the Pediatric Sleep Questionnaire for detecting obstructive sleep apnea syndrome in this sample was only 0.57 and the specificity was 0.48. Positive predictive value and negative predictive value were 0.30 and 0.74, respectively. The correlation between the apnea hypopnea index and Pediatric Sleep Questionnaire score was 0.152 (p = 0.17). A substantial portion of craniofacial patients referred for polysomnography was found to have obstructive sleep apnea syndrome. However, the Pediatric Sleep Questionnaire is not a good screening tool for obstructive sleep apnea syndrome in children with craniofacial conditions. More research is needed to determine which patients with

  13. Accuracy of positive airway pressure device-measured apneas and hypopneas: role in treatment followup.

    PubMed

    Stepnowsky, Carl; Zamora, Tania; Barker, Robert; Liu, Lin; Sarmiento, Kathleen

    2013-01-01

    Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP) devices in the home environment. Although clinicians' treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. "PAP efficacy" studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO), which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA) via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI) was 14.2 ± 11.8 (median: 11.7; range: 3.9-46.3) and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2-39.3). Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring.

  14. Classification algorithms for predicting sleepiness and sleep apnea severity

    PubMed Central

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

    2013-01-01

    SUMMARY Identifying predictors of subjective sleepiness and severity of sleep apnea are important yet challenging goals in sleep medicine. Classification algorithms may provide insights, especially when large data sets are available. We analyzed polysomnography and clinical features available from the Sleep Heart Health Study. The Epworth Sleepiness Scale and the apnea–hypopnea index were the targets of three classifiers: k-nearest neighbor, naive Bayes and support vector machine algorithms. Classification was based on up to 26 features including demographics, polysomnogram, and electrocardiogram (spectrogram). Naive Bayes was best for predicting abnormal Epworth class (0–10 versus 11–24), although prediction was weak: polysomnogram features had 16.7% sensitivity and 88.8% specificity; spectrogram features had 5.3% sensitivity and 96.5% specificity. The support vector machine performed similarly to naive Bayes for predicting sleep apnea class (0–5 versus >5): 59.0% sensitivity and 74.5% specificity using clinical features and 43.4% sensitivity and 83.5% specificity using spectrographic features compared with the naive Bayes classifier, which had 57.5% sensitivity and 73.7% specificity (clinical), and 39.0% sensitivity and 82.7% specificity (spectrogram). Mutual information analysis confirmed the minimal dependency of the Epworth score on any feature, while the apnea–hypopnea index showed modest dependency on body mass index, arousal index, oxygenation and spectrogram features. Apnea classification was modestly accurate, using either clinical or spectrogram features, and showed lower sensitivity and higher specificity than common sleep apnea screening tools. Thus, clinical prediction of sleep apnea may be feasible with easily obtained demographic and electrocardiographic analysis, but the utility of the Epworth is questioned by its minimal relation to clinical, electrocardiographic, or polysomnographic features. PMID:21752133

  15. Severity of nocturnal cardiac arrhythmias correlates with intensity of sleep apnea in men.

    PubMed

    Szaboova, E; Holoubek, D; Tomori, Z; Szabo, P; Donic, V; Stancak, B

    2013-01-01

    Various cardiac arrhythmias frequently occur in patients with sleep apnea, but complex analysis of the relationship between their severity and the probable arrhythmogenic risk factors is conflicting. The question is what cardiovascular risk factors and how strongly they are associated with the severity of cardiac arrhythmias in sleep apnea. Adult males (33 with and 16 without sleep apnea), matched for cardiovascular co-morbidity were studied by polysomnography with simultaneous ECG monitoring. Arrhythmia severity was evaluated for each subject by a special 7-degree scoring system. Laboratory, clinical, echocardiographic, carotid ultrasonographic, ambulatory blood pressure, and baroreflex sensitivity values were also assessed. Moderate sleep apnea patients had benign, but more exaggerated cardiac arrhythmias than control subjects (2.53 ± 2.49 vs. 1.13 ± 1.64 degrees of cumulative severity, p < 0.05). We confirmed strong correlations between the arrhythmia severity and known arrhythmogenic risk factors (left ventricular ejection fraction and dimensions, right ventricular diameter, baroreflex sensitivity, carotid intima-media thickness, age, previous myocardial infarction, and also apnea-hypopnea index). In multivariate modelling only the apnea-hypopnea index indicating the sleep apnea intensity remained highly significantly correlated with the cumulative arrhythmia severity (beta = 0.548, p < 0.005). In conclusion, sleep apnea modifying cardiovascular risk factors and structures or functions provoked various nocturnal arrhythmias. The proposed scoring system allowed a complex analysis of the contribution of various triggers to arrhythmogenesis and confirmed the apnea-hypopnea index as an independent risk for nocturnal cardiac arrhythmia severity in sleep apnea.

  16. [Obstructive sleep apnea syndrome in the elderly].

    PubMed

    Ketata, W; Feki, W; Yangui, I; Msaad, S; Ayoub, A

    2014-08-01

    Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a common disease in the general population. However, original works on the SAHS in the elderly are few and their results are discordant. Studies show an increased prevalence of OSAHS with age, and despite this high prevalence, it remains under-diagnosed due to lack of knowledge of geriatric features of this disease and the frequency of comorbidities that may worsen as a result of nocturnal breathing problems but can also mask the symptoms necessary for positive diagnosis. The functional symptoms are dominated by neurological signs such as daytime hypersomnia and cognitive impairment often reported by those around the patient. The treatment is based mainly on continuous positive airway pressure which tolerance in elderly patients suffering from sleep apnea is similar to that of younger patients. Mandibular implants can be discussed depending on the severity of the condition. Surgical treatment is not indicated because of the increased frequency of complications. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  17. Facial morphology and obstructive sleep apnea

    PubMed Central

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

    2015-01-01

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

  18. Brain Structural Changes in Obstructive Sleep Apnea

    PubMed Central

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

    2008-01-01

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

  19. Obstructive Sleep Apnea in Infants

    PubMed Central

    Mitchell, Ron B.; D'Ambrosio, Carolyn M.

    2012-01-01

    Obstructive sleep apnea in infants has a distinctive pathophysiology, natural history, and treatment compared with that of older children and adults. Infants have both anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities; including a superiorly placed larynx, increased chest wall compliance, ventilation–perfusion mismatching, and ventilatory control instability. Congenital abnormalities of the airway, such as laryngomalacia, hemangiomas, pyriform aperture stenosis, choanal atresia, and laryngeal webs, may also have adverse effects on airway patency. Additional exacerbating factors predisposing infants toward airway collapse include neck flexion, airway secretions, gastroesophageal reflux, and sleep deprivation. Obstructive sleep apnea in infants has been associated with failure to thrive, behavioral deficits, and sudden infant death. The proper interpretation of infant polysomnography requires an understanding of normative data related to gestation and postconceptual age for apnea, arousal, and oxygenation. Direct visualization of the upper airway is an important diagnostic modality in infants with obstructive apnea. Treatment options for infant obstructive sleep apnea are predicated on the underlying etiology, including supraglottoplasty for severe laryngomalacia, mandibular distraction for micrognathia, tonsillectomy and/or adenoidectomy, choanal atresia repair, and/or treatment of gastroesophageal reflux. PMID:22135346

  20. Sleep apnea and REM sleep behavior disorder in patients with Chiari malformations.

    PubMed

    Henriques-Filho, Paulo Sérgio A; Pratesi, Riccardo

    2008-06-01

    Chiari malformations (CM) may result in the appearance of REM sleep behavior disorder (RBD) and sleep apnea syndrome (SAS) that can be considered markers of brain stem dysfunction. To evaluate the frequency of RBD and SAS in patients with CM type I and II. Were evaluated 103 patients with CM by means of full night polysomnography. Were scoring different sleep stages, frequency of abnormal movements (through video monitoring) and abnormal respiratory events. Of the 103 patients, 36 showed CM type I and 67 CM type II. Episodes of RBD were observed in 23 patients. Abnormal apnea-hypopnea index (AHI) was observed in 65 patients. The high rate of RBD suggests that this parassomnia and the increased frequency of central sleep apnea episodes, may be considered as a marker of progressive brain stem dysfunction.

  1. Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable Monitoring

    PubMed Central

    Prasad, Bharati; Usmani, Sarah; Steffen, Alana D.; Van Dongen, Hans P.A.; Pack, Francis M.; Strakovsky, Inna; Staley, Bethany; Dinges, David; Maislin, Greg; Pack, Allan I.; Weaver, Terri E.

    2016-01-01

    Study Objectives: Apnea-hypopnea index (AHI) is the primary measure used to confirm a diagnosis of obstructive sleep apnea (OSA). However, there may be significant night-to-night variability (NNV) in AHI, limiting the value of AHI in clinical decision-making related to OSA management. We examined short-term NNV in AHI and its predictors during home portable monitoring (PM). Methods: Single center prospective observational study of patients (n = 84) with newly diagnosed OSA by polysomnography (PSG) AHI ≥ 5/h. All participants underwent 2 to 8 consecutive nights of PM. Results: Participants (n = 84) were middle-aged (47 ± 8.3 y, mean ± standard deviation; SD), including 28 women, with mean AHI on baseline PSG (AHIPSG) of 30.1 ± 31.8. Mean AHI on PM (AHIPM) was 27.4 ± 23.7. Intraclass correlation coefficient (ICC) for AHIPM in the entire sample was 0.73 (95% CI 0.66–0.8), indicating that 27% of the variability in AHIPM was due to intra-individual factors. Mild severity of OSA, defined by AHIPSG 5–15/h, was associated with higher NNV (likelihood ratio, −0.4 ± 0.14; p = 0.006) and absence of comorbidity showed a trend towards higher NNV (−0.54 ± 0.27, p = 0.05) on AHIPM. Conclusions: The intraindividual short-term NNV in AHIPM is higher in mild versus moderately severe OSA, even in the home setting, where first-night effect is not expected. Larger studies of NNV focused on patients with mild OSA are needed to identify characteristics that predict need and timing for repeated diagnostic testing and treatment. Commentary: A commentary on this article appears in this issue on page 787. Citation: Prasad B, Usmani S, Steffen AD, Van Dongen HP, Pack FM, Strakovsky I, Staley B, Dinges D, Maislin G, Pack AI, Weaver TE. Short-term variability in apnea-hypopnea index during extended home portable monitoring. J Clin Sleep Med 2016;12(6):855–863. PMID:26857059

  2. Diagnostic accuracy of a mathematical model to predict apnea-hypopnea index using nighttime pulse oximetry

    NASA Astrophysics Data System (ADS)

    Ebben, Matthew R.; Krieger, Ana C.

    2016-03-01

    The intent of this study is to develop a predictive model to convert an oxygen desaturation index (ODI) to an apnea-hypopnea index (AHI). This model will then be compared to actual AHI to determine its precision. One thousand four hundred and sixty-seven subjects given polysomnograms with concurrent pulse oximetry between April 14, 2010, and February 7, 2012, were divided into model development (n=733) and verification groups (n=734) in order to develop a predictive model of AHI using ODI. Quadratic regression was used for model development. The coefficient of determination (r2) between the actual AHI and the predicted AHI (PredAHI) was 0.80 (r=0.90), which was significant at a p<0.001. The areas under the receiver operating characteristic curve ranged from 0.96 for AHI thresholds of ≥10 and ≥15/h to 0.97 for thresholds of ≥5 and ≥30/h. The algorithm described in this paper provides a convenient and accurate way to convert ODI to a predicted AHI. This tool makes it easier for clinicians to understand oximetry data in the context of traditional measures of sleep apnea.

  3. Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis

    PubMed Central

    Filiatrault, Marie-Lou; Chauny, Jean-Marc; Daoust, Raoul; Roy, Marie-Pier; Denis, Ronald; Lavigne, Gilles

    2016-01-01

    Study Objective: Opioids are associated with higher risk for ataxic breathing and sleep apnea. We conducted a systematic literature review and meta-analysis to assess the influence of long-term opioid use on the apnea-hypopnea and central apnea indices (AHI and CAI, respectively). Methods: A systematic review protocol (Cochrane Handbook guidelines) was developed for the search and analysis. We searched Embase, Medline, ACP Journal Club, and Cochrane Database up to November 2014 for three topics: (1) narcotics, (2) sleep apnea, and (3) apnea-hypopnea index. The outcome of interest was the variation in AHI and CAI in opioid users versus non-users. Two reviewers performed the data search and extraction, and disagreements were resolved by discussion. Results were combined by standardized mean difference using a random effect model, and heterogeneity was tested by χ2 and presented as I2 statistics. Results: Seven studies met the inclusion criteria, for a total of 803 patients with obstructive sleep apnea (OSA). We compared 2 outcomes: AHI (320 opioid users and 483 non-users) and 790 patients with CAI (315 opioid users and 475 non-users). The absolute effect size for opioid use was a small increased in apnea measured by AHI = 0.25 (95% CI: 0.02–0.49) and a medium for CAI = 0.45 (95% CI: 0.27–0.63). Effect consistency across studies was calculated, showing moderate heterogeneity at I2 = 59% and 29% for AHI and CAI, respectively. Conclusions: The meta-analysis results suggest that long-term opioid use in OSA patients has a medium effect on central sleep apnea. Citation: Filiatrault ML, Chauny JM, Daoust R, Roy MP, Denis R, Lavigne G. Medium increased risk for central sleep apnea but not obstructive sleep apnea in long-term opioid users: a systematic review and meta-analysis. J Clin Sleep Med 2016;12(4):617–625. PMID:26943709

  4. Sleep apnea syndrome: implications on cardiovascular diseases.

    PubMed

    Bhadriraju, Satish; Kemp, Carlton R; Cheruvu, Mani; Bhadriraju, Srinivas

    2008-12-01

    Global risk assessment is the standard of care for coronary artery disease management. In this setting, sleep apnea syndrome, which includes obstructive sleep apnea and central sleep apnea, is being increasingly recognized as a potentially modifiable risk factor for coronary artery disease. Emerging evidence points toward a cause and effect relationship between sleep apnea syndrome and medical conditions like insulin resistance, hypertension, heart failure, and myocardial ischemia. The effects of sleep apnea on coronary artery disease can be independent of many traditional risk factors. Continuous positive airway pressure has been shown to decrease inflammatory markers that are elevated in sleep apnea syndrome. Well-designed randomized controlled clinical trials are needed to better establish the role of sleep apnea in the genesis and progression of coronary artery disease.

  5. An animal model of obstructive sleep apnea in rabbit.

    PubMed

    Yu, Myeong S; Jung, Na R; Choi, Kyoung H; Choi, Kuiwon; Lee, Bong-Jae; Chung, Yoo-Sam

    2014-03-01

    An animal model of obstructive sleep apnea (OSA) may help to investigate the pathophysiology of this disorder and develop appropriate treatments. We investigated the feasibility of a rabbit model of OSA. Animal study. Twelve New Zealand white rabbits were injected at the base of their tongues under endoscopic guidance with liquid silicone (experimental group, n = 6) or normal saline (control group, n = 6). Polysomnography was performed before and after injection. The development of OSA and changes in sleep parameters were compared between the two groups. Before injection, all rabbits showed normal breathing during sleep without hypopnea. In the silicone group, the rabbits had a mean of 29.9 ± 6.9 hypopneas/hour and a mean of 10.4 ± 3.1 apneas/hour 1 month after silicone injection and 28.4 ± 6.9 hypopneas/hour and 10.0 ± 3.3 apneas/hour 3 months after silicone injection (P < 0.05). Mean total sleep time decreased from 260.3 ± 70.2 minutes at baseline to 152.5 ± 38.8 minutes 1 month and 206.8 ± 60.3 minutes 3 months after injection, with a decrease in stage II sleep. In the saline group, however, there were no breathing events during sleep. These results show that silicone injections into the tongue base of rabbits can result in OSA. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Validation of ApneaLink™ Plus for the diagnosis of sleep apnea.

    PubMed

    Cho, Jae Hoon; Kim, Hyun Jun

    2017-07-01

    The aim of this study is to evaluate the validation of ApneaLink™ Plus (ALP) based on a large number of subjects in a prospective design. We recommended enrolling of 200 consecutive patients who had been referred because of habitual snoring or witnessed apnea during sleep. If consent was obtained, patients underwent standard polysomnography (PSG) and ALP evaluation simultaneously at the hospital (ALPlab), and repeated ALP at home (ALPhome) within 1 month. The parameters of ALP were scored based on three different systems, Manual, Auto AASM, and Auto scoring systems. Among the 200 patients who were recommended for enrollment, 149 completed the study. Sensitivity was good for all three scoring systems, while specificity was poor for the Auto scoring system. The area under curve was highest for the manual scoring system and lowest for the auto scoring system, and increased as the apnea-hypopnea index (AHI) cutoff value increased from 5 to 30. Regarding agreement with PSG, the manual scoring system was most superior, followed by the Auto AASM, and Auto scoring systems. The degree of agreement between PSG and ALP was affected by sleep efficiency and the arousal index. Moderate agreement between PSG and ALP based on central apnea index was observed. ALP is an accurate and reliable device for the diagnosis of OSA. Manual scoring is recommended; however, Auto AASM is also acceptable. ALP detects central sleep apnea to a certain degree. Both sleep efficiency and the arousal index affect the results of ALP.

  7. Tongue fat and its relationship to obstructive sleep apnea.

    PubMed

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

    2014-10-01

    The objective of this study was to determine whether tongue fat is increased in obese sleep apneics compared to obese subjects without sleep apnea. We hypothesized that excess fat is deposited in the tongue in obese patients with sleep apnea. Case-control design. Academic medical center. We examined tongue fat in 31 obese controls (apnea-hypopnea index, 4.1 ± 2.7 events/h) and 90 obese apneics (apnea-hypopnea index, 43.2 ± 27.3 events/h). Analyses were repeated in a subsample of 18 gender-, race-, age-, and BMI-matched case-control pairs. All subjects underwent a MRI with three-point Dixon magnetic resonance imaging. We used sophisticated volumetric reconstruction algorithms to study the size and distribution of upper airway fat deposits in the tongue and masseter muscles within apneics and obese controls. The data supported our a priori hypotheses that after adjustment for age, BMI, gender, and race, the tongue in apneics was significantly larger (P = 0.001) and had an increased amount of fat (P = 0.002) compared to controls. Similar results were seen in our matched sample. Our data also demonstrate that within the apneic and normal tongue, there are regional differences in fat distribution, with larger fat deposits at the base of the tongue. There is increased tongue volume and deposition of fat at the base of tongue in apneics compared to controls. Increased tongue fat may begin to explain the relationship between obesity and obstructive sleep apnea. © 2014 Associated Professional Sleep Societies, LLC.

  8. Automated sleep apnea quantification based on respiratory movement.

    PubMed

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

    2014-01-01

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

  9. What Is Sleep Apnea?

    MedlinePlus

    ... CPAP High Blood Pressure Overweight and Obesity Sleep Deprivation and Deficiency Sleep Studies Send a link to ... it because it only occurs during sleep. A family member or bed partner might be the first ...

  10. Effects of Positive Airway Pressure on Patients with Obstructive Sleep Apnea during Acute Ascent to Altitude

    PubMed Central

    Nishida, Katsufumi; Cloward, Tom V.; Weaver, Lindell K.; Brown, Samuel M.; Bell, James E.; Grissom, Colin K.

    2015-01-01

    Rationale: In acute ascent to altitude, untreated obstructive sleep apnea (OSA) is often replaced with central sleep apnea (CSA). In patients with obstructive sleep apnea who travel to altitude, it is unknown whether their home positive airway pressure (PAP) settings are sufficient to treat their obstructive sleep apnea, or altitude-associated central sleep apnea. Methods: Ten participants with positive airway pressure–treated obstructive sleep apnea, who reside at 1,320 m altitude, underwent polysomnography on their home positive airway pressure settings at 1,320 m and at a simulated altitude of 2,750 m in a hypobaric chamber. Six of the participants were subsequently studied without positive airway pressure at 2,750 m. Measurements and Main Results: At 1,320 m, all participants’ sleep apnea was controlled with positive airway pressure on home settings; at 2,750, no participants’ sleep apnea was controlled. At higher altitude, the apnea–hypopnea index was higher (11 vs. 2 events/h; P < 0.01), mostly due to hypopneas (10.5 vs. 2 events/h; P < 0.01). Mean oxygen saturations were lower (88 vs. 93%; P < 0.01) and total sleep time was diminished (349 vs. 393 min; P = 0.03). Four of six participants without positive airway pressure at 2,750 m required supplemental oxygen to prevent sustained oxygen saturation (as determined by pulse oximetry) less than 80%. Positive airway pressure also was associated with reduced central sleep apnea (0 vs. 1; P = 0.03), improved sleep time (358 vs. 292 min; P = 0.06), and improved sleep efficiency (78 vs. 63%; P = 0.04). Conclusions: Acute altitude exposure in patients with obstructive sleep apnea treated with positive airway pressure is associated with hypoxemia, decreased sleep time, and increased frequency of hypopneas compared with baseline altitude. Application of positive airway pressure at altitude is associated with decreased central sleep apnea and increased sleep efficiency. PMID:25884271

  11. The Heterogeneity of Obstructive Sleep Apnea (Predominant Obstructive vs Pure Obstructive Apnea)

    PubMed Central

    Xie, Ailiang; Bedekar, Ajay; Skatrud, James B.; Teodorescu, Mihaela; Gong, Yuansheng; Dempsey, Jerome A.

    2011-01-01

    Study Objectives: To compare the breathing instability and upper airway collapsibility between patients with pure OSA (i.e. 100% of apneas are obstructive) and patients with predominant OSA (i.e., coexisting obstructive and central apneas). Design: A cross-sectional study with data scored by a fellow being blinded to the subjects' classification. The results were compared between the 2 groups with unpaired student t-test. Setting and interventions: Standard polysomnography technique was used to document sleep-wake state. Ventilator in pressure support mode was used to introduce hypocapnic apnea during CO2 reserve measurement. CPAP with both positive and negative pressures was used to produce obstructive apnea during upper airway collapsibility measurement. Participants: 21 patients with OSA: 12 with coexisting central/mixed apneas and hypopneas (28% ± 6% of total), and 9 had pure OSA. Measurements: The upper airway collapsibility was measured by assessing the critical closing pressure (Pcrit). Breathing stability was assessed by measuring CO2 reserve (i.e., ΔPCO2 [eupnea-apnea threshold]) during NREM sleep. Results: There was no difference in Pcrit between the 2 groups (pure OSA vs. predominant OSA: 2.0 ± 0.4 vs. 2.7 ± 0.4 cm H2O, P = 0.27); but the CO2 reserve was significantly smaller in predominant OSA group (1.6 ± 0.7 mm Hg) than the pure OSA group (3.8 ± 0.6 mm Hg) (P = 0.02). Conclusions: The present data indicate that breathing stability rather than upper airway collapsibility distinguishes OSA patients with a combination of obstructive and central events from those with pure OSA. Citation: Xie A; Bedekar A; Skatrud JB; Teodorescu M; Gong Y; Dempsey JA. The heterogeneity of obstructive sleep apnea (predominant obstructive vs pure obstructive apnea). SLEEP 2011;34(6):745-750. PMID:21629362

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

    PubMed Central

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

    2016-01-01

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

  13. Using the Karolinska Sleep Questionnaire to identify obstructive sleep apnea syndrome in a sleep clinic population.

    PubMed

    Westerlund, Anna; Brandt, Lena; Harlid, Richard; Åkerstedt, Torbjörn; Lagerros, Ylva Trolle

    2014-10-01

    In Scandinavia, portable monitoring has virtually replaced standard polysomnography for diagnosis of obstructive sleep apnea syndrome (OSAS). Because waiting times for specialized OSAS care remain long, an accurate screening tool to exclude low-risk patients from diagnostic testing would be valuable. To examine the diagnostic accuracy of the Karolinska Sleep Questionnaire (KSQ) for OSAS. Consecutive patients, 30–66 years old, attending a large sleep clinic in Sweden for OSAS evaluation completed the KSQ and underwent in-home portable monitoring and medical history evaluation. OSAS was defined as apnea-hypopnea index ≥5 with symptoms of disease. We calculated sensitivity and specificity of apnea/snoring and sleepiness indices of the KSQ. Retrospectively, we combined six KSQ items (snoring, breathing cessations, disturbed sleep, etc.) and four clinical variables (age, sex, body mass index, smoking status) predictive of OSAS into a new instrument, which we also evaluated. Instrument score ranged between 0 and 21; a higher score indicated more severe symptoms. Of 103 patients, 62 were diagnosed with OSAS. Sensitivity and specificity of the indices were 0.56 and 0.68 (apnea/snoring), and 0.37 and 0.71 (sleepiness). The new instrument performed optimally at a score of 9. Sensitivity was 0.76 (95% confidence interval 0.63–0.86) and specificity 0.88 (0.74–0.96). Between 19.4% and 50.5% of patients were unaware of having apnea/snoring symptoms. Diagnostic accuracy of the apnea/snoring and sleepiness indices for OSAS was poor but could be improved by combining clinical and KSQ items. The usefulness of the apnea/snoring index and the combined instrument was questionable because of extensive symptom unawareness.

  14. Sleep Disruption in Patients with Sleep Apnea and End-Stage Renal Disease

    PubMed Central

    Loewen, Andrea; Siemens, AnDrea; Hanly, Patrick

    2009-01-01

    Objectives: Sleep apnea (SA) is common in patients with end-stage renal disease (ESRD) and such patients are likely to suffer additional sleep disruption associated with restless legs syndrome (RLS) and periodic leg movements (PLM). Our objective was to evaluate sleep quality in ESRD patients who are newly diagnosed with SA and determine the additional contribution of PLM to sleep disruption. Methods: Two groups of patients with SA (apnea-hypopnea index (AHI) > 15) were compared, one with ESRD (n = 12) and the other with normal renal function (n = 18), using a sleep history questionnaire, sleep diary, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, polysomnography (1 night) and actigraphy (6 nights). Results: The prevalence of RLS was higher in ESRD patients (60% vs 6%, p < 0.001). ESRD patients had shorter total sleep time (TST) (264 ± 78 vs 330 ± 46 min, p = 0.01), lower sleep efficiency (68 ± 20 % vs 81 ± 11 %, p = 0.03), and more stage 1 NREM sleep (23 ± 18 vs 8 ± 5 % TST, p = 0.002). ESRD patients had a higher frequency of PLM (31 ± 37 hr-1 vs 8.0 ± 16 hr-1, p = 0.02) and PLM-related arousals (15 ± 18 hr-1 vs 1 ± 2 hr-1, p = 0.003). Actigraphy demonstrated a higher movement and fragmentation index in ESRD patients (23 ± 10 % sleep time vs 17 ± 6 % sleep time, p = 0.04). Conclusions: The co-existence of PLM is an additional source of sleep disruption in patients with ESRD and SA. Treatment of PLM, in addition to treatment of sleep apnea, may be required to improve sleep quality in this patient population. Citation: Loewen A; Siemens A; Hanly P. Sleep disruption in patients with sleep apnea and end-stage renal disease. J Clin Sleep Med 2009;5(4):324-329. PMID:19968009

  15. Obstructive sleep apnea and asthma*

    PubMed Central

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

    2013-01-01

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

  16. Genetic Associations with Obstructive Sleep Apnea Traits in Hispanic/Latino Americans.

    PubMed

    Cade, Brian E; Chen, Han; Stilp, Adrienne M; Gleason, Kevin J; Sofer, Tamar; Ancoli-Israel, Sonia; Arens, Raanan; Bell, Graeme I; Below, Jennifer E; Bjonnes, Andrew C; Chun, Sung; Conomos, Matthew P; Evans, Daniel S; Johnson, W Craig; Frazier-Wood, Alexis C; Lane, Jacqueline M; Larkin, Emma K; Loredo, Jose S; Post, Wendy S; Ramos, Alberto R; Rice, Ken; Rotter, Jerome I; Shah, Neomi A; Stone, Katie L; Taylor, Kent D; Thornton, Timothy A; Tranah, Gregory J; Wang, Chaolong; Zee, Phyllis C; Hanis, Craig L; Sunyaev, Shamil R; Patel, Sanjay R; Laurie, Cathy C; Zhu, Xiaofeng; Saxena, Richa; Lin, Xihong; Redline, Susan

    2016-10-01

    Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic basis is still largely unknown. Prior genetic studies focused on traits defined using the apnea-hypopnea index, which contains limited information on potentially important genetically determined physiologic factors, such as propensity for hypoxemia and respiratory arousability. To define novel obstructive sleep apnea genetic risk loci for obstructive sleep apnea, we conducted genome-wide association studies of quantitative traits in Hispanic/Latino Americans from three cohorts. Genome-wide data from as many as 12,558 participants in the Hispanic Community Health Study/Study of Latinos, Multi-Ethnic Study of Atherosclerosis, and Starr County Health Studies population-based cohorts were metaanalyzed for association with the apnea-hypopnea index, average oxygen saturation during sleep, and average respiratory event duration. Two novel loci were identified at genome-level significance (rs11691765, GPR83, P = 1.90 × 10(-8) for the apnea-hypopnea index, and rs35424364; C6ORF183/CCDC162P, P = 4.88 × 10(-8) for respiratory event duration) and seven additional loci were identified with suggestive significance (P < 5 × 10(-7)). Secondary sex-stratified analyses also identified one significant and several suggestive associations. Multiple loci overlapped genes with biologic plausibility. These are the first genome-level significant findings reported for obstructive sleep apnea-related physiologic traits in any population. These findings identify novel associations in inflammatory, hypoxia signaling, and sleep pathways.

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

    PubMed

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

    2015-08-01

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

  18. Initial Evaluation of a Titration Appliance for Temporary Treatment of Obstructive Sleep Apnea.

    PubMed

    Levendowski, Daniel J; Morgan, Todd; Westbrook, Philip

    2012-01-01

    Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances, however, are expensive, must be fitted by a dentist, and the likelihood of successful outcomes are difficult to predict. An inexpensive trial appliance, if proven efficacious, might be used to predict custom appliance outcomes or to provide temporary therapeutic benefit. The aim of this initial study was to assess the treatment efficacy of a novel titration oral appliance with that of an optimized custom appliance. Seventeen patients, treated with a custom oral appliance for at least one year, successfully completed a three-night home sleep test. The baseline obstructive sleep apnea severity was established on Night 1 with seven patients exhibiting severe, six moderate and four mild apnea/hypopnea indexes. Patients were randomly assigned to wear their custom appliance or the titration appliance on Nights 2 and 3. Significant reductions in the mean overall and supine apnea indexes (p < 0.05), and the overall (p < 0.01) and supine (p < 0.05) apnea/hypopnea indexes were observed for both the titration and custom appliances. The proportion of patients who exhibited at least a 50% reduction in the overall apnea index and supine apnea/hypopnea were similar for the titration and custom appliance (~60%). The custom appliance reduced the overall apnea/hypopnea index by 50% in a greater proportion of the patients compared to the titration appliance (77% vs. 53%). The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01). Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy. The titration appliance may be useful in assessing oral appliance treatment efficacy. When set to 70% of maximum protrusion, the titration appliance may

  19. Initial Evaluation of a Titration Appliance for Temporary Treatment of Obstructive Sleep Apnea

    PubMed Central

    Levendowski, Daniel J.; Morgan, Todd; Westbrook, Philip

    2015-01-01

    Background Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances, however, are expensive, must be fitted by a dentist, and the likelihood of successful outcomes are difficult to predict. An inexpensive trial appliance, if proven efficacious, might be used to predict custom appliance outcomes or to provide temporary therapeutic benefit. Objective The aim of this initial study was to assess the treatment efficacy of a novel titration oral appliance with that of an optimized custom appliance. Methods Seventeen patients, treated with a custom oral appliance for at least one year, successfully completed a three-night home sleep test. The baseline obstructive sleep apnea severity was established on Night 1 with seven patients exhibiting severe, six moderate and four mild apnea/hypopnea indexes. Patients were randomly assigned to wear their custom appliance or the titration appliance on Nights 2 and 3. Results Significant reductions in the mean overall and supine apnea indexes (p < 0.05), and the overall (p < 0.01) and supine (p < 0.05) apnea/hypopnea indexes were observed for both the titration and custom appliances. The proportion of patients who exhibited at least a 50% reduction in the overall apnea index and supine apnea/hypopnea were similar for the titration and custom appliance (~60%). The custom appliance reduced the overall apnea/hypopnea index by 50% in a greater proportion of the patients compared to the titration appliance (77% vs. 53%). The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01). Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy. Conclusion The titration appliance may be useful in assessing oral appliance treatment efficacy. When set to 70% of

  20. Snoring and Sleep Apnea

    MedlinePlus

    ... good muscle tone and lose weight. • Avoid tranquilizers, sleeping pills, and antihistamines before bedtime. • Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring. • Establish regular sleeping patterns. • Sleep on your side rather than your ...

  1. Sleep Apnea and Obstructive Airway Disease in Older Men: Outcomes of Sleep Disorders in Older Men Study.

    PubMed

    Zhao, Ying Y; Blackwell, Terri; Ensrud, Kristine E; Stone, Katie L; Omachi, Theodore A; Redline, Susan

    2016-07-01

    To evaluate the association between obstructive airway disease (OAD) and sleep apnea in older men. A community-based cross-sectional study of 853 community-dwelling older men (mean age 80.7 ± 4.1 years [range 73 to 90]) across 6 centers in the United States from the Outcomes of Sleep Disorders in Older Men Study. Sleep was objectively measured using full in-home polysomnography and lung function was objectively measured using spirometry. The association of OAD (pre-bronchodilator FEV1/FVC ratio < 0.7 and FEV1 < 80% predicted) and sleep apnea (apnea-hypopnea index [AHI] ≥ 15 events/hour) was assessed using logistic regression. OAD and sleep apnea were identified in 111 (13.0%) and 247 (29.0%) men, respectively. In univariate analysis, participants with OAD had a lower AHI (mean ± SD; 8.7 ± 11.7 vs. 12.7 ± 13.8, P = 0.0009) and a lower prevalence of sleep apnea (14.4 vs. 31.1%, P = 0.0003) compared to participants without OAD. OAD remained independently associated with a lower odds of sleep apnea (odds ratio 0.30, 95% CI 0.16 to 0.55, P = 0.0001) after adjustment for demographics, body composition, smoking, and potential mediators (arousal index, time spent in rapid eye movement sleep). Individuals with OAD and sleep apnea (n = 16) had an increased arousal index and lower oxygen saturation level as compared to individuals with OAD alone (P values < 0.05). Obstructive airway disease was associated with a lower prevalence of sleep apnea in a cohort of community-dwelling elderly men, and unexplained by differences in adiposity or sleep architecture. Although uncommon in this cohort, coexisting sleep apnea and OAD was associated with increased sleep fragmentation and nocturnal oxygen desaturation compared to OAD alone. © 2016 Associated Professional Sleep Societies, LLC.

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

    PubMed Central

    Luyster, Faith S.; Kip, Kevin E.; Drumheller, Oliver J.; Rice, Thomas B.; Edmundowicz, Daniel; Matthews, Karen; Reis, Steven E.; Strollo, Patrick J.

    2012-01-01

    Study Objectives: Sleep apnea has been implicated as an independent risk factor for atherosclerotic coronary artery disease (CAD). An association between the severity of sleep apnea and total cholesterol levels has previously been reported. However, the association with small dense low density lipoprotein (LDL) cholesterol concentration (subclass B), one of the strongest predictors of atherosclerosis, is unknown. We examined the relationship between sleep apnea and LDL subclass B, considering body size. Methods: This is a cross-sectional observational cohort of participants enrolled in a cardiovascular health study. Sleep apnea was assessed with a validated portable monitor. Lipid panels included total cholesterol, triglycerides, high density lipoprotein cholesterol, LDL cholesterol, and LDL subclasses A, B, and A/B. Sleep apnea was analyzed categorically using the apnea hypopnea index (AHI). Results: A total of 519 participants were evaluated. Mean age was 58.7 ± 7.4 years; BMI was 29.6 ± 5.7; 65% were female; 59% were Caucasian, and 37% were African American. Among participants with abnormal waist circumference by ATP III criteria, moderate to severe sleep apnea (AHI ≥ 25) was not independently associated with LDL subclass B. In contrast, among participants with normal waist circumference, moderate to severe sleep apnea was associated with 4.5-fold odds of having LDL subclass B. Conclusions: Sleep apnea is independently associated with an atherogenic phenotype (LDL subclass B) in non-obese individuals. The association between sleep apnea and LDL subclass B in those with normal waist circumference may account, in part, for the increased risk of atherosclerosis and subsequent vascular events. Citation: Luyster FS; Kip KE; Drumheller OJ; Rice TB; Edmundowicz D; Matthews K; Reis SE; Strollo PJ. Sleep apnea is related to the atherogenic phenotype, lipoprotein subclass B. J Clin Sleep Med 2012;8(2):155-161. PMID:22505860

  3. Sleep Apnea and Risk of Panic Disorder.

    PubMed

    Su, Vincent Yi-Fong; Chen, Yung-Tai; Lin, Wei-Chen; Wu, Li-An; Chang, Shi-Chuan; Perng, Diahn-Warng; Su, Wei-Juin; Chen, Yuh-Min; Chen, Tzeng-Ji; Lee, Yu-Chin; Chou, Kun-Ta

    2015-01-01

    Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear. Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder. A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P <.001). After multivariate adjustment, the hazard ratio for subsequent panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68-2.81; P <.001). Sleep apnea appears to confer a higher risk for future development of panic disorder. © 2015 Annals of Family Medicine, Inc.

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

    PubMed Central

    Daulatzai, Mak Adam

    2011-01-01

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

  5. Obstructive Sleep Apnea in Women: Specific Issues and Interventions

    PubMed Central

    Woehrle, Holger; Ketheeswaran, Sahisha; Ramanan, Dinesh; Armitstead, Jeffery

    2016-01-01

    Obstructive sleep apnea (OSA) has traditionally been seen as a male disease. However, the importance of OSA in women is increasingly being recognized, along with a number of significant gender-related differences in the symptoms, diagnosis, consequences, and treatment of OSA. Women tend to have less severe OSA than males, with a lower apnea-hypopnea index (AHI) and shorter apneas and hypopneas. Episodes of upper airway resistance that do not meet the criteria for apneas are more common in women. Prevalence rates are lower in women, and proportionally fewer women receive a correct diagnosis. Research has also documented sex differences in the upper airway, fat distribution, and respiratory stability in OSA. Hormones are implicated in some gender-related variations, with differences between men and women in the prevalence of OSA decreasing as age increases. The limited data available suggest that although the prevalence and severity of OSA may be lower in women than in men, the consequences of the disease are at least the same, if not worse for comparable degrees of severity. Few studies have investigated gender differences in the effects of OSA treatment. However, given the differences in physiology and presentation, it is possible that personalized therapy may provide more optimal care. PMID:27699167

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

    PubMed Central

    2014-01-01

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

  7. 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.

  8. [Could mouth breathing lead to obstructive sleep apnea syndromes. A preliminary study].

    PubMed

    Raskin, S; Limme, M; Poirrier, R

    2000-01-01

    The aim of this preliminary work is to determine an easy method to diagnose "buccal breather" children and "nasal breather" children. Then, to establish a possible connection with the syndrome of obstructive sleep apnea. 22 children agreed to participate. Clinical, orthophonic, orthodontic, postural and polysomnographical exams have been carried out. The proposed clinical exam turns out to be a good means of diagnosing between buccal breathers and nasal breathers. The aerophonoscope reveals velar inadequacies in buccal breathers. The latter also present osseous discrepancies mainly in the mandible. The polysomnography reveals a higher apnea/hypopnea index and more agitated sleep in buccal breathers. Mandibular lowering movements are more frequent and similar to those of adults suffering from apnea. These elements similar to those encountered in adults suffering from apnea make us think that buccal breathing could be the origin of obstructive sleep apnea, several decades later.

  9. [Orthodontic contribution in sleep apnea].

    PubMed

    Raskin, S; Limme, M; Poirrier, R; Lacroix, A; Bonnet, S; Jeusette, M; Lecloux, G; Lahaye, T

    1997-01-01

    This study details the role that the orthodontist can play, when faced with sleeping obstructive apneas and snoring phénomena. Of special importance are knowledge of cranio-facial growth, radiographic exam and cephalometric analysis: they mainly help to understand all the aspects of this specific syndrome, and reveal the interest for a neuro-orthodontic or a neuro-surgical orthodontic approach.

  10. Sleep problems and obstructive sleep apnea in children with down syndrome, an overwiew.

    PubMed

    Maris, Mieke; Verhulst, Stijn; Wojciechowski, Marek; Van de Heyning, Paul; Boudewyns, An

    2016-03-01

    Children with Down syndrome (DS) have a high prevalence of sleep problems, including behavioural sleep disturbances and obstructive sleep apnea. Sleep problems are associated with a wide range of adverse health effects. Since children with DS are already known to have many comorbidities, they are particularly susceptible for the negative impact of sleep problems. Aim of this study is (1) to evaluate the prevalence of sleep problems in children with DS, (2) compare the prevalence of sleep problems in children with DS with a community sample of typical developing school-aged children, and (3) to correlate the existence of sleep problems in children with DS and OSA. Children enrolled at the multidisciplinary Down team of the University Hospital Antwerp and seen at the ENT department were eligible for this study. The prevalence of sleep problems was evaluated by the use of the Child Sleep Habits Questionnaire (CSHQ) and a full overnight polysomnography was performed to screen for obstructive sleep apnea. Parents of fifty-four children with DS, aged 7.5 years (5.4-11.6), completed the CSHQ and an overall prevalence of sleep problems was found in 74.1%. In 57.1% of the children OSA was diagnosed with a median obstructive apnea-hypopnea index (oAHI) 7.25/h (5.7-9.8). Overall sleep problems were not age-or gender related, however boys suffer more from daytime sleepiness. Symptoms of sleep disordered breathing correlate with parasomnias, a longer sleep duration and more daytime sleepiness. No correlation was found between sleep problems and underlying OSA. Children with Down syndrome have a significantly higher prevalence of sleep problems, compared to normal developing healthy school-aged children. We didn't find any correlation between the parental report of sleep problems and underlying OSA, or OSA severity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Association of aldosterone excess and apnea-hypopnea index in patients with resistant hypertension

    PubMed Central

    Ke, Xiao; Guo, Wenyu; Peng, Hu; Hu, Chengheng; Zhang, Henghong; Peng, Changnong; Wang, Xiaoqing

    2017-01-01

    The present study was to investigate the association of aldosterone excess and apnea-hypopnea index (AHI) in patients with resistant hypertension. Patients with resistant hypertension were enrolled and baseline characteristics including plasma aldosterone concentration (PAC) and 24 h-urine aldosterone levels were collected and compared between groups with different degrees of AHI as assessed by polysomnography. Association of key variables and AHI was then evaluated by univariate and multiple linear regression analysis. A total of 534 patients with resistant hypertension were enrolled and mean age was 57 ± 11 years. Overall, mean number of AHI was 21.7 ± 9.6 and nearly 92.3% of resistant hypertensive patients had obstructive sleep apnea (OSA). Mean PAC and 24 h-urine aldosterone level was 12.4 ± 6.3 ng/dL and 13.1 ± 6.8 ug, respectively. Compared with other groups, participants in the severe OSA group (AHI ≥ 30) had significantly higher PAC and 24 h-urine aldosterone level. Multiple linear regression analysis showed that PAC and 24 h-urine aldosterone levels were positively associated with AHI, while spironolactone was negatively associated with AHI, independent of age, gender, body mass index, smoking, plasma renin activity and diuretics. OSA is highly prevalent in patients with resistant hypertension and both PAC and 24 h-urine aldosterone level are significantly associated with AHI. PMID:28327653

  12. Immediate postarousal sleep dynamics: an important determinant of sleep stability in obstructive sleep apnea.

    PubMed

    Younes, Magdy; Hanly, Patrick J

    2016-04-01

    Arousability from sleep is increasingly recognized as an important determinant of the clinical spectrum of sleep disordered breathing (SDB). Patients with SDB display a wide range of arousability. The reason for these differences is not known. We hypothesized that differences in the speed with which sleep deepens following arousals/awakenings (postarousal sleep dynamics) is a major determinant of these differences in arousability in patients with SDB. We analyzed 40 preexisting clinical polysomnography records from patients with a range of SDB severity (apnea-hypopnea index 5-135/h). Sleep depth was determined every 3 s using the odds ratio product (ORP) method, a continuous index of sleep depth (0 = deep sleep, 2.5 = full wakefulness) that correlates strongly (r = 0.98) with arousability (Younes M, Ostrowski M, Soiferman M, Younes H, Younes M, Raneri J, and Hanly P. Sleep 38: 641-654, 2015). Time course of ORP was determined from end of arousal until the next arousal. All arousals were analyzed (142 ± 65/polysomnogram). ORP increased from 0.58 ± 0.32 during sleep to 1.67 ± 0.35 during arousals. ORP immediately (first 9 s) following arousals/awakenings (ORP-9) ranged from 0.21(very deep sleep) to 1.71 (highly arousable state) in different patients. In patients with high ORP-9, sleep deepened slowly (over minutes) beyond 9 s but only if no arousals/awakenings recurred. ORP-9 correlated strongly with average non-rapid eye movement sleep depth (r = 0.87, P < 2E-13), the arousal/awakening index (r = 0.68, P < 5E-6), and with the apnea-hypopnea index (r = 0.60, P < 0.001). ORP-9 was consistent within each patient and did not change on continuous positive airway pressure despite marked improvement in sleep architecture. We conclude that postarousal sleep dynamics are highly variable among patients with sleep-disordered breathing and largely determine average sleep depth and continuity.

  13. Impaired cerebral autoregulation in obstructive sleep apnea.

    PubMed

    Urbano, Fred; Roux, Francoise; Schindler, Joseph; Mohsenin, Vahid

    2008-12-01

    Obstructive sleep apnea (OSA) increases the risk of stroke independent of known vascular and metabolic risk factors. Although patients with OSA have higher prevalence of hypertension and evidence of hypercoagulability, the mechanism of this increased risk is unknown. Obstructive apnea events are associated with surges in blood pressure, hypercapnia, and fluctuations in cerebral blood flow. These perturbations can adversely affect the cerebral circulation. We hypothesized that patients with OSA have impaired cerebral autoregulation, which may contribute to the increased risk of cerebral ischemia and stroke. We examined cerebral autoregulation in patients with and without OSA by measuring cerebral artery blood flow velocity (CBFV) by using transcranial Doppler ultrasound and arterial blood pressure using finger pulse photoplethysmography during orthostatic hypotension and recovery as well as during 5% CO(2) inhalation. Cerebral vascular conductance and reactivity were determined. Forty-eight subjects, 26 controls (age 41.0+/-2.3 yr) and 22 OSA (age 46.8+/-2.3 yr) free of cerebrovascular and active coronary artery disease participated in this study. OSA patients had a mean apnea-hypopnea index of 78.4+/-7.1 vs. 1.8+/-0.3 events/h in controls. The oxygen saturation during sleep was significantly lower in the OSA group (78+/-2%) vs. 91+/-1% in controls. The dynamic vascular analysis showed mean CBFV was significantly lower in OSA patients compared with controls (48+/-3 vs. 55+/-2 cm/s; P <0.05, respectively). The OSA group had a lower rate of recovery of cerebrovascular conductance for a given drop in blood pressure compared with controls (0.06+/-0.02 vs. 0.20+/-0.06 cm.s(-2).mmHg(-1); P <0.05). There was no difference in cerebrovascular vasodilatation in response to CO(2). The findings showed that patients with OSA have decreased CBFV at baseline and delayed cerebrovascular compensatory response to changes in blood pressure but not to CO(2). These perturbations may

  14. Atomoxetine improves sleepiness and global severity of illness but not the respiratory disturbance index in mild to moderate obstructive sleep apnea with sleepiness.

    PubMed

    Bart Sangal, R; Sangal, JoAnne M; Thorp, Krista

    2008-07-01

    Norepinephrine reuptake inhibitors such as protriptyline have been shown to improve sleepiness in sleep apnea, with or without improvement in the respiratory disturbance index (RDI). This study was performed to evaluate whether the selective norepinephrine reuptake inhibitor atomoxetine improves sleepiness, the clinical global impression (CGI) of severity of illness, and the RDI in patients with mild to moderate obstructive sleep apnea with excessive sleepiness. Patients aged 18-60 years with RDI (including apneas, hypopneas with desaturations and hypopneas with arousals) >5/h sleep, apnea-hypopnea index (AHI; including apneas, hypopneas with 4% desaturations, but not apneas with arousals) <15/h sleep, and excessive sleepiness (Epworth Sleepiness Scale [ESS]>or=10) received open-label treatment with atomoxetine 40-80 mg HS for 4 weeks, with repeat polysomnography at the end of treatment. Of 20 patients screened, 17 started treatment and 15 completed treatment. ESS improved from 15.3 to 10.5 and CGI improved from 4.3 to 3.1 (both significant at p<0.01), but there was no significant change in RDI. ESS and CGI improved in a linear fashion across the weeks of treatment. Sleep efficiency and % stage rapid eye movement (REM) sleep were decreased, and % stage 1, awakenings and wake after sleep onset were increased. Atomoxetine improved sleepiness and the CGI in patients with mild to moderate obstructive sleep apnea with sleepiness. However, it did not improve the RDI.

  15. Treatment of obstructive sleep apnea syndrome with a Kampo-formula, San'o-shashin-to: a case report.

    PubMed

    Hisanaga, A; Saitoh, O; Fukuda, H; Kurokawa, K; Okabe, A; Tachibana, H; Hagino, H; Mita, T; Yamashita, I; Tsutsumi, M; Kurachi, M; Itoh, T

    1999-04-01

    The following describes a 76-year-old male with obstructive sleep apnea syndrome successfully treated with a Kampo-formula, San'o-shashin-to (Formula medicamentorum tres ad dispellendi cordis). Polysomnography, performed before and after administration of San'o-shashin-to, revealed that the apnea index decreased from 11.1 events/hour to 4.1 events/hour, and that the apnea plus hypopnea index decreased from 18.4 events/hour to 10.7 events/hour. The patient was normo-weight (body mass index: 20.4 kg/m2), and events of sleep apnea and hypopnea were mostly noted during a non-rapid eye movement sleep. It is possible that San'o-shashin-to has some alleviating effects on the upper airway resistance during sleep.

  16. [Relationship between sleep architecture and blood pressure dynamic change in patients with sleep apnea syndrome].

    PubMed

    Zhu, Y Q; Long, Q; Wang, C; Shuai, X J; Chen, B; Kong, J; Wei, Y L

    2016-07-26

    To investigate sleep architecture and blood pressure dynamic change in patients with Sleep apnea syndrome by electrocardiogram-based cardiopulmonary coupling analysis system. Seventy-nine sleep disorder participants (PSQI≥8) were enrolled. Electrocardiogram-based cardiopulmonary coupling analysis device and ambulatory blood pressure monitoring were synchronously used to evaluate sleep architecture and blood pressure circadian rhythm. The patients were divided into SAS group (47 participants) and non-SAS group (32 participants) according to the Apnea Hypopnea Index (AHI) that calculated by CPC device. The data of sleep architecture and blood pressure variability were compared between two groups. Compared with non-SAS group, SAS group have less proportion of deep sleep, more proportion of light sleep, higher mean blood pressure in 24 hours and daytime, lower nocturnal blood pressure dipping, faster mean heart rate in night time (P<0.05). AHI has moderate inverse correlation with deep sleep time, wake/dream time (-0.6≤r<-0.3), moderate positive correlation with light sleep time (0.3sleep, more proportion of light sleep, 24 hours mean blood pressure and nocturnal blood pressure increase in the patients with Sleep Apnea Syndrome. The severity of Sleep Apnea Syndrome has a positive correlation with the severity of abnormal sleep architecture and the degree of blood pressure elevation.

  17. Predictors of Obstructive Sleep Apnea Severity in Adenotonsillectomy Candidates

    PubMed Central

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

    2014-01-01

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

  18. Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age.

    PubMed

    Marcus, Carole L; Meltzer, Lisa J; Roberts, Robin S; Traylor, Joel; Dix, Joanne; D'ilario, Judy; Asztalos, Elizabeth; Opie, Gillian; Doyle, Lex W; Biggs, Sarah N; Nixon, Gillian M; Narang, Indra; Bhattacharjee, Rakesh; Davey, Margot; Horne, Rosemary S C; Cheshire, Maureen; Gibbons, Jeremy; Costantini, Lorrie; Bradford, Ruth; Schmidt, Barbara

    2014-10-01

    Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain. We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep. A total of 201 ex-preterm children aged 5-12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography. There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of -6.7 [95% confidence interval (CI) = -15.3 to 2.0 min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea-hypopnea index of 0.89 [95% CI = 0.55-1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups. Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood.

  19. A home sleep apnea screening device with time-domain signal processing and autonomous scoring capability.

    PubMed

    Jin, Jiayi; Sánchez-Sinencio, Edgar

    2015-02-01

    Current solutions of sleep apnea diagnosis require the patient to undergo overnight studies at a specialized sleep laboratory. Due to such inconvenience and high cost, millions of sleep apnea patients remain undiagnosed and thus untreated. Based on a micro-electro-mechanical systems (MEMS) sensor and an effective apnea detection algorithm, we propose a low-cost single-channel apnea screening solution applicable in the comfort of patients' homes. A prototype device was designed and assembled including a MEMS sensor for measuring the patient's nasal air flows, and a time-domain signal processing IC for apnea detection and autonomous scoring. The IC chip was fabricated in standard 0.5- μm CMOS technology. The proposed device was tested for both respiratory rhythm detection and sleep apnea screening under clinical environment. Apnea-hypopnea indices (AHI) were scored to indicate severity of sleep apnea conditions. Test results suggest that the proposed device can be a valuable screening solution for the broader public with undiagnosed apnea conditions.

  20. Differing relationship of nocturnal fluid shifts to sleep apnea in men and women with heart failure.

    PubMed

    Kasai, Takatoshi; Motwani, Shveta S; Yumino, Dai; Mak, Susanna; Newton, Gary E; Bradley, T Douglas

    2012-07-01

    In men with heart failure, nocturnal rostral fluid shift is associated with an overnight increase in the neck circumference (NC) and with severity of obstructive sleep apnea. Because the prevalence of obstructive sleep apnea is lower in women than in men with heart failure, we hypothesized that less fluid would shift into the neck in association with less severe obstructive sleep apnea in women than in men with heart failure. In 35 men and 30 women with heart failure, we assessed overnight changes in NC (ΔNC) and leg fluid volume before and after polysomnography. The severity of obstructive sleep apnea was assessed by the apnea-hypopnea index. Although the changes in leg fluid volume did not differ significantly between men and women (-131 ± 90 versus -180 ± 132 mL, P=0.081), in women, ΔNC was smaller (P<0.001) than in men. Furthermore, although in men, changes in leg fluid volume correlated inversely with ΔNC (r=-0.755, P<0.001) and apnea-hypopnea index (r=-0.765, P<0.001), it did not in women. Despite no difference in overnight displacement of fluid from the legs compared with in men, in women, less of this fluid reached the neck, and unlike men, there was no relationship between changes in leg fluid volume and either ΔNC or apnea-hypopnea index. These findings suggest a differing relationship between overnight fluid shift from the legs and severity of obstructive sleep apnea in women than in men with heart failure.

  1. Impact of obstructive sleep apnea on sleep-wake stage ratio.

    PubMed

    Ng, Andrew Keong; Guan, Cuntai

    2012-01-01

    Patients with obstructive sleep apnea (OSA) experience fragmented sleep and exhibit different sleep architectures. While polysomnographic metrics for quantifying sleep architecture are studied, there is little information about the impact of OSA on the ratio of different sleep-wake stages (wake, W; rapid eye movement, REM; non-REM stages 1 to 3, N1 to N3). This study, therefore, aims to investigate the relationship between apnea-hypopnea index (AHI, a measure of OSA severity) and all possible ratios of sleep-wake stages. Sleep architectures of 24 adult subjects with suspected OSA were constructed according to the American Academy of Sleep Medicine scoring manual, and subsequently analyzed through various correlation (Pearson, Spearman, and Kendall) and regression (linear, logarithmic, exponential, and power-law) approaches. Results show a statistically significant positive, linear and monotonic correlation between AHI and REM/N3, as well as between AHI and N1/W (p-values < 0.05). These findings imply that patients with increased severity of OSA may spend more time in REM than deep sleep, and in light sleep than wake (or less time in deep sleep than REM, and in wake than light sleep). A power-law regression model may possibly explain the relationships of AHI-REM/N3 and AHI-N1/W, and predict the value of AHI using REM/N3 or N1/W.

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

    PubMed Central

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

    2011-01-01

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

  3. Validation of ApneaLink Ox™ for the diagnosis of obstructive sleep apnea.

    PubMed

    Nigro, Carlos Alberto; Dibur, Eduardo; Malnis, Silvana; Grandval, Sofia; Nogueira, Facundo

    2013-03-01

    The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox™ (ALOX) in patients with suspected obstructive sleep apnea (OSA). All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed. Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m(2)). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a-RDI, -3.6 ± 10.1; AHI4-a-RDI, -6.5 ± 10.9, p < 0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k = 0.81). The AHI obtained automatically from the ApneaLink Ox™ using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox™ was better than the automatic scoring to

  4. Establishment of a rabbit model of obstructive sleep apnea by paralyzing the genioglossus.

    PubMed

    Lee, Myung-Chul; Lee, Chul Hee; Hong, Sung-Lyong; Kim, Sang-Wook; Lee, Woo-Hyun; Lim, Jae Young; Joe, Sam; Yoon, In-Young; Kim, Jeong-Whun

    2013-08-01

    This study presents an innovative method for developing a neuromuscular model of obstructive sleep apnea (OSA). To establish a new OSA animal model simulating real upper airway conditions during sleep. In vivo animal study at an academic tertiary referral center. A total of 27 New Zealand white male rabbits were used. Sleep was induced by intramuscular injection of 0.3 mL/kg of tiletamine hydrochloride plus zolazepam hydrochloride and 0.2 mL/kg of xylazine. Upper airway obstruction was induced by injecting botulinum toxin type A (2.5 U in 8 rabbits, 5.0 U in 10 rabbits, and 7.5 U in 1 rabbit) into the genioglossus. Eight rabbits were injected with normal saline as a control. Drug-induced sleep was evaluated using a portable polysomnography device for electroencephalography, electrooculography, chin electromyography, nasal airflow, breathing efforts, and pulse oxymetry. Respiratory events (apneas or hypopneas) during sleep were evaluated using a sleep-screening tool. All the rabbits showed no apneas or hypopneas before injection of botulinum toxin type A. In the control rabbits injected with normal saline, apneas or hypopneas were not found. The respiratory events were observed in 5 of 8 rabbits injected with 2.5 U of botulinum toxin type A, whereas they were observed in 7 of 10 rabbits injected with 5.0 U of botulinum toxin type A. The median (interquartile range) apnea hypopnea index was 9.6 (5.3-14.8) per hour and 45.6 (21.5-70.5) per hour in the rabbits injected with 2.5 U and 5.0 U of botulinum toxin type A, respectively (P = .03). An animal model of OSA could be developed by paralyzing the genioglossus in rabbits. This model may contribute to identifying the pathogenesis of upper airway obstruction in OSA and to developing new diagnostic or treatment devices targeting specific obstruction sites.

  5. Anterior-inferior mandibular osteotomy in treatment of obstructive sleep apnea syndrome.

    PubMed

    Krekmanov, L; Andersson, L; Ringqvist, M; Wilhelmsson, B; Walker-Engström, M L; Tegelberg, A; Ringqvist, I

    1998-01-01

    In a prospective randomized study on treatment of obstructive sleep apnea syndrome, anterior-inferior mandibular osteotomy with the purpose of stretching the suprahyoidal muscle was performed as one of the treatment methods. Ten men aged 20 to 65 years, without cardiovascular or neurologic disease, with normal maxillomandibular relation, and having an apnea index between 5 and 25 were included in the study. After a specially designed osteotomy of the chin, the anterior suprahyoidal muscles were detached, stretched approximately 10 to 12 mm, and sutured. The chin was then placed in its original position and post-operative evaluation was performed. Although there were initial reports of decreased daytime sleepiness and less snoring after surgery, the results after 12 months were discouraging. Somnographic registration (apnea index, apnea/hypopnea index, and oxygen desaturation index) as well as cephalometric analysis failed to show positive results. Hence, suspension of the suprahyoidal muscles as a method of treatment for obstructive sleep apnea syndrome cannot be recommended.

  6. Obstructive sleep apnea during pregnancy. Therapy and implications for fetal health.

    PubMed

    Charbonneau, M; Falcone, T; Cosio, M G; Levy, R D

    1991-08-01

    A 32 yr-old woman in her last trimester of pregnancy was found to have severe obstructive sleep apnea (OSA). The overnight polysomnogram demonstrated an apnea plus hypopnea index of 159 events per hour. Apneas were associated with severe oxygen desaturation to 40% during rapid eye movement sleep, maternal bradycardia, and second degree heart block. External cardiotocography showed normal fetal heart rate reactivity to fetal movements, even during the apneas and episodes of oxygen desaturation. Nasal continuous positive airway pressure at a level of 15 cm H2O effectively treated the apneas and desaturation and had no effect on the fetal heart rate. The patient was induced electively during the 39th wk of pregnancy and gave birth to a newborn with growth retardation. Early recognition and treatment of OSA in pregnancy might prevent problems with fetal development.

  7. The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea.

    PubMed

    Smith, Matthew M; Peterson, Ed; Yaremchuk, Kathleen L

    2017-03-01

    Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to <20. Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.

  8. Obstructive sleep apnea during REM sleep and hypertension. results of the Wisconsin Sleep Cohort.

    PubMed

    Mokhlesi, Babak; Finn, Laurel A; Hagen, Erika W; Young, Terry; Hla, Khin Mae; Van Cauter, Eve; Peppard, Paul E

    2014-11-15

    Obstructive sleep apnea (OSA) is associated with hypertension. We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension. We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n = 4,385 sleep studies on 1,451 individuals) and additionally in a subset with ambulatory blood pressure data (n = 1,085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM sleep, either by statistical adjustment or by stratification. Fully adjusted models demonstrated significant dose-relationships between REM apnea-hypopnea index (AHI) and prevalent hypertension. The higher relative odds of prevalent hypertension were most evident with REM AHI greater than or equal to 15. In individuals with non-REM AHI less than or equal to 5, a twofold increase in REM AHI was associated with 24% higher odds of hypertension (odds ratio, 1.24; 95% confidence interval, 1.08-1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (P trend = 0.017). Non-REM AHI was not a significant predictor of hypertension in any of the models. Our findings indicate that REM OSA is cross-sectionally and longitudinally associated with hypertension. This is clinically relevant because treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated.

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

    PubMed

    Kezirian, Eric J

    2011-06-01

    To examine drug-induced sleep endoscopy (DISE) findings in nonresponders to previous pharyngeal obstructive sleep apnea (OSA) surgery. Cross-sectional. DISE using propofol for unconscious sedation was performed in nonresponders to previous OSA surgery (including palate surgery with or without tonsillectomy and possible other procedures). Nonresponders were defined as subjects with a postoperative apnea-hypopnea index more than 10 events/hr. Recorded findings from DISE included the presence and degree of obstruction in the palatal and hypopharyngeal regions, the contributions of specific structures (velum, oropharyngeal lateral walls, tongue, and/or epiglottis) to upper airway obstruction, and the degree of mouth opening. Thirty-three nonresponders underwent DISE examinations. Age was 46.2 ± 11.8 years, and 9% (3 of 33) were female. On diagnostic sleep studies prior to DISE, the apnea-hypopnea index was 43.4 ± 26.6 events/hr. During DISE, a majority of subjects demonstrated residual palatal obstruction, and almost all demonstrated hypopharyngeal obstruction. A diversity of individual structures contributed to upper airway obstruction, often in combination. Moderate to severe mouth opening occurred in one-third of subjects and was associated with narrowing of upper airway dimensions. Residual upper airway obstruction in surgery nonresponders likely occurs due to multiple mechanisms, and DISE may enhance the understanding of them. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  10. Electro-oculography-based detection of sleep-wake in sleep apnea patients.

    PubMed

    Virkkala, Jussi; Toppila, Jussi; Maasilta, Paula; Bachour, Adel

    2015-09-01

    Recently, we have developed a simple method that uses two electro-oculography (EOG) electrodes for the automatic scoring of sleep-wake in normal subjects. In this study, we investigated the usefulness of this method on 284 consecutive patients referred for a suspicion of sleep apnea who underwent a polysomnography (PSG). We applied the AASM 2007 scoring rules. A simple automatic sleep-wake classification algorithm based on 18-45 Hz beta power was applied to the calculated bipolar EOG channel and was compared to standard polysomnography. Epoch by epoch agreement was evaluated. Eighteen patients were excluded due to poor EOG quality. One hundred fifty-eight males and 108 females were studied, their mean age was 48 (range 17-89) years, apnea-hypopnea index 13 (range 0-96) /h, BMI 29 (range 17-52) kg/m(2), and sleep efficiency 78 (range 0-98) %. The mean agreement in sleep-wake states between EOG and PSG was 85% and the Cohen's kappa was 0.56. Overall epoch-by-epoch agreement was 85%, and the Cohen's kappa was 0.57 with positive predictive value of 91% and negative predictive value of 65%. The EOG method can be applied to patients referred for suspicion of sleep apnea to indicate the sleep-wake state.

  11. 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.

  12. Sleep apnea in patients reporting insomnia or restless legs symptoms.

    PubMed

    Bianchi, M T; Goparaju, B; Moro, M

    2016-01-01

    Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles. We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire. More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk. Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Short Sleep Duration Combined with Obstructive Sleep Apnea is Associated with Visceral Obesity in Korean Adults

    PubMed Central

    Kim, Nam Hoon; Lee, Seung Ku; Eun, Chai Ryoung; Seo, Ji A; Kim, Sin Gon; Choi, Kyung Mook; Baik, Sei Hyun; Choi, Dong Seop; Yun, Chang-Ho; Kim, Nan Hee; Shin, Chol

    2013-01-01

    Study Objectives: To determine whether short sleep duration alone or combined with obstructive sleep apnea (OSA) is associated with regional body fat including abdominal visceral fat area (VFA) among Korean adults. Design: Cross-sectional study. Setting: Ansan, South Korea. Participants: There were 838 community participants age 40-69 y from the Korean Genome and Epidemiology Study. Measurements and Results: Subjective habitual sleep duration and OSA were defined based on a structured sleep questionnaire and a home portable sleep study, respectively. Abdominal VFA and hepatic fat components were assessed by computed tomography. Adjusted mean VFA and hepatic fat were highest in the shortest sleep duration group (< 5 h) and decreased linearly with increasing sleep duration. Individuals with OSA (apnea-hypopnea index ≥ 5) had a higher body mass index, waist circumference, percent body fat, VFA, and hepatic fat than those without OSA after adjusting for age and sex. The adjusted odds ratio (OR) for visceral obesity (VFA ≥ 100 cm2) was 2.05 (95% confidence interval [CI], 1.09-3.86) in individuals sleeping less than 5 h compared with those sleeping longer than 7 h, and 1.57 (95% CI, 1.08-2.26) in individuals with OSA compared with those without OSA, after adjusting for all confounding factors including body mass index. A combination of short sleep duration (< 5 h) and OSA substantially increased the OR for visceral obesity (OR, 4.40, 95% CI, 1.80-10.77) compared with those who slept longer (≥ 7 h) without OSA. Conclusion: Short sleep duration and OSA are independently associated with visceral obesity in adults. The association is particularly strong in short sleepers with OSA. Citation: Kim NH; Lee SK; Eun CR; Seo JA; Kim SG; Choi KM; Baik SH; Choi DS; Yun CH; Kim NH; Shin C. Short sleep duration combined with obstructive sleep apnea is associated with visceral obesity in Korean adults. SLEEP 2013;36(5):723-729. PMID:23633755

  14. Sleep Apnea, Reproductive Hormones and Quality of Sexual Life in Severely Obese Men

    PubMed Central

    Hammoud, Ahmad O.; Walker, James M.; Gibson, Mark; Cloward, Tom V.; Hunt, Steven C.; Kolotkin, Ronette L.; Adams, Ted D.; Meikle, A. Wayne

    2013-01-01

    The effect of sleep apnea on the reproductive function of obese men is not entirely elucidated. The objective of this study was to define the effect of sleep apnea on the reproductive hormones and sexual function in obese men. This study included 89 severely obese men with BMI ≥35 kg/m2 considering gastric bypass surgery. Anthropometrics (weight, and BMI), reproductive hormones, and sleep studies were measured. The sexual quality of life was assessed using the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite). The mean age of our patients was 46.9 ± 11.0 years, the mean BMI was 47.8 ± 8.7 kg/m2 and the mean weight was 337.7 ± 62.4 lb. After correction for age and BMI, means of free testosterone per severity group of sleep apnea were as follows: no or mild sleep apnea 74.4 ± 3.8 pg/ml, moderate sleep apnea 68.6 ± 4.2 pg/ml, and severe sleep apnea 60.2 ± 2.92 pg/ml, P = 0.014. All other parameters of sleep apnea including hypopnea index, percent time below a SpO2 of 90%, and percent time below a SpO2 of 80% were also negatively correlated with testosterone levels after correction for age and BMI. BMI and presence of coronary artery disease decreased the sexual quality of life. Sleep apnea was associated with reduced sexual quality of life. In summary, sleep apnea negatively affects testosterone levels independent of BMI. Severely obese men had decreased sexual quality of life. PMID:21273994

  15. Expiratory Time Constant and Sleep Apnea Severity in the Overlap Syndrome.

    PubMed

    Wiriyaporn, Darunee; Wang, Lu; Aboussouan, Loutfi S

    2016-03-01

    Lung mechanics in the overlap of COPD and sleep apnea impact the severity of sleep apnea. Specifically, increased lung compliance with hyperinflation protects against sleep apnea, whereas increased airway resistance worsens sleep apnea. We sought to assess whether the expiratory time constant, which reflects lung mechanics, is associated with sleep apnea severity in such patients. Polysomnographies in 34 subjects with the overlap syndrome were reviewed. Three time constants were measured for each of up to 5 stages (wake, NREM stages, and REM). The time constants were derived by fitting time and pressure coordinates on the expiratory portion of a nasal pressure signal along an exponentially decaying equation, and solving for the time constant. Demographics, morphometrics, wake end-tidal CO2, right diaphragmatic arc on a chest radiograph, and the apnea-hypopnea index (AHI) were recorded. The time constant was not associated with age, gender, body mass index, right diaphragmatic arc, or wake end-tidal CO2, and was not significantly different between sleep stages. A mean time constant (TC) was therefore obtained. Subjects with a TC > 0.5 seconds had a greater AHI than those with a TC ≤ 0.5 seconds (median AHI 58 vs. 18, respectively, p = 0.003; Odds ratio of severe sleep apnea 10.6, 95% CI 3.9-51.1, p = 0.005). A larger time constant in the overlap syndrome is associated with increased odds of severe sleep apnea, suggesting a greater importance of airway resistance relative to lung compliance in sleep apnea causation in these subjects. © 2016 American Academy of Sleep Medicine.

  16. Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features.

    PubMed

    Shoda, Naoki; Seichi, Atsushi; Takeshita, Katsushi; Chikuda, Hirotaka; Ono, Takashi; Oka, Hiroyuki; Kawaguchi, Hiroshi; Nakamura, Kozo

    2009-06-01

    Since sleep apnea is a risk factor for high mortality of rheumatoid arthritis (RA) patients, this study examined the prevalence in RA patients with occipitocervical lesions, and the associated radiographic features. Twenty-nine RA patients requiring surgery for progressive myelopathy due to occipitocervical lesions (3 males, 26 females, average age 65 years) were preoperatively evaluated. Twenty-three (79%) had sleep apnea defined as apnea-hypopnea index >5 events per hour measured by a portable monitoring device, and all of them were classified as the obstructive type. Among gender, age, bone mass index (BMI), and radiographic parameters related to occipitocervical lesions: atlantodental interval (ADI), cervical angles (O/C1, C1/2, and C2/6), and cervical lengths (O-C2 and O-C6), the ADI and cervical lengths were shown to be significantly associated with the presence of sleep apnea by parametric statistical analysis. Since there were positive correlations between the ADI and cervical lengths by Pearson's test, we performed a multivariate logistic regression analysis after adjustment for confounding factors and found that small ADI was the principle parameter associated with sleep apnea. We therefore conclude that the prevalence of sleep apnea is higher than that in a general RA population that was reported previously, and believe that occipitocervical lesions are an independent risk factor for this condition. Small ADI and short neck, secondary to the vertical translocation by RA, may cause obstructive sleep apnea, probably through mechanical or neurological collapse of the upper airway.

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

    PubMed Central

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

    2007-01-01

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

  18. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension.

    PubMed

    Friedman, Oded; Bradley, T Douglas; Chan, Christopher T; Parkes, Robert; Logan, Alexander G

    2010-12-01

    Obstructive sleep apnea occurs frequently in patients with drug-resistant hypertension. The factors accounting for this observation, however, are unclear. Both conditions demonstrate clinical features suggestive of extracellular fluid volume overload. The aims of this study were to examine whether the spontaneous overnight fluid shift from the legs to the upper body is associated with obstructive sleep apnea in hypertensive subjects and whether its magnitude is greater in drug-resistant hypertension. Leg fluid volume and the circumference of the calf and neck were measured before and after sleep in drug-resistant hypertensive (n = 25) and controlled hypertensive (n=15) subjects undergoing overnight polysomnography. The severity of obstructive sleep apnea was greater in the drug-resistant hypertensive group than in the controlled hypertensive group (apnea-hypopnea index: 43.0 ± 5.4 versus 18.1 ± 4.2 events per hour of sleep; P = 0.02, case-mix adjusted). In both groups, the apnea-hypopnea index strongly related to the amount of leg fluid volume displaced (R² = 0.56; P < 0.0001), although the magnitude of change was greater in the drug-resistant hypertensive group (346.7 ± 24.1 versus 175.8 ± 31.3 mL; P = 0.01, propensity-score adjusted). The overnight reduction in calf circumference and increase in neck circumference were also greater in drug-resistant hypertension (both P ≤ 0.02). In hypertensive subjects, rostral fluid displacement strongly relates to the severity of obstructive sleep apnea with its magnitude being greater in drug-resistant hypertension. Our findings support the concept that fluid redistribution centrally during sleep accounts for the high prevalence of obstructive sleep apnea in drug-resistant hypertension.

  19. Sleep apnea syndrome: experience of the pulmonology department in Ibn Sina Hospital, Rabat, Morocco

    PubMed Central

    Jniene, Asmaa; el Ftouh, Mustapha; Fihry, Mohamed Tawfiq el Fassy

    2012-01-01

    Introduction Sleep apnea syndrome is a highly prevalent disorder that is still underdiagnosed and undertreated and whose obstructive form is the most common. The diagnosis is suspected on clinical signs collected by interrogation and questionnaires (Berlin questionnaire and Epworth sleepiness scale), then confirmed by objective sleep study findings (polygraphy or polysomnography). It is necessary to conduct studies in each context on the characteristics and management of sleep apnea syndrome comprising the testing of reliability of the questionnaires. Methods Prospective and descriptive study of 104 patients addressed to sleep consultation at pulmononology Department of Ibn Sina Hospital, Morocco over a period of 5 years (January 2006 to December 2010), agreed to participate in the study, responded to a predetermined questionnaire, and benefited from clinical examination and paraclinical tests including a polygraphy or a polysomnography Results 59(56.7%) patients had an obstructive sleep apnea-hypopnea syndrome with a similar prevalence in both sexes. 32.2% of patients were obese and 28,8% had cardio-vascular diseases. Snoring, excessive daytime sleepiness and witnessed apnea were found in respectively 79.7%, 50.8% and 16.9%. Berlin questionnaire and Epworth sleepiness scale had an acceptable internal consistency against apnea hypopnea index with a Cronbach’s alpha coefficient respectively 0.79 and 0.78. Depending on severity, clinical impact and results of investigations, the adequate treatment has been proposed based on the 2010 recommendations for clinical practice. Conclusion This study has provided an idea about the profile and the management of patients having an obstructive sleep apnea-hypopnea syndrome and showed that both Berlin questionnaire and Epworth sleepiness scale are two simple and reliable methods in our context. A larger and further study across the country should be considered. PMID:23308333

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

    PubMed

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

    2016-09-08

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

  1. Tetraplegia is a risk factor for central sleep apnea.

    PubMed

    Sankari, Abdulghani; Bascom, Amy T; Chowdhuri, Susmita; Badr, M Safwan

    2014-02-01

    Sleep-disordered breathing (SDB) is highly prevalent in patients with spinal cord injury (SCI); the exact mechanism(s) or the predictors of disease are unknown. We hypothesized that patients with cervical SCI (C-SCI) are more susceptible to central apnea than patients with thoracic SCI (T-SCI) or able-bodied controls. Sixteen patients with chronic SCI, level T6 or above (8 C-SCI, 8 T-SCI; age 42.5 ± 15.5 years; body mass index 25.9 ± 4.9 kg/m(2)) and 16 matched controls were studied. The hypocapnic apneic threshold and CO2 reserve were determined using noninvasive ventilation. For participants with spontaneous central apnea, CO2 was administered until central apnea was abolished, and CO2 reserve was measured as the difference in end-tidal CO2 (PetCO2) before and after. Steady-state plant gain (PG) was calculated from PetCO2 and VE ratio during stable sleep. Controller gain (CG) was defined as the ratio of change in VE between control and hypopnea or apnea to the ΔPetCO2. Central SDB was more common in C-SCI than T-SCI (63% vs. 13%, respectively; P < 0.05). Mean CO2 reserve for all participants was narrower in C-SCI than in T-SCI or control group (-0.4 ± 2.9 vs.-2.9 ± 3.3 vs. -3.0 ± 1.2 l·min(-1)·mmHg(-1), respectively; P < 0.05). PG was higher in C-SCI than in T-SCI or control groups (10.5 ± 2.4 vs. 5.9 ± 2.4 vs. 6.3 ± 1.6 mmHg·l(-1)·min(-1), respectively; P < 0.05) and CG was not significantly different. The CO2 reserve was an independent predictor of apnea-hypopnea index. In conclusion, C-SCI had higher rates of central SDB, indicating that tetraplegia is a risk factor for central sleep apnea. Sleep-related hypoventilation may play a significant role in the mechanism of SDB in higher SCI levels.

  2. 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

  3. Regional Reductions in Sleep Electroencephalography Power in Obstructive Sleep Apnea: A High-Density EEG Study

    PubMed Central

    Jones, Stephanie G.; Riedner, Brady A.; Smith, Richard F.; Ferrarelli, Fabio; Tononi, Giulio; Davidson, Richard J.; Benca, Ruth M.

    2014-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is associated with significant alterations in neuronal integrity resulting from either hypoxemia and/or sleep loss. A large body of imaging research supports reductions in gray matter volume, alterations in white matter integrity and resting state activity, and functional abnormalities in response to cognitive challenge in various brain regions in patients with OSA. In this study, we used high-density electroencephalography (hdEEG), a functional imaging tool that could potentially be used during routine clinical care, to examine the regional distribution of neural activity in a non-clinical sample of untreated men and women with moderate/severe OSA. Design: Sleep was recorded with 256-channel EEG in relatively healthy subjects with apnea-hypopnea index (AHI) > 10, as well as age-, sex-, and body mass index-matched controls selected from a research population initially recruited for a study on sleep and meditation. Setting: Sleep laboratory. Patients or Participants: Nine subjects with AHI > 10 and nine matched controls. Interventions: N/A. Measurements and Results: Topographic analysis of hdEEG data revealed a broadband reduction in EEG power in a circumscribed region overlying the parietal cortex in OSA subjects. This parietal reduction in neural activity was present, to some extent, across all frequency bands in all stages and episodes of nonrapid eye movement sleep. Conclusion: This investigation suggests that regional deficits in electroencephalography (EEG) power generation may be a useful clinical marker for neural disruption in obstructive sleep apnea, and that high-density EEG may have the sensitivity to detect pathological cortical changes early in the disease process. Citation: Jones SG; Riedner BA; Smith RF; Ferrarelli F; Tononi G; Davidson RJ; Benca RM. Regional reductions in sleep electroencephalography power in obstructive sleep apnea: a high-density EEG study. SLEEP 2014;37(2):399-407. PMID:24497668

  4. Clinical evaluation in predicting childhood obstructive sleep apnea.

    PubMed

    Xu, Zhifei; Cheuk, Daniel Ka Leung; Lee, So Lun

    2006-12-01

    To determine whether parents' observation, clinical examination, and lateral upper airway radiograph are useful in detecting clinically significant obstructive sleep apnea (OSA) in children. We retrospectively reviewed data of 50 children aged 4 to 18 years who were consecutively referred to a sleep clinic for suspected OSA. All subjects underwent clinical assessments including standardized history collection, physical examination, and lateral neck radiograph for measurement of postnasal space. Each child underwent overnight polysomnography on the night of clinical assessments. Patients with clinically significant OSA, defined as apnea-hypopnea index (AHI) > 5, were compared with primary snorers, defined as AHI < or = 5. Thirty-one children had clinically significant OSA, and 19 children were primary snorers. The prevalence of risk factors including allergic rhinitis, obesity, and craniofacial anomaly was similar between the two groups. Observable apnea during sleep, nocturnal enuresis, intrusive naps, mouth breathing, enlarged tonsils, and radiologic features of upper airway narrowing due to adenoid hypertrophy were found to be predictors for clinically significant OSA. Combining upper airway narrowing and mouth breathing or nocturnal enuresis had a sensitivity of 90.3%, and combining all six predictors had a sensitivity of 93.5% of detecting OSA. Combining clinical and radiologic findings might be helpful to screen for children with clinically significant OSA who need earlier investigation and intervention.

  5. Automatic Video Analysis for Obstructive Sleep Apnea Diagnosis

    PubMed Central

    Abad, Jorge; Muñoz-Ferrer, Aida; Cervantes, Miguel Ángel; Esquinas, Cristina; Marin, Alicia; Martínez, Carlos; Morera, Josep; Ruiz, Juan

    2016-01-01

    Study Objectives: We investigated the diagnostic accuracy for the identification of obstructive sleep apnea (OSA) and its severity of a noninvasive technology based on image processing (SleepWise). Methods: This is an observational, prospective study to evaluate the degree of agreement between polysomnography (PSG) and SleepWise. We recruited 56 consecutive subjects with suspected OSA who were referred as outpatients to the Sleep Unit of the Hospital Universitari Germans Trias i Pujol (HUGTiP) from January 2013 to January 2014. All patients underwent laboratory PSG and image processing with SleepWise simultaneously the same night. Both PSG and SleepWise analyses were carried independently and blindly. Results: We analyzed 50 of the 56 patients recruited. OSA was diagnosed through PSG in a total of 44 patients (88%) with a median apnea-hypopnea index (AHI) of 25.35 (24.9). According to SleepWise, 45 patients (90%) met the criteria for a diagnosis of OSA, with a median AHI of 22.8 (22.03). An analysis of the ability of PSG and SleepWise to classify patients by severity on the basis of their AHI shows that the two diagnostic systems distribute the different groups similarly. According to PSG, 23 patients (46%) had a diagnosis of severe OSA, 11 patients (22%) moderate OSA, and 10 patients (20%) mild OSA. According to SleepWise, 20, 13, and 12 patients (40%, 26%, and 24%, respectively) had a diagnosis of severe, moderate, and mild OSA respectively. For OSA diagnosis, SleepWise was found to have sensitivity of 100% and specificity of 83% in relation to PSG. The positive predictive value was 97% and the negative predictive value was 100%. The Bland-Altman plot comparing the mean AHI values obtained through PSG and SleepWise shows very good agreement between the two diagnostic techniques, with a bias of −3.85, a standard error of 12.18, and a confidence interval of −0.39 to −7.31. Conclusions: SleepWise was reasonably accurate for noninvasive and automatic diagnosis

  6. 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

  7. 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

  8. Nitric oxide and obstructive sleep apnea.

    PubMed

    Weiss, J Woodrow; Liu, Yuzhen; Li, Xianghong; Ji, En-sheng

    2012-11-15

    Obstructive sleep apnea is a common disease, affecting 16% of the working age population. Although sleep apnea has a well-established connection to daytime sleepiness presumably mediated through repetitive sleep disruption, some other consequences are less well understood. Clinical, epidemiological, and physiological investigations have demonstrated a connection between sleep apnea and daytime hypertension. The elevation of arterial pressure is evident during waking, when patients are not hypoxic, and is mediated by sustained sympathoexcitation and by altered peripheral vascular reactivity. This review summarizes data suggesting that both the sympathoexcitation and the altered vascular reactivity are, at least in part, a consequence of reduced expression of nitric oxide synthase, in neural tissue and in endothelium. Reduced nitric oxide generation in central and peripheral sites of sympathoregulation and in endothelium together may, in part, explain the elevations in waking pressures observed in sleep apnea patients. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. [Hypertension and cardiovascular risk associated with obstructive sleep apnea in adult in Guadeloupe (French West Indies)].

    PubMed

    Billy Brissac, R; Phiraï, S; Larifla, L; Atallah, A; Hedreville, M; Hedreville, S; Fassih, M; Cadelis, G; Rhinan, P; Hamony Soter, V; Foucan, L

    2015-06-01

    In Guadeloupe, data on the relationships between arterial hypertension and obstructive sleep apnea are unavailable. The aim of this study was: to assess the frequency of hypertension and non-dipper pattern evaluated by 48-hour ambulatory blood pressure monitoring in an adult population identified obstructive sleep apnea/non-obstructive sleep apnea during overnight polygraphy ; to determine the cardio-metabolic factors associated with obstructive sleep apnea. A cross-sectional study was realized at Pointe-à-Pitre Hospital. Patients were referred for suspected sleep apnea to sleep specialist and performed a nocturnal polygraphy. Diagnosis was confirmed if the apnea-hypopnea index was ≥ 5. We obtained two groups: sleep apnea/non-sleep apnea. All patients underwent 48-hour ambulatory blood pressure monitoring. The cardio-metabolic factors were identified and assessed (fasten level of hs-CRP and Homa-IR index). A total of 204 patients were included. Mean age at diagnosis was 54 ± 10 years, 63% were women. OSA was present in 69.6% with a higher frequency in men than in women. Difference was not significant between the two groups for hypertension frequency (84.5% vs 77%; P=0.22), non-dipper pattern (77.5% vs 76%; P=0.79) and hs-CRP. Differences for age, snoring, body max index, mean waist circumference, Homa-IR index, obesity, dyslipidemia, and type 2 diabetes were significant. Our data highlight raised frequency of cardiovascular metabolic factors in patients with obstructive sleep apnea and confirm their high cardiovascular risk. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. A real-world comparison of apnea-hypopnea indices of positive airway pressure device and polysomnography.

    PubMed

    Agrawal, Ritwick; Wang, Julie A; Ko, Anita G; Getsy, Joanne E

    2017-01-01

    The apnea hypopnea index (AHI) reported by positive airway pressure (PAP) device is widely used in clinical practice, yet its correlation with standardized AHI obtained during the sleep study is not established. The current study was conducted to investigate the correlation between AHI estimated by the PAP device and reported on the smart card with the AHI found during the PAP polysomnography (PSG) in the "real world" setting at an academic sleep center. We retrospectively reviewed the medical records of 280 patients who underwent a PAP titration PSG at Drexel sleep center, and were later prescribed a PAP device. The AHI was categorized in clinically relevant subgroups (as AHI ≤5 and AHI >5). The AHI at the final pressure on the PSG and the average AHI from the prescribed PAP device were compared. The results showed that in the majority (77.3%) of patients (126 of 163), the AHI from both PAP device and PSG correlated well and were in the same category (AHI ≤5 and AHI >5 respectively). The majority of patients (80.7%) with PSG AHI of <5 had PAP device AHI <5 as well. By contrast, if PSG AHI was >5, 61.5% patients reported good control, with AHI <5 on PAP device AHI. We conclude that in a majority of patients who were optimally titrated in the sleep laboratory, the PAP device continued to show optimal control at home.

  11. [Prolonged apnea/hypopnea during water swallowing in patients with amyotrophic lateral sclerosis].

    PubMed

    Nozaki, Sonoko; Sugishita, Shuhei; Saito, Toshio; Umaki, Yoshifumi; Adachi, Katsuhito; Shinno, Susumu

    2008-09-01

    Swallowing difficulty is increased along with progression of respiratory disturbance in patients with Amyotrophic Lateral Scalerosis (ALS). To analyze the respiratory patterns during swallowing is important for the management of this disease. In this study, we evaluated apnea/hypopnea during water swallowing and the respiratory cycle at rest and after water swallowing. We evaluated respiratory patterns in swallowing in 10 ALS patients (66.0 +/- 7.1 years old), in 10 Myotonic dystrophy (MD) patients (46.5 +/- 12.2 years old), and in 10 healthy volunteers as control subjects (61.7 +/- 10.0 years old). The ALS and MD patients had consulted the Department of Neurology of Toneyama National Hospital or Tokushima National Hospital between April 2002 and July 2006. Respiratory patterns were evaluated by simultaneous recording of cervical swallowing sound in water swallow. A hypersensitive microphone measured cervical sound. A thermister was used for pneumography. The means of four continuous respiratory cycles at rest and after swallow of 3 ml water were used for analysis. Respiration with amplitude of 1/2 or smaller than that of the pneumography at rest was defined as hypopnea, and the apnea/hypopnea duration was evaluated as the respiratory suppression time. All analyses were performed using SPSS 11.0J (SPSS Inc., Chicago, IL). In the ALS group, the respiratory cycle was 3.15 +/- 0.76 sec (2.31-4.39 sec) at rest, while after swallowing, it was 2.78 +/- 0.83 sec (1.77-4.80 sec) (p = 0.1). In the MD group, the respiratory cycle was 2.56 +/- 0.46 sec (1.91-3.67 sec) at rest, while after swallowing, it was 2.94 +/- 0.60 sec (2.03-4.29 sec). In the control group, it was 3.46 +/- 0.57 sec (3.18-4.34 sec) at rest and 3.24 +/- 0.50 sec (2.64-4.04 sec) after swallowing. The apnea/hypopnea duration during water swallow was 14.33 +/- 8.89 sec (2.50-30.68 sec) in the ALS group, 3.66 +/- 1.58 sec (1.78-6.42 sec) in the MD group, and 3.64 +/- 1.00 sec (2.34-5.56 sec) in the control

  12. Long-Term Effects of Caffeine Therapy for Apnea of Prematurity on Sleep at School Age

    PubMed Central

    Meltzer, Lisa J.; Roberts, Robin S.; Traylor, Joel; Dix, Joanne; D’ilario, Judy; Asztalos, Elizabeth; Opie, Gillian; Doyle, Lex W.; Biggs, Sarah N.; Nixon, Gillian M.; Narang, Indra; Bhattacharjee, Rakesh; Davey, Margot; Horne, Rosemary S. C.; Cheshire, Maureen; Gibbons, Jeremy; Costantini, Lorrie; Bradford, Ruth; Schmidt, Barbara

    2014-01-01

    Rationale: Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain. Objectives: We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep. Methods: A total of 201 ex-preterm children aged 5–12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea–hypopnea index on polysomnography. Measurements and Main Results: There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of −6.7 [95% confidence interval (CI) = −15.3 to 2.0 min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea–hypopnea index of 0.89 [95% CI = 0.55–1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups. Conclusions: Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood. PMID:25171195

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2001-12-01

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

  15. Mechanisms of obstructive sleep apneas in infants.

    PubMed

    Kahn, A; Groswasser, J; Sottiaux, M; Rebuffat, E; Franco, P

    1994-01-01

    During sleep, infants with obstructive sleep apneas are characterised by snoring, laborious breathing, and profuse sweating. During wakefulness, they may have breath-holding spells, and during feeding, difficult breathing and swallowing coordination. Abnormal weight, difficult growth, and recurring ear infections may also develop. During sleep apneas, cinefluoroscopy shows approximation of tongue and hypopharyngeal tissues, with an obliteration of the air space. The obstructed breaths occur mainly in REM, and light NREM sleep, associated with total short sleep time, and frequent arousals. Preterm infants, and term neonates are more prone to obstructive apneas than older healthy infants. Apneas are more frequently seen in boys and in case of excess in body weight. Obstructive apneas are frequently associated with upper airway anatomic abnormalities: malformations, soft tissue infiltration, and neurologic lesions impairing muscle contractions. Alterations of the autonomic nervous control may induce airways obstructions. Contributing factors include mucopolysaccharide storage disease, hypothyroidism, or Down's syndrome. Superimposed factors may occur, such as nasal obstruction, secretions in the airways, or tissue edema. Pressure- and chemo-sensitive reflexes may also favor obstruction. Environmental factors also contribute to the development of sleep apneas: body position, neck flexion, sleep deprivation, or the effects of sedative drugs.

  16. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial.

    PubMed

    Barbé, F; Mayoralas, L R; Duran, J; Masa, J F; Maimó, A; Montserrat, J M; Monasterio, C; Bosch, M; Ladaria, A; Rubio, M; Rubio, R; Medinas, M; Hernandez, L; Vidal, S; Douglas, N J; Agustí, A G

    2001-06-05

    The sleep apnea-hypopnea syndrome is defined by a pathologic number of respiratory events during sleep (the apnea-hypopnea index, defined as the number of apnea and hypopnea episodes per hour) and daytime symptoms (mostly, excessive sleepiness). In patients with the sleep apnea syndrome, treatment with continuous positive airway pressure (CPAP) normalizes both the apnea-hypopnea index and diurnal symptoms. However, the effect of CPAP in persons with a pathologic apnea-hypopnea index without daytime sleepiness is unclear. To investigate the short-term effects of CPAP on quality of life, objective sleepiness, cognitive function, and arterial blood pressure in nonsleepy patients with a pathologic apnea-hypopnea index. Multicenter randomized, placebo-controlled, parallel-group study. Six teaching hospitals in Spain. 55 patients with an apnea-hypopnea index of 30 or greater who did not have daytime sleepiness (Epworth Sleepiness Scale score Sleep Latency Test score), cognitive function, and arterial blood pressure. The intervention and control groups were similar in terms of mean (+/-SE) age (54 +/- 2 vs. 52 +/- 2 years), apnea-hypopnea index (54 +/- 3 vs. 57 +/- 4), Epworth Sleepiness Scale score (7.0 +/- 0.4 vs. 7.0 +/- 0.4) and adherence to CPAP treatment (5.0 +/- 0.4 vs. 4.0 +/- 0.5 hours/d). Other variables, such as quality of life, cognitive function, and arterial blood pressure, were also similar in both groups before treatment. After 6 weeks of CPAP or sham CPAP, none of these variables changed significantly. In patients with an apnea-hypopnea index of 30 or greater and no subjective daytime sleepiness, CPAP does not modify quality of life, objective sleepiness, vigilance, attention, memory, information processing, visuomotor coordination, or arterial blood pressure. Treatment with CPAP is

  17. Cerebrovascular Reactivity in Young Subjects with Sleep Apnea

    PubMed Central

    Buterbaugh, John; Wynstra, Charles; Provencio, Natalie; Combs, Daniel; Gilbert, Michael; Parthasarathy, Sairam

    2015-01-01

    Study Objectives: Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding. Design: Case-control study. Setting: Academic center. Participants: Twelve subjects with OSA (age 24–42 y; apnea-hypopnea index 17; interquartile range [IQR] 9, 69 per hour) and control subjects (n = 10; age 29–44 y; AHI 2; IQR 1, 3 per hour). Measurements and Results: Subjects underwent blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) while awake, swallowing, and breath holding. In subjects with OSA, during swallowing, there was less activity in the brainstem than in controls (P = 0.03) that remained reduced after adjusting for cortical motor strip activity (P = 0.036). In OSA subjects, brain regions of increased cerebrovascular reactivity (38; IQR 17, 96 cm3) was smaller than that in controls (199; IQR 5, 423 cm3; P = 0.01). In OSA subjects, brain regions of decreased cerebrovascular reactivity during breath hold was greater (P = 0.01), and the ratio of increased-to-decreased brain regions was lower than that of controls (P = 0.006). Adjustment for cerebral volumes, body mass index, and white matter lesions did not change these results substantively. Conclusions: In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA. Citation: Buterbaugh J, Wynstra C, Provencio N, Combs D, Gilbert M, Parthasarathy S. Cerebrovascular reactivity in

  18. Obstructive Sleep Apnea Is Common in Idiopathic Pulmonary Fibrosis

    PubMed Central

    Lancaster, Lisa H.; Mason, Wendi R.; Parnell, James A.; Rice, Todd W.; Loyd, James E.; Milstone, Aaron P.; Collard, Harold R.; Malow, Beth A.

    2009-01-01

    Background: From 1984 to 2006, studies of sleep in patients with interstitial lung disease revealed disturbed sleep, frequent nocturnal desaturations, nocturnal cough, and obstructive sleep apnea (OSA). Our goal was to analyze OSA in an outpatient population of stable patients with idiopathic pulmonary fibrosis (IPF). Methods: Patients with IPF who had been followed up in the Vanderbilt Pulmonary Clinic were asked to participate. All patients were given a diagnosis of IPF by the 2000 American Thoracic Society consensus statement criteria. Subjects completed an Epworth sleepiness scale (ESS) questionnaire and a sleep apnea scale of sleep disorders questionnaire (SA-SDQ) before undergoing nocturnal polysomnography (NPSG). OSA was defined as an apnea-hypopnea index (AHI) of > 5 events per hour. Results: Fifty subjects enrolled and completed a NPSG. The mean age was 64.9 years, and the mean BMI was 32.3. OSA was diagnosed in 88% of subjects. Ten subjects (20%) had mild OSA (AHI, 5 to 15 events per hour), and 34 subjects (68%) had moderate-to-severe OSA (AHI, > 15 events per hour). Only 6 subjects (12%) had a normal AHI. One patient was asymptomatic as determined by ESS and SA-SDQ, but had an AHI of 24 events per hour. The sensitivity of the ESS was 75% with a specificity of 15%, whereas the SA-SDQ had a sensitivity of 88% with a specificity of 50%. BMI did not correlate strongly with AHI (r = 0.30; p = 0.05). Conclusions: OSA is prevalent in patients with IPF and may be underrecognized by primary care providers and specialists. Neither ESS nor SA-SDQ alone or in combination was a strong screening tool. Given the high prevalence found in our sample, formal sleep evaluation and polysomnography should be considered in patients with IPF. PMID:19567497

  19. Obstructive sleep apnea and psychomotor vigilance task performance

    PubMed Central

    Batool-Anwar, Salma; Kales, Stefanos N; Patel, Sanjay R; Varvarigou, Vasileia; DeYoung, Pamela N; Malhotra, Atul

    2014-01-01

    Background Obstructive sleep apnea (OSA) is a highly prevalent disorder with considerable morbidity and mortality. Vigilance and attentiveness are often impaired in OSA patients. In occupational medicine settings, subjective reports of sleepiness are notoriously inaccurate, making the identification of objective measures of vigilance potentially important for risk assessments of fitness for duty. In order to evaluate the effects of OSA on attentiveness and vigilance, we conducted a cross-sectional study to examine the association between OSA and psychomotor vigilance task (PVT) performance. Methods Patients attending sleep clinics for evaluation of possible sleep apnea were recruited. The subjects underwent either a standard overnight laboratory polysomnography or home sleep study. Subjective daytime sleepiness was assessed by Epworth sleepiness scale, and vigilance was tested using a portable device. The participants were asked to respond to the PVT signals using their dominant hand. Each PVT administration lasted 10 minutes, with stimuli signals appearing randomly at variable intervals of 2–10 seconds. Results Mean age of the participants was 46±15 years, and mean body mass index was 34.3±9.8 kg/m2. Participants with higher Epworth scores had worse PVT performance (P<0.05). In multivariate analyses, age, body mass index, and poor sleep efficiency (measured by Pittsburgh sleep quality index score) were associated with worse PVT performance (P<0.05). In contrast, PVT performance did not differ significantly across categories of apnea hypopnea index severity. Subgroup analysis demonstrated that women had worse performance on all PVT measures (P<0.05). Conclusion PVT performance can be utilized for risk assessments of sleepiness and may be particularly useful among populations where subjective reports are unreliable. PMID:24920941

  20. Sleep Apnea and Obstructive Airway Disease in Older Men: Outcomes of Sleep Disorders in Older Men Study

    PubMed Central

    Zhao, Ying Y.; Blackwell, Terri; Ensrud, Kristine E.; Stone, Katie L.; Omachi, Theodore A.; Redline, Susan

    2016-01-01

    Study Objectives: To evaluate the association between obstructive airway disease (OAD) and sleep apnea in older men. Methods: A community-based cross-sectional study of 853 community-dwelling older men (mean age 80.7 ± 4.1 years [range 73 to 90]) across 6 centers in the United States from the Outcomes of Sleep Disorders in Older Men Study. Sleep was objectively measured using full in-home polysomnography and lung function was objectively measured using spirometry. The association of OAD (pre-bronchodilator FEV1/FVC ratio < 0.7 and FEV1 < 80% predicted) and sleep apnea (apnea-hypopnea index [AHI] ≥ 15 events/hour) was assessed using logistic regression. Results: OAD and sleep apnea were identified in 111 (13.0%) and 247 (29.0%) men, respectively. In univariate analysis, participants with OAD had a lower AHI (mean ± SD; 8.7 ± 11.7 vs. 12.7 ± 13.8, P = 0.0009) and a lower prevalence of sleep apnea (14.4 vs. 31.1%, P = 0.0003) compared to participants without OAD. OAD remained independently associated with a lower odds of sleep apnea (odds ratio 0.30, 95% CI 0.16 to 0.55, P = 0.0001) after adjustment for demographics, body composition, smoking, and potential mediators (arousal index, time spent in rapid eye movement sleep). Individuals with OAD and sleep apnea (n = 16) had an increased arousal index and lower oxygen saturation level as compared to individuals with OAD alone (P values < 0.05). Conclusions: Obstructive airway disease was associated with a lower prevalence of sleep apnea in a cohort of community-dwelling elderly men, and unexplained by differences in adiposity or sleep architecture. Although uncommon in this cohort, coexisting sleep apnea and OAD was associated with increased sleep fragmentation and nocturnal oxygen desaturation compared to OAD alone. Citation: Zhao YY, Blackwell T, Ensrud KE, Stone KL, Omachi TA, Redline S, Osteoporotic Fractures in Men (MrOS) Study Group. Sleep apnea and obstructive airway disease in older men: outcomes of sleep

  1. Quantitative airway analysis during drug-induced sleep endoscopy for evaluation of sleep apnea.

    PubMed

    Borek, Ryan C; Thaler, Erica R; Kim, Christopher; Jackson, Nicholas; Mandel, Jeff E; Schwab, Richard J

    2012-11-01

    To quantitatively measure changes in airway caliber at multiple anatomical levels during drug-induced sleep endoscopy (DISE) for evaluation of sleep apnea. We hypothesize that patients undergoing DISE will show: 1) collapse at multiple upper airway regions (retropalatal, retroglossal, and retroepiglottic), with greater collapse in the retropalatal region; and 2) greater anterior-posterior dimensional narrowing than the lateral. Case series. Patients underwent DISE employing propofol as part of a nonrandomized prospective trial assessing candidacy for transoral robotic surgery intervention for sleep apnea. Images of the retropalatal, retroglossal, and retroepiglottic regions were captured during an initial period of light sedation and again in a period of deep sedation. Images were analyzed using software to measure the percent change in regional airway measurements as a result of DISE. Thirty-seven sleep endoscopy videos were analyzed from patients with obstructive sleep apnea (apnea-hypopnea index: 42.9 ± 27.0 events/hour). Analyzable images were in the retropalatal (n = 24), retroglossal (n = 27), and retroepiglottic (n = 29) regions. The patients demonstrated mean reductions in airway area in the retropalatal (84.1 ± 18.7%), retroglossal (39.3 ± 37.5%), and retroepiglottic region (44.6 ± 42.8%). No statistically significant differences were found between lateral and anterior-posterior airway dimensional changes. Patients undergoing DISE had significant reductions in airway area at multiple regions under deep sedation with propofol. We conclude that collapse in the retropalatal region is greater than the hypopharyngeal region. This method can be used to quantitatively measure DISE upper airway changes, which could potentially be used as a means for understanding surgical outcomes in patients with sleep apnea. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  2. The Emergence of Central Sleep Apnea after Surgical Relief of Nasal Obstruction in Obstructive Sleep Apnea

    PubMed Central

    Goldstein, Cathy; Kuzniar, Tomasz J.

    2012-01-01

    By the current definition, complex sleep apnea (CompSA) refers to the emergence of central sleep apnea (CSA) during the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, new-onset CSA has been described with use of other treatments for OSA, including tracheostomy, maxillofacial surgery, and mandibular advancement device. We present a patient with CSA beginning after endoscopic sinus and nasal surgery for nasal obstruction in the setting of mild OSA. This case highlights the importance of non-PAP mechanisms in the pathogenesis of CompSA. Citation: Goldstein C; Kuzniar TJ. The emergence of central sleep apnea after surgical relief of nasal obstruction in obstructive sleep apnea. J Clin Sleep Med 2012;8(3):321-322. PMID:22701391

  3. Effect of Semirecumbent Sleep Position on Severity of Obstructive Sleep Apnea in Patients With Heart Failure.

    PubMed

    Basoglu, Ozen K; Keskin, Bengisu; Tasbakan, Mehmet Sezai; Gurgun, Cemil

    2015-10-01

    Overnight rostral leg fluid displacement in heart failure (HF) patients is related to the high prevalence and severity of obstructive sleep apnea syndrome (OSAS). We hypothesized that rostral fluid shift would decrease in a semirecumbent (45-degree elevated) position, and evaluated the effect of semirecumbent sleeping on severity of sleep apnea in HF patients with OSAS. Demographic, anthropometric characteristics, and medical history of 30 consecutive patients with HF and OSAS were recorded. The patients underwent 2 polysomnographic procedures within 1 week: 1 while lying flat and the other in a semirecumbent position. Out of 30 patients (mean age 54.7 ± 10.2, 26 men), 16 (53.3%) were obese and 29 (96.7%) had comorbidities other than HF. Mean apnea-hypopnea index was 30.8 ± 20.7 events/h while lying flat which decreased to 17.8 ± 12.1 events/h in semirecumbent position (P < .0001). Similarly, oxygen desaturation index decreased from 22.3 ± 19.8 to 12.7 ± 11.5 events/h (P < .0001), and the percentage of sleep time with oxygen saturation (SpO2) <90% (P = .036) and lowest SpO2 (P = .004) were improved in the semirecumbent position. Furthermore, the percentage of stage N2 sleep decreased from 47.0% while lying flat to 39.6% (P = .014). The present findings support that the severity of OSAS decreased significantly in a semirecumbent sleep position in patients with HF. Therefore, semirecumbent sleeping may be a promising therapeutic option in the management of HF-related sleep apnea. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Analysis of sleep parameters in patients with obstructive sleep apnea studied in a hospital vs. a hotel-based sleep center.

    PubMed

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

    2008-04-15

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

  5. Cervical osteophytes: a rare cause of obstructive sleep apnea.

    PubMed

    Eyigor, Hulya; Selcuk, Omer Tarik; Osma, Ustun; Koca, Rahime; Yilmaz, Mustafa Deniz

    2012-09-01

    Uncertain etiology of cervical osteophytes, in particular emerging in geriatric population, is a rare skeletal system disease. Often, the cases are asymptomatic and may lead to symptoms such as dysphagia, cough, dyspnea, and dysphonia. We present a patient who had anterior osteophytes causing symptoms of severe obstructive sleep apnea (OSA), and literature on etiology of OSA has been reviewed. A 57-year-old male patient with complaints of snoring and cessation of breathing during sleep was referred to the ear nose throat clinic. Cervical radiograph and computed tomography showed the osteophytes in the anterior of the vertebral corpus at the level C1-2. In addition, bridging osteophyte was observed between C6 and C7 vertebrae. The patient's neck circumference was 41 cm, body mass index was 29 kg/m2, Epworth Sleepiness Scale score was 11, and apnea hypopnea index was 62. Surgery was recommended, but the patient refused. Continuous positive airway pressure titration was applied with 12.6 cm H2O pressure; apnea control was attained with an AHI of 2.7. One of the rare causes of OSA, a case of cervical vertebral osteophyte, was presented, and we would like to draw attention to the importance of ear nose throat examination in the diagnosis of OSA.

  6. 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

  7. Sleep apnea in chronic heart failure.

    PubMed

    Anselm, Anjali H; Gauthier, Nadine; Beanlands, Rob S B; Haddad, Haissam

    2008-03-01

    As heart failure continues to carry significant morbidity and mortality it is crucial to pursue new lines of therapy. Addressing sleep apnea, which is highly prevalent in these patients, offers just such an avenue. We discuss how sleep apnea may contribute to the propagation of heart failure, and how understanding its effects and reversing these effects might benefit heart failure patients. Continuous positive airway pressure ventilation, atrial pacing, and chronic resynchronization therapy have all been studied in sleep apnea. Some of these therapies have shown benefits in heart failure. This offers hope for improved outcomes, particularly with respect to mortality. Delineating how these therapies affect the heart's energetics and metabolism may also provide further understanding of the relationship between sleep apnea and heart failure. As both obstructive and central sleep apnea are highly prevalent in heart failure, treating these patients with continuous positive airway pressure, atrial pacing, or chronic resynchronization therapy may offer morbidity and mortality benefits. Much remains to be understood about the relationship between sleep apnea and heart failure, and understanding the interaction between the two at both the myocardial and clinical level is crucial.

  8. Sleep duration and body mass index in children and adolescents with and without obstructive sleep apnea.

    PubMed

    Moraleda-Cibrián, Marta; O'Brien, Louise M

    2014-09-01

    The prevalence of pediatric obesity and short sleep duration has simultaneously increased in recent decades. Sleep plays a critical role in metabolic and endocrine regulation and insufficient sleep has been shown to be associated with changes in metabolism. Obesity, a major risk factor for obstructive sleep apnea (OSA), has been also associated with metabolic dysregulation. Despite this, no study investigating short sleep and obesity has addressed the potential confounder of OSA. The aim of this study was to investigate the association between short sleep duration and obesity in children with and without OSA. In this retrospective study, 306 children who underwent polysomnography between January and December 2010 were included. A diagnosis of OSA was made if the apnea/hypopnea index on polysomnography is ≥1. Typical sleep times were obtained by parental report. Short sleep duration was defined as a reduction of >1 h from the minimum total sleep time (TST) recommended for age from the National Sleep Foundation (NSF). Overall, 32% were obese, 39.5% had short sleep duration, and 78% had OSA. Children with OSA had a similar frequency of short sleep duration than those without (39.6 vs. 42.4%, p = 0.950). In children with short sleep duration, the odds ratio for obesity was 2.5 (95% CI 1.3-4.9; p = 0.009) compared to children with TST within normal limits even after accounting for the presence of OSA. A parental history of total sleep duration of only 1 h less than recommended per age by the NSF is associated with a higher risk for obesity in children independently of the presence of OSA.

  9. The acute effects of uvulopalatopharyngoplasty on breathing during sleep in sleep apnea patients.

    PubMed

    Sanders, M H; Johnson, J T; Keller, F A; Seger, L

    1988-02-01

    Uvulopalatopharyngoplasty (UPPP) is frequently employed in the treatment of obstructive sleep apnea (OSA). Despite anecdotal reports of early post-UPPP deaths and the recommendation by some authors to perform a prophylactic tracheotomy for selected patients at the time of UPPP, there has been no systematic examination of breathing during sleep in the early post-UPPP period. In order to evaluate the early postoperative risk and the need for prophylactic tracheotomy in UPPP patients, we conducted polysomnograms (PSGs) on eight obese OSA patients on the second post-UPPP night and on another obese OSA patient on the fifth night after surgery. Postoperatively during wakefulness there was a significant increase in the alveolar-arterial oxygen gradient (p less than 0.05); in three individuals, the PaO2 was sufficiently reduced to warrant supplemental oxygen. For the group of nine patients there were no differences between the pre- and post-UPPP apnea index (AI), hypopnea index (HI), or apnea plus hypopnea index during non-rapid eye movement sleep. In individual patients, the pattern of sleep-disordered breathing events was variably altered, but there was a reciprocal relationship between the changes in AI and HI (r = 0.75; p less than 0.02). The duration of apnea in non-rapid eye movement sleep was shorter in four patients and unchanged in five patients postoperatively. Although the mean nadir of hemoglobin saturation was unchanged before and after UPPP, one patient desaturated to dramatically low levels in association with several excessively prolonged apneas post-UPPP. Desaturation was probably minimized in the three patients receiving supplemental oxygen. There were no serious adverse effects resulting directly from sleep-disordered breathing or nocturnal hemoglobin oxygen desaturation following UPPP. Our data suggest that performing a tracheotomy in a nonselective fashion in OSA patients undergoing UPPP is not warranted. In lieu of this, these individuals should be

  10. Obstructive Sleep Apnea: Women’s Perspective

    PubMed Central

    Jehan, Shazia; Auguste, Evan; Zizi, Ferdinand; Pandi-Perumal, Seithikurippu R.; Gupta, Ravi; Attarian, Hrayr; Jean-Louis, Giradin; McFarlane, Samy I.

    2016-01-01

    The main characteristics of sleep-disordered breathing (SDB) are airflow limitation, chronic intermittent hypoxia, or apnea; which may lead to tissue hypoperfusion and recurrent arousal from sleep. These episodes of hypoxia or apnea can lead to tissue inflammation, and are causal factors of disturbed sleep in both men and women. Several lines of evidence suggest that sleep patterns differ along the lifespan in both male and female subjects, and this may result from the influence of female gonadotropic hormones on sleep. Compared to men, women have more sleep complaints, as women’s sleep is not only influenced by gonadotropins, but also by conditions related to these hormones, such as pregnancy. It is therefore not surprising that sleep disturbances are seen during menopause, too. Factors that may play a role in this type of SDB in women include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle factors. PMID:28239685

  11. Effective Apnea-Hypopnea Index (“Effective AHI”): A New Measure of Effectiveness for Positive Airway Pressure Therapy

    PubMed Central

    Boyd, Scott B.; Upender, Raghu; Walters, Arthur S.; Goodpaster, R. Lucas; Stanley, Jeffrey J.; Wang, Li; Chandrasekhar, Rameela

    2016-01-01

    Study Objectives: To assess a new measure of positive airway pressure (PAP) effectiveness, the Effective AHI, which accounts for sleep disordered breathing events during the time PAP is (PAP On) and is not (PAP Off) being used. A secondary aim was to test the accuracy of the Watch-PAT 200 (WP) portable monitor for measurement of the Effective AHI. Methods: A prospective two-center cohort study design was used to evaluate patients who had been prescribed PAP therapy for ≥ 2 months. The primary outcome measure was the Effective AHI as determined by an in-laboratory polysomnogram (PSG) where patients used their PAP machine as they did at home, and concomitantly wore the WP. The Effective AHI equals the sum of apneas and hypopneas with PAP On and PAP Off divided by hours of total sleep time. Results: Twenty-eight adult patients (75% men, age 51.4 ± 10.8 years [mean ± SD]) comprised the study sample. The mean Effective AHI of 18.3, was significantly lower than the mean Diagnostic AHI of 67.9 (P < 0.0001). All patients using PAP ≥ 6 h had an Effective AHI < 5. For patients using PAP < 6 h, Effective AHI scores < 5 only occurred in patients who slept in a non-supine position during PAP Off time; leaving 63.6% of patients with residual moderate-to-severe OSA. There was a high correlation between the PSG and WP for the Effective AHI (r = 0.871). Conclusions: Significant disease burden, as objectively measured by the Effective AHI, may still exist in many patients with severe OSA in whom PAP therapy is not utilized for the entire sleep period. The WP is a reasonably accurate device to measure the Effective AHI. Citation: Boyd SB, Upender R, Walters AS, Goodpaster L, Stanley JJ, Wang L, Chandrasekhar R. Effective apnea-hypopnea index (“Effective AHI”): a new measure of effectiveness for positive airway pressure therapy. SLEEP 2016;39(11):1961–1972. PMID:27568799

  12. Memory Before and After Sleep in Patients with Moderate Obstructive Sleep Apnea

    PubMed Central

    Kloepfer, Corinna; Riemann, Dieter; Nofzinger, Eric A.; Feige, Bernd; Unterrainer, Josef; O'Hara, Ruth; Sorichter, Stephan; Nissen, Christoph

    2009-01-01

    Objective: The aim of this study was to investigate the effects of obstructive sleep apnea (OSA) on procedural and declarative memory encoding in the evening prior to sleep, on memory consolidation during subsequent sleep, and on retrieval in the morning after sleep. Methods: Memory performance (procedural mirror-tracing task, declarative visual and verbal memory task) and general neuropsychological performance were assessed before and after one night of polysomnographic monitoring in 15 patients with moderate OSA and 20 age-, sex-, and IQ-matched healthy subjects. Results: Encoding levels prior to sleep were similar across groups for all tasks. Conventional analyses of averaged mirror tracing performance suggested a significantly reduced overnight improvement in OSA patients. Single trial analyses, however, revealed that this effect was due to significantly flattened learning curves in the evening and morning session in OSA patients. OSA patients showed a significantly lower verbal retention rate and a non-significantly reduced visual retention rate after sleep compared to healthy subjects. Polysomnography revealed a significantly reduced REM density, increased frequency of micro-arousals, elevated apnea-hypopnea index, and subjectively disturbed sleep quality in OSA patients compared to healthy subjects. Conclusions: The results suggest that moderate OSA is associated with a significant impairment of procedural and verbal declarative memory. Future work is needed to further determine the contribution of structural or functional alterations in brain circuits relevant for memory, and to test whether OSA treatment improves or normalizes the observed deficits in learning. Citation: Kloepfer C; Riemann D; Nofzinger EA; Feige B; Unterrainer J; O'Hara R; Sorichter S; Nissen C. Memory before and after sleep in patients with moderate obstructive sleep apnea. J Clin Sleep Med 2009;5(6):540-548. PMID:20465021

  13. Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

    PubMed Central

    Finn, Laurel A.; Hagen, Erika W.; Young, Terry; Hla, Khin Mae; Van Cauter, Eve; Peppard, Paul E.

    2014-01-01

    Rationale: Obstructive sleep apnea (OSA) is associated with hypertension. Objectives: We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension. Methods: We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n = 4,385 sleep studies on 1,451 individuals) and additionally in a subset with ambulatory blood pressure data (n = 1,085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM sleep, either by statistical adjustment or by stratification. Measurements and Main Results: Fully adjusted models demonstrated significant dose-relationships between REM apnea–hypopnea index (AHI) and prevalent hypertension. The higher relative odds of prevalent hypertension were most evident with REM AHI greater than or equal to 15. In individuals with non-REM AHI less than or equal to 5, a twofold increase in REM AHI was associated with 24% higher odds of hypertension (odds ratio, 1.24; 95% confidence interval, 1.08–1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (P trend = 0.017). Non-REM AHI was not a significant predictor of hypertension in any of the models. Conclusions: Our findings indicate that REM OSA is cross-sectionally and longitudinally associated with hypertension. This is clinically relevant because treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated. PMID

  14. Chronic kidney disease in European patients with obstructive sleep apnea: the ESADA cohort study.

    PubMed

    Marrone, Oreste; Battaglia, Salvatore; Steiropoulos, Paschalis; Basoglu, Ozen K; Kvamme, John A; Ryan, Silke; Pepin, Jean-Louis; Verbraecken, Johan; Grote, Ludger; Hedner, Jan; Bonsignore, Maria R

    2016-12-01

    The cross-sectional relationship of obstructive sleep apnea with moderate to severe chronic kidney disease, defined as an estimated glomerular filtration rate <60 mL min(-1) ∙1.73 m(-2) , was investigated in a large cohort of patients with suspected obstructive sleep apnea studied by nocturnal polysomnography or cardiorespiratory polygraphy. Data were obtained from the European Sleep Apnea Database, where information from unselected adult patients with suspected obstructive sleep apnea afferent to 26 European sleep centres had been prospectively collected. Both the Modification of Diet in Renal Disease and the Chronic Kidney Disease-Epidemiology Collaboration equations were used for the assessment of estimated glomerular filtration rate. The analysed sample included 7700 subjects, 71% male, aged 51.9 ± 12.5 years. Severe obstructive sleep apnea (apnea-hypopnea index ≥30) was found in 34% of subjects. The lowest nocturnal oxygen saturation was 81 ± 10.2%. Chronic kidney disease prevalence in the whole sample was 8.7% or 6.1%, according to the Modification of Diet in Renal Disease or the Chronic Kidney Disease-Epidemiology Collaboration equations, respectively. Subjects with lower estimated glomerular filtration rate were older, more obese, more often female, had worse obstructive sleep apnea and more co-morbidities (P < 0.001, each). With both equations, independent predictors of estimated glomerular filtration rate <60 were: chronic heart failure; female gender; systemic hypertension; older age; higher body mass index; and worse lowest nocturnal oxygen saturation. It was concluded that in obstructive sleep apnea, chronic kidney disease is largely predicted by co-morbidities and anthropometric characteristics. In addition, severe nocturnal hypoxaemia, even for only a small part of the night, may play an important role as a risk factor for kidney dysfunction.

  15. Evaluation of a Single-Channel Nasal Pressure Device to Assess Obstructive Sleep Apnea Risk in Laboratory and Home Environments

    PubMed Central

    Crowley, Kate E.; Rajaratnam, Shantha M.W.; Shea, Steven A.; Epstein, Lawrence J.; Czeisler, Charles A.; Lockley, Steven W.

    2013-01-01

    Study Objectives: To evaluate the sensitivity and specificity of a portable single-channel (intra-nasal pressure) sleep apnea device (ApneaLink) in both the laboratory and at home for assessment of sleep apnea risk in comparison with standard polysomnography (PSG). Methods: Fifty-five participants underwent simultaneous recordings of standard PSG and ApneaLink in the laboratory. Of these, 38 participants also used the ApneaLink device in their own homes for one night. PSG respiratory events were scored using standard criteria. Intra-nasal pressure signals were analyzed using the ApneaLink automated computerized algorithm provided to yield estimates of airflow for detection of apneas and hypopneas. Apnea-hypopnea indices (AHI) were compared. Results: There was high sensitivity and specificity for the ApneaLink AHI when compared to simultaneous PSG at comparable AHI levels (AHI ≥ 15 events/h; sensitivity 100%, specificity 92%; positive and negative predictive values 70% and 100%, respectively). Home-measured ApneaLink AHI sensitivity and specificity were also reliable when compared with PSG (AHI ≥ 5, 81% and 77%, respectively; AHI ≥ 15, 67% and 91%), and improved slightly when two nights' data were used (AHI ≥ 5, 88% and 85%; AHI ≥ 15, 67% and 93%). Conclusions: The ApneaLink demonstrated good sensitivity and specificity in quantifying AHI when compared to PSG in a population with and without confirmed OSA. This simple, easy-to-use device may be useful in de novo large-scale occupational or underserved community OSA diagnostic programs to identify those with unambiguous disease who need immediate treatment or indicate those who may be at increased risk of OSA. Citation: Crowley KE; Rajaratnam SMW; Shea SA; Epstein LJ; Czeisler CA; Lockley SW. Evaluation of a single-channel nasal pressure device to assess obstructive sleep apnea risk in laboratory and home environments. J Clin Sleep Med 2013;9(2):109–116. PMID:23372462

  16. Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea in a Multicenter German Postmarket Study.

    PubMed

    Heiser, Clemens; Maurer, Joachim T; Hofauer, Benedikt; Sommer, J Ulrich; Seitz, Annemarie; Steffen, Armin

    2017-02-01

    Objective Selective stimulation of the hypoglossal nerve is a new surgical therapy for obstructive sleep apnea, with proven efficacy in well-designed clinical trials. The aim of the study is to obtain additional safety and efficacy data on the use of selective upper airway stimulation during daily clinical routine. Study Design Prospective single-arm study. Setting Three tertiary hospitals in Germany (Munich, Mannheim, Lübeck). Subjects and Methods A multicenter prospective single-arm study under a common implant and follow-up protocol took place in 3 German centers (Mannheim, Munich, Lübeck). Every patient who received an implant of selective upper airway stimulation was included in this trial (apnea-hypopnea index ≥15/h and ≤65/h and body mass index <35 kg/m(2)). Before and 6 months after surgery, a 2-night home sleep test was performed. Data regarding the safety and efficacy were collected. Results From July 2014 through October 2015, 60 patients were included. Every subject reported improvement in sleep and daytime symptoms. The average usage time of the system was 42.9 ± 11.9 h/wk. The median apnea-hypopnea index was significantly reduced at 6 months from 28.6/h to 8.3/h. No patient required surgical revision of the implanted system. Conclusion Selective upper airway stimulation is a safe and effective therapy for patients with obstructive sleep apnea and represents a powerful option for its surgical treatment.

  17. Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children.

    PubMed

    Konstantinopoulou, Sofia; Gallagher, Paul; Elden, Lisa; Garetz, Susan L; Mitchell, Ron B; Redline, Susan; Rosen, Carol L; Katz, Eliot S; Chervin, Ronald D; Amin, Raouf; Arens, Raanan; Paruthi, Shalini; Marcus, Carole L

    2015-02-01

    Adenotonsillectomy is the treatment of choice for most children with obstructive sleep apnea syndrome, but can lead to complications. Current guidelines recommend that high-risk children be hospitalized after adenotonsillectomy, but it is unclear which otherwise-healthy children will develop post-operative complications. We hypothesized that polysomnographic parameters would predict post-operative complications in children who participated in the Childhood AdenoTonsillectomy (CHAT) study. Children in the CHAT study aged 5-9 years with apnea hypopnea index 2-30/h or obstructive apnea index 1-20/h without comorbidities other than obesity/asthma underwent adenotonsillectomy. Associations between demographic variables and surgical complications were examined with Chi square and Fisher's exact tests. Polysomnographic parameters between subjects with/without complications were compared using Mann-Whitney tests. Of the 221 children (median apnea hypopnea index 4.7/h, range 1.2-27.7/h; 31% obese), 16 (7%) children experienced complications. 3 (1.4%) children had respiratory complications including pulmonary edema, hypoxemia and bronchospasm. Thirteen (5.9%) had non-respiratory complications, including dehydration (4.5%), hemorrhage (2.3%) and fever (0.5%). There were no statistically significant associations between demographic parameters (gender, race, and obesity) or polysomnographic parameters (apnea hypopnea index, % total sleep time with SpO2<92%, SpO2 nadir, % sleep time with end-tidal CO2>50Torr) and complications. This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at greatest risk of post-operative complications. Copyright

  18. Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

    PubMed Central

    Konstantinopoulou, Sofia; Gallagher, Paul; Elden, Lisa; Garetz, Susan L.; Mitchell, Ron B.; Redline, Susan; Rosen, Carol L.; Katz, Eliot S.; Chervin, Ronald D.; Amin, Raouf; Arens, Raanan; Paruthi, Shalini; Marcus, Carole L.

    2015-01-01

    Introduction Adenotonsillectomy is the treatment of choice for most children with obstructive sleep apnea syndrome, but can lead to complications. Current guidelines recommend that high-risk children be hospitalized after adenotonsillectomy, but it is unclear which otherwise-healthy children will develop post-operative complications. We hypothesized that polysomnographic parameters would predict post-operative complications in children who participated in the Childhood AdenoTonsillectomy (CHAT) study. Methods Children in the CHAT study aged 5–9 years with apnea hypopnea index 2–30/hr or obstructive apnea index 1–20/hr without comorbidities other than obesity/asthma underwent adenotonsillectomy. Associations between demographic variables and surgical complications were examined with Chi square and Fisher’s exact tests. Polysomnographic parameters between subjects with/without complications were compared using Mann-Whitney tests. Results Of the 221 children (median apnea hypopnea index 4.7/hr, range 1.2–27.7/hr; 31% obese), 16 (7%) children experienced complications. 3 (1.4%) children had respiratory complications including pulmonary edema, hypoxemia and bronchospasm. Thirteen (5.9%) had non-respiratory complications, including dehydration (4.5%), hemorrhage (2.3%) and fever (0.5%). There were no statistically significant associations between demographic parameters (gender, race, and obesity) or polysomnographic parameters (apnea hypopnea index, % total sleep time with SpO2<92%, SpO2 nadir, % sleep time with end-tidal CO2>50 Torr) and complications. Conclusions This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at

  19. Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project).

    PubMed

    Namtvedt, Silje K; Randby, Anna; Einvik, Gunnar; Hrubos-Strøm, Harald; Somers, Virend K; Røsjø, Helge; Omland, Torbjørn

    2011-10-15

    Increased prevalence of cardiac arrhythmias has been reported in patients with severe obstructive sleep apnea (OSA), but this may not be generalizable to patients from the general population with a milder form of the condition. The aim of this study was to assess the association between cardiac arrhythmias and OSA of mainly mild and moderate severity. In total, 486 subjects (mean age 49 years, 55% men) recruited from a population-based study in Norway underwent polysomnography for OSA assessment and Holter recordings for arrhythmia assessment. Of these, 271 patients were diagnosed with OSA (apnea-hypopnea index [AHI] ≥5, median AHI 16.8, quartiles 1 to 3 8.9 to 32.6). Mean nadir oxygen saturations were 82% and 89% in patients with and without OSA, respectively. Ventricular premature complexes (≥5/hour) were more prevalent in subjects with OSA compared to subjects without OSA (median AHI 1.4, quartiles 1 to 3 0.5 to 3.0) during the night (12.2% vs 4.7%, p = 0.005) and day (14% vs 5.1%, p = 0.002). In multivariate analysis after adjusting for relevant confounders, AHI was independently associated with an increased prevalence of ventricular premature complexes at night (odds ratio per 1-U increase of log-transformed AHI 1.5, 95% confidence interval 1.1 to 2.0, p = 0.008) and during the day (odds ratio 1.37, 95% confidence interval 1.0 to 1.8, p = 0.035). In conclusion, the prevalence of ventricular premature complexes is increased in middle-aged patients with mainly mild or moderate OSA, suggesting an association between OSA and ventricular arrhythmias even in mild OSA.

  20. Sleep Quality and Risk for Sleep Apnea in Incarcerated Women

    PubMed Central

    Harner, Holly M.; Budescu, Mia

    2014-01-01

    Background Little is known about characteristics of women's sleep during incarceration. Objectives The study objectives were to: describe incarcerated women's sleep quality; document incarcerated women's risk for sleep apnea; and identify other factors that contribute to poor sleep quality during incarceration. Methods This cross-sectional descriptive exploratory investigation was conducted in a maximum security women's prison in the United States. Incarcerated women's sleep quality and their risk for sleep apnea was assessed by using the Pittsburgh Sleep Quality Index (PSQI) and the Multivariable Apnea Prediction Score (MAPS), respectively. Results Four hundred thirty-eight incarcerated women participated in this investigation. Results indicate that 72% of the sample met the PSQI criteria for “poor sleepers.” Poor sleepers were significantly more likely to report sleep disturbances, and scored significantly higher on the risk for sleep apnea scale compared to women who did not meet the poor sleep threshold. Approximately 10% of the sample had a probability for sleep apnea higher than .50. Factors that contributed to poor sleep included: (a) “racing thoughts/worry/thinking about things”; (b) environmental noise and other factors; (c) physical health conditions/pain; (d) nightmares and flashbacks; and (e) not taking sleep medication. Discussion Most participants reported poor sleep quality during incarceration. Poor sleep might exacerbate existing health conditions and contribute to the development of new health problems for incarcerated women. Furthermore, poor sleep quality may reduce a woman's ability to fully participate in beneficial prison programming. This investigation provides a first look at how women sleep in prison and offers recommendations for future research. PMID:24785244

  1. Study Finds a Connection between Glaucoma and Sleep Apnea

    MedlinePlus

    ... News Study Finds a Connection Between Glaucoma and Sleep Apnea Sep. 06, 2013 Over the years, several studies have demonstrated an increased rate of glaucoma among those with sleep apnea, but these studies only proved that the ...

  2. 77 FR 25226 - Proposed Recommendations on Obstructive Sleep Apnea

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration Proposed Recommendations on Obstructive Sleep Apnea AGENCY... withdrawing its proposed regulatory guidance for obstructive sleep apnea (OSA) and request for comment as...

  3. Sleep apnea and the heart: diagnosis and treatment.

    PubMed

    Yumino, Dai; Kasanuki, Hiroshi

    2008-01-01

    Although sleep apnea is closely associated with cardiovascular disease, it remains underdiagnosed and undertreated. Obstructive sleep apnea elicits a cascade of harmful cardiovascular stimuli, and central sleep apnea is a prognostic factor for heart failure and may exert adverse effects on outcomes. The adverse effects of obstructive sleep apnea can promote the development of atherosclerosis and have also been implicated in the pathogenesis of cardiovascular disease. Sleep apnea characterized by variables of the autonomic nervous system may have a direct association with arrhythmia. Polysomnography with electroencephalography is the gold standard for assessing sleep apnea. Alternative methods of screening for OSA have recently become available. Continuous positive airway pressure for obstructive sleep apnea reduces cardiac risk and cardiovascular disease mortality. Targeting sleep apnea in the primary and/or secondary prevention of cardiovascular disease may lead to better outcomes.

  4. Asthma and Obstructive Sleep Apnea.

    PubMed

    Qiao, Yi-Xian; Xiao, Yi

    2015-10-20

    To get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology, pathophysiology, and clinical manifestation and then summarizing the latest progress on diagnosis and treatment. Articles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms "OSA" and "asthma" as the main keywords. Highly regarded older publications were also included. Information about the features of the two diseases in common, the pathophysiologic association between them and their current treatments from the literature search were identified, retrieved, and summarized. Both OSA and asthma are very prevalent conditions. The incidences of them have kept on rising in recent years. Asthma is often accompanied by snoring and apnea, and OSA often combines with asthma, as well. They have many predisposing and aggravating factors in common. Possible shared direct mechanistic links between them include mechanical effects, intermittent hypoxia, nerve reflex, inflammation, leptin, etc. Indirect mechanistic links include medication, nose diseases, smoking, obesity, and gastroesophageal reflux disease. Since OSA presents many similar features with nocturnal asthma, some scholars termed them as a sole syndrome - "alternative overlap syndrome," and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure. OSA and asthma are closely associated in pathogenesis, symptoms, and therapies. With the growing awareness of the relationship between them, we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients. Further studies are still needed to guide the clinical works.

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

    PubMed Central

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

    2008-01-01

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

  6. Adenotonsillectomy outcomes in children with sleep apnea and narcolepsy.

    PubMed

    Biyani, Sneh; Cunningham, Tina D; Baldassari, Cristina M

    2017-09-01

    To identify improvements in daytime sleepiness following adenotonsillectomy in children with non-severe obstructive sleep apnea and narcolepsy. Case series with chart review over 15 years. Tertiary Children's Hospital. Children between 6 and 17 years of age with narcolepsy that underwent adenotonsillectomy for non-severe obstructive sleep apnea (OSA) were included. Narcolepsy was diagnosed based on clinical assessment and the Multiple Sleep Latency Test (MSLT) results. A standardized instrument, the pediatric Epworth Sleepiness Scale (ESS), was used to assess daytime sleepiness before and after adenotonsillectomy. Nine children with a mean age of 12.1 years were included. The majority of the subjects (78%, n = 7) were African American and six children (66.7%) were obese. Four children (44%) were treated with wake promoting agents during the study. The mean preoperative apnea hypopnea index on polysomnography was 4.89 (SD 1.86), while the mean sleep latency on MSLT was 6.32 min (SD 3.14). The mean preoperative ESS was 16.10 and the postoperative ESS was 10.80 (SD 3.96). There was significant improvement (p = 0.02) in the ESS following adenotonsillectomy with seven children (78%) reporting diminished daytime sleepiness. Children with non-severe OSA and narcolepsy experience significant improvement in daytime sleepiness following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of non-severe OSA in children with narcolepsy. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Does Obstructive Sleep Apnea Impair the Cardiopulmonary Response to Exercise?

    PubMed Central

    Rizzi, Camila F.; Cintra, Fatima; Mello-Fujita, Luciane; Rios, Lais F.; Mendonca, Elisangela T.; Feres, Marcia C.; Tufik, Sergio; Poyares, Dalva

    2013-01-01

    Study Objectives: The aim of this study was to evaluate cardiopulmonary exercise performance in lean and obese patients with obstructive sleep apnea (OSA) compared with controls. Design: Case-control study. Setting: The study was carried out in Sao Paulo Sleep Institute, Sao Paulo, Brazil. Patients and Participants: Individuals with similar ages were allocated into groups: 22 to the lean OSA group, 36 to the lean control group, 31 to the obese OSA group, and 26 to the obese control group. Interventions: The participants underwent a clinical evaluation, polysomnography, a maximum limited symptom cardiopulmonary exercise test, two-dimensional transthoracic echocardiography, and spirometry. Measurements and Results: The apnea-hypopnea index, arousal index, lowest arterial oxygen saturation (SaO2) and time of SaO2 < 90% were different among the groups. There were differences in functional capacity based on the following variables: maximal oxygen uptake (VO2max), P < 0.01 and maximal carbon dioxide production (VCO2max), P < 0.01. The obese patients with OSA and obese controls presented significantly lower VO2max and VCO2max values. However, the respiratory exchange ratio (RER) and anaerobic threshold (AT) did not differ between groups. Peak diastolic blood pressure (BP) was higher among the obese patients with OSA but was not accompanied by changes in peak systolic BP and heart rate (HR). When multiple regression was performed, body mass index (P < 0.001) and male sex in conjunction with diabetes (P < 0.001) independently predicted VO2max (mL/kg/min). Conclusions: The results of this study suggest that obesity alone and sex, when associated with diabetes but not OSA, influenced exercise cardiorespiratory function. Citation: Rizzi CF; Cintra F; Mello-Fujita L; Rios LF; Mendonca ET; Feres MC; Tufik S; Poyares D. Does obstructive sleep apnea impair the cardiopulmonary response to exercise? SLEEP 2013;36(4):547-553. PMID:23565000

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

    PubMed Central

    Matthews, Les; Fortier, Normand

    2013-01-01

    The present study was designed to investigate body position changes resulting from wearing a Rematee Bumper Belt (Rematee, Canada) during sleep. The majority of obstructive sleep apnea (OSA) patients will experience up to two times as many apneas and hypopneas while supine relative to lateral or prone body positions during sleep. It has been suggested that a positional therapy device could reduce the number of apneas and hypopneas in such patients. The present study was conducted to determine whether the Rematee Bumper Belt positional therapy device could prevent healthy subjects from sleeping in the supine position. Test subjects wore the belt for one to two nights. Each belt was equipped with an accelerometer that was used to measure the orientation of the belt relative to the horizontal plane. The results suggest that the belt creates an exclusion zone approximately 80° wide centred near the supine orientation, where subjects are effectively prevented to enter. Results of the present preliminary study suggests that the Rematee Bumper Belt positional therapy device is effective at limiting healthy subjects from sleeping in a supine position. The device appears to be most effective between 150° and 230°. A device with this capability may provide an inexpensive and potentially effective alternative treatment option for patients with OSA. This device has the capacity for reducing snoring and the apnea-hypopnea index in individuals with positional OSA. PMID:26078596

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

    PubMed

    Matthews, Les; Fortier, Normand

    2013-01-01

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

  10. Sleep apnea: State of the art.

    PubMed

    Cowie, Martin R

    2017-05-01

    Many patient with, or at risk of, cardiovascular disease have sleep disordered breathing (SDB), which can be either obstructive (with intermittent collapse of the upper airway) or central (episodic loss of respiratory drive). SDB is associated with sleep disturbance, hypoxemia, hemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalize the sleep and respiratory physiology, but recent randomized trials of cardiovascular outcomes in SDB have either been neutral (obstructive sleep apnea) or suggested the possibility of harm, likely from increased sudden death, in central sleep apnea. Alternative methods for the treatment of SDB are being explored, including implantable technologies, but these have not been studied in adequately powered randomized controlled studies. International guidelines recommend screening for SDB, which can be done easily in clinical practice, as there may be a role for the treatment of patients with obstructive sleep apnea and daytime sleepiness, or resistant hypertension, or atrial fibrillation. Further randomised outcome studies are required to determine whether mask-based treatment for SDB is appropriate for patients with chronic systolic heart failure and obstructive sleep apnea; for those with heart failure with preserved ejection fraction; and for those with decompensated heart failure. The case is made that no longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with sleep apnea and cardiovascular disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 77 FR 23794 - Proposed Recommendations on Obstructive Sleep Apnea

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-20

    ... Federal Motor Carrier Safety Administration Proposed Recommendations on Obstructive Sleep Apnea AGENCY...) and the Medical Review Board (MRB) on Obstructive Sleep Apnea (OSA) and the medical certification of... with oxygen exchange and may result in incapacitation, including sleep apnea. If the medical...

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

    NASA Astrophysics Data System (ADS)

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

    2013-01-01

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

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

    PubMed Central

    Kezirian, Eric J.

    2011-01-01

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

  14. Sleep Apnea and Circadian Extracellular Fluid Change as Independent Factors for Nocturnal Polyuria.

    PubMed

    Niimi, Aya; Suzuki, Motofumi; Yamaguchi, Yasuhiro; Ishii, Masaki; Fujimura, Tetsuya; Nakagawa, Tohru; Fukuhara, Hiroshi; Kume, Haruki; Igawa, Yasuhiko; Akishita, Masahiro; Homma, Yukio

    2016-10-01

    We investigated the relationships among nocturnal polyuria, sleep apnea and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome. We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were administered to evaluate sleep disorder and lower urinary tract symptoms, including nocturia. Voiding frequency and voided volume were recorded using a 24-hour frequency-volume chart. Body fluid composition was estimated in the morning and at night using bioelectric impedance analysis. Frequency-volume chart data were analyzed in 22 patients after continuous positive airway pressure therapy. Patients with nocturnal polyuria showed a higher apnea-hypopnea index (33.9 vs 24.2, p = 0.03) and a larger circadian change in extracellular fluid adjusted to lean body mass (0.22 vs -0.19, p = 0.019) than those without nocturnal polyuria. These relations were more evident in patients 65 years old or older than in those 64 years or younger. A multivariate linear regression model showed an independent relationship of nocturnal polyuria with the apnea-hypopnea index and the circadian change in extracellular fluid adjusted to lean body mass (p = 0.0012 and 0.022, respectively). Continuous positive airway pressure therapy significantly improved nocturnal polyuria and nocturia only in patients with nocturnal polyuria. This study identified sleep apnea and the circadian change in extracellular fluid as independent factors for nocturnal polyuria. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

    PubMed

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

    2014-10-01

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

  16. Accuracy of clinical evaluation in pediatric obstructive sleep apnea.

    PubMed

    Wang, R C; Elkins, T P; Keech, D; Wauquier, A; Hubbard, D

    1998-01-01

    Eighty-two children underwent polysomnography (PSG) for symptoms suggestive of obstructive sleep apnea (OSA). Symptoms reported included snoring, witnessed apneic episodes, daytime somnolence, mouth breathing, and enuresis. Tonsillar size, nasal airway patency, and percentile weight were recorded. OSA was diagnosed on PSG when obstructive events were noted and apnea + hypopnea index was five or more per hour. The overall predictive accuracy of clinical suspicion of OSA was 25 (30%) of 82. Predictive accuracies (as a percentage of those with symptoms/signs who have OSA) and prevalences (as a percentage of those with OSA who have the symptom/sign), respectively, were for moderate snoring 29% (12 of 41), 48%; loud snoring 31% (11 of 35), 44%; witnessed apneas 32% (22 of 69), 88%; enuresis 46% (11 of 24), 44%; 2+ tonsillar size 37% (21 of 57), 84%; 3+ tonsillar size 33% (3 of 9), 12%; 90th percentile weight or greater 26% (7 of 27), 28%; 10th percentile weight or less 33% (5 of 15), 20%. Multiple regression analysis did not reveal a significant association between clinical parameters and the presence of OSA as defined by PSG.

  17. [Evaluation of polysomnographic diagnostic criteria for obstructive sleep apnea syndrome in children].

    PubMed

    Xu, Z F; Wu, Y X; Feng, G S; Zhang, Y M; Ni, X

    2016-11-07

    Objective: To determine the appropriate criteria of obstructive sleep apnea syndrome (OSAS) in children. Method: Children with snoring and healthy children were recruited from October 2014 to September 2015. Subjects were divided into four groups based on polysomnography(PSG). Group 1: children with obstructive apnea hypopnea index(OAHI)≥1 (the OSAS criteria of the International Classification of Sleep Disorders, ICSD) but their AHI≤5 or OAI ≤1 (under the OSAS criteria of AHI>5 or OAI>1 by the American Thoracic Society, ATS); Group 2: children with OAHI<1 (the primary snoring criteria of the ICSD); Group 3: children with AHI>5 or OAI>1; and Group 4: normal children as controls. Sleep disorder scales and polysomnography parameters were compared among the four groups. Results: A total of 1 115 children were included.There were 143, 345, 529 and 98 children in each group. After adjust for age, gender and body mass index(BMI), children in group 1 had higher total sleep disorder scale score (P<0.01), as well as sub-scores for severe snoring (P<0.01), daytime behavior problem (P<0.01) and sleep related nighttime abnormality (P<0.05) compared with normal controls, and they had longer mean and longest duration of obstructive apnea and hypopnea and lower minimum oxygen saturation compared with children with obstructive AHI<1 (all P<0.05 or <0.01). Conclusion: OAHI>1 should be defined as the criteria of OSAS in children.

  18. Effect of Continuous Positive Airway Pressure on Sleep Structure in Heart Failure Patients with Central Sleep Apnea

    PubMed Central

    Ruttanaumpawan, Pimon; Logan, Alexander G.; Floras, John S.; Bradley, T. Douglas

    2009-01-01

    Study Objectives: At termination of obstructive apneas, arousal is a protective mechanism that facilitates restoration of upper airway patency and airflow. Treating obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) reduces arousal frequency indicating that such arousals are caused by OSA. In heart failure (HF) patients with central sleep apnea (CSA), however, arousals frequently occur several breaths after apnea termination, and there is uncertainty as to whether arousals from sleep are a consequence of CSA. If so, they should diminish in frequency when CSA is attenuated. We therefore sought to determine whether attenuation of CSA by CPAP reduces arousal frequency. Design: Randomized controlled clinical trial. Patients and Setting: We examined data from 205 HF patients with CSA (apnea-hypopnea index [AHI] ≥ 15, > 50% were central) randomized to CPAP or control who had polysomnograms performed at baseline and 3 months later. Measurements and Results: In the control group, there was no change in AHI or frequency of arousals. In the CPAP-treated group, the AHI decreased significantly (from [mean ± SD] 38.9 ± 15.0 to 17.6 ± 16.3, P < 0.001) but neither the frequency of arousals nor sleep structure changed significantly. Conclusion: These data suggest that attenuation of CSA by CPAP does not reduce arousal frequency in HF patients. We conclude that arousals were not mainly a consequence of CSA, and may not have been acting as a defense mechanism to terminate apneas in the same way they do in OSA. Citation: Ruttanaumpawan P; Logan AG; Floras JS; Bradley TD. Effect of Continuous Positive Airway Pressure on Sleep Structure in Heart Failure Patients with Central Sleep Apnea. SLEEP 2009;32(1):91-98. PMID:19189783

  19. Sleep Apnea Cardiovascular Clinical Trials-Current Status and Steps Forward: The International Collaboration of Sleep Apnea Cardiovascular Trialists.

    PubMed

    Gottlieb, Daniel J; Craig, Sonya E; Lorenzi-Filho, Geraldo; Heeley, Emma; Redline, Susan; McEvoy, R Doug; Durán-Cantolla, Joaquín

    2013-07-01

    Sleep apnea is a common chronic disease that is associated with coronary heart disease, stroke, heart failure and mortality, although the ability of sleep apnea treatment to reduce cardiovascular morbidity and mortality has not been demonstrated. In contrast to patients seeking treatment in sleep disorders centers, as many as half of individuals with moderate to severe sleep apnea in the general population do not report excessive sleepiness; however, if treatment of sleep apnea were shown to reduce cardiovascular disease risk, this would provide a strong rationale for treatment of sleep apnea even in the absence of daytime sleepiness. This article summarizes the status of clinical trials evaluating the potential cardiovascular benefits of sleep apnea treatment and discusses the challenges of conducting such trials, and introduces the International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT), a clinical research collaboration formed to foster cardiovascular sleep research.

  20. Accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea.

    PubMed

    Pinto, José Antonio; Godoy, Luciana Balester Mello de; Ribeiro, Renata Coutinho; Mizoguchi, Elcio Izumi; Hirsch, Lina Ana Medeiros; Gomes, Leonardo Marques

    2015-01-01

    The use of handheld devices that assess peripheral arterial tonometry has emerged as an auxiliary method for assessment and diagnosis of obstructive sleep apnea syndrome. To evaluate the accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea. Contemporary cohort cross-sectional study. Thirty patients with suspected obstructive sleep apnea underwent peripheral arterial tonometry and assisted nocturnal polysomnography concomitantly. The mean apnea/hypopnea index by peripheral arterial tonometry was significantly higher than that by polysomnography (p<0.001), but the values of both sleep studies were significantly correlated (r=0.762). There was a high correlation between variables: minimum oxygen saturation (r=0.842, p<0.001), oxygen saturation<90% (r=0.799, p<0.001), and mean heart rate (r=0.951, p<0.001). Sensitivity and specificity were 60% and 96.2% (AUC: 0.727; p=0.113), respectively, when at a threshold value of 5 events/h. In severe cases (≥30 events/h), the result was a sensitivity of 77.8% and a specificity of 86.4% (AUC: 0.846, p=0.003). Peripheral arterial tonometry is a useful portable device for the diagnosis of obstructive sleep apnea; its accuracy is higher in moderate and severe cases. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  1. Relationship Between Rem Density, Duty Cycle, and Obstructive Sleep Apnea in Children

    PubMed Central

    Karamessinis, Laurie; Galster, Patricia; Schultz, Brian; Elliott, Joanne; Mason, Thornton A.; Brooks, Lee J.; Gallagher, Paul R.; Marcus, Carole L.

    2007-01-01

    Study Objectives: The pattern and distribution of rapid eye movement (REM) sleep changes during development, yet there have been few studies of REM density in children. Although children with obstructive apnea syndrome (OSAS) obstruct primarily during REM sleep, the relationship between REM density and obstructive apnea has not been established for this population. We hypothesized that (i) REM density and REM cycle duration increases over the course of the night in children, (ii) the duty cycle (inspiratory time divided by respiratory cycle time) increases over the course of the night in children with suspected OSAS, and (iii) the increase in REM density over the course of the night is associated with increased severity of obstructive apnea. Design: REM density and respiratory parameters were measured during polysomnography. Setting: Sleep laboratory Patients: 76 children with suspected OSAS. Interventions: NA Measurements and Results: REM density and the duration of REM cycles increased over the course of the night until the fifth REM cycle, and then stabilized. The duty cycle increased across the first 6 REM cycles. However, the apnea hypopnea index (AHI) did not increase across REM cycles, and was not affected by the changes in REM density or duty cycle. We speculate that the increase in the duty cycle is a compensatory response to increased upper airway loads during sleep, and that this may lead to ventilatory or upper airway muscle fatigue. Citation: Karamessinis L; Galster P; Schultz B et al. Relationship between rem density, duty cycle, and obstructive sleep apnea in children. PMID:17682653

  2. Should children with suspected obstructive sleep apnea syndrome and normal nap sleep studies have overnight sleep studies?

    PubMed

    Saeed, M M; Keens, T G; Stabile, M W; Bolokowicz, J; Davidson Ward, S L

    2000-08-01

    Overnight polysomnography (ONP) is the "gold standard" for the diagnosis of sleep-disordered breathing, but it is expensive and time-consuming. Thus, daytime nap studies have been used as screening tests. If the findings of a nap study are normal or mildly abnormal, should ONP be performed? Do specific abnormalities in nap studies predict abnormal findings in ONP? To answer these questions, we conducted this study. Retrospective chart review. Children's hospital. One hundred forty-three children with suspected obstructive sleep apnea syndrome secondary to isolated adenotonsillar hypertrophy, who had normal or mildly abnormal nap studies, and underwent ONP. We compared daytime nap and overnight polysomnograms in 143 children (52 girls; mean [+/- SD] age, 5.6 +/- 3.1 years). Total sleep time was 1 h in daytime nap, and 5.1 +/- 1.3 h in ONP. The interval between the two studies was 5.9 +/- 4.8 months. The findings of 59% of the nap studies were mildly abnormal, while 66% of overnight studies were abnormal. No individual nap study parameter (including short obstructive apneas, hypopneas, hypoxemia, hypoventilation, snoring, paradoxical breathing, gasping, retractions) had good sensitivity at predicting abnormal overnight polysomnograms, but most had good specificity and positive predictive value. We conclude that individual nap study parameters are not very sensitive in predicting abnormal ONP findings. However, when nap study parameters are abnormal, the chance of obstructive sleep apnea syndrome is high.

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

    PubMed Central

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

    2015-01-01

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

  4. Regional reductions in sleep electroencephalography power in obstructive sleep apnea: a high-density EEG study.

    PubMed

    Jones, Stephanie G; Riedner, Brady A; Smith, Richard F; Ferrarelli, Fabio; Tononi, Giulio; Davidson, Richard J; Benca, Ruth M

    2014-02-01

    Obstructive sleep apnea (OSA) is associated with significant alterations in neuronal integrity resulting from either hypoxemia and/or sleep loss. A large body of imaging research supports reductions in gray matter volume, alterations in white matter integrity and resting state activity, and functional abnormalities in response to cognitive challenge in various brain regions in patients with OSA. In this study, we used high-density electroencephalography (hdEEG), a functional imaging tool that could potentially be used during routine clinical care, to examine the regional distribution of neural activity in a non-clinical sample of untreated men and women with moderate/severe OSA. Sleep was recorded with 256-channel EEG in relatively healthy subjects with apnea-hypopnea index (AHI) > 10, as well as age-, sex-, and body mass index-matched controls selected from a research population initially recruited for a study on sleep and meditation. Sleep laboratory. Nine subjects with AHI > 10 and nine matched controls. N/A. Topographic analysis of hdEEG data revealed a broadband reduction in EEG power in a circumscribed region overlying the parietal cortex in OSA subjects. This parietal reduction in neural activity was present, to some extent, across all frequency bands in all stages and episodes of nonrapid eye movement sleep. This investigation suggests that regional deficits in electroencephalography (EEG) power generation may be a useful clinical marker for neural disruption in obstructive sleep apnea, and that high-density EEG may have the sensitivity to detect pathological cortical changes early in the disease process.

  5. The relation between sleep and weight in a suburban sleep center: observations and speculations on apnea and weight

    PubMed Central

    Hooper, Robert G

    2016-01-01

    Study objectives The relationship between obstructive sleep apnea (OSA) and body weight is not clearly established. In order to describe the relationship of weight and OSA severity seen in a suburban sleep center, an observational review was performed of initial diagnostic polysomnograms (PSGs) ordered on patients with American Academy of Sleep Medicine (AASM) symptomatic indications. Methodology/principle findings Initial, full-night diagnostic or initial split-night (diagnostic portion) PSGs performed for any indication on patients >18 years old were retrospectively reviewed for a two year period. All studies were performed following AASM guidelines. PSG data were reviewed for the presence and severity of apnea (no OSA – apnea hypopnea index (AHI) <5, mild – AHI 5–14, moderate – AHI 15–29, severe – AHI 30–59, and very severe – AHI >60). Data were reviewed from 629 PSGs (37% females and 63% males) of which 450 met the criteria for apnea. Studies were classified by apnea severity (196 mild, 103 moderate, 91 severe apnea and 60 with very severe apnea) and weight (body mass index (BMI)). Of those with apnea, and BMIs <25, severe or very severe apnea occurred in 22% (10/45). Three individuals with BMIs <20 had apnea, one severe. Of those with BMIs ≥40, one (1.6%) did not have apnea and 52% (31/60) had AHI >30. Conclusion/significance The profile of this nonrandom series, tested because they were suspected of having a disorder of sleep, provides guidelines for physicians in their approach to symptomatic patients. Individuals with a normal BMI can have apnea, including severe apnea. Severe obesity (BMI >40) is almost always associated with apnea when symptoms are present. Obesity increases the severity of the diagnosed apnea. Excessive weight should be an indication for testing, but normal weight should not exclude individuals with appropriate symptoms. Obesity, while a major contributing factor to severity, is not the etiological cause of OSA in the

  6. Positive airway pressure treatment for obstructive sleep apnea.

    PubMed

    Kakkar, Rahul K; Berry, Richard B

    2007-09-01

    Positive airway pressure (PAP) is the treatment of choice for patients with moderate-to-severe obstructive sleep apnea (OSA). Randomized controlled trials have demonstrated that PAP can effectively reduce the apnea-hypopnea index and improve subjective and objective sleepiness. Some studies have also demonstrated benefits in sleep quality and quality of life for both the patient and bed partner. Observational studies have shown a reduction in the risk of cardiovascular events in OSA patients treated with PAP compared to untreated patients. Since continuous PAP (CPAP) treatment of OSA was described, additional modes of pressure delivery have been developed (bilevel PAP, autoadjusting PAP, flexible PAP). While none of the variants of PAP improves adherence in unselected patients compared to CPAP, individual patients may respond to a change in pressure mode. Attended PAP titration remains the standard of practice for selecting a treatment pressure. However, use of autotitrating PAP devices in the unattended setting can provide an effective titration alternative with careful patient selection and review of titration results. More choices of mask interface are now available to improve comfort and intervene for mask or mouth leaks. However, despite the increase in PAP treatment options, lack of acceptance and inadequate adherence to PAP therapy remain the major causes of treatment failure. Some studies suggest that heated humidification can improve PAP adherence, especially in patients with nasal congestion or dryness. A systematic approach to PAP treatment including education, objective adherence monitoring, early intervention for side effects, and telephone and clinic support is essential to optimize adherence.

  7. Gray Matter Hypertrophy and Thickening with Obstructive Sleep Apnea in Middle-aged and Older Adults.

    PubMed

    Baril, Andrée-Ann; Gagnon, Katia; Brayet, Pauline; Montplaisir, Jacques; De Beaumont, Louis; Carrier, Julie; Lafond, Chantal; L'Heureux, Francis; Gagnon, Jean-François; Gosselin, Nadia

    2017-06-01

    Obstructive sleep apnea causes intermittent hypoxemia, hemodynamic fluctuations, and sleep fragmentation, all of which could damage cerebral gray matter that can be indirectly assessed by neuroimaging. To investigate whether markers of obstructive sleep apnea severity are associated with gray matter changes among middle-aged and older individuals. Seventy-one subjects (ages, 55-76 yr; apnea-hypopnea index, 0.2-96.6 events/h) were evaluated by magnetic resonance imaging. Two techniques were used: (1) voxel-based morphometry, which measures gray matter volume and concentration; and (2) FreeSurfer (an open source software suite) automated segmentation, which estimates the volume of predefined cortical/subcortical regions and cortical thickness. Regression analyses were performed between gray matter characteristics and markers of obstructive sleep apnea severity (hypoxemia, respiratory disturbances, and sleep fragmentation). Subjects had few symptoms, that is, sleepiness, depression, anxiety, and cognitive deficits. Although no association was found with voxel-based morphometry, FreeSurfer revealed increased gray matter with obstructive sleep apnea. Higher levels of hypoxemia correlated with increased volume and thickness of the left lateral prefrontal cortex as well as increased thickness of the right frontal pole, the right lateral parietal lobules, and the left posterior cingulate cortex. Respiratory disturbances positively correlated with right amygdala volume, and more severe sleep fragmentation was associated with increased thickness of the right inferior frontal gyrus. Gray matter hypertrophy and thickening were associated with hypoxemia, respiratory disturbances, and sleep fragmentation. These structural changes in a group of middle-aged and older individuals may represent adaptive/reactive brain mechanisms attributed to a presymptomatic stage of obstructive sleep apnea.

  8. 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

  9. Altered Resting-State Brain Activity in Obstructive Sleep Apnea

    PubMed Central

    Zhang, Quan; Wang, Dawei; Qin, Wen; Li, Qiong; Chen, Baoyuan; Zhang, Yunting; Yu, Chunshui

    2013-01-01

    Study Objectives: Structural and functional brain changes may contribute to neural dysfunction in patients with obstructive sleep apnea (OSA). However, the effect of OSA on resting-state brain activity has not been established. The objective of this study was to investigate alterations in resting-state functional connectivity (rsFC) of the common brain networks in patients with OSA and their relationships with changes in gray matter volume (GMV) in the corresponding brain regions. Designs: Resting-state functional and structural MRI data were acquired from patients with OSA and healthy controls. Seven brain networks were identified by independent component analysis. The rsFC in each network was compared between groups and the GMV of brain regions with significant differences in rsFC was also compared. Setting: University hospital. Patients and Participants: Twenty-four male patients with untreated OSA and 21 matched healthy controls. Interventions: N/A. Measurements and Results: OSA specifically affected the cognitive and sensorimotor-related brain networks but not the visual and auditory networks. The medial prefrontal cortex and left dorsolateral prefrontal cortex (DLPFC) showed decreased rsFC and GMV in patients with OSA, suggesting structural and functional deficits. The right DLPFC and left precentral gyrus showed decreased rsFC and unchanged GMV, suggesting a functional deficit. The right posterior cingulate cortex demonstrated increased rsFC and unchanged GMV, suggesting functional compensation. In patients with OSA, the rsFC of the right DLPFC was negatively correlated with the apnea-hypopnea index. Conclusions: OSA specifically affects resting-state functional connectivity in cognitive and sensorimotor-related brain networks, which may be related to the impaired cognitive and motor functions in these patients. Citation: Zhang Q; Wang D; Qin W; Li Q; Chen B; Zhang Y; Yu C. Altered resting-state brain activity in obstructive sleep apnea. SLEEP 2013

  10. Medication Adherence and Persistence in Severe Obstructive Sleep Apnea

    PubMed Central

    Villar, Isabel; Izuel, Monica; Carrizo, Santiago; Vicente, Eugenio; Marin, Jose M.

    2009-01-01

    Study Objective: The aim of this study was to compare 2 groups of patients with severe obstructive sleep apnea (OSA) who were taking medication for cardiovascular disease: those who were compliant with nasal continuous positive airway pressure (CPAP) treatment and those who refused treatment or were noncompliant with CPAP treament. Methods: In a cohort of 2158 patients with severe OSA (apnea-hypopnea index > 30) a 2-year prospective longitudinal assessment of adherence and persistence with 3 medication categories (antihypertensives, statins, and antiplatelets) was carried out using the administrative database of the National Health Service. MEdication adherence was evaluated by calculating the medication possession ratio (%MPR = days supply/actual days to refill x 100) for each drug. Medication persistency was defined as the proportion of subjects having filled a prescription in the last 30 days of the 2-year period. CPAP use was assessed at every follow-up visit after the treatment was prescribed. Medication adherence was compared between patients who had adequate CPAP adherence (> 4 h/day) and those who declined CPAP therapy or had discontinued CPAP due to an average use of less than 4 hours per day. Results: The average 2-year MPR for antihypertensives, statins, and antiplatelets was not different among patients who used CPAP (88%, 81%, 95%) or did not use CPAP (86%, 77%, 93%). Female sex and increased number of comorbidities were predictors of good medication adherence (MPR > 80%). The rates of persistence for the 3 studied medications after the 2-year observation period were not different between the 2 groups (patients with or without CPAP). Conclusions: Medication adherence and persistence during a 2-year period for 3 well-known protective cardiovascular medications were not different in patients with severe OSA, whether or not they were treated with CPAP. Citation: Villar I; Izuel M; Carrizo S; Vicente E; Marin JM. Medication adherence and persistence in

  11. 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

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

    PubMed Central

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

    2016-01-01

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

  13. Association between Drug-Induced Sleep Endoscopy and Measures of Sleep Apnea Burden.

    PubMed

    Dedhia, Raj C; Weaver, Edward M

    2015-11-01

    To test the following associations: (1) complete obstruction on drug-induced sleep endoscopy (DISE) and polysomnographic and subjective measures of obstructive sleep apnea; (2) tongue base/epiglottic obstruction and apnea index. Retrospective cohort. Academic medical center. Subjects included surgically naïve adult patients with DISE. Chart extraction included demographics, polysomnography, and Epworth Sleepiness Scale and SNORE25 (Symptoms of Nocturnal Obstruction and Related Events 25) scores. Each DISE video was examined for complete obstruction at velum, oropharynx, tongue, epiglottis (VOTE system). Student's t test, correlation, and multivariate linear regression were performed. Among 65 subjects, complete obstruction was observed at 0 (3%), 1 (46%), 2 (48%), and 3 (3%) subsites, respectively. Subjects with 0-1 subsites vs 2-4 subsites of complete obstruction had similar apnea indexes (13 ± 24 vs 12 ± 17, P = .78, 83% power to detect difference of 15), apnea-hypopnea indexes (30 ± 25 vs 31 ± 28, P = .96, 54% power to detect difference of 15), Epworth Sleepiness Scale scores (11 ± 7 vs 12 ± 5, P = .34, 91% power to detect difference of 5), and SNORE25 scores (2.0 ± 1.1 vs 1.9 ± 1.0, P = .70, 96% power to detect difference of 1.0), with similar results after adjusting for age, sex, body mass index, and tonsil status. Neither tongue base nor epiglottic obstruction was associated with apnea index. The number of subsites with complete obstruction on DISE was not associated with polysomnographic, subjective sleepiness, and quality-of-life measures. Tongue base and epiglottic obstruction were not associated with apnea index. Larger detailed analyses are needed to determine the importance of each site and degree of obstruction seen on DISE. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  14. Increasing the functional residual capacity may reverse obstructive sleep apnea.

    PubMed

    Sériès, F; Cormier, Y; Lampron, N; La Forge, J

    1988-08-01

    We describe the reversal of obstructive sleep apnea with a 0.5 L increase in the functional residual capacity (FRC) in a patient with sleep apnea syndrome. The patient had been treated with medroxyprogesterone acetate for 8 months. The increase in FRC was obtained by applying a constant negative extrathoracic pressure (NEP) with a poncho-type respirator. With pulmonary inflation, there was a dramatic decrease in the apnea index and the percent apnea time, and an improvement in sleep architecture. At all sleep stages, the desaturation duration was shorter with NEP. The exact mechanisms by which pulmonary expansion improved sleep apnea in this patient remain unclear; lung volume dependence of upper airway patency and the improvements in apnea-induced desaturation may be contributing factors. Our observation illustrates that lung volumes may be an important factor in the pathophysiology of obstructive sleep apnea, especially in the apnea onset and in the apneic-induced desaturation.

  15. Unconstrained sleep apnea monitoring using polyvinylidene fluoride film-based sensor.

    PubMed

    Hwang, Su Hwan; Lee, Hong Ji; Yoon, Hee Nam; Jung, Da Woon; Lee, Yu-Jin G; Lee, Yu Jin; Jeong, Do-Un; Park, Kwang Suk

    2014-07-01

    We established and tested an unconstrained sleep apnea monitoring method using a polyvinylidene (PVDF) film-based sensor for continuous and accurate monitoring of apneic events occurred during sleep. Twenty-six sleep apnea patients and six normal subjects participated in this study. Subjects' respiratory signals were measured using the PVDF-based sensor during polysomnography. The PVDF sensor comprised a 4 × 1 array, and a thin silicon pad was placed over the sensor to prevent damage. Total thickness of the merged system was approximately 1.1 mm which was thin enough to prevent the subject from being consciously aware of its presence. It was designed to be placed under subjects' backs and installed between a bed cover and mattress. The proposed method was based on the standard deviation of the PVDF signals, and it was applied to a test set for detecting apneic events. The method's performance was assessed by comparing the results with a sleep physician's manual scoring. The correlation coefficient for the apnea-hypopnea index (AHI) values between the methods was 0.94 (p < 0.001). The areas under the receiver operating curves at three AHI threshold levels (>5, >15, and >20) for sleep apnea diagnosis were 0.98, 0.99, and 0.98, respectively. For min-by-min apnea detection, the method classified sleep apnea with an average sensitivity of 72.9%, specificity of 90.6%, accuracy of 85.5%, and kappa statistic of 0.60. The developed system and method can be applied to sleep apnea detection in home or ambulatory monitoring.

  16. Mouth breathing in obstructive sleep apnea prior to and during nasal continuous positive airway pressure.

    PubMed

    Ruhle, Karl Heinz; Nilius, Georg

    2008-01-01

    Patients with obstructive sleep apnea syndrome (OSAS) often complain of dryness of mouth and throat prior to and during nasal continuous positive airway pressure (nCPAP). It is believed that this is due to mouth breathing (MB). However, the association between mouth breathing and apneas/hypopneas and the effect of CPAP on MB has not been studied. The purpose of the present study was, therefore, to assess the frequency and duration of episodes of MB prior to and during treatment with nCPAP. MB was recorded prior to and during nCPAP with a closely fitting mouth mask connected to a pneumotachograph and nasal flow was measured via nasal prongs. MB episodes were expressed as the number of events divided by total sleep time x 60, to give the MB event index per hour of sleep. MB time divided by total sleep time x 60 was calculated in minutes to get the MB time index per hour of sleep. Eleven male patients with OSAS (mean age 57.9 +/- 8.3 years, body mass index 30.2 +/- 3.8) were recruited to the study. Prior to nCPAP, the apnea/hypopnea index was 55.8 +/- 26 and decreased during nCPAP to 8.0 +/- 3.4. The lowest SaO2 measured was 82.9 +/- 4.7%, and increased to 87.5 +/- 2.7% under nCPAP. The mean nCPAP was 7.8 +/- 1.6 cm H2O. MB event index per hour of sleep decreased from 35.2 +/- 19.7 prior to treatment to 5.0 +/- 5.2 under nCPAP (p < 0.01). In 52.2 +/- 27.4% of obstructive respiratory events, MB started at the end of an apnea/hypopnea episode, decreasing to 8.5 +/- 12.5% with nCPAP treatment. MB time index per hour of sleep was reduced from 13.5 +/- 10.2 min prior to treatment to 4.6 +/- 5.5 min under nCPAP (p < 0.05). In OSAS patients, MB episodes often appear at the termination of an apnea/hypopnea episode. In many cases, MB episodes can be markedly reduced by nCPAP treatment. When patients on nCPAP complain of dry mouth, appropriate measurements should be performed to verify MB. 2007 S. Karger AG, Basel.

  17. Phrenic nerve stimulation for the treatment of central sleep apnea.

    PubMed

    Abraham, William T; Jagielski, Dariusz; Oldenburg, Olaf; Augostini, Ralph; Krueger, Steven; Kolodziej, Adam; Gutleben, Klaus-Jürgen; Khayat, Rami; Merliss, Andrew; Harsch, Manya R; Holcomb, Richard G; Javaheri, Shahrokh; Ponikowski, Piotr

    2015-05-01

    The aim of this study was to evaluate chronic, transvenous, unilateral phrenic nerve stimulation to treat central sleep apnea (CSA) in a prospective, multicenter, nonrandomized study. CSA occurs predominantly in patients with heart failure and increases the risk for morbidity and mortality. Established therapies for CSA are lacking, and those available are limited by poor patient adherence. Fifty-seven patients with CSA underwent baseline polysomnography followed by transvenous phrenic nerve stimulation system implantation and follow-up. Feasibility was assessed by implantation success rate and therapy delivery. Safety was evaluated by monitoring of device- and procedure-related adverse events. Efficacy was evaluated by changes in the apnea-hypopnea index at 3 months. Quality of life at 6 months was evaluated using a sleepiness questionnaire, patient global assessment, and, in patients with heart failure at baseline, the Minnesota Living With Heart Failure Questionnaire. The study met its primary end point, demonstrating a 55% reduction in apnea-hypopnea index from baseline to 3 months (49.5 ± 14.6 episodes/h vs. 22.4 ± 13.6 episodes/h of sleep; p < 0.0001; 95% confidence interval for change: -32.3 to -21.9). Central apnea index, oxygenation, and arousals significantly improved. Favorable effects on quality of life and sleepiness were noted. In patients with heart failure, the Minnesota Living With Heart Failure Questionnaire score significantly improved. Device- or procedure-related serious adverse events occurred in 26% of patients through 6 months post therapy initiation, predominantly due to lead repositioning early in the study. Therapy was well tolerated. Efficacy was maintained at 6 months. Transvenous, unilateral phrenic nerve stimulation appears safe and effective for treating CSA. These findings should be confirmed in a prospective, randomized, controlled trial. (Chronic Evaluation of Respicardia Therapy; NCT01124370). Copyright © 2015 American

  18. Effect of diuretics and sodium-restricted diet on sleep apnea severity: study protocol for a randomized controlled trial.

    PubMed

    Fiori, Cintia Zappe; Martinez, Denis; Gonçalves, Sandro Cadaval; Montanari, Carolina Caruccio; Fuchs, Flavio Danni

    2015-04-25

    Obstructive sleep apnea occurs as a result of increased collapsibility of the upper airway. Overnight fluid displacement from the legs to the neck causes pharyngeal narrowing and increased apnea severity. Sodium intake is associated with apnea severity. We hypothesized that interventions that decrease bodily fluid content might reduce the severity of sleep apnea. This is a randomized clinical trial including men with an apnea-hypopnea index greater than 30 events/hour, previously diagnosed by full-night in-laboratory polysomnography. A total of 54 men will be included and randomly assigned to three groups: Diuretic (n = 18), sodium-restricted diet (n = 18), and control (n = 18). The intervention will last one week. Intention-to-treat and per-protocol analyses will be performed. The diuretic group will receive combined spironolactone 100 mg plus furosemide 20 mg daily, taken in the morning. The diet group will receive a regimen with a maximum intake of 3 g of sodium per day. The control group will receive a placebo pill and will maintain all eating habits while keeping a recall diary of their dietary behavior. The primary outcome measure will be change in apnea-hypopnea index. The secondary outcome measures will be variations of: anthropometric and bioelectrical impedance variables, office blood pressure, respiratory variables from in-home level III polysomnography, excessive daytime sleepiness, glycolipid profile, C-reactive protein, 24 h urinary variables, and adverse events. Despite the high efficacy of continuous positive airway pressure to reverse upper airway obstruction in sleep apnea, partial adherence to this form of treatment reduces its efficiency. Thus, additional forms of treating apnea need to be investigated. If the results of this proof-of-concept trial show that decreases in bodily fluid content, either by diuretic or dietary intervention, reduces the severity of sleep apnea, further investigation will be necessary before these results can be

  19. Sleep Apnea in Patients with Acromegaly. Frequency, Characterization and Positive Pressure Titration

    PubMed Central

    Hernández-Gordillo, Daniel; Ortega-Gómez, María del Rocío; Galicia-Polo, Lourdes; Castorena-Maldonado, Armando; Vergara-López, Alma; Guillén-González, Miguel Ángel; Torre-Bouscoulet, Luis

    2012-01-01

    Objectives: to describe the frequency of sleep apnea in patients with acromegaly;to identify the proportion of candidates for treatment with positive airway pressure;to report our experience with the positive pressure titration process in acromegaly patients. Methods: A cross-sectional study that included the acromegaly cohort at the Centro Medico Nacional “20 de Noviembre” in Mexico City (n=44). A standard polysomnography (PSG) was carried out for each patient. A second PSG was done for purposes of CPAP titration. Results: A total of 35 patients were studied (80% of the cohort, 20 [57%] women). Polysomnography results showed that 34 subjects (97%, 95%CI 91-100%) had apnea hypopnea indexes (AHI) ≥ 5. No patient had central apnea. We identified 19 subjects with AHI ≥5 and Epworth ≥10, for a frequency of obstructive sleep apnea syndrome of 54% (95%CI 36-71%). A total of 31 patients (88%; 95%CI 77-99%) were deemed to be candidates for positive pressure treatment, but only 8 of them accepted CPAP. They required pressures that ranged from 10 to 18 cmH2O. Conclusions: Our results confirm a high prevalence of sleep apnea in patients with acromegaly, and provide evidence that the majority of those patients are candidates for treatment with positive pressure. Contrary to what has been reported, we identified no patients with central apnea. PMID:22754597

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

    PubMed Central

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

    2013-01-01

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

  1. Bench Test Evaluation of Adaptive Servoventilation Devices for Sleep Apnea Treatment

    PubMed Central

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

    2013-01-01

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

  2. Treating obstructive sleep apnea with hypoglossal nerve stimulation.

    PubMed

    Eastwood, Peter R; Barnes, Maree; Walsh, Jennifer H; Maddison, Kathleen J; Hee, Geoffrey; Schwartz, Alan R; Smith, Philip L; Malhotra, Atul; McEvoy, R Douglas; Wheatley, John R; O'Donoghue, Fergal J; Rochford, Peter D; Churchward, Tom; Campbell, Matthew C; Palme, Carsten E; Robinson, Sam; Goding, George S; Eckert, Danny J; Jordan, Amy S; Catcheside, Peter G; Tyler, Louise; Antic, Nick A; Worsnop, Christopher J; Kezirian, Eric J; Hillman, David R

    2011-11-01

    Reduced upper airway muscle activity during sleep is fundamental to obstructive sleep apnea (OSA) pathogenesis. Hypoglossal nerve stimulation (HGNS) counteracts this problem, with potential to reduce OSA severity. To examine safety and efficacy of a novel HGNS system (HGNS, Apnex Medical, Inc.) in treating OSA. Twenty-one patients, 67% male, age (mean ± SD) 53.6 ± 9.2 years, with moderate to severe OSA and unable to tolerate continuous positive airway pressure (CPAP). Each participant underwent surgical implantation of the HGNS system in a prospective single-arm interventional trial. OSA severity was defined by apnea-hypopnea index (AHI) during in-laboratory polysomnography (PSG) at baseline and 3 and 6 months post-implant. Therapy compliance was assessed by nightly hours of use. Symptoms were assessed using the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Calgary Sleep Apnea Quality of Life Index (SAQLI), and the Beck Depression Inventory (BDI). HGNS was used on 89% ± 15% of nights (n = 21). On these nights, it was used for 5.8 ± 1.6 h per night. Nineteen of 21 participants had baseline and 6-month PSGs. There was a significant improvement (all P < 0.05) from baseline to 6 months in: AHI (43.1 ± 17.5 to 19.5 ± 16.7), ESS (12.1 ± 4.7 to 8.1 ± 4.4), FOSQ (14.4 ± 2.0 to 16.7 ± 2.2), SAQLI (3.2 ± 1.0 to 4.9 ± 1.3), and BDI (15.8 ± 9.0 to 9.7 ± 7.6). Two serious device-related adverse events occurred: an infection requiring device removal and a stimulation lead cuff dislodgement requiring replacement. HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms. NAME: Australian Clinical Study of the Apnex Medical HGNS System to Treat Obstructive Sleep Apnea. NCT01186926. URL: http://clinicaltrials.gov/ct2/show/NCT01186926.

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

    PubMed Central

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

    2015-01-01

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

  4. Inflammatory cytokines in pediatric obstructive sleep apnea

    PubMed Central

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

    2016-01-01

    Abstract Pediatric obstructive sleep apnea (OSA) is associated with chronic systemic inflammation and with cognitive impairments. This study aimed to investigate the status of proinflammatory cytokines, particularly interleukin 17 (IL-17) and interleukin 23 (IL-23) and cognition in pediatric OSA. Controls and OSA children participated in the study. Exclusion criteria were adenotonsillectomy, heart, neurological and severe psychiatric diseases, craniofacial syndromes, and obesity. Polysomnogram was followed by serum testing for inflammatory markers and neurocognitive tests such as continuous performance task (CPT) and Wisconsin card sorting test, questionnaires, analyses of plasma high-sensitivity C-reactive protein (HS-CRP), tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6), IL-17, and IL-23. Seventy-nine, 4 to 12-year-old subjects in 2 groups ended the study: 47 nonobese OSA children (mean age = 7.84 ± 0.56 years, body mass index [BMI] = 16.95 ± 0.47 kg/m2, BMI z-score = 0.15 ± 0.21, and mean apnea–hypopnea index [AHI] = 9.13 ± 1.67 events/h) and 32 healthy control children (mean age = 7.02 ± 0.65 years, with BMI = 16.55 ± 0.58 kg/m2, BMI z-score = −0.12 ± 0.27, and mean AHI = 0.41 ± 0.07 event/h) were enrolled. Serum cytokine analyses showed significantly higher levels of HS-CRP, IL-17, and IL-23 in OSA children (P = 0.002, P = 0.024, and P = 0.047). Regression test showed significant influence of HS-CRP, TNF-α, IL-6, IL-17, and specifically IL-23, with the continuous performance test and Wisconsin card sorting test. OSA children have abnormal levels of IL-17, an interleukin related to T helper 17 cells, a T helper cell involved in development of autoimmunity and inflammation. This high expression level may contribute to the complications of pediatric OSA; we also found a significant influence of inflammatory cytokines, particularly IL-23, on abnormal neurocognitive testing. PMID

  5. Respiratory Inductance Plethysmography Improved Diagnostic Sensitivity and Specificity of Obstructive Sleep Apnea.

    PubMed

    Kogan, Dmitriy; Jain, Arad; Kimbro, Shawn; Gutierrez, Guillermo; Jain, Vivek

    2016-08-01

    Respiratory inductance plethysmography (RIP) is a tool used during a polysomnogram (PSG), which serves as a surrogate of respiratory effort and can help detect inspiratory air-flow limitation. We hypothesize that RIP can improve the sensitivity and specificity of scoring hypopneas when compared with both the recommended and acceptable criteria of the American Academy of Sleep Medicine. We retrospectively analyzed a cohort of 12 subjects who had no obstructive sleep apnea (OSA) or mild OSA on PSG when scored by the American Academy of Sleep Medicine acceptable criteria for hypopneas but had high clinical suspicion for a diagnosis of OSA. These subjects were rescored using the American Academy of Sleep Medicine recommended criteria as well as RIP. Hypopnea was scored when there was a 50% decrease in the amplitude of the RIP sum channel (which combined input from chest and abdominal belts). OSA was diagnosed if the subjects had >5 respiratory events/h of sleep. The subject's response to CPAP was assessed by using a short questionnaire called the post-PSG sleep assessment. which evaluated subjective sleep quality. A positive response was considered an improvement in the post-PSG sleep assessment score after CPAP use. When scored using the American Academy of Sleep Medicine acceptable criteria, 10 subjects had a negative study, and 2 subjects had mild OSA for a sensitivity of 11% and specificity of 50%. When scored using the recommended criteria, 10 subjects had OSA, and 2 were negative, for a sensitivity of 78% and specificity of 70%. By RIP scoring, all 12 subjects had >5 respiratory events/h for a sensitivity of 100% and specificity of 75%. This small retrospective pilot study showed improved sensitivity and specificity when scoring hypopneas by RIP sum channel. Copyright © 2016 by Daedalus Enterprises.

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

    PubMed Central

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

    2014-01-01

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

  7. Treatment of the Obstructive Sleep Apnea Syndrome

    PubMed Central

    Wiggins, Robert V.; Schmidt-Nowara, Wolfgang W.

    1987-01-01

    The obstructive sleep apnea syndrome is a disorder of sleep and breathing that is being recognized with increasing frequency. The pathophysiologic consequences range from mild sleepiness to life-threatening cardiovascular and respiratory decompensation. The primary forms of treatment are directed at modifying the upper airway with either an operation or continuous positive airway pressure. Aside from tracheostomy, which is virtually always successful, other forms of treatment have met with varying results. Ancillary therapy, including oxygen, weight loss and drugs, is often helpful but seldom curative. Follow-up sleep studies are necessary to evaluate the effectiveness of treatment. Selecting therapy for a patient with obstructive sleep apnea requires a comprehensive evaluation including polysomnography, special examinations of the upper airway and assessing the cardiopulmonary status. Therapy is based on the severity of disease and must be tailored to each patient. PMID:3321711

  8. Trajectories of Emergent Central Sleep Apnea During CPAP Therapy.

    PubMed

    Liu, Dongquan; Armitstead, Jeff; Benjafield, Adam; Shao, Shiyun; Malhotra, Atul; Cistulli, Peter A; Pepin, Jean-Louis; Woehrle, Holger

    2017-10-01

    The emergence of central sleep apnea (CSA) during positive airway pressure (PAP) therapy has been observed clinically in approximately 10% of obstructive sleep apnea titration studies. This study assessed a PAP database to investigate trajectories of treatment-emergent CSA during continuous PAP (CPAP) therapy. U.S. telemonitoring device data were analyzed for the presence/absence of emergent CSA at baseline (week 1) and week 13. Defined groups were as follows: obstructive sleep apnea (average central apnea index [CAI] < 5/h in week 1, < 5/h in week 13); transient CSA (CAI ≥ 5/h in week 1, < 5/h in week 13); persistent CSA (CAI ≥ 5/h in week 1, ≥ 5/h in week 13); emergent CSA (CAI < 5/h in week 1, ≥ 5/h in week 13). Patients (133,006) used CPAP for ≥ 90 days and had ≥ 1 day with use of ≥ 1 h in week 1 and week 13. The proportion of patients with CSA in week 1 or week 13 was 3.5%; of these, CSA was transient, persistent, or emergent in 55.1%, 25.2%, and 19.7%, respectively. Patients with vs without treatment-emergent CSA were older, had higher residual apnea-hypopnea index and CAI at week 13, and more leaks (all P < .001). Patients with any treatment-emergent CSA were at higher risk of therapy termination vs those who did not develop CSA (all P < .001). Our study identified a variety of CSA trajectories during CPAP therapy, identifying several different clinical phenotypes. Identification of treatment-emergent CSA by telemonitoring could facilitate early intervention to reduce the risk of therapy discontinuation and shift to more efficient ventilator modalities. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing

    PubMed Central

    Walker, James M.; Farney, Robert J.; Rhondeau, Steven M.; Boyle, Kathleen M; Valentine, Karen; Cloward, Tom V.; Shilling, Kevin C.

    2007-01-01

    Background: Chronic opioid therapy for pain management has increased dramatically without adequate study of potential deleterious effects on breathing during sleep. Methods: A retrospective cohort study comparing 60 patients taking chronic opioids matched for age, sex, and body mass index with 60 patients not taking opioids was conducted to determine the effect of morphine dose equivalent on breathing patterns during sleep. Results: The apnea-hypopnea index was greater in the opioid group (43.5/h vs 30.2/h, p < .05) due to increased central apneas (12.8/h vs 2.1/h; p < .001). Arterial oxygen saturation (SpO2) in the opioid group was significantly lower during both wakefulness (difference 2.1%, p < .001) and non-rapid eye movement (NREM) sleep (difference 2.2%, p < .001) but not during rapid eye movement (REM) sleep (difference 1.2%) than in the nonopioid group. Within the opioid group, and after controlling for body mass index, age, and sex, there was a dose-response relationship between morphine dose equivalent and apnea-hypopnea (p < .001), obstructive apnea (p < .001), hypopnea (p < .001), and central apnea indexes (p < .001). Body mass index was inversely related to apnea-hypopnea index severity in the opioid group. Ataxic or irregular breathing during NREM sleep was also more prevalent in patients who chronically used opioids (70% vs 5.0%, p < .001) and more frequent (92%) at a morphine dose equivalent of 200 mg or higher (odds ratio = 15.4, p = .017). Conclusions: There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing. Although potentially significant, the clinical relevance of these observations remains to be established. Citation: Walker JM; Farney RJ; Rhondeau SM; Boyle KM; Cloward TV; Shilling KC. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med 2007

  10. Relationship between obstructive sleep apnea and endogenous carbon monoxide.

    PubMed

    Azuma, Masanori; Murase, Kimihiko; Tachikawa, Ryo; Hamada, Satoshi; Matsumoto, Takeshi; Minami, Takuma; Inouchi, Morito; Tanizawa, Kiminobu; Handa, Tomohiro; Oga, Toru; Mishima, Michiaki; Chin, Kazuo

    2017-01-01

    Endogenous carbon monoxide (CO) levels are recognized as a surrogate marker for activity of heme oxygenase-1, which is induced by various factors, including hypoxia and oxidative stress. Few reports have evaluated endogenous CO in patients with obstructive sleep apnea (OSA). Whether OSA more greatly affects exhaled or blood CO is not known. Sixty-nine patients with suspected OSA were prospectively included in this study. Exhaled and blood CO were evaluated at night and morning. Blood and exhaled CO levels were well correlated both at night and morning (r = 0.52, P < 0.0001 and r = 0.61, P < 0.0001, respectively). Although exhaled CO levels both at night and morning significantly correlated with total sleep time with arterial oxygen saturation < 90% (ρ = 0.41, P = 0.0005 and ρ = 0.27, P = 0.024, respectively), blood CO levels did not correlate with any sleep parameter. Seventeen patients with an apnea and hypopnea index (AHI) < 15 (control group) were compared with 52 patients with AHI ≥ 15 (OSA group). Exhaled CO levels at night in the OSA group were significantly higher than in the control group (3.64 ± 1.2 vs. 2.99 ± 0.70 ppm, P < 0.05). Exhaled CO levels at night decreased after 3 mo of continuous positive airway pressure (CPAP) therapy in OSA patients (n = 36; P = 0.016) to become nearly the same level as in the control group (P = 0.21). Blood CO levels did not significantly change after CPAP therapy. Exhaled CO was positively related to hypoxia during sleep in OSA patients, but blood CO was not. Exhaled CO might better correlate with oxidative stress associated with OSA than blood CO.

  11. Clinical verification of patients with obstructive sleep apnea provided with a customized cushion for continuous positive airway pressure.

    PubMed

    Cheng, Yih-Lin; Hsu, Ding-Yang; Lee, Hsin-Chien; Bien, Mauo-Ying

    2015-01-01

    Patients with obstructive sleep apnea may stop breathing momentarily during sleep because of a narrow upper respiratory tract. One of the main treatments for obstructive sleep apnea is continuous positive airway pressure. However, after long-term treatment, patients tend to complain about the leakage, inconvenience, and discomfort of the nasal mask. The purpose of the study was to develop customized cushions and compare the clinical performance of the customized cushion with the conventional one. Each participant's face was replicated by using a 3-dimensional scanner and reverse-engineering technology, and computer numerical control techniques were used to design and manufacture customized cushions. Forty participants were randomly divided into 2 groups, a control group with conventional cushions and an experimental group with customized cushions. The saturation level of peripheral oxygen, apnea-hypopnea index, leakage data, and answers to a comfort questionnaire were examined. Customized and conventional cushions were compared with independent sampling t tests and relational analyses. A significant difference was found in the apnea-hypopnea index (P=.001) of participants with the customized cushion and those with the conventional cushion. Participants with the conventional cushion had a lower apnea-hypopnea index. The customized cushion applied less headgear force and fit better than the conventional cushion. The leakage volume, saturation of peripheral oxygen (SpO2), treatment compliance, and degree of comfort were not significantly different between the groups. Customized nasal mask cushions fit better and reduce the force applied by the headgear. Participants using a customized cushion showed an improved apnea-hypopnea index. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  12. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea.

    PubMed

    Suratt, P M; McTier, R F; Findley, L J; Pohl, S L; Wilhoit, S C

    1987-10-01

    The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea (OSA). We therefore prospectively studied eight patients before and after dietary-induced weight loss. Mean weight loss was 20.6 kg +/- 12.8 SD. After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness, and in the number of desaturation episodes per hour of sleep, average desaturation per episode, and number of movement arousals. The number of apneas and hypopneas significantly decreased in six of eight patients. There was a significant correlation between body mass index and number of disordered breathing events. Nasopharyngeal collapsibility and pulse flow resistance decreased in awake patients after weight loss. We conclude that moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness, decreases the number of disordered breathing events in many patients, decreases the collapsibility of the nasopharyngeal airway.

  13. [Effect of obstructive sleep apnea on sleep architecture of acute ischemic stroke patients].

    PubMed

    Xu, Y N; Li, J; Huang, J Y; Zhu, C; Mao, C J; Shen, Y; Liu, C F

    2017-03-28

    Objective: To investigate the effect of obstructive sleep apnea (OSA) on sleep architecture in acute ischemic stroke (AIS) patients. Methods: Seventy AIS patients with polysomnography examination from June 2014 to April 2016 were included in the Second Affiliated Hospital of Soochow University. Twenty-seven healthy controls during the same period were chosen as control group. According to apnea-hypopnea index (AHI), AIS patients were divided into AIS group (AHI<5/h) and AIS+ OSA group (AHI≥5/h). Their general conditions, Neurological function defect (national institutes of health stroke scale, NIHSS) on admission and at discharge and self-care ability (modified Rankin Scale, mRS) at discharge and 3 months later (mRS score <2 reflected good prognosis, and mRS score≥2 reflected unfavorable prognosis) were collected. Results: Fifty-two patients (74.3%) had OSA in total seventy AIS patients. Total sleep time (TST) was significantly shorter and sleep efficiency (SE) was lower in AIS group than the control group (P=0.007, 0.008, respectively). AIS+ OSA group had longer non-rapid eye movement (NREM)1 than control group [24.9(21.3) vs 14.3(10.6), P=0.044]. Compared with AIS group, AIS+ OSA group had shorter NREM3 [13.0(13.2) vs 19.6(12.8), P=0.039]. There was no significant difference between the infarct location of AIS group and AIS+ OSA group. However, AIS+ OSA group had higher mRS score observed at 3 months through follow-up visit than AIS group (P=0.027). Spearman correlation analysis showed a positive correlation between unfavorable prognosis of stroke at 3 months and atrial fibrillation, the oxygen desaturation index (ODI), percentage of oxygen saturation <90% of total recording time (TS90%), AHI, the longest time of apnea and hypopnea, respiratory related microarousal and NIHSS, while a negative correlation between unfavorable prognosis of stroke and NREM3, lowest nocturnal oxygen saturation (L-SaO(2)). On Logistic analysis, the unfavorable prognosis was

  14. The Interaction of Obstructive Sleep Apnea and Obesity on the Inflammatory Markers C-Reactive Protein and Interleukin-6: The Icelandic Sleep Apnea Cohort

    PubMed Central

    Arnardottir, Erna S.; Maislin, Greg; Schwab, Richard J.; Staley, Bethany; Benediktsdottir, Bryndis; Olafsson, Isleifur; Juliusson, Sigurdur; Romer, Micah; Gislason, Thorarinn; Pack, Allan I.

    2012-01-01

    Study Objectives: To assess the relative roles and interaction of obstructive sleep apnea (OSA) severity and obesity on interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Design: Cross-sectional cohort. Setting: The Icelandic Sleep Apnea Cohort. Participants: 454 untreated OSA patients (380 males and 74 females), mean ± standard deviation age 54.4 ± 10.6 yr. Interventions: N/A. Measurements and Results: Participants underwent a sleep study, abdominal magnetic resonance imaging to measure total abdominal and visceral fat volume, and had fasting morning IL-6 and CRP levels measured in serum. A significantly higher correlation was found for BMI than visceral fat volume with CRP and IL-6 levels. Oxygen desaturation index, hypoxia time, and minimum oxygen saturation (SaO2) significantly correlated with IL-6 and CRP levels, but apnea-hypopnea index did not. When stratified by body mass index (BMI) category, OSA severity was associated with IL-6 levels in obese participants only (BMI > 30 kg/m2). A multiple linear regression model with interaction terms showed an independent association of OSA severity with IL-6 levels and an interaction between OSA severity and BMI, i.e., degree of obesity altered the relationship between OSA and IL-6 levels. An independent association of OSA severity with CRP levels was found for minimum SaO2 only. A similar interaction of OSA severity and BMI on CRP levels was found for males and postmenopausal women. Conclusions: OSA severity is an independent predictor of levels of IL-6 and CRP but interacts with obesity such that this association is found only in obese patients. Citation: Arnardottir ES; Maislin G; Schwab RJ; Staley B; Benediktsdottir B; Olafsson I; Juliusson S; Romer M; Gislason T; Pack AI. The interaction of obstructive sleep apnea and obesity on the inflammatory markers c-reactive protein and interleukin-6: the Icelandic Sleep Apnea Cohort. SLEEP 2012;35(7):921-932. PMID:22754038

  15. High altitude pulmonary edema, down syndrome, and obstructive sleep apneas.

    PubMed

    Richalet, Jean-Paul; Chenivesse, Cécile; Larmignat, Philippe; Meille, Laurent

    2008-01-01

    A 24-year-old adult with a Down syndrome was admitted in December 2006 at the Moutiers hospital in the French Alps for an acute inaugural episode of high altitude pulmonary edema (HAPE) that occurred in the early morning of day 3 after his arrival to La Plagne (2000 m). This patient presented an interventricular septal defect operated on at the age of 7, a hypothyroidism controlled by 50 microg levothyrox, a state of obesity (BMI 37.8 kg/m(2)), and obstructive sleep apneas with a mean of 42 obstructive apneas or hypopneas per hour, treated with continuous positive airway pressure (CPAP). The patient refused to use his CPAP during his stay in La Plagne. At echocardiography, resting parameters were normal, with a left ventricular, ejection fraction of 60%, a normokinetic right ventricle, and an estimated systolic pulmonary artery pressure (sPAP) of 30 mmHg. At exercise, sPAP rose to 45 mmHg and the right ventricle was still normokinetic and not dilated. An exercise hypoxic tolerance test performed at 60 W and at the equivalent altitude of 3300 m revealed a severe drop in arterial oxygen saturation down to 60%, with an abnormal low ventilatory response to hypoxia, suggesting a defect in peripheral chemosensitivity to hypoxia. In conclusion, patients with Down syndrome, including adults with no cardiac dysfunction and regular physical activity, are at risk of HAPE even at moderate altitude when they suffer from obstructive sleep apneas associated with obesity and low chemoresponsiveness. This observation might be of importance since an increasing number of young adults with Down syndrome participate in recreational or sport activities, including skiing and mountaineering.

  16. Behavioral Hyperventilation and Central Sleep Apnea in Two Children

    PubMed Central

    Johnston, Thomas P.; Tam-Williams, Jade; Schmandt, Margaret; Patel, Anand C.; Cleveland, Claudia; Coste, Ferdinand; Kemp, James S.

    2015-01-01

    Behavioral hyperventilation is a rarely recognized cause of central sleep apnea (CSA) among children. We report two pediatric patients who presented with prolonged central sleep apnea secondary to behavioral hyperventilation. One patient also had a prolonged corrected QT (QTC) interval resulting from hyperventilation. Citation: Johnston TP, Tam-Williams J, Schmandt M, Patel AC, Cleveland C, Coste F, Kemp JS. Behavioral hyperventilation and central sleep apnea in two children. J Clin Sleep Med 2015;11(4):487–489. PMID:26106657

  17. Continuous Positive Airway Pressure Improves Sleep and Daytime Sleepiness in Patients with Parkinson Disease and Sleep Apnea

    PubMed Central

    Neikrug, Ariel B.; Liu, Lianqi; Avanzino, Julie A.; Maglione, Jeanne E.; Natarajan, Loki; Bradley, Lenette; Maugeri, Alex; Corey-Bloom, Jody; Palmer, Barton W.; Loredo, Jose S.; Ancoli-Israel, Sonia

    2014-01-01

    Study Objectives: Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. Design: This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. Setting: Sleep laboratory. Participants: Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). Intervention: Continuous positive airway pressure. Measurements: PSG outcome measures: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). Results: There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). Conclusions: Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in

  18. Determinants of Wake Pco2 and Increases in Wake Pco2 over Time in Patients with Obstructive Sleep Apnea.

    PubMed

    Kittivoravitkul, Prapun; Kaw, Roop; Hatipoğlu, Umur; Wang, Lu; Aboussouan, Loutfi S

    2016-02-01

    The progression from obesity and obstructive sleep apnea to obesity with hypoventilation and daytime hypercapnia may relate to features of sleep-disordered breathing events that affect loading and unloading of carbon dioxide. To determine whether the wake Pco2 increases over time in untreated obstructive sleep apnea, and whether that increase is explained by changes in sleep-disordered breathing event duration, interevent duration, or postevent ventilation amplitude. We selected 14 adults who had two polysomnographic studies more than 1 year apart because of untreated or suboptimally treated moderate to severe obstructive sleep apnea. Demographic and polysomnographic data were reviewed for both sets of studies, including the evening wake end-tidal CO2, the ratio of mean event to mean interevent duration (subsuming apneas and hypopneas), and the ratio of mean post- to preevent breath amplitude. The mean (SD) wake end-tidal Pco2 increased between studies from 35.9 (4.2) to 39.5 (3.9) mm Hg (P < 0.005). The wake end-tidal CO2 correlated inversely with the post- to pre-event breath amplitude and positively with the ratio of mean event to mean interevent duration and with body mass index. However, those three variables were not significantly changed between the two studies. The wake end-tidal CO2 did not correlate with the apnea-hypopnea index or age. There was a significant increase in bicarbonate level between studies (median, 24.0-26.5 mmol/L; P = 0.01). In our study cohort, wake end-tidal CO2 correlated with body mass index and features of sleep apnea that influence the balance of loading and unloading of CO2. However, those features remained fixed over time, even as the wake Pco2 and bicarbonate levels increased with untreated sleep apnea.

  19. Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea.

    PubMed

    Truong, Mai Thy; Woo, Victoria G; Koltai, Peter J

    2012-05-01

    Ten to twenty percent of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy (T&A). We hypothesize that sleep endoscopy, a flexible fiberoptic examination of the pharynx under anesthesia, is an effective tool for identifying sites of persistent obstruction. In this retrospective cohort study, we reviewed records of children who had symptoms consistent with OSA and a positive polysomnogram (PSG) who underwent sleep endoscopy followed by sleep endoscopy directed surgery. Data collection included age, BMI and co-morbidities. Apnea-hypopnea index (AHI) was compared to pre and post surgery for each child using a paired t-test. Of the 80 children who underwent sleep endoscopy followed by directed surgery, 65% were male, mean age was 6 years (SD 3.75 years), average BMI was 19 (SD 0.43 years) and 28% had co-morbidities. For the 51% of patients who had persistent OSA after T&A, the mean AHI after sleep endoscopy directed surgery was significantly lower then before surgery (7.9 vs. 15.7, p<.01). For the 49% of patients who had never undergone surgery for OSA, or who were surgically naïve, and underwent sleep endoscopy directed surgery, the mean AHI was significantly lower then before surgery (8.0 vs. 13.8, p<.01). Sleep endoscopy is a consistently reliable tool for identifying the sites of obstruction in both surgically naive children and those with persistent OSA after T&A. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial.

    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

    2011-12-01

    To evaluate the efficacy of a 12-week exercise training program for reducing obstructive sleep apnea (OSA) severity and improving sleep quality, and to explore possible mechanisms by which exercise may reduce OSA severity. Randomized controlled trial. Clinical exercise physiology center, sleep laboratory. Forty-three sedentary and overweight/obese adults aged 18-55 years with at least moderate-severity untreated OSA (screening apnea-hypopnea index [AHI] ≥ 15). Participants randomized to exercise training (n = 27) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity, followed by resistance training twice/week. Participants randomized to a stretching control (n = 16) met twice weekly for 12 weeks to perform low-intensity exercises designed to increase whole-body flexibility. OSA severity was assessed with one night of laboratory polysomnography (PSG) before and following the 12-week intervention. Measures of sleep quality included PSG, actigraphy (7-10 days), and the Pittsburgh Sleep Quality Index. Compared with stretching, exercise resulted in a significant AHI reduction (exercise: 32.2 ± 5.6 to 24.6 ± 4.4, stretching: 24.4 ± 5.6 to 28.9 ± 6.4; P < 0.01) as well as significant changes in oxygen desaturation index (ODI; P = 0.03) and stage N3 sleep (P = 0.03). Reductions in AHI and ODI were achieved without a significant decrease in body weight. Improvements in actigraphic sleep and subjective sleep quality were also noted following exercise compared with stretching. Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults, which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss. Clinicaltrials.gov identification number NCT00956423.

  1. Added value of a mandible movement automated analysis in the screening of obstructive sleep apnea.

    PubMed

    Maury, Gisele; Cambron, Laurent; Jamart, Jacques; Marchand, Eric; Senny, Frédéric; Poirrier, Robert

    2013-02-01

    In-laboratory polysomnography is the 'gold standard' for diagnosing obstructive sleep apnea syndrome, but is time consuming and costly, with long waiting lists in many sleep laboratories. Therefore, the search for alternative methods to detect respiratory events is growing. In this prospective study, we compared attended polysomnography with two other methods, with or without mandible movement automated analysis provided by a distance-meter and added to airflow and oxygen saturation analysis for the detection of respiratory events. The mandible movement automated analysis allows for the detection of salient mandible movement, which is a surrogate for arousal. All parameters were recorded simultaneously in 570 consecutive patients (M/F: 381/189; age: 50±14 years; body mass index: 29±7 kg m(-2) ) visiting a sleep laboratory. The most frequent main diagnoses were: obstructive sleep apnea (344; 60%); insomnia/anxiety/depression (75; 13%); and upper airway resistance syndrome (25; 4%). The correlation between polysomnography and the method with mandible movement automated analysis was excellent (r: 0.95; P<0.001). Accuracy characteristics of the methods showed a statistical improvement in sensitivity and negative predictive value with the addition of mandible movement automated analysis. This was true for different diagnostic thresholds of obstructive sleep severity, with an excellent efficiency for moderate to severe index (apnea-hypopnea index ≥15h(-1) ). A Bland & Altman plot corroborated the analysis. The addition of mandible movement automated analysis significantly improves the respiratory index calculation accuracy compared with an airflow and oxygen saturation analysis. This is an attractive method for the screening of obstructive sleep apnea syndrome, increasing the ability to detect hypopnea thanks to the salient mandible movement as a marker of arousals.

  2. The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Lv, Zheng-tao; Jiang, Wen-xiu; Huang, Jun-ming; Zhang, Jin-ming; Chen, An-min

    2016-01-01

    Purpose. This study aims to determine the clinical efficacy of acupuncture therapy in the treatment of obstructive sleep apnea. Methods. A systematic literature search was conducted in five databases including PubMed, EMBASE, CENTRAL, Wanfang, and CNKI to identify randomized controlled trials (RCTs) on the effect of acupuncture therapy for obstructive sleep apnea. Meta-analysis was conducted using the RevMan version 5.3 software. Results. Six RCTs involving 362 subjects were included in our study. Compared with control groups, manual acupuncture (MA) was more effective in the improvement of apnea/hypopnea index (AHI), apnea index, hypopnea index, and mean SaO2. Electroacupuncture (EA) was better in improving the AHI and apnea index when compared with control treatment, but no statistically significant differences in hypopnea index and mean SaO2 were found. In the comparison of MA and nasal continuous positive airway pressure, the results favored MA in the improvement of AHI; there was no statistical difference in the improvement in mean SaO2. No adverse events associated with acupuncture therapy were documented. Conclusion. Compared to control groups, both MA and EA were more effective in improving AHI and mean SaO2. In addition, MA could further improve apnea index and hypopnea index compared to control. PMID:27127530

  3. Sleep Apnea Detection Based on Thoracic and Abdominal Movement Signals of Wearable Piezo-Electric Bands.

    PubMed

    Lin, Yin-Yan; Wu, Hau-Tieng; Hsu, Chi-An; Huang, Po-Chiun; Huang, Yuan-Hao; Lo, Yu-Lun

    2016-12-07

    Physiologically, the thoracic (THO) and abdominal (ABD) movement signals, captured using wearable piezo-electric bands, provide information about various types of apnea, including central sleep apnea (CSA) and obstructive sleep apnea (OSA). However, the use of piezo-electric wearables in detecting sleep apnea events has been seldom explored in the literature. This study explored the possibility of identifying sleep apnea events, including OSA and CSA, by solely analyzing one or both the THO and ABD signals. An adaptive non-harmonic model was introduced to model the THO and ABD signals, which allows us to design features for sleep apnea events. To confirm the suitability of the extracted features, a support vector machine was applied to classify three categories - normal and hypopnea, OSA, and CSA. According to a database of 34 subjects, the overall classification accuracies were on average 75.9%±11.7% and 73.8%±4.4%, respectively, based on the cross validation. When the features determined from the THO and ABD signals were combined, the overall classification accuracy became 81.8%±9.4%. These features were applied for designing a state machine for online apnea event detection. Two event-byevent accuracy indices, S and I, were proposed for evaluating the performance of the state machine. For the same database, the S index was 84.01%±9.06%, and the I index was 77.21%±19.01%. The results indicate the considerable potential of applying the proposed algorithm to clinical examinations for both screening and homecare purposes.

  4. Do optic nerve head and visual field parameters in patients with obstructive sleep apnea syndrome differ from those in control individuals?

    PubMed

    Salzgeber, R; Iliev, M E; Mathis, J

    2014-04-01

    It has been suggested that sleep apnea syndrome may play a role in normal-tension glaucoma contributing to optic nerve damage. The purpose of this study was to evaluate if optic nerve and visual field parameters in individuals with sleep apnea syndrome differ from those in controls. From the records of the sleep laboratory at the University Hospital in Bern, Switzerland, we recruited consecutive patients with severe sleep apnea syndrome proven by polysomnography, apnea-hypopnea index >20, as well as no sleep apnea controls with apnea-hypopnea index <10. Participants had to be unknown to the ophtalmology department and had to have no recent eye examination in the medical history. All participants underwent a comprehensive eye examination, scanning laser polarimetry (GDx VCC, Carl Zeiss Meditec, Dublin, California), scanning laser ophthalmoscopy (Heidelberg Retina Tomograph II, HRT II), and automated perimetry (Octopus 101 Programm G2, Haag-Streit Diagnostics, Koeniz, Switzerland). Mean values of the parameters of the two groups were compared by t-test. The sleep apnea group consisted of 69 eyes of 35 patients; age 52.7 ± 9.7 years, apnea-hypopnea index 46.1 ± 24.8. As controls served 38 eyes of 19 patients; age 45.8 ± 11.2 years, apnea-hypopnea index 4.8 ± 1.9. A difference was found in mean intraocular pressure, although in a fully overlapping range, sleep apnea group: 15.2 ± 3.1, range 8-22 mmHg, controls: 13.6 ± 2.3, range 9-18 mmHg; p<0.01. None of the extende