The impact of the microphone position on the frequency analysis of snoring sounds.

PubMed

Herzog, Michael; Kühnel, Thomas; Bremert, Thomas; Herzog, Beatrice; Hosemann, Werner; Kaftan, Holger

2009-08-01

Frequency analysis of snoring sounds has been reported as a diagnostic tool to differentiate between different sources of snoring. Several studies have been published presenting diverging results of the frequency analyses of snoring sounds. Depending on the position of the used microphones, the results of the frequency analysis of snoring sounds vary. The present study investigated the influence of different microphone positions on the outcome of the frequency analysis of snoring sounds. Nocturnal snoring was recorded simultaneously at six positions (air-coupled: 30 cm middle, 100 cm middle, 30 cm lateral to both sides of the patients' head; body contact: neck and parasternal) in five patients. The used microphones had a flat frequency response and a similar frequency range (10/40 Hz-18 kHz). Frequency analysis was performed by fast Fourier transformation and frequency bands as well as peak intensities (Peaks 1-5) were detected. Air-coupled microphones presented a wider frequency range (60 Hz-10 kHz) compared to contact microphones. The contact microphone at cervical position presented a cut off at frequencies above 300 Hz, whereas the contact microphone at parasternal position revealed a cut off above 100 Hz. On an exemplary base, the study demonstrates that frequencies above 1,000 Hz do appear in complex snoring patterns, and it is emphasised that high frequencies are imported for the interpretation of snoring sounds with respect to the identification of the source of snoring. Contact microphones might be used in screening devices, but for a natural analysis of snoring sounds the use of air-coupled microphones is indispensable.

Self-Reported Snoring Is Associated with Dyslipidemia, High Total Cholesterol, and High Low-Density Lipoprotein Cholesterol in Obesity: A Cross-Sectional Study from a Rural Area of China.

PubMed

Zhang, Naijin; Chen, Yintao; Chen, Shuang; Jia, Pengyu; Guo, Xiaofan; Sun, Guozhe; Sun, Yingxian

2017-01-17

Studies to explore the relationship between self-reported snoring and dyslipidemia, especially high total cholesterol (TC) and high low-density lipoprotein cholesterol (LDL-C), in the general population are still lacking. Our study was designed to examine whether self-reported snoring is significantly associated with dyslipidemia and ascertain the effects of different snoring intensities on dyslipidemia. There were 10,139 participants in our study. After adjustment for all confounding factors, self-reported snoring (OR = 1.207; p = 0.003), moderate (OR = 1.229; p = 0.015), strong (OR = 1.222; p = 0.033), and very strong (OR = 1.467; p = 0.012) snoring intensity, but not low (OR = 1.110; p = 0.224) snoring intensity, were significantly associated with dyslipidemia among adults with BMI (body mass index) ≥ 25 kg/m². In addition, self-reported snoring was significantly associated with high TC (OR = 1.167; p = 0.048) and high LDL-C (OR = 1.228; p = 0.044), rather than low HDL-C (OR = 1.171; p = 0.057) and high triglyceride (TG) (OR = 1.110; p = 0.141). In conclusion, adults with BMI ≥ 25 kg/m² and who experience snoring, especially moderate, strong, and very strong intensity levels of snoring, should be on the alert regarding the possibility of dyslipidemia, especially high LDL-C and high TC.

Sleep disordered breathing (SDB) experiences associated with snoring in adult Nigerians.

PubMed

Sogebi, O A; Oyewole, E A; Olusoga-Peters, O O

2011-09-01

Snorers often experience symptoms of sleep disordered breathing (SDB) which is largely undiagnosed in the population. Information on SDB experiences is needed to target high-risk individuals that may benefit from treatment of snoring. This study compares the experience of the nighttime and daytime symptoms of SDB of habitual snorers with that of non-habitually snoring adult subjects in a tertiary health facility in Nigeria. A cross-sectional, comparative, hospital based study was conducted. Berlin questionnaire was administered to consecutive adult patients (subjects) attending ENT Clinic of OOUTH, Sagamu, Nigeria. Based on the responses to their experience of snoring, the subjects were categorized as habitual snorers or non-habitual snorers. General physical examinations with emphases on the nose, throat and neck were performed on the subjects. The experiences of nighttime and daytime symptoms of SDB were recorded and those of habitual snorers compared to non-habitual snorers. One hundred and ninety- five subjects participated in the study. M:F =1.3:1. Overall prevalence of snoring was 37.9% and habitual snoring was 18.5%. Habitual snoring was significantly associated with age, marital status and obesity (BMI>=30.0). There were statistically significant increased odds of experiencing the nighttime and daytime symptoms of SDB in habitual snorers compared to non-habitual snorers. Adults that snore habitually had significantly more nighttime and daytime symptoms of SDB compared to those who do not snore habitually. Habitual snoring predisposes adult subjects to experiencing symptoms of SDB.

Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy.

PubMed

Qiu, Chunfang; Lawrence, Wayne; Gelaye, Bizu; Stoner, Lee; Frederick, Ihunnaya O; Enquobahrie, Daniel A; Sorensen, Tanya K; Williams, Michelle A

2017-01-01

Obstructive sleep apnea (OSA) or habitual snoring is known to be associated with impaired glucose tolerance and type 2 diabetes among both men and non-pregnant women. We examined the association of habitual snoring during early pregnancy with risk of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM). A cohort of 1,579 women was interviewed during early pregnancy. We collected information about snoring frequency during early pregnancy. Results from screening and diagnostic tests for IGT and GDM were abstracted from medical records. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of IGT and GDM associated with snoring in early pregnancy. Overall, women who snored "most or all of the time" had a 2.1-fold increased odds of IGT (OR 2.10; 95% CI 1.31-3.35) and a 2.5-fold increased odds of GDM (OR 2.50; 95% CI 1.34-4.67) as compared with women who never snored. Compared with lean women (pre-pregnancy body mass index (BMI) <25 kg/m2) who did not snore, lean snorers had a 2-fold increased odds of GDM (OR = 1.99, 95% CI: 1.07-3.68). The odds of GDM risk was particularly elevated among overweight women (BMI ≥ 25 kg/m2) who snored (OR = 5.01; 95% CI 2.71-9.26). However, there was no evidence of an interaction between overweight and snoring with GDM risk (p-value = 0.144). These findings, if confirmed, may have important implications for tailoring prenatal care for overweight pregnant women, and /or those with a history of habitual snoring in early pregnancy.

Single-stage CO2 laser assisted uvuloplasty for treatment of snoring and mild obstructive sleep apnoea.

PubMed

Herford, A S; Finn, R

2000-08-01

The purpose of this study was to describe a single-stage laser assisted uvuloplasty (uvulectomy) and to determine its effectiveness in treatment of snoring and mild obstructive sleep apnoea (OSA). All patients treated with laser assisted uvuloplasty in a 49-month period for snoring and/or mild OSA were studied. Frequency of snoring before and after surgery, loudness of snoring and postoperative discomfort were investigated. Patients were asked to evaluate change in daytime energy, sleep habits, missed days of work and also overall satisfaction following laser assisted uvuloplasty. Thirty patients underwent a single-stage laser assisted uvuloplasty. A preoperative diagnosis of OSA was established in 19 patients, the remaining 11 patients were treated for snoring. There were no complications and only one patient required an additional stage. A questionnaire was completed by 18 patients (10 patients diagnosed with sleep apnoea, and eight patients with snoring only). Preoperatively the frequency of snoring averaged 9.3 cm on a visual analogue scale. Postoperatively there were 12 patients with either none or very minimal snoring and six patients who had an average score of 3.2. Loudness of snoring also decreased from an average of 5.4 to 2.5 cm. Postoperative discomfort averaged 1.1 cm. Improvement in sleep was noted by 16 patients and improved daytime energy was noted by 17 patients. Eleven patients reported that they missed at least one day of work postoperatively with an average of 3 days missed. Patient satisfaction was reported by 17 patients with only one stating that he was unsatisfied with the procedure. Laser-assisted uvuloplasty (uvulectomy) is an effective surgical procedure for treatment of snoring and some types of OSA. A single-stage procedure appears to be effective and may further decrease the morbidity associated with this disease.

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.

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

Code of Federal Regulations, 2013 CFR

2013-04-01

... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air...

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

Code of Federal Regulations, 2012 CFR

2012-04-01

... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air...

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

Code of Federal Regulations, 2011 CFR

2011-04-01

... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air...

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

Code of Federal Regulations, 2014 CFR

2014-04-01

... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air...

Habitual snoring in school-aged children: environmental and biological predictors.

PubMed

Li, Shenghui; Jin, Xinming; Yan, Chonghuai; Wu, Shenghu; Jiang, Fan; Shen, Xiaoming

2010-10-19

Habitual snoring, a prominent symptom of sleep-disordered breathing, is an important indicator for a number of health problems in children. Compared to adults, large epidemiological studies on childhood habitual snoring and associated predisposing factors are extremely scarce. The present study aimed to assess the prevalence and associated factors of habitual snoring among Chinese school-aged children. A random sample of 20,152 children aged 5.08 to 11.99 years old participated in a cross-sectional survey, which was conducted in eight cities of China. Parent-administrated questionnaires were used to collect information on children's snoring frequency and the possible correlates. The prevalence of habitual snoring was 12.0% (14.5% for boys vs. 9.5% for girls) in our sampled children. Following factors were associated with an increased risk for habitual snoring: lower family income (adjusted odds ratio [OR] = 1.46), lower father's education (OR = 1.38 and 1.14 for middle school or under and high school of educational level, respectively), breastfeeding duration < 6 months (OR = 1.17), pregnancy maternal smoking (OR = 1.51), obesity (OR = 1.50), overweight (OR = 1.35), several respiratory problems associated with atopy and infection, such as chronic/allergic rhinitis (OR = 1.94), asthma (OR = 1.43), adenotonsillar hypertrophy (OR = 2.17), and chronic otitis media (OR = 1.31), and family history of habitual snoring (OR = 1.70). The prevalence of habitual snoring in Chinese children was similar to that observed in other countries. The potential predisposing factors covered socioeconomic characteristics, environmental exposures, chronic health problems, and family susceptibility. Compared to socioeconomic status and family susceptibility, environmental exposures and chronic health problems had greater impact, indicating childhood habitual snoring could be partly prevented by health promotion and environmental intervention.

Snoring intensity after a first session of soft palate radiofrequency: predictive value of the final result.

PubMed

Blumen, Marc Bernard; Vezina, Jean Philippe; Bequignon, Emilie; Chabolle, Frederic

2013-06-01

To determine whether snoring sound intensity measured after a first soft palate radiofrequency (RF) session for simple snoring helps predict the final result of the treatment. Observational retrospective study. We conducted a retrospective review of 105 subjects presenting with simple snoring or mild sleep apnea. All patients underwent two to three sessions of RF-assisted stiffening of the soft palate. In addition, uvulectomy was performed in case of a long uvula, and two paramedian trenches were created in the presence of palatal webbing. Snoring sound intensity was evaluated by the bed partner after each session. Eighty-six men and 19 women were included in the study. Mean age was 51.7 ± 9.8 years, and mean body mass index was 24.7 ± 4.4 kg/m(2) . The mean apnea/hypopnea index was 6.6 ± 4.2/h. The mean snoring sound intensity, as evaluated on a 10-cm visual analog scale (VAS), decreased from 8.2 ± 1.5 to 3.5 ± 2.2 after all sessions (P < .0001). A score of 3 was determined as being a score that satisfied the bed partner. Two groups were formed according to the final snoring sound intensity, using 3 as a threshold. Both groups had similar preoperative characteristics, but the snoring sound intensity was significantly lower after the first session in the group with final score <3 (P = .01). Similarly, a VAS score >7 after the first session was associated with a final score <3 in 30% of the cases. Snoring sound intensity after the first RF session helps predict the final outcome of RF-assisted stiffening of the soft palate for simple snoring. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

Unconstrained snoring detection using a smartphone during ordinary sleep.

PubMed

Shin, Hangsik; Cho, Jaegeol

2014-08-15

Snoring can be a representative symptom of a sleep disorder, and thus snoring detection is quite important to improving the quality of an individual's daily life. The purpose of this research is to develop an unconstrained snoring detection technique that can be integrated into a smartphone application. In contrast with previous studies, we developed a practical technique for snoring detection during ordinary sleep by using the built-in sound recording system of a smartphone, and the recording was carried out in a standard private bedroom. The experimental protocol was designed to include a variety of actions that frequently produce noise (including coughing, playing music, talking, rining an alarm, opening/closing doors, running a fan, playing the radio, and walking) in order to accurately recreate the actual circumstances during sleep. The sound data were recorded for 10 individuals during actual sleep. In total, 44 snoring data sets and 75 noise datasets were acquired. The algorithm uses formant analysis to examine sound features according to the frequency and magnitude. Then, a quadratic classifier is used to distinguish snoring from non-snoring noises. Ten-fold cross validation was used to evaluate the developed snoring detection methods, and validation was repeated 100 times randomly to improve statistical effectiveness. The overall results showed that the proposed method is competitive with those from previous research. The proposed method presented 95.07% accuracy, 98.58% sensitivity, 94.62% specificity, and 70.38% positive predictivity. Though there was a relatively high false positive rate, the results show the possibility for ubiquitous personal snoring detection through a smartphone application that takes into account data from normally occurring noises without training using preexisting data.

Treatment Options for Adults with Snoring

MedlinePlus

... entnet.org . Snoring is a sound produced by vibration of the soft tissues of the upper airway ... in stiffening of the palate, and subsequently, less vibration and flutter that causes snoring. Potential benefits of ...

Does Snoring Intensity Correlate with the Severity of Obstructive Sleep Apnea?

PubMed Central

Maimon, Nimrod; Hanly, Patrick J.

2010-01-01

Study Objectives: It is commonly believed that louder snoring is associated with more severe obstructive sleep apnea (OSA). We evaluated the association between snoring intensity and the severity of OSA to better understand this clinical correlation. We also investigated the relationships between body mass index (BMI), neck size, sleep stage, and body position with the intensity of snoring. Methods: Overnight polysomnography, including objective measurement of snoring intensity, in 1643 habitual snorers referred for evaluation of sleep apnea. Results: Sixty-five percent of patients were male; the cohort had a mean age of 48.7 ± 13.7 y and BMI of 30.9 ± 8.8 kg/m2. The mean apnea-hypopnea index (AHI) was 28.2 ± 26. The severity of OSA was graded as no OSA (AHI < 5), mild (AHI 5 to 15), moderate (AHI 15 to 30), severe (AHI 30 to 50), and very severe OSA (AHI > 50). Snoring intensity increased progressively across all 5 categories of AHI frequency and ranged from 46.3 ± 3.6 db in patients with AHI < 5 to 60.5 ± 6.4 db in those with AHI > 50. Furthermore, there was a positive correlation between the intensity of snoring and the AHI (r = 0.66, p < 0.01). Conclusions: The intensity of snoring increases as OSA becomes more severe. Citation: Maimon N; Hanly PJ. Does snoring intensity correlate with the severity of obstructive sleep apnea? J Clin Sleep Med 2010;6(5):475-478. PMID:20957849

Preliminary study for the personal handheld device based snoring detection in ordinary sleep situation.

PubMed

Shin, Hangsik; Choi, Wangrim; Kim, Yi-gon; Cho, Jaegeol

2014-01-01

Snoring is one of the representative phenomena of the sleep disorder and detection of snoring is quite important for improving quality of daily human life. The purpose of this research is to define the noises of the ordinary sleep situation and to find its characteristics as a preliminary research of snoring detection. Differently from previous snoring researches, we use a built-in sound recording system of Smartphone for practical use in ordinary sleep condition, and recording was carried out in a general private bedroom. Especially, we designed the experimental protocol, including the various noises could be frequently occurred during sleep such as cough, music, talking, alarm, door open/close, fan, radio and footstep to make closer to the actual sleep circumstance. The sound data set was recorded during actual sleep from 10 normal subjects. Totally 44 snoring data set and 75-noise dataset is acquired and analyzed.

Comparison of snoring sounds between natural and drug-induced sleep recorded using a smartphone.

PubMed

Koo, Soo Kweon; Kwon, Soon Bok; Moon, Ji Seung; Lee, Sang Hoon; Lee, Ho Byung; Lee, Sang Jun

2018-08-01

Snoring is an important clinical feature of obstructive sleep apnea (OSA), and recent studies suggest that the acoustic quality of snoring sounds is markedly different in drug-induced sleep compared with natural sleep. However, considering differences in sound recording methods and analysis parameters, further studies are required. This study explored whether acoustic analysis of drug-induced sleep is useful as a screening test that reflects the characteristics of natural sleep in snoring patients. The snoring sounds of 30 male subjects (mean age=41.8years) were recorded using a smartphone during natural and induced sleep, with the site of vibration noted during drug-induced sleep endoscopy (DISE); then, we compared the sound intensity (dB), formant frequencies, and spectrograms of snoring sounds. Regarding the intensity of snoring sounds, there were minor differences within the retrolingual level obstruction group, but there was no significant difference between natural and induced sleep at either obstruction site. There was no significant difference in the F 1 and F 2 formant frequencies of snoring sounds between natural sleep and induced sleep at either obstruction site. Compared with natural sleep, induced sleep was slightly more irregular, with a stronger intensity on the spectrogram, but the spectrograms showed the same pattern at both obstruction sites. Although further studies are required, the spectrograms and formant frequencies of the snoring sounds of induced sleep did not differ significantly from those of natural sleep, and may be used as a screening test that reflects the characteristics of natural sleep according to the obstruction site. Copyright © 2017 Elsevier B.V. All rights reserved.

Snoring classified: The Munich-Passau Snore Sound Corpus.

PubMed

Janott, Christoph; Schmitt, Maximilian; Zhang, Yue; Qian, Kun; Pandit, Vedhas; Zhang, Zixing; Heiser, Clemens; Hohenhorst, Winfried; Herzog, Michael; Hemmert, Werner; Schuller, Björn

2018-03-01

Snoring can be excited in different locations within the upper airways during sleep. It was hypothesised that the excitation locations are correlated with distinct acoustic characteristics of the snoring noise. To verify this hypothesis, a database of snore sounds is developed, labelled with the location of sound excitation. Video and audio recordings taken during drug induced sleep endoscopy (DISE) examinations from three medical centres have been semi-automatically screened for snore events, which subsequently have been classified by ENT experts into four classes based on the VOTE classification. The resulting dataset containing 828 snore events from 219 subjects has been split into Train, Development, and Test sets. An SVM classifier has been trained using low level descriptors (LLDs) related to energy, spectral features, mel frequency cepstral coefficients (MFCC), formants, voicing, harmonic-to-noise ratio (HNR), spectral harmonicity, pitch, and microprosodic features. An unweighted average recall (UAR) of 55.8% could be achieved using the full set of LLDs including formants. Best performing subset is the MFCC-related set of LLDs. A strong difference in performance could be observed between the permutations of train, development, and test partition, which may be caused by the relatively low number of subjects included in the smaller classes of the strongly unbalanced data set. A database of snoring sounds is presented which are classified according to their sound excitation location based on objective criteria and verifiable video material. With the database, it could be demonstrated that machine classifiers can distinguish different excitation location of snoring sounds in the upper airway based on acoustic parameters. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cardiorespiratory and autonomic interactions during snoring related resistive breathing.

PubMed

Mateika, J H; Mitru, G

2001-03-15

We hypothesized that blood pressure (BP) is less during snoring as compared to periods of non-snoring in non-apneic individuals. Furthermore, we hypothesized that this reduction may be accompanied by a simultaneous decrease in sympathetic (SNSA) and parasympathetic (PNSA) nervous system activity and an increase in heart rate (HR). N/A. N/A. N/A. The variables mentioned above in addition to breathing frequency were measured in 9 subjects during NREM sleep. In addition, the lowest systolic (SBP) and diastolic blood pressure (DBP) during inspiration and the highest SBP and DBP during expiration was determined breath-by-breath from segments selected from each NREM cycle. Heart rate variability was used as a marker of autonomic nervous system activity. Our results showed that BP during snoring decreased compared to non-snoring and the breath-by-breath BP analysis suggested that this difference may have been mediated by changes in intrathoracic pressure. In conjunction with the decrease in BP, SNSA decreased and HR increased however PNSA remained constant. Thus, a decrease in PNSA was likely not the primary mechanism responsible for the HR response. We conclude that BP responses and SNSA during snoring are similar to that reported previously in non-snoring individuals. However, the causal mechanisms maybe different and manifested in other measures such as HR. Thus, nocturnal cardiovascular and autonomic function maybe uniquely different in non-apneic snoring individuals.

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

Synchronized imaging and acoustic analysis of the upper airway in patients with sleep-disordered breathing.

PubMed

Chang, Yi-Chung; Huon, Leh-Kiong; Pham, Van-Truong; Chen, Yunn-Jy; Jiang, Sun-Fen; Shih, Tiffany Ting-Fang; Tran, Thi-Thao; Wang, Yung-Hung; Lin, Chen; Tsao, Jenho; Lo, Men-Tzung; Wang, Pa-Chun

2014-12-01

Progressive narrowing of the upper airway increases airflow resistance and can produce snoring sounds and apnea/hypopnea events associated with sleep-disordered breathing due to airway collapse. Recent studies have shown that acoustic properties during snoring can be altered with anatomic changes at the site of obstruction. To evaluate the instantaneous association between acoustic features of snoring and the anatomic sites of obstruction, a novel method was developed and applied in nine patients to extract the snoring sounds during sleep while performing dynamic magnetic resonance imaging (MRI). The degree of airway narrowing during the snoring events was then quantified by the collapse index (ratio of airway diameter preceding and during the events) and correlated with the synchronized acoustic features. A total of 201 snoring events (102 pure retropalatal and 99 combined retropalatal and retroglossal events) were recorded, and the collapse index as well as the soft tissue vibration time were significantly different between pure retropalatal (collapse index, 2 ± 11%; vibration time, 0.2 ± 0.3 s) and combined (retropalatal and retroglossal) snores (collapse index, 13 ± 7% [P ≤ 0.0001]; vibration time, 1.2 ± 0.7 s [P ≤ 0.0001]). The synchronized dynamic MRI and acoustic recordings successfully characterized the sites of obstruction and established the dynamic relationship between the anatomic site of obstruction and snoring acoustics.

Association between Self-reported Snoring and Prediabetes among Adults Aged 40 Years and Older without Diabetes.

PubMed

Wang, Hai-Bin; Yan, Wen-Hua; Dou, Jing-Tao; Lu, Zhao-Hui; Wang, Bao-An; Mu, Yi-Ming

2017-04-05

Several previous studies have shown that snoring is associated with glucose metabolism and the development of diabetes, but rare study has shown the association between snoring frequency and prediabetes, particularly in China. We hypothesized that individuals who snore might have a higher risk of prediabetes. This study aimed to investigate the association between self-reported snoring and prediabetes in a Chinese population. A cross-sectional study was performed in three large communities of Beijing from December 2011 to August 2012 by recruiting individuals aged ≥40 years old. All participants were requested to complete a detailed questionnaire and undergo anthropometric measurements. A 75 g oral glucose tolerance test was performed in individuals without diabetes. Blood samples of all participants were collected; blood glucose and blood fat levels were measured. Multivariate logistic regression models were built to assess the association between snoring frequency and prediabetes. A total of 13,592 participants (female: 66.56%; mean age: 56.8 ± 7.9 years; mean body mass index: 25.5 ± 3.4 kg/m2) were included in the final analysis. Of these, 30.9% were diagnosed with prediabetes, while 41.3% and 25.4% had occasional and habitual snoring, respectively. Habitual snoring was associated with an increased risk of prediabetes (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1-1.4, P< 0.001), after adjusting for diabetes and sleep-related confounders in the multivariable models. Habitual snoring was also associated with isolated impaired fasting glucose (IFG; OR: 1.3, 95% CI: 1.0-1.6; P< 0.001) and isolated impaired glucose tolerance (IGT; OR: 1.3, 95% CI: 1.2-1.5; P< 0.001), but not IFG + IGT (OR: 1.1, 95% CI: 0.9-1.4; P = 0.281). When stratified by total cholesterol (TC) levels, this association between habitual snoring and prediabetes was observed only in individuals with TC <5.6 mmol/L (OR: 1.4, 95% CI: 1.2-1.6; P< 0.001). Habitual snoring is associated with prediabetes, but only in individuals with TC <5.6 mmol/L. Further prospective studies are needed to confirm this finding.

The Efficacy of Low-Level Continuous Positive Airway Pressure for the Treatment of Snoring

PubMed Central

Guzman, Michelle A.; Sgambati, Francis P.; Pho, Huy; Arias, Rafael S.; Hawks, Erin M.; Wolfe, Erica M.; Ötvös, Tamás; Rosenberg, Russell; Dakheel, Riad; Schneider, Hartmut; Kirkness, Jason P.; Smith, Philip L.; Schwartz, Alan R.

2017-01-01

Study Objectives: To assess effects of low-level continuous positive airway pressure (CPAP) on snoring in habitual snorers without obstructive sleep apnea (OSA). Methods: A multicenter prospective in-laboratory reversal crossover intervention trial was conducted between September 2013 and August 2014. Habitual snorers were included if they snored (inspiratory sound pressure level ≥ 40 dBA) for ≥ 30% all sleep breaths on a baseline sleep study (Night 1), and if significant OSA and daytime somnolence were absent. Included participants then underwent a CPAP titration study at 2, 4, or 6 cm H2O (Night 2) to examine snoring responses to step-increases in nasal pressure, a treatment night at optimal pressure (Night 3), followed by baseline night (Night 4). At each pressure, snoring intensity was measured on each breath. Snoring frequency was quantified as a percentage of sleep breaths at thresholds of 40, 45, 50, and 55 dBA. Sleep architecture and OSA severity were characterized using standard measurements. Results: On baseline sleep studies, participants demonstrated snoring at ≥ 40 dBA on 53 ± 3% and ≥ 45 dBA on 35 ± 4% of breaths. Snoring frequency decreased progressively as nasal pressure increased from 0 to 4 cm H2O at each threshold, and plateaued thereafter. CPAP decreased snoring frequency by 67% and 85% at 40 and 45 dBA, respectively. Intervention did not alter sleep architecture and sleep apnea decreased minimally. Conclusions: Low-level CPAP below the range required to treat OSA diminished nocturnal snoring, and produced uniform reduction in nightly noise production below the World Health Organization's limit of 45 dBA. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT01949584. Citation: Guzman MA, Sgambati FP, Pho H, Arias RS, Hawks EM, Wolfe EM, Ötvös T, Rosenberg R, Dakheel R, Schneider H, Kirkness JP, Smith PL, Schwartz AR. The efficacy of low-level continuous positive airway pressure for the treatment of snoring. J Clin Sleep Med. 2017;13(5):703–711. PMID:28356182

[Treatment of simple snoring by radiofrequency velar coblation].

PubMed

Pessey, J-J; Rose, X; Michenet, F; Calmels, M-N; Lagleyre, S

2005-02-01

Short- and long-term evaluation of the efficacy and safety of radiofrequency velar coblation for simple snoring. From February 2000 to May 2004, 175 patients underwent a single radiofrequency session for velar coblation. All patients suffered from snoring without sleep apnea. They presented modifications of the velo-pharyngeal region but did not have tonsillar or basilingual hypertrophy. Outcome was assessed in terms of pain, changes in snoring, secondary effects and complications at three months and one, two, and three years. Secondary uvulectomy was performed in 28 patients. At three months, snoring had decreased in 82% of patients with complete resolution in 12%. Outcome remained unchanged in 70% of patients at one, two, and three years. After uvulectomy, snoring declined in 96% of patients with complete resolution in 48%. Post-treatment pain lasted less than five days in 68% of patients. Mean duration was three days. Fifteen patients developed pharyngeal paresthesia which regressed at one year. Two patients had a nasal voice and three developed necrosis of the uvula. Velar coblation is a simple treatment for snoring which can be performed in a single session. The best results are achieved in patients whose body mass index is below 25 and after secondary uvulectomy.

Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight.

PubMed

Misiolek, M; Marek, B; Namyslowski, G; Scierski, W; Zwirska-Korczala, K; Kazmierczak-Zagorska, Z; Kajdaniuk, D; Misiolek, H

2007-03-01

The relation between snoring and obstructive sleep apnea as well as hypothyroidism is the object of interest of many authors. The respiratory disturbances during sleep are often observed in patients suffering from hypothyroidism. The relation of snoring to overweight in those patients has not been taken into account. The aim of the study was to evaluate the relations between hypothyroidism and quantitative and qualitative respiratory disturbances during sleep. Additional aim was to establish the relations of sleep apnea syndrome, snoring, hypothyroidism and overweight. The subjects included 15 patients (11 females and 4 males) aged from 28 to 73 (mean 50.3) suffering from hypothyroidism. All of them underwent thyroid testing before and after the hormonal treatment. TSH and fT4 concentrations were determined. At the same time the sleep assessment (PolyMESAM) was performed twice. Data were obtained from sleep studies and questionnaires (Epworth sleepiness scale). After the thyroid hormones stabilization significant decrease of snoring severity was observed. On the contrary, the respiratory disturbance index (RDI), desaturation index (DI), the lowest saturation (LSAT) did not change significantly, however, the Epworth scale score showed significant improvement. The correlations showed the strong relation between loud snoring and TSH (r=0.73, p<0.01) and fT4 (r=-0.66, p<0.003) concentrations before the treatment. The analysis showed no correlation between body mass (BMI) and snoring. The hormonal stabilization in patients suffering from hypothyroidism causes improvement in snoring severity. Based on our investigation the relationship between hypothyroidism and severity of snoring and excessive daytime somnolence was confirmed. It indicates a possible connection between hypothyroidism and upper airway resistance syndrome.

Snoring and its management.

PubMed

Calhoun, Karen H; Templer, Jerry; Patenaude, Bart

2006-01-01

There are numerous strategies, devices and procedures available to treat snoring. The surgical procedures have an overall success rate of 60-70%, but this probably decreases over time, especially if there is weight gain. There are no long-term rigorously-designed studies comparing the various procedures for decreasing snoring.

Maternal Snoring May Predict Adverse Pregnancy Outcomes: A Cohort Study in China.

PubMed

Ge, Xing; Tao, Fangbiao; Huang, Kun; Mao, Leijing; Huang, Sanhuan; Niu, Ying; Hao, Jiahu; Sun, Yanli; Rutayisire, Erigene

2016-01-01

To examine the prevalence of snoring during pregnancy and its effects on key pregnancy outcomes. Pregnant women were consecutively recruited in their first trimester. Habitual snoring was screened by using a questionnaire in the 1st and 3rd trimester, respectively. According to the time of snoring, participants were divided into pregnancy onset snorers, chronic snorers and non-snorers. Logistic regressions were performed to examine the associations between snoring and pregnancy outcomes. Of 3 079 pregnant women, 16.6% were habitual snorers, with 11.7% were pregnancy onset snorers and 4.9% were chronic snorers. After adjusting for potential confounders, chronic snorers were independently associated with gestational diabetes mellitus (GDM) (RR 1.66, 95%CI 1.09-2.53). Both pregnancy onset and chronic snorers were independently associated with placental adhesion (RR 1.96, 95%CI 1.17-3.27, and RR 2.33, 95%CI 1.22-4.46, respectively). Pregnancy onset snorers were at higher risk of caesarean delivery (RR 1.37, 95%CI 1.09-1.73) and having macrosomia (RR 1.54, 95%CI 1.05-2.27) and large for gestational age (LGA) (RR 1.71, 95%CI 1.31-2.24) infants. In addition, being overweight or obese before pregnancy plays an important role in mediating snoring and adverse pregnancy outcomes. Maternal snoring may increase the risk of adverse pregnancy outcomes, and being overweight or obese before pregnancy with snoring is remarkable for researchers. Further studies are still needed to confirm our results.

Snoring during early childhood and academic performance at ages thirteen to fourteen years.

PubMed

Gozal, D; Pope, D W

2001-06-01

Obstructive sleep apnea syndrome in young children is associated with an adverse effect on learning. However, the long-term impact of sleep-disordered breathing (SDB) during early childhood on learning remains unknown. Questionnaires were mailed to seventh and eighth graders attending public schools whose class ranking was either in the top 25% (high performance [HP]) or bottom 25% of their class (low performance [LP]), and who were matched for age, gender, race, school, and street of residence. Snoring frequency and loudness at 2 to 6 years of age, tonsillectomy and adenoidectomy (T&A) for snoring or recurrent infection, school grades, and parental smoking and snoring were assessed. The questionnaire response rate was 82.8%. Because of ongoing ring, 13 responders were excluded, such that 1588 questionnaires could be analyzed (797 in LP and 791 in HP group). Frequent and loud snoring during early childhood was reported in 103 LP children (12.9%) compared with 40 HP children (5.1%; odds ratio: 2.79; confidence interval: 1.88-4.15). Furthermore, 24 LP and 7 HP children underwent T&A for snoring (odds ratio: 3.40; confidence interval: 1.47-7.84), while 21 LP and 19 HP children required surgery for recurrent tonsillitis. Children with lower academic performance in middle school are more likely to have snored during early childhood and to require T&A for snoring compared with better performing schoolmates. These findings support the concept that SDB-associated neurocognitive morbidity may be only partially reversible or that a "learning debt" may develop with SDB during early childhood and hamper subsequent school performance.

Maternal Snoring May Predict Adverse Pregnancy Outcomes: A Cohort Study in China

PubMed Central

Ge, Xing; Tao, Fangbiao

2016-01-01

Objective To examine the prevalence of snoring during pregnancy and its effects on key pregnancy outcomes. Methods Pregnant women were consecutively recruited in their first trimester. Habitual snoring was screened by using a questionnaire in the 1st and 3rd trimester, respectively. According to the time of snoring, participants were divided into pregnancy onset snorers, chronic snorers and non-snorers. Logistic regressions were performed to examine the associations between snoring and pregnancy outcomes. Results Of 3 079 pregnant women, 16.6% were habitual snorers, with 11.7% were pregnancy onset snorers and 4.9% were chronic snorers. After adjusting for potential confounders, chronic snorers were independently associated with gestational diabetes mellitus (GDM) (RR 1.66, 95%CI 1.09–2.53). Both pregnancy onset and chronic snorers were independently associated with placental adhesion (RR 1.96, 95%CI 1.17–3.27, and RR 2.33, 95%CI 1.22–4.46, respectively). Pregnancy onset snorers were at higher risk of caesarean delivery (RR 1.37, 95%CI 1.09–1.73) and having macrosomia (RR 1.54, 95%CI 1.05–2.27) and large for gestational age (LGA) (RR 1.71, 95%CI 1.31–2.24) infants. In addition, being overweight or obese before pregnancy plays an important role in mediating snoring and adverse pregnancy outcomes. Conclusions Maternal snoring may increase the risk of adverse pregnancy outcomes, and being overweight or obese before pregnancy with snoring is remarkable for researchers. Further studies are still needed to confirm our results. PMID:26871434

Monitoring sound to quantify snoring and sleep apnea severity using a smartphone: proof of concept.

PubMed

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

2014-01-15

Habitual snoring is a prevalent condition that is not only a marker of obstructive sleep apnea (OSA) but can also lead to vascular risk. However, it is not easy to check snoring status at home. We attempted to develop a snoring sound monitor consisting of a smartphone alone, which is aimed to quantify snoring and OSA severity. The subjects included 50 patients who underwent diagnostic polysomnography (PSG), of which the data of 10 patients were used for developing the program and that of 40 patients were used for validating the program. A smartphone was attached to the anterior chest wall over the sternum. It acquired ambient sound from the built-in microphone and analyzed it using a fast Fourier transform on a real-time basis. Snoring time measured by the smartphone highly correlated with snoring time measured by PSG (r = 0.93). The top 1 percentile value of sound pressure level (L1) determined by the smartphone correlated with the ambient sound L1 during sleep determined by PSG (r = 0.92). Moreover, the respiratory disturbance index estimated by the smartphone (smart-RDI) highly correlated with the apnea-hypopnea index (AHI) obtained by PSG (r = 0.94). The diagnostic sensitivity and specificity of the smart-RDI for diagnosing OSA (AHI ≥ 15) were 0.70 and 0.94, respectively. A smartphone can be used for effectively monitoring snoring and OSA in a controlled laboratory setting. Use of this technology in a noisy home environment remains unproven, and further investigation is needed.

Uvulectomy in the office setting.

PubMed

Ariyasu, L; Young, G; Spinelli, F

1995-10-01

Snoring is a common problem which affects 50% of male and 30% of female patients. In a small number of patients, partial uvulopalatoplasty in the office setting has been found to ameliorate loud snoring. In our study, 28 patients had uvulectomy for snoring, 17 of whom responded to our survey. The procedure was somewhat beneficial (rated 3.2 on a scale of 10, with 10 representing no snoring) and had little impact on quality of life (rated 2.7 on a scale of 10, with 10 representing great improvement). After the procedure patients had considerable pain (rated 7.4 on a scale of 10, with 10 representing excruciating pain) which lasted > 10 days in 35% and led to a mean of 2.9 missed work days. There were no complications. Fourteen of 17 patients wanted additional treatment to reduce snoring.

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

PubMed Central

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

2014-01-01

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

[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.

Mucosal-strip/uvulectomy by the CO2 laser as a method of treating simple snoring.

PubMed

Morar, P; Nandapalan, V; Lesser, T H; Swift, A C

1995-08-01

The effect of stiffening the soft palate by inducing scarring after removing a central strip of mucosa with a CO2 laser was investigated in 25 heavy snorers. The results were assessed using a series of Visual Analogue Score (VAS) assessment questionnaires completed by the partner over a period of 6 months. Of the 22 patients who had the laser-strip and uvulectomy, snoring improved in 18 (82%) (median improvement of 75% at 3 months). Four patients did not improve. Between 3 and 6 months, snoring increased in one patient and decreased in four (< 10% change on VAS). Snoring did not improve in the three patients who did not undergo uvulectomy. We conclude that the laser-strip/uvulectomy can reduce snoring to a tolerable level in eight out of 10 heavy snorers, but the procedure is painful for several days.

Self-reported snoring frequency and incidence of cardiovascular disease: the Circulatory Risk in Communities Study (CIRCS).

PubMed

Nagayoshi, Mako; Tanigawa, Takeshi; Yamagishi, Kazumasa; Sakurai, Susumu; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Maeda, Kenji; Ohira, Tetsuya; Imano, Hironori; Sato, Shinichi; Iso, Hiroyasu

2012-01-01

Although associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese. The subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke. During the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4-2.0) for sometimes snoring and 2.5 (1.0-6.1) for everyday snoring in women and 0.7 (0.3-1.3) and 1.0 (0.5-2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4-1.9) and 2.1 (0.9-5.4). Self-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association.

Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea.

PubMed

Ulfberg, J; Carter, N; Talbäck, M; Edling, C

1996-09-01

To evaluate excessive daytime sleepiness (EDS) at work and effects on reported work performance among men in the general population and male patients suffering from snoring and obstructive sleep apnea syndrome (OSAS). A cross-sectional study of Swedish men between the ages of 30 and 64 years in the county of Kopparberg, in mid-Sweden. A random sample of the general population (n = 285) and consecutive patients referred to a sleep laboratory who fulfilled objective diagnostic criteria (snorers = 289, OSAS = 62) responded to a questionnaire. Responders from the general population were divided into 2 groups, nonsnorers (n = 223) and snorers (n = 62). To validate a question on snoring in the questionnaire, 50 men, randomly selected from the sample of the general population, underwent sleep apnea screening in their homes. The specificity of the questions about snoring was 83% and the sensitivity was 42%. The risk ratios for reporting EDS at work were 4-fold for snorers in the general population, 20-fold for snoring patients, and 40-fold for patients with OSAS as compared with nonsnoring men in the general population. Patients with OSAS and snoring patients both showed increased ratios on measures of difficulties with concentration, learning new tasks, and performing monotonous tasks when compared with nonsnorers. Snoring and sleep apnea were highly associated with excessive EDS at work and subjective work performance problems. The results provide additional evidence that snoring is not merely a nuisance.

Sleep problems in children and adolescents at pediatric clinics

PubMed Central

Kim, Dong Soon; Lee, Cho Long

2017-01-01

Purpose To investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces. Methods Children (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire. Results Among patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was 4.35±3.02 years (range, 0–18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children <2 years and those between 2–5 years was 9% and 18%, respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and insomnia did not vary significantly with gender. However, snoring was more prevalent in boys. Conclusion Sleep problems are frequent among children in Korea. Children with snoring have an increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children's sleep habits to improve their health. PMID:28592979

Self-Reported Snoring Frequency and Incidence of Cardiovascular Disease: The Circulatory Risk in Communities Study (CIRCS)

PubMed Central

Nagayoshi, Mako; Tanigawa, Takeshi; Yamagishi, Kazumasa; Sakurai, Susumu; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Maeda, Kenji; Ohira, Tetsuya; Imano, Hironori; Sato, Shinichi; Iso, Hiroyasu

2012-01-01

Background Although associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese. Methods The subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke. Results During the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4–2.0) for sometimes snoring and 2.5 (1.0–6.1) for everyday snoring in women and 0.7 (0.3–1.3) and 1.0 (0.5–2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4–1.9) and 2.1 (0.9–5.4). Conclusions Self-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association. PMID:22447210

Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. American Sleep Disorders Association.

PubMed

1995-07-01

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association (ASDA), provide recommendations for the practice of sleep medicine in North American with regards to the use of oral appliances for the treatment of snoring and obstructive sleep apnea. Oral appliances have been developed for the treatment of snoring and have been applied to the treatment of obstructive sleep apnea, a syndrome associated with morbidity. Based on a review of the relevant scientific literature, the Standards of Practice Committee of the ASDA has developed guidelines describing the use of oral appliances for the treatment of snoring and obstructive sleep apnea in adults.

Age Effects on Cerebral Oxygenation and Behavior in Children with Sleep-disordered Breathing.

PubMed

Tamanyan, Knarik; Walter, Lisa M; Weichard, Aidan; Davey, Margot J; Nixon, Gillian M; Biggs, Sarah N; Horne, Rosemary S C

2018-06-01

Childhood sleep-disordered breathing ranges in severity from primary snoring to obstructive sleep apnea and is associated with behavioral and neurocognitive deficits. It remains unknown why children with primary snoring, who do not experience peripheral oxygen desaturation or sleep fragmentation, experience similar daytime deficits as those with obstructive sleep apnea or why effects are age-dependent. To examine cerebral tissue oxygenation and oxygen extraction as an explanation for daytime deficits in children with primary snoring. Children referred for suspected sleep-disordered breathing and nonsnoring control subjects underwent overnight polysomnography with near-infrared spectroscopy. Children were categorized into 3- to 6-year (n = 87) and 7- to 12-year (n = 72) old groups, and according to the obstructive apnea-hypopnea index into primary snoring (≤1 event/h), mild (>1-5 events/h), and moderate/severe obstructive sleep apnea (>5 events/h). Cognitive and behavioral performance were assessed. In the 3- to 6-year group, there were no differences in cerebral oxygenation or oxygen extraction between severity groups. In the 7- to 12-year group, cerebral oxygenation was significantly lower, although these differences were small, in control subjects versus primary snoring during quiet wakefulness before sleep onset, N1, and REM. Oxygen extraction was significantly higher in control subjects versus primary snoring during N1 sleep, with no differences between primary snoring and obstructive sleep apnea groups. Cerebral oxygenation was not associated with cognitive performance in either age group or behavior in the 3- to 6-year group; however, it was associated with behavior in the school-aged children. Children with sleep-disordered breathing are able to maintain cerebral oxygenation, and the small changes observed are not related to cognitive deficits. However, in older children these differences were related to behavioral measures.

Snoring-Induced Vibratory Angioedema

PubMed Central

Kalathoor, Ipe

2015-01-01

Patient: Female, 70 Final Diagnosis: Snoring induced vibratory angioedema Symptoms: Swelling of tongue • roof of mouth and throat • multiple episodes at night Medication: — Clinical Procedure: Continuous positive airway pressure therapy Specialty: Allergology Objective: Rare disease Background: Vibratory angioedema (VA) is a rare physical urticaria, with symptoms of itching and swelling of the skin or mucosa when it is exposed to vibration. Avoidance of vibration is the best way to manage this condition. This case report will assist physicians to diagnose this rare condition. Here, a previously unpublished potential successful treatment modality is being presented, with good symptom control, along with some photographs taken during an acute attack. A literature review points towards potential undiagnosed cases. Case Report: A 70-year-old woman had multiple emergency department visits for tongue and throat swelling over 3 years. The episodes always happened at night. Detailed history elicited some episodes of itching and swelling of hands when driving as well as significant snoring while sleeping. Physical examination was unremarkable except for morbid obesity. Complement factor 4 and C1esterase inhibitor level were within normal limits. A tentative diagnosis of angioedema induced by oropharyngeal vibration from snoring was made. A sleep study confirmed sleep apnea with severe snoring. After CPAP (continuous positive airway pressure) treatment, she had successful symptom control. Conclusions: Snoring-induced VA is very likely an under-diagnosed condition in the community. The typical history is the key to the diagnosis. This condition could be confirmed by vibration test or by the resolution of symptoms with elimination of vibration. Effective symptom control is possible by avoidance of oropharyngeal vibration from snoring with the administration of CPAP therapy, making it a potential novel indication for this condition. PMID:26437464

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

PubMed

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

2017-03-01

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

Hypertension, Snoring, and Obstructive Sleep Apnea During Pregnancy: A Cohort Study

PubMed Central

O’Brien, Louise M.; Bullough, Alexandra S.; Chames, Mark C.; Shelgikar, Anita V.; Armitage, Roseanne; Guilleminualt, Christian; Sullivan, Colin E.; Johnson, Timothy R. B.; Chervin, Ronald D.

2014-01-01

Objective To assess the frequency of obstructive sleep apnea among women with and without hypertensive disorders of pregnancy. Design Cohort study. Setting Obstetric clinics at an academic medical center. Population Pregnant women with hypertensive disorders (chronic hypertension, gestational hypertension, or pre-eclampsia) and normotensive women. Methods Women completed a questionnaire about habitual snoring and underwent overnight ambulatory polysomnography. Main Outcome Measures The presence and severity of obstructive sleep apnea. Results Obstructive sleep apnoea was found among 21 of 51 women with hypertensive disorders (41%), but in only three of 16 women who were normotensive (19%, chi-square test, P = 0.005). Non-snoring hypertensive women typically had mild obstructive sleep apnea but >25% of snoring hypertensive women had moderate-to-severe obstructive sleep apnea. Among the hypertensive women, the mean apnea/hypopnea index was substantially higher in snorers than non-snorers (19.9±34.1 vs. 3.4±3.1, p=0.013) and the oxyhemoglobin saturation nadir was significantly lower (86.4±6.6 vs. 90.2±3.5, p=0.021). Among hypertensive women, after stratification by obesity the pooled relative risk for obstructive sleep apnea in snoring women with hypertension compared to non-snoring hypertension was 2.0 [95%CI 1.4–2.8]. Conclusions Pregnant women with hypertension are at high risk for unrecognised obstructive sleep apnea. While longitudinal and intervention studies are urgently needed, it would seem pertinent given the known relationship between obstructive sleep apnea and hypertension in the general population, that hypertensive pregnant women who snore should be tested for obstructive sleep apnea, a condition believed to cause or promote hypertension. PMID:24888772

Hypertension, snoring, and obstructive sleep apnoea during pregnancy: a cohort study.

PubMed

O'Brien, L M; Bullough, A S; Chames, M C; Shelgikar, A V; Armitage, R; Guilleminualt, C; Sullivan, C E; Johnson, T R B; Chervin, R D

2014-12-01

To assess the frequency of obstructive sleep apnoea among women with and without hypertensive disorders of pregnancy. Cohort study. Obstetric clinics at an academic medical centre. Pregnant women with hypertensive disorders (chronic hypertension, gestational hypertension, or pre-eclampsia) and women who were normotensive. Women completed a questionnaire about habitual snoring and underwent overnight ambulatory polysomnography. The presence and severity of obstructive sleep apnoea. Obstructive sleep apnoea was found among 21 of 51 women with hypertensive disorders (41%), but in only three of 16 women who were normotensive (19%, chi-square test, P=0.005). [Author correction added on 16 June 2014, after first online publication: Results mentioned in the abstract were amended.] Non-snoring women with hypertensive disorders typically had mild obstructive sleep apnoea, but >25% of snoring women with hypertensive disorders had moderate to severe obstructive sleep apnoea. Among women with hypertensive disorders, the mean apnoea/hypopnoea index was substantially higher in snorers than in non-snorers (19.9±34.1 versus 3.4±3.1, P=0.013), and the oxyhaemoglobin saturation nadir was significantly lower (86.4±6.6 versus 90.2±3.5, P=0.021). Among women with hypertensive disorders, after stratification by obesity, the pooled relative risk for obstructive sleep apnoea in snoring women with hypertension compared with non-snoring women with hypertension was 2.0 (95% CI 1.4-2.8). Pregnant women with hypertension are at high risk for unrecognised obstructive sleep apnoea. Although longitudinal and intervention studies are urgently needed, given the known relationship between obstructive sleep apnoea and hypertension in the general population, it would seem pertinent that hypertensive pregnant women who snore should be tested for obstructive sleep apnoea, a condition believed to cause or promote hypertension. © 2014 Royal College of Obstetricians and Gynaecologists.

Outpatient erbium:YAG (2940 nm) laser treatment for snoring: a prospective study on 40 patients.

PubMed

Storchi, Isabelle Fini; Parker, Steven; Bovis, Francesca; Benedicenti, Stefano; Amaroli, Andrea

2018-02-01

Snoring is a sleep phenomenon due to the partial upper airway obstruction during sleep which causes vibration of the tissues of the rhino-oro-hypopharynx and less frequently the larynx. This study evaluated the use and effectiveness of the erbium:YAG 2940-nm laser as an adjunctive in providing treatment for patients suffering from chronic snoring-related sleep disorders. A prospective study of 40 consecutive patients with snoring and sleep disorders was performed, assessing data before and after three Er:YAG laser treatment sessions. During laser treatment, the pain was almost absent. There were no side effects, except a very mild sore throat in 1 out of 40 patients. The patient's evaluation of satisfaction of the results obtained after the treatments showed that 85% of cases were very satisfied, 5 patients (12.5%) reported being fairly satisfied with the treatment and only 1 subject (2.5%) was not satisfied. Mallampati, Friedman Tongue Position, and degree of O (oropharynx) at nose oropharynx hypopharynx and larynx classification were significantly decreased after the laser sessions. The decrease of Epworth Sleepiness Scale and Visual Analogue Scale for loudness of snoring, waking up during sleep because of snoring, dry mouth on waking, and choking was all statistically significant. The incidence of dreaming during the night also raised significantly; 30/40 (75%) of cases perceived less tightness in their throat and better breathing after treatment. These results were stable at 20 months follow-up (14-24 q) in 72% of cases. Nonsurgical and non-invasive Er:YAG laser treatment demonstrated to be a valid procedure in reducing the loudness of snoring.

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

PubMed Central

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

2015-01-01

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

Snoring surgery: a retrospective review.

PubMed

Jones, T M; Earis, J E; Calverley, P M A; De, S; Swift, A C

2005-11-01

To undertake a retrospective, questionnaire review of surgery for heavy snoring, to ascertain patients' perception of the procedure and its effect on their snoring. A specifically designed postal questionnaire was sent to 261 patients who underwent snoring surgery at University Hospital Aintree, Liverpool, UK, between April 1993 and March 2000. One hundred ninety-three patients responded (73.9%), including 151 men and 42 women. Mean age was 49.0 years (range, 24-74 yrs). Twenty-two patients had a uvulopalatopharyngoplasty, 53 a traditional laser palatoplasty and uvulectomy, and 118 an uvulopalatal elevation palatoplasty. There was a 26% patient-reported postoperative infection rate. Morbidity regarding postoperative swallowing, pharyngeal sensation or voice change appeared minimal. Seventy-six percent scored postoperative pain as "moderate" or "severe," irrespective of the operation performed (P = 0.989). Thirty-seven percent of patients perceived an improvement in postoperative sleep quality. Twenty-four percent of patients reported no improvement in snoring after surgery. Forty-three percent reported an initial improvement that was not sustained for 2 years, whereas 34% of patients benefited from an improvement sustained for longer than 2 years, irrespective of the operation performed (P = 0.143). Only 47%, with hindsight, would have undergone surgery. These data highlight that snoring surgery has a high postoperative morbidity rate and a high failure rate. Research endeavors should be directed to the development of a strategy which enables reliable preoperative identification of patients' who enjoy sustained benefit postoperatively.

Increased risk of snoring and adenotonsillectomy in children referred for tympanostomy tube insertion.

PubMed

Tauman, Riva; Derowe, Ari; Ophir, Orna; Greenfeld, Michal; Sivan, Yakov

2010-02-01

Eustachian tube dysfunction and sleep-disordered breathing (SDB) share common pathophysiologic mechanisms. Our objective was to investigate whether children referred for isolated TTI (tympanostomy tube insertion) are at increased risk for snoring and upper airway procedures. Telephone interviews to parents of children who underwent isolated TTI and to age- and gender-matched controls were conducted. Four hundred fifty-seven children were included in the study; 352 had isolated TTI (study group) and 105 children were controls. Twenty-two percent of children in the study group were reported to snore compared with 7.6% in the controls (p=0.001). Eighteen percent of children in the study group were reported to have undergone adenotonsillectomy compared with 4.8% in the controls (p=0.0005). Future SDB, i.e., either snoring or adenotonsillectomy following TTI, was found in 34% of children in the study group compared with 11% in the controls (p=0.0004). Children who underwent isolated TTI were at increased risk for future snoring (OR=3.4, CI: 1.6-7.2) and future adenotonsillectomy (OR=4.4, CI: 1.7-11.2). Children who undergo isolated TTI are at increased risk for snoring and for adenotonsillectomy. We suggest that these children be followed for symptoms of SDB on a scheduled basis to allow for early diagnosis and intervention. 2009 Elsevier B.V. All rights reserved.

Snoring

MedlinePlus

... Hall Award Winning Abstracts from AADSM 2018 Qualified Dentist Designation Practice Resources Practice Resources Product Store Medicare ... Directory For Patients For Patients Find-An-AADSM-Dentist Snoring Obstructive Sleep Apnea Oral Appliance Therapy Teen ...

Prevalence of upper airway tumors and cysts among patients who snore.

PubMed

Suzuki, Masaaki; Saigusa, Hanako; Chiba, Shintaro; Hoshino, Tadahiko; Okamoto, Makito

2007-11-01

Sleep specialists usually do not pay much attention to the upper airway in patients who snore, because they can make the diagnosis of sleep-disordered breathing without performing nasopharyngeal endoscopy if they have the Epworth Sleepiness Scale scores and the results of polysomnography. The purpose of this study was to determine the prevalence of benign and malignant tumors and cysts in the upper airway in patients who snore. A retrospective multicenter trial was performed in 4 sleep laboratories. Adult male and female patients whose chief complaint on their first visit was witnessed snoring were enrolled in this study. All of the patients were evaluated by otolaryngologists using nasopharyngeal endoscopy to detect organic diseases in the upper airway. Among 2,923 patients, 2 patients had malignant tumors, 5 had benign tumors, and 2 had cysts in the upper airway. The prevalence of upper airway benign and malignant tumors and cysts among adult male and female patients was 0.24%. Routine detailed nasopharyngeal endoscopy should be carried out in each institution so as not to overlook organic diseases in the upper airway among patients who snore.

Apps in sleep medicine.

PubMed

Stippig, Andreas; Hübers, Ulrich; Emerich, Markus

2015-03-01

Users of mobile devices such as iPhones or iPads are offered a wide range of applications (apps) regarding sleep and sleep medicine. This article will give an overview about the apps that are available. Moreover, it will present how they work and determine if they can be used in therapy. The apps' competence to count snoring noises had to be evaluated. This was done with a three-piece test set-up to analyze the apps' ability to distinguish between snoring sounds and disturbing noises such as cars driving past the window, conversations in the bedroom, or even just the rustling of sheets and blankets. The tested apps monitor and record snoring noises well as long as they are used in a soundproof environment. In a real-life environment with various disturbing noises, the apps show difficulties in telling snoring sounds and other noises apart. The tested apps are not accurate enough to replace the common diagnostic standard in therapy. However, they can be a helpful addition. Especially, singles could use them who do not know if their snoring has improved with an OA and do not have anybody to ask.

Current child, but not maternal, snoring is bi-directionally related to adiposity and cardiometabolic risk markers: A cross-sectional and a prospective cohort analysis.

PubMed

Farr, Olivia M; Rifas-Shiman, Sheryl L; Oken, Emily; Taveras, Elsie M; Mantzoros, Christos S

2017-11-01

Obstructive sleep apnea (OSA), typically manifested as snoring, is closely associated with obesity. However, the directionality of associations of OSA with cardiometabolic risk markers is unclear, as obesity increases risk for OSA, and OSA results in excess weight gain and its metabolic consequences. Less is known about how obesity and OSA may relate in children and adolescents and whether maternal OSA may influence the development of obesity and cardiometabolic dysfunction in offspring. Among 1078 children from the Project Viva cohort, we examined cross-sectionally and prospectively associations of parent-reported child or maternal snoring with cardiometabolic outcomes, including adiposity, adipokines, and insulin resistance. Cross-sectionally, child snoring was related to adiposity and metabolic risk, particularly body mass index (BMI; β 0.61kg/m 2 , 95% CI 0.33, 0.89; p<0.001), trunk fat mass index (β 0.23kg/m 2 , CI 0.12, 0.34; p<0.001), high-density lipoprotein cholesterol (β -1.47mg/dL, CI -2.69, -0.25; p=0.02), and metabolic risk z-score (β 0.08, CI 0.02, 0.14; p=0.01) after correction for covariates. Prospectively, adiposity (BMI, trunk fat, fat mass, and waist circumference) and cardiometabolic (leptin, HOMA-IR, CRP, and global metabolic risk) measures at mid-childhood (~7y) were associated with child snoring at the early teen visit (~12y) after correction for covariates. Child snoring at ~9y was related to changes in adiposity between mid-childhood and early teen visits. Child but not maternal snoring, was related to child adiposity and cardiometabolic outcomes. Adiposity and child snoring are associated with each other cross-sectionally and are each predictive of the other among children/adolescents prospectively. These results suggest similar mechanisms in pediatric/adolescent populations as in adults for the development of sleep-disordered breathing and sleep apnea that will need to be confirmed in randomized clinical trials. Importantly, this research points to the need to target both sleep and obesity in order to break this vicious cycle. Copyright © 2017 Elsevier Inc. All rights reserved.

Snoring

MedlinePlus

... a sign of a serious sleep disorder called sleep apnea. You should see your health care provider if you are often tired during the day, don't feel that you sleep well, or wake up gasping. To reduce snoring ...

Snoring-Induced Vibratory Angioedema.

PubMed

Kalathoor, Ipe

2015-10-01

Vibratory angioedema (VA) is a rare physical urticaria, with symptoms of itching and swelling of the skin or mucosa when it is exposed to vibration. Avoidance of vibration is the best way to manage this condition. This case report will assist physicians to diagnose this rare condition. Here, a previously unpublished potential successful treatment modality is being presented, with good symptom control, along with some photographs taken during an acute attack. A literature review points towards potential undiagnosed cases. A 70-year-old woman had multiple emergency department visits for tongue and throat swelling over 3 years. The episodes always happened at night. Detailed history elicited some episodes of itching and swelling of hands when driving as well as significant snoring while sleeping. Physical examination was unremarkable except for morbid obesity. Complement factor 4 and C1esterase inhibitor level were within normal limits. A tentative diagnosis of angioedema induced by oropharyngeal vibration from snoring was made. A sleep study confirmed sleep apnea with severe snoring. After CPAP (continuous positive airway pressure) treatment, she had successful symptom control. Snoring-induced VA is very likely an under-diagnosed condition in the community. The typical history is the key to the diagnosis. This condition could be confirmed by vibration test or by the resolution of symptoms with elimination of vibration. Effective symptom control is possible by avoidance of oropharyngeal vibration from snoring with the administration of CPAP therapy, making it a potential novel indication for this condition.

Influence of uvulopalatopharyngoplasty on alpha-EEG arousals in nonapnoeic snorers.

PubMed

Boudewyns, A; De Cock, W; Willemen, M; Wagemans, M; De Backer, W; Van de Heyning, P H

1997-01-01

Arousals are more numerous in heavy snorers than in nonsnorers and might be a cause of excessive daytime sleepiness (EDS) in these patients. The present study investigated whether treatment of snoring by uvulopalatopharyngoplasty (UPPP) had an influence on sleep microstructure in nonapnoeic snorers. The polysomnographic records of 10 nonapnoeic snorers were reviewed retrospectively and arousals scored according to the American Sleep Disorders Association (ASDA) 3 s definition. Scores for snoring, EDS and polysomnographic data were compared before and after UPPP (mean (+/-SD) time interval 249 +/- 183 days). UPPP resulted in a subjective improvement of snoring and a significant decrease in the arousal index (mean 14.6, 95% confidence interval (95% CI) 8.5-20.8 vs mean 9.1, 95% CI 6.6-11.5) (p = 0.01). EDS and the amount of slow-wave sleep remained unchanged. Uvulopalatopharyngoplasty resulted in an improvement of subjective snoring and a significant decrease of arousals in nonapnoeic snorers. Although these data do not provide any insight into whether the improvement observed can be maintained on a long-term basis, uvulopalatopharyngoplasty can be considered as a useful treatment modality to reduce sleep fragmentation and snoring in nonapnoeic snorers.

The effect of sitting and calf activity on leg fluid and snoring.

PubMed

Singh, Bhajan; Yadollahi, Azadeh; Lyons, Owen; Alshaer, Hisham; Bradley, T Douglas

2017-06-01

Prolonged sitting may promote leg fluid retention that redistributes to the neck during sleep and contributes to snoring. This could be attenuated by calf activity while sitting. In 16 healthy non-obese subjects we measured leg fluid volume (LFV) below the knees using bioelectrical impedance while sitting for 4h, snoring using a portable BresoDx™ device, and Mallampati grade. Using a double cross-over study design, subjects were randomized to one of two arms and crossed-over one week later: control arm - no calf exercise while sitting; intervention arm - calf contraction against a pedal resistance while sitting. The effects of sitting±calf activity on LFV and snoring were compared. We found that LFV increased by 216±101.0ml (p<0.0001) after sitting. Calf activity while sitting attenuated LFV by 53.8ml (p<0.0001) and, in all five subjects with severe upper airway narrowing (Mallampati grade IV), reduced snoring duration (from 357±132.9 to 116.2±72.1s/h, p=0.02) suggesting reduced overnight rostral fluid shift to the neck. Copyright © 2017 Elsevier B.V. All rights reserved.

Uvulopalatopharyngoplasty: The Leicester experience.

PubMed

Prichard, A J; Marshall, J; Ahmed, A; Thomas, R S; Hanning, C D

1994-08-01

Twenty-nine patients undergoing uvulopalatopharyngoplasty (UPPP) for snoring are presented. Ninety per cent expressed an overall improvement in their symptoms: 21 per cent had complete abolition of snoring. Post-operative complications included nasal regurgitation of food/fluids and hyponasal speech development.

[Acoustic information in snoring noises].

PubMed

Janott, C; Schuller, B; Heiser, C

2017-02-01

More than one third of all people snore regularly. Snoring is a common accompaniment of obstructive sleep apnea (OSA) and is often disruptive for the bed partner. This work gives an overview of the history of and state of research on acoustic analysis of snoring for classification of OSA severity, detection of obstructive events, measurement of annoyance, and identification of the sound excitation location. Based on these objectives, searches were conducted in the literature databases PubMed and IEEE Xplore. Publications dealing with the respective objectives according to title and abstract were selected from the search results. A total of 48 publications concerning the above objectives were considered. The limiting factor of many studies is the small number of subjects upon which the analyses are based. Recent research findings show promising results, such that acoustic analysis may find a place in the framework of sleep diagnostics, thus supplementing the recognized standard methods.

Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample.

PubMed

Xiao, Qian; Gu, Fangyi; Caporaso, Neil; Matthews, Charles E

2016-01-01

Short sleep has been linked to obesity. However, sleep is a multidimensional behavior that cannot be characterized solely by sleep duration. There is limited study that comprehensively examined different sleep characteristics in relation to obesity. We examined various aspects of sleep in relation to adiposity in 2005-2006 NHANES participants who were 18 or older and free of cardiovascular disease, cancer, emphysema, chronic bronchitis and depression ( N  = 3995). Sleep characteristics were self-reported, and included duration, overall quality, onset latency, fragmentation, daytime sleepiness, snoring, and sleep disorders. Body measurements included weight, height, waist circumference, and dual-energy X-ray absorptiometry measured fat mass. Snoring was associated with higher BMI (adjusted difference in kg/m 2 comparing snoring for 5+ nights/week with no snoring (95 % confidence interval), 1.85 (0.88, 2.83)), larger waist circumference (cm, 4.52 (2.29, 6.75)), higher percentage of body fat (%, 1.61 (0.84, 2.38)), and higher android/gynoid ratio (0.03 (0.01, 0.06)). The associations were independent of sleep duration and sleep quality, and cannot be explained by the existence of sleep disorders such as sleep apnea. Poor sleep quality (two or more problematic sleep conditions) and short sleep duration (<6 h) were also associated with higher measures of body size and fat composition, although the effects were attenuated after snoring was adjusted. In a nationally representative sample of healthy US adults, snoring, short sleep, and poor sleep quality were associated with higher adiposity.

Radiofrequency of the soft palate for sleep-disordered breathing: a 6-year follow-up study.

PubMed

De Kermadec, H; Blumen, M-B; Engalenc, D; Vezina, J-P; Chabolle, F

2014-02-01

To determine the long-term (>3 years) outcome of patients suffering from simple snoring or non-severe obstructive sleep apnea syndrome (OSAS) treated by radiofrequency ablation of the soft palate. Observational retrospective study. Tertiary care university hospital. Seventy-seven subjects were included between 1999 and 2006. Twenty-seven suffered from mild or moderate OSAS. All patients were treated by radiofrequency-assisted stiffening of the soft palate, with or without uvulectomy. Snoring (assessed on a 10 cm visual analog scale (VAS)), marital status, presence of cardiovascular risk factors or pathologies and follow-up time were evaluated by postal questionnaire. Mean follow-up time was 6.3 ± 2.3 years. Mean snoring intensity decreased significantly in the immediate postoperative period (8.1 ± 2.9 to 3.5 ± 2.2 cm on VAS). Over the longer term, however, we observed a significant increase in snoring intensity (5.7 ± 2.9 cm), which nevertheless remained below the preoperative values (P<0.001). Bed-partners noticed a relapse of snoring in 92.7% of cases. Nine percent of couples separated. Hypertension and diabetes were diagnosed during follow-up in 12.1% and 6.6% of the subjects, respectively. A majority of patients failed to undergo repeat polysomnography or further treatment. Relapse of snoring was observed in nearly all patients in the long run, although intensity appears to remain lower than preoperatively. Most patients did not comply with the follow-up instructions and did not seek other forms of treatment when recurrence occurred. Copyright © 2013. Published by Elsevier Masson SAS.

Self-reported exposure to traffic pollution in relation to daytime sleepiness and habitual snoring: a questionnaire study in seven North-European cities.

PubMed

Gislason, Thorarinn; Bertelsen, Randi J; Real, Francisco Gomez; Sigsgaard, Torben; Franklin, Karl A; Lindberg, Eva; Janson, Christer; Arnardottir, Erna Sif; Hellgren, Johan; Benediktsdottir, Bryndis; Forsberg, Bertil; Johannessen, Ane

2016-08-01

Little is known about associations between traffic exposure and sleep disturbances. We examined if self-reported exposure to traffic is associated with habitual snoring and daytime sleepiness in a general population. In the RHINE III study, 12184 adults answered questions on sleep disturbances and traffic exposure. We analysed bedrooms near roads with traffic, bedrooms with traffic noise, and travelling regularly along busy roads as proxies for traffic exposures, using logistic regression. Adjustment factors were study centre, gender, age, smoking habits, educational level, body mass index, physical activity, obstructive sleep apnoea, and sleep duration. One in ten lived near a busy road, 6% slept in a bedroom with traffic noise, and 11% travelled regularly along busy roads. Habitual snoring affected 25% and daytime sleepiness 21%. More men reported snoring and more women reported daytime sleepiness. Having a bedroom with traffic noise was associated with snoring (adjusted OR 1.29, [95% CI 1.12, 1.48]). For daytime sleepiness, on the other hand, bedroom with traffic noise and high exposure to traffic pollution have significant risk factors (adjusted ORs 1.46 [1.11, 1.92] and 1.65 [1.11, 2.45]). Results were consistent across study centres. Daytime sleepiness is associated with traffic pollution and traffic noise, while habitual snoring is only associated with traffic noise. Self-reported traffic exposure should be taken into account when diagnosing and planning treatment for patients with sleep disturbances, because reducing noise and pollution exposure in the bedroom may have a beneficial effect. Copyright © 2016 Elsevier B.V. All rights reserved.

Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification.

PubMed

Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

2008-08-01

In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong potential to distinguish among simple snorers and OSA patients, both marginally, i.e., when the parameters are examined individually, and jointly. The parameters obtained from the SEP sequences and the corresponding STCV sequences, on the other hand, did not have a strong discrimination capability. However, the joint behaviour of these parameters showed some potential to distinguish among simple snorers and OSA patients.

Effect of Modified Fujita Technique Uvulopalatoplasty on Oxidative DNA Damage Levels in Patients With Obstructive Sleep Apnea Syndrome.

PubMed

Bakan, Ebubekir; Fidan, Vural; Alp, Hamit Hakan; Baygutalp, Nurcan Kilic; Cokluk, Erdem

2015-07-01

Snoring is a social hindrance problem and it can cause life threatening problems. Because of this it must be taken seriously and must be treated. Although there are many ways for treating this problem, still uvulopalatopharngoplasty (UPPP) which is an accepted classical method maintains its importance. Antioxidant status in patients with snoring have been investigated. All studies investigated the effect of CPAP treatment on the level of antioxidant agents. In this study we have examined the effect of UPPP on the level of antioxidant agents in patients with snoring.

Comparison of SVM and ANFIS for Snore Related Sounds Classification by Using the Largest Lyapunov Exponent and Entropy

PubMed Central

Ankışhan, Haydar; Yılmaz, Derya

2013-01-01

Snoring, which may be decisive for many diseases, is an important indicator especially for sleep disorders. In recent years, many studies have been performed on the snore related sounds (SRSs) due to producing useful results for detection of sleep apnea/hypopnea syndrome (SAHS). The first important step of these studies is the detection of snore from SRSs by using different time and frequency domain features. The SRSs have a complex nature that is originated from several physiological and physical conditions. The nonlinear characteristics of SRSs can be examined with chaos theory methods which are widely used to evaluate the biomedical signals and systems, recently. The aim of this study is to classify the SRSs as snore/breathing/silence by using the largest Lyapunov exponent (LLE) and entropy with multiclass support vector machines (SVMs) and adaptive network fuzzy inference system (ANFIS). Two different experiments were performed for different training and test data sets. Experimental results show that the multiclass SVMs can produce the better classification results than ANFIS with used nonlinear quantities. Additionally, these nonlinear features are carrying meaningful information for classifying SRSs and are able to be used for diagnosis of sleep disorders such as SAHS. PMID:24194786

Follow-up of obstructive sleep apnea in children.

PubMed

Barros, Emília Leite de; Pradella-Hallinan, Marcia; Moreira, Gustavo Antonio; Stefanini, Daniele de Oliveira Soares; Tufik, Sergio; Fujita, Reginaldo Raimundo

2014-01-01

the evolution of snoring and OSAS in children is not well established since few studies of patients without surgical treatment have been published. to evaluate the evolution of sleep disordered breathing in children who had not been submitted to upper airway surgery. twenty-six children with snoring who had not undergone upper airway surgery were evaluated prospectively. Patients were evaluated by full physical examination and nocturnal polysomnography, after which they were divided into 2 groups: apnea (16 children) and snoring (10 children). After 6 months following the initial evaluation, patients were submitted to a new nocturnal polysomnography, and all data were compared to those of the first examination. the groups did not show any differences regarding age, weight, height and airway physical examination. After 6 months of follow-up, the apnea index did not change, but the respiratory disturbance index increased in the snoring group and the number of hypopneas decreased in the group apnea. there was an increase in the percentage of N1 sleep stage and the respiratory disturbance index in the patients with primary snore. The AHI did not show significant alteration in both groups, but the number of hypopneas decreased in patients with SAOS. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Obstructive apnea hypopnea index estimation by analysis of nocturnal snoring signals in adults.

PubMed

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

2012-09-01

To develop a whole-night snore sounds analysis algorithm enabling estimation of obstructive apnea hypopnea index (AHI(EST)) among adult subjects. 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 AHI(EST). University-affiliated sleep-wake disorder center and biomedical signal processing laboratory. Ninety subjects (age 53 ± 13 years, BMI 31 ± 5 kg/m(2)) 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. AHI(EST) correlated with AHI (AHI(PSG); r(2) = 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 AHI(EST) with AHI(PSG), respectively. 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.

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.

Seasonal trends in sleep-disordered breathing: evidence from Internet search engine query data.

PubMed

Ingram, David G; Matthews, Camilla K; Plante, David T

2015-03-01

The primary aim of the current study was to test the hypothesis that there is a seasonal component to snoring and obstructive sleep apnea (OSA) through the use of Google search engine query data. Internet search engine query data were retrieved from Google Trends from January 2006 to December 2012. Monthly normalized search volume was obtained over that 7-year period in the USA and Australia for the following search terms: "snoring" and "sleep apnea". Seasonal effects were investigated by fitting cosinor regression models. In addition, the search terms "snoring children" and "sleep apnea children" were evaluated to examine seasonal effects in pediatric populations. Statistically significant seasonal effects were found using cosinor analysis in both USA and Australia for "snoring" (p < 0.00001 for both countries). Similarly, seasonal patterns were observed for "sleep apnea" in the USA (p = 0.001); however, cosinor analysis was not significant for this search term in Australia (p = 0.13). Seasonal patterns for "snoring children" and "sleep apnea children" were observed in the USA (p = 0.002 and p < 0.00001, respectively), with insufficient search volume to examine these search terms in Australia. All searches peaked in the winter or early spring in both countries, with the magnitude of seasonal effect ranging from 5 to 50 %. Our findings indicate that there are significant seasonal trends for both snoring and sleep apnea internet search engine queries, with a peak in the winter and early spring. Further research is indicated to determine the mechanisms underlying these findings, whether they have clinical impact, and if they are associated with other comorbid medical conditions that have similar patterns of seasonal exacerbation.

Relationship of sleep pattern and snoring with chronic disease: findings from a nationwide population-based survey.

PubMed

Yunus, Fakir Md; Khan, Safayet; Mitra, Dipak K; Mistry, Sabuj Kanti; Afsana, Kaosar; Rahman, Mahfuzar

2018-02-01

To investigate the association of total sleep time and presence or absence of snoring with chronic disease among the Bangladeshi adult population. Cross-sectional survey. Urban and rural Bangladesh. A total of 12,338 men and women aged ≥35 years. Total sleep time was considered as the total hours of sleep in 24 hours. Furthermore, sleep time was categorized into <7, 7-9, and >9 hours according to National Sleep Foundation (2015) guidelines. Self-reported snoring history was captured and corroborated with their respective sleep partner/spouse in more than 80% cases. Registered physician-diagnosed current and/or previous cases of hypertension, diabetes, coronary heart disease, cancer, stroke, chronic obstructive pulmonary disease, and any other chronic conditions were counted. Overall prevalence of at least 1 chronic disease in our study population was around 18%: men (15.4%) and women (20.0%). Hypertension has the highest prevalence (overall: 12.7%, men: 12.2%, women: 15%) followed by diabetes (4.9%), coronary heart diseases (3.2%), stroke (1.8%), chronic obstructive pulmonary disease (0.9%), and cancer (any type: 0.1%). Sleep pattern and snoring are significantly associated with all individual chronic disease except cancer. Sociodemographic, behavioral, and lifestyle variables were adjusted, and inadequate total sleep time (<7 hours) and snoring (yes/no) showed significant association with chronic disease status (risk ratio = 1.11, 95% confidence interval 1.00-1.22 and risk ratio = 1.20, 95% confidence interval 1.11-1.29, respectively). Inadequate sleep and snoring are independently associated with chronic disease in Bangladeshi adult population and perhaps elsewhere. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

A prospective single-blind randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy.

PubMed

Uppal, S; Nadig, S; Jones, C; Nicolaides, A R; Coatesworth, A P

2004-06-01

The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single-blind, randomized-controlled trial. Eighty-three patients entered the trial. After a mean follow-up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98-36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93-2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.

Friedman tongue position: age distribution and relationship to sleep-disordered breathing.

PubMed

Ingram, David G; Ruiz, Amanda; Friedman, Norman R

2015-05-01

Friedman tongue position (FTP) may play an important role in the evaluation of children with sleep-related breathing disorders (SRBD), but there are no previous data on FTP distribution by age. The objective of the current study was to determine the distribution of FTP by age and examine the relationship between FTP and snoring in children. Prospective cross-sectional study of 199 children (mean age, 6.8 years; 59% male) had tongue position assessed by FTP as part of their clinical examination of the oral cavity during routine ENT visits at a tertiary care children's hospital. The FTP and snoring frequency of participants was examined across the entire age range as well as by comparing those older (middle childhood and above) and younger than 5 years of age. Tongue position did not correlate with age or snoring frequency. The proportion of children with FTP III/IV was not significantly different in children younger than five years of age compared to older than five. Habitual snoring was not associated with having a higher FTP. Among children who snored <3 times per week, those who had previously undergone tonsillectomy did have higher FTP compared to those who had not (p=0.007). BMI-%-for-age was significantly correlated with FTP (p=0.003). The percent of children having FTP class III/IV differed significantly between ethnicities (22% of whites, 26% of others, 45% of hispanics, 53% of African-Americans; p=0.011). Inter-rater reliability among pediatric otolaryngologist was excellent (kappa=0.93, p<0.001). There does not appear to be an association between FTP with age or snoring frequency in children. The excellent inter-rater reliability for FTP among pediatric ENT providers suggests the null findings are not due to rater bias. These findings may serve as an important reference for those studying the role of tongue position in pediatric SRBD and complement previous studies examining FTP among children with known OSA or snoring. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Associations of Self-Reported Sleep Duration and Snoring with Colorectal Cancer Risk in Men and Women

PubMed Central

Zhang, Xuehong; Giovannucci, Edward L.; Wu, Kana; Gao, Xiang; Hu, Frank; Ogino, Shuji; Schernhammer, Eva S.; Fuchs, Charles S.; Redline, Susan; Willett, Walter C.; Ma, Jing

2013-01-01

Study Objectives: We assessed the relationship between sleep duration, snoring and colorectal cancer risk. Design: Prospective cohort studies. Setting: United States. Participants: A total of 30,121 men aged 41 to 79 years in the Health Professionals Follow-up Study and 76,368 women aged 40 to 73 years in the Nurses' Health Study. Interventions: None. Measurements and Results: We queried information on sleep duration and snoring in 1986/87. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs, 95% CIs). We documented 1,973 incident colorectal cancer cases (709 men and 1,264 women) over a 22-year follow-up period. Compared to sleep an average 7 h, ≥ 9 h of sleep was significantly associated with a higher risk of colorectal cancer among men (HR = 1.35, 95% CI: 1.00, 1.82), and to a lesser degree, among women (HR = 1.11, 95% CI: 0.85, 1.44). The risk associated with longer sleep was restricted to individuals who regularly snored (men: HR = 1.80, 95% CI: 1.14, 2.84; women: HR = 2.32, 95% CI: 1.24, 4.36) and to overweight individuals (i.e., BMI ≥ 25 kg/m2) (men: HR = 1.52, 95% CI: 1.04, 2.21; women: HR = 1.37, 95% CI: 0.97, 1.94). Short sleep duration (≤ 5 h) was not associated with an increased risk of colorectal cancer in the entire sample or in subgroups stratified by snoring or BMI. Conclusions: Longer sleep duration was associated with an increased risk of developing colorectal cancer among individuals who were overweight or snored regularly. This observation raises the possibility that sleep apnea and its attendant intermittent hypoxemia may contribute to cancer risk. Citation: Zhang X; Giovannucci EL; Wu K; Gao X; Hu F; Ogino S; Schernhammer ES; Fuchs CS; Redline S; Willett WC; Ma J. Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women. SLEEP 2013;36(5):681-688. PMID:23633750

Prevalence of Snoring in College Students

ERIC Educational Resources Information Center

Patel, Minal; Tran, Duyen; Chakrabarti, Ashoke; Vasquez, Audrey; Gilbert, Paul; Davidson, Terence

2008-01-01

Snoring in college students may be the earliest presentation of adult sleep-disordered breathing, yet the literature contains few studies that demonstrate its effects on learning or whether early diagnosis leads to interruption of disease progression or prevention of comorbidities. Objective and Participants: The authors conducted this study in…

Prevalence of major obstructive sleep apnea syndrome symptoms in coal miners and healthy adults.

PubMed

Kart, Levent; Dutkun, Yalçın; Altın, Remzi; Ornek, Tacettin; Kıran, Sibel

2010-01-01

Obstructive sleep apnea syndrome obstructive sleep apnea syndrome is associated with symptoms including habitual snoring, witness apnea and excessive daytime sleepiness. Also obstructive sleep apnea syndrome is related to some occupations which are needed attention for work accident. We aimed to determine the prevalence of snoring, witnessed apnea and excessive daytime sleepiness in coal workers and healthy adults in Zonguldak city center, and also evaluate the differences between these groups. This study consisted of 423 underground coal workers and 355 individuals living in centre of Zonguldak. Study and comparison group were chosen by nonstratified randomized sampling method. Data were collected by a questionnaire that included information regarding snoring, witnessed apnea and excessive daytime sleepiness. Mean age was 43.3 ± 6.05 years in miners and 44.3 ± 11.8 years in comparison group. In miners, snoring frequency was determined as 42.6%, witnessed apneas were 4.0%, and daytime sleepiness were 4.7%. In comparison group, these symptoms were 38.6%, 4.8% and 2.8% respectively. There were no statistical differences between coal workers and comparison group in these symptoms. Also snoring prevalence was higher in smoker miners. We found that major symptoms of obstructive sleep apnea syndrome in coal workers are similar to general population in Zonguldak. Further studies that constucted higher populations and with polysomnography are needed to evaluate these findings.

Ambulatory treatment of snoring with CO2 laser: laser-assisted UPPP (LAUP), results on 856 patients

NASA Astrophysics Data System (ADS)

Kamami, Yves-Victor

1995-05-01

The usual treatment of snoring in the absence of sleep apneas has been UPPP. Patients are often reluctant to undergo this painful procedure under general anesthesia. The Laser Assisted Uvulopalatoplasty (LAUP) is a new procedure, introduced six years ago by the author, using local anesthesia for the treatment of snoring in an office setting. This technique is designed to correct breathing abnormalities during sleep, caused by pharyngeal airway obstruction in patients suffering of Snoring or Obstructive Sleep Apnea Syndrome. This is done by reducing the amount of tissue in the uvula, the velum, and the upper part of the posterior pillars. LAUP allows surgery for the relief of snoring to be performed in the office, under local anesthesia. LAUP has many advantages over the traditional UPPP. It is simple, reliable, hemostatic, and less painful. It is also less expensive as it can be performed as an outpatient. This makes the LAUP more accessible to patients. Our experience with LAUP in 856 patients from December 1988 to July 1994 (141 women and 715 men) is described. Good results were obtained in 94.8% of patients and there were no complications. This new technique can be easily performed by other otolaryngologists after serious suitable training. LAUP provides a simple alternative for many patients who do not wish to undergo a traditional UPPP.

[The prevalence of obstructive sleep apnea-hypopnea syndrome in adults aged over 20 years in Changchun city].

PubMed

Li, Ming-xian; Wang, Ying; Hua, Shu-cheng; Li, Chun-mei; Wang, Mu-peng; Liu, Yang; Li, Zhong-min; Wang, Chun-yong; Fan, Jin-rong; Wang, Jing-Hua; Kong, Fan-yu; Wang, Min

2005-12-01

To investigate the prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in adults aged over 20 years in Changchun city, providing epidemiological data for treatment and prevention of the disease. 3,960 subjects were derived from a stratified cluster and random sampling of the population in two districts of Changchun city. They were asked to answer the questions from a questionnaire in their houses. According to the degree of snoring, 200 subjects with a snoring score >or= 2 degree were selected to undergo polysomnography for a whole night and the prevalence of the disease was estimated. A total of 3,648 (97.64%) validated questionnaires was collected. Of them 31.00% had a snoring score >or= 2 degree, the prevalence was higher in males (40.07%) than in females (21.76%). The prevalence of snoring was higher in drivers (42.47%) than in other occupations. The estimated prevalence of OSAHS defined by apnea-hypopnea index (AHI) >or= 5, Epworth sleepiness scale (ESS) >or= 9 and arterial oxygen saturation (SaO(2)) < 90% was 4.81%. The estimated prevalence of OSAHS in adults aged over 20 years in Changchun city was 4.81%. Doctors should pay more attention to the disease and the ordinary people should be informed of the health impact of snoring and OSAHS.

Treatment of snorers with a volatile oil: a randomized, double-blind placebo-controlled trial.

PubMed

Ulfberg, J; Nyström, B

2001-01-01

Snoring is a significant problem both for the patient and for the bed partner. Seventy-two male and female heavy snorers and their bed partners participated in a double-blinded, placebo-controlled study on the effects of a volatile oil administered by gargling. The patients were diagnosed as heavy snorers after they underwent overnight polysomnography showing that their apnea indexes were below 5, thus sleep apnea patients were not included in the study. The participants and their partners filled out evaluations concerning snoring intensity, mouth dryness, nasal stuffiness and the Epworth Sleepiness Scale prior to and after using the volatile oil or placebo for 14 consecutive nights. There were no statistically significant decreases in snoring as graded by the bed partner or in mouth dryness, nasal stuffiness, or the Epworth Sleepiness Scale scores graded by the patients who were randomized to use the volatile oil. The results of this study indicate that this volatile oil is not an effective treatment in patients presenting with symptoms of snoring. Copyright 2001 S. Karger AG, Basel

Snoring and obstructive sleep apnoea in children: why should we treat?

PubMed

Gozal, David; O'Brien, Louise M

2004-01-01

Frequent and loud snoring is a very frequent condition in prepubertal children affecting approximately 10% of all 2-8 year old children. If polysomnographical evaluations are performed in these snoring children, approximately 10% will be diagnosed with obstructive sleep apnoea (OSA). The pathophysiology of OSA in children is still poorly understood. Indeed, while adenotonsillar hypertrophy is certainly a major contributor to OSA, other factors need to be implicated for OSA to develop. In recent years, it has become apparent that OSA and snoring are not as innocuous as previously thought. Indeed, epidemiological and pre-post treatment analyses have identified substantial morbidities that primarily affect cardiovascular and neurobehavioural systems, namely pulmonary hypertension, systemic elevation of arterial blood pressure, nocturnal enuresis, reduced somatic growth, behavioural problems that resemble attention deficit-hyperactivity disorder, as well as learning and cognitive deficits. These problems are associated with marked increases in healthcare-related costs. More importantly, if timely diagnosis and intervention are not implemented, some of these morbid complications may not be completely reversible, leading to long-lasting residual consequences.

Headache, snoring and sleep apnoea.

PubMed

Ulfberg, J; Carter, N; Talbäck, M; Edling, C

1996-09-01

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30-64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.

Occupational exposure to organic solvents and sleep-disordered breathing.

PubMed

Ulfberg, J; Carter, N; Talbäck, M; Edling, C

1997-01-01

To investigate whether people with occupational exposure to organic solvents have a higher prevalence of obstructive sleep apnea syndrome (OSAS) than the general population and to examine the relationship between snoring and exposure to organic solvents. Consecutive patients, aged 30-64 years, referred during a 3-year period to the sleep laboratory at Avesta Hospital, Sweden, because of suspected OSAS made up the patient groups. Following admission, patients underwent a simplified sleep apnea investigation and were divided into two groups, OSAS (n = 320) and snorers (n = 443). A random sample of 296 men and 289 women aged 30-64 years obtained from a register of all country residents maintained by the county tax authority served as referents (controls). Both patients and referents responded to two questionnaires, including questions about occupation, exposure to organic solvents, and other chemical and physical agents. Men with OSAS or snoring and women with snoring had more often been occupationally exposed to organic solvents than the referents, showing an almost twofold increase in risk for those exposed during whole workdays. For men, the risk of OSAS or snoring increased with increasing exposure. The result indicates that occupational exposure to organic solvents might cause sleep apnea. A new observation is that even snoring could be caused by exposure to organic solvents. It is important to elucidate whether exposure to organic solvents is a cause of OSAS, because such a finding may have important implications for prevention and treatment of sleep disturbances.

Tissue Vibration Induces Carotid Artery Endothelial Dysfunction: A Mechanism Linking Snoring and Carotid Atherosclerosis?

PubMed Central

Cho, Jin-Gun; Witting, Paul K.; Verma, Manisha; Wu, Ben J.; Shanu, Anu; Kairaitis, Kristina; Amis, Terence C.; Wheatley, John R.

2011-01-01

Study Objectives: We have previously identified heavy snoring as an independent risk factor for carotid atherosclerosis. In order to explore the hypothesis that snoring-associated vibration of the carotid artery induces endothelial dysfunction (an established atherogenic precursor), we utilized an animal model to examine direct effects of peri-carotid tissue vibration on carotid artery endothelial function and structure. Design: In supine anesthetized, ventilated rabbits, the right carotid artery (RCA) was directly exposed to vibrations for 6 h (peak frequency 60 Hz, energy matched to that of induced snoring in rabbits). Similarly instrumented unvibrated rabbits served as controls. Features of OSA such as hypoxemia, large intra-pleural swings and blood pressure volatility were prevented. Carotid endothelial function was then examined: (1) biochemically by measurement of tissue cyclic guanosine monophosphate (cGMP) to acetylcholine (ACh) and sodium nitroprusside (SNP); and (2) functionally by monitoring vessel relaxation with acetylcholine in a myobath. Measurement and Results: Vessel cGMP after stimulation with ACh was reduced in vibrated RCA compared with unvibrated (control) arteries in a vibration energy dose-dependent manner. Vibrated RCA also showed decreased vasorelaxation to ACh compared with control arteries. Notably, after addition of SNP (nitric oxide donor), cGMP levels did not differ between vibrated and control arteries, thereby isolating vibration-induced dysfunction to the endothelium alone. This dysfunction occurred in the presence of a morphologically intact endothelium without increased apoptosis. Conclusions: Carotid arteries subjected to 6 h of continuous peri-carotid tissue vibration displayed endothelial dysfunction, suggesting a direct plausible mechanism linking heavy snoring to the development of carotid atherosclerosis. Citation: Cho JG; Witting PK; Verma M; Wu BJ; Shanu A; Kairaitis K; Amis TC; Wheatley JR. Tissue vibration induces carotid artery endothelial dysfunction: a mechanism linking snoring and carotid atherosclerosis?. SLEEP 2011;34(6):751-757. PMID:21629363

Does the length of uvula affect the palatal implant outcome in the management of habitual snoring?

PubMed

Akpinar, Meltem Esen; Yigit, Ozgur; Kocak, Ismail; Altundag, Aytug

2011-05-01

To evaluate the impact of the uvular length on the efficacy of palatal implants in primary snoring. Prospective case series, tertiary hospital, snoring and respiratory sleep disorders center. Forty subjects with inserted palatal implants and diagnoses of primary snoring were included. All met the inclusion criteria of age >18 years, body mass index <30, apnea-hypopnea index <5, tonsil grade <3, soft-palate length >25 mm, and Friedman tongue position <3 following clinical, endoscopic, and polysomnographic evaluation. Epworth sleepiness scale (ESS) and the snoring-intensity visual analogue scale (VAS) were recorded before and 9 months after the implant. Four subjects with extruded implants were excluded; the remaining 36 subjects were divided into two groups, Group I and Group II, with uvular lengths of ≤15 mm and >15 mm, respectively. The study assessed and compared subjective outcome measures including the partner's satisfaction (PS), partner's reported improvement (PRI), 50% VAS and ESS reduction, and subjective success (SS) defined as 50% VAS reduction. The Student t test, χ(2) test, and logistic regression models were used for statistical evaluation. SS (50% VAS reduction), PS, PRI, and 50% ESS reduction were significantly higher in Group I (P < .001, P = .0257, P = .027, P < .001). The overall SS, PRI, PS, and 50% ESS reduction were 33%, 78%, 50%, and 50%, respectively. The uvular length was found to be the determinant factor of SS (P = .005; odds ratio = 0.75), PRI (P = .039; odds ratio = 0.83), and 50% ESS reduction (P = .038; odds ratio: 0.84) following implant insertion through stepwise logistic regression analysis. Excess uvular length (>15 mm) is an important anatomic feature decreasing the efficacy of palatal implants in snoring, and additional measures, such as uvulectomy, should be considered simultaneously for better outcomes (level 4). Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Chronic Snoring and Sleep in Children: A Demonstration of Sleep Disruption

ERIC Educational Resources Information Center

Lopes, M. Cecilia; Guilleminault, Christian

2007-01-01

Objective: Chronic snoring that does not adhere to the criteria for a diagnosis of obstructive sleep apnea syndrome may be associated with learning and behavioral problems. We investigated the sleep structure of chronic snorers who had an apnea-hypopnea index of less than 1 event per hour and analyzed the cyclic alternating pattern. Methods:…

Magnetic therapy is ineffective for the treatment of snoring and obstructive sleep apnea syndrome.

PubMed

Dexter, D

1997-03-01

Snoring and the obstructive sleep apnea syndrome are common and chronic ailments with potentially serious medical complications. There are several accepted treatments, but these can be uncomfortable, inconvenient, and expensive. A number of alternative treatments have been reported to be beneficial in the treatment of obstructive sleep apnea and snoring. They are advertised in magazines, on the radio and television, and on the Internet. The lay press is reporting about the effectiveness of these treatments without the benefit of clinical trials or scientific studies. Among the therapies currently being promoted for the treatment of snoring and sleep apnea is biomagnetic therapy. Unlike many of the other treatments which have not undergone scientific evaluation, biomagnetic therapy has been evaluated in the past. In fact, the evaluation of biomagnetic therapy is one of the first controlled scientific investigations found in the literature. This report showed that magnet therapy had no medicinal value. Despite this clear evidence, magnetic therapy continues to be utilized today and currently is being promoted for the treatment of snoring and sleep apnea. At out Sleep Disorder Center, we have had the opportunity to evaluate a patient with severe obstructive sleep apnea both before and after treatment with magnetic therapy, as well as with conventional therapy. Our study clearly indicates there was no benefit from magnetic therapy in this case. While alternative therapy may be helpful in the treatment of certain medical conditions, extreme care must be exercised to prevent inappropriate treatment or undertreat-ment of significant medical problems. Close clinical follow-up and controlled studies are important in determining the effectiveness of therapies.

The association of snoring and risk of obstructive sleep apnea with poor academic performance among university students.

PubMed

Khassawneh, Basheer Y; Alkhatib, Loiy L; Ibnian, Ali M; Khader, Yousef S

2018-04-20

Subjects with obstructive sleep apnea (OSA) have neurocognitive dysfunction. The aim of this study was to estimate the prevalence of symptoms and risk of OSA among university students and the association with academic performance. A cross-sectional study was conducted at Jordan University of Science and Technology. Students from faculties of engineering, medicine, nursing, pharmacy, and dentistry were asked to participate in this study. The Berlin Sleep Questionnaire was used to report symptoms and risk of OSA. Below average cumulative scores were considered poor academic performance. A total of 777 students (51% female; mean age, 20 years) completed the study questionnaire. According to the study definition, 42 students (5.4%) had high risk for OSA. Snoring was reported by 11% and daytime sleepiness and fatigue by 30%. Compared to female students, male students had more snoring (14.6 vs. 7.6%, p = 0.002) and higher risk for OSA (6.5 vs. 1.6%, p = 0.001). Both self-reported snoring and being at high risk for OSA were associated with poor academic performance (27.9 vs. 11.6% and 23.1 vs. 9.2%, respectively; p < 0.02). After adjusting for confounding factors, the odds ratio of having poor academic performance in students at high risk for OSA was 2.4 (CI 1.11-5.2, p = 0.027). Snoring and OSA were uncommon among university students. However, both were more common among male students and were associated with poor academic performance.

[Obstructive Sleep Apnea Syndrom during pregnancy: prevalence of main symptoms and relationship with Pregnancy Induced-Hypertension and Intra-Uterine Growth Retardation].

PubMed

Calaora-Tournadre, D; Ragot, S; Meurice, J C; Pourrat, O; D'Halluin, G; Magnin, G; Pierre, F

2006-04-01

To investigate the frequency of main symptoms of Obstructive Sleep Apnea Syndrom (OSAS) and their relationship with Pregnancy Induced-Hypertension (PIH) as well as Intrauterine Growth Retardation (IGR) as suggested by recent studies. Four hundred (and) thirty-eight enquiry forms completed during post-partum period were analysed, after exclusion of multiple pregnancies. Collected data were demographic characteristics, obstetrical events, sleep disorders during last trimester, screening of snoring and vigilance troubles with an Epworth score. Forty-five percentages of the patients reported to have habitual snoring during pregnancy. Among these, 85% were non-snorers before pregnancy. Daytime somnolence concerned 84,5% of the population with an Epworth score significatively increased (P<0,0001). The prevalence of PIH was found to be 4,5%, with two apparently independent risk factors: the body mass index (OR=1,1) and an association between snoring and increased vigilance trouble (OR=2,6). No statistical difference was found concerning IGR. SAS symptoms are frequent during pregnancy and snoring appears to be linked with PIH. However, polysomnographic data are not yet sufficient to explain pathophysiological mechanisms and find relevant diagnostic markers during pregnancy.

Latest trends in the assessment and management of paediatric snoring and sleep apnoea.

PubMed

Sharma, S D; Kanona, H; Kumar, G; Kotecha, B

2016-05-01

To investigate the assessment and management of paediatric snoring and obstructive sleep apnoea in UK otolaryngology departments. A telephone questionnaire survey of UK otolaryngology departments was conducted over a 16-week period. The response rate was 61 per cent (85 out of 139 trusts). Use of pre-operative pulse oximetry was reported by 84 per cent of respondents, mainly to diagnose obstructive sleep apnoea (73 per cent) or stratify post-operative risk (46 per cent). Thirty-one per cent of respondents reported using post-operative pulse oximetry. Twenty-five per cent of respondents have a dedicated management protocol for paediatric obstructive sleep apnoea and snoring. Thirty-four per cent require prior clinical commissioning group approval before performing surgery. Fifty-eight per cent of respondents reported following up their obstructive sleep apnoea patients after surgery. The mean follow-up period (±standard deviation) was 6.8 ± 1.2 weeks. There is variation in the assessment and management of paediatric snoring and obstructive sleep apnoea across the UK, particularly in the use of pre- and post-operative pulse oximetry monitoring, and further guidelines regarding this are necessary.

Adverse health effects among women living with heavy snorers.

PubMed

Ulfberg, J; Carter, N; Talbäck, M; Edling, C

2000-03-01

Women living with heavy snorers were more frequently affected by symptoms of insomnia, morning headache, daytime sleepiness, and fatigue than women living with non-snorers. Questionnaire data were collected from 1,032 women 30 to 64 years of age residing in Dalarna county, in mid-Sweden. There were indications of a "dose-response relationship" between the conjectured sound exposure and reported symptoms, regardless of whether the female herself snored. Sleeping in separate bedrooms did not seem to give the women any alleviation. The results point to a possible contributory cause of disturbed sleep, morning headache, and daytime sleepiness among women living with a snoring spouse. The results also indicate that prevention and treatment of snoring are important issues for the couple as well as for the snorer.

Preschool Children with Obstructive Sleep Apnea: The Beginnings of Elevated Blood Pressure?

PubMed Central

Nisbet, Lauren C.; Yiallourou, Stephanie R.; Biggs, Sarah N.; Nixon, Gillian M.; Davey, Margot J.; Trinder, John A.; Walter, Lisa M.; Horne, Rosemary S. C.

2013-01-01

Study Objectives: In adults and older children, snoring and obstructive sleep apnea (OSA) are associated with elevated blood pressure (BP). However, BP has not been assessed in preschool children, the age of highest OSA prevalence. We aimed to assess overnight BP in preschool children with snoring and OSA using pulse transit time (PTT), an inverse continuous indicator of BP changes. Design: Overnight polysomnography including PTT. Children were grouped according to their obstructive apnea-hypopnea index (OAHI); control (no snoring, with OAHI of one event or less per hour), primary snoring (OAHI one event or less per hour), mild OSA (OAHI greater than one event to five events per hour) and moderate-severe OSA (OAHI more than five events per hour). Setting: Pediatric sleep laboratory. Patients: There were 128 clinically referred children (aged 3-5 years) and 35 nonsnoring community control children. Measurement and Results: PTT was averaged for each 30-sec epoch of rapid eye movement (REM) or nonrapid eye movement (NREM) sleep and normalized to each child's mean wake PTT. PTT during NREM was significantly higher than during REM sleep in all groups (P < 0.001 for all). During REM sleep, the moderate-severe OSA group had significantly lower PTT than the mild and primary snoring groups (P < 0.05 for both). This difference persisted after removal of event-related PTT changes. Conclusions: Moderate-severe OSA in preschool children has a significant effect on pulse transit time during REM sleep, indicating that these young children have a higher baseline BP during this state. We propose that the REM-related elevation in BP may be the first step toward development of daytime BP abnormalities. Given that increased BP during childhood predicts hypertension in adulthood, longitudinal studies are needed to determine the effect of resolution of snoring and/or OSA at this age. Citation: Nisbet LC; Yiallourou SR; Biggs SN; Nixon GM; Davey MJ; Trinder JA; Walter LM; Horne RSC. Preschool children with obstructive sleep apnea: the beginnings of elevated blood pressure? SLEEP 2013;36(8):1219-1226. PMID:23904682

The association between sleep duration, snoring and prevalent type 2 diabetes mellitus with regard to gender and menopausal status: the CKB study in Zhejiang rural area, China.

PubMed

Wu, Hai-Bin; Wang, Hao; Hu, Ru-Ying; Zhong, Jie-Ming; Qian, Yi-Jian; Wang, Chun-Mei; Xie, Kai-Xu; Chen, Ling-Li; Gong, Wei-Wei; Guo, Yu; Bian, Zheng; Chen, Zheng-Ming; Li, Li-Ming; Yu, Min

2017-01-01

To evaluate the association between sleep duration, snoring and diabetes according to gender and menopausal status in rural China. The data were part of the baseline survey of China Kadoorie Biobank, from a rural county in the south-east costal Zhejiang province. Participants including 24,027 men and 33,677 women aged 30-79 years were enrolled during 2004-2008. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for diabetes. Sleep duration was shown to have a U-shaped association with diabetes in women, in particular in postmenopausal women after adjustment for potential confounders. Compared with 7-h sleepers, ORs (95 % CIs) of sleep duration ≤5 and ≥10 h for diabetes were 1.32 (1.02-1.69) and 1.30 (1.03-1.65), respectively, in postmenopausal women (P for quadratic trend = 0.016). However, this U-shaped association was not obvious in men and premenopausal women. Frequently snoring was positively associated with diabetes in all participants. However, this association was not independent of socioeconomic status, health behaviors, obesity and chronic diseases. With increasing sleep duration, the proportion of frequently snoring increased in all participants (P trend <0.05). Postmenopausal women had 23 % (95 % CI 6-44 %) higher odds of diabetes compared with premenopausal women, and the duration of menopause had cumulative effects on diabetes. Short and long sleep durations were significantly associated with diabetes in postmenopausal women, independent of potential confounders. The proportion of frequently snoring had linear trend with sleep duration. Postmenopausal status and the duration of menopause increased the odds of diabetes.

Sleep disordered breathing and daytime sleepiness are associated with poor academic performance in teenagers. A study using the Pediatric Daytime Sleepiness Scale (PDSS).

PubMed

Perez-Chada, Daniel; Perez-Lloret, Santiago; Videla, Alejandro J; Cardinali, Daniel; Bergna, Miguel A; Fernández-Acquier, Mariano; Larrateguy, Luis; Zabert, Gustavo E; Drake, Christopher

2007-12-01

Inadequate sleep and sleep disordered breathing (SDB) can impair learning skills. Questionnaires used to evaluate sleepiness in adults are usually inadequate for adolescents. We conducted a study to evaluate the performance of a Spanish version of the Pediatric Daytime Sleepiness Scale (PDSS) and to assess the impact of sleepiness and SDB on academic performance. A cross-sectional survey of students from 7 schools in 4 cities of Argentina. A questionnaire with a Spanish version of the PDSS was used. Questions on the occurrence of snoring and witnessed apneas were answered by the parents. Mathematics and language grades were used as indicators of academic performance. The sample included 2,884 students (50% males; age: 13.3 +/- 1.5 years) Response rate was 85%; 678 cases were excluded due to missing data. Half the students slept <9 h per night on weekdays. The mean PDSS value was 15.74 +/- 5.93. Parental reporting of snoring occurred in 511 subjects (23%); snoring was occasional in 14% and frequent in 9%. Apneas were witnessed in 237 cases (11%), being frequent in 4% and occasional in 7%. Frequent snorers had higher mean PDSS scores than occasional or nonsnorers (18 +/- 5, 15.7 +/- 6 and 15.5 +/- 6, respectively; P < 0.001). Reported snoring or apneas and the PDSS were significant univariate predictors of failure and remained significant in multivariate logistic regression analysis after adjusting for age, sex, body mass index, specific school attended, and sleep habits. Insufficient hours of sleep were prevalent in this population. The Spanish version of the PDSS was a reliable tool in middle-school-aged children. Reports of snoring or witnessed apneas and daytime sleepiness as measured by PDSS were independent predictors of poor academic performance.

Prognosis for Spontaneous Resolution of OSA in Children

PubMed Central

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

2015-01-01

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

Changes in emotional state of bed partners of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation: a pilot study.

PubMed

Uloza, Virgilijus; Balsevicius, Tomas; Sakalauskas, Raimundas; Miliauskas, Skaidrius; Zemaitiene, Nida

2010-06-01

To test the hypothesis that obstructive sleep apnea/hypopnea syndrome (OSAHS) and snoring affect not only the patients but also their bed partners, resulting in increased severity of symptoms of depression and sleepiness that may improve after the patients receive radiofrequency tissue ablation (RFTA) treatment. Thirty-six snoring and/or OSAHS patients from 24 to 63 years of age (mean age 41.67 +/- 9.86 years) underwent full-night polysomnography (PSG) and two sessions of RFTA at palatal or palatal and tongue base levels. Follow-up PSG was carried out within the period of 2-3 months after the second RFTA session. The baseline and posttreatment clinical tests battery consisting of Spielberg's Trait-State Anxiety Inventory, Beck Depression Inventory-Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess the changes in emotional state of study group patient's bed partners. Mean apnea/hypopnea index decreased from 13.16 +/- 10.76 preoperatively to 10.69 +/- 8.28 postoperatively (p = 0.043) for the entire group of the patients. A statistically significant decrease of the mean BDI-II scores (12.69 +/- 7.66 preoperatively to 9.17 +/- 6.88 postoperatively, p < 0.005) for the entire group of the patients' bed partners was observed. There was no statistically significant difference between pre- and posttreatment mean daytime sleepiness scores in both OSAHS and in simple snoring patients' bed partners when measured with ESS. Based on present study results, we conclude that RFTA therapy results in improved depression scores for the bed partners of snoring and OSAHS patients during a short follow-up period, as measured with BDI-II.

Assessment of Snoring and obstructive sleep apnoea in a Nigerian university: Association with cardiovascular risk factors

PubMed Central

Akintunde, Adeseye A.; Salawu, Afolabi A.; Opadijo, Oladimeji G.

2014-01-01

Background: Snoring remains under diagnosed in general population. It however has significant morbidity and mortality risk factors with multiple effects on the cardiovascular system. The Berlin questionnaire is a worldwide validated instrument to identify those at increased risk for obstructive sleep apnoea (OSA). Materials and Methods: In all, 206 workers of LAUTECH were invited to participate in the study. The Berlin questionnaire was used for this study. It was a cross-sectional study. Socio-demographic and clinical data were taken with a data form. Statistical Package for the Social Sciences software (SPSS 17.0) was used for statistical analysis. P < 0.05 was taken as statistically significant value. Results: The study participants consisted of 96 males (46.6%) and 110 (53.4%) females. The mean age was 45.3 ± 7.9 years. The mean body mass index was 28.5 ± 6.0 kg/m². The frequency of occurrence of snoring was 91 (44.2%) including 50 males (54.9% and 41 females (37.3 %, P <0.05). Using the Berlin score, 63 (30.6%) including 34 females (30.9%) were assessed to be at high risk for OSA. Snorers were more likely to be at higher risk of OSA compared to non snorers: odd risk was 113.8, relative risk was 3.3. Snoring was most likely to be associated with obesity, elevated blood pressure and male gender in this study. Conclusion: We concluded that snoring and high risk for sleep apnoea is common among this unselected University population and they are closely related to many conventional cardiovascular risk factors. Appropriate interventional strategies are indicated to reduce the burden of the increased morbidity and mortality associated with sleep apnoea in our population. PMID:25538364

Analysis of respiratory events in obstructive sleep apnea syndrome: Inter-relations and association to simple nocturnal features.

PubMed

Ghandeharioun, H; Rezaeitalab, F; Lotfi, R

2016-01-01

This study carefully evaluates the association of different respiration-related events to each other and to simple nocturnal features in obstructive sleep apnea-hypopnea syndrome (OSAS). The events include apneas, hypopneas, respiratory event-related arousals and snores. We conducted a statistical study on 158 adults who underwent polysomnography between July 2012 and May 2014. To monitor relevance, along with linear statistical strategies like analysis of variance and bootstrapping a correlation coefficient standard error, the non-linear method of mutual information is also applied to illuminate vague results of linear techniques. Based on normalized mutual information weights (NMIW), indices of apnea are 1.3 times more relevant to AHI values than those of hypopnea. NMIW for the number of blood oxygen desaturation below 95% is considerable (0.531). The next relevant feature is "respiratory arousals index" with NMIW of 0.501. Snore indices (0.314), and BMI (0.203) take the next place. Based on NMIW values, snoring events are nearly one-third (29.9%) more dependent to hypopneas than RERAs. 1. The more sever the OSAS is, the more frequently the apneic events happen. 2. The association of snore with hypopnea/RERA revealed which is routinely ignored in regression-based OSAS modeling. 3. The statistical dependencies of oximetry features potentially can lead to home-based screening of OSAS. 4. Poor ESS-AHI relevance in the database under study indicates its disability for the OSA diagnosis compared to oximetry. 5. Based on poor RERA-snore/ESS relevance, detailed history of the symptoms plus polysomnography is suggested for accurate diagnosis of RERAs. Copyright © 2015 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Prevalence of human papillomavirus and Epstein-Barr virus DNA in Chinese children with tonsillar and/or adenoidal hypertrophy.

PubMed

Xue, Xiao-cheng; Chen, Xiao-ping; Yao, Wen-hao; Zhang, Yi; Sun, Guang-bin; Tan, Xue-jun

2014-06-01

Tonsillar and adenoidal hypertrophy are prevalent otolaryngologic disorders in children, but their pathogenesis is largely unknown. The presence of human papillomavirus (HPV) and Epstein-Barr virus (EBV) DNA in 146 tonsil and/or adenoid tissue specimens from 104 Chinese children with tonsillar and/or adenoidal hypertrophy were screened using flow-through hybridization gene-chip technology and real-time fluorescence-based quantitative PCR. Then, the relationships between the prevalence of the viruses and other clinical characteristics of tonsillar and/or adenoidal hypertrophy were analyzed. No patient had HPV DNA. EBV DNA was detected in 19/42 (45.2%) tonsil tissues and 72/104 (69.2%) adenoid tissue specimens (P < 0.05). EBV DNA was not related to the patients' age, gender, disease course, or nationality, but children positive for EBV were less likely to snore; 14/15 (93.3%) patients who did not snore and 59/89 (66.3%) patients who snored were EBV positive. EBV DNA, but not HPV DNA was detected in Chinese children with tonsillar and/or adenoidal hypertrophy. Adenoid tissues might more susceptible than tonsil tissues to EBV infection. In addition, EBV infection did not aggravate snoring in patients with tonsillar and/or adenoidal hypertrophy. © 2014 Wiley Periodicals, Inc.

Accelerating Biomedical Signal Processing Using GPU: A Case Study of Snore Sound Feature Extraction.

PubMed

Guo, Jian; Qian, Kun; Zhang, Gongxuan; Xu, Huijie; Schuller, Björn

2017-12-01

The advent of 'Big Data' and 'Deep Learning' offers both, a great challenge and a huge opportunity for personalised health-care. In machine learning-based biomedical data analysis, feature extraction is a key step for 'feeding' the subsequent classifiers. With increasing numbers of biomedical data, extracting features from these 'big' data is an intensive and time-consuming task. In this case study, we employ a Graphics Processing Unit (GPU) via Python to extract features from a large corpus of snore sound data. Those features can subsequently be imported into many well-known deep learning training frameworks without any format processing. The snore sound data were collected from several hospitals (20 subjects, with 770-990 MB per subject - in total 17.20 GB). Experimental results show that our GPU-based processing significantly speeds up the feature extraction phase, by up to seven times, as compared to the previous CPU system.

The Efficacy of a Chinstrap in Treating Sleep Disordered Breathing and Snoring

PubMed Central

Bhat, Sushanth; Gushway-Henry, Neola; Polos, Peter G.; DeBari, Vincent A.; Riar, Sandeep; Gupta, Divya; Lysenko, Liudmila; Patel, Disha; Pi, Justin; Chokroverty, Sudhansu

2014-01-01

Study Objectives: A previously published case report suggested that a chinstrap alone might improve obstructive sleep apnea (OSA). We conducted this study to determine whether a chinstrap was a feasible alternative to continuous positive airway pressure (CPAP) in patients with OSA. Methods: 26 adult patients with OSA (apnea-hypopnea index [AHI] > 5/h on diagnostic polysomnogram [PSG]) underwent a modified split-night PSG, using only a chinstrap for the first 2 hours of sleep, followed by CPAP titration for the remainder of the night. Improvements in AHI, arterial oxygen saturation (SpO2), and snoring with chinstrap use were compared to results with optimal CPAP pressures. Results: There was no significant difference between the diagnostic PSG and the chinstrap portion of the split-night PSG in the following parameters: general AHI (median [IQR] 16.0/h [9.7-26.0] vs. 25.9/h [10.7-42.7]), SpO2 nadir (84.0% [80.5-87.5] vs. 87.0 [84.0-88.5]), AHI in REM sleep (26.7/h [16.8-43.7] vs. 42.4/h [21.3-57.7]), AHI in supine sleep (24.9/h [11.9-51.5] vs. 29.8/h [11.7-55.5]), snoring index (253.2/h [147.5-353.1] vs. 180.0/h [9.8-393.3]) or subjective snoring scale (3.0 [0.8-3.0] vs. 2.5 [0.4-3.0]). The AHI and SpO2 nadir in the 13 patients with mild OSA also did not improve with chinstrap use (9.6/h [8.1-12.2] vs. 10.6/h [6.8-35.4] and 87.0% [83.0-90.0] vs. 88.0% [87.0-89.0]). All these parameters showed significant improvement with optimal CPAP titration (p < 0.05). Conclusions: A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring. Citation: Bhat S, Gushway-Henry N, Polos PG, DeBari VA, Riar S, Gupta D, Lysenko L, Patel D, Pi J, Chokroverty S. The efficacy of a chinstrap in treating sleep disordered breathing and snoring. J Clin Sleep Med 2014;10(8):887-892. PMID:25126035

Omission of polysomnography in treatment of snoring: common reasons and medico-legal implications.

PubMed

Goh, Y H; Choy, D K

2000-07-01

Although polysomnography (PSG) is an important investigation in the treatment of snorers, it was observed that a large number of patients did not have pre-operative PSG assessment in a tertiary hospital in Singapore. Of the 118 Asian patients who underwent surgery for snoring from January 1997 to December 1998, 36 (30.5 per cent) of patients did not have pre-operative PSG and only 21 (17.8 per cent) of patients had post-operative PSG. In this cohort, 43 (36.4 per cent) patients presented with snoring as their only complaint and not associated with symptoms indicative of obstructive sleep apnoea syndrome (OSAS). Thirty-one of these 'simple snorers' underwent sleep studies with the following outcome: two (6.5 per cent) true simple snorers, two (6.5 per cent) upper airway resistance syndrome, nine (29 per cent) mild OSAS, seven (22.6 per cent) moderate OSAS and 11 (35.5 per cent) severe OSAS. Our study showed that without the aid of PSG, it would be difficult to predict the severity of sleep apnoea based on clinical history alone. In an increasingly litigation-conscious society such as Singapore, there is therefore little justification in omitting PSG in the treatment of snoring. The common reasons for omission of pre-operative PSG and the medico-legal implications are also discussed.

Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children.

PubMed

Urschitz, Michael S; Eitner, Steffen; Guenther, Anke; Eggebrecht, Esther; Wolff, Judith; Urschitz-Duprat, Pilar M; Schlaud, Martin; Poets, Christian F

2004-10-01

Sleep-disordered breathing is associated with impaired behavior and poor academic performance in children. We aimed to determine the extent of behavioral problems in snoring children, clarify the role of intermittent hypoxia, and test the reversibility of impaired behavior and poor academic performance. In 1144 children, habitual snoring (HS; snoring frequently or always) and impaired behavior were assessed using parental questionnaires. Intermittent hypoxia (ie, presence of > or =5 arterial oxygen desaturations by > or =4% or > or =1 desaturation to < or =90%) was investigated with pulse oximetry. Poor academic performance (grade 4-6 on a 6-point scale in mathematics, science, or spelling) was based on the last school report. HS, impaired behavior, and academic performance were reevaluated after 1 year. Adjusted odds ratios (ORs) were calculated using unconditional logistic regression. HS was significantly associated with hyperactive (OR: 2.4) and inattentive behavior (OR: 4.0), daytime tiredness (OR: 7.1), and sleepiness (OR: 2.6-4.8). These associations were independent of intermittent hypoxia. HS was also significantly associated with bad conduct (OR: 2.8), emotional symptoms (OR: 5.5), and peer problems (OR: 9.7). At follow-up, hyperactive and inattentive behavior but not academic success had significantly improved in children in whom HS had ceased. We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.

Laser plaltopharyngoplasty (LPPP)

NASA Astrophysics Data System (ADS)

Ru, Yi-zhong; Hu, Zai-Wen

1998-11-01

The snoring disease is apt to give rise to the obstructive seep apnea syndrome. Its clinical feature is noisy stertorous breathing during sleeping, accompanied with frequency stoppages of breathing. As the sufferer is subjected to a state of chronic anoxemia during the night, he is liable to spiritlessness, obliviousness, and disordered sensibility in the day. Arrhythmia, hypertension, etc. may follow in severer case. We have obtained satisfactory therapeutic effects by laser palatopharyngoplasty on 20 cases of snoring disease for the period February 1992 - January 1996.

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

PubMed Central

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

2015-01-01

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

Epidemiology of pediatric obstructive sleep apnea.

PubMed

Lumeng, Julie C; Chervin, Ronald D

2008-02-15

Pediatric obstructive sleep apnea (OSA) has become widely recognized only in the last few decades as a likely cause of significant morbidity among children. Many of the clinical characteristics of pediatric OSA, and the determinants of its epidemiology, differ from those of adult OSA. We systematically reviewed studies on the epidemiology of conditions considered part of a pediatric sleep-disordered breathing (SDB) continuum, ranging from primary snoring to OSA. We highlight a number of methodologic challenges, including widely variable methodologies for collection of questionnaire data about symptomatology, definitions of habitual snoring, criteria for advancing to further diagnostic testing, and objective diagnostic criteria for SDB or OSA. In the face of these limitations, estimated population prevalences are as follows: parent-reported "always" snoring, 1.5 to 6%; parent-reported apneic events during sleep, 0.2 to 4%; SDB by varying constellations of parent-reported symptoms on questionnaire, 4 to 11%; OSA diagnosed by varying criteria on diagnostic studies, 1 to 4%. Overall prevalence of parent-reported snoring by any definition in meta-analysis was 7.45% (95% confidence interval, 5.75-9.61). A reasonable preponderance of evidence now suggests that SDB is more common among boys than girls, and among children who are heavier than others, with emerging data to suggest a higher prevalence among African Americans. Less convincing data exist to prove differences in prevalence based on age. We conclude by outlining specific future research needs in the epidemiology of pediatric SDB.

Novel porous oral patches for patients with mild obstructive sleep apnea and mouth breathing: a pilot study.

PubMed

Huang, Tsung-Wei; Young, Tai-Horng

2015-02-01

Habitual open-mouth breathing (OMB) during sleep can cause snoring and obstructive sleep apnea (OSA). This study used a porous oral patch (POP) to treat patients with mild OSA and OMB during sleep. The subjective and objective outcomes were evaluated. Prospective study. Tertiary referral center. Patients with ≥5 events hourly but <15 hourly on the apnea-hypopnea index (AHI) were enrolled. All patients slept with their mouths closed by using the POP, which is a porous skin pad consisting of 3 layers: silicone sheet, polyurethane foam, and polyurethane film. Before treatment and during treatment, subjective outcomes were assessed using the Epworth Sleepiness Scale (ESS) and visual analog scale (VAS) of snoring. Objective outcomes were assessed using polysomnography and cephalometry. Thirty patients were enrolled in this study. All patients slept with their mouths closed while using a POP. The ESS and VAS of snoring scores were 8.1 ± 1.5 and 7.5 ± 2.0 before the POP, respectively, in contrast to 5.2 ± 1.6 and 2.4 ± 1.4 while using a POP, respectively (P < .05). The median AHI score was significantly decreased by using a POP from 12.0 per hour before treatment to 7.8 per hour during treatment (P < .01). The snoring intensity and median snoring index were 49.1 ± 10.8 dB and 146.7 per hour before the POP, respectively, which decreased to 41.1 ± 7.8 dB and 40.0 per hour while using a POP, respectively (P < .01). Cephalometry revealed that the retropalatal space and retrolingual space were 7.4 ± 1.6 mm and 6.8 ± 2.5 mm before the POP, respectively, compared with 8.6 ± 1.2 mm and 10.2 ± 1.8 mm during treatment, respectively (P < .01). The POP is a useful device to treat patients with mild OSA and habitual OMB. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

The efficacy of a chinstrap in treating sleep disordered breathing and snoring.

PubMed

Bhat, Sushanth; Gushway-Henry, Neola; Polos, Peter G; DeBari, Vincent A; Riar, Sandeep; Gupta, Divya; Lysenko, Liudmila; Patel, Disha; Pi, Justin; Chokroverty, Sudhansu

2014-08-15

A previously published case report suggested that a chinstrap alone might improve obstructive sleep apnea (OSA). We conducted this study to determine whether a chinstrap was a feasible alternative to continuous positive airway pressure (CPAP) in patients with OSA. 26 adult patients with OSA (apnea-hypopnea index [AHI] > 5/h on diagnostic polysomnogram [PSG]) underwent a modified split-night PSG, using only a chinstrap for the first 2 hours of sleep, followed by CPAP titration for the remainder of the night. Improvements in AHI, arterial oxygen saturation (SpO2), and snoring with chinstrap use were compared to results with optimal CPAP pressures. There was no significant difference between the diagnostic PSG and the chinstrap portion of the split-night PSG in the following parameters: general AHI (median [IQR] 16.0/h [9.7-26.0] vs. 25.9/h [10.7-42.7]), SpO2 nadir (84.0% [80.5-87.5] vs. 87.0 [84.0-88.5]), AHI in REM sleep (26.7/h [16.8-43.7] vs. 42.4/h [21.3-57.7]), AHI in supine sleep (24.9/h [11.9-51.5] vs. 29.8/h [11.7-55.5]), snoring index (253.2/h [147.5-353.1] vs. 180.0/h [9.8-393.3]) or subjective snoring scale (3.0 [0.8-3.0] vs. 2.5 [0.4-3.0]). The AHI and SpO2 nadir in the 13 patients with mild OSA also did not improve with chinstrap use (9.6/h [8.1-12.2] vs. 10.6/h [6.8-35.4] and 87.0% [83.0-90.0] vs. 88.0% [87.0-89.0]). All these parameters showed significant improvement with optimal CPAP titration (p < 0.05). A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring.

Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival

PubMed Central

Phipps, Amanda I.; Bhatti, Parveen; Neuhouser, Marian L.; Chen, Chu; Crane, Tracy E.; Kroenke, Candyce H.; Ochs-Balcom, Heather; Rissling, Michelle; Snively, Beverly M.; Stefanick, Marcia L.; Treggiari, Miriam M.; Watson, Nathaniel F.

2016-01-01

Study Objectives: Poor sleep quality and short sleep duration have been associated with elevated risk for several cancer types; however, the relationship between sleep and cancer outcomes has not been well characterized. We assessed the association between pre-diagnostic sleep attributes and subsequent cancer survival within the Women's Health Initiative (WHI). Methods: We identified WHI participants in whom a first primary invasive cancer had been diagnosed during follow-up (n = 21,230). Participants provided information on sleep characteristics at enrollment. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between these pre-diagnostic sleep characteristics and cancer-specific survival for all cancers combined and separately for common cancers. Analyses were adjusted for age, study arm, cancer site, marital status, income, smoking, physical activity, and time to diagnosis. Results: No individual pre-diagnostic sleep characteristics were found to be significantly associated with cancer survival in analyses of all cancer sites combined; however, women who reported short sleep duration (≤ 6 h sleep/night) combined with frequent snoring (≥ 5 nights/w experienced significantly poorer cancer-specific survival than those who reported 7–8 h of sleep/night and no snoring (HR = 1.32, 95% CI: 1.14–1.54). Short sleep duration (HR = 1.46, 95% CI: 1.07–1.99) and frequent snoring (HR = 1.34, 95% CI: 0.98–1.85) were each associated with poorer breast cancer survival; those reporting short sleep combined with frequent snoring combined had substantially poorer breast cancer survival than those reporting neither (HR = 2.14, 95% CI: 1.47–3.13). Conclusions: Short sleep duration combined with frequent snoring reported prior to cancer diagnosis may influence subsequent cancer survival, particularly breast cancer survival. Citation: Phipps AI, Bhatti P, Neuhouser ML, Chen C, Crane TE, Kroenke CH, Ochs-Balcom H, Rissling M, Snively BM, Stefanick ML, Treggiari MM, Watson NF. Pre-diagnostic sleep duration and sleep quality in relation to subsequent cancer survival. J Clin Sleep Med 2016;12(4):495–503. PMID:26612513

Sleep Disordered Breathing And Daytime Sleepiness Are Associated With Poor Academic Performance In Teenagers. A Study Using The Pediatric Daytime Sleepiness Scale (PDSS)

PubMed Central

Perez-Chada, Daniel; Perez-Lloret, Santiago; Videla, Alejandro J.; Cardinali, Daniel; Bergna, Miguel A.; Fernández-Acquier, Mariano; Larrateguy, Luis; Zabert, Gustavo E.; Drake, Christopher

2007-01-01

Study Objectives: Inadequate sleep and sleep disordered breathing (SDB) can impair learning skills. Questionnaires used to evaluate sleepiness in adults are usually inadequate for adolescents. We conducted a study to evaluate the performance of a Spanish version of the Pediatric Daytime Sleepiness Scale (PDSS) and to assess the impact of sleepiness and SDB on academic performance. Design: A cross-sectional survey of students from 7 schools in 4 cities of Argentina. Measurements: A questionnaire with a Spanish version of the PDSS was used. Questions on the occurrence of snoring and witnessed apneas were answered by the parents. Mathematics and language grades were used as indicators of academic performance. Participants: The sample included 2,884 students (50% males; age: 13.3 ± 1.5 years) Results: Response rate was 85%; 678 cases were excluded due to missing data. Half the students slept <9 h per night on weekdays. The mean PDSS value was 15.74 ± 5.93. Parental reporting of snoring occurred in 511 subjects (23%); snoring was occasional in 14% and frequent in 9%. Apneas were witnessed in 237 cases (11%), being frequent in 4% and occasional in 7%. Frequent snorers had higher mean PDSS scores than occasional or nonsnorers (18 ± 5, 15.7 ± 6 and 15.5 ± 6, respectively; P < 0.001). Reported snoring or apneas and the PDSS were significant univariate predictors of failure and remained significant in multivariate logistic regression analysis after adjusting for age, sex, body mass index, specific school attended, and sleep habits. Conclusions: Insufficient hours of sleep were prevalent in this population. The Spanish version of the PDSS was a reliable tool in middle–school-aged children. Reports of snoring or witnessed apneas and daytime sleepiness as measured by PDSS were independent predictors of poor academic performance. Citation: Perez-Chada D; Perez-Lloret S; Videla AJ; Cardinali D; Bergna MA; Fernández-Acquier M; Larrateguy L; Zabert GE; Drake C. Sleep disordered breathing and daytime sleepiness are associated with poor academic performance in teenagers. A study using the pediatric daytime sleepiness scale (PDSS). SLEEP 2007;30(12):1698-1703. PMID:18246979

Impact of sleep disordered breathing on behaviour among elementary school-aged children: a cross-sectional analysis of a large community-based sample.

PubMed

Smith, Dale L; Gozal, David; Hunter, Scott J; Philby, Mona F; Kaylegian, Jaeson; Kheirandish-Gozal, Leila

2016-12-01

Sleep disordered breathing (SDB) in children has been associated with inattention, impulsivity and hyperactivity, but the associations between SDB severity and the type and severity of behavioural disruption are unclear.1022 children aged 5-7 years old prospectively underwent sleep studies and behavioural assessments through completion of standardised instruments. Participants were subdivided into four categorical groups based on the apnoea-hypopnoea index (AHI; measured per hour of total sleep time (hTST)), i.e. Group 1: nonsnoring and AHI <1 hTST -1 ; Group 2: habitual snoring and AHI <1 hTST -1 ; Group 3: habitual snoring and AHI 1-5 hTST -1 ; and Group 4: habitual snoring and AHI >5 hTST -1 , followed by comparisons of behavioural functioning across the groups.All 10 behavioural variables differed significantly between Group 1 and all other groups. Post hoc comparisons indicated that Group 2 was the most impaired for most behavioural measures. Furthermore, differences between Group 2 and more severe sleep pathology conditions were rarely significant.This large community-based paediatric cohort confirms earlier findings highlighting a significant impact of SDB on behavioural regulation, with the greatest impact being already apparent among habitually snoring children. Thus, a likely low asymptote exists regarding SDB behavioural impact, such that further increases in severity do not measurably increase parent-rated difficulties with behavioural regulation relative to controls. Our findings do support the need for considering early intervention, particularly among those children manifesting a behavioural impact of SDB. Copyright ©ERS 2016.

Physics-based analysis and control of human snoring

NASA Astrophysics Data System (ADS)

Sanchez, Yaselly; Wang, Junshi; Han, Pan; Xi, Jinxiang; Dong, Haibo

2017-11-01

In order to advance the understanding of biological fluid dynamics and its effects on the acoustics of human snoring, the study pursued a physics-based computational approach. From human magnetic resonance image (MRI) scans, the researchers were able to develop both anatomically and dynamically accurate airway-uvula models. With airways defined as rigid, and the uvula defined as flexible, computational models were created with various pharynx thickness and geometries. In order to determine vortex shedding with prescribed uvula movement, the uvula fluctuation was categorized by its specific parameters: magnitude, frequency, and phase lag. Uvula vibration modes were based on one oscillation, or one harmonic frequency, and pressure probes were located in seven different positions throughout the airway-uvula model. By taking fast Fourier transforms (FFT) from the pressure probe data, it was seen that four harmonics were created throughout the simulation within one oscillation of uvula movement. Of the four harmonics, there were two pressure probes which maintained high amplitudes and led the researcher to believe that different vortices formed with different snoring frequencies. This work is supported by the NSF Grant CBET-1605434.

Sleep duration, snoring habits, and cardiovascular disease risk factors in an ethnically diverse population.

PubMed

Mosca, Matthew; Aggarwal, Brooke

2012-01-01

Lack of sleep has been associated with an increased risk for cardiovascular disease (CVD) and all-cause mortality, but the mechanisms are not fully understood. Prior research has often been conducted in select populations and has not consistently adjusted for confounders, especially psychosocial factors. The aims of this study were to assess the association between sleep habits and established risk factors for CVD and to evaluate potential interactions by race and gender. Participants were part of a CVD screening and educational outreach program in New York City. Free-living men older than 40 years and women older than 50 years (n = 371, mean age = 60 years, 57% women, 60% racial/ethnic minorities) were systematically assessed for CVD risk (including traditional, lifestyle, and psychosocial risk factors) and completed a standardized questionnaire regarding sleep habits (including sleep duration and snoring). Lipids were analyzed by validated finger-stick technology. Stress at work and at home was assessed using a validated screening tool from the INTERHEART study. Associations between participants' sleep habits and CVD risk factors/demographic factors were assessed using multivariable logistic regression. The proportion of participants who reported sleeping less than 6 hours per night on average was 28%, and 52% of participants reported snoring. Sleeping less than 6 hours per night was significantly (P < .05) associated with female gender, being single, increased stress at home, increased financial stress, and low-density lipoprotein cholesterol (LDL-C) level. Gender modified the association between sleep duration and LDL-C level (P = .04): Sleeping less than 6 hours per night was significantly associated with reduced LDL-C level among women and increased LDL-C level among men. Snoring was significantly associated with low high-density lipoprotein cholesterol (HDL-C) level (<40 mg/dL for men/<50 mg/dL for women), being married, increased stress at work and at home, less than 30 minutes of exercise per day, less than 5 servings of fruits and vegetables per day, and being overweight/obese (body mass index ≥25 kg/m). The association between snoring and low HDL-C level remained significant in logistic regression models adjusted for demographic confounders (odds ratio, 1.83; 95% confidence interval, 1.06-3.19) but not after adjustment for body mass index greater than 25 kg/m. Sleeping less than 6 hours per night was associated with several traditional and psychosocial CVD risk factors, and snoring was associated with low HDL-C level, likely mediated through overweight/obesity. These data may have significance for health care providers to identify individuals who may be at increased CVD risk based on sleep habits.

Sleep History and Hypertension Burden in First-Generation Chinese Migrants Settled in Italy: The CHIinese In Prato Cross-Sectional Survey

PubMed Central

Modesti, Pietro A.; Calabrese, Maria; Perruolo, Eleonora; Bussotti, Alessandro; Malandrino, Danilo; Bamoshmoosh, Mohamed; Biggeri, Annibale; Zhao, Dong

2016-01-01

Abstract Migration flows from China are largely directed towards the South of Europe, Chinese being now the third largest overseas-born population in Italy. The aim of the study was to investigate hypertension burden and self-reported sleep disorders among 1608 first-generation Chinese migrants aged 16 to 59 years settled in Prato and recruited in a cross-sectional survey. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg or self-reported antihypertensive treatment; potential impact of sleep disorders was analyzed by logistic regression adjusted for age, sex, marital status, education, health insurance, current smoking, parental hypertension, alcohol drinking, overweight or obesity, central obesity, diabetes, high total cholesterol, and high triglycerides. Among the 1608 participants, 21.7% were hypertensive (age-standardized prevalence 19.2%; 95% Cl: 18.5–20.0); 54% of hypertensive subjects were aware of their condition; 70% of aware hypertensive subjects received drugs, and 39% of treated subjects had blood pressure controlled. Self-reported snoring increased the risk of hypertension; when compared with no snoring, the age- and sex-adjusted OR for hypertension of snoring 3 to 6 d/week was 2.11 (95% Cl: 1.48–3.01) and 2.48 (95% Cl: 1.79–3.46) of snoring every day. When compared with a sleep duration ≤5 hours, subjects with sleep duration of 7 hours had reduced risk of high triglycerides (adjusted OR: 0.66; 95% Cl: 0.43–0.95). Despite a high level of awareness, low treatment rates for hypertension were observed among Chinese participants, independently of health insurance. Sleep history is to be considered in screening and prevention programs. PMID:27057856

Characteristics and correlates of sleep duration, daytime napping, snoring and insomnia symptoms among 0.5 million Chinese men and women.

PubMed

Chen, Yiping; Kartsonaki, Christiana; Clarke, Robert; Guo, Yu; Yu, Canqing; Bian, Zheng; Jiang, Qilian; Li, Shanpeng; Chen, Junshi; Li, Liming; Chen, Zhengming

2018-04-01

Inadequate sleep duration and insomnia can affect both physical and mental health. There is limited evidence, however, on characteristics and correlates of sleep patterns and insomnia in urban and rural China. This cross-sectional study, involving 512,891 adults aged 30-79 years from ten (five urban and five rural) diverse areas in China, recorded detailed information, using interviewer-administered laptop-based questionnaires, on sleep patterns (duration, daytime napping and snoring) and insomnia symptoms. Logistic regression was used to examine the associations of sleep patterns and insomnia symptoms with a range of socio-economic, lifestyle, behaviour and health-related factors. Overall, the mean (SD) sleep duration was 7.38 (1.37) h, with 23% reporting short (≤6 h) and 16% reporting long (≥9 h) sleep duration, 21% taking daytime naps and 22% having frequent snoring. Overall, 17% reported having insomnia symptoms, with a higher proportion in women than in men (19% vs 13%), in rural than in urban residents (19% vs 15%), and in individuals who were living alone (23%). The adjusted odds ratios (ORs) of having insomnia symptoms were significantly higher among people with major depressive episodes (6.10, 95% CI: 5.69-6.55), generalised anxiety disorders (7.46, 6.65-8.37) and any chronic diseases (1.46; 1.44-1.49). In contrast, the ORs of insomnia symptoms were significantly lower among those reporting napping (0.77, 0.75-0.78) and frequent snoring (0.86, 0.84-0.87). Among Chinese adults, sleep patterns varied greatly by socio-economic, lifestyle and health-related factors. The risk of insomnia symptoms was associated with both poor mental and physical health status. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing.

PubMed

Walter, Lisa M; Biggs, Sarah N; Nisbet, Lauren C; Weichard, Aidan J; Hollis, Samantha L; Davey, Margot J; Anderson, Vicki; Nixon, Gillian M; Horne, Rosemary S C

2015-10-15

Sleep disordered breathing (SDB) in preschool-aged children is common, but long-term outcomes have not been investigated. We aimed to compare sleep and respiratory parameters in preschool children to examine the effects of treatment or non-treatment after 3 years. Children (3-5 years) diagnosed with SDB (n = 45) and non-snoring controls (n = 30) returned for repeat overnight polysomnography (39% of original cohort), 3 years following baseline polysomnography. Children with SDB were grouped according to whether they had received treatment or not. SDB resolution was defined as an obstructive apnea hypopnea index (OAHI) ≤ 1 event/h, no snoring detected on polysomnography and habitual snoring not indicated by parents on questionnaire. Fifty-one percent (n = 23) of the children with SDB were treated. Overall, SDB resolved in 49% (n = 22), either spontaneously (n = 8) or with treatment (n = 14). SDB remained unresolved in 39% (n = 9) of those treated and 64% (n = 14) of the children who were untreated. Two of the non-snoring controls developed SDB at follow-up. The treated group had significantly lower OAHI (p < 0.01), respiratory disturbance index (p < 0.001), total arousal and respiratory arousal indices (p < 0.01 for both) at follow-up compared with baseline. There were no differences between studies for the untreated group. Although treatment resulted in an improvement in indices related to SDB severity, 39% had SDB 3 years following diagnosis. These findings highlight that parents should be made aware of the possibility that SDB may persist or recur several years after treatment. This is relevant regardless of the severity of SDB at baseline and the treatment given. © 2015 American Academy of Sleep Medicine.

Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.

PubMed

Larrain, Augusto; Kapur, Vishesh K; Gooley, Ted A; Pope, Charles E

2010-04-15

To determine the effect of the drug combination domperidone and pseudoephedrine on nocturnal oximetry measurements and daytime sleepiness in patients with obstructive sleep apnea. We recruited patients with severe snoring and apneic episodes willing to undergo repeated nocturnal oximetry testing. Following baseline clinical history, Epworth Sleepiness Scale administration, and home overnight nocturnal oximetry, patients were started on weight-adjusted doses of domperidone and pseudoephedrine. Follow-up oximetry studies were performed at the patient's convenience. On the final visit, a repeat clinical history, Epworth score, and oximetry were obtained. Seventeen of 23 patients noted disappearance of snoring and apneic episodes. Another 2 patients reported improvement in snoring and no apneic episodes. All but one patient had a decrease in Epworth scores (mean decrease 9.4 (95% CI, 6.8-12.1, p < 0.0001). Mean oxygen saturation (2.5; 95% Cl, 0.66-4.41, p = 0.008), percent time with oxygen saturation < 90% (14.8; 95% CI, 24.4 to 5.2, p = 0.003), and the 4% oxygen desaturation index (18.2; 95% CI, 27.3 to 9.1, p < 0.0001) improved significantly. No adverse effects of treatment were noted. The combination of domperidone and pseudoephedrine improved self reported snoring and sleepiness, and may have improved apneic episodes and sleep-related nocturnal oxygen desaturation in patients with obstructive sleep apnea provided the proportion of time spent asleep did not diminish. This drug combination warrants further study as a treatment for obstructive sleep apnea. Obstructive sleep apnea; oximetry; sleepiness; domperidone; pseudoephedrine; pharmacotherapy; desaturation; treatment Larrain A; Kapur VK; Gooley TA; Pope CE. Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.

Pharmacological Treatment of Obstructive Sleep Apnea with a Combination of Pseudoephedrine and Domperidone

PubMed Central

Larrain, Augusto; Kapur, Vishesh K.; Gooley, Ted A.; Pope, Charles E.

2010-01-01

Study Objectives: To determine the effect of the drug combination domperidone and pseudoephedrine on nocturnal oximetry measurements and daytime sleepiness in patients with obstructive sleep apnea. Methods: We recruited patients with severe snoring and apneic episodes willing to undergo repeated nocturnal oximetry testing. Following baseline clinical history, Epworth Sleepiness Scale administration, and home overnight nocturnal oximetry, patients were started on weight-adjusted doses of domperidone and pseudoephedrine. Follow-up oximetry studies were performed at the patient's convenience. On the final visit, a repeat clinical history, Epworth score, and oximetry were obtained. Results: Sixteen of 23 patients noted disappearance of snoring and apneic episodes. Another 3 patients reported improvement in snoring and no apneic episodes. All but one patient had a decrease in Epworth scores (mean decrease 9.9 (95% CI, 7.2-12.6, p < 0.0001). Mean oxygen saturation (2.5; 95% CI, 0.66-4.41, p = 0.008), percent time with oxygen saturation < 90% (14.8; 95% CI, 24.4 to 5.2, p = 0.003), and the 4% oxygen desaturation index (18.2; 95% CI, 27.3 to 9.1, p < 0.0001) improved significantly. No adverse effects of treatment were noted. Conclusions: The combination of domperidone and pseudoephedrine improved self reported snoring and sleepiness, and may have improved apneic episodes and sleep-related nocturnal oxygen desaturation in patients with obstructive sleep apnea provided the proportion of time spent asleep did not diminish. This drug combination warrants further study as a treatment for obstructive sleep apnea. Citation: Larrain A; Kapur VK; Gooley TA; Pope CE. Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone. J Clin Sleep Med 2010;6(2):117-123. PMID:20411686

Sleep disturbances and cognitive decline in the Northern Manhattan Study

PubMed Central

Ramos, Alberto R.; Gardener, Hannah; Rundek, Tatjana; Elkind, Mitchell S.V.; Boden-Albala, Bernadette; Dong, Chuanhui; Cheung, Ying Kuen; Stern, Yaakov; Sacco, Ralph L.

2016-01-01

Objective: To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. Methods: The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 ± 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 ± 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis–derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain. Results: In the cross-sectional analysis, adjusting for demographics and the NOMAS vascular risk score, participants with frequent snoring had worse executive function (β = −12; p = 0.04) and processing speed (β = −13; p = 0.02), but no difference in with episodic memory or language. Those with severe daytime sleepiness (β = −26; p = 0.009) had worse executive function, but no changes in the other NP domains. There was no cross-sectional association between sleep duration and NP performance. Frequent snoring (β = −29; p = 0.0007), severe daytime sleepiness (β = −29; p = 0.05), and long sleep duration (β = −29; p = 0.04) predicted decline in executive function, adjusting for demographic characteristics and NOMAS vascular risk score. Sleep symptoms did not explain change in episodic memory, language, or processing speed. Conclusions: In this race-ethnically diverse community-based cohort, sleep symptoms led to worse cognitive performance and predicted decline in executive function. PMID:27590286

SNORAP: A Device for the Correction of Impaired Sleep Health by Using Tactile Stimulation for Individuals with Mild and Moderate Sleep Disordered Breathing.

PubMed

Yağanoğlu, Mete; Kayabekir, Murat; Köse, Cemal

2017-09-01

Sleep physiology and sleep hygiene play significant roles in maintaining the daily lives of individuals given that sleep is an important physiological need to protect the functions of the human brain. Sleep disordered breathing (SDB) is an important disease that disturbs this need. Snoring and Obstructive Sleep Apnea Syndrome (OSAS) are clinical conditions that affect all body organs and systems that intermittently, repeatedly, with at least 10 s or more breathing stops that decrease throughout the night and disturb sleep integrity. The aim of this study was to produce a new device for the treatment of patients especially with position and rapid eye movement (REM)-dependent mild and moderate OSAS. For this purpose, the main components of the device (the microphone (snore sensor), the heart rate sensor, and the vibration motor, which we named SNORAP) were applied to five volunteer patients (male, mean age: 33.2, body mass index mean: 29.3). After receiving the sound in real time with the microphone, the snoring sound was detected by using the Audio Fingerprint method with a success rate of 98.9%. According to the results obtained, the severity and the number of the snoring of the patients using SNORAP were found to be significantly lower than in the experimental conditions in the apnea hypopnea index (AHI), apnea index, hypopnea index, in supine position's AHI, and REM position's AHI before using SNORAP (Paired Sample Test, p < 0.05). REM sleep duration and nocturnal oxygen saturation were significantly higher when compared to the group not using the SNORAP (Paired Sample Test, p < 0.05).

[Current research of dentistry on obstructive sleep apnea hypopnea syndrome].

PubMed

Zeng, Xiang-long; Gao, Xue-mei

2009-02-18

Obstructive sleep apnea hypopnea syndrome (OSAHS) has been the main research area of the Dental Therapy Center for Sleep Apnea, Peking University School and Hospital of Stomatology. The basic research in the center includes: epidemic survey of OSAHS and snoring in a Beijing population, setting up the cephalometric and MRI standard of airway and surrounding structures for non-snoring Chinese, aetology exploring OSAHS from views of airway size, craniofacial form, neck circumference and genioglossus muscle activity. Clinically, different dental appliances were developed. The treatment effects of the oral appliances for OSAHS patients were evaluated quantitatively. Two and three dimension changes of the airway and surrounding structures, genioglossus muscle activity, as well as snoring loudness following mandible advancing and opening were studied. Besides, research was expended to OSAHS in children recently. Under the support of National Nature Science Foundation 7 PhD and 3 MS students have graduated. More than 60 papers were published domestically and abroad and two awards were received from the National Ministry of Education and Chinese Medical Association in the past 10 years. This paper is a review of the past and current situation of dental research on OSAHS in China.

Snoring and Sleep Apnea

MedlinePlus

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Elevated serum aminotransferase levels in children at risk for obstructive sleep apnea.

PubMed

Kheirandish-Gozal, Leila; Sans Capdevila, Oscar; Kheirandish, Ebrahim; Gozal, David

2008-01-01

Fatty liver disease (FLD) is a highly prevalent condition in obese (Ob) children, who are at increased risk for obstructive sleep apnea (OSA). However, the contribution of OSA to FLD remains unknown. Prospective study. Polysomnographic evaluation and assessment of plasma levels of insulin, glucose, and lipids, and liver function tests. A total of 518 consecutive snoring children 4 to 17 years of age who were being evaluated for habitual snoring and suspected OSA. A total of 376 children had body mass index z score of < 1.20 (non-Ob children), 3 children (<1%) had elevated serum aminotransferase (LFT) levels, and 248 had OSA (65.9%). Among the 142 overweight/Ob children, 46 had elevated LFT levels (32.4%); of these children, 42 had OSA (91.3%). In contrast, OSA was present in only 71.8% of Ob children without elevated LFT level (p < 0.01). Insulin resistance and hyperlipidemia were more likely to occur in children with FLD. Furthermore, FLD was improved after treatment of OSA in 32 of 42 Ob children (p < 0.0001). Increased liver enzyme levels are frequently found in Ob snoring children, particularly among those with OSA and/or metabolic dysfunction. Effective treatment of OSA results in improved liver function test results in the vast majority of these patients.

Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation.

PubMed

Pilaete, Karen; De Medts, Joris; Delsupehe, Kathelijne Godelieve

2014-05-01

Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41% of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting.

Insufficient sleep and suicidality in adolescents.

PubMed

Lee, Yu Jin; Cho, Seong-Jin; Cho, In Hee; Kim, Seog Ju

2012-04-01

To investigate the association between the behaviorally induced insufficient sleep and suicidality among adolescents. A population-based, cross-sectional survey. General community. A sample of 8,530 students (grades 7-11) was recruited in the Republic of Korea. The participants were 8,010 students who completed all questionnaires. N/A. The survey included the Beck Scale for Suicidal Ideation (SSI), the Beck Depression Inventory (BDI), a modified Epworth Sleepiness Scale (ESS), and questionnaires about sleep (weekday/weekend sleep schedule/duration, insomnia and snoring). Adolescents with behaviorally induced insufficient sleep syndrome (BISS) had higher SSI scores than those who slept ≥ 7 hours on weekdays, even after controlling for age, sex, and BDI score (F = 11.71, P < 0.001). After controlling for age and sex, longer weekend oversleep and shorter weekday sleep duration predicted a higher SSI score (β = 0.19, P < 0.001; β = 0.37, P < 0.001). The association between weekend oversleep and SSI score remained significant even after additionally controlling for BDI and ESS scores and presence of insomnia and snoring (β = 0.07, P < 0.01). BISS was found to be associated with increased suicidality. Weekend oversleep was associated with suicidality independently of depression, daytime sleepiness, snoring, and insomnia. The study findings suggest that chronic sleep restriction among adolescents may increase suicidal risk.

Comparing the clinical profile of non obese children with sleep apnea and snoring.

PubMed

Stefanini, Daniele de Oliveira Soares; Barros, Emília Leite de; Stefanini, Renato; Pradella-Hallinan, Márcia Lurdes de Cássia; Pignatari, Shirley Shizue Nagata; Fujita, Reginaldo Raimundo

2012-10-01

Few studies in the literature have looked into the cardiovascular and metabolic effects of Obstructive Sleep Apnea Syndrome (OSAS) in children. This study aims to evaluate the metabolic profile of non-obese children with OSAS. Fifty-two children were enrolled in this study, 21 girls and 31 boys. Patients were divided into two groups: OSAS (28 children) and Snore (22 children) according to polysomnographic evaluation. All children were submitted to ENT examination, measurements of weight, height and blood pressure. Blood samples were tested for hemoglobin, hematocrit, fasting glucose, fasting insulin, triglycerides, total cholesterol, HDL, LDL, VLDL, TSH and T4. The gathered data sets were compared between groups and also within the OSAS group according to the severity of the syndrome. The children from both groups had no alterations in blood pressure levels. The results of the blood tests were normal for both groups. Results of hemoglobin, hematocrit, and HDL were all significantly higher in the Snore group when compared to the OSAS group; by their turn, VLDL levels were higher in the OSAS group. There was no statistical difference between the groups based on OSAS severity. Non-obese children with OSAS present no significant alterations in metabolic tests or blood pressure levels.

Treatment Options for Adults with Snoring

MedlinePlus

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Reconstructive procedures for disturbed functions within the upper airway: pharyngeal breathing/snoring

PubMed Central

Verse, Thomas

2005-01-01

Breathing disorders which have their origin within the pharynx mainly occur during sleep. These so-called obstructive sleep-related breathing disorders include three different disturbances which have to be distinguished properly: simple snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA). Each disturbance requires a different treatment. Simple snoring does not affect the physical health of the snorer himself, but often leads to social problems due to the annoying character of the breathing sounds. Appropriate treatment modalities are oral devices and transcutaneous or ttransmucosal electrical stimulation of the muscles of the floor of the mouth via surface electrodes. As reconstructive surgical procedures adenotomies, tonsillectomies, tonsillotomies, or adenotonsillectomies are successfully used in children. Moreover, in adults radiofrequency treatments of the tonsils, the soft palate and of the base of tongue, as well as uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP) and palatal implants are adequate treatments for simple snoring. Adequate therapies for UARS and mild OSA (less than 20 breathing events per hour of sleep) are oral appliances. Nasal continuos positive airway pressure (NCPAP) ventilation is a very successful treatment modality, but shows low compliance in these patients, as daytime symptoms like excessive sleepiness or or impaired cognitive functions are often unincisive in patients with mild OSA. Reconstructive procedures like UPPP, radiofrequency surgery of the tonsils or the base of tongue, hyoid suspension, mandibular osteotomy with genioglossus advancement (MO) are successful treatment options either as isolated procedures or in combination within so-called multi-level surgery concepts. Goldstandard for the treatment of moderate to severe OSA is the nCPAP ventilation. All patients should at least try this treatment modality. Only in the rare cases of nCPAP failure (2%) and in the relatively frequent cases of nCPAP incompliance (30%) reconstructive surgical procedures become necessary as second choice treatments. These are adenectomies, tonsillectomies, tonsillotomies in children and hyoid suspension, MO, multi-level surgery concepts, or maxillomandibular advancement osteotomies in adults. PMID:22073056

Associations of Sleep Duration and Disturbances With Hypertension in Metropolitan Cities of Delhi, Chennai, and Karachi in South Asia: Cross-Sectional Analysis of the CARRS Study.

PubMed

Shivashankar, Roopa; Kondal, Dimple; Ali, Mohammed K; Gupta, Ruby; Pradeepa, Rajendra; Mohan, Viswanathan; Kadir, Muhammad Masood; Narayan, K M Venkat; Tandon, Nikhil; Prabhakaran, Dorairaj; Peasey, Anne

2017-09-01

Sleep duration and disturbances may be risk factors for hypertension. Despite the high burden of hypertension in South Asia, little is known about this relationship in this region. We analyzed population-level cross-sectional data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) study that recruited representative samples of adults ≥ 20 years from three cities-Delhi, Chennai (India), and Karachi (Pakistan) during 2010-2011. We defined hypertension as self-reported treatment or measured blood pressure (BP) ≥140/90 mm Hg. Data on usual duration of sleep, insomnia, and snoring were collected using "The Sleep Habits Questionnaire" and excessive daytime sleepiness (EDS) using Epworth Sleepiness Score. Logistic and linear regression were done with hypertension and BP as outcome variables, respectively. Age, gender, education, wealth index, family history, and body mass index (BMI) were included as covariates. We used multiple imputation to account for missing variables. Prevalence of hypertension was 30.1%. The mean (SD) sleep duration was 7.3 (1.2) hours. Insomnia, snoring, and EDS were present in 13.6%, 28.7%, and 4.6%, respectively. Moderate and habitual snoring were associated with increased odds of hypertension (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.04 to 1.33] and 1.47 [1.29 to 1.67], respectively), after adjusting for covariates. Rare, occasional, and frequent insomnia were associated with increased hypertension (OR 1.41 [1.12 to 1.77], 1.39 [1.16 to 1.67], and 1.34 [1.09 to 1.65], respectively). Sleep duration and EDS were not associated with hypertension. Self-reported snoring and insomnia were associated with hypertension in South Asia. This relationship needs further exploration through robust longitudinal studies in this region. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.

PubMed

Schwartz, Noah G; Rattner, Adi; Schwartz, Alan R; Mokhlesi, Babak; Gilman, Robert H; Bernabe-Ortiz, Antonio; Miranda, J Jaime; Checkley, William

2015-09-01

Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. There were 2,682 adults aged 35 to 92 y. Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms. Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong independent associations with chronic diseases. © 2015 Associated Professional Sleep Societies, LLC.

Snoring and Sleep Apnea

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Snoring

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The Finite Element Simulation of the Upper Airway of Patients with Moderate and Severe Obstructive Sleep Apnea Hypopnea Syndrome

PubMed Central

Luo, Huiping; Scholp, Austin

2017-01-01

Objectives To investigate the snoring modes of patients with Obstructive Sleep Apnea Hypopnea Syndrome and to discover the main sources of snoring in soft tissue vibrations. Methods A three-dimensional finite element model was developed with SolidEdge to simulate the human upper airway. The inherent modal simulation was conducted to obtain the frequencies and the corresponding shapes of the soft tissue vibrations. The respiration process was simulated with the fluid-solid interaction method through ANSYS. Results The first 6 orders of modal vibration were 12 Hz, 18 Hz, 21 Hz, 22 Hz, 36 Hz, and 39 Hz. Frequencies of modes 1, 2, 4, and 5 were from tongue vibrations. Frequencies of modes 3 and 6 were from soft palate vibrations. Steady pressure distribution and air distribution lines in the upper airway were shown clearly in the fluid-solid interaction simulation results. Conclusions We were able to observe the vibrations of soft tissue and the modeled airflow by applying the finite element methods. Future studies could focus on improving the soft tissues vibration compliances by adjusting the model parameters. Additionally, more attention should be paid to vibrational components below 20 Hz when performing an acoustic analysis of human snore sounds due to the presence of these frequencies in this model. PMID:29204444

[Symptoms of obstructive sleep apnea-hypopnea syndrome in children].

PubMed

Gregório, Paloma Baiardi; Athanazio, Rodrigo Abensur; Bitencourt, Almir Galvão Vieira; Neves, Flávia Branco Cerqueira Serra; Terse, Regina; Hora, Francisco

2008-06-01

To investigate the symptoms most frequently found in children with a polysomnographic diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS). We evaluated 38 children consecutively referred to the sleep laboratory with suspicion of OSAHS between June of 2003 and December of 2004. The patients were submitted to a pre-sleep questionnaire and to polysomnography. The mean age was 7.8 +/- 4 years (range, 2-15 years), and 50% of the children were male. Children without apnea accounted for 7.9% of the sample. The obstructive sleep apnea observed in the remainder was mild in 42.1%, moderate in 28.9% and severe in 22.1%. Severe cases of apnea were most common among children under the age of six (pre-school age). In children with OSAHS, the most common symptoms were snoring and nasal obstruction, which were observed in 74.3 and 72.7% of the children, respectively. Excessive sleepiness and bruxism were seen in 29.4 and 34.3%, respectively, and reflux disease was seen in only 3.1%. Restless legs and difficulty in falling asleep were identified in 65 and 33%, respectively. All of the children diagnosed with severe OSAHS also presented snoring and bruxism. Snoring and nasal obstruction were the most common symptoms found in our sample of children and adolescents with OSAHS. In addition, OSAHS severity was associated with being in the lower age bracket.

The Finite Element Simulation of the Upper Airway of Patients with Moderate and Severe Obstructive Sleep Apnea Hypopnea Syndrome.

PubMed

Luo, Huiping; Scholp, Austin; Jiang, Jack J

2017-01-01

To investigate the snoring modes of patients with Obstructive Sleep Apnea Hypopnea Syndrome and to discover the main sources of snoring in soft tissue vibrations. A three-dimensional finite element model was developed with SolidEdge to simulate the human upper airway. The inherent modal simulation was conducted to obtain the frequencies and the corresponding shapes of the soft tissue vibrations. The respiration process was simulated with the fluid-solid interaction method through ANSYS. The first 6 orders of modal vibration were 12 Hz, 18 Hz, 21 Hz, 22 Hz, 36 Hz, and 39 Hz. Frequencies of modes 1, 2, 4, and 5 were from tongue vibrations. Frequencies of modes 3 and 6 were from soft palate vibrations. Steady pressure distribution and air distribution lines in the upper airway were shown clearly in the fluid-solid interaction simulation results. We were able to observe the vibrations of soft tissue and the modeled airflow by applying the finite element methods. Future studies could focus on improving the soft tissues vibration compliances by adjusting the model parameters. Additionally, more attention should be paid to vibrational components below 20 Hz when performing an acoustic analysis of human snore sounds due to the presence of these frequencies in this model.

Nocturnal snoring decreases daytime baroreceptor sensitivity.

PubMed

Schöbel, Christoph; Fietze, Ingo; Glos, Martin; Schary, Inett; Blau, Alexander; Baumann, Gert; Penzel, Thomas

2014-07-01

In patients with obstructive sleep apnea heart rate variability and baroreceptor sensitivity during night and daytime are impaired. Snoring without obstructive sleep apnea may already influence heart rate variability and baroreceptor sensitivity during daytime. Cardiovascular daytime testing was performed in 11 snorers and age, BMI, and gender matched controls. Sleep apnea and snoring were quantified by sleep recordings. Paced breathing was performed during daytime with ECG, non-invasive blood pressure, and respiration recorded. Heart rate variability and blood pressure variability were analyzed in the time and frequency domain. Baroreceptor sensitivity (alpha gain) was calculated. In snorers a significant increase in high frequency systolic blood pressure variability (SBPV-HF) compared to control group (0.37 mm Hg(2) vs. 0.11 mm Hg(2) for 12 breaths and 0.35 mm Hg(2) vs. 0.10 mm Hg(2) for 15 breaths) was demonstrated. Furthermore a lower baroreceptor sensitivity was found in snorers compared to controls (9.2 ms/mm Hg vs. 16.2 ms/mm Hg for 12 breaths and 8.5 ms/mm Hg vs. 17.4 ms/mm Hg for 15 breaths per minute) using the paced breathing protocol. Mean heart rate was elevated in snorers as well. Snorers may have a reduced parasympathetic tone during daytime rather than an increased sympathetic tone. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Kamami, Yves-Victor

1995-05-01

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

Minimally Invasive, Single-Stage, Multilevel Surgery for Obstructive Sleep Apnea in Asian Patients.

PubMed

Lin, Hsin-Ching; Friedman, Michael; Chang, Hsueh-Wen; Bonzelaar, Lauren; Salapatas, Anna M; Lin, Meng-Chih; Huang, Kuo-Tung

2017-02-01

This study adds to the literature on the efficacy and low complication rates associated with minimally invasive, single-stage, multilevel surgery for Asian adults with obstructive sleep apnea (OSA) for whom conservative treatment had failed. Overall, our experience has produced results that make this procedure an option for select patients with snoring and OSA. To investigate the effectiveness and safety of anatomy-based, minimally invasive, single-stage, multilevel surgery in the treatment of OSA in an Asian population. This retrospective study enrolled 59 consecutive patients with OSA from a tertiary academic medical center who had multilevel obstruction and unsuccessful conservative therapy and then underwent minimally invasive, single-stage, multilevel surgery. The subjective symptoms and objective polysomnographic findings were collected preoperatively and at a minimum of 3 months postoperatively. The Global Patient Assessment questionnaire was used to assess patient satisfaction after minimally invasive, single-stage, multilevel surgery. Scores on the Epworth Sleepiness Scale and bed partner evaluation of patient's snoring on a visual analog scale (scale of 0-10, with 0 indicating no snoring and 10 indicating the bed partner to leave the room or sleep separately, as assessed by the bed partner). The primary outcomes are a 50% decrease in bed partner's snoring visual analog scale level postoperatively and an improvement of 50% or more in apnea-hypopnea index by an at least 3-month follow-up. Adverse events and patient-reported quality measures were also assessed. Forty-seven patients (36 men and 11 women; mean [SD], 47.3 [10.9] years) with a minimum 3-month follow-up and complete data were included in the analysis. None of the patients had serious perioperative or postoperative complications. Three months postoperatively, the mean (SD) scores on the Epworth Sleepiness Scale and bed partner evaluation of patient's snoring on the visual analog scale decreased from 11.6 (4.3) to 9.2 (3.1), with a mean (SD) difference of -2.4 (3.7) (95% CI, -3.5 to -1.3), and 9.4 (1.5) to 3.9 (1.9), with a mean (SD) difference of -5.6 (2.0) (95% CI, -6.2 to -5.0), respectively. The mean (SD) apnea-hypopnea index and lowest oxygen saturation changed from 30.5 (18.8) to 26.0 (16.5), with a mean (SD) difference of -4.5 (14.1) (95% CI, -8.6 to -0.3), and 78.2% (9.9%) to 80.8% (8.2%), with a mean (SD) difference of +2.6 (8.7) (95% CI, 0-5.1), respectively. The surgical response rate was 46.8% (22 of 47 patients) (95% CI, 32.5%-61.1%). The success rate by the classic definition was 14.9% (7 of 47 patients) (95% CI, 6.2%-28.3%). This study reveals the improvement of the 2 relevant clinical outcomes in snoring severity and daytime sleepiness after minimally invasive, single-stage, multilevel surgery for patients with OSA but the limited effects on the polysomnographic parameters. Although the current role of minimally invasive, single-stage, multilevel surgery for Asian adults with OSA remains to be established, it is hoped that ongoing and future studies will solidify their role in the treatment of OSA.

Snoring -- adults

MedlinePlus

... In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . 6th ed. Philadelphia, ... member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www. ...

Prevalence and Persistence of Sleep Disordered Breathing Symptoms in Young Children: A 6-Year Population-Based Cohort Study

PubMed Central

Bonuck, Karen A.; Chervin, Ronald D.; Cole, Timothy J.; Emond, Alan; Henderson, John; Xu, Linzhi; Freeman, Katherine

2011-01-01

Study Objectives: To describe the prevalence, persistence, and characteristics associated with sleep disordered breathing (SDB) symptoms in a population-based cohort followed from 6 months to 6.75 years. Design: Avon Longitudinal Study of Parents and Children (ALSPAC). Setting: England, 1991-1999. Participants: 12,447 children in ALSPAC with parental report of apnea, snoring, or mouth-breathing frequency on any one of 7 questionnaires. Measurements: Symptom prevalence rates—assessed as “Always” and “Habitually”—are reported at 0.5, 1.5, 2.5, 3.5, 4.75, 5.75, and 6.75 years of age. The proportion of children in whom symptoms develop, persist or abate between observation points is reported. Exploratory multivariate analyses identified SDB risk factors at 1.5, 4.75, and 6.75 years. Results: The prevalence of apnea (“Always”) is 1%-2% at all ages assessed. In contrast, snoring “Always” ranges from 3.6% to 7.7%, and snoring “Habitually” ranges from 9.6% to 21.2%, with a notable increase from 1.5- 2.5 years. At 6 years old, 25% are habitual mouth-breathers. The “Always” and “Habitual” incidence of each symptom between time points is 1%-5% and 5%-10%, respectively. In multivariate analyses of combined symptoms, socioeconomic factors have stronger, more persistent effects upon increased SDB risk than gestational age, gender, or race (aside from 1.5 years); adenoidectomy decreases risk by 40%-50%. Conclusions: This is the first natural history study of the primary symptoms of SDB across a key 6-year period in the development of SDB symptoms. Snoring rates are higher and spike earlier than previously reported. Symptoms are dynamic, suggesting the need for early and continued vigilance in early childhood. Citation: Bonuck KA; Chervin RD; Cole TJ; Emond A; Henderson J; Xu L; Freeman K. Prevalence and persistence of sleep disordered breathing symptoms in young children: a 6-year population-based cohort study. SLEEP 2011;34(7):875-884. PMID:21731137

Prevalence of Sleep Related Symptoms in Four Latin American Cities

PubMed Central

Bouscoulet, Luis Torre; Vázquez-García, Juan Carlos; Muiño, Adriana; Márquez, Maria; López, Maria Victorina; de Oca, Maria Montes; Talamo, Carlos; Valdivia, Gonzalo; Pertuze, Julio; Menezes, Ana Maria B.; Pérez-Padilla, Rogelio

2008-01-01

Study Objectives: to estimate the prevalence of the most common sleep related symptoms (SRS) in the metropolitan areas of Mexico City, Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Methods: The study consisted of a multistage cluster sampling of adults aged ≥ 40 years living in metropolitan areas. All participants completed a questionnaire on sleep related symptoms. Simplified respiratory polygraphy during sleep was conducted on 188 subjects from Mexico City. Obstructive sleep apnea syndrome was defined as Epworth Sleepiness Scale score ≥ 11 and respiratory disturbance index (RDI) ≥ 15 events/h; a cut-off of 15 was chosen because of its high sensitivity and specificity in association with the portable monitor used in the study. Results: The study included 4,533 subjects (1,062 in Mexico City, 941 in Montevideo, 1,173 in Santiago, and 1,357 in Caracas). Snoring was reported by 60.2% (95% CI 58.8% to 61.6%), excessive daytime sleepiness by 16.4% (15.3% to 17.5%), observed apneas by 12.3% (11.4% to 13.3%), insomnia by 34.7% (33.3% to 36%), sedative use by 15.1% (14.1% to 16.2%), daytime napping by 29.2% (27.7% to 30.6%), and a combination of snoring, sleepiness, and observed apneas by 3.4% (2.9% to 4%). Men had a higher frequency of snoring and daytime napping, whereas women reported more insomnia and sedative use. Prevalence of OSAS varied from 2.9% among subjects who denied snoring, excessive daytime sleepiness, and observed apneas, to 23.5% among those reporting these 3 symptoms. Conclusions: A high prevalence of sleep related symptoms and undiagnosed obstructive sleep apnea in Latin America was observed. Citation: Bouscoulet LT; Vázquez-García JC; Muiño A; Márquez M; López MV; Montes de Oca M; Talamo C; Valdivia G; Pertuze J; Menezes AMB; Pérez-Padilla R. Prevalence of Sleep Related Symptoms in Four Latin American Cities. J Clin Sleep Med 2008;4(6):579-585. PMID:19110888

The predictive value of polysomnography combined with quality of life for treatment decision of children with habitual snoring related to adenotonsillar hypertrophy.

PubMed

Zhao, Guoqiang; Li, Yanru; Wang, Xiaoyi; Ding, Xiu; Wang, Chunyan; Xu, Wen; Han, Demin

2018-06-01

Both surgical treatment and non-surgical treatment are suggested by clinicians for children with habitual snoring related to adenotonsillar hypertrophy; However, how should the decision be made remains unclear. The objective of this study was to investigate potential predictors for the treatment decision, i.e., surgical treatment vs wait and see in children with habitual snoring related to adenoidal and/or tonsillar hypertrophy. Children with complaints of snoring and/or apnea associated with adenotonsillar hypertrophy who received polysomnography (PSG) monitoring at our Hospital were recruited. After at least 6 months, the subjects were followed up and grouped according to whether or not they had received adenoidectomy and/or tonsillectomy (AT) execution. The heights, weights, as well as the quality of life (assessed using the obstructive sleep apnea-18 (OSA-18) quality of life questionnaire) and baseline PSG of the subjects were recorded and compared. Two logistic regressions were performed to reveal the factors influencing decision-making on conducting AT. A total of 509 children were finally included (345 males and 164 females). Among these children, 287 eventually received AT. Significant differences in age, scores for item 1 and 5 of the OSA-18, apnea-hypopnea index, obstructive apnea index, obstructive apnea-hypopnea index (OAHI), and Lowest arterial oxygen saturation (P < 0.05) were observed between groups. By multivariate logistic regression, the factors that influenced the surgical decision were identified as follows: age < 7 years (P = 0.008: odds ratio [OR] = 1.667, 95% confidence interval [CI] 1.140-2.438), score for item 5 of OSA-18 > 4 points (P = 0.042: OR = 1.489, 95% CI 1.014-2.212) and OAHI > 1/h (P = 0.044: OR = 1.579, 95% CI 1.013-2.463). School-age children aged < 7 years, with OAHI > 1/h and mouth breathing scored > 4 points were more likely to receive AT during the disease process and thus require increased attention.

Your Wake-Up Call

MedlinePlus

... sleep comprise a broad range of problems, including sleep apnea, narcolepsy, insomnia, parasomnia, jet-lag syndrome, and disturbed ... health risks." Photo courtesy of NIH/NHLBI/NCSDR Sleep Apnea and Children Snoring is common in children and ...

Enlarged Adenoids (For Parents)

MedlinePlus

... topic for: Parents Kids Teens Tonsils and Tonsillectomies Strep Throat Obstructive Sleep Apnea Preparing Your Child for Surgery ... the Operating Room? Snoring Tonsillitis All About Adenoids Strep Throat Enlarged Adenoids Tonsils and Tonsillectomies What's It Like ...

Guide to Understanding Your Sleep Study

MedlinePlus

... these numbers and alphabet soups, and a better comprehension of what they quantify and signify, here is ... constitute another sleep disorder. And yes, someone is listening to–though not measuring in decibels–your snoring, ...

Insufficient Sleep and Suicidality in Adolescents

PubMed Central

Lee, Yu Jin; Cho, Seong-Jin; Cho, In Hee; Kim, Seog Ju

2012-01-01

Study Objectives: To investigate the association between the behaviorally induced insufficient sleep and suicidality among adolescents. Design: A population-based, cross-sectional survey. Setting: General community. Participants: A sample of 8,530 students (grades 7-11) was recruited in the Republic of Korea. The participants were 8,010 students who completed all questionnaires. Intervention: N/A. Measurements: The survey included the Beck Scale for Suicidal Ideation (SSI), the Beck Depression Inventory (BDI), a modified Epworth Sleepiness Scale (ESS), and questionnaires about sleep (weekday/weekend sleep schedule/duration, insomnia and snoring). Results: Adolescents with behaviorally induced insufficient sleep syndrome (BISS) had higher SSI scores than those who slept ≥ 7 hours on weekdays, even after controlling for age, sex, and BDI score (F = 11.71, P < 0.001). After controlling for age and sex, longer weekend oversleep and shorter weekday sleep duration predicted a higher SSI score (β = 0.19, P < 0.001; β = 0.37, P < 0.001). The association between weekend oversleep and SSI score remained significant even after additionally controlling for BDI and ESS scores and presence of insomnia and snoring (β = 0.07, P < 0.01). Conclusion: BISS was found to be associated with increased suicidality. Weekend oversleep was associated with suicidality independently of depression, daytime sleepiness, snoring, and insomnia. The study findings suggest that chronic sleep restriction among adolescents may increase suicidal risk. Citation: Lee YJ; Cho SJ; Cho IH; Kim SJ. Insufficient sleep and suicidality in adolescents. SLEEP 2012;35(4):455-460. PMID:22467982

Snoring and Nasal Congestion

MedlinePlus

... treat the various causes of nasal congestion include: Topical nasal steroid spray Topical nasal antihistamine spray Oral antibiotic (in case of ... include more than just the decrease in oxygen levels at night during the apnea episodes. They also ...

Oral Appliances Therapy

MedlinePlus

... for travel Easy to care for How a Dentist Can Help: The First Visit Dentists work closely with physicians to treat snoring and sleep apnea. At your first visit, your dentist will talk to you about the benefits of ...

1. OVERALL VIEW SHOWING FACE OF CONCRETE GRAVITY DAM AND ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. OVERALL VIEW SHOWING FACE OF CONCRETE GRAVITY DAM AND FISH LADDER, LOOKING SOUTHWEST (UPSTREAM) FROM SNORE OPPOSITE FISH LADDER - Van Arsdale Dam, South Fork of Eel River, Ukiah, Mendocino County, CA

Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS)

MedlinePlus

... Professional Version Sleep Disorders Overview of Sleep Snoring Insomnia and Excessive Daytime Sleepiness (EDS) Circadian Rhythm Sleep ... pressure when a person stands (orthostatic hypotension), and insomnia. Benzodiazepines: These drugs (such as clonazepam ) cause drowsiness, ...

Snore related signals processing in a private cloud computing system.

PubMed

Qian, Kun; Guo, Jian; Xu, Huijie; Zhu, Zhaomeng; Zhang, Gongxuan

2014-09-01

Snore related signals (SRS) have been demonstrated to carry important information about the obstruction site and degree in the upper airway of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) patients in recent years. To make this acoustic signal analysis method more accurate and robust, big SRS data processing is inevitable. As an emerging concept and technology, cloud computing has motivated numerous researchers and engineers to exploit applications both in academic and industry field, which could have an ability to implement a huge blue print in biomedical engineering. Considering the security and transferring requirement of biomedical data, we designed a system based on private cloud computing to process SRS. Then we set the comparable experiments of processing a 5-hour audio recording of an OSAHS patient by a personal computer, a server and a private cloud computing system to demonstrate the efficiency of the infrastructure we proposed.

The History of Sleep Surgery.

PubMed

Yaremchuk, Kathleen; Garcia-Rodriguez, Laura

2017-01-01

Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cure rate of 81%. The only other surgical procedure for OSA was permanent tracheostomy, but patients suffered from social stigma from the visible stoma with skin flaps and complications such as tracheal granulomas and tracheitis. UPPP was introduced in the USA as an alternative to permanent tracheostomy by Fujita in 1981. Since then, multiple surgical approaches and combinations of approaches have surfaced, with variable success rates. © 2017 S. Karger AG, Basel.

The Effect of Breathing Exercises on the Nocturnal Enuresis in the Children with the Sleep-Disordered Breathing

PubMed Central

Khaleghipour, Shahnaz; Masjedi, Mohsen; Kelishadi, Roya

2013-01-01

Background The nocturnal enuresis is one of the most common complaints of childhood. Upper airway obstruction and nocturnal snoring affect the nocturnal enuresis in children. Objectives The aim of this study was to investigate the effects of breathing exercises on the nocturnal enuresis in the children with the sleep-disordered breathing. Patients and Methods This study was conducted in year of 2011 by a semi-experimental design with the control group among 40 children, aged 6 - 12 years, who had the nocturnal enuresis. Participants were examined based on the criteria of nocturnal enuresis, oral breathing, and nocturnal snoring. Subsequently, they were randomly assigned to the case and control groups. In the case group, the breathing exercises were performed for 45 minutes, and were pursued for four weeks in the morning following and prior to sleeping, and subsequently the arterial blood gases were measured and the frequency of enuresis and the respiratory rates (RR) were recorded. Results After intervention the means of PaCO2 and RR in the control group were significantly higher than the case group (P < 0.0001). Likewise, O2sat, PaO2 in the case group were higher than the control group (P < 0.0001). The nocturnal enuresis decreased significantly in the case group, compared to the control group (P < 0.0001). Conclusions This study suggests that the breathing exercises may reduce the frequency of nocturnal enuresis in the patients with the oral breathing and nocturnal snore. The clinical implications of these findings should be verified in the future longitudinal studies. PMID:24719691

A history of binge drinking during adolescence is associated with poorer sleep quality in young adult Mexican Americans and American Indians.

PubMed

Ehlers, Cindy L; Wills, Derek; Gilder, David A

2018-06-01

Binge drinking during adolescence is common, and adolescents and young adults with alcohol problems may also have sleep difficulties. However, few studies have documented the effects of a history of adolescent binge drinking on sleep in young adulthood in high-risk minority populations. To quantify sleep disturbance, as indexed by the Pittsburgh Sleep Quality Index (PSQI), in a sample of young adult Mexican American and American Indian men and women (18-30 years, n = 800) with and without a history of alcohol binge drinking during adolescence, controlling for age, gender, and race. Gender was found to affect PSQI responses with females reporting waking up at night, having more bad dreams, and later habitual bedtimes than males, and males reporting more problems with breathing and snoring. Increasing age was associated with snoring or coughing, less hours spent in bed, and later evening bedtimes. Race also influenced the PSQI with American Indians reporting longer sleep latencies and sleep durations, more hours spent in bed, and more trouble with coughing and snoring than Mexican Americans, and Mexican Americans reporting later bedtimes. A history of adolescent regular binge drinking was associated with longer sleep latencies, more problems with breathing, bad dreams, and an overall higher PSQI total score, when controlling for age, race, and gender. This report suggests, like what has been found in young adults in general population samples, that binge drinking during adolescence is associated with deleterious consequences on sleep quality in young adulthood in these high-risk and understudied ethnic groups.

Long-Term Cognitive and Behavioral Outcomes following Resolution of Sleep Disordered Breathing in Preschool Children.

PubMed

Biggs, Sarah N; Walter, Lisa M; Jackman, Angela R; Nisbet, Lauren C; Weichard, Aidan J; Hollis, Samantha L; Davey, Margot J; Anderson, Vicki; Nixon, Gillian M; Horne, Rosemary S C

2015-01-01

This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.

Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence.

PubMed

Spilsbury, James C; Storfer-Isser, Amy; Rosen, Carol L; Redline, Susan

2015-01-01

To study the incidence, remission, and prediction of obstructive sleep apnea (OSA) from middle childhood to late adolescence. Longitudinal analysis. The Cleveland Children's Sleep and Health Study, an ethnically mixed, urban, community-based cohort, followed 8 y. There were 490 participants with overnight polysomnography data available at ages 8-11 and 16-19 y. Baseline participant characteristics and health history were ascertained from parent report and US census data. OSA was defined as an obstructive apnea- hypopnea index ≥ 5 or an obstructive apnea index ≥ 1. OSA prevalence was approximately 4% at each examination, but OSA largely did not persist from middle childhood to late adolescence. Habitual snoring and obesity predicted OSA in cross-sectional analyses at each time point. Residence in a disadvantaged neighborhood, African-American race, and premature birth also predicted OSA in middle childhood, whereas male sex, high body mass index, and history of tonsillectomy or adenoidectomy were risk factors among adolescents. Obesity, but not habitual snoring, in middle childhood predicted adolescent OSA. Because OSA in middle childhood usually remitted by adolescence and most adolescent cases were incident cases, criteria other than concern alone over OSA persistence or incidence should be used when making treatment decisions for pediatric OSA. Moreover, OSA's distinct risk factors at each time point underscore the need for alternative risk-factor assessments across pediatric ages. The greater importance of middle childhood obesity compared to snoring in predicting adolescent OSA provides support for screening, preventing, and treating obesity in childhood. © 2014 Associated Professional Sleep Societies, LLC.

[Effect of Continuous Positive Airway Pressure Treatment on Depression, Anxiety and Perceived Stress Levels in Patients with Obstructive Sleep Apnea Syndrome].

PubMed

Çelik, Mustafa; Sarıkaya, Yasin; Acar, Mustafa; Kalenderoğlu, Aysun; Doğan, Sedat; Kaskalan, Emin; Karataş, Mehmet

2016-01-01

The aim of this study is to determine the effects of continuous positive airway pressure (CPAP) treatment on depression, anxiety, and perceived stress levels and to identify factors predictive of treatment efficacy in patients with obstructive sleep apnea syndrome (OSAS). This study included 51 patients admitted to the Adiyaman University Medical School Otorhinolaryngology Department or Eskisehir Yunus Emre State Hospital between January and September 2014 with one or more complaints including snoring, excessive daytime sleepiness, or apnea witnessed by the partner. Diagnosis of OSAS was made by polysomnography and CPAP treatment was initiated. Depression levels were assessed in all study subjects using the Hospital Anxiety and Depression Scale (HADS) at the start of treatment and at 3 months. Anxiety levels were assessed using both the HADS and the State and Trait Anxiety Inventory (STAI), and perceived stress level was assessed using the Perceived Stress Questionnaire (PSQ). After CPAP treatment, we observed significant decreases in both the Depression and Anxiety Subscales of the HADS, in the Trait Anxiety subscale of the STAI, and in the PSQ. An evaluation of the initial parameters that predict improvements in these scales revealed that snoring time predicted decreases in all scale scores. In OSAS patients CPAP treatment has positive effects on psychological parameters like depression, anxiety, and perceived stress. We suggest that possible psychogenic benefits should be considered when deciding to start CPAP treatment, particularly in patients with pronounced and extended snoring who may also have social problems.

Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases

PubMed Central

Schwartz, Noah G.; Rattner, Adi; Schwartz, Alan R.; Mokhlesi, Babak; Gilman, Robert H.; Bernabe-Ortiz, Antonio; Miranda, J. Jaime; Checkley, William

2015-01-01

Study Objectives: Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Design: Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Setting: Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. Participants: There were 2,682 adults aged 35 to 92 y. Measurements and Results: Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5–32.0%), observed apneas (20.9%, 95% CI 19.4–22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1–20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18–5.84) was observed in those with all three versus no SDB symptoms. Conclusions: Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong independent associations with chronic diseases. Citation: Schwartz NG, Rattner A, Schwartz AR, Mokhlesi B, Gilman RH, Bernabe-Ortiz A, Miranda JJ, Checkley W, CRONICAS Cohort Study Group. Sleep disordered breathing in four resource-limited settings in Peru: prevalence, risk factors, and association with chronic diseases. SLEEP 2015;38(9):1451–1459. PMID:25845694

Validation of the Sonomat Against PSG and Quantitative Measurement of Partial Upper Airway Obstruction in Children With Sleep-Disordered Breathing.

PubMed

Norman, Mark B; Pithers, Sonia M; Teng, Arthur Y; Waters, Karen A; Sullivan, Colin E

2017-03-01

To validate the Sonomat against polysomnography (PSG) metrics in children and to objectively measure snoring and stertor to produce a quantitative indicator of partial upper airway obstruction that accurately reflects the pathology of pediatric sleep-disordered breathing (SDB). Simultaneous PSG and Sonomat recordings were performed in 76 children (46 male, age 5.8 ± 2.8, BMI = 18.5 ± 3.8 kg/m2). Sleep time, individual respiratory events and the apnea/hypopnea index (AHI) were compared. Obstructed breathing sounds were measured from the unobtrusive non-contact experimental device. There was no significant difference in total sleep time (TST), respiratory events or AHI values, the latter over-estimated by 0.3 events hr-1 by the Sonomat. Poor signal quality was minimal and gender, BMI, and body position did not adversely influence event detection. Obstructive and central events were classified correctly. The number of runs and duration of snoring (13 399 events, 20% TST) and stertor (5748 events, 24% TST) were an order of magnitude greater than respiratory events (1367 events, 1% TST). Many children defined as normal by PSG had just as many or more runs of snoring and stertor as those with mild, moderate and severe obstructive sleep apnea (OSA). The Sonomat accurately diagnoses SDB in children using current metrics. In addition, it permits quantification of partial airway obstruction that can be used to better describe pediatric SDB. Its non-contact design makes it ideal for use in children. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep problems of adolescents: A detailed survey.

PubMed

Muluk, Nuray Bayar; Bulbul, Selda Fatma; Turğut, Mahmut; Ağirtaş, Gülşah

2015-06-01

We investigated the sleep problems and sleep habits of adolescents at three public primary schools and two high schools. Our study included 428 Turkish school children (244 girls and 184 boys). We used a questionnaire to determine the time they went to sleep at night; waking time in the morning; incidence of nightmares, snoring, daytime sleepiness, and intrafamilial physical trauma; concentration difficulty in class; and school success. The students were divided into age-related groups (group 1 = 11 to 13 years of age; group 2 = 14 to 15 years; group 3 = 16 to 18 years). The time they went to sleep was mostly between 10 and 11 p.m. in groups 1 and 2, and 11 to 12 p.m. in group 3. Difficulty in falling asleep was reported by 16.8 to 19.6% of the students in the three groups. Difficulty in waking up in the morning was reported by 12.7% of group 1, 16.0% of group 2, and 16.8% of group 3. Snoring was present in 12.1% of females and 22.0% of males. The occurrence of one nightmare in the preceding 3 months was reported by 11.3% of the students; 17.9% of the students reported having nightmares several times. Daytime sleepiness was present in 65.1%, and concentration difficulty was present in 56.8% of the students. We conclude that difficulty in falling asleep, snoring, and daytime sleepiness may be seen in adolescents who are in both primary and high schools. Watching inappropriate programs and movies on television and intrafamilial physical trauma may cause nightmares and sleeping problems in these adolescents. Students and families should be educated about the importance of sleep in academic performance. Countries' public health policies should address sleep problems and related educational activities.

A nationwide, cross-sectional survey on unusual sleep postures and sleep-disordered breathing-related symptoms in people with Down syndrome.

PubMed

Kuroda, H; Sawatari, H; Ando, S; Ohkusa, T; Rahmawati, A; Ono, J; Nishizaka, M; Hashiguchi, N; Matsuoka, F; Chishaki, A

2017-07-01

People with Down syndrome (DS) often have sleep-disordered breathing (SDB). Unusual sleep postures, such as leaning forward and sitting, are observed in people with DS. This study aimed to clarify the prevalence of unusual sleep postures and their relationships with SDB-related symptoms (SDB-RSs), such as snoring, witnessed apnoea, nocturnal awakening and excessive daytime sleepiness. A questionnaire, including demographic characteristics and the presence of unusual sleep postures, as well as SDB-RSs, was completed by 1149 parents of people with DS from Japan. Unusual sleep postures were recorded in 483 (42.0%) people with DS. These participants were significantly younger and had a history of low muscle tone more frequently than people without unusual sleep postures. In all ages, the leaning forward posture was more frequent than sitting. People with DS with unusual sleep postures suffered from SDB-RSs. Those who slept in the sitting posture had more frequent SDB-RSs than did those who slept with the leaning forward posture. Snoring, witnessed apnoea and nocturnal awakening were observed in 73.6, 27.2 and 58.2% of participants, respectively. Snoring increased with aging. Witnessed apnoea was more common in males and in those with hypothyroidism than in females and in those without hypothyroidism. Our study shows that there is a close relationship between unusual sleep postures and SDB-RSs. We recommend that all people with DS with unusual sleep postures should be checked for the presence of SDB. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Four novel prosthodontic methods for managing upper airway resistance syndrome: an investigative analysis revealing the efficacy of the new nasopharyngeal aperture guard appliance.

PubMed

Venkat, R; Gopichander, N; Vasantakumar, M

2010-01-01

Obstructive sleep apnea is the most frequent cause for insomnia in the populace. Snoring is mulled over as the potential factor that can lead the sequel to obstructive sleep apnea. Although the etiology and deterrence measures for snoring are yet to be undoubtedly clarified by our scientific sorority, various means of surgical corrections have been affirmed and put into practice, with a substantial degree of success. Despite this, it is implicit that a noninvasive method of managing obstructive sleep apnea is more relevant for overcoming this condition. This manuscript intends to establish how snoring can be controlled prosthodontically by different modalities of scientifically defensible approaches. The most effective among the modalities was affirmed as the investigative analyses of the treatment outcomes with each modality. NOVEL METHODS: Four new methods of managing obstructive sleep apnea--uvula lift appliance, uvula and velopharynx lift appliance, nasopharyngeal aperture guard, and soft palate lift appliance were demonstrated through this article. The four new modalities stated and one conventional modality of mandibular advancement appliance for managing obstructive sleep apnea, a total of five types of appliance therapies, were described with case reports for each. Five individuals undergoing the appliance therapy were chosen for each modality. The treatment outcome with each modality was examined by analysis of clinical predictors and also by means of standard investigation, with nasal and oral endoscopic analyses. Among the five types of appliance therapies, the nasopharyngeal aperture guard provided the best treatment outcome in terms of clinical predictors and endoscopic analyses. Nasopharyngeal aperture guard, the novel method stated in this article is the better modality for managing obstructive sleep apnea, among the five different appliance therapies.

The influence of the lateral pharyngeal wall anatomy on snoring and sleep apnoea.

PubMed

Korhan, Ibrahim; Gode, Sercan; Midilli, Rasit; Basoglu, Ozen Kacmaz

2015-02-01

To elucidate the variations of the lateral pharyngeal wall anatomy on physical examination and to assess the clinical importance of the examination of the lateral pharyngeal wall on the presence and severity of obstructive sleep apnoea syndrome. The cross-sectional study was conducted at Ege University Medical School, Izmir, Turkey, between May 2010 and April 2011. The patients were divided into four equal groups: Group 1--snoring without apnoea (age 20-40); Group 2--snoring without apnoea (age 40-60); Group 3--apnoea-hypopnoea index < 5/hr; Group 4: apnoea-hypopnoea index > 30/hr. Calibrated oropharynx pictures were taken. Distance between palatoglossal and palatopharyngeal arches, height of palatoglossal and palatopharyngeal arches, uvula width, uvula length and distance between tonsils were measured. SPSS 17 was used for statistical analysis. Of the 80 patients in the study, 44 (55%) were men. Mean distance between palatopharyngeal and palatoglossal arches were 1.55 ± 0.34 cm and 2.70 ± 0.43 cm respectively. Mean height of palatopharyngeal and palatoglossal arches were 0.60 ± 0.21 cm and 1.37 ± 0.36 cm respectively (p > 0.05). Mean uvula width and uvula length were 0.80 ± 0.12cm and 1.25 ± 0.27 cm respectively (p > 0.05). Mean distance between tonsils was 2.24 ± 0.56 cm (p > 0.05). Distance between palatopharyngeal arches was significantly different between groups 3 and 4 (p < 0.05). Palatopharyngeal arch anatomy was found to be significantly associated with obstructive sleep apnoea syndrome severity, especially in patients with normal or small tonsil size. Patients with the palatopharyngeal arches, which narrow the oropharyngeal inlet more than the tonsils, should further be investigated with polysomnography.

Cough hypersensitivity in patients with obstructive sleep apnea hypopnea syndrome.

PubMed

Shi, Cuiqin; Liang, Siwei; Xu, Xianghuai; Chen, Qiang; Wang, Lan; Yu, Li; Lv, Hanjing; Qiu, Zhongmin

2018-02-16

The purpose of this study was to investigate cough hypersensitivity and its potential mechanisms in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Fifteen OSAHS patients, 12 simple snoring patients, and 15 healthy volunteers received cough sensitivity test and induced sputum cytology. Cough thresholds C2 and C5 (the minimum of capsaicin inducing ≥ 2 and ≥ 5 coughs, respectively), total cell count, cell differentials and the levels of bradykinin, histamine, prostaglandin E 2 , substance P, calcitonin gene-related peptide, pepsin, and interleukin-2 in the induced sputum detected by enzyme-linked immunosorbent assay were compared. The linear correlation between lgC2 and lgC5 and apnea hypopnea index, cell differentials, and inflammatory mediators in the induced sputum was calculated in OSAHS patients. OSAHS patients presented with a significant lower C2 and C5 (P < 0.01), increased lymphocyte but decreased macrophage and neutrophil proportions in the induced sputum (P < 0.01), and higher contents of substance P, calcitonin gene-related peptide and interleukin-2 (P < 0.01) but similar levels of bradykinin, pepsin, prostaglandin E 2 , and histamine (P > 0.05) in the supernatant of induced sputum, when compared with simple snoring patients and healthy volunteers. However, theses variable were comparable between simple snoring patients and healthy volunteers (P > 0.05). Finally, lgC2 or lgC5 was negatively related to apnea hypopnea index, lymphocyte percentage, and the levels of substance P, calcitonin gene-related peptide or interleukin-2 in the sputum (P < 0.01). There was a positive linear correlation between lymphocyte percentage and interleukin-2 level in the induced sputum (r = 0.63, P = 0.00). OSAHS patients have a predisposition of cough hypersensitivity associated with airway inflammation.

Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study.

PubMed

Sharma, S K; Nehra, A; Sinha, S; Soneja, M; Sunesh, K; Sreenivas, V; Vedita, D

2016-03-01

Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes. A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis. Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH-4.0 (95 % CI 1.3-11.9), 1.5 (95 % CI 0.5-4.5), and 2.9 (95 % CI 1.0-8.2) and for undergoing CS-5.3 (95 % CI 1.7-16.3), 4.9 (95 % CI 1.8-13.1), and 5.1 (95 % CI 1.9-14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS. Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.

Incidence of Sleep Disorders Reported by Patients at UTHSC College of Dentistry: A Two-Year Follow-Up and Proposed Educational Program.

PubMed

Ivanoff, Chris S; Pancratz, Frank

2015-05-01

A 2011 study at one U.S. dental school found that patients were not routinely screened by dental students for obstructive sleep apnea and/or other related sleep disorders, nor were students being trained to screen. Consequently, the medical history questionnaire used in the clinic was updated to include five specific screening questions. The aim of this two-year follow-up study was to determine whether screening had improved at the school. A retrospective chart review of all patients (age 14-70+) in the third- and fourth-year dental clinics in 2012 and 2013 searched for "YES" responses to the five questions. Of 5,931 patients, 38% reported they snore or were told they snore. By age 50-59, their reports of snoring increased to 50%. About 5% reported incidents waking up choking. By age 50, between one-fifth and one-quarter indicated they woke up frequently during the night. One in six frequently felt overly tired during the daytime, often falling asleep. This problem was evenly reported by all age groups between ages 30 and 69. About half the patients reporting sleep problems also had hypertension and cardiovascular problems with an equal distribution between males and females. The results showed that updating the medical history form had dramatically improved screening for sleep-disordered breathing by these dental students. Though screening is neither a definitive diagnosis nor an attempt to distinguish among sleep disorders, the results correlate with national statistics. Screening is an important step to increase student awareness of this serious health trend as it prepares students to engage more constructively in its management and referral.

Prevalence, Awareness and Reporting of Symptoms of Obstructive Sleep Apnoea among Hospitalized Adult Patients in Nigeria: A Multicenter Study.

PubMed

Desalu, Olufemi; Onyedum, Cajetan; Sanya, Emmanuel; Fadare, Joseph; Adeoti, Adekunle; Salawu, Fatai; Oluyombo, Rotimi; Olamoyegun, Micheal; Fawale, Micheal; Gbadegesin, Babajide; Bello, Hamzat

2016-07-01

Obstructive sleep apnoea is the most common form of sleep-disordered breathing in adults and children. It is associated with many adverse health consequences. The objectives this study were to determine the prevalence, awareness and reporting of symptoms of obstructive sleep apnoea among hospitalized adult patients in Nigeria. This was a multicenter cross-sectional study involving 1420 adult patients admitted to general medical and surgical wards of selected hospitals from March to April 2013. A questionnaire embedded with Berlin questionnaire, Epworth sleepiness scale and questions on level of awareness and reporting of symptoms of sleep apnoea was used for data collection. One-third of the patients (33.4%) reported snoring, 16.3% had excessive daytime sleepiness, 10.0% experienced daytime fatigue, and 8.0% experienced drowsy driving. Approximately 5% reported witnessed apnoea and 18.0% had high risks for obstructive sleep apnoea. The frequency of high risk for sleep apnoea increased with age and declined after 65 years and also increased with the body mass index. Snoring, excessive daytime sleepiness and high risk for obstructive sleep apnoea were more common in patients with chronic medical conditions and who were admitted to the urban hospitals. The majority were not aware that snoring (77.3%) and excessive daytime sleepiness (65.8%) constitute a medical problem, and only 4.5% reported these symptoms to their doctors. The level of awareness and under-reporting of sleep apnoea symptoms are poor. The high prevalence of obstructive sleep apnoea symptoms from this study should form the basis for screening hospitalized patients with chronic medical condition across the country.

Patient's experience of treatment for sleep apnoea with a mandibular advancement splint.

PubMed

Bhamrah, Gurprit; Dhir, Arti; Cash, Alex; Ahmad, Sofia; Winchester, Lindsay J

2015-10-01

Obstructive sleep apnoea (OSA) is a well recognised clinical disorder in which there is narrowing and repeated collapse of the upper airway during sleep resulting in the cessation of breathing. Patients with mild to moderate sleep apnoea are often provided with mandibular advancement splint (MAS) therapy as a form of first line or definitive treatment. The aims of this audit were to evaluate patient satisfaction and success of MAS therapy. 93 patients diagnosed with sleep apnoea and suitable for a splint were recruited prospectively at Queen Victoria Hospital, East Grinstead between January 2009 and October 2010. A patient satisfaction questionnaire was developed by health professionals involved in the care of patients with sleep apnoea and assessed for face and content validity and reliability. Participants completed the questionnaire six weeks after the splint was fitted. 44% who previously experienced snoring now reported no snoring and 47% reported less snoring since wearing the MAS appliance. 69% reported complete resolution of sleep apnoea symptoms. 37% experienced aching teeth and 33% experienced having a dry throat when wearing the appliance. 86% of sleeping partners felt that their quality of sleep was improved following their partners treatment. The standards set for each criteria in this audit were met. MAS treatment has a key role to play in the management of obstructive sleep apnoea with high rates of patient satisfaction and the majority of patients partners reporting a significant improvement in their own and their partners sleep quality. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Parent versus teacher report of daytime behavior in snoring children.

PubMed

Kohler, Mark J; Kennedy, J D; Martin, A J; Lushington, K

2013-05-01

Problematic behavior is widely reported in children with sleep-disordered breathing (SDB). Daytime behavior is an important component in the evaluation of clinical history in SDB; however, there is a reliance on parental report alone, and it is unclear whether reports by teachers will aid diagnosis. We assessed sleep and behavior reported by both parents and teachers in 19 children with SDB and 27 non-snoring controls. All children were screened for prior diagnoses of other medical and/or behavior and learning disorders and underwent polysomnography and both parental and teacher assessment of behavior. Both parents and teachers report greater problematic behavior in SDB children, predominantly of an internalizing nature. Despite this consistency and moderate correlation between informants, the agreement between parent and teacher reports of individual child behavior was poor when assessed using Bland-Altman plots. Clinicians should be mindful that the behavioral history of a child being evaluated for SDB may vary depending on whether parent or teacher report is being discussed as this may influence clinical decision making.

Parental Report of Sleep Problems in Down Syndrome

ERIC Educational Resources Information Center

Breslin, J. H.; Edgin, J. O.; Bootzin, R. R.; Goodwin, J. L.; Nadel, L.

2011-01-01

Background: Children with Down syndrome (DS) suffer from sleep problems, including sleep maintenance problems, as well as snoring, and other symptoms of disordered breathing. To examine sleep in DS, we gave parents a questionnaire assessing their child's sleep. Materials and methods: The parents of 35 children with DS (mean age = 12.65 years,…

Is passive smoking associated with sleep disturbance among pregnant women?

PubMed

Ohida, Takashi; Kaneita, Yoshitaka; Osaki, Yoneatsu; Harano, Satoru; Tanihata, Takeo; Takemura, Shinji; Wada, Kiyoshi; Kanda, Hideyuki; Hayashi, Kenji; Uchiyama, Makoto

2007-09-01

Pregnant women suffer from sleep disturbance, which may be aggravated by passive smoking. In this study we investigated the effects of passive smoking on sleep disturbance during pregnancy. Two cross-sectional questionnaire surveys conducted in 2002 and 2006. Clinical institutions specializing in obstetrics and gynecology that participated in the nationwide surveys: 260 in the 2002 survey and 344 in the 2006 survey. 16,396 and 19,386 pregnant women in Japan surveyed in 2002 and 2006, respectively. N/A. Pregnant women exposed to passive smoking were likely to have sleep disturbances, such as subjective insufficient sleep, difficulty in initiating sleep, short sleep duration, and snoring loudly/breathing uncomfortably. Smoking pregnant women had the same sleep disturbances and also experienced excessive daytime sleepiness and early morning awakening. The prevalence of 5 types of sleep disturbance (insufficient sleep, difficulty in initiating sleep, short sleep duration, excessive daytime sleepiness, and snoring loudly/breathing uncomfortably) among nonsmokers with environmental tobacco smoke showed a mean value intermediate between that of active smokers and that of nonsmokers without environmental tobacco smoke. Passive smoking is independently associated with increased sleep disturbance during pregnancy.

Nasal Involvement in Obstructive Sleep Apnea Syndrome

PubMed Central

Michels, Daniel de Sousa; Rodrigues, Amanda da Mota Silveira; Nakanishi, Márcio; Sampaio, André Luiz Lopes; Venosa, Alessandra Ramos

2014-01-01

Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected. PMID:25548569

Childhood obstructive sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges.

PubMed

Halbower, Ann C; Ishman, Stacey L; McGinley, Brian M

2007-12-01

Childhood sleep-disordered breathing (SDB) has been known to be associated with health and cognitive impacts for more than a century, and yet our understanding of this disorder is in its infancy. Neuropsychological consequences in children with snoring or subtle breathing disturbances not meeting the traditional definition of sleep apnea suggest that "benign, or primary snoring" may be clinically significant, and that the true prevalence of SDB might be underestimated. There is no standard definition of SDB in children. The polysomnographic technology used in many sleep laboratories may be inadequate to diagnose serious but subtle forms of clinically important airflow limitation. In the last several years, advances in digital technology as well as new observational studies of respiratory and arousal patterns in large populations of healthy children have led to alternative views of what constitutes sleep-related breathing and arousal abnormalities that may refine our diagnostic criteria. This article reviews our knowledge of childhood SDB, highlights recent advances in technology, and discusses diagnostic and treatment strategies that will advance the management of children with pediatric SDB.

Obstructive Sleep Apnea Screening Using a Piezo-Electric Sensor

PubMed Central

2017-01-01

In this study, we propose a novel method for obstructive sleep apnea (OSA) detection using a piezo-electric sensor. OSA is a relatively common sleep disorder. However, more than 80% of OSA patients remain undiagnosed. We investigated the feasibility of OSA assessment using a single-channel physiological signal to simplify the OSA screening. We detected both snoring and heartbeat information by using a piezo-electric sensor, and snoring index (SI) and features based on pulse rate variability (PRV) analysis were extracted from the filtered piezo-electric sensor signal. A support vector machine (SVM) was used as a classifier to detect OSA events. The performance of the proposed method was evaluated on 45 patients from mild, moderate, and severe OSA groups. The method achieved a mean sensitivity, specificity, and accuracy of 72.5%, 74.2%, and 71.5%; 85.8%, 80.5%, and 80.0%; and 70.3%, 77.1%, and 71.9% for the mild, moderate, and severe groups, respectively. Finally, these results not only show the feasibility of OSA detection using a piezo-electric sensor, but also illustrate its usefulness for monitoring sleep and diagnosing OSA. PMID:28480645

Evaluation of effects of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with pure snoring and obstructive sleep apnea syndrome.

PubMed

Selcuk, Adin; Ozer, Tulay; Esen, Erkan; Ozdogan, Fatih; Ozel, Halil Erdem; Yuce, Turgut; Caliskan, Sebla; Dasli, Sinem; Bilal, Nagihan; Genc, Gulden; Genc, Selahattin

2017-05-01

To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test. Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm 3 before treatment to 6.57 ± 2.03 cm 3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05). Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

Effect of reductions in biomass fuel exposure on symptoms of sleep apnea in children living in the peruvian andes: a preliminary field study.

PubMed

Castañeda, Jacqueline L; Kheirandish-Gozal, Leila; Gozal, David; Accinelli, Roberto A

2013-10-01

Multiple studies have evaluated the prevalence of sleep apnea in pediatric populations. Although environmental exposures to cigarette smoke (ECS) increase the risk of habitual snoring, no studies have thus far examined the potential contribution of indoor pollution in children. To determine the frequency of symptoms associated with sleep apnea in children exposed to traditional wood-burning stoves to open fire, and assess whether symptoms subside following implementation of improved less environmentally contaminating stoves. Residents of the communities of Chucllapampa, Sayhuapata, and Alparcuna in Cangallo province, department of Ayacucho, Peru were surveyed on two occasions within 12 months before and after the installation of an improved Inkawasi wood stove. The frequency of symptoms associated with sleep apnea was assessed in all children <15 years of age using a previously validated questionnaire. Parents of 59 children (62.7% males; mean age 7.76 ± 4.2 years) were interviewed representing >97% of the children in those small villages. The most common symptoms included nighttime awakenings, habitual snoring, repetitive movements during sleep, nasal congestion, and sore throat. After implementation of improved stoves in the homes, snoring (52.5% vs. 18.2%, P < 0.0001) nasal congestion (33.9% vs. 1.8%, P < 0.0001), behavioral hyperactivity (28.8% vs. 3.8%, P < 0.002), nighttime awakenings (42.4% vs. 1.7%, P < 0.0001), sore throat (38.2% vs. 5.5% P < 0.0001), breathing through the mouth during the day (33.9% vs. 1.8%, P < 0.001), daytime sleepiness (21.1% vs. 1.8%, P < 0.003), and falling asleep at school (14.6% vs. 0%, P < 0.03) were all significantly improved. Children exposed to traditional biomass fuel stoves had a higher frequency of symptoms related to sleep apnea, which decrease with improvements in biomass pollution. © 2012 Wiley Periodicals, Inc.

Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children: A Study Protocol of a Crossover Randomized Controlled Trial.

PubMed

Idris, Ghassan; Galland, Barbara; Robertson, Christopher J; Farella, Mauro

2016-01-01

Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children's wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children. To determine the efficacy of mandibular advancement appliances for the management of SDB and related health problems in children. The study will be designed as a single-blind crossover randomized controlled trial with administration of both an "Active MAS" (Twin-block) and a "Sham MAS." Eligible participants will be children aged 8-12 years whose parents report they snore ≥3 nights per week. Sixteen children will enter the full study after confirming other inclusion criteria, particularly Skeletal class I or class II confirmed by lateral cephalometric radiograph. Each child will be randomly assigned to either a treatment sequence starting with the Active or the Sham MAS. Participants will wear the appliances for 3 weeks separated by a 2-week washout period. For each participant, home-based polysomnographic data will be collected four times; once before and once after each treatment period. The Apnea Hypopnea Index (AHI) will represent the main outcome variable. Secondary outcomes will include, snoring frequency, masseter muscle activity, sleep symptoms, quality of life, daytime sleepiness, children behavior, and nocturnal enuresis. In addition, blood samples will be collected to assess growth hormone changes. This study was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR): [ACTRN12614001013651].

Sleep Disturbances, Quality of Life, and Ethnicity: The Sleep Heart Health Study

PubMed Central

Baldwin, Carol M.; Ervin, Ann-Margret; Mays, Mary Z.; Robbins, John; Shafazand, Shirin; Walsleben, Joyce; Weaver, Terri

2010-01-01

Study Objectives: To compare health-related quality of life (HR-QOL) across subgroups defined by sleep disturbances and ethnicity. Methods: Men (47%) and women (53%) Sleep Heart Health Study participants age 40 and older (N = 5237) underwent overnight polysomnography and completed self-report questionnaires on symptoms of sleep disturbances. The physical and mental composite scales (PCS and MCS) of the Medical Outcomes Study 36-item short form survey assessed HR-QOL and were compared to sleep data. Results: Participants self-identified as Caucasian/White (n = 4482, 86%), African American/Black (n = 490, 9%), or Hispanic/Mexican American (n = 265, 5%). The prevalence of obstructive sleep apnea (OSA) was 17%, frequent snoring was 34%, difficulty initiating or maintaining sleep (DIMS; insomnia symptoms) was 30%, and excessive daytime sleepiness (EDS) was 25%. African American participants with frequent snoring, insomnia symptoms, or EDS had significantly poorer physical health compared to Caucasians (p < 0.001). Hispanics with frequent snoring, insomnia symptoms, or EDS had significantly poorer mental health than Caucasian participants (p < 0.001). Neither PCS nor MCS scores differed significantly across ethnic subgroups for participants with moderate to severe OSA (respiratory disturbance index ≥ 15, 4% desaturation). Conclusions: Across ethnic/racial subgroups, sleep disturbances are associated with worse physical and better mental HR-QOL than the U.S. norm, but this relationship may be moderated by comorbid health conditions. This study replicates and extends prior research indicating differences among minority and non-minority participants and highlights the need for future studies of sleep disturbances with larger samples of minorities that control for comorbid health conditions. Citation: Baldwin CM; Ervin A; Mays MZ; Robbins J; Shafazand S; Walsleben J; Weaver T. Sleep disturbances, quality of life, and ethnicity: the sleep heart health study. J Clin Sleep Med 2010;6(2):176-183. PMID:20411696

Sex-Specific Prediction Models for Sleep Apnea From the Hispanic Community Health Study/Study of Latinos.

PubMed

Shah, Neomi; Hanna, David B; Teng, Yanping; Sotres-Alvarez, Daniela; Hall, Martica; Loredo, Jose S; Zee, Phyllis; Kim, Mimi; Yaggi, H Klar; Redline, Susan; Kaplan, Robert C

2016-06-01

We developed and validated the first-ever sleep apnea (SA) risk calculator in a large population-based cohort of Hispanic/Latino subjects. Cross-sectional data on adults from the Hispanic Community Health Study/Study of Latinos (2008-2011) were analyzed. Subjective and objective sleep measurements were obtained. Clinically significant SA was defined as an apnea-hypopnea index ≥ 15 events per hour. Using logistic regression, four prediction models were created: three sex-specific models (female-only, male-only, and a sex × covariate interaction model to allow differential predictor effects), and one overall model with sex included as a main effect only. Models underwent 10-fold cross-validation and were assessed by using the C statistic. SA and its predictive variables; a total of 17 variables were considered. A total of 12,158 participants had complete sleep data available; 7,363 (61%) were women. The population-weighted prevalence of SA (apnea-hypopnea index ≥ 15 events per hour) was 6.1% in female subjects and 13.5% in male subjects. Male-only (C statistic, 0.808) and female-only (C statistic, 0.836) prediction models had the same predictor variables (ie, age, BMI, self-reported snoring). The sex-interaction model (C statistic, 0.836) contained sex, age, age × sex, BMI, BMI × sex, and self-reported snoring. The final overall model (C statistic, 0.832) contained age, BMI, snoring, and sex. We developed two websites for our SA risk calculator: one in English (https://www.montefiore.org/sleepapneariskcalc.html) and another in Spanish (http://www.montefiore.org/sleepapneariskcalc-es.html). We created an internally validated, highly discriminating, well-calibrated, and parsimonious prediction model for SA. Contrary to the study hypothesis, the variables did not have different predictive magnitudes in male and female subjects. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2015-01-01

Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. Recommendations: We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits— as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations. Citation: Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11(7):773–827. PMID:26094920

Mahalo, Kumu

ERIC Educational Resources Information Center

Pierpont, Katherine

2005-01-01

It had been a long 12-hour journey. As the passengers around us snored in slumber or pecked away at their laptops, we shifted in our seats for what seemed like the hundredth time and wondered (again, for what seemed like the hundredth time) if we were ever going to get to our destination. A low rumble issued from beneath our feet and finally, we…

When It Rains, It Pours

ERIC Educational Resources Information Center

Mills, Linda

2012-01-01

"It's raining, it's pouring, the old man is snoring!" "The itsy, bitsy spider crawled up the waterspout, down came the rain and washed the spider out. Out came the sun and dried up all the rain, and the itsy, bitsy spider went up the spout again." What do children's nursery rhymes have to do with the school library? The author begins by telling a…

Initial indication of treatment in 60 patients with sleep obstructive ventilatory disturbance.

PubMed

de Tarso Moura Borges, Paulo; Paschoal, Jorge Rizzato

2005-01-01

The author present a retrospective descriptive study of 60 patients with sleep obstructive ventilatory disturbance who have taken medical advice at the Centro Campinas de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço during a period of three years. All the patients have been examined after standardized protocol and decisions related to the treatment have been taken after systematic multidisciplinary discussion. clinical retrospective. The patients were distributed into two groups according to the proposal of surgical and non-surgical treatment. After so, they were studied according to the model of treatment proposed and the main propaedeutic findings: respiratory disturbance index (RDI), body mass index (BMI), cephalometric analysis and Müller maneuver. The main features were compared--isolated or in association--with the model of treatment proposed. Amongst several conclusions obtained, the most important were: surgical and non-surgical treatment were indicated almost in the same proportion for of snoring; surgical treatments were most indicated for snoring and Apnoea-Hipopnoea Syndrome, despite of its modality; RDI, BMI and cephalometric analysis and Müller maneuver had no influence at any therapeutic modality; the therapeutic decision was taken after standardized protocol and systematic multidisciplinary discussion, where each case was discussed individually.

Obstructive Sleep Apnea Screening Using a Piezo-Electric Sensor.

PubMed

Erdenebayar, Urtnasan; Park, Jong Uk; Jeong, Pilsoo; Lee, Kyoung Joung

2017-06-01

In this study, we propose a novel method for obstructive sleep apnea (OSA) detection using a piezo-electric sensor. OSA is a relatively common sleep disorder. However, more than 80% of OSA patients remain undiagnosed. We investigated the feasibility of OSA assessment using a single-channel physiological signal to simplify the OSA screening. We detected both snoring and heartbeat information by using a piezo-electric sensor, and snoring index (SI) and features based on pulse rate variability (PRV) analysis were extracted from the filtered piezo-electric sensor signal. A support vector machine (SVM) was used as a classifier to detect OSA events. The performance of the proposed method was evaluated on 45 patients from mild, moderate, and severe OSA groups. The method achieved a mean sensitivity, specificity, and accuracy of 72.5%, 74.2%, and 71.5%; 85.8%, 80.5%, and 80.0%; and 70.3%, 77.1%, and 71.9% for the mild, moderate, and severe groups, respectively. Finally, these results not only show the feasibility of OSA detection using a piezo-electric sensor, but also illustrate its usefulness for monitoring sleep and diagnosing OSA. © 2017 The Korean Academy of Medical Sciences.

[Sleep-disordered breathing in children].

PubMed

Cohen-Gogo, S; Do, Ngoc Thanh C; Levy, D; Métreau, J; Mornand, P; Parisot, P; Fauroux, B

2009-02-01

Sleep-disordered breathing (SDB) in children comprises a wide spectrum of symptoms ranging from primary snoring to obstructive sleep apnea (OSA). Twelve percent of children present primary snoring and 1-2% OSA. Polysomnography is the gold standard for diagnosis of SDB allowing the analysis of sleep stages, respiratory movements, airflow, and gas exchange. However, this test remains highly technical, expensive, and difficult to conduct; other simpler diagnostic methods are under evaluation. Recent studies highlight the frequency and importance of cognitive and behavioral disorders in children with SDB; both the age and the severity of the SDB seem to modulate in the expression of neurocognitive consequences. Local and systemic inflammation plays a key role in the physiopathology of SDB and its complications: OSA is a cardiovascular risk factor in childhood that could favor atheromatous complications later in life. Adenoidotonsillectomy is the treatment of choice, but anti-inflammatory therapies such as leukotriene receptor antagonists or nasal corticoids may be beneficial in mild SDB or in residual OSA after adenotonsillectomy. In case of failure, noninvasive ventilation by means of nasal continuous positive pressure will be necessary, aided by specialists. SDB and OSA are a public health problem, underlining the pivotal role of the pediatrician in preventing, diagnosing, and treating these frequent disorders.

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

PubMed Central

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

2016-01-01

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

Hypersomnolence and Sleep-related Complaints in Metropolitan, Urban, and Rural Georgia

PubMed Central

Decker, Michael J.; Lin, Jin-Mann S.; Tabassum, Humyra

2009-01-01

Persistent daytime hypersomnolence is associated with significant morbidity and mortality, but its prevalence in the population has been poorly documented. This study sought to characterize the prevalence of persistent daytime hypersomnolence, difficulties initiating and maintaining sleep, unrefreshing sleep, snoring, and the presence of physician-diagnosed sleep disorders in metropolitan, urban, and rural US Georgia populations. Between September 2004 and July 2005, a total of 6,530 randomly selected well and unwell adults, identified by screening interviews of 10,837 households (contacted by random digit dialing), completed a detailed phone interview. Sixteen percent reported persistent problems staying awake during the day; 26% reported persistent problems falling asleep at night; 31% experienced problems sleeping through the night; 34% were bothered by unrefreshing sleep; and 33% reported that they snored. In spite of the high occurrence of reported persistent sleep problems, only 10% of the survey participants reported having been diagnosed with a sleep disorder. These study findings highlight the need for increased public and clinician awareness with respect to proactively indentifying signs and symptoms of sleep disorders, a better understanding of their adverse impact upon morbidity and mortality, and their negative impact upon socioeconomic and academic potential. PMID:19066308

Efficacy of Adjunct Sleep Interventions for PTSD

DTIC Science & Technology

2007-03-01

untreated severe PTSD, depression, of alcohol / substance use (n = 8), or sleep apnea (n = 4). Of the remaining 18 participants, all completed the...recommendations for further evaluation. Participants who endorsed symptoms consistent with sleep apnea (e.g., snoring, recalled or witnessed apneas , subjective...reported symptoms consistent with sleep apnea , screening sleep studies were conducted; 3 participants were excluded due to sig- nificant sleep apnea (AHI

Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children: A Study Protocol of a Crossover Randomized Controlled Trial

PubMed Central

Idris, Ghassan; Galland, Barbara; Robertson, Christopher J.; Farella, Mauro

2016-01-01

Background: Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children's wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children. Aims: To determine the efficacy of mandibular advancement appliances for the management of SDB and related health problems in children. Methods/design: The study will be designed as a single-blind crossover randomized controlled trial with administration of both an “Active MAS” (Twin-block) and a “Sham MAS.” Eligible participants will be children aged 8–12 years whose parents report they snore ≥3 nights per week. Sixteen children will enter the full study after confirming other inclusion criteria, particularly Skeletal class I or class II confirmed by lateral cephalometric radiograph. Each child will be randomly assigned to either a treatment sequence starting with the Active or the Sham MAS. Participants will wear the appliances for 3 weeks separated by a 2-week washout period. For each participant, home-based polysomnographic data will be collected four times; once before and once after each treatment period. The Apnea Hypopnea Index (AHI) will represent the main outcome variable. Secondary outcomes will include, snoring frequency, masseter muscle activity, sleep symptoms, quality of life, daytime sleepiness, children behavior, and nocturnal enuresis. In addition, blood samples will be collected to assess growth hormone changes. Trial registration: This study was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR): [ACTRN12614001013651]. PMID:27594841

Menopause is associated with self-reported poor sleep quality in women without vasomotor symptoms.

PubMed

Hung, Hao-Chang; Lu, Feng-Hwa; Ou, Horng-Yih; Wu, Jin-Shang; Yang, Yi-Ching; Chang, Chih-Jen

2014-08-01

The aim of this study was to investigate the relationship between menopause and self-reported sleep quality in Chinese women without vasomotor symptoms. Cross-sectional data were collected from a decoded database of the National Cheng Kung University Hospital. Menopause was defined as absence of menses for at least 12 months or a history of hysterectomy and oophorectomy. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer self-reported sleep quality, and a global PSQI score greater than 5 differentiates poor sleepers from good sleepers. Of the 1,088 women recruited, 353 (32.4%) were in postmenopause status. Postmenopausal women had higher mean (SD) global PSQI scores (8.0 [3.3] vs. 6.1 [2.2], P < 0.001) and a greater prevalence of poor sleepers (73.1% vs. 60.8%, P < 0.001) compared with premenopausal women. Multivariate linear regression analysis showed that menopause (β = 1.532; 95% CI, 1.135 to 1.949; P < 0.001) and snoring (β = 0.764; 95% CI, 0.299 to 1.228; P = 0.001) were positively associated with global PSQI scores, whereas long sleep duration (β = -0.791; 95% CI, -1.113 to -0.468; P < 0.001) was negatively associated with global PSQI scores. Multivariate logistic regression analyses showed that menopause (odds ratio, 1.453; 95% CI, 1.030 to 2.051; P < 0.05), long sleep duration (odds ratio, 0.545; 95% CI, 0.418 to 0.710; P < 0.001), and snoring (odds ratio, 2.022; 95% CI, 1.312 to 3.116; P = 0.001) were independent predictors of poor sleepers. Postmenopausal women without vasomotor symptoms have significantly higher global PSQI scores and a higher risk of being poor sleepers than premenopausal women. In addition, menopause and snoring are associated with an increased risk of poor self-reported sleep quality independently of cardiometabolic factors and lifestyle, whereas long sleep duration is associated with a decreased risk of poor self-reported sleep quality.

Microgravity reduces sleep-disordered breathing in humans.

PubMed

Elliott, A R; Shea, S A; Dijk, D J; Wyatt, J K; Riel, E; Neri, D F; Czeisler, C A; West, J B; Prisk, G K

2001-08-01

To understand the factors that alter sleep quality in space, we studied the effect of spaceflight on sleep-disordered breathing. We analyzed 77 8-h, full polysomnographic recordings (PSGs) from five healthy subjects before spaceflight, on four occasions per subject during either a 16- or 9-d space shuttle mission and shortly after return to earth. Microgravity was associated with a 55% reduction in the apnea-hypopnea index (AHI), which decreased from a preflight value of 8.3 +/- 1.6 to 3.4 +/- 0.8 events/h inflight. This reduction in AHI was accompanied by a virtual elimination of snoring, which fell from 16.5 +/- 3.0% of total sleep time preflight to 0.7 +/- 0.5% inflight. Electroencephalogram (EEG) arousals also decreased in microgravity (by 19%), and this decrease was almost entirely a consequence of the reduction in respiratory-related arousals, which fell from 5.5 +/- 1.2 arousals/h preflight to 1.8 +/- 0.6 inflight. Postflight there was a return to near or slightly above preflight levels in these variables. We conclude that sleep quality during spaceflight is not degraded by sleep-disordered breathing. This is the first direct demonstration that gravity plays a dominant role in the generation of apneas, hypopneas, and snoring in healthy subjects.

A unique complication of radiofrequency therapy to the tongue base

PubMed Central

Tornari, Chrysostomos; Wong, Gentle; Arora, Asit; Kotecha, Bhik

2015-01-01

Introduction Radiofrequency ablation treatment of the tongue base can be used either alone or as part of a multilevel approach in the treatment of snoring. This involves the generation of thermal energy around the circumvallate papillae of the tongue. Potential complications include ulceration, dysphagia, haematoma and abscess formation. Presentation of case We present the case of a 50-year-old patient who developed an anterior neck swelling following a second application of radiofrequency ablation therapy to the tongue base for snoring. This was secondary to an infection of a previously undiagnosed thyroglossal cyst. The patient made a full recovery following intravenous antibiotic therapy and ultrasound-guided needle aspiration. Discussion Thyroglossal tract remnants are thought to be present in seven percent of the adult population. An infection in a thyroglossal tract cyst has not previously been reported following radiofrequency ablation of the tongue base. Given the relatively high complication rate of tongue base radiofrequency ablation in some series, this complication may be under-recognised. Conclusion An infected thyroglossal tract cyst should be suspected in patients with anterior neck swellings following radiofrequency ablation therapy to the tongue base. We advise caution when performing this procedure on patients with known thyroglossal tract remnants though there is insufficient evidence to suggest that this procedure is contraindicated. PMID:25603484

Two-Dimensional Differential In-Gel Electrophoresis Proteomic Approaches Reveal Urine Candidate Biomarkers in Pediatric Obstructive Sleep Apnea

PubMed Central

Gozal, David; Jortani, Saeed; Snow, Ayelet B.; Kheirandish-Gozal, Leila; Bhattacharjee, Rakesh; Kim, Jinkwan; Capdevila, Oscar Sans

2009-01-01

Rationale: Sleep studies are laborious, expensive, inaccessible, and inconvenient for diagnosing obstructive sleep apnea (OSA) in children. Objectives: To examine whether the urinary proteome uncovers specific clusters that are differentially expressed in the urine of children with OSA. Methods: Two-dimensional differential in-gel electrophoresis (2D-DIGE) and mass spectrometry proteomics followed by validation with western blot of ELISA. Measurements and Main Results: Morning urine proteins from 60 children with polysomnographically confirmed OSA and from matched children with primary snoring (n = 30) and control subjects (n = 30) were assessed. A total of 16 proteins that are differentially expressed in OSA were identified, and 7 were confirmed by either immunoblots or ELISA. Among the latter, receiver–operator curve analyses of urinary concentrations of uromodulin, urocortin-3, orosomucoid-1, and kallikrein assigned favorable predictive properties to these proteins. Furthermore, combinatorial approaches indicated that the presence of values beyond the calculated cutoff concentrations for three or more of the proteins yielded a sensitivity of 95% and a specificity of 100%. Conclusions: Proteomic approaches reveal that pediatric OSA is associated with specific and consistent alterations in urinary concentrations of specific protein clusters. Future studies aiming to validate this approach as a screening method of habitually snoring children appears warranted. PMID:19797158

Lifestyle and oral facial disorders associated with sleep bruxism in children.

PubMed

Alencar, Nashalie Andrade de; Fernandes, Alline Birra Nolasco; Souza, Margareth Maria Gomes de; Luiz, Ronir Raggio; Fonseca-Gonçalves, Andréa; Maia, Lucianne Cople

2017-05-01

The aim of the study was to investigate the routine, sleep history, and orofacial disorders associated with children aged 3-7 years with nocturnal bruxism. Children (n = 66) were divided into groups of parent reported nocturnal bruxism (n = 34) and those without the disorder (n = 32). Data about the child's routine during the day, during sleep and awakening, headache frequency, temporomandibular joint (TMJ), and hearing impairments were obtained through interviews with parents/caregivers. Electromyography examination was used to assess the activity of facial muscles. Multiple logistic regression (MLR), chi-square test, and t-test analyses were performed. MLR revealed association of nightmares (p = 0.002; OR = 18.09) and snoring (p = 0.013; OR = 0.14) with bruxism. Variables related to awakening revealed an association with bruxism (p < 0.05). Parents of the main group (children with nocturnal bruxism) reported more complaints of orofacial pain, facial appearance, and headache occurrence (p < 0.05). Auditory and muscle disorders were not significant variables (p > 0.05). Nightmares and snoring are associated with nocturnal bruxism in children. Bruxism in children elicits consequences such as headache, orofacial pain, and pain related to awakening.

Abnormal afferent nerve endings in the soft palatal mucosa of sleep apnoics and habitual snorers.

PubMed

Friberg, D; Gazelius, B; Hökfelt, T; Nordlander, B

1997-07-23

Habitual snoring precedes obstructive sleep apnea (OSA), but the pathophysiological mechanisms behind progression are still unclear. The patency of upper airways depends on a reflexogen mechanism reacting on negative intrapharyngeal pressure at inspiration, probably mediated by mucosal receptors, i.e., via afferent nerve endings. Such nerves contain a specific nerve protein, protein-gene product 9.5 (PGP 9.5) and in some cases substance P (SP) and calcitonin gene-related (CGRP). Biopsies of the soft palatial mucosa were obtained from non-smoking men ten OSA patients, 11 habitual snorers and 11 non-snoring controls. The specimens were immunohistochemically analyzed for PGP 9.5, SP and CGRP. As compared to controls, an increased number of PGP-, SP- and CGRP-immunoreactive nerves were demonstrated in the mucosa in 9/10 OSA patients and 4/11 snorers, in addition to varicose nerve endings in the papillae and epithelium. Using double staining methodology, it could be shown that SP- and CGRP-like immunoreactivities (LIs) often coexisted in these fibres, as did CGRP- and PGP 9.5-LIs. The increased density in sensory nerve terminals are interpreted to indicate an afferent nerve lesion. Our results support the hypothesis of a progressive neurogenic lesion as a contributory factor to the collapse of upper airways during sleep in OSA patients.

Microgravity reduces sleep-disordered breathing in humans

NASA Technical Reports Server (NTRS)

Elliott, A. R.; Shea, S. A.; Dijk, D. J.; Wyatt, J. K.; Riel, E.; Neri, D. F.; Czeisler, C. A.; West, J. B.; Prisk, G. K.

2001-01-01

To understand the factors that alter sleep quality in space, we studied the effect of spaceflight on sleep-disordered breathing. We analyzed 77 8-h, full polysomnographic recordings (PSGs) from five healthy subjects before spaceflight, on four occasions per subject during either a 16- or 9-d space shuttle mission and shortly after return to earth. Microgravity was associated with a 55% reduction in the apnea-hypopnea index (AHI), which decreased from a preflight value of 8.3 +/- 1.6 to 3.4 +/- 0.8 events/h inflight. This reduction in AHI was accompanied by a virtual elimination of snoring, which fell from 16.5 +/- 3.0% of total sleep time preflight to 0.7 +/- 0.5% inflight. Electroencephalogram (EEG) arousals also decreased in microgravity (by 19%), and this decrease was almost entirely a consequence of the reduction in respiratory-related arousals, which fell from 5.5 +/- 1.2 arousals/h preflight to 1.8 +/- 0.6 inflight. Postflight there was a return to near or slightly above preflight levels in these variables. We conclude that sleep quality during spaceflight is not degraded by sleep-disordered breathing. This is the first direct demonstration that gravity plays a dominant role in the generation of apneas, hypopneas, and snoring in healthy subjects.

What sleep behaviors are associated with bruxism in children? A systematic review and meta-analysis.

PubMed

Guo, Huaqi; Wang, Tongxia; Li, Xuechao; Ma, Qiong; Niu, Xiaohong; Qiu, Jie

2017-12-01

The aim of this article was to assess the sleep behaviors that serve as risk factors related to bruxism in children ages 0 to 12 years by performing a systematic review and meta-analysis of published studies. Seven databases were searched to identify all peer-reviewed articles potentially relevant to the review. Data were pooled for random-effects modeling. Sleep risk factors related to bruxism in this age group are summarized using pooled odds ratios (ORs), 95% confidence intervals (CIs), and P values. Of 5637 initially identified articles, 14 met inclusion criteria. Study qualities of all case-control studies were high. Quality of cross-sectional studies was more variable. The pooled ORs, 95% CIs, and P values were as follows: snoring (2.86, 1.85-4.42, <0.0001), mouth breathing (1.51, 1.04-2.18, 0.029), restless sleep (2.31, 1.89-2.83, <0.0001), drooling (1.79, 1.07-2.97, 0.026), stomach position during sleep (1.70, 1.0-2.39, 0.003), and inadequate sleep time (2.56, 1.48-4.43, 0.001). Snoring, mouth breathing, restless sleep, drooling, stomach position during sleep, and lack of sleep were the risk factors related to bruxism in children.

Just a scary dream? A brief review of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder.

PubMed

Haupt, Mark; Sheldon, Stephen H; Loghmanee, Darius

2013-10-01

The clinical spectrum of sleep disorders in children is broad, ranging from primary snoring and obstructive sleep apnea (OSA) syndrome to complex sleep-related behaviors and movement disorders. Although snoring and OSA typically receive significant attention and discussion, other biologically based sleep disorders are as common, if not more common, in children. A general pediatrician is frequently presented with the complaint of sleep talking, sleep walking, or abnormal movements during sleep. Even more alarming is the presentation of the child suddenly and explosively screaming during sleep. Such complaints fall under the category of parasomnias. Exclusive to sleep and wake-to-sleep transitions, these parasomnias include arousals with abnormal motor, behavioral, autonomic, or sensory symptoms. Parasomnias can be noticeably dissimilar in clinical manifestations, but most share biologic characteristics. Three parasomnias associated with loud vocalizations associated with sleep that can present to general practitioners include sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD). Although usually benign, these sleep disorders can be disruptive and even potentially dangerous to the patient and can often be threatening to quality of life. In this article, we describe the clinical features of some of these disorders and how to differentiate between their alarming presentations. Copyright 2013, SLACK Incorporated.

A Rare Cause of Obstructive Sleep Apnea Syndrome: Retropharyngeal Lipoma

PubMed Central

Dilek, Okan; Yilmaz, Cengiz; Gulek, Bozkurt; Akin, Mehmet Ali

2017-01-01

Lipoma is the most common benign mesenchymal neoplasm. About 16% of lipomas arise in the head and neck region, especially in the posterior neck. Large lipomas that originate from the retropharyngeal space may cause dyspnea, dysphagia, and snoring and occasionally may lead to obstructive sleep apnea syndrome (OSAS). Herein, we report a 45-year-old male patient with OSAS caused by a giant retropharyngeal lipoma with emphasis on CT findings. PMID:28912996

The adenoid as a key factor in upper airway infections.

PubMed

van Cauwenberge, P B; Bellussi, L; Maw, A R; Paradise, J L; Solow, B

1995-06-01

The adenoids (and the nasopharynx) play a key role in the normal functioning and in various pathologies of the upper respiratory tract. In this paper the role of adenoidal pathology and the beneficial effect of adenoidectomy in some upper respiratory tract and facial anomalies and diseases are discussed; otitis media with effusion, recurrent acute otitis media, sinusitis, snoring and sleep apnea and abnormal patterns in the midface growth and development.

Did Napoleon suffer from chronic rhonchopathy?

PubMed

Chouard, Claude-Henri

2017-04-01

If Napoleon had been treated, Europa would then have doubtless been different, and perhaps would not have known the last two World wars. This study plans to demonstrate that Napoleon very probably suffered from Chronic Rhonchopathy. Between 1983-1993, the author led their ENT department of CHU Saint-Antoine to contribute in the knowledge of chronic snoring and Obstructive Sleep Apneas Syndrome (OSAS), and to define the treatment of their consequences. As a result of these efforts, in Paris in 1987 the First International Congress on Chronic Rhonchopathy was organized. Obstructive Sleep Apnoea Syndrome (OSAS) is caused by anatomical and intermittent obstruction of the upper airway, which impedes passage of air to the lungs during sleep. Recent literature demonstrates that chronic snoring frequently precedes this obstruction by several years, and always accompanies this syndrome. All life long, there is a severity increasing continuum between more light snoring and more severe OSAS, i.e. Pickwick Syndrome. This continuum is described as a new disease called Chronic Rhonchopathy. This term was never discussed; since 2006, it has been implicitly recognized. Napoleon would sleep very little. He used to wake up in the night and then grasp the chance to work. Brief sleeping time in day repaired his fatigue. He also had a short and thick neck. In the last quarter of his life he had progressively suffered from obesity, daily involuntary sleepiness, and his intellectual capabilities had been undoubtedly decreasing. In the vast literature concerning Napoleon's behavior, the author brought together the clinical elements which could be due to this disease. This study looked for the morphological peculiarities of this OSAS in sculpture and painting, that had the Emperor as the model. Napoleon presented surely diurnal somnolence, asthenia, obesity, neck shortness, retrognatia, and nasal pathology. He did not suffer from these troubles while he was young. On the contrary, he took advantage of his multiple awakenings, doubtlessly due to apnea occurring during his paradoxical sleep, to deal with some of his main masterpieces, e.g. the French Code Civil. With age, the Emperor's chronic rhonchopathy became more severe. If he had benefitted of modern treatments, maybe Moskowa would not have been a French defeat and Waterloo would have been a victory for France.

Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis.

PubMed

Hamerschmidt, Rodrigo; Hamerschmidt, Rogério; Moreira, Ana Tereza Ramos; Tenório, Sérgio Bernardo; Timi, Jorge Rufno Ribas

2016-01-01

Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

[Changes of serum aminotransferase in children with obstructive sleep apnea hypopnea syndrome].

PubMed

Chen, Zhenjiang; Duo, Likun

2013-08-01

Obstructive sleep apnea hypopnea syndrome (OSAHS) and non-alcoholic fatty liver disease (NAFLD) are both strongly associated with obesity. Whether OSAHS is an independent risk factor for liver injury or not is uncertain. To assess the hypothesis that OSAHS is associated with liver injury independent of obesity. One hundred and thirty children with OSAHS and 77 children with primary snoring(PS) were enrolled. Polysomnography was performed. Body mass index (BMI), liver function tests, serum lipids, fasting plasma glucose (FPG), and insulin (INS) were measured. Seventeen children of OSAHS had elevated serum aminotransferase levels,while only 2 children of non-OSAHS had elevated serum aminotransferase in healthy control group (chi2 = 5.18, P < 0.05; OR = 5.64 CI 1.27-24.97). Fifteen children of obese had elevated serum aminotransferase levels, while only 4 children had elevated serum aminotransferase in non-obese group (chi2 = 4.58, P < 0.05; (OR = 1.97 CI 1.06-3.67). Seventy cases of obese children, 15 cases of elevated aminotransferase levels (21.4%), namely fatty liver patients, of these children, 14 had OSAHS (93.3%). In contrast, OSAHS was present in only 67.3% of obese children without elevated aminotransferase. OSAHS may be a risk factor for liver injury independent of obesity; Increased liver enzyme levels are frequently found in obese snoring children, particularly among those with OSAHS.

How do we recognize the child with OSAS?

PubMed

Joosten, Koen F; Larramona, Helena; Miano, Silvia; Van Waardenburg, Dick; Kaditis, Athanasios G; Vandenbussche, Nele; Ersu, Refika

2017-02-01

Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Associations of sleep bruxism with age, sleep apnea, and daytime problematic behaviors in children.

PubMed

Tachibana, M; Kato, T; Kato-Nishimura, K; Matsuzawa, S; Mohri, I; Taniike, M

2016-09-01

The aims of this study were to investigate the prevalence of sleep bruxism in children in Japan, and its relationships with sleep-related factors and daytime problematic behavior. Guardians of 6023 children aged 2-12 years completed the Japanese Sleep Questionnaire. Multiple regression analysis and structural equation modeling were performed. Sleep bruxism was reported in 21.0% children (n = 1263): the prevalence was highest in the age group of 5-7 years (27.4%). Multiple regression analysis showed that sleep bruxism had significant correlations with age 5-7 years (OR: 1.72; P < 0.0001), 'Moves a lot during sleep' (OR: 1.47; P < 0.0001), 'sleeps with mouth open' (OR: 1.56; P < 0.0001), and 'snores loudly' (OR: 1.80; P < 0.0001). In structural equation modeling, sleep bruxism had a significant but weak direct effect on daytime problematic behavior, while sleep bruxism significantly correlated with obstructive sleep apnea, which had a higher direct effect on daytime problematic behavior. Sleep bruxism was reported in 21.0% of Japanese children and had independent relationships with age, movements during sleep, and snoring. A comorbidity of sleep-disordered breathing might be related to daytime problematic behavior in children with sleep bruxism. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Usefulness and diagnostic value of the NEMA parameter combined with other selected bedside tests for prediction of difficult intubation.

PubMed

Torres, Kamil; Błoński, Marcin; Pietrzyk, Łukasz; Piasecka-Twaróg, Małgorzata; Maciejewski, Ryszard; Torres, Anna

2017-02-01

To assess the usefulness of the new NEMA (Neck Circumference Minus Acromion-Acromion Distance) parameter, in preoperative identification of patients' difficult intubation and compare it with other commonly used scales and tests. Prospective study. District Specialist Hospital of Lublin, Poland. Six hundreds twenty-nine patients underwent nonemergency surgical interventions. The NEMA parameter was confronted with: Modified Mallampati classification, TMD, RHTMD, NC, MPND, SMD, I-I D, A-AD, and medical history of difficult intubation and diagnosed obstructive sleep apnea syndrome or snoring. Higher medians of NEMA and Mallampati parameters were reported in patients with difficult intubation. AUC for Mallampati parameter was 0.733 while the NEMA parameter's AUC was 0.625. Sensitivity and specificity for Mallampati and NEMA parameter were respectively 0.79; 0.55 and 0.42; 0.75. Significantly higher MPN, RHTMD, Mallampati, and NEMA parameter were observed in patients in whom the BURP was used. Easy intubation occurs more frequently in patients with a history of OSAS or snoring than in those with difficult intubation. It seems that none of the known bedside tests for predicting difficult intubation have a discriminating power sufficient for clinicians. Our study draws attention to a novel parameter, called NEMA, which appears to be a strong predictor of DEI, especially in combination with the Mallampati scale. Copyright © 2016 Elsevier Inc. All rights reserved.

Sleep Duration, Snoring Prevalence, Obesity, and Behavioral Problems in a Large Cohort of Primary School Students in Japan.

PubMed

Sakamoto, Naoko; Gozal, David; Smith, Dale L; Yang, Limin; Morimoto, Noriko; Wada, Hiroo; Maruyama, Kotatsu; Ikeda, Ai; Suzuki, Yohei; Nakayama, Meiho; Horiguchi, Itsuko; Tanigawa, Takeshi

2017-03-01

Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey. We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics. In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school. Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

The effects of oral appliance therapy on occlusal function in patients with obstructive sleep apnea: a short-term prospective study.

PubMed

Otsuka, Ryo; Almeida, Fernanda Ribeiro; Lowe, Alan A

2007-02-01

The aim of this study was to objectively and prospectively assess whether oral appliances (OAs) alter occlusal function in patients treated for snoring or obstructive sleep apnea. The occlusal contact area (OCA) and bite force (Bf) of 12 patients who used OAs were measured with pressure-sensitive sheets in the morning and evening with the Dental Prescale Occluzer System. OCA and Bf were compared in each measurement period by using ANOVA. Percentage changes in the morning relative to the evening (OCA(M-E) and Bf(M-E)) were compared between the 2 periods by using the Wilcoxon signed rank test. Correlations between percentage changes in pretreatment and posttitration ((Pre-Post)OCA and (Pre-Post)Bf), age, and cephalometric variables were also assessed. Patients showed significant decreases in OCA and Bf when posttitration readings were compared with corresponding pretreatment measurements. OCA(M-E) and Bf(M-E) were significantly different between pretreatment and posttitration, suggesting that OCA and Bf tend to be smaller in the morning with OA use. (Pre-Post)Bf measured in the evening correlated with age. Effects on occlusal function after OA use were observed. These results suggest that practitioners should pay attention to the possible side effects of OAs on the dentition when treating patients with snoring or obstructive sleep apnea.

A Novel Approach to Prediction of Mild Obstructive Sleep Disordered Breathing in a Population-Based Sample: The Sleep Heart Health Study

PubMed Central

Caffo, Brian; Diener-West, Marie; Punjabi, Naresh M.; Samet, Jonathan

2010-01-01

This manuscript considers a data-mining approach for the prediction of mild obstructive sleep disordered breathing, defined as an elevated respiratory disturbance index (RDI), in 5,530 participants in a community-based study, the Sleep Heart Health Study. The prediction algorithm was built using modern ensemble learning algorithms, boosting in specific, which allowed for assessing potential high-dimensional interactions between predictor variables or classifiers. To evaluate the performance of the algorithm, the data were split into training and validation sets for varying thresholds for predicting the probability of a high RDI (≥ 7 events per hour in the given results). Based on a moderate classification threshold from the boosting algorithm, the estimated post-test odds of a high RDI were 2.20 times higher than the pre-test odds given a positive test, while the corresponding post-test odds were decreased by 52% given a negative test (sensitivity and specificity of 0.66 and 0.70, respectively). In rank order, the following variables had the largest impact on prediction performance: neck circumference, body mass index, age, snoring frequency, waist circumference, and snoring loudness. Citation: Caffo B; Diener-West M; Punjabi NM; Samet J. A novel approach to prediction of mild obstructive sleep disordered breathing in a population-based sample: the Sleep Heart Health Study. SLEEP 2010;33(12):1641-1648. PMID:21120126

Is Passive Smoking Associated With Sleep Disturbance Among Pregnant Women?

PubMed Central

Ohida, Takashi; Kaneita, Yoshitaka; Osaki, Yoneatsu; Harano, Satoru; Tanihata, Takeo; Takemura, Shinji; Wada, Kiyoshi; Kanda, Hideyuki; Hayashi, Kenji; Uchiyama, Makoto

2007-01-01

Study Objective: Pregnant women suffer from sleep disturbance, which may be aggravated by passive smoking. In this study we investigated the effects of passive smoking on sleep disturbance during pregnancy. Design: Two cross-sectional questionnaire surveys conducted in 2002 and 2006. Setting: Clinical institutions specializing in obstetrics and gynecology that participated in the nationwide surveys: 260 in the 2002 survey and 344 in the 2006 survey. Participants: 16,396 and 19,386 pregnant women in Japan surveyed in 2002 and 2006, respectively. Intervention: N/A. Measurements and Results: Pregnant women exposed to passive smoking were likely to have sleep disturbances, such as subjective insufficient sleep, difficulty in initiating sleep, short sleep duration, and snoring loudly/breathing uncomfortably. Smoking pregnant women had the same sleep disturbances and also experienced excessive daytime sleepiness and early morning awakening. The prevalence of 5 types of sleep disturbance (insufficient sleep, difficulty in initiating sleep, short sleep duration, excessive daytime sleepiness, and snoring loudly/breathing uncomfortably) among nonsmokers with environmental tobacco smoke showed a mean value intermediate between that of active smokers and that of nonsmokers without environmental tobacco smoke. Conclusion: Passive smoking is independently associated with increased sleep disturbance during pregnancy. Citation: Ohida T; Kaneita Y; Osaki Y; Harano S; Tanihata T; Takemura S; Wada K; Kanda H; Hayashi K; Uchiyama M. Is passive smoking associated with sleep disturbance among pregnant women? SLEEP 2007;30(9):1155-1161. PMID:17910387

The eye in sleep apnea syndrome.

PubMed

Abdal, Helen; Pizzimenti, Joseph J; Purvis, Cheryl C

2006-03-01

Sleep apnea syndrome (SAS) is a disease characterized by recurrent complete or partial upper airway obstructions during sleep. The majority of patients with SAS demonstrate this obstruction either at the nasopharynx or the oropharynx. Risk factors for SAS include obesity, male gender, upper airway abnormalities, alcohol use, snoring, and neck girth of more than 17 in. in men or 16 in. in women. Reported ophthalmic findings in patients with SAS include floppy eyelid syndrome (FES), glaucoma, and non-arteritic anterior ischemic optic neuropathy (NAION).

Dream Content in Patients With Sleep Apnea: A Prospective Sleep Laboratory Study.

PubMed

Di Pauli, Franziska; Stefani, Ambra; Holzknecht, Evi; Brandauer, Elisabeth; Mitterling, Thomas; Holzinger, Brigitte; Högl, Birgit

2018-01-15

Few studies have addressed dreaming in patients with sleep apnea. We hypothesized that respiratory events and subsequent oxygen desaturation act as an important physiological trigger and may thus influence dream content in patients with a sleep-related breathing disorder. Seventy-six patients (28 women, mean age 54 years, range 20-82) who underwent polysomnography because of suspected sleep apnea participated in this study. Dream reports and dream questionnaires were collected immediately after first morning awakening, at 5:30 AM, at the sleep laboratory. Dream content analysis with respect to possible respiratory-related content was performed. Patients were stratified into primary snoring, mild, moderate, and severe sleep apnea groups. In 63 patients sleep apnea was diagnosed (mild n = 31, 49.2%, moderate n = 13, 20.6%, severe n = 19, 30.2%), and 13 subjects in whom a sleep-related breathing disorder was not confirmed were included as a control group with primary snoring. There was no significant difference in respiratory-related dream topics between patients and controls. Also, no influence of respiratory parameters measured during polysomnography on dream content was detectable. We failed to detect a difference in dream content between patients with sleep apnea and controls. Further studies are required to determine whether these results indicate that the incorporation of respiratory events into dreams is absent in patients with sleep apnea or represents a bias due to the collection of dream content in the early morning hours. © 2018 American Academy of Sleep Medicine

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

Position paper by Canadian dental sleep medicine professionals regarding the role of different health care professionals in managing obstructive sleep apnea and snoring with oral appliances

PubMed Central

Gauthier, Luc; Almeida, Fernanda; Arcache, Patrick; Ashton-McGregor, Catherine; Côté, David; Driver, Helen; Ferguson, Kathleen; Lavigne, Gilles; Martin, Philippe; Masse, Jean-François; Morisson, Florence; Pancer, Jeffrey; Samuels, Charles; Schachter, Maurice; Sériès, Frédéric; Sullivan, Glendon

2012-01-01

The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe OSA patients who cannot tolerate CPAP, are inappropriate candidates for CPAP or who have failed CPAP treatment attempts. The purpose of the present position paper is to guide interdisciplinary teamwork (sleep physicians and sleep dentists) and to clarify the role of each professional in the management of OA therapy. The diagnosis of OSA should always be made by a physician, and OAs should be fitted by a qualified dentist who is trained and experienced in dental sleep medicine. Follow-up assessment by the referring physician and polysomnography or sleep studies are required to verify treatment efficacy. The present article emphasizes the need for a team approach to OA therapy and provides treatment guidelines for dentists trained in dental sleep medicine. Many of the dentists and sleep physicians who contributed to the preparation of the present article are members of the Canadian Sleep Society and the authors reached a consensus based on the current literature. PMID:23061075

Maternal Sleep-Disordered Breathing.

PubMed

Pamidi, Sushmita; Kimoff, R John

2018-04-01

Emerging literature suggests that sleep-disordered breathing (SDB) worsens over the course of pregnancy and is associated with adverse maternal and fetal outcomes. Earlier studies, using mainly snoring as a surrogate marker for SDB, have shown an increase in the prevalence of SDB during pregnancy compared with that in the pregravid state. More recently, prospective observational studies in which the investigators ascertained SDB by using complete polysomnography have shown a prevalence ranging from approximately 17% to 45% in the third trimester. Pregnancy itself can be associated with daytime hypersomnolence, so complaints of increasing fatigue and sleepiness during pregnancy are not specific for SDB. Moreover, snoring in isolation also has relatively poor sensitivity and specificity as a screening tool for diagnosing maternal SDB. The indications for screening for SDB during routine obstetric prenatal visits are still unclear, but observational studies indicate that maternal SDB is linked with the development of adverse pregnancy outcomes, such as gestational hypertension and gestational diabetes mellitus. Some studies also have identified a relationship between maternal SDB and the delivery of infants who are small for gestational age. Aside from a few small interventional studies of CPAP in pregnant patients with gestational hypertension, little currently is known about whether treatment of SDB during pregnancy improves clinical outcomes for the mother and/or baby. Additional current knowledge gaps include elucidating underlying mechanisms of maternal SDB, determining optimal treatment strategies, and understanding the trajectory of SDB after delivery. Copyright © 2017. Published by Elsevier Inc.

Afternoon serum-melatonin in sleep disordered breathing.

PubMed

Ulfberg, J; Micic, S; Strøm, J

1998-08-01

To study afternoon serum-melatonin values in patients with sleep disordered breathing. Melatonin has a strong circadian rhythm with high values during the night-time and low values in the afternoon. Sleep disordered breathing may change the circadian rhythm of melatonin which may have diagnostic implications. The Sleep Laboratory, The Department of Internal Medicine, Avesta Hospital, Sweden, and the Department of Anaesthesiology, Glostrup University Hospital, Copenhagen, Denmark. We examined 60 consecutive patients admitted for sleep disordered breathing and 10 healthy non snoring controls. The patients underwent a sleep apnoea screening test having a specificity of 100% for the obstructive sleep apnoea syndrome (OSAS) using a combination of static charge sensitive bed and oximetry. Obstructive sleep apnoea syndrome was found in 49 patients, eight patients had borderline sleep disordered breathing (BSDB) and three patients were excluded due to interfering disease. Patients and controls had an afternoon determination of serum-melatonin. The Epworth Sleepiness Scale was used to score day-time sleepiness. In comparison with normal controls patients suffering from OSAS had significantly higher serum-melatonin levels in the afternoon. However, as a diagnostic test for OSAS in patients with sleep disordered breathing serum-melatonin showed a low sensitivity but a high specificity. The results indicate that breathing disorders during sleep in general affect pineal function. Sleep disordered breathing seems to disturb pineal function. Determination of afternoon serum-melatonin alone or together with a scoring of daytime sleepiness does not identify OSAS-patients in a heterogeneous population of patients complaining of heavy snoring and excessive daytime sleepiness.

Effect of an occlusal splint on sleep bruxism in children in a pilot study with a short-term follow up.

PubMed

Giannasi, Lilian Chrystiane; Santos, Israel Reis; Alfaya, Thays Almeida; Bussadori, Sandra Kalil; Franco de Oliveira, Luis Vicente

2013-10-01

The aim of the present study was to evaluate the effect of the use of an occlusal splint in children with bruxism in a pilot study with a short-term follow up. Seventeen children were recruited, only nine of whom formed the sample following the application of the inclusion criteria: presence of sleep bruxism for at least six months (based on parents' reports); presence of at least the first permanent molars; and no previous history of treatment involving an occlusal splint. The sample was submitted to a clinical exam. Other sleep problems were screened with the use of a sleep questionnaire filled out by parents before and after 90 days of occlusal splint usage. The children received a flat acrylic resin splint with full coverage of the occlusal surfaces to be worn in the maxilla. In children with erupting teeth, a space was created in the splint to allow normal eruption. After the 90-day period, the absence of sleep bruxism and sleep movements was noted in most of children. Moreover, snoring was reduced in nearly 50%, which raises a new issue to be investigated with regard to the pathophysiology of sleep bruxism. The use of an occlusal splint was effective in reducing the symptoms of sleep bruxism and other sleep problems. Further investigations should be carried out on the relationship between snoring and sleep bruxism in children. Copyright © 2013 Elsevier Ltd. All rights reserved.

Association of Sleep Apnea and Snoring With Incident Atrial Fibrillation in the Multi-Ethnic Study of Atherosclerosis

PubMed Central

Lin, Gen-Min; Colangelo, Laura A.; Lloyd-Jones, Donald M.; Redline, Susan; Yeboah, Joseph; Heckbert, Susan R.; Nazarian, Saman; Alonso, Alvaro; Bluemke, David A.; Punjabi, Naresh M.; Szklo, Moyses; Liu, Kiang

2015-01-01

The association between sleep apnea and atrial fibrillation (AF) has not been examined in a multiethnic adult population in prospective community-based studies. We prospectively (2000–2011) investigated the associations of physician-diagnosed sleep apnea (PDSA), which is considered more severe sleep apnea, and self-reported habitual snoring without PDSA (HS), a surrogate for mild sleep apnea, with incident AF in white, black, and Hispanic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of clinical cardiovascular disease at baseline (2000–2002). Cox proportional hazards models were used to assess the associations, with adjustment for socioeconomic status, traditional vascular disease risk factors, race/ethnicity, body mass index, diabetes, chronic kidney disease, alcohol intake, and lipid-lowering therapy. Out of 4,395 respondents to a sleep questionnaire administered in MESA, 181 reported PDSA, 1,086 reported HS, and 3,128 reported neither HS nor PDSA (unaffected). Over an average 8.5-year follow-up period, 212 AF events were identified. As compared with unaffected participants, PDSA was associated with incident AF in the multivariable analysis, but HS was not (PDSA: hazard ratio = 1.76, 95% confidence interval: 1.03, 3.02; HS: hazard ratio = 1.02, 95% confidence interval: 0.72, 1.44). PDSA, a marker of more severe sleep apnea, was associated with higher risk of incident AF in this analysis of MESA data. PMID:25977516

Adjustable tongue advancement for obstructive sleep apnea: a pilot study.

PubMed

Hamans, Evert; Boudewyns, An; Stuck, Boris A; Baisch, Alexander; Willemen, Marc; Verbraecken, Johan; Van de Heyning, Paul

2008-11-01

Surgical treatment of obstructive sleep apnea (OSA) caused by hypopharyngeal collapse of the upper airway can be considered in patients who are intolerant to continuous positive airway pressure (CPAP). The present procedures addressing the hypopharynx are invasive and have substantial morbidity and limited efficacy. Ten patients (mean age, 44 years) with moderate to severe OSA, ie, an apnea-hypopnea index (AHI) between 15 and 50, with CPAP intolerance were included in a prospective, nonrandomized, multicenter study to evaluate the feasibility, safety, and efficacy of a novel tongue advancement procedure. The procedure consists of the implantation of a tissue anchor in the tongue base and an adjustment spool at the mandible. Titration of this tissue anchor results in advancement of the tongue and a patent upper airway. The mean AHI decreased from 22.8 at baseline to 11.8 at the 6-month follow-up (p = 0.007). The Epworth Sleepiness Scale score decreased from 11.4 at baseline to 7.7 at the 6-month follow-up (p = 0.094), and the snoring score decreased from 7.5 at baseline to 3.9 at the 6-month follow-up (p = 0.005). Four technical adverse events were noted, and 1 clinical adverse event occurred. Adjustable tongue advancement is a feasible and relatively safe way to reduce the AHI and snoring in selected patients with moderate to severe OSA and CPAP intolerance. Technical improvements and refinements to the procedure are ongoing.

Impaired memory consolidation in children with obstructive sleep disordered breathing

PubMed Central

Katz, Eliot S.; Kapur, Kush; Stickgold, Robert

2017-01-01

Memory consolidation is stabilized and even enhanced by sleep (and particularly by 12–15 Hz sleep spindles in NREM stage 2 sleep) in healthy children but it is unclear what happens to these processes when sleep is disturbed by obstructive sleep disordered breathing. This cross-sectional study investigates differences in declarative memory consolidation among children with primary snoring (PS) and obstructive sleep apnea (OSA) compared to controls. We further investigate whether memory consolidation group differences are associated with NREM stage 2 (N2) sigma (12–15 Hz) or NREM slow oscillation (0.5–1 Hz) spectral power bands. In this study, we trained and tested participants on a spatial declarative memory task with cued recall. Retest occurred after a period of daytime wake (Wake) or a night of sleep (Sleep) with in-lab polysomnography. 36 participants ages 5–9 years completed the protocol: 14 with OSA as defined by respiratory disturbance index (RDI) > 1/hour, 12 with primary snoring (PS) and 10 controls. OSA participants had poorer overall memory consolidation than controls across Wake and Sleep conditions [OSA: mean = -18.7% (5.8), controls: mean = 1.9% (7.2), t = -2.20, P = 0.04]. In contrast, PS participants and controls had comparable memory consolidation across conditions (t = 0.41; P = 0.38). We did not detect a main effect for condition (Sleep, Wake) or group x condition interaction on memory consolidation. OSA participants had lower N2 sigma power than PS (P = 0.03) and controls (P = 0.004) and N2 sigma power inversely correlated with percentage of time snoring on the study night (r = -0.33, P<0.05). Across all participants, N2 sigma power modestly correlated with memory consolidation in both Sleep (r = 0.37, P = 0.03) and Wake conditions (r = 0.44, P = 0.009). Further observed variable path analysis showed that N2 sigma power mediated the relationship between group and mean memory consolidation across Sleep and Wake states [Bindirect = 6.76(3.5), z = 2.03, P = 0.04]. NREM slow oscillation power did not correlate with memory consolidation. All results retained significance after controlling for age and BMI. In sum, participants with mild OSA had impaired memory consolidation and results were mediated by N2 sigma power. These results suggest that N2 sigma power could serve as biomarker of risk for cognitive dysfunction in children with sleep disordered breathing. PMID:29095855

Impaired memory consolidation in children with obstructive sleep disordered breathing.

PubMed

Maski, Kiran; Steinhart, Erin; Holbrook, Hannah; Katz, Eliot S; Kapur, Kush; Stickgold, Robert

2017-01-01

Memory consolidation is stabilized and even enhanced by sleep (and particularly by 12-15 Hz sleep spindles in NREM stage 2 sleep) in healthy children but it is unclear what happens to these processes when sleep is disturbed by obstructive sleep disordered breathing. This cross-sectional study investigates differences in declarative memory consolidation among children with primary snoring (PS) and obstructive sleep apnea (OSA) compared to controls. We further investigate whether memory consolidation group differences are associated with NREM stage 2 (N2) sigma (12-15 Hz) or NREM slow oscillation (0.5-1 Hz) spectral power bands. In this study, we trained and tested participants on a spatial declarative memory task with cued recall. Retest occurred after a period of daytime wake (Wake) or a night of sleep (Sleep) with in-lab polysomnography. 36 participants ages 5-9 years completed the protocol: 14 with OSA as defined by respiratory disturbance index (RDI) > 1/hour, 12 with primary snoring (PS) and 10 controls. OSA participants had poorer overall memory consolidation than controls across Wake and Sleep conditions [OSA: mean = -18.7% (5.8), controls: mean = 1.9% (7.2), t = -2.20, P = 0.04]. In contrast, PS participants and controls had comparable memory consolidation across conditions (t = 0.41; P = 0.38). We did not detect a main effect for condition (Sleep, Wake) or group x condition interaction on memory consolidation. OSA participants had lower N2 sigma power than PS (P = 0.03) and controls (P = 0.004) and N2 sigma power inversely correlated with percentage of time snoring on the study night (r = -0.33, P<0.05). Across all participants, N2 sigma power modestly correlated with memory consolidation in both Sleep (r = 0.37, P = 0.03) and Wake conditions (r = 0.44, P = 0.009). Further observed variable path analysis showed that N2 sigma power mediated the relationship between group and mean memory consolidation across Sleep and Wake states [Bindirect = 6.76(3.5), z = 2.03, P = 0.04]. NREM slow oscillation power did not correlate with memory consolidation. All results retained significance after controlling for age and BMI. In sum, participants with mild OSA had impaired memory consolidation and results were mediated by N2 sigma power. These results suggest that N2 sigma power could serve as biomarker of risk for cognitive dysfunction in children with sleep disordered breathing.

Polymorphisms in nitric oxide synthase and endothelin genes among children with obstructive sleep apnea.

PubMed

Chatsuriyawong, Siriporn; Gozal, David; Kheirandish-Gozal, Leila; Bhattacharjee, Rakesh; Khalyfa, Ahamed A; Wang, Yang; Sukhumsirichart, Wasana; Khalyfa, Abdelnaby

2013-09-06

Obstructive sleep apnea (OSA) is associated with adverse and interdependent cognitive and cardiovascular consequences. Increasing evidence suggests that nitric oxide synthase (NOS) and endothelin family (EDN) genes underlie mechanistic aspects of OSA-associated morbidities. We aimed to identify single nucleotide polymorphisms (SNPs) in the NOS family (3 isoforms), and EDN family (3 isoforms) to identify potential associations of these SNPs in children with OSA. A pediatric community cohort (ages 5-10 years) enriched for snoring underwent overnight polysomnographic (NPSG) and a fasting morning blood draw. The diagnostic criteria for OSA were an obstructive apnea-hypopnea Index (AHI) >2/h total sleep time (TST), snoring during the night, and a nadir oxyhemoglobin saturation <92%. Control children were defined as non-snoring children with AHI <2/h TST (NOSA). Endothelial function was assessed using a modified post-occlusive hyperemic test. The time to peak reperfusion (Tmax) was considered as the indicator for normal endothelial function (NEF; Tmax<45 sec), or ED (Tmax ≥ 45 sec). Genomic DNA from peripheral blood was extracted and allelic frequencies were assessed for, NOS1 (209 SNPs), NOS2 (122 SNPs), NOS3 (50 SNPs), EDN1 (43 SNPs), EDN2 (48 SNPs), EDN3 (14 SNPs), endothelin receptor A, EDNRA, (27 SNPs), and endothelin receptor B, EDNRB (23 SNPs) using a custom SNPs array. The relative frequencies of NOS-1,-2, and -3, and EDN-1,-2,-3,-EDNRA, and-EDNRB genotypes were evaluated in 608 subjects [128 with OSA, and 480 without OSA (NOSA)]. Furthermore, subjects with OSA were divided into 2 subgroups: OSA with normal endothelial function (OSA-NEF), and OSA with endothelial dysfunction (OSA-ED). Linkage disequilibrium was analyzed using Haploview version 4.2 software. For NOSA vs. OSA groups, 15 differentially distributed SNPs for NOS1 gene, and 1 SNP for NOS3 emerged, while 4 SNPs for EDN1 and 1 SNP for both EDN2 and EDN3 were identified. However, in the smaller sub-group for whom endothelial function was available, none of the significant SNPs was retained due to lack of statistical power. Differences in the distribution of polymorphisms among NOS and EDN gene families suggest that these SNPs could play a contributory role in the pathophysiology and risk of OSA-induced cardiovascular morbidity. Thus, analysis of genotype-phenotype interactions in children with OSA may assist in the formulation of categorical risk estimates.

[Obstructive sleep apnoea syndrome].

PubMed

García Castillo, Sergio; Hoyos Vázquez, María Del Perpetuo Socorro; Coloma Navarro, Ramón; Cruz Ruiz, Javier; Callejas González, Francisco Javier; Godoy Mayoral, Raúl; Tárraga López, Pedro Juan; Rodríguez Montes, José Antonio

2018-05-01

Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. Retrospective descriptive study of sleep tests conducted on children up to 14 years-old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age 5 was years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, Sat.O2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

All APAPs Are Not Equivalent for the Treatment of Sleep Disordered Breathing: A Bench Evaluation of Eleven Commercially Available Devices.

PubMed

Zhu, Kaixian; Roisman, Gabriel; Aouf, Sami; Escourrou, Pierre

2015-07-15

This study challenged on a bench-test the efficacy of auto-titrating positive airway pressure (APAP) devices for obstructive sleep disordered breathing treatment and evaluated the accuracy of the device reports. Our bench consisted of an active lung simulator and a Starling resistor. Eleven commercially available APAP devices were evaluated on their reactions to single-type SDB sequences (obstructive apnea and hypopnea, central apnea, and snoring), and to a long general breathing scenario (5.75 h) simulating various SDB during four sleep cycles and to a short scenario (95 min) simulating one sleep cycle. In the single-type sequence of 30-minute repetitive obstructive apneas, only 5 devices normalized the airflow (> 70% of baseline breathing amplitude). Similarly, normalized breathing was recorded with 8 devices only for a 20-min obstructive hypopnea sequence. Five devices increased the pressure in response to snoring. Only 4 devices maintained a constant minimum pressure when subjected to repeated central apneas with an open upper airway. In the long general breathing scenario, the pressure responses and the treatment efficacy differed among devices: only 5 devices obtained a residual obstructive AHI < 5/h. During the short general breathing scenario, only 2 devices reached the same treatment efficacy (p < 0.001), and 3 devices underestimated the AHI by > 10% (p < 0.001). The long scenario led to more consistent device reports. Large differences between APAP devices in the treatment efficacy and the accuracy of report were evidenced in the current study. © 2015 American Academy of Sleep Medicine.

The relationship between sleep problems and working memory in children born very preterm.

PubMed

McCann, Marie; Bayliss, Donna M; Anderson, Mike; Campbell, Catherine; French, Noel; McMichael, Judy; Reid, Corinne; Bucks, Romola S

2018-01-01

In two studies, the relationship between sleep and working memory performance was investigated in children born very preterm (i.e., gestation less than 32 weeks) and the possible mechanisms underlying this relationship. In Study 1, parent-reported measures of snoring, night-time sleep quality, and daytime sleepiness were collected on 89 children born very preterm aged 6 to 7 years. The children completed a verbal working memory task, as well as measures of processing speed and verbal storage capacity. Night-time sleep quality was found to be associated with verbal working memory performance over and above the variance associated with individual differences in processing speed and storage capacity, suggesting that poor sleep may have an impact on the executive component of working memory. Snoring and daytime sleepiness were not found to be associated with working memory performance. Study 2 introduced a direct measure of executive functioning and examined whether sleep problems would differentially impact the executive functioning of children born very preterm relative to children born to term. Parent-reported sleep problems were collected on 43 children born very preterm and 48 children born to term (aged 6 to 9 years). Problematic sleep was found to adversely impact executive functioning in the very preterm group, while no effect of sleep was found in the control group. These findings implicate executive dysfunction as a possible mechanism by which problematic sleep adversely impacts upon cognition in children born very preterm, and suggest that sleep problems can increase the cognitive vulnerability already experienced by many of these children.

Improved long-term autonomic function following resolution of sleep-disordered breathing in preschool-aged children.

PubMed

Walter, Lisa M; Biggs, Sarah N; Nisbet, Lauren C; Weichard, Aidan J; Hollis, Samantha L; Davey, Margot J; Anderson, Vicki; Nixon, Gillian M; Horne, Rosemary S C

2016-03-01

Sleep-disordered breathing (SDB) prevalence peaks in preschool children and is associated with deficits in cardiovascular functioning during sleep. No long-term studies have investigated the effects of SDB resolution in mitigating these outcomes. We hypothesized that following 3 years, normalization of alterations to heart rate (HR), pulse transit time (PTT), heart rate variability (HRV), and urinary catecholamines identified at the initial diagnosis would be associated with resolution of SDB. Forty-five children with SDB and 28 non-snoring controls underwent polysomnography at baseline (3-5 years) and follow-up (6-9 years). Children were classified into control, resolved, and unresolved SDB. Resolution was defined as an obstructive apnea-hypopnea index (OAHI) ≤1 event/h, no snoring on polysomnography (PSG), or indicated by parents. PTT is an inverse surrogate measure of blood pressure change. HRV was assessed using power spectral analysis. There was no change in PTT or HR between studies for any group. Our HRV data suggest reduced parasympathetic activity in children whose SDB resolved and increased parasympathetic activity in children whose SDB remained the same or worsened at follow-up. We identified a significant correlation between low frequency power and urinary dopamine and adrenaline levels at follow-up in the unresolved group, suggesting increased sympathetic activity in children with unresolved SDB. Our findings suggest an association between resolution of SDB and normalization of HRV in the long term in these preschool children and an augmented sympathetic activity in the children with residual SDB. This highlights the autonomic impact of SDB in young children and the importance of detection and treatment.

Spanish translation and cross-language validation of a sleep habits questionnaire for use in clinical and research settings.

PubMed

Baldwin, Carol M; Choi, Myunghan; McClain, Darya Bonds; Celaya, Alma; Quan, Stuart F

2012-04-15

To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples.

Prevalence of obstructive sleep apnea among obese toddlers and preschool children.

PubMed

Bin-Hasan, Saadoun; Katz, Sherri; Nugent, Zoe; Nehme, Joy; Lu, Zihang; Khayat, Abdullah; Al-Saleh, Suhail; Amin, Reshma; Narang, Indra

2018-05-01

Obstructive sleep apnea (OSA) is a common disorder estimated at 1-5% in the school-aged children. With the obesity prevalence reaching staggering rates globally, OSA in obese adolescents is estimated to be 4-5-folds higher than their lean peers. There is a paucity of data regarding obesity-related OSA in children 6 years and less. This is particularly relevant as OSA is associated with neurocognitive deficits. The aim of this study is to evaluate the prevalence of OSA among obese toddlers and preschool children and further to determine what other factors may be associated with the presence of OSA. A retrospective study involving children ≤6 years, identified from two Canadian pediatric tertiary care centers who had an in-lab polysomnography (PSG). Obesity was defined by a BMI of > 95th percentile for age and gender or a z-score of > 2. OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) was greater than 2 events per hour. There were 60 participants included; the mean age was 4.4 years (standard deviation [SD] ± 1.7), mean BMI z-score was 3.0 (SD ± 1.2). Of these, 22/60 (36.6%) had OSA. Compared with the non-OSA group, the OSA group had a higher Epworth sleepiness score (p = 0.03) and were more likely to snore (p = 0.01). Young obese children should be assessed for OSA. A history of snoring and daytime sleepiness may be useful indicators to facilitate triage for a PSG, especially in resource-limited settings.

Sleep apnoea in heart failure: To treat or not to treat?

PubMed

Naughton, Matthew T; Kee, Kirk

2017-02-01

Heart failure (HF) and sleep apnoea are common disorders which frequently coexist. Two main types of apnoea occur: one is obstructive which, through recurring episodes of snoring, hypoxaemia, large negative intra-thoracic pressures and arousals from sleep leading to downstream inflammatory and autonomic nervous system changes, is thought to be a causative factor to the development of systemic hypertension and HF. The other type of apnoea, Cheyne-Stokes respiration with central sleep apnoea (CSR-CSA), is characterized by an oscillatory pattern of ventilation with a prevailing hyperventilation-induced hypocapnia, often in the absence of significant hypoxaemia and snoring, and is thought to be a consequence of advanced HF-related low cardiac output, high sympathetic nervous system activation and pulmonary congestion. CSR-CSA may be a compensatory response to advanced HF. Rostral fluid shift during sleep may play an important role in the pathogenesis of both obstructive sleep apnoea (OSA) and CSA. Studies of positive airway pressure (PAP) treatment of OSA and CSA in HF have shown short-term improvements in cardiac and autonomic function; however, there is no evidence of improved survival. Loop gain may provide useful marker of continuous PAP (CPAP) responsiveness in patients with central apnoea. A greater understanding of the pathophysiology of the interaction between obstructive and central apnoea and the various types of HF, and the mechanisms of therapies, such as PAP, is required to develop new strategies to overcome the disabling symptoms, and perhaps improve the mortality, that accompany HF with sleep apnoea. © 2016 Asian Pacific Society of Respirology.

Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience.

PubMed

Verma, Roshan K; Johnson J, Jai Richo; Goyal, Manoj; Banumathy, N; Goswami, Upendra; Panda, Naresh K

2016-12-01

Oropharyngeal exercises are new, non-invasive, cost effective treatment modality for the treatment of mild to moderate obstructive sleep apnoea. It acts by increasing the tone of pharyngeal muscles, is more physiological, and effects are long lasting. The aim of our present study was to evaluate the effect of oropharyngeal exercises in the treatment of mild to moderate obstructive sleep apnoea. Twenty patients of mild to moderate obstructive sleep apnoea syndrome (OSAS) were given oropharyngeal exercise therapy for 3 months divided into three phases in graded level of difficulty. Each exercise had to be repeated 10 times, 5 sets per day at their home. Oropharyngeal exercises were derived from speech-language pathology and included soft palate, tongue, and facial muscle exercises. Anthropometric measurements, snoring frequency, intensity, Epworth daytime sleepiness and Berlin sleep questionnaire, and full polysomnography were performed at baseline and at study conclusion. Body mass index (25.6 ± 3.1) did not change significantly at the end of the study period. There was significant reduction in the neck circumference (38.4 ± 1.3 to 37.8 ± 1.6) at the end of the study. Significant improvement was seen in symptoms of daytime sleepiness, witnessed apnoea, and snoring intensity. Significant improvement was also seen in sleep indices like minimum oxygen saturation, time duration of Sao2 < 90 %, sleep efficiency, arousal index, and total sleep time N3 stage of sleep at the end of study. Graded oropharyngeal exercise therapy increases the compliance and also reduces the severity of mild to moderate OSAS.

Sleep Symptoms, Race/Ethnicity, and Socioeconomic Position

PubMed Central

Grandner, Michael A.; Petrov, Megan E. Ruiter; Rattanaumpawan, Pinyo; Jackson, Nicholas; Platt, Alec; Patel, Nirav P.

2013-01-01

Study Objectives: Growing evidence indicates sleep is a major public health issue. Race/ethnicity and socioeconomics may contribute to sleep problems. This study assessed whether sleep symptoms were more prevalent among minorities and/or the socioeconomically disadvantaged. Design: Cross-sectional. Setting: Epidemiologic survey. Patients or Participants: 2007-2008 National Health and Nutrition Examination Survey (N = 4,081). Interventions: None. Measurements and Results: Sociodemographics included age, sex, race/ethnicity, marital status, and immigration. Socioeconomics included poverty, education, private insurance, and food insecurity. Sleep symptoms assessed were sleep latency > 30 min, difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, non-restorative sleep, daytime sleepiness, snorting/gasping, and snoring. Decreased reported problems for most symptoms were found among minorities, immigrants, and lower education levels. In general, in fully adjusted models, long sleep latency was associated with female gender, being black/African American, lower education attainment, no private insurance, and food insecurity. Difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, and non-restorative sleep were also associated with female gender and food insecurity. Daytime sleepiness was seen in female and divorced respondents. Snorting/gasping was more prevalent among male, other-Hispanic/Latino, and 9th- to 11th-grade-level respondents. Snoring was prevalent among male, other-Hispanic/Latino, less-educated, and food-insecure respondents. Conclusions: Sleep symptoms were associated with multiple sociodemographic and economic factors, though these relationships differed by predictor and sleep outcome. Also, reports depended on question wording. Citation: Grandner MA; Petrov MER; Rattanaumpawan P; Jackson N; Platt A; Patel NP. Sleep symptoms, race/ethnicity, and socioeconomic position. J Clin Sleep Med 2013;9(9):897-905. PMID:23997702

Blood pressure associated with sleep-disordered breathing in a population sample of children.

PubMed

Bixler, Edward O; Vgontzas, Alexandros N; Lin, Hung-Mo; Liao, Duanping; Calhoun, Susan; Fedok, Fred; Vlasic, Vukmir; Graff, Gavin

2008-11-01

The current criteria for sleep-disordered breathing (SDB) in children are not based on a clinically relevant outcome. The purpose of this study was to assess the association of blood pressure with SDB in a random sample of the local elementary school children (kindergarten through grade 5) using a 2-phased strategy. During phase 1, a brief questionnaire was completed for all of the children (N=5740) with a response rate of 78.5%. During phase 2, 700 randomly selected children from phase 1 with a response rate of 70.0% were assessed with a full polysomnograph and a history/physical, including an ECG; ear, nose, and throat; and pulmonary evaluation. We observed a significantly elevated systolic blood pressure associated with the apnea hypopnea index (AHI): AHI >or=1 (2.9 mm Hg); AHI >or=3 (7.1 mm Hg); and AHI >or=5 (12.9 mm Hg). The SDB and blood pressure association remained significant after adjusting for age, sex, race, body mass index percentile or waist circumference, sleep efficiency, percentage of rapid eye movement sleep, and snoring. In addition, older age, body mass index percentile, waist circumference, and snoring were significantly associated with blood pressure, independent of SDB. Based on these findings, our study suggests that SDB is significantly associated with higher levels of systolic blood pressure in children aged 5 to 12 years even after adjusting for the various confounding factors. Clinically, the data support the threshold of AHI >or=5 for the initiation of treatment for SDB. Additional research is indicated to assess the efficacy of SDB treatment on reducing blood pressure.

Characteristics of wake-up stroke.

PubMed

Tanimoto, Aki; Mehndiratta, Prachi; Koo, Brian B

2014-07-01

Wake-up stroke (WUS) accounts for up to 29.6% of ischemic strokes, but its mechanisms are poorly understood. The purpose of this study is to identify risk factors and characteristics of WUS. Seven-two ischemic strokes were classified as WUS or non-WUS. Collected were demographic information, medical history, cholesterol profile, and stroke characteristics including severity (National Institutes of Health Stroke Scale [NIHSS]) and mechanism (Trial of Org 10172 in Acute Stroke Treatment criteria). Subjects completed questionnaires screening for sleep apnea (Berlin questionnaire) and assessing sleep characteristics. There were 72 ischemic strokes, of which 28 WUS (38.9%). WUS and non-WUS patients were similar in regard to stroke risk factors. WUS patients tended to be African American and were significantly younger. WUS was significantly more likely to result from small-vessel disease mechanism (42.9% versus 14.0%; P=.006) and tended to be less severe WUS (NIHSS score 3 [1, 4] versus 4 [2, 11]; P=.13) than non-WUS. Groups did not differ in regard to scoring positively on the Berlin questionnaire, but WUS sufferers were more likely to snore frequently (90.5% versus 70.0%, P=.08). The lipid profile was significantly worse in WUS compared with non-WUS (low-density lipoprotein 124.6±38.4 versus 103.7±36.8; P=.03; cholesterol to high-density lipoprotein ratio 5.2±1.6 versus 4.3±1.6; P=.02). WUS is more likely to result from small-vessel disease mechanism. Poorer cholesterol profile and frequent snoring may contribute to WUS. Published by Elsevier Inc.

Sleep-disordered breathing: a survey of otolaryngologic practice at military hospitals.

PubMed

Davidson, T M; Do, K L

2000-11-01

We conducted a survey of otolaryngologists at all Veterans Administration and Department of Defense hospitals in the United States to ascertain the nature and scope of their treatment of sleep-disordered breathing. Questionnaire responses indicated that head and neck surgeons in military hospitals have a strong interest in the management of patients with snoring and sleep apnea. Because of the difficulty in obtaining timely sleep test results and the low number of referrals from physicians who perform such testing, many otolaryngologists expressed a desire to be able to perform their own sleep testing.

The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood.

PubMed

Beebe, Dean W; Ris, M Douglas; Kramer, Megan E; Long, Elizabeth; Amin, Raouf

2010-11-01

(1) to determine the associations of sleep disordered breathing (SDB) with behavioral functioning, cognitive test scores, and school grades during middle- to late-childhood, an under-researched developmental period in the SDB literature, and (2) to clarify whether associations between SDB and school grades are mediated by deficits in cognitive or behavioral functioning. cross-sectional correlative study. Office/hospital, plus reported functioning at home and at school. 163 overweight subjects aged 10-16.9 years were divided into 4 groups based upon their obstructive apnea+hypopnea index (AHI) during overnight polysomnography and parent report of snoring: Moderate-Severe OSA (AHI > 5, n = 42), Mild OSA (AHI = 1-5, n = 58), Snorers (AHI < 1 + snoring, n = 26), and No SDB (AHI < 1 and nonsnoring, n = 37). inpatient overnight polysomnography, parent- and self-report of school grades and sleep, parent- and teacher-report of daytime behaviors, and office-based neuropsychological testing. The 4 groups significantly differed in academic grades and parent- and teacher-reported behaviors, particularly inattention and learning problems. These findings remained significant after adjusting for subject sex, race, socioeconomic status, and school night sleep duration. Associations with SDB were confined to reports of behavioral difficulties in real-world situations, and did not extend to office-based neuropsychological tests. Findings from secondary analyses were consistent with, but could not definitively confirm, a causal model in which SDB affects school grades via its impact on behavioral functioning. SDB during middle- to late-childhood is related to important aspects of behavioral functioning, especially inattention and learning difficulties, that may result in significant functional impairment at school.

Catathrenia (Nocturnal Groaning): A Social Media Survey and State-of-the-Art Review.

PubMed

Alonso, Jose; Camacho, Macario; Chhetri, Dinesh K; Guilleminault, Christian; Zaghi, Soroush

2017-04-15

Catathrenia is an underrecognized nocturnal vocalization phenomenon that can be a source of perplexity to patients, bed partners, and medical providers. Catathrenia is distinct from both sleep talking (a parasomnia with loud talking during sleep) and snoring (noise due to vibration of upper airway soft tissues related to variations in airway resistance). The objective of this review is to provide an evidence-based resource to help the practitioner reliably evaluate and manage patients with this condition. Data were gathered from: (1) PubMed, Scopus, Web of Science, and Google Scholar; and (2) catathrenia social media groups (Yahoo and Facebook). Data collected were (1) 15 case reports and 17 case series describing 191 patients with catathrenia; (2) questionnaires from 47 catathrenia subjects; (3) 5 audio files. Catathrenia is a noise produced during sleep (distinct from snoring) with identifiable harmonics, a computable main frequency, and high-decibel intensity that involves active adduction and vibration of the vocal cords during expiration. The quality of groaning in catathrenia is monotone, and often presents with a morose or sexual connotation, causing a significant social problem for patients. Although there is no association with risk of physical harm, catathrenia does present a significant disturbance to the bed partner and has been associated with subjective impairments to sleep quality, including unrefreshing sleep and fatigue. Polysomnography can be useful if performed properly to confirm the diagnosis and to evaluate for comorbid sleep disturbances, such as obstructive sleep apnea or parasomnia. Directions for further research could involve consideration of deep breathing exercises, yoga, meditation, or myofunctional therapy to help abate symptoms. © 2017 American Academy of Sleep Medicine

Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea.

PubMed

Levendowski, Daniel J; Seagraves, Sean; Popovic, Djordje; Westbrook, Philip R

2014-08-15

A majority of patients diagnosed with obstructive sleep apnea are position dependent whereby they are at least twice as severe when sleeping supine (POSA). This study evaluated the accuracy and efficacy of a neck-worn device designed to limit supine sleep. The study included nightly measurements of snoring, sleep/wake, time supine, and the frequency and duration of feedback to monitor compliance. Thirty patients between ages 18 and 75 years, BMI ≤ 35 with an overall apnea-hypopnea index (AHI) ≥ 5 and an overall AHI ≥ 1.5 times the non-supine AHI, and an Epworth score ≥ 5 were prospectively studied. Subjective reports and polysomnography were used to assess efficacy resulting from 4 weeks of in-home supine-avoidance therapy and to measure device accuracy. From 363 polysomnography reports, 209 provided sufficient positional data to estimate one site's prevalence of positional OSA. In 83% of participants exhibiting > 50% reduction in overall AHI, the mean and median reductions were 69% and 79%. Significant reductions in the overall and supine AHI, apnea index, percent time SpO2 < 90%, and snoring contributed to significant improvements in stage N1 and N2 sleep, reductions in cortical arousals and awakenings, and improved depression scores. Supine position was under-detected by > 5% in 3% of cases. Sleep efficiency by neck actigraphy was within 10% of polysomnography in 87% of the studies when position feedback was delivered. The prevalence of POSA was consistently > 70% when the overall AHI was < 60. The neck position therapy device is accurate and effective in restricting supine sleep, improving AHI, sleep architecture and continuity, and monitoring treatment outcomes.

All APAPs Are Not Equivalent for the Treatment of Sleep Disordered Breathing: A Bench Evaluation of Eleven Commercially Available Devices

PubMed Central

Zhu, Kaixian; Roisman, Gabriel; Aouf, Sami; Escourrou, Pierre

2015-01-01

Study Objectives: This study challenged on a bench-test the efficacy of auto-titrating positive airway pressure (APAP) devices for obstructive sleep disordered breathing treatment and evaluated the accuracy of the device reports. Methods: Our bench consisted of an active lung simulator and a Starling resistor. Eleven commercially available APAP devices were evaluated on their reactions to single-type SDB sequences (obstructive apnea and hypopnea, central apnea, and snoring), and to a long general breathing scenario (5.75 h) simulating various SDB during four sleep cycles and to a short scenario (95 min) simulating one sleep cycle. Results: In the single-type sequence of 30-minute repetitive obstructive apneas, only 5 devices normalized the airflow (> 70% of baseline breathing amplitude). Similarly, normalized breathing was recorded with 8 devices only for a 20-min obstructive hypopnea sequence. Five devices increased the pressure in response to snoring. Only 4 devices maintained a constant minimum pressure when subjected to repeated central apneas with an open upper airway. In the long general breathing scenario, the pressure responses and the treatment efficacy differed among devices: only 5 devices obtained a residual obstructive AHI < 5/h. During the short general breathing scenario, only 2 devices reached the same treatment efficacy (p < 0.001), and 3 devices underestimated the AHI by > 10% (p < 0.001). The long scenario led to more consistent device reports. Conclusion: Large differences between APAP devices in the treatment efficacy and the accuracy of report were evidenced in the current study. Citation: Zhu K, Roisman G, Aouf S, Escourrou P. All APAPs are not equivalent for the treatment of sleep disordered breathing: a bench evaluation of eleven commercially available devices. J Clin Sleep Med 2015;11(7):725–734. PMID:25766708

Obstructive Sleep Apnea Syndrome in Company Workers: Development of a Two-Step Screening Strategy with a New Questionnaire.

PubMed

Eijsvogel, Michiel M; Wiegersma, Sytske; Randerath, Winfried; Verbraecken, Johan; Wegter-Hilbers, Esther; van der Palen, Job

2016-04-15

To develop and evaluate a screening questionnaire and a two-step screening strategy for obstructive sleep apnea syndrome (OSAS) in healthy workers. This is a cross-sectional study of 1,861 employees comprising healthy blue- and white-collar workers in two representative plants in the Netherlands from a worldwide consumer electronic company who were approached to participate. Employees were invited to complete various sleep questionnaires, and undergo separate single nasal flow recording and home polysomnography on two separate nights. Of the 1,861 employees, 249 provided informed consent and all nasal flow and polysomnography data were available from 176 (70.7%). OSAS was diagnosed in 65 (36.9%). A combination of age, absence of insomnia, witnessed breathing stops, and three-way scoring of the Berlin and STOPBANG questionnaires best predicted OSAS. Factor analysis identified a six-factor structure of the resulting new questionnaire: snoring, snoring severity, tiredness, witnessed apneas, sleep quality, and daytime well-being. Subsequently, some questions were removed, and the remaining questions were used to construct a new questionnaire. A scoring algorithm, computing individual probabilities of OSAS as high, intermediate, or low risk, was developed. Subsequently, the intermediate risk group was split into low and high probability for OSAS, based on nasal flow recording. This two-step approach showed a sensitivity of 63.1%, and a specificity of 90.1%. Specificity is important for low prevalence populations. A two-step screening strategy with a new questionnaire and subsequent nasal flow recording is a promising way to screen for OSAS in a healthy worker population. Development and validation of a screening instrument for obstructive sleep apnea syndrome in healthy workers. Netherlands Trial Register (www.trailregister.nl), number: NTR2675. © 2016 American Academy of Sleep Medicine.

Airway assessment by volumetric computed tomography in snorers and subjects with obstructive sleep apnea in a Far-East Asian population (Chinese).

PubMed

Chen, Ning-Hung; Li, Kasey K; Li, Shia-Yu; Wong, Chao-Reng; Chuang, Ming-Lung; Hwang, Chung-Chi; Wu, Yao-Kaung

2002-04-01

To evaluate the airway dimension of simple snorers and subjects with obstructive sleep apnea (OSA) in a Far-East Asian population (Chinese). Prospective study of 117 near-consecutive patients evaluated for snoring and possible OSA from January 1998 to December 1998 in a sleep laboratory. Overnight polysomnography (PSG) was performed on all patients and the sleep parameters, including respiratory disturbance index (RDI), snoring index, minimal oxygen saturation (min O2), percentage of slow wave sleep (SWS), and rapid eye movement (REM) were recorded. Three-dimensional computerized tomography (CT) during awake periods was performed. The anteroposterior (AP) and the lateral distance of the retropalatal (RP) region in the oropharynx, the smallest area of RP, and retroglossal (RG) regions, and the total volume of the oropharynx were measured. Ninety-eight patients were diagnosed with OSA (mean RDI, 41.48 +/- 26.45 events per hour; min O2, 72.82 +/- 12.86%), whereas 19 were simple snorers. The AP and the lateral distance of the RP region, as well as the smallest area of the RP region, are significantly smaller in subjects with OSA. However, no differences in the RG region and the total volume of the oropharynx were found between the two groups. Linear regression analysis demonstrated that the lateral dimension and the smallest RP area in overweight subjects inversely correlated with the RDI, but only the AP dimension of the RP area was found to have an inverse correlation with the RDI in the underweight subjects. In Far-East Asians (Chinese), the RP airway was found to be the primary site of narrowing in subjects with OSA, and the narrowest RP area was inversely correlated with RDI. Furthermore, weight may influence the pattern of RP narrowing by contributing to lateral collapse.

Impact of night sleep duration on glycemic and triglyceride levels in Chinese with different glycemic status.

PubMed

Zheng, Yu; Wang, Anping; Pan, Changyu; Lu, Juming; Dou, Jingtao; Lu, Zhaohui; Ba, Jianming; Wang, Baoan; Mu, Yiming

2015-01-01

The aim of the present study was to assess the relationship between night sleep duration and glycemic and triglyceride (TG) levels among people with different glycemic status. In all, 18,121 subjects aged ≥40 years were enrolled in this cross-sectional study, including 4318 with impaired glucose regulation (IGR), 4225 with diabetes, and 9578 with normal glucose regulation (NGR). The IGR + diabetes and NGR groups were divided into three subgroups according to self-reported night sleep duration as follows: (i) <6 h; (ii) 6-9 h; and (iii) >9 h. The associations of sleep duration with HbA1c, fasting plasma glucose (FPG), 2-h post-load plasma glucose (PPG), and TG levels were examined. Long night sleep duration (>9 h) was associated with higher HbA1c, FPG, PPG, and TG levels compared with sleep duration of 6-9 h (P < 0.01 for all) in the IGR + diabetes group, but not in the NGR group. This association was adjusted for potential confounders, including body mass index and depressive symptoms, and remained significant even after adjusting for snoring. A significant interaction between sleep duration and TG or snoring was observed for HbA1c levels, which attenuated the sleep-HbA1c association in the IGR + diabetes group. However, no significant association was observed between short night sleep duration and HbA1c levels. Long night sleep duration is associated with higher HbA1c, FPG, PPG, and TG levels in IGR and diabetes patients, independent of potential confounders. This may be important in clinical management of IGR and diabetes patients. © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography

PubMed Central

Duarte, Ricardo Luiz de Menezes; Magalhães-da-Silveira, Flavio José

2015-01-01

Objective: To identify the main predictive factors for obtaining a diagnosis of obstructive sleep apnea (OSA) in patients awaiting bariatric surgery. Methods: Retrospective study of consecutive patients undergoing pre-operative evaluation for bariatric surgery and referred for in-laboratory polysomnography. Eight variables were evaluated: sex, age, neck circumference (NC), BMI, Epworth Sleepiness Scale (ESS) score, snoring, observed apnea, and hypertension. We employed ROC curve analysis to determine the best cut-off value for each variable and multiple linear regression to identify independent predictors of OSA severity. Results: We evaluated 1,089 patients, of whom 781 (71.7%) were female. The overall prevalence of OSA-defined as an apnea/hypopnea index (AHI) ≥ 5.0 events/h-was 74.8%. The best cut-off values for NC, BMI, age, and ESS score were 42 cm, 42 kg/m2, 37 years, and 10 points, respectively. All eight variables were found to be independent predictors of a diagnosis of OSA in general, and all but one were found to be independent predictors of a diagnosis of moderate/severe OSA (AHI ≥ 15.0 events/h), the exception being hypertension. We devised a 6-item model, designated the NO-OSAS model (NC, Obesity, Observed apnea, Snoring, Age, and Sex), with a cut-off value of ≥ 3 for identifying high-risk patients. For a diagnosis of moderate/severe OSA, the model showed 70.8% accuracy, 82.8% sensitivity, and 57.9% specificity. Conclusions: In our sample of patients awaiting bariatric surgery, there was a high prevalence of OSA. At a cut-off value of ≥ 3, the proposed 6-item model showed good accuracy for a diagnosis of moderate/severe OSA. PMID:26578136

Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension.

PubMed

Pedrosa, Rodrigo P; Drager, Luciano F; Gonzaga, Carolina C; Sousa, Marcio G; de Paula, Lílian K G; Amaro, Aline C S; Amodeo, Celso; Bortolotto, Luiz A; Krieger, Eduardo M; Bradley, T Douglas; Lorenzi-Filho, Geraldo

2011-11-01

Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9-14.2]; P<0.01), neck circumference ≥41 cm for women and ≥43 cm for men (odds ratio: 4.7 [95% CI: 1.3-16.9]; P=0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3-11]; P=0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.

Prevalence and risk factors for active convulsive epilepsy in rural northeast South Africa

PubMed Central

Wagner, Ryan G.; Ngugi, Anthony K.; Twine, Rhian; Bottomley, Christian; Kamuyu, Gathoni; Gómez-Olivé, F. Xavier; Connor, Myles D.; Collinson, Mark A.; Kahn, Kathleen; Tollman, Stephen; Newton, Charles R.

2014-01-01

Summary Rationale Epilepsy is among the most common neurological disorders worldwide. However, there are few large, population-based studies of the prevalence and risk factors for epilepsy in southern Africa. Methods From August 2008 to February 2009, as part of a multi-site study, we undertook a three-stage, population-based study, embedded within the Agincourt health and socio-demographic surveillance system, to estimate the prevalence and identify risk factors of active convulsive epilepsy (ACE) in a rural South African population. Results The crude prevalence of ACE, after adjusting for non-response and the sensitivity of the screening method, was 7.0/1,000 individuals (95%CI 6.4–7.6) with significant geographic heterogeneity across the study area. Being male (OR = 2.3; 95%CI 1.6–3.2), family history of seizures (OR = 4.0; 95%CI 2.0–8.1), a sibling with seizures (OR = 7.0; 95%CI 1.6–31.7), problems after delivery (OR = 5.9; 95%CI 1.2–24.6), and history of snoring (OR = 6.5; 95%CI 4.5–9.5) were significantly associated with ACE. For children, their mother's exposure to some formal schooling was protective (OR = 0.30; 95%CI 0.11–0.84) after controlling for age and sex. Human immunodeficiency virus was not found to be associated with ACE. Conclusions ACE is less frequent in this part of rural South Africa than other parts of sub-Saharan Africa. Improving obstetric services could prevent epilepsy. The relationship between snoring and ACE requires further investigation, as does the relative contribution of genetic and environmental factors to examine the increased risk in those with a family history of epilepsy. PMID:24582322

Prevalence and risk factors for active convulsive epilepsy in rural northeast South Africa.

PubMed

Wagner, Ryan G; Ngugi, Anthony K; Twine, Rhian; Bottomley, Christian; Kamuyu, Gathoni; Gómez-Olivé, F Xavier; Connor, Myles D; Collinson, Mark A; Kahn, Kathleen; Tollman, Stephen; Newton, Charles R

2014-05-01

Epilepsy is among the most common neurological disorders worldwide. However, there are few large, population-based studies of the prevalence and risk factors for epilepsy in southern Africa. From August 2008 to February 2009, as part of a multi-site study, we undertook a three-stage, population-based study, embedded within the Agincourt health and socio-demographic surveillance system, to estimate the prevalence and identify risk factors of active convulsive epilepsy (ACE) in a rural South African population. The crude prevalence of ACE, after adjusting for non-response and the sensitivity of the screening method, was 7.0/1,000 individuals (95% CI 6.4-7.6) with significant geographic heterogeneity across the study area. Being male (OR=2.3; 95% CI 1.6-3.2), family history of seizures (OR=4.0; 95% CI 2.0-8.1), a sibling with seizures (OR=7.0; 95% CI 1.6-31.7), problems after delivery (OR=5.9; 95% CI 1.2-24.6), and history of snoring (OR=6.5; 95% CI 4.5-9.5) were significantly associated with ACE. For children, their mother's exposure to some formal schooling was protective (OR=0.30; 95% CI 0.11-0.84) after controlling for age and sex. Human immunodeficiency virus was not found to be associated with ACE. ACE is less frequent in this part of rural South Africa than other parts of sub-Saharan Africa. Improving obstetric services could prevent epilepsy. The relationship between snoring and ACE requires further investigation, as does the relative contribution of genetic and environmental factors to examine the increased risk in those with a family history of epilepsy. Copyright © 2014 Elsevier B.V. All rights reserved.

Effect of Lifestyle Modification Using a Smartphone Application on Obesity With Obstructive Sleep Apnea: A Short-term, Randomized Controlled Study.

PubMed

Cho, Sung-Woo; Wee, Jee Hye; Yoo, Sooyoung; Heo, Eunyoung; Ryu, Borim; Kim, Yoojung; Lee, Joong Seek; Kim, Jeong-Whun

2018-01-30

To investigate the short-term effects of a lifestyle modification intervention based on a mobile application (app) linked to a hospital electronic medical record (EMR) system on weight reduction and obstructive sleep apnea (OSA). We prospectively enrolled adults (aged >20 years) with witnessed snoring or sleep apnea from a sleep clinic. The patients were randomized into the app user (n=24) and control (n=23) groups. The mobile app was designed to collect daily lifestyle data by wearing a wrist activity tracker and reporting dietary intake. A summary of the lifestyle data was displayed on the hospital EMR and was reviewed. In the control group, the lifestyle modification was performed as per usual practice. All participants underwent peripheral arterial tonometry (WatchPAT) and body mass index (BMI) measurements at baseline and after 4 weeks of follow-up. Age and BMI did not differ significantly between the two groups. While we observed a significant decrease in the BMI of both groups, the decrease was greater in the app user group (P <0.001). Apnea-hypopnea index, respiratory distress index, and oxygenation distress index did not change significantly in both groups. However, the proportion of sleep spent snoring at >45 dB was significantly improved in the app user group alone (P =0.014). In either group, among the participants with successful weight reduction, the apnea-hypopnea index was significantly reduced after 4 weeks (P =0.015). Multiple regression analyses showed that a reduction in the apnea-hypopnea index was significantly associated with BMI. Although a short-term lifestyle modification approach using a mobile app was more effective in achieving weight reduction, improvement in OSA was not so significant. Long-term efficacy of this mobile app should be evaluated in the future studies.

[Assessment of the validity and utility of the Beijing questionnaire as atool to evaluate for obstructive sleep apnea hypopnea syndrome].

PubMed

Wang, X T; Gao, L M; Xu, W; Ding, X

2016-10-20

Objective: To test the Beijing questionnaire as a means of identifying patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. Method: The Beijing questionnaire is designed as an explorative tool consist of 11 questions for patients with obstructive sleep apnea hypopnea, and is targeted toward key symptoms include snoring, apneas, daytime sleepiness, hypertension and overweight. 1 336 female participants living in communities of age≥40 years and 198 male adult subjects visting clinics were given questionnaires. Finally, 59 female and 198 male subjects underwent sleep studies after factor analysis,reliability check,internal consistency study. The correlation analysis was performed between the scores from the Beijing questionnaire and the apnea-hypopnea index from inlaboratory polysomnography.Receiver operating characteristics were constructed to determine optimal sensitivity and specificity. Twenty-four male subjects were recorded in the sleep laberatory again after operative. Result: Factor analysis reduced 11 questions of scale to four common factors as we have designed: snoring,apneas,other symptoms,risk factors. Cronbach's α coefficient of scale reached 0.7.There were an acceptable level of testretest reliability(r=0.619, P <0.01).The apnea hypopnea indices were significantly correlated with their Beijing questionnaire scores( P <0.01).For wemen,an Beijing questionnaire scroe of 19.5 provided a sensitivity of 74.3% and a specificity of 62.5%.For men,an Beijing questionnaire scroe of 22.5 provided a sensitivity of 90.9% and a specificity of 54.5%. And the postoperative Beijing questionnaire scroes changed with the apnea hypopnea indices. Conclusion: This questionnaire has a good validity and reliability and appears to be valid and sensitive to clinical change. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

[A case of severe obstructive sleep apnea hypopnea syndrome with urinary and anal incontinence].

PubMed

Zhou, Li; Ouyang, Ruoyun; Chen, Ping; Luo, Hong; Liu, Hanmei; Liu, Guiqian

2018-03-28

A case of a young male patient, who came to the Second Xiangya Hospital, Central South University because of snoring for 10 years and nocturnal gatism for half month, was analyzed retrospectively. He was diagnosed as obstructive sleep apnea hypopnea syndrome (OSAHS) finally. The patient had been diagnosed and treated as stroke in the local hospital, while urinary and anal incontinence were not relieved. It was a dilemma for him to be properly diagnosed and treated. Polysomnography in our hospital revealed apnea hypopnea index (AHI) at 44.7 events/h, oxygen desaturation index (ODI) at 70.8 events/h and the longest apnea time at 185 seconds while the lowest blood oxygen saturation reduced to 31%. In addition, 413 events of apnea accounted for 61.2% of the sleep time and the minimal heart rate was 23 times/min. The patient was diagnosed as severe OSAHS with hypoxia metabolic brain disease, moderate pulmonary arterial hypertension, secondary polycythemia and obesity hypoventilation syndrome finally. He received the treatment of positive airway pressure non-invasive ventilator with an average pressure at 11.7 cmH2O with reduced AHI and increased blood oxygen saturation. The urinary and anal incontinence disappeared during the first night of treatment and it has been totally resolved so far. We considered that gatism was secondary to OSAHS with severe hypoxia resulted from attenuated regulation of primary defecation in the night. Physicians should pay attention to OSAHS when accepting obese patients with nocturnal incontinence, obvious daytime sleepiness and night snoring. Urinary and anal incontinence could be completely disappeared under therapy of positive airway pressure.

Sleep Complaints in the Adult Brazilian Population: A National Survey Based on Screening Questions

PubMed Central

Bittencourt, Lia Rita A.; Santos-Silva, Rogerio; Taddei, Jose A.; Andersen, Monica L.; de Mello, Marco T.; Tufik, Sergio

2009-01-01

Study Objectives: The aim of the current survey was to investigate the prevalence of sleep complaints in a randomized cluster sample of the Brazilian population. Methods: A 3-stage cluster sampling technique was utilized to randomly select Brazilian subjects older than 16 years, of both genders and all socioeconomic classes. The final sample of 2,110 subjects from 150 different cities was enough to estimate prevalence in the Brazilian population with a sampling error of ± 2%. Questions about sleep complaints were administered face-to-face by Instituto Datafolha interviewers on March 26 and 27, 2008. Data were expanded using a weighted variable. Results: Of all interviewed subjects, 63% reported at least one sleep related complaint. Sleep complaint prevalence increased with age and was similar among inhabitants of different Brazilian regions, as well as between metropolitan areas and smaller cities. Insomnia and nightmares were significantly more prevalent in women (40% and 25%, respectively), and snoring was more prevalent in men (35%). For sleep complaints with frequencies greater than 3 times per week, we found the following prevalence: 61% for snoring, 35% for insomnia, 17% for nightmares, 53% for leg kicking, and 37% for breathing pauses. Conclusions: Because sleep disorders are affect a high proportion of the population and are known to be correlated with decreased well-being and productivity, more detailed national surveys are necessary to provide relevant information to develop approaches to prevention and treatment. Citation: Bittencourt LRA; Santos-Silva R; Taddei JA; Andersen ML; de Mello MT; Tufik S. Sleep complaints in the adult brazilian population: a national survey based on screening questions. J Clin Sleep Med 2009;5(5):459-463. PMID:19961032

Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing?

PubMed

Kovacevic, Larisa; Wolfe-Christensen, Cortney; Lu, Hong; Toton, Monika; Mirkovic, Jelena; Thottam, Prasad J; Abdulhamid, Ibrahim; Madgy, David; Lakshmanan, Yegappan

2014-05-01

We analyzed the outcome of nocturnal enuresis after adenotonsillectomy in children with sleep disordered breathing. We also evaluated differences in demographic, clinical, laboratory and polysomnography parameters between responders and nonresponders after adenotonsillectomy. We prospectively evaluated children 5 to 18 years old diagnosed with sleep disordered breathing (snoring or obstructive sleep apnea syndrome) on polysomnography and monosymptomatic primary nocturnal enuresis requiring adenotonsillectomy to release upper airway obstruction. Plasma antidiuretic hormone and brain natriuretic peptide were measured preoperatively and 1 month postoperatively. Sleep studies were done in 46 children and 32 also underwent blood testing preoperatively and postoperatively. Mean ± SD patient age was 8.79 ± 2.41 years and the mean number of wet nights weekly was 6.39 ± 1.26. Polysomnography revealed obstructive sleep apnea syndrome in 71.7% of patients and snoring in 28.3%. After adenotonsillectomy 43.5% of patients became dry. Preoperative polysomnography findings indicated that responders, who were dry, had significantly more arousals and obstructive apnea episodes but fewer awakenings than nonresponders, who were wet. Significant increases in plasma antidiuretic hormone and significant decreases in plasma brain natriuretic peptide were seen in all children with no difference between responders and nonresponders. No difference between the groups was noted in age, gender, race, body mass index, constipation, preoperative number of wet nights weekly or type of sleep disordered breathing. Nocturnal enuresis resolved after adenotonsillectomy in almost half of the children with sleep disordered breathing. Those who became dry had more frequent arousal episodes caused by apnea events than those who remained wet. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Otorhinolaryngological aspects of sleep-related breathing disorders

PubMed Central

Virk, Jagdeep S.

2016-01-01

Snoring and obstructive sleep apnoea (OSA) are disorders within a wide spectrum of sleep-related breathing disorders (SRBD). Given the obesity epidemic, these conditions will become increasingly prevalent and continue to serve as a large economic burden. A thorough clinical evaluation and appropriate investigations will allow stratification of patients into appropriate treatment groups. A multidisciplinary team is required to manage these patients. Patient selection is critical in ensuring successful surgical and non-surgical outcomes. A wide range of options are available and further long term prospective studies, with standardised data capture and outcome goals, are required to evaluate the most appropriate techniques and long term success rates. PMID:26904262

Combined Orthodontic and Surgical Treatment in a 8-Years-Old Patient Affected By Severe Obstructive Sleep Apnea: A Case-Report.

PubMed

Gracco, Antonio; Bruno, Giovanni; de Stefani, Alberto; Ragona, Rosario Marchese; Mazzoleni, Sergio; Stellini, Edoardo

An eight-years-old girl showed a restless sleep with snoring and severe apnea episodes, a mandibular retrognathia, mouth breathing, maxillary transverse discrepancy, mandibular transverse discrepancy, moderate crowding and anterior open-bite. The CBCT showed an anterior collapse of the epiglottis. The treatment consisted in a rapid palatal expansion, an epiglottoplasty and a reduction of the tongue base. Polysomnography revealed that apnea-hypopnea index improved from 21,8 episodes/hr at the baseline to 0,6 episodes/hr, average oxygen saturation from 96,5% to 98,1%, oxygen desaturation events from 23,4 episodes/hr to 1/hr.

Sleep-Related Behaviors and Beliefs Associated With Race/Ethnicity in Women

PubMed Central

Grandner, Michael A.; Patel, Nirav P.; Jean-Louis, Girardin; Jackson, Nicholas; Gehrman, Philip R.; Perlis, Michael L.; Gooneratne, Nalaka S.

2013-01-01

Explore how social factors influence sleep, especially sleep-related beliefs and behaviors. Sleep complaints, sleep hygiene behaviors, and beliefs about sleep were studied in 65 black/African American and white/European American women. Differences were found for snoring and discrepancy between sleep duration and need. Sleep behaviors differed across groups for napping, methods for coping with sleep difficulties, and nonsleep behaviors in bed. Beliefs also distinguished groups, with differences in motivation for sleep and beliefs about sleep being important for health and functioning. These findings have important public health implications in terms of developing effective sleep education interventions that include consideration of cultural aspects. PMID:23862291

Functions of the uvula and Z-pharyngoplasty.

PubMed

Mukai, S; Mukai, C; Nitta, M

2000-06-01

UPPP includes uvulotomy. The uvula works as the pilot for eating and swallowing. We performed an operation which left the uvula intact and opened the pharynx by Z-opening the palate, Z-pharyngoplasty (ZPP). Twenty-four patients were studied before and after ZPP. The results of the operations were satisfactory. No patients complained of symptoms after uvulectomy. As for the changes indicated by sleep monitoring, minimum SaO2 increased significantly (P = 0.0026), pulse rate decreased significantly (P = 0.0144), apnea index decreased significantly (P = 0.0392), snoring decreased (P = 0.064), and the amount of hours of sleep when SaO2 was over 95% increased (P = 0.0690) after ZPP.

Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure.

PubMed

Zhang, Xiao-Bin; Lin, Qi-Chang; Zeng, Hui-Qing; Jiang, Xing-Tang; Chen, Bo; Chen, Xiao

2016-01-01

In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.

Plasma radiofrequency preceded by pressure recording enhances success for treating sleep-related breathing disorders.

PubMed

Tvinnereim, Magne; Mitic, Svetislav; Hansen, Rolf K

2007-04-01

Sleep-related breathing disorders (SRBD) that cannot be treated conservatively are commonly treated using uvulopalatopharyngoplasty, although success rates are generally less than 70%. The purpose of this study was to assess a plasma-mediated radiofrequency (RF)-based coblation assisted upper airway procedure (CAUP) to treat SRBD patients determined to have obstruction localized to the upper (mid)-pharyngeal region. Prospective case series (n = 40). Six patients had socially bothersome snoring, and 34 patients had mild to moderate sleep apnea (apnea/hypopnea index [AHI] <20), with the primary level of obstruction (>50%) within the upper pharyngeal region as determined using whole night recordings, including airway pressure fluctuation monitoring (ApneaGraph, MRA-Medical Ltd, Gloucestershire, UK). CAUP consisted of making a lateral palatal incision, ablating three upward channels on each side of the midline (fan-shaped) into the soft palate using a plasma mediated RF-based device (ArthroCare Corporation, Austin, TX), and performing a partial uvulectomy. Clinical outcomes included the Epworth Sleepiness Scale (ESS), partner rating of snoring using a visual analogue scale (VAS), and night-time apnea and hypopnea events (AHI, hypopnea index [HI], apnea index [AI]). Patients were 28 to 68 (46 +/- 12) years old; 28 (70%) were male. Preoperatively, clinical assessment scores (median +/- interquartile range) were as follows: ESS (11.0 +/- 3.0), VAS (8.15 +/- 1.00), AHI (9.58 +/- 5.58), HI (9.00 +/- 5.29), AI (0.333 +/- 0.625). After CAUP, no postoperative scarring, fibrosis, or any other clinically significant side effects were observed. Postoperatively (9.1 +/- 1.5; 7-15 mo), ESS (4.0 +/- 1.0), VAS (2.70 +/- 1.38), AHI (3.75 +/- 2.92), HI (3.58 +/- 2.50), and AI (0.167 +/- 0.167) were significantly improved (P < .001). CAUP preceded by site-specific obstruction diagnosis using pressure recording is a well-tolerated outpatient treatment that is well suited for treating SRBD.

Catathrenia (Nocturnal Groaning): A Social Media Survey and State-of-the-Art Review

PubMed Central

Alonso, Jose; Camacho, Macario; Chhetri, Dinesh K.; Guilleminault, Christian; Zaghi, Soroush

2017-01-01

Study Objectives: Catathrenia is an underrecognized nocturnal vocalization phenomenon that can be a source of perplexity to patients, bed partners, and medical providers. Catathrenia is distinct from both sleep talking (a parasomnia with loud talking during sleep) and snoring (noise due to vibration of upper airway soft tissues related to variations in airway resistance). The objective of this review is to provide an evidence-based resource to help the practitioner reliably evaluate and manage patients with this condition. Methods: Data were gathered from: (1) PubMed, Scopus, Web of Science, and Google Scholar; and (2) catathrenia social media groups (Yahoo and Facebook). Results: Data collected were (1) 15 case reports and 17 case series describing 191 patients with catathrenia; (2) questionnaires from 47 catathrenia subjects; (3) 5 audio files. Conclusions: Catathrenia is a noise produced during sleep (distinct from snoring) with identifiable harmonics, a computable main frequency, and high-decibel intensity that involves active adduction and vibration of the vocal cords during expiration. The quality of groaning in catathrenia is monotone, and often presents with a morose or sexual connotation, causing a significant social problem for patients. Although there is no association with risk of physical harm, catathrenia does present a significant disturbance to the bed partner and has been associated with subjective impairments to sleep quality, including unrefreshing sleep and fatigue. Polysomnography can be useful if performed properly to confirm the diagnosis and to evaluate for comorbid sleep disturbances, such as obstructive sleep apnea or parasomnia. Directions for further research could involve consideration of deep breathing exercises, yoga, meditation, or myofunctional therapy to help abate symptoms. Citation: Alonso J, Camacho M, Chhetri DK, Guilleminault C, Zaghi S. Catathrenia (nocturnal groaning): a social media survey and state-of-the-art review. J Clin Sleep Med. 2017;13(4):613–622. PMID:28095968

Spanish Translation and Cross-Language Validation of a Sleep Habits Questionnaire for Use in Clinical and Research Settings

PubMed Central

Baldwin, Carol M.; Choi, Myunghan; McClain, Darya Bonds; Celaya, Alma; Quan, Stuart F.

2012-01-01

Study Objectives: To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. Methods: Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. Results: All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. Conclusions: The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples. Citation: Baldwin CM; Choi M; McClain DB; Celaya A; Quan SF. Spanish translation and cross-language validation of a Sleep Habits Questionnaire for use in clinical and research settings. J Clin Sleep Med 2012;8(2):137-146. PMID:22505858

Risk factors for chronic and recurrent otitis media-a meta-analysis.

PubMed

Zhang, Yan; Xu, Min; Zhang, Jin; Zeng, Lingxia; Wang, Yanfei; Zheng, Qing Yin

2014-01-01

Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13-1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13-13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78-2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06-116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02-1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11-13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria.

Risk Factors for Chronic and Recurrent Otitis Media–A Meta-Analysis

PubMed Central

Zhang, Yan; Xu, Min; Zhang, Jin; Zeng, Lingxia; Wang, Yanfei; Zheng, Qing Yin

2014-01-01

Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13–1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13–13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78–2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06–116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02–1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11–13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria. PMID:24466073

The Association Between Sleep Disordered Breathing, Academic Grades, and Cognitive and Behavioral Functioning Among Overweight Subjects During Middle to Late Childhood

PubMed Central

Beebe, Dean W.; Ris, M. Douglas; Kramer, Megan E.; Long, Elizabeth; Amin, Raouf

2010-01-01

Study Objectives: (1) to determine the associations of sleep disordered breathing (SDB) with behavioral functioning, cognitive test scores, and school grades during middle- to late-childhood, an under-researched developmental period in the SDB literature, and (2) to clarify whether associations between SDB and school grades are mediated by deficits in cognitive or behavioral functioning. Design: Cross-sectional correlative study. Setting: Office/hospital, plus reported functioning at home and at school. Participants: 163 overweight subjects aged 10-16.9 years were divided into 4 groups based upon their obstructive apnea+hypopnea index (AHI) during overnight polysomnography and parent report of snoring: Moderate-Severe OSA (AHI > 5, n = 42), Mild OSA (AHI = 1-5, n = 58), Snorers (AHI < 1 + snoring, n = 26), and No SDB (AHI < 1 and nonsnoring, n = 37). Measurements: Inpatient overnight polysomnography, parent- and self-report of school grades and sleep, parent- and teacher-report of daytime behaviors, and office-based neuropsychological testing. Results: The 4 groups significantly differed in academic grades and parent- and teacher-reported behaviors, particularly inattention and learning problems. These findings remained significant after adjusting for subject sex, race, socioeconomic status, and school night sleep duration. Associations with SDB were confined to reports of behavioral difficulties in real-world situations, and did not extend to office-based neuropsychological tests. Findings from secondary analyses were consistent with, but could not definitively confirm, a causal model in which SDB affects school grades via its impact on behavioral functioning. Conclusions: SDB during middle- to late-childhood is related to important aspects of behavioral functioning, especially inattention and learning difficulties, that may result in significant functional impairment at school. Citation: Beebe DW; Ris MD; Kramer ME; Long E; Amin R. The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. SLEEP 2010;33(11):1447-1456. PMID:21102986

Severity of OSAS, CPAP and cardiovascular events: A follow-up study.

PubMed

Baratta, Francesco; Pastori, Daniele; Fabiani, Mario; Fabiani, Valerio; Ceci, Fabrizio; Lillo, Rossella; Lolli, Valeria; Brunori, Marco; Pannitteri, Gaetano; Cravotto, Elena; De Vito, Corrado; Angelico, Francesco; Del Ben, Maria

2018-05-01

Previous studies suggested obstructive sleep apnoea syndrome (OSAS) as a major risk factor for incident cardiovascular events. However, the relationship between OSAS severity, the use of continuous positive airway pressure (CPAP) treatment and the development of cardiovascular disease is still matter of debate. The aim was to test the association between OSAS and cardiovascular events in patients with concomitant cardio-metabolic diseases and the potential impact of CPAP therapy on cardiovascular outcomes. Prospective observational cohort study of consecutive outpatients with suspected metabolic disorders who had complete clinical and biochemical workup including polysomnography because of heavy snoring and possible OSAS. The primary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE). Median follow-up was 81.3 months, including 434 patients (2701.2 person/years); 83 had a primary snoring, 84 had mild, 93 moderate and 174 severe OSAS, respectively. The incidence of MACCE was 0.8% per year (95% confidence interval [CI] 0.2-2.1) in primary snorers and 2.1% per year (95% CI 1.5-2.8) for those with OSAS. A positive association was observed between event-free survival and OSAS severity (log-rank test; P = .041). A multivariable Cox regression analysis showed obesity (HR = 8.011, 95% CI 1.071-59.922, P = .043), moderate OSAS (vs non-OSAS HR = 3.853, 95% CI 1.069-13.879, P = .039) and severe OSAS (vs non-OSAS HR = 3.540, 95% CI 1.026-12.217, P = .045) as predictors of MACCE. No significant association was observed between CPAP treatment and MACCE (log-rank test; P = .227). Our findings support the role of moderate/severe OSAS as a risk factor for incident MACCE. CPAP treatment was not associated with a lower rate of MACCE. © 2018 Stichting European Society for Clinical Investigation Journal Foundation.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes.

PubMed

Ford, Earl S; Wheaton, Anne G; Chapman, Daniel P; Li, Chaoyang; Perry, Geraldine S; Croft, Janet B

2014-07-01

There is limited information from population-based investigations of the associations between sleep duration and sleep disorders and parameters of glucose homeostasis. The objective of the present study was to examine cross-sectional associations between sleep duration and sleep disordered breathing with concentrations of insulin, fasting and 2-h glucose, and HbA1c. Data from 11 815 adults aged ≥20 years without diagnosed diabetes (5002 with an oral glucose tolerance test) from the National Health and Nutrition Examination Survey 2005-2010 were used. Information about sleep duration (2005-2010) and sleep apnea and sleep-disordered breathing (2005-2008) was obtained via questionnaire. An estimated 36.0% of participants reported sleeping ≤6 h/night, 62.0% reported sleeping 7-9 h/night, and 2.0% reported sleeping ≥10 h/night. In 2005-2008, 33.0% reported snoring ≥5 nights per week, 5.9% reported they snorted, gasped, or stopped breathing ≥5 nights/week, and 4.2% reported sleep apnea. Sleep duration was significantly associated with fasting concentrations of insulin and concentrations of HbA1c only in models that did not adjust for body mass index (BMI). Concentrations of fasting and 2-h glucose were significantly associated with sleep duration in models that adjusted only for age. Snoring frequency was positively associated with concentrations of insulin and HbA1c. Frequency of snorting or stopping breathing and sleep apnea status were associated with concentrations of insulin and of HbA1c only when BMI was not accounted for. In a representative sample of US adults, concentrations of insulin and HbA1c were significantly associated with short sleep duration, possibly mediated by BMI. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Assessment of a Neck-Based Treatment and Monitoring Device for Positional Obstructive Sleep Apnea

PubMed Central

Levendowski, Daniel J.; Seagraves, Sean; Popovic, Djordje; Westbrook, Philip R.

2014-01-01

Study Objectives: A majority of patients diagnosed with obstructive sleep apnea are position dependent whereby they are at least twice as severe when sleeping supine (POSA). This study evaluated the accuracy and efficacy of a neck-worn device designed to limit supine sleep. The study included nightly measurements of snoring, sleep/wake, time supine, and the frequency and duration of feedback to monitor compliance. Methods: Thirty patients between ages 18 and 75 years, BMI ≤ 35 with an overall apnea-hypopnea index (AHI) ≥ 5 and an overall AHI ≥ 1.5 times the non-supine AHI, and an Epworth score ≥ 5 were prospectively studied. Subjective reports and polysomnography were used to assess efficacy resulting from 4 weeks of in-home supine-avoidance therapy and to measure device accuracy. From 363 polysomnography reports, 209 provided sufficient positional data to estimate one site's prevalence of positional OSA. Results: In 83% of participants exhibiting > 50% reduction in overall AHI, the mean and median reductions were 69% and 79%. Significant reductions in the overall and supine AHI, apnea index, percent time SpO2 < 90%, and snoring contributed to significant improvements in stage N1 and N2 sleep, reductions in cortical arousals and awakenings, and improved depression scores. Supine position was under-detected by > 5% in 3% of cases. Sleep efficiency by neck actigraphy was within 10% of polysomnography in 87% of the studies when position feedback was delivered. The prevalence of POSA was consistently > 70% when the overall AHI was < 60. Conclusions: The neck position therapy device is accurate and effective in restricting supine sleep, improving AHI, sleep architecture and continuity, and monitoring treatment outcomes. Citation: Levendowski DJ, Seagraves S, Popovic D, Westbrook PR. Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. J Clin Sleep Med 2014;10(8):863-871. PMID:25126032

Myocutaneous sternocleidomastoid flap for reconstruction after the resection of a parapharyngeal heterotopic glioma in a child with cleft palate, and systematic review of parapharyngeal glial heterotopia.

PubMed

Prado-Calleros, Héctor M; Arrieta-Gómez, José R; Castillo-Ventura, Beatriz; Martínez, Sara Parraguirre; Jiménez-Gutiérrez, Carlos; Jiménez-Escobar, Irma

2016-02-01

We describe the surgery and reconstruction employed with a sternocleidomastoid myocutaneous flap for the treatment of a heterotopic glioma in a 2-year-old boy with incomplete palatal fissure who presented with dysphagia and snoring, in whom a lateral pharyngeal wall mass obstructing 60% of the airway was noted. Heterotopic gliomas are uncommonly reported in the parapharyngeal space and should be included in the differential diagnosis at this location in children. Parapharyngeal tumors present difficult diagnostic and management challenges; head and neck surgeons must be prepared not only for the resection but also for the reconstruction of these rare lesions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Why is obstructive sleep apnea (OSA) a cardiovascular risk factor?].

PubMed

Koehler, U; Becker, H F; Gross, V; Reinke, C; Penzel, T; Schäfer, H; Vogelmeier, C

2003-12-01

Patients with obstructive sleep apnea (OSA) frequently suffer from cardiovascular diseases. Mechanisms like intrathoracic pressure variations, changes in blood gases (hypoxia), arousals and neurohumeral adaptation mechanisms, combined with breathing disorders are causing these cardiovascular sequelae. In particular repetitive hypoxemia and activation of the sympathetic nervous system have to be considered as stressors for the cardiovascular system. Special clinical findings should take OSA into consideration as a differential diagnosis. A systematic anamnesis with questions to daytime conditions (hypersomnia, decrease of performance), snoring and apneas while sleeping is easy to ascertain, and will lead to the correct diagnosis in more than 90% of cases. The extent and need for therapy should be assessed by three criteria: 1) daytime symptoms, 2) the extent of breathing disorder and 3) cardiovascular comorbidity.

The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study

PubMed Central

Al Ali, Ala; Richmond, Stephen; Popat, Hashmat; Playle, Rebecca; Pickles, Timothy; Zhurov, Alexei I; Marshall, David; Rosin, Paul L; Henderson, John; Bonuck, Karen

2015-01-01

Objective To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children. Design Observational longitudinal cohort study Setting Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England. Participants Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents’ report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy. Main outcome measures Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences. Results Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI −0.52 to −0.05); a decrease in mandibular prominence of 0.9° (95% CI −1.30 to −0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI −0.10 to −0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence. Conclusions The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of SDB. PMID:26351193

The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study.

PubMed

Al Ali, Ala; Richmond, Stephen; Popat, Hashmat; Playle, Rebecca; Pickles, Timothy; Zhurov, Alexei I; Marshall, David; Rosin, Paul L; Henderson, John; Bonuck, Karen

2015-09-08

To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children. Observational longitudinal cohort study Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England. Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents' report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy. Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences. Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI -0.52 to -0.05); a decrease in mandibular prominence of 0.9° (95% CI -1.30 to -0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI -0.10 to -0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence. The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of SDB. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux.

PubMed

Emilsson, Össur Ingi; Benediktsdóttir, Bryndís; Ólafsson, Ísleifur; Cook, Elizabeth; Júlíusson, Sigurður; Björnsson, Einar Stefán; Guðlaugsdóttir, Sunna; Guðmundsdóttir, Anna Soffía; Mirgorodskaya, Ekaterina; Ljungström, Evert; Arnardóttir, Erna Sif; Gíslason, Þórarinn; Janson, Christer; Olin, Anna-Carin

2016-09-20

Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation. Participants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months. Asthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79-281) vs 67 (32-182), p = 0.004). Pepsin (2.5 ng/ml (0.8-5.8) vs 0.8 ng/ml (0.8-3.6), p = 0.03), substance P (741 pg/ml (626-821) vs 623 pg/ml (562-676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7-3.9) vs 2.6 pg/ml (2.2-2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI. In a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.

Identifying patients at high risk for obstructive sleep apnoea syndrome in Nigeria: A multicentre observational study.

PubMed

Desalu, Olufemi O; Onyedum, Cajetan C; Adeoti, Adekunle O; Fadare, Joseph O; Sanya, Emmanuel O; Fawale, Michael B; Bello, Hamzat A

2017-06-01

Obstructive sleep apnoea is associated with significant health consequences. A significant proportion of hospitalized patients at risk for obstructive sleep apnoea were never identified and referred for polysomnography for diagnosis. The objective of this study was to determine the factors associated with high risk for obstructive sleep apnoea and use it to identify patients at risk for the condition in tertiary hospitals in Nigeria. This was a multicentre observational study of adult patients hospitalized in three selected hospitals from 15th January to 17th March 2015. Berlin questionnaire and Epworth sleepiness scale were used to assess for obstructive sleep apnoea risk and excessive daytime sleepiness respectively. Additional questions on traditional risk factors for obstructive sleep apnoea were also obtained. Nine hundred and twenty-six patients were recruited into the study. Respondents' mean age was 44.3 years ± 15.2years, 486 (52.5%) were females and 556 (60.0%) had one or more medical co-morbidity and none of the patients had a previous diagnosis of obstructive sleep apnoea. Factors that were independently associated with high risk for obstructive sleep apnoea include systemic hypertension(aOR-10.33;95%: CI 6.42-16.61), obesity(aOR-7.87;95% CI: 4.33-14.29); excessive daytime sleepiness (aOR-3.77;95% CI :2.28-6.22), tobacco smoking (aOR-2.99;95% CI: 1.76-5.07), snoring in a first-degree relative (aOR-1.83;95% CI: 1.19-2.81); and the use of sedative (aOR-1.82;95% CI: 1.06-3.15). This study shows that patients with systemic hypertension, obesity, excessive daytime sleepiness, history of smoking, snoring in a first-degree relative and use of sedatives are at high risk of obstructive sleep apnoea. None of the patients at high risk had a previous diagnosis of sleep apnoea by a physician, highlighting the diagnostic challenges of this condition. The results of this study will assist health care professionals in early identification of individuals at risk of obstructive sleep apnoea and subsequent referral for a sleep study.

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 and others; SAVE ClinicalTrials.gov number, NCT00738179 ; Australian New Zealand Clinical Trials Registry number, ACTRN12608000409370 .).

Sleep habits and road traffic accident risk for Iranian occupational drivers.

PubMed

Ebrahimi, Mohammad Hossein; Sadeghi, Masoumeh; Dehghani, Mohsen; Niiat, Khosro Sadegh

2015-01-01

The aim of this study is to assess the sleep quality and sleep disorders (prevalence of obstructive sleep apnea and sleepiness) among occupational drivers in Iran and to determine which demographic factors and occupational habits are linked to road traffic accidents. In this analytic cross-sectional study 556 occupational road drivers from Shahroud city (in the northeast of Iran) participated, upon a prior verbal informed consent, during 2013-2014. The Pittsburgh Sleep Quality Index (PSQI) standard questionnaire that scored on 7 point scale, the 8-item Epworth Sleepiness Scale (ESS) questionnaire and the 8-question STOP-Bang questionnaire along with demographic information and occupational data were used. To explore the independent factors associated with odds of poor sleep quality and road accident, multiple logistic regression models were used. Prevalence of previous road accidents, sleepiness while driving, and obstructive sleep apnea scored ≥ 3 in the study, and drivers accounted for 23.8%, 29%, and 24.8%, respectively. The global mean score of sleep quality and excessive sleepiness score were 5.2 and 4.8, respectively. The main factors related to the odds of poor sleep quality were snoring (odds ratio (OR) = 2.34; 95% confidence interval (CI): 1.15-4.77), smoking (OR = 2.12; 95% CI: 1.15-3.97), and driving times in a day (OR = 1.12; 95% CI: 1.03-1.21). The Epworth Sleepiness Scale (OR = 1.13; 95% CI: 1.07-1.23) and suffering from apnea (OR = 4.89; 95% CI: 1.07-23.83) were the best predictors for odds (increased risk) of road accidents. A considerable proportion of Iranian drivers had records of road accidents; poor sleep quality, sleepiness while driving, and sleep disorder breathing (obstructive sleep apnea - OSA). Snoring, smoking, driving time in a day, excessive sleepiness, and presumably apnea increase the odds of poor sleep quality and road traffic accident for Iranian occupational drivers. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

[Methadone and sleep apnea syndrome].

PubMed

Durst, Philippe; Palazzolo, Jérôme; Peyrelong, Jean-Pierre; Berger, Michel; Chalabreysse, Michel; Billiard, Michel; Vialle, André

2005-03-01

Sleep apnea syndrome occurs when, during sleep, breathing stops for 10 seconds or longer, with an index of 5 times or more an hour. It is clinically characterized by loud snoring at night, continuous or interrupted by pauses followed by loud breathing. Sleep is fitful, broken by arousals, and yields little rest. There is daytime excessive sleepiness with repeated involuntary falling asleep, often unknown by the subject. In this article, we describe an observation of central sleep apnea syndrome in a female patient receiving an opiate replacement therapy. An analysis of the before and after methadone withdrawal polysomnograhic tracing was done for this patient. This diagnosis etiology and physiopathology are critically approached. Clinicians should be careful in treating induced sleep disorders in such patients. Prescribing benzodiazepines during an opiate withdrawal of the methadone type is not recommended when central apnea occurs.

Adult obstructive sleep apnoea

PubMed Central

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

2013-01-01

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

Analyzing non-respiratory movements of the chest: methods and devices

NASA Astrophysics Data System (ADS)

Pariaszewska, Katarzyna; Młyńczak, Marcel; Cybulski, Gerard

2015-09-01

Respiration is the main reason of the chest movements. However, there are also non-respiratory ones, resulting from e.g. snoring, wheezing, stridor, throat clearing or coughing. They may exist sporadically, however should be examined in case when their incidences increase. Detecting non-respiratory movements is very important, because many of them are symptoms of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) or lung cancer. Assessment of the presence of non-respiratory movements could be important element of effective diagnosis. It is also necessary to provide quantitative and objective results for intra-subject studies. Most of these events generate vibroacoustic signals that contain components of sound and vibrations. This work provides the review of the solutions and devices for monitoring of the non-respiratory movements, primarily considering the accuracy of the chest movements' detection and distinguishing.

External nasal dilators: definition, background, and current uses

PubMed Central

Dinardi, Ricardo Reis; de Andrade, Cláudia Ribeiro; Ibiapina, Cássio da Cunha

2014-01-01

Our goal was to revise the literature about external nasal dilators (ENDs) as to their definition, history, and current uses. We reviewed journals in the PubMed and MEDLINE databases. The current uses hereby presented and discussed are physical exercise, nasal congestion and sleep, snoring, pregnancy, cancer, and healthy individuals. Numerous studies have shown that ENDs increase the cross-sectional area of the nasal valve, reducing nasal resistance and transnasal inspiratory pressure and stabilizing the lateral nasal vestibule, avoiding its collapse during final inspiration. These effects also facilitate breathing and are beneficial to patients with nasal obstruction. Furthermore, END use is simple, noninvasive, painless, affordable, and bears minimum risk to the user. Most studies have limited sample size and are mainly focused on physical exercise. In conclusion, ENDs seem useful, so further studies involving potential effects on the performance of physical tests and improvements in sleep quality are necessary, especially in children and teenagers. PMID:25419156

Obstructive sleep apnea presenting as pseudopheochromocytoma

PubMed Central

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

2016-01-01

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

Effects of zolpidem on sleep architecture, night time ventilation, daytime vigilance and performance in heavy snorers.

PubMed Central

Quera-Salva, M A; McCann, C; Boudet, J; Frisk, M; Borderies, P; Meyer, P

1994-01-01

1. In a double-blind, crossover, placebo controlled trial, zolpidem 10 mg, a new imidazopyridine hypnotic drug, was administered in a single dose to 10 healthy non-obese heavy snorers. 2. Nocturnal polysomnography showed that zolpidem increased total sleep time, sleep efficiency and the percentage of stage 2. 3. Respiratory monitoring showed that zolpidem did not modify the percentage of total sleep time spent snoring. The percentages of total sleep time with a SaO2 < 4% of the baseline value and with a SaO2 < 90% and the mean SaO2 were also unchanged with zolpidem. The respiratory disturbance index was modestly increased by zolpidem although in all but one subject it remained < 5 with both treatments. 4. Zolpidem intake did not impair daytime vigilance and performance evaluated the day after. PMID:7917771

Sleep Disorders as a Risk to Language Learning and Use.

PubMed

McGregor, Karla K; Alper, Rebecca M

2015-05-01

Are people with sleep disorders at higher risk for language learning deficits than healthy sleepers? Scoping Review. PubMed, Google Scholar, Trip Database, ClinicalTrials.gov. sleep disorders AND language AND learning; sleep disorders language learning -deprivation -epilepsy; sleep disorders AND verbal learning. 36. Children and adults with sleep disorders were at a higher risk for language problems than healthy sleepers. The language problems typically co-occurred with problems of attention and executive function (in children and adults), behavior (in children), and visual-spatial processing (in adults). Effects were typically small. Language problems seldom rose to a level of clinical concern but there were exceptions involving phonological deficits in children with sleep-disordered breathing and verbal memory deficits among adults with sleep-disordered breathing or idiopathic REM sleep behavior disorder. Case history interviews should include questions about limited sleep, poor-quality sleep, snoring, and excessive daytime sleepiness. Medical referrals for clients with suspected sleep disorders are prudent.

Ubiquity of Undiagnosed Sleep Disordered Breathing in Community-Dwelling Older Male Veterans.

PubMed

Iqbal, Navneet; Kinoshita, Lisa M; Noda, Art; Friedman, Leah; Yesavage, Jerome A; Zeitzer, Jamie M

2016-02-01

To determine the point prevalence of sleep disordered breathing (SDB) in a community-based sample of older male veterans and to determine if common markers of SDB apply to this population. Two hundred fourteen older male Veterans (age 55-89 years) were recruited for a study on post-traumatic stress disorder and cognitive decline. Questionnaires concerning anthropomorphic and psychological variables were obtained, as was an overnight polysomnographic examination of sleep. Only 13% of the participants lacked clinically meaningful SDB, whereas 33% had moderate SDB and 54% had severe SDB. Being overweight, self-reported snoring, and excessive daytime sleepiness all had good sensitivity (0.86-0.92) but very poor specificity (0.10-0.28) for the prediction of SDB. Undiagnosed SDB was more than threefold higher than expected in these community-dwelling older veterans. Traditional markers of SDB were not specific for predicting clinically relevant SDB. Published by Elsevier Inc.

The value of oral appliances in the treatment of obstructive sleep apnoea

PubMed Central

Rose, Edmund Clemens

2006-01-01

Oral appliances have long been used to treat snoring and mild to moderate obstructive sleep apnoea. This kind of treatment is considered an alternative, non-invasive treatment option. Mandibular protrusive appliances enlarge and stabilise the oro- and hypo-pharyngeal airway space by advancing the mandible, and stretching the attached soft tissue, in particular the tongue, soft palate, uvula, and the pharyngeal tissues. This article summarises the indications, contraindications, and possible side-effects of using oral appliances. Therapeutic efficacy is influenced by multiple parameters that are clinically difficult to control. One major parameter is the patient`s stomatognathic situation of the patient. Thus oral appliances are restricted to patients whose dental retention is adequate for permanent treatment and who do not suffer from temporomandibular joint dysfunction. Regular follow-up sleep studies and dental evaluations are necessary to ensure adequate permanent treatment. PMID:22073072

Tracheobronchomegaly associated tracheomalacia: analysis by sleep study.

PubMed

Sundaram, P; Joshi, J M

2004-01-01

Tracheobronchomegaly (TBM) occasionally may progress to extensive tracheomalacia which leads to respiratory failure. Spirometry, dynamic expiratory multidetector computed tomography (CT), bronchoscopy are used to diagnose patients of suspected tracheobronchomalacia. We used the technique of night-time monitoring of respiratory variables to show the presence of respiratory abnormalities during sleep and which was corrected by applying nasal continuous positive airway pressure (CPAP). The study showed the presence of both apnoea and hypopnoeas, which were obstructive in nature with an apnoea-hypopnoea index (AHI) of 11, no snoring and associated oxygen desaturation of 75 per cent. A second overnight study with nasal continuous positive airway pressure at a critical pressure of 8 cm, the AHI decreased to 3 along with no drop in oxygen saturation. This non-invasive technique should be considered as a diagnostic tool in tracheobronchomalacia and to know the outcome of CPAP, surgical or stent therapy in this condition.

Adult obstructive sleep apnoea.

PubMed

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

2014-02-22

Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss. Copyright © 2014 Elsevier Ltd. All rights reserved.

Piezosurgery an Asset in Treatment of Pierre Robin Sequence.

PubMed

Singh, Divya; Gadre, Pushkar; Gadre, Kiran; Ramanojam, Shandilya

2017-03-01

Pierre Robin sequence (formerly a syndrome) is named after the French stomatologist who, in 1923 and 1934, described the problems associated with micrognathia in newborn. It comprises mandibular micrognathia, U-shaped cleft palate, and glossoptosis. The typical symptoms are hypoxaemia, noisy breathing, snoring, stridor, cyanosis, bradycardia, feeding difficulties, and failure to thrive. Distraction osteogenesis has recently been considered as a surgical option for early intervention to lengthen the mandible and relieve respiratory problems. Piezosurgery offers a modality to make precise bone cuts preserving vital structures, minimizing the invasiveness of the surgical procedure, and offering bloodless field. We present case of 1-year-old male malnourished child with Pierre Robin sequence and tracheostomy in situ since day 11 of his birth. The staged treatment plan involving mandibular lengthening in which mandibular osteotomies were performed with the piezoelectric scalpel followed by decannulation of tracheostomy, which has been described in detail in this article.

Metastatic renal cell carcinoma in the nasopharynx.

PubMed

Atar, Yavuz; Topaloglu, Ilhan; Ozcan, Deniz

2013-01-01

Metastatic renal cell carcinoma of the nasopharynx, nasal cavity, and paranasal sinuses can be misdiagnosed as primary malignant or benign diseases. A 33-year-old male attended our outpatient clinic complaining of difficulty breathing through the nose, bloody nasal discharge, postnasal drop, snoring, and discharge of phlegm. Endoscopic nasopharyngeal examination showed a vascularized nasopharyngeal mass. Under general anesthesia, multiple punch biopsies were taken from the nasopharynx. Pathologically, the tumor cells had clear cytoplasm and were arranged in a trabecular pattern lined by a layer of endothelial cells. After the initial pathological examination, the pathologist requested more information about the patient's clinical status. A careful history revealed that the patient had undergone left a nephrectomy for a kidney mass diagnosed as renal cell carcinoma 3 years earlier. Subsequently, nasopharyngeal metastatic renal cell carcinoma was diagnosed by immunohistochemical staining with CD10 and vimentin. Radiotherapy was recommended for treatment.

Upper airway stabilization by osteopathic manipulation of the sphenopalatine ganglion versus sham manipulation in OSAS patients: a proof-of-concept, randomized, crossover, double-blind, controlled study.

PubMed

Jacq, Olivier; Arnulf, Isabelle; Similowski, Thomas; Attali, Valérie

2017-12-20

Osteopathic manipulative treatment (OMT) of the sphenopalatine ganglion (SPG) is used empirically for the treatment of rhinitis and snoring and is thought to increase pharyngeal stability. This trial was designed to study the effects of this treatment on pharyngeal stability evaluated by critical closing pressure in obstructive sleep apnoea syndrome. This single-centre, randomized, crossover, double-blind study compared active manipulation and sham manipulation of the SPG. Randomization was computer-generated. Patients each received one active manipulation and one sham manipulation at an interval of 21 days and were evaluated 30 min and 48 h after each session administered by a qualified osteopath. Neither the patients, nor the investigator performing the evaluations were informed about the order of the two techniques (double-blind). The primary endpoint was the percentage of responding patients presenting increased pharyngeal stability defined by a variation of critical closing pressure (Pcrit) of at least -4 cmH 2 O at 30 min. Secondary endpoints were the variation of Pcrit in absolute values, sleepiness and snoring. Others endpoints were lacrimation (Schirmer's test), induced pain, sensations experienced during OMT. Ten patients were included and nine (57 [50; 58] years, comprising 7 men, with an apnoea-hypopnoea index of 31.0 [25.5; 33.2]/h; (values are median [quartiles])) were analysed. Seven patients were analysed for the primary endpoint and nine patients were analysed for secondary endpoints. Five patients responded after active manipulation versus no patients after sham manipulation (p = 0.0209). Active manipulation induced more intense pain (p = 0.0089), increased lacrimation (ns) and more tactile, nociceptive and gustatory sensations (13 versus 1) compared to sham manipulation. No significant difference was observed for the other endpoints. Osteopathic manipulative treatment of the SPG may improve pharyngeal stability in obstructive sleep apnoea syndrome. This trial validates the feasibility of the randomized, controlled, double-blind methodology for evaluation of this osteopathic treatment. Studies on a larger sample size must specify the efficacy on the apnoea-hypopnoea index. The study was retrospectively registered in the clinicaltrial.gov registry under reference NCT01193738 on 1st September 2010 (first inclusion May 19, 2010).

Children with a history of prematurity presenting with snoring and sleep-disordered breathing: a cross-sectional study.

PubMed

Manuel, Anura; Witmans, Manisha; El-Hakim, Hamdy

2013-08-01

To report on the prevalence of premature (PM) birth in a consecutive series of children treated for snoring and sleep-disordered breathing (S/SDB), the parameters specific to their management and variables predictive of disease severity. A retrospective study was undertaken at a tertiary pediatric hospital. Children with history of PM and presenting with S/SDB were identified from a prospectively kept surgical database. We set out to determine the prevalence of PM among the patients presenting with S/SDB who required airway evaluations and surgery. Pulse oximetry is overnight recordable oxygen saturation and heart rate tracing that provides information about hypoxemia during sleep. This was performed on all children preoperatively. The pulse oximetry findings were used to plan for perioperative monitoring and care. A multivariable analysis was used to identify factors predictive of abnormal pulse oximetry studies. We evaluated the associated diagnoses, surgical procedures required, and response to treatment in these selected children. Fifty-seven out of 1,038 patients were PM (33 males; mean age, 62.09 ± 34.91 months; range, 4-190 months). The mean gestational age was 30.3 ± 4.0 weeks. The prevalence rate of PM among patients treated surgically for SDB is 5.5% (95% CI 5.2-5.8) at our center. Comorbid pulmonary and gastrointestinal disorders were encountered on 23 (40%) and 17 (29.8%) occasions, respectively, and were the most commonly encountered comorbid diagnostic categories. Large airway abnormalities were encountered in 11 (19.3%) children, and the most common were subglottic stenosis (four) and laryngeal paralysis (four). Comorbid respiratory disease was negatively predictive of abnormal pulse oximetry (coefficient -0.35, P<.05). Postoperative respiratory outcomes correlated with abnormal pulse oximetry (coefficient 0.3; P<.05). Our findings suggest children with PM presenting to pediatric otolaryngology require a comprehensive evaluation for S/SDB. A significant proportion of children with S/SDB and a history of PM frequently had pulmonary and gastrointestinal comorbidities in our cohort. One-half required admission postoperatively, and these were predictable based on preoperative pulse oximetry. Respiratory comorbidity was negatively predictive of severity of SDB. Inversely, children with untreated pulmonary comorbidities are more likely to have postoperative complications. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

[The investigation rate and influence factors of tinnitus with chronic suppurative otitis media].

PubMed

Lin, Y J; Wu, X Q; Ma, X; Lai, R Z

2018-04-01

Objective: To investigate the incidence of tinnitus and its influencing factors in patients with chronic suppurative otitis media, and to provide clinical data for the study of the pathogenesis of tinnitus. Method: The clinical data of 77 patients with chronic suppurative otitis media who underwent modified radical mastoidectomy and tympanoplasty were investigated. When tinnitus and otitis media happened in the same side,then the tinnitus is judged to be otitis media related. Patients were further divided into otitis media related tinnitus and the no tinnitus groups. The differences of tinnitus severity, sleep disturbance, migraine (migraine features), snoring and gastroesophageal reflux were compared between the two groups in tinnitus occurrence and classification. Result: The incidence of otitis media related tinnitus was 55.8%(43/77). Most of the tinnitus happened(33/43) later than the occurrence of otitis media for several years or even decades. There were 43 cases of tinnitus associated with otitis media, and 31 cases without tinnitus. Between the groups, significant differences were observed in migraine features, and the P value is 0.011, while no significant differences were noticed in the severity of hearing loss and sleep disorders, snoring, gastroesophageal reflux. Ranking of otitis media related tinnitus was positively related to the degree of hearing loss, especially the bone conduction threshold. With Spearman rank correlation test,P values of mean value(250Hz,500Hz,1kHz,2kHz,4kHz), middle frequency (1kHz, 2kHz)and high frequency (4kHz) of bone conduction threshold were 0.010,0.019 and 0.003, and the correlation coefficients were 0.391,0.356 and 0.443, respectively. Conclusion: The occurrence of tinnitus in patients with otitis media may not be consistent with the time of otitis media, and theoretically later than the occurrence of otitis media is more reasonable. Whether tinnitus occurs in patients with otitis media is not related to sleep disorders, the degree of air conduction and bone conduction hearing loss, but is related to migraine features. The severity of tinnitus associated with otitis media is associated with bone conduction hearing loss. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Increasing trends of sleep complaints in the city of Sao Paulo, Brazil.

PubMed

Santos-Silva, Rogerio; Bittencourt, Lia Rita Azeredo; Pires, Maria Laura Nogueira; de Mello, Marco Tulio; Taddei, Jose Augusto; Benedito-Silva, Ana Amelia; Pompeia, Celine; Tufik, Sergio

2010-06-01

The aim of this study was to compare the prevalence of sleep habits and complaints and to estimate the secular trends through three population-based surveys carried out in 1987, 1995, and 2007 in the general adult population of the city of Sao Paulo, Brazil. Surveys were performed using the same three-stage cluster-sampling technique in three consecutive decades to obtain representative samples of the inhabitants of Sao Paulo with respect to gender, age (20-80 years), and socio-economic status. Sample sizes were 1000 volunteers in 1987 and 1995 surveys and 1101 in a 2007 survey. In each survey, the UNIFESP Sleep Questionnaire was administered face-to-face in each household selected. For 1987, 1995, and 2007, respectively, difficulty initiating sleep (weighted frequency %; 95% CI) [(13.9; 11.9-16.2), (19.15; 16.8-21.6), and (25.0; 22.5-27.8)], difficulty maintaining sleep [(15.8; 13.7-18.2), (27.6; 24.9-30.4), and (36.5; 33.5-39.5)], and early morning awakening [(10.6; 8.8-12.7), (14.2; 12.2-16.5), and (26.7; 24-29.6)] increased in the general population over time, mostly in women. Habitual snoring was the most commonly reported complaint across decades and was more prevalent in men. There was no statistically significant difference in snoring complaints between 1987 (21.5; 19.1-24.2) and 1995 (19.0; 16.7-21.6), but a significant increase was noted in 2007 (41.7; 38.6-44.8). Nightmares, bruxism, leg cramps, and somnambulism complaints were significantly higher in 2007 compared to 1987 and 1995. All were more frequent in women. This is the first study comparing sleep complaints in probabilistic population-based samples from the same metropolitan area, using the same methodology across three consecutive decades. Clear trends of increasing sleep complaints were observed, which increased faster between 1995 and 2007 than from 1987 to 1995. These secular trends should be considered a relevant public health issue and support the need for development of health care and educational strategies to supply the population's increased need for information on sleep disorders and their consequences. Copyright 2010 Elsevier B.V. All rights reserved.

[Sleep disorders in childhood and adolescence, with special reference to allergic diseases].

PubMed

Wasilewska, Jolanta; Kaczmarski, Maciej; Protas, Piotr T; Kowalczuk-Krystoń, Monika; Mazan, Barbara; Topczewska, Magdalena

2009-03-01

Allergic diseases have a significant impact on the quality of life. The aim of the study was to compare sleep parameters of allergic and non-allergic children. Pediatric Sleep Questionnaire was used to asses sleep quality in 202 participants in a 3-year prospective study: in 122 hospitalized (mean age 7.9 +/- 4.7) (F/M 75/47) due to allergic (n = 70) or non-allergic disease (n = 52), and in 80 healthy children (mean age 6.3 +/- 5.0) (F/M 36/44). Of 70 allergic participants, 26 had atopic dermatitis (SCORAD > or = 20); 25 were with bronchial asthma (GINA' criteria) and 19 with IgE-dependent food allergy confirmed by oral food challenge. Of 52 non-allergic patients, 31 children had gastro-esophageal reflux disease and 21 children had recurrent respiratory infection. The group of patients needed significantly more time to fall asleep than controls (17.9 +/- 13.7 vs 12.8 +/- 8.5 min; p < 0.004). Children with food allergy and atopic dermatitis had greatest problems with falling asleep (21.4 +/- 13.8 vs 12.8 +/- 8.5 min; p < 0.006) and 20.4 +/- 14.9 vs 12.8 +/- 8.5 min; p < 0.024). The number of nights of sound sleep without waking up was lower in the study group than in controls (3.5 +/- 2.6 vs 5.0 +/- 2.7; p < 0.0002). Atopic dermatitis and food allergy were found to predispose to sleep disruption most. Snoring history was revealed in 43.4% of patients and in 6.4% of controls (p < 0.0001), being significantly more common in children with bronchial asthma and recurrent respiratory tract infections. Allergic disease was a risk factor for snoring (OR--2.94; 95%CI--1.72-5.05; p < 0.001). As many as 91% of parents did not inform doctors about poor sleep of their children. 1. Allergic diseases are accompanied by different sleep disorders included dyssomnias and parasomnias, e.g. bedtime resistance, disrupted sleep or sleep-disordered breathing. 2. Physicians should pay particular attention to sleep quality in children with allergic diseases irrespective of which body system is affected i.e. the skin (atopic dermatitis), the respiratory tract (bronchial asthma) or the alimentary system (food allergy).

[Effects of recent upper respiratory-tract infections on incidence of the perioperative respiratory adverse events in children: a prospective cohort study].

PubMed

Li, C Q; Wang, D X; Cheng, T; Zheng, X Y

2017-10-18

To investigate the effects of the recent upper respiratory tract infections (URI) on the incidence of perioperative respiratory adverse events in children scheduled to undergo general anesthesia and elective surgery. In the study, 232 children undergoing general anesthesia with laryngeal mask airway (LMA) for elective ophthalmic surgeries at Peking University First Hospital, Beijing, China, from Nov. 1, 2015 to May 10, 2016 were enrolled. On the day of the surgery, the parents of the children were preoperatively asked to fill out a questionnaire regarding the baseline characteristics and medical history of the children, including gender, age, height, weight, history of URI within the last 2 weeks before anesthesia, history of premature, long-term passive smoking exposure, habitual sleep snoring, and history of asthma. In addition, all adverse respiratory events throughout the perioperative periods (oxygen desaturation, cough, copious secretions, laryngospasm and bronchospasm) as well as peri-operative variables (number of attempts to insert the LMA successfully, anesthesia duration and so on) were recorded. Multivariate Logistic regression analysis was applied to identify independent risk factors of perioperative respiratory adverse events. Among the 232 children included in the study, 28.0% (65/232) presented with a history of a recent URI within the last 2 weeks before anesthesia. The presence of the recent URI increased the incidence of oxygen desaturation (23.1% vs.12.0%, P=0.034), copious secretions (15.4% vs. 6.6%, P=0.036) and any of all the adverse respiratory events (32.3% vs. 18.6%, P=0.024). Multivariate Logistic regression analysis identified two independent risk factors of perioperative adverse respiratory events: a history of URI within the last 2 weeks before general anesthesia (OR=2.021, 95%CI: 1.023-3.994, P=0.043) and habitual sleep snoring (OR=3.660, 95%CI: 1.517-8.832, P=0.004). A history of a recent URI within 2 weeks before general anesthesia was associated with a higher incidence of oxygen desaturation, copious secretions and the overall respiratory adverse events. For the children with recent URI, we recommend the general anesthesia and elective surgery should be postponed for at least 2 weeks after the URI.

Extranasopharyngeal Angiofibroma Originating in the Inferior Turbinate: A Distinct Clinical Entity at an Unusual Site

PubMed Central

Baptista, Marco Antonio Ferraz de Barros; Pinna, Fábio de Rezende; Voegels, Richard Louis

2014-01-01

Introduction The extranasopharyngeal angiofibroma is histologically similar to juvenile nasopharyngeal angiofibroma, differing from the latter in clinical and epidemiologic characteristics. Objectives We present a case of extranasopharyngeal angiofibroma originating in the inferior turbinate. Resumed Report The patient was a girl, 8 years and 6 months of age, who had constant bilateral nasal obstruction and recurrent epistaxis for 6 months, worse on the right side, with hyposmia and snoring. Nasal endoscopy showed a reddish lesion, smooth, friable, and nonulcerated. Computed tomography showed a lesion with soft tissue density in the right nasal cavity. We used an endoscopic approach and found the lesion inserted in the right inferior turbinate. We did a subperiosteal dissection and excision with a partial turbinectomy with a resection margin of 0.5 cm. Histopathology reported it to be an extranasopharyngeal angiofibroma. Conclusion Although rare, extranasopharyngeal angiofibroma should be considered in the diagnosis of vascular tumors of the head and neck. PMID:25992131

Forestier syndrome and obstructive sleep apnea: Surgical treatment.

PubMed

Ribeiro, D K; Pinto, J A; Freitas, G S

2018-01-20

We report a case of obstructive sleep apnea that occurred as a result of Forestier disease and describe the surgical treatment that was performed. The patient is a 56-year-old man who presented dysphagia for solids and liquids, snoring (score 10) and excessive daytime sleepiness for 5 years. On fiber optic laryngoscopy examination, there was interarytenoid edema and protrusion of the posterior wall of the larynx. The cervical X-Ray showed protrusion of intervertebral disc between C3-C5 (skeletal hyperostosis) and the polysomnography revealed apnea-hypopnea index (AHI) of 56 events/h. Surgery was performed by the otorhinolaryngology and orthopedic teams. The patient evolved with complete symptom resolution and an AHI of 3,9 events/h on the control polysomnography. This is the first reported case of Forestier Syndrome (FS) associated with Obstructive Sleep Apnea (OSA) that was proposed surgical treatment and the patient evolved with complete symptom improvement. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Update in obstructive sleep apnea syndrome in children.

PubMed

Balbani, Aracy P S; Weber, Silke A T; Montovani, Jair C

2005-01-01

The prevalence of OSAS in children is 0.7-3%, with peak incidence in pre-schoolers. It is characterised by partial or complete upper airway obstruction during sleep, causing intermittent hypoxia. Both anatomical (severe nasal obstruction, craniofacial anomalies, hypertrophy of the pharyngeal lymphoid tissue, laryngeal anomalies, etc.) and functional factors (neuromuscular diseases) predispose to OSAS during childhood. The main cause of OSAS in children in adenotonsillar hypertrophy. The most common clinical manifestations of OSAS are: nocturnal snoring, respiratory pauses, restless sleep and mouth breathing. Nocturnal pulse oximetry, nocturnal noise audio/videotape recording and nap polysomnography are useful tools for screening suspected cases of OSAS in children, and the gold-standard for diagnosis is overnight polysomnography in the sleep laboratory. On the contrary of SAOS adults, children usually present: less arousals associated to apnea events, more numerous apneas/hypopneas during REM sleep, and more significant oxyhemoglobin desaturation even in short apneas. The treatment of OSAS may be surgical (adenotonsillectomy, craniofacial abnormalities correction, tracheostomy) or clinical (sleep hygiene, continuous positive airway pressure--CPAP).

'A good shepherd, but with obstructive sleep apnoea syndrome': traditional uvulectomy case series and literature review.

PubMed

Ravesloot, M J L; de Vries, N

2011-09-01

In the West, removal of the uvula is predominantly undertaken as part of palatal surgery, in cases of obstructive sleep apnoea. In the developing world, such as the Middle East and Africa, uvulectomy is a more common practice. The uvula is removed for curative or preventive purposes, or as part of ritual practice. Due to immigration from developing to developed world countries, and to Western doctors working abroad, such doctors are increasingly being confronted with unfamiliar traditional healing practices, within a medical context. The Medline and Embase online databases were systematically searched for literature on traditional uvulectomy. We present a review of this literature. We also present the first report, to our best knowledge, of obstructive sleep apnoea as a late complication of traditional uvulectomy. Traditional uvulectomy may be complicated by post-operative haemorrhage and local infections, among many other problems. We report cases of obstructive sleep apnoea and snoring caused by palatal stenosis resulting from traditional uvulectomy during childhood.

Sleep-wake patterns reported by parents in hyperactive children diagnosed according to ICD-10, as compared to paired controls.

PubMed

Gomes, Ana Allen; Parchão, Carla; Almeida, Anabela; Clemente, Vanda; Pinto de Azevedo, Maria Helena

2014-10-01

This study aimed primarily to compare the parent-reported sleep of children with ICD-10 hyperkinetic disorder (HKD) versus community children. Thirty children aged 5-13 years (83.3% boys) diagnosed with HKD by their child and adolescent psychiatrists took part in this study, plus 30 community children, matched for sex, age, and school year. Compared to the controls, the HKD children showed significantly later bedtimes, stronger bedtime resistance, longer sleep latency, shorter sleep; more frequent behaviors and symptoms concerning falling asleep into parents bed, needing something special to initiate sleep, nightmares, sleep talking, sleep bruxism, fear from darkness, bedwetting, and, most notably, loud snoring (26.7%); they also tended to show higher daytime somnolence. Attention deficit/hyperactivity disorder (ADHD)/HKD children may thus have more sleep-related problems than typically developing children. Alternatively, our results may reflect misdiagnoses; thus, special attention should be directed to comorbidity and differential diagnosis issues between sleep disturbances and ADHD/HKD.

Sleep and Speech Outcomes After Superior Adenoidectomy in Children with Cleft Palate.

PubMed

Waselchuk, Emily; Sidman, James D; Lander, Timothy; Tibesar, Robert; Roby, Brianne B

2018-01-21

Objective To describe the sleep and speech outcomes in patients with cleft palate who underwent superior adenoidectomy. Subjectives and methods This is a case series with chart review of patients with diagnoses of cleft palate and sleep disordered breathing (SDB), obstructive sleep apnea (OSA) or nasal obstruction treated with superior adenoidectomy from 1991-2015 at the Children's Hospital of Minnesota. Postoperative clinic notes documented the changes in symptoms following surgery. All speech outcomes were recorded. Results Fifty patients (23 females, 27 males) aged 11 months to 17 years were included. Forty-six patients (92%) had improvement of sleep symptoms including snoring, nighttime restlessness, and witnessed apnea events, following superior adenoidectomy. Forty-two of the 46 patients (91%) had stable speech postoperatively with either no development or no worsening of velopharyngeal insufficiency (VPI). Conclusion Superior adenoidectomy is an effective procedure to alleviate symptoms of sleep disordered breathing in patients with cleft palate without significantly affecting speech.

Use of intranasal corticosteroids in adenotonsillar hypertrophy.

PubMed

Sakarya, E U; Bayar Muluk, N; Sakalar, E G; Senturk, M; Aricigil, M; Bafaqeeh, S A; Cingi, C

2017-05-01

This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy. The related literature was searched using PubMed and Proquest Central databases. Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system. Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

Spatial acoustic radiation of respiratory sounds for sleep evaluation.

PubMed

Shabtai, Noam R; Zigel, Yaniv

2017-09-01

Body posture has an effect on sleeping quality and breathing disorders and therefore it is important to be recognized for the completion of the sleep evaluation process. Since humans have a directional acoustic radiation pattern, it is hypothesized that microphone arrays can be used to recognize different body postures, which is highly practical for sleep evaluation applications that already measure respiratory sounds using distant microphones. Furthermore, body posture may have an effect on distant microphone measurement; hence, the measurement can be compensated if the body posture is correctly recognized. A spherical harmonics decomposition approach to the spatial acoustic radiation is presented, assuming an array of eight microphones in a medium-sized audiology booth. The spatial sampling and reconstruction of the radiation pattern is discussed, and a final setup for the microphone array is recommended. A case study is shown using recorded segments of snoring and breathing sounds of three human subjects in three body postures in a silent but not anechoic audiology booth.

An autopsy case of acetyl fentanyl intoxication caused by insufflation of 'designer drugs'.

PubMed

Takase, Izumi; Koizumi, Takako; Fujimoto, Ihoko; Yanai, Aya; Fujimiya, Tatsuya

2016-07-01

We present a fatal case of intoxication due to insufflation of acetyl fentanyl. His blood concentration of acetyl fentanyl was 270ng/mL, and the manner of death was classified as an accident. This is the first report of an autopsy case of acetyl fentanyl delivered by insufflation, rather than intravenous administration. He had been snoring loudly for at least 12h prior to death, and transport to a hospital during this time and treatment with naloxone may have saved his life. In this sense, it can be said that his death was preventable. This case reemphasizes the risk of death associated with drug overdose and the narrow range of acetyl fentanyl between the effective dose (ED50) and lethal dose (LD50). The case should also raise awareness among medical professionals of the effectiveness of naloxone and the need to establish a comprehensive system for toxicological analysis while keeping the possibility of use of 'designer drugs' in mind. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Headache in patients with chronic obstructive pulmonary disease: effects of chronic hypoxaemia.

PubMed

Ozge, Aynur; Ozge, Cengiz; Kaleagasi, Hakan; Yalin, Osman Ozgür; Unal, Ozgür; Ozgür, Eylem S

2006-02-01

The frequency and characteristics of headache in patients with chronic obstructive pulmonary disease (COPD) are not clear and there are only a few studies that have assessed the relationship between chronic hypoxaemia and headache. We performed this study in order to evaluate the frequency and characteristics of headache in COPD patients. A total of 119 patients, with a mean age of 63.4 +/- 8.2 years, diagnosed with moderate or severe stable COPD were included in the study. Overall 31.9% of the patients complained of headache and 45.4% were reported to have sleep disorders. There were significant effects of family history of COPD, having other systemic disorders or sleep disorders (snoring, bruxism, restless leg syndrome, etc.) and laboratory data of chronic hypoxaemia and airway obstruction on headache co-morbidity. In conclusion, possibly being a specific subtype of elderly headache, headache in patients with moderate or severe COPD is a common problem and future studies are needed to obtain more knowledge about its pathophysiological and clinical basis.

Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint.

PubMed

Bates, C J; McDonald, J P

2006-01-28

To determine in detail the complications associated with the use of mandibular repositioning splints (MRS) to treat sleep-related breathing disorders. This prospective cross-sectional cohort study audits the management with mandibular repositioning splints of 121 patients suffering from sleep-related breathing disorders. Investigation of patients' and sleeping partners' perspectives on treatment was undertaken with the use of a questionnaire based study. Sixty-eight per cent of respondents reported that they were compliant with treatment; various side effects were reported of which excess salivation was the most common. Investigation of sleeping partners' perspectives revealed that 70% felt that their partners' snoring was improved and 47% felt that their partner's breathing pauses during sleep were reduced. Sixty-four per cent of the sleeping partners also reported that their own sleep pattern had improved since their partner's treatment. Mandibular repositioning splints used in the manner described by this paper are demonstrated to have a good compliance rate, provide successful treatment and exhibit only minor, reversible side effects.

Are questionnaires reliable in diagnosing sleep-disordered breathing in university students?

PubMed

Migacz, E; Wichniak, A; Kukwa, W

2017-11-01

This study aimed to screen young adults for sleep-disordered breathing, and compare those with high and low risk for sleep-disordered breathing. A survey based on the Berlin questionnaire was completed by 330 university students, and the results were used to divide them into sleep-disordered breathing positive and sleep-disordered breathing negative groups. A representative group was selected from each cohort (positive group, n = 16; negative group, n = 21), and assessed with sleep study, ENT examination, the Nose Obstruction Symptom Evaluation scale, and the Epworth Sleepiness Scale. Sleep-disordered breathing prevalence was 11.2 per cent in the questionnaire and 24 per cent according to the sleep study. The sleep-disordered breathing positive and negative groups significantly differed in terms of coexisting sleep-disordered breathing symptoms. There were no significant differences between the positive and negative groups with regard to sleep study parameters (apnoea/hypopnoea index, respiratory disturbance index, oxygen desaturation index, snoring intensity) and the Epworth Sleepiness Scale. Subjective and objective diagnostic tools revealed that sleep-disordered breathing is a common problem among young adults.

Sleep Disordered Breathing Symptoms and Daytime Sleepiness are Associated with Emotional Problems and Poor School Performance in Children

PubMed Central

Liu, Jianghong; Liu, Xianchen; Ji, Xiaopeng; Wang, Yingjie; Zhou, Guoping; Chen, Xinyin

2016-01-01

This study examined the prevalence of sleep disordered breathing (SDB) symptoms and their associations with daytime sleepiness, emotional problems, and school performance in Chinese children. Participants included 3,979 children (10.99 ± 0.99 years old) from four elementary schools in Jintan City, Jiangsu Province, China. Children completed a self-administered questionnaire on sleep behavior and emotional problems, while parents completed the Child Sleep Habit Questionnaire (CSHQ). SDB symptoms included 3 items: loud snoring, stopped breathing, and snorting/ gasping during sleep. Teachers rated the children's school performance. The prevalence rates of parent- and self-reported SDB symptoms were 17.2% and 10.1% for “sometimes” and 8.9% and 5.6% for “usually”. SDB symptoms, more prevalent in boys than in girls, increased the risks for depression, loneliness, and poor school performance. Daytime sleepiness mediated the relationship between SDB symptoms and depression, loneliness, and poor school performance. This study suggests the importance of early screening and intervention of SDB and daytime sleepiness in child behavioral and cognitive development. PMID:27289327

Sublingual epidermoid cyst presenting with distinctive magnetic resonance imaging findings.

PubMed

Yoshida, Naohiro; Kodama, Kozue; Iino, Yukiko

2014-06-18

A case of sublingual epidermoid cyst presenting distinctive magnetic resonance imaging (MRI) findings is described. A 39-year-old man presented to our hospital with a three months progressive left submandibular swelling, difficulty moving his tongue, and snoring. Preoperative evaluation with MRI and fine needle aspiration cytology (FNAC) revealed that the heterogeneous cystic lesion contained the squamous cells, which is compatible with ectodermal tissue. The mass was located above the mylohyoid muscle and spread to the pharyngeal space. By considering the size, infection history, patient age, and location, the cyst was completely resected under general anesthesia via cervical approach without any complication. Histopathologically, the cyst wall was lined by stratified squamous epithelium with no skin appendage, suggesting an epidermoid cyst. Ultrasound (US), MRI and FNAC were very useful of the preoperative diagnosis for oral and sublingual lesion. The postoperative course was uneventful and without recurrence after 24 months. This case showed that epidermoid cysts formed the rarely heterogeneous cystic tumor and it underlined usefulness of preoperative diagnosis, such as US, MRI and FNAC for oral and sublingual tumor.

Epidemiology of central sleep apnoea in heart failure.

PubMed

Naughton, Matthew T

2016-03-01

Central sleep apnoea occurs in about a third of patients with reduced systolic heart failure and is a marker of increased mortality. Such patients usually are older males with advanced heart failure (i.e., high pulmonary wedge pressure), often in atrial fibrillation, with evidence of hyperventilation (i.e., low PaCO2) in the absence of hypoxemia. Characteristically, ventilation waxes and wanes in a sinusoidal pattern, with mild hypoxemia, occurring in the lighter levels of sleep usually when supine. Snoring may also occur in central sleep apnoea, often at the peak of hyperventilation, sometimes contributing to the confusion or overlap with obstructive sleep apnoea. Central sleep apnoea is associated with orthopnoea, paroxysmal nocturnal dyspnoea and an oscillatory respiratory pattern with an incremental cardiopulmonary exercise study. Importantly, heart failure therapies (e.g., afterload reduction, diuresis, pacemakers, transplantation) attenuate central sleep apnoea. Night to night variability in severity of central sleep apnoea may occur with changes in patients' posture during sleep (less severe when sleeping on-side or upright). Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

Rapid tooling method for soft customized removable oral appliances.

PubMed

Salmi, Mika; Tuomi, Jukka; Sirkkanen, Rauno; Ingman, Tuula; Mäkitie, Antti

2012-01-01

Traditionally oral appliances i.e. removable orthodontic appliances, bite splints and snoring / sleep apnea appliances are made with alginate impressions and wax registrations. Our aim was to describe the process of manufacturing customized oral appliances with a new technique i.e. rapid tooling method. The appliance should ideally be custom made to match the teeth. An orthodontic patient, scheduled for conventional orthodontic treatment, served as a study subject. After a precise clinical and radiographic examination, the approach was to digitize the patient's dental arches and then to correct them virtually by computer. Additive manufacturing was then used to fabricate a mould for a soft customized appliance. The mould was manufactured using stereolithography from Somos ProtoGen O-XT 18420 material. Casting material for the mould to obtain the final appliance was silicone. As a result we managed to create a customized soft orthodontic appliance. Also, the accuracy of the method was found to be adequate. Two versions of the described device were manufactured: one with small and one with moderate orthodontic force. The study person also gave information on the subjective patient adaptation aspects of the oral appliance.

[Sleep apnea and heart failure: pathophysiology, diagnosis and therapy].

PubMed

Monda, Cinzia; Scala, Oriana; Paolillo, Stefania; Savarese, Gianluigi; Cecere, Milena; D'Amore, Carmen; Parente, Antonio; Musella, Francesca; Mosca, Susanna; Filardi, Pasquale Perrone

2010-11-01

Sleep apnea, defined as a pathologic pause in breathing during sleep >10 s, promotes the progression of chronic heart failure and may be a predictor of poor prognosis. It causes, in fact, several mechanical, hemodynamic, chemical and inflammatory changes that negatively compromise cardiovascular homeostasis of heart failure patients. Sleep apnea is recognized as sleep apnea syndrome when specific symptoms, such as sleepiness and headache during the daytime and snoring, are present and is diagnosed with an overnight test called polysomnography. There are two different forms of sleep apnea, central and obstructive. Breathing is interrupted by the loss of respiratory drive and the lack of respiratory effort in the central form, which affects about 40-60% of heart failure patients. In obstructive sleep apnea, breathing stops when throat muscles relax, despite respiratory effort. This form affects about 3% of the general population, while it is present in at least 30% of heart failure patients. The diagnosis of sleep disorders in heart failure becomes very important to help patients adopting lifestyle changes and starting specific therapies to improve quality of life and retard the progression of chronic heart failure.

Mandibular Advancement Appliance for Obstructive Sleep Apnea Treatment.

PubMed

Kostrzewa-Janicka, J; Śliwiński, P; Wojda, M; Rolski, D; Mierzwińska-Nastalska, E

2017-01-01

A combination of abnormal anatomy and physiology of the upper airway can produce its repetitive narrowing during sleep, resulting in obstructive sleep apnea (OSA). Treatment of sleep-breathing disorder ranges from lifestyle modifications, upper airway surgery, continuous positive airway pressure (CPAP) to the use of oral appliances. A proper treatment selection should be preceded by thorough clinical and instrumental examinations. The type and number of specific oral appliances are still growing. The mandibular advancement appliance (MAA) is the most common type of a dental device in use today. The device makes the mandible protrude forward, preventing or minimizing the upper airway collapse during sleep. A significant variability in the patients' response to treatment has been observed, which can be explained by the severity of sleep apnea at baseline and duration of treatment. In some trials, patients with mild OSA show a similar treatment effect after the use of CPAP or MAA. It is worthwhile to give it a try with an oral appliance of MAA type in snoring, mild-to-moderate sleep apnea, and in individuals who are intolerant to CPAP treatment.

Impact of Alzheimer disease patients' sleep disturbances on their caregivers.

PubMed

Gehrman, Philip; Gooneratne, Nalaka S; Brewster, Glenna S; Richards, Kathy C; Karlawish, Jason

Sleep disturbance symptoms are common in persons living with Alzheimer disease (AD). However little is known about the impact of sleep disturbance symptoms in patients living with AD on caregiver burden and quality of life (QOL). The aims of this study were to determine the prevalence of symptoms of disturbed sleep in patients with AD, identify the care-recipient sleep disturbance symptoms that predict caregiver burden and QoL, and determine how care-recipient sleep disturbance symptoms compare to other caregiver and patient characteristics when predicting caregiver QoL. Caregiver burden was assessed using the Screen for Caregiver Burden. Sixty percent of the care-recipients had at least one sleep symptom. In 130 caregiver/patient dyads, nocturnal awakenings, nocturnal wandering, and snoring predicted caregiver burden. Multivariate modeling demonstrated that caregiver burden, caregiver physical and mental health, and caregiver depression were predictors of overall caregiver QoL. Treating disturbed sleep in care-recipients and caregiver mental health symptoms could have important public health impact by improving the lives of the caregiving dyad. Copyright © 2017 Elsevier Inc. All rights reserved.

The epidemiology of adult obstructive sleep apnea.

PubMed

Punjabi, Naresh M

2008-02-15

Obstructive sleep apnea is a chronic condition characterized by frequent episodes of upper airway collapse during sleep. Its effect on nocturnal sleep quality and ensuing daytime fatigue and sleepiness are widely acknowledged. Increasingly, obstructive sleep apnea is also being recognized as an independent risk factor for several clinical consequences, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. Estimates of disease prevalence are in the range of 3% to 7%, with certain subgroups of the population bearing higher risk. Factors that increase vulnerability for the disorder include age, male sex, obesity, family history, menopause, craniofacial abnormalities, and certain health behaviors such as cigarette smoking and alcohol use. Despite the numerous advancements in our understanding of the pathogenesis and clinical consequences of the disorder, a majority of those affected remain undiagnosed. Simple queries of the patient or bed-partner for the symptoms and signs of the disorder, namely, loud snoring, observed apneas, and daytime sleepiness, would help identify those in need of further diagnostic evaluation. The primary objective of this article is to review some of the epidemiologic aspects of obstructive sleep apnea in adults.

Bone-anchored maxillary expansion and bilateral interoral mandibular distraction osteogenesis in adult with severe obstructive sleep apnea syndrome.

PubMed

Nie, Ping; Zhu, Min; Lu, Xiao-Feng; Fang, Bing

2013-05-01

Severe obstructive sleep apnea syndrome (OSAS) threatens patients' lives. To solve ventilation problem, snoring, and avoid another orthognathic surgery for mandibular advancement, bone-anchored rapid maxillary expansion and bilateral interoral mandibular distraction osteogenesis were tried on a 20-year-old Chinese male patient with severe skeletal class II malocclusion and OSAS.The patient had polysomnography (apnea-hypopnea index 54.2), body mass index measurement (19.7 kg/m), and cephalometry before the treatment. Bone-anchored rapid maxillary expansion was performed for the correction of maxillary transverse and minor sagittal deficiency and the improvement of nasal airflow by decreasing nasal resistance. Bilateral interoral mandibular distraction osteogenesis was operated to lengthen the small, retruded mandible by 15 mm. Orthodontic treatment after the maxillary expansion and mandibular distraction osteogenesis can help obtain stable occlusion.The Epworth Sleepiness Scale, a questionnaire for temporomandibular joint, cephalometric analysis, polysomnography, acoustic rhinometry, and multislice spiral computed tomography were performed to evaluate changes from the treatment. All the results showed that the patient had a significantly alleviated OSAS. In addition, an acceptable occlusion was also obtained.

Frequency of EEG arousals from nocturnal sleep in normal subjects.

PubMed

Mathur, R; Douglas, N J

1995-06-01

Brief arousals are clinically important and increasingly scored during polysomnography. However, the frequency of arousals during routine polysomnography in the normal population is unknown. We performed overnight polysomnography in the 55 of 59 control subjects from a family practice list who were approached and agreed to undergo polysomnography. Awakenings were scored according to the criteria of Rechtschaffen and Kales and briefer arousals according to three different criteria, including the American Sleep Disorders Association (ASDA) definition. There was a mean of 4 [95% confidence interval (CI), 1-15) Rechtschaffen and Kales awakenings per hour, whereas the ASDA definition gave 21 (95% CI, 7-56) per hour slept. Arousal frequencies increased significantly (p < 0.001) with age in our subjects, who ranged from the late teens to early 70s. The high upper limit of the frequency of brief arousals was not altered by exclusion of patients who snored or had witnessed apneas or daytime sleepiness. It is important that those scoring arousals on routine polysomnography recognize that high arousal frequencies occur in the normal population on 1-night polysomnography.

[Treatment analyses of 143 patients with maxillofacial and cervical venous malformations involved in isthmus faucium area].

PubMed

Ge, C X; Tai, M Z; Chen, T; Li, K L; Qin, Z P

2017-12-07

Objective: To analyze the clinical data and summarize therapeutic experiences of cervicofacial venous malformations involving isthmus faucium area. Methods: Clinical records from 143 patients with venous malformations involving isthmus faucium area treated at our hospital between January 2012 and January 2016 were reviewed. There were 70 males and 73 females. Age ranged from 1 to 52 years old, with a median age of 14.5 years. There were 19 cases with lesions involving in only 1 subanatomic area above and 124 cases with lesions involving in more than 1 subanatomic areas, including 63 cases with lesions involving in more than 2 areas. There were 50 patients presenting with additional maxillofacial and cervical lesions. Clinical symptoms included snoring ( n =98), indistinct phonation ( n =49), and tonsil hypertrophy more than degree Ⅱ ( n =19). Tracheotomy was performed in 3 patients prior to hospitalization, contigency tracheotomy during hospitalization in 10 patients, and oral trachea cannula in other patients. All therapeutic procedures, including single chemical ablation with ethanol injection ( n =94), single lesion resection ( n =9) and both of them ( n =40), were performed under general anesthesia. Treatment remedies included mesh suture, macroglossia reduction and excision of maxillofacial and cervical lesions for patients presenting with extensive malformations extending to maxillofacial and cervical area. Tonsil resection were done in patients having tonsil venous malformations or tonsil hypertrophy more than degree II. Achauer's 4-grade criterion was applied to evaluate the treatment outcomes. SPSS 18.0 software was used to analyze the data. Results: Trachea cannula were not extubated untill 24 to 48 hours after treatment. Emergency tracheotomy was done in 2 cases after extubations because of dyspnea, and successful extubations were obtained in other cases. There were no advents of pulmonary vascular spasm or pulmonary embolism. There was significant difference between before and after operation (snore: χ(2)=105.431, ambiguous pronunciation: χ(2)=59.698, tonsil hypertrophy more than degree Ⅱ: χ(2)=33.530, all P <0.01). The patients were followed-up for 1-4 years, and there were 123 cases at grade Ⅳ (complete disappear of lesions in 62 cases without recurrence), 17 at grade Ⅲ , 3 at grade Ⅱ, and no case at gradeⅠ. Conclusions: Chemical ablation with ethanol injection for venous malformations involving isthmus faucium area is recommended, wheras combined remedies including injection, mesh suture, macroglossia reduction, and excision of cervicofacial lesions are suggested in treatment of extensive lesions extending to maxillofacial and cervical area. Tonsil resection should be done in patients having tonsil venous malformations or tonsil hypertrophy more than degree Ⅱ, which is safe and highly effective, with good reservation of function, in the treatment of maxillofacial and cervical venous malformations involving isthmus faucium area.

Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8 +  T cells expressing TNFα and IFNγ.

PubMed

Kontos, Anna; Willoughby, Scott; van den Heuvel, Cameron; Kennedy, Declan; Martin, James; Hodge, Greg; Worthley, Matthew; Chin, Adelene Kaihui; Nelson, Adam; Teo, Karen; Baumert, Mathias; Pamula, Yvonne; Lushington, Kurt

2018-05-01

Sleep-disordered breathing (SDB) is associated with cardiovascular disease and systemic inflammation in adults but this remains to be explored in children, especially in children with the most common form of SDB, i.e. primary snoring/mild SDB. This pilot study investigated the relationship between the cardiovascular function and inflammation in children with mild SDB. Nineteen participants aged 5-14 years underwent overnight polysomnography, cardiac magnetic resonance imaging (aortic blood flow velocity and left and right ventricular systolic function) and assessment for inflammatory markers (intracellular cytokine analysis of T cells by flow cytometry). Parents also completed the Sleep Disturbances Scale for Children (SDSC). Children with mild SDB exhibited increased ascending aortic peak systolic velocity compared to controls (SDB 119.95 m/s vs. control 101.49 m/s, p < 0.05). No significant group differences were observed for left and right ventricular ejection fraction or mean aortic blood flow velocity from either the ascending aorta or pulmonary artery. Children with mild SDB had increased inflammatory markers as demonstrated by elevated T cell interferon gamma (IFNγ) (SDB 52 ± 4% vs. control 25 ± 3% positive cells, p < 0.005) and tumour necrosis factor alpha (TNFα) (SDB 39 ± 4% vs. control 20 ± 2% positive cells, p < 0.005) expression from CD8 + cells. A strong positive correlation was observed between ascending aorta peak blood flow velocity and both TNFα and IFNγ (TNFα, r = 0.54, p < 0.03; IFNγ, r = 0.63, p < 0.005, respectively). Polysomnography revealed that oxygen saturation (SaO 2 ) nadir was significantly lower in children with mild SDB compared to controls (SDB 92.3 ± 2.7% vs. control 94.4 ± 1.6%, p < 0.05). A lower SaO 2 nadir was associated with an increased ascending aorta peak systolic velocity (r = - 0.48, p < 0.05). As well, both a lower SaO 2 nadir and an increased ascending aorta peak systolic velocity were associated with higher SDSC Sleep-Disordered Breathing and Disorder of Initiating and Maintaining Sleep subscale scores but not the polysomnographic-derived Obstructive Apnea-Hypopnea Index. The finding of elevated ascending aortic peak systolic blood flow velocity and its association with increased inflammatory markers suggests that the profile of cardiovascular changes noted in adult SDB may also occur in children with mild SDB.

[Prevalence of obstructive sleep apnea hypopnea syndrome in professional drivers and the relationship with traffic accidents].

PubMed

Liu, Y; Tu, C L; Yao, W F; Yu, Y F; Wang, Z; Hu, J R

2016-12-27

Objective: To study the prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) and its relationship with traffic accidents in the professional drivers. Methods: Questionnaires of OSAHS were sent to 950 professional drivers who had annual physical examination at the Central Hospital of Jiading District in Shanghai from October 2014 to September 2015. Those with moderate to severe snoring and/or Epworth Sleepiness Scale (ESS)≥9 performed the home sleep testing. All drivers were divided into OSAHS and non-OSAHS according to the survey and monitoring. The following parameters were compared such as driving ages, neck circumference, body mass index (BMI), average night sleep time, ESS, hypertension, diabetes, hypertrophy of tonsil and the incidence of traffic accidents. The risk factors of traffic accidents were analyzed by multivariate Logistic regression. Results: Totally 826 responses were eligible, including 578 (70.0%) with self-reported snoring. There was measurement failure involving 3 of 233 the home sleep testing due to sensor off, 823 subjects were included in the study. The prevalence of OSAHS was 13.5% (111/823). The mild, moderate and severe OSAHS were 47, 38 and 26 cases respectively. There were 712 drives without OSAHS. The neck circumference[(39.8±3.8) vs (39.0±3.0) cm]and BMI[(26.7±4.2) vs (24.4±3.8) kg/m 2 ]were significantly higher in the drivers suffering from OSAHS (all P <0.05). The percentage of ESS≥ 9 (57.7% vs 12.6%), hypertension (27.9% vs 5.9%), diabetes (4.5% vs 1.1%), hypertrophy of tonsil (7.2% vs 2.3%) were higher in the drivers with OSAHS (all P <0.05). There were no significant difference in driving ages and average night sleep time between two groups (all P >0.05). The overall incidence of traffic accidents was 5.8% (48/823) in a year. The percentage was respectively 17.1% (19/111) in OSAHS and 4.1% (29/712) in non-OSAHS ( P <0.001). Multiple logistic regression analysis showed that sleepiness ( OR =30.578, 95% CI: 10.699-87.394; P <0.001), OSAHS ( OR =14.062, 95% CI: 4.791-41.269; P <0.001) and vehicle years ( OR =2.345, 95% CI : 1.183-4.646; P <0.05)were the risk factors, while the average night sleep time ( OR =0.037, 95% CI : 0.014-0.098; P <0.001) was the protective factor. Conclusion: Professional drivers have higher prevalence of OSAHS, which contributes to the increased risk of traffic accidents.

Effects of Adenotonsillectomy on Neurocognitive Function in Pediatric Obstructive Sleep Apnea Syndrome

PubMed Central

Horiuchi, Fumie; Oka, Yasunori; Komori, Kenjiro; Tokui, Yasumasa; Matsumoto, Teruhisa; Ueno, Shu-ichi

2014-01-01

Obstructive sleep apnea syndrome (OSAS) in children does not only present with symptoms of sleep disturbances but also with associated symptoms such as growth failure, enuresis, academic learning difficulties, and behavioral problems, including attention deficit/hyperactivity disorder- (ADHD-) like symptoms. We evaluated neurocognitive functions before and after adenotonsillectomy in a patient with OSAS. An 11-year-old boy suspected of having ADHD with nocturnal enuresis was referred for evaluation. He was found to have adenotonsillar hypertrophy. Presence of snoring was evident only after detailed medical interview. Polysomnography confirmed the diagnosis of OSAS, which was subsequently treated by adenotonsillectomy. The apnea/hypopnea index decreased from 21.9 at baseline to 1.8 after surgery, and the frequency of enuresis fell from almost nightly to 2-3 times per month. Neurocognitive and behavioral assessment after the treatment of OSAS showed significant improvement in cognitive functions, especially attention capacity and considerable amelioration of behavioral problems including ADHD-like symptoms. As the most common cause of pediatric OSAS is adenotonsillar hypertrophy, medical interview and oropharyngeal examination should always be performed in children suspected of having ADHD. The necessity of sleep evaluation for children with ADHD-like symptoms was also emphasized. PMID:24971187

A randomized cross over study comparing the efficacy of two mandibular advancement appliances in the treatment of mild-moderate obstructive sleep apnea.

PubMed

Al-Dharrab, Ayman

2017-11-01

To compare efficacy, side effects, patient compliance, and preference between two types of custom-made mandibular advancement appliances (MAAs) in the treatment of patients with mild to moderate obstructive sleep apnea (OSA). This prospective, randomized, crossover study of 12 patients with mild to moderate OSA compared a titratable and a non-titratable MAA. Each patient was fitted with both appliances in a random order with a washout period of two weeks. Efficacy, side effects, compliance, and preference were evaluated by a questionnaire. All patients underwent overnight home sleep recordings prior to and after the use of each appliance in order to objectively assess sleep quality in terms of the apnea and hypopnea index (AHI), snoring frequency and oxygen desaturation index. Treatment successes (relief of symptoms and/or reduction of AHI to <10/h) were reported with both types of appliances. No compliance failure was reported, and in most patients, the side effects were mild, and improved with time. Both types of oral appliances were effective treatments for patients with mild to moderate OSA, with fewer side effects and higher patient satisfaction.

That is Cool: the Nature Of Aesthetics in Fluid Physics

NASA Astrophysics Data System (ADS)

Hertzberg, Jean

2013-11-01

Aesthetics has historically been defined as the study of beauty and thus as a metric of art. More recently, psychologists are using the term to describe a spectrum of responses from ``I hate it'' to ``I love it.'' In the context of fluid physics, what is beautiful? What elicits a ``Wow! Awesome! Cool!'' response versus a snore? Can we use aesthetics to deepen or change students' or the public's perceptions of physics and/or the world around them? For example, students seem to appreciate the aesthetics of destruction: environmental fluid dynamics such as storms, tornadoes, floods and wildfires are often responsible for massive destruction, yet humans draw pleasure from watching such physics and the attendant destruction from a safe distance. Can this voyeurism be turned to our advantage in communicating science? Observations of student and Facebook Flow Visualization group choices for fluid physics that draw a positive aesthetic response are sorted into empirical categories; the aesthetics of beauty, power, destruction, and oddness. Each aesthetic will be illustrated with examples drawn from flow visualizations from both the Flow Visualization course (MCEN 4151) taught at the University of Colorado, Boulder, and sources on the web. This work is supported by NSF: EEC 1240294.

Novel Positional Devices for the Treatment of Positional Obstructive Sleep Apnea, and How This Relates to Sleep Surgery.

PubMed

Ravesloot, Madeline J L; Benoist, Linda; van Maanen, Peter; de Vries, Nico

2017-01-01

If untreated, obstructive sleep apnea (OSA) develops as a gradual progressive disease. In the early stage of the disease most patients with OSA are positional. The archetypical patient might progress from simple positional snoring via positional early-stage mild disease to less positional moderate and finally nonpositional severe OSA. At first, the apnea-hypopnea index (AHI) is high only in the supine position, and later is high in all sleeping positions. The phenomenon is reversible. After partial effective treatment, patients with severe OSA can reverse to less severe positional OSA or, in other words, the AHI drops more in the lateral position than in supine position. This has been shown for palatal surgery, multilevel surgery, bimaxillary osteotomies, and bariatric surgery. The absence or presence of positional dependency has a great influence on sleep surgery. First, the results of sleep surgery might be worse in positional patients. Second, the addition of positional therapy to sleep surgery might improve the overall outcome and, as such, enhance the indication of sleep surgery as an alternative to continuous positive airway pressure and mandibular advancement device treatment. © 2017 S. Karger AG, Basel.

[Is a sedentary lifestyle a risk factor for sleep-related respiratory disturbance?].

PubMed

Teculescu, D; Chenuel, B; Benamghar, L; Michaely, J-P; Hannhart, B

2010-09-01

This questionnaire-based epidemiological study was aimed at identifying possible sleep disturbance in a sample of active French males. Eight hundred and fifty male subjects, aged 22 to 66 years, completed a structured sleep questionnaire supplemented by information about their life habits and medical history. The study compared the prevalence of positive responses between an "at risk" group of sedentary people (with no declared leisure exercise) and a control group of "exercising" subjects (with more than 5 hours of planned exercise weekly). Among the symptoms suggesting sleep-disordered breathing, only the question "Have you ever been told that you snore?" significantly separated the two groups. In addition, the sedentary group declared a history of treated hypertension significantly more often. The present survey identified only one item that differed significantly between a sedentary of men and an exercising group - a history of treated hypertension. The result may be explained by the limitations of a questionnaire survey and by the limited contrast in exercise practice: the "sedentary" subjects had an occupational labour demand (not quantified), and the control group had a relatively modest leisure physical activity. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Defending sleepwalkers with science and an illustrative case.

PubMed

Cartwright, Rosalind D; Guilleminault, Christian

2013-07-15

To test whether laboratory-based research differentiating sleepwalkers (SW) from controls (C) can be applied in an uncontrolled forensic case as evidence the alleged crime was committed during an arousal from sleep in which the mind is not fully conscious due to a SW disorder. A PSG study recorded 8 months after the defendant was charged was analyzed independently by spectral analysis. Slow wave activity (SWA) and cyclic alternating pattern (CAP) rates were computed. Clinical interviews and police records were reviewed for data re: the defendant's sleep prior to the event and use of drugs, alcohol, and stimulants. The SWA distribution was abnormally low and flat, significantly lower than published controls; in the first NREM cycle, CAP rate 55 was above normal. Two weeks of prior sleep deprivation was confirmed from interviews and defendant's observed daytime sleepiness. Caffeine intake the day before the event was calculated at 826 mg over 14 hours. Snoring and a mild breathing disorder were present in the PSG. Testimony based on spectral analysis of PSG recorded following an alleged criminal event supported a SW explanation for the non-rational behaviors charged. The defendant was acquitted of all charges and has been successfully treated.

Long-term recording and automatic analysis of cough using filtered acoustic signals and movements on static charge sensitive bed.

PubMed

Salmi, T; Sovijärvi, A R; Brander, P; Piirilä, P

1988-11-01

Reliable long-term assessment of cough is necessary in many clinical and scientific settings. A new method for long-term recording and automatic analysis of cough is presented. The method is based on simultaneous recording of two independent signals: high-pass filtered cough sounds and cough-induced fast movements of the body. The acoustic signals are recorded with a dynamic microphone in the acoustic focus of a glass fiber paraboloid mirror. Body movements are recorded with a static charge-sensitive bed located under an ordinary plastic foam mattress. The patient can be studied lying or sitting with no transducers or electrodes attached. A microcomputer is used for sampling of signals, detection of cough, statistical analyses, and on-line printing of results. The method was validated in seven adult patients with a total of 809 spontaneous cough events, using clinical observation as a reference. The sensitivity of the method to detect cough was 99.0 percent, and the positive predictivity was 98.1 percent. The system ignored speaking and snoring. The method provides a convenient means of reliable long-term follow-up of cough in clinical work and research.

Sleep architecture and sleep apnea in patients with Cushing's disease.

PubMed

Shipley, J E; Schteingart, D E; Tandon, R; Starkman, M N

1992-12-01

Patients with Cushing's syndrome (CS) frequently have sleep complaints. We evaluated sleep polysomnographically in 22 patients, including 17 with pituitary-ACTH-dependent Cushing's disease (CD) and five with CS from an adrenal tumor. Data were compared to healthy controls of comparable age. Seven patients (32%) demonstrated at least mild sleep apnea (> or = 9.4 events/hour), and four of 22 (18%) had > or = 17.5 events/hour. The apneic CD and CS patients had a trend for a greater complaint of excessive daytime sleepiness. Both apneic and nonapneic groups had considerable snoring and obesity. The electroencephalographic (EEG) sleep of nonapneic patients was compared to that of normal subjects. Nonapneic CD patients differed strikingly from healthy volunteers in sleep continuity and architecture, demonstrating lighter, fragmented sleep. Rapid eye movement (REM) sleep in CD patients bore many similarities to the sleep of patients with major depression, with REM latency being significantly shortened and REM density significantly increased. Continued examination of EEG sleep in CD patients may shed light on similarities in pathophysiology between CD and major depression, disorders which are characterized by both a dysfunction of the hypothalamic-pituitary-adrenal axis and alterations in mood.

[Case of exploding head syndrome].

PubMed

Okura, Mutsumi; Taniguchi, Mitsutaka; Muraki, Hisae; Sugita, Hideko; Ohi, Motoharu

2010-01-01

Exploding head syndrome (EHS) attacks are characterized by the sensation of sudden loud banging noises, and are occasionally accompanied by the sensation of a flash light. Although these attacks in themselves are usually not painful, it is reported that EHS attacks may precede migraines and may be perceived as auras. A 53-year-old woman, with a 40-year history of fulgurating migraines, experienced 2 different types of EHS attacks. During most of the attacks, which were not painful, she heard sounds like someone yelling or cars passing by. Only 1 episode was accompanied with the sensation of a flash light and of sounds similar to those of an electrical short circuit. On the video-polysomnography, video-polysomnography showed 11 EHS attacks occurred during stage N1 and stage N2; these attacks were preceded by soft snoring. She also had moderate obstructive sleep apnea syndrome (Apnea Hypopnea Index: 16.7) for which an oral appliance was prescribed; the EHS attacks did not recur after this treatment. The pathophysiology of EHS is still unclear. A detailed analysis of PSG data may help in understanding the pathophysiology of this syndrome and also in the selection of therapeutic strategies.

Numerical tool development of fluid-structure interactions for investigation of obstructive sleep apnea

NASA Astrophysics Data System (ADS)

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

2016-11-01

Obstructive sleep apnea (OSA) is a medical condition characterized by repetitive partial or complete occlusion of the airway during sleep. The soft tissues in the upper airway of OSA patients are prone to collapse under the low pressure loads incurred during breathing. The ultimate goal of this research is the development of a versatile numerical tool for simulation of air-tissue interactions in the patient specific upper airway geometry. This tool is expected to capture several phenomena, including flow-induced vibration (snoring) and large deformations during airway collapse of the complex airway geometry in respiratory flow conditions. Here, we present our ongoing progress toward this goal. To avoid mesh regeneration, for flow model, a sharp-interface embedded boundary method is used on Cartesian grids for resolving the fluid-structure interface, while for the structural model, a cut-cell finite element method is used. Also, to properly resolve large displacements, non-linear elasticity model is used. The fluid and structure solvers are connected with the strongly coupled iterative algorithm. The parallel computation is achieved with the numerical library PETSc. Some two- and three- dimensional preliminary results are shown to demonstrate the ability of this tool.

P4 medicine approach to obstructive sleep apnoea.

PubMed

Lim, Diane C; Sutherland, Kate; Cistulli, Peter A; Pack, Allan I

2017-07-01

P4 medicine is an evolving approach to personalized medicine. The four Ps offer a means to: Predict who will develop disease and co-morbidities; Prevent rather than react to disease; Personalize diagnosis and treatment; have patients Participate in their own care. P4 medicine is very applicable to obstructive sleep apnoea (OSA) because each OSA patient has a different pathway to disease and its consequences. OSA has both structural and physiological mechanisms with different clinical subgroups, different molecular profiles and different consequences. This may explain why there are different responses to alternative therapies, such as intraoral devices and hypoglossal nerve stimulation therapy. Currently, technology facilitates patients to participate in their own care from screening for OSA (snoring and apnoea apps) to monitoring response to therapy (sleep monitoring, blood pressure, oxygen saturation and heart rate) as well as monitoring their own continuous positive airway pressure (CPAP) compliance. We present a conceptual framework that provides the basis for a new, P4 medicine approach to OSA and should be considered more in depth: predict and prevent those at high risk for OSA and consequences, personalize the diagnosis and treatment of OSA and build in patient participation to manage OSA. © 2017 Asian Pacific Society of Respirology.

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.

Role of Cholestyramine in Refractory Hyperthyroidism: A Case Report and Literature Review.

PubMed

Alswat, Khaled A

2015-07-24

Hyperthyroidism is a common disease that usually responds to the conventional therapy of anti-thyroidal medications (methimazole or PTU) and beta-blocker. Refractory hyperthyroidism is a rare condition in which hyperthyroidism fails to respond to the above therapy. Cholestyramine has been shown to decrease thyroid hormone level when added to the ongoing anti-thyroidal medications. A 52-year-old woman with past medical history of enlarging goiter presented with obstructive symptoms of worsening shortness of breath and snoring. Admission thyroid function test showed mild hyperthyroidism (suppressed TSH, slightly high FT4, and high normal FT3) that worsened after she received a CT scan with contrast and failed to respond to a 3-week course of high-dose dexamethasone, high-dose carbimazole, and up-titrated propranolol. Five days after cholestyramine was added, her FT4 decreased by 30% and normalized after 12 days. The patient underwent total thyroidectomy as definitive treatment for the hyperthyroidism and for the obstructive symptoms. Cholestyramine is an effective additional treatment for hyperthyroidism and may be an effective treatment for refractory iodine-induced hyperthyroidism. The possibility of self-remission (natural course) is less likely given the dramatic and rapid response to cholestyramine.

[Research of the Epworth sleepiness scale based on ruzzy comprehensive evaluation].

PubMed

Li, P; Lv, Y H; Ma, L; Yang, S H; Xiang, Y; Lei, Q; Du, G D; Huang, D J

2017-03-05

Objective: This research explores the effect of Epworth sleepiness scale (ESS) items on domestic patients. Method: Four thousand six hundred and thirty-three suspected OSAHS patients with snoring were selected from respiratory sleep center in the first people's hospital, Yunnan province, between January 2006 and December 2012. These patients filled in the ESS before PSG test. Firstly, these questionnaires were preprocessed, and the null and incorrect ones were deleted. Then, the fuzzy comprehensive evaluation was applied for the value of each item in ESS. Finally, the reliability was compared between before and after the removal of the lowest values. Result: Fuzzy comprehensive evaluation results show that the total value is 1.016, the item value of Sitting and talking to someone and In a car, while stopped for a few minutes in traffic is the lowest, which is 0.131. The result of reliability analysis shows that the value increases 0.2% after the two items being deleted. Conclusion: Some items of ESS are not suitable for Chinese patients, and they need to be deleted or modified to improve the screening efficiency. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

How, what, and why of sleep apnea. Perspectives for primary care physicians.

PubMed

Chung, Sharon A; Jairam, Shani; Hussain, Mohamed R G; Shapiro, Colin M

2002-06-01

To review the need for primary care physicians to screen for patients with obstructive sleep apnea (OSA). Literature was reviewed via MEDLINE from 1993 to 2000, inclusive, using the search term "sleep apnea" combined with "epidemiology," "outcome," and "diagnosis and treatment." Citations in this review favour more recent, well controlled and randomized studies, but findings of pilot studies are included where other research is unavailable. Obstructive sleep apnea is a disorder with serious medical, socioeconomic, and psychological morbidity, yet most patients with OSA remain undetected. Primary care physicians have a vital role in screening for these patients because diagnosis can be made only through overnight (polysomnographic) studies at sleep clinics. Physicians should consider symptoms of excessive or loud snoring, complaints of daytime sleepiness or fatigue, complaints of unrefreshing sleep, and an excess of weight or body fat distribution in the neck or upper chest area as possible indications of untreated OSA. Current research findings indicate that treating OSA patients substantially lowers morbidity and mortality rates and reduces health care costs. Primary care physicians need more information about screening for patients with OSA to ensure proper diagnosis and treatment of those with the condition.

Obstructive Sleep Apnea Syndrome: From Phenotype to Genetic Basis

PubMed Central

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

2009-01-01

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

[Comparison of polysomnographic characteristics in preschool and school aged children with obstructive sleep apnea hypopnea syndrome].

PubMed

Sun, Yuanfeng; Lei, Fei; Du, Lina; Tang, Xiangdong; Yang, Linghui

2016-03-01

To compare the characteristics of polysomnography in preschool and school aged children with obstructive sleep apnea hypopnea syndrome (OSAHS). The clinical data were collected from October 2009 to October 2013 among children monitored in Sleep Medical Center of West China Hospital. Among them, 189 preschool aged (aged 3-5 years) and 211 school aged (aged 6-13 years) children with sleep breathing disorder, and 33 children complained with sleep talking as controls were enrolled and underwent polysomnography. According to apnea hyponea index (AHI), they were classified as primary snoring (AHI<1/h), mild OSAHS (1/h≤AHI<5/h), and moderate/severe OSAHS (AHI≥5/h) and then their sleep architecture was compared among groups. No significant difference was found in sleep latency, total sleep time, sleep efficiency, the percentage of rapid eye movement stage and N2 stage among groups (P>0.05). In preschool aged children, the percentage of N1 stage in the moderate/severe group was more than other three groups (moderate/severe group vs control group, primary snoring group, mild group: 24.7%±13.7% vs 17.0%±8.7%, 21.7%±12.4%, 20.9%±11.6%, all P<0.05). In school aged children, the percentage of N1 stage in the moderate/severe group was more than the control group (moderate/severe group vs control group: 18.0%±10.4% vs 12.0%±4.8%, P<0.05), the percentage of N3 stage in the moderate/severe group and the mild group were less than the control group (moderate/severe group, mild group vs control group: 28.3%±9.6%, 28.8%±8.8% vs 33.9%±13.0%, both P<0.05). In addition, in preschool and school aged children group, the arouse index in the moderate/severe group was higher than other three groups, the mean oxygen saturation and the lowest oxygen saturation in the moderate/severe group were lower than those of the other three groups, the differences were statistically significant (all P<0.05). Correlation analysis suggested that no significant correlation was found between AHI and body mass index (BMI) in preschool children (r=-0.02, P>0.05). However, there was significance in school aged children (r=0.26, P<0.01). In addition, the correlations were significant between AHI and arousal index in preschool and school aged (r=0.42, 0.55, both P<0.01). The sleep architecture is milder affected by OSAHS in preschool children than in school aged children. The severity is mainly related to enlarged tonsils and adenoids. School aged children with OSAHS may be more susceptible to sleep structure disorder and the severity is mainly related to BMI.

Rapid eye movement sleep behaviour disorder symptomatic of a brain stem cavernoma.

PubMed

Felix, Sandra; Thobois, Stephane; Peter-Derex, Laure

2016-04-01

A 75-year-old man complained of excessive daytime sleepiness (EDS), difficulty falling asleep and nocturnal agitation during sleep. Restless legs syndrome (RLS) was diagnosed and treated. Because of persistent EDS, snoring and nycturia, a nocturnal polysomnography (PSG) was performed. PSG showed high sleep fragmentation related to a moderate to severe obstructive sleep apnea syndrome. Continuous positive airway pressure treatment (CPAP) was proposed. Because of the persistence of abnormal nocturnal behaviours, characterized by screaming, punching and falling out of bed, a video-PSG with CPAP treatment was performed. The recording showed typical chin electromyography (EMG) activity increase associated with violent movements during rapid eye movement (REM) sleep, suggesting REM sleep behaviour disorders (RBD). Clinical neurological examination found no parkinsonian syndrome, no dysautonomic sign and no neurological focal sign. Dopamine transporter imaging [123I-FP-CIT single photon emission computed tomography (SPECT)] did not find any presynaptic dopaminergic pathways degeneration. Brain magnetic resonance imaging showed a vascular lesion suggestive of cavernoma located in the pons. The present case illustrates the complexity of sleep disturbance diagnosis with a possible entanglement of aetiologies responsible for nocturnal agitation, and confirms that an isolated pons cavernoma should be considered among the rare causes of RBD. © 2016 European Sleep Research Society.

Use of a new generation of adaptive servo ventilation for sleep-disordered breathing in patients with multiple system atrophy.

PubMed

Hamada, Satoshi; Takahashi, Ryosuke; Mishima, Michiaki; Chin, Kazuo

2015-11-06

A 70-year-old man (case 1) and a 64-year-old woman (case 2) with multiple system atrophy (MSA) and snoring were admitted for polysomnography. Their awake PaCO2 indicated normocapnia. Apnoea-hypopnoea index (AHI), max transcutaneous carbon dioxide partial pressure (PtcCO2) and ΔPtcCO2 (max PtcCO2 (during sleep)-baseline PtcCO2 (while awake)) were 11.4/h, 63 mm Hg and 18 mm Hg, respectively, in case 1 and 53.1/h, 59 mm Hg and 13 mm Hg, respectively, in case 2. Their sleep-disordered breathing (SDB) was diagnosed as obstructive sleep apnoea with hypoventilation. We thought that variable expiratory positive airway pressure and pressure support ventilation (advanced-adaptive servo ventilation (ASV)) might be favourable for their SDB. Polysomnography after introducing advanced-ASV revealed that AHI, max PtcCO2 and ΔPtcCO2 were 0.2/h, 53 mm Hg and 5 mm Hg, respectively, in case 1 and 1.5/h, 56 mm Hg and 9 mm Hg, respectively, in case 2. Advanced-ASV for treating Cheyne-Stokes breathing may be helpful in SDB in patients with MSA. 2015 BMJ Publishing Group Ltd.

Respiratory difficulties and breathing disorders in achondroplasia.

PubMed

Afsharpaiman, S; Saburi, A; Waters, Karen A

2013-12-01

Respiratory difficulties and breathing disorders in achondroplasia are thought to underlie the increased risk for sudden infant death and neuropsychological deficits seen in this condition. This review evaluates literature regarding respiratory dysfunctions and their sequelae in patients with achondroplasia. The limited number of prospective studies of respiratory disease in achondroplasia means that observational studies and case series provide a large proportion of the data regarding the spectrum of respiratory diseases in achondroplasia and their treatments. Amongst clinical respiratory problems described, snoring is the commonest observed abnormality, but the reported incidence of obstructive sleep apnoea (OSA) shows wide variance (10% to 75%). Reported treatments of OSA include adenotonsillectomy, the use of CPAP, and surgical improvement of the airway, including mid-face advancement. Otolaryngologic manifestations are also common. Respiratory failure due to small thoracic volumes is reported, but uncommon. Mortality rate at all ages was 2.27 (CI: 1.7-3.0) with age-specific mortality increased at all ages. Sudden death was most common in infants and children. Cardiovascular events are the main cause of mortality in adults. Despite earlier recognition and treatment of respiratory complications of achondroplasia, increased mortality rates and other complications remain high. Future and ongoing evaluation of the prevalence and impact of respiratory disorders, particularly OSA, in achondroplasia is recommended. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

[New use of pulse-oximeter as a prophylactic Stimulator to the wearer and a lifesaving tools for prevention of hypoxic mishaps].

PubMed

Morioka, Tohru; Terasaki, Hidenori

2014-03-01

Pulse-oximeter has been widely used for the clinical assessment of physical status of a patient and as an alarming tool of hypoxia to medical personnel at the bedside or in the observation center. However, it has never been used for direct stimulation of the wearer. We considered innovation of pulse-oximeter as a prophylactic alarm-oximeter for the wearer. If SPO2 goes down to unfavorable level, the alarm-oximeter starts to send signal through a control box to a stimulator, such as an electrical nerve stimulator, a cold thermal tip, or mechanical device like a vibrator or compressor. The dermal stimulator is usually fixed to the right or left wrist with a Velcro band. The control box is affixed to the wristband by using Velcro. The alarm may be sent to an earphone or speaker with a verbal command like "take a deep breath". Alarm-oximeter will be combined to an oxygen inhaler or mechanical ventilatory assist device, or a drug administration system through electric line or wireless transmitter to start or change its function before the arrival of medical personnel. It will prevent hypoxic mishaps during medical intervention or sleep apnea syndrome. It will be also applicable to stop snoring.

REM sleep behavior disorder and other sleep disturbances in Disney animated films.

PubMed

Iranzo, Alex; Schenck, Carlos H; Fonte, Jorge

2007-08-01

During a viewing of Disney's animated film Cinderella (1950), one author (AI) noticed a dog having nightmares with dream-enactment that strongly resembled RBD. This prompted a study in which all Disney classic full-length animated films and shorts were analyzed for other examples of RBD. Three additional dogs were found with presumed RBD in the classic films Lady and the Tramp (1955) and The Fox and the Hound (1981), and in the short Pluto's Judgment Day (1935). These dogs were elderly males who would pant, whine, snuffle, howl, laugh, paddle, kick, and propel themselves while dreaming that they were chasing someone or running away. In Lady and the Tramp the dog was also losing both his sense of smell and his memory, two associated features of human RBD. These four films were released before RBD was first formally described in humans and dogs. In addition, systematic viewing of the Disney films identified a broad range of sleep disorders, including nightmares, sleepwalking, sleep related seizures, disruptive snoring, excessive daytime sleepiness, insomnia and circadian rhythm sleep disorder. These sleep disorders were inserted as comic elements. The inclusion of a broad range of accurately depicted sleep disorders in these films indicates that the Disney screenwriters were astute observers of sleep and its disorders.

Sleep duration, daytime napping, markers of obstructive sleep apnea and stroke in a population of southern China

PubMed Central

Wen, Ye; Pi, Fu-Hua; Guo, Pi; Dong, Wen-Ya; Xie, Yu-Qing; Wang, Xiang-Yu; Xia, Fang-Fang; Pang, Shao-Jie; Wu, Yan-Chun; Wang, Yuan-Yuan; Zhang, Qing-Ying

2016-01-01

Sleep habits are associated with stroke in western populations, but this relation has been rarely investigated in China. Moreover, the differences among stroke subtypes remain unclear. This study aimed to explore the associations of total stroke, including ischemic and hemorrhagic type, with sleep habits of a population in southern China. We performed a case-control study in patients admitted to the hospital with first stroke and community control subjects. A total of 333 patients (n = 223, 67.0%, with ischemic stroke; n = 110, 23.0%, with hemorrhagic stroke) and 547 controls were enrolled in the study. Participants completed a structured questionnaire to identify sleep habits and other stroke risk factors. Least absolute shrinkage and selection operator (Lasso) and multiple logistic regression were performed to identify risk factors of disease. Incidence of stroke, and its subtypes, was significantly associated with snorting/gasping, snoring, sleep duration, and daytime napping. Snorting/gasping was identified as an important risk factor in the Lasso logistic regression model (Lasso’ β = 0.84), and the result was proven to be robust. This study showed the association between stroke and sleep habits in the southern Chinese population and might help in better detecting important sleep-related factors for stroke risk. PMID:27698374

Is the grading system of the severity of the OSAHS used presently rational or not?: from the view of incidence of hypertension in different severity groups.

PubMed

Li, Jinrang; Chen, Xi; Sun, Jianjun

2014-09-01

The grading system of the severity of obstructive sleep apnea hypopnea syndrome (OSAHS) used presently showed that the severe OSAHS had an extensive range of apnea hypopnea index (AHI) (≥ 30, even over 100). So this grading system is not rational. From Jan 1999 to June 2011, there were 2,618 patients complaining of snoring took the polysomnography. The patients were divided into 11 groups according to their AHI. Frequencies of OSAHS with hypertension in each group were tested using crosstabs. The incidence of hypertension was increased as the increasing of AHI. Crosstab analysis showed that there were four cutoff points of AHI (5, 30, 50, 100). There was a significant difference in the incidence of hypertension between the groups of AHI more than the cutoff point and AHI less than the cutoff point. So from the view of hypertension in each group, we recommend that the AHI <5 should be considered as normal or simple snorer, AHI = 5-30 as mild degree of OSAHS, AHI = 30-50 as moderate degree of OSAHS, AHI = 50-100 as severe degree of OSAHS, and AHI ≥ 100 as profound degree of OSAHS.

The Epidemiology of Sleep Disordered Breathing and Hypertension in Various Populations.

PubMed

Sawatari, Hiroyuki; Chishaki, Akiko; Ando, Shin-ich

2016-01-01

Hypertension is prevalent in patients with sleep disordered breathing (SDB). Since hypertension significantly relates to cardiovascular diseases, the treatment and prevention of SDB could be targets for the prevention of cardiovascular diseases. In this article, we summarize about epidemiology of SDB and hypertension in various populations. General population based studies on the prevalence of SDB reported that 24 to 47% male and 9 to 30% female had SDB. Furthermore, the prevalence of hypertension in individuals with SDB was high, ranging from 36 to 57%. American and Korean based studies reported that the severity of SDB related to increase of blood pressure and hypertension. In the elderly, however, the severity of SDB did not relate to increase in blood pressure and hypertension, but to dipping pattern of blood pressure. With respect to children, the severity of SDB also related to increase in blood pressure, but the trend was inconstant in children with habitual snoring. In addition to the sexual differences, the severity of SDB related to hypertension in males. On the other hand, there was no relationship between the severity of SDB and hypertension in females. SDB was prevalent in the general population, regardless of race, and affected blood pressure. We should pay attention to the subjects' individual character when we interrupt the outcome.

Reactive oxygen metabolites (ROMs) as an index of oxidative stress in obstructive sleep apnea patients.

PubMed

Christou, Kostas; Markoulis, Nikolaos; Moulas, Anargyros N; Pastaka, Chaido; Gourgoulianis, Kostantinos I

2003-09-01

Obstructive sleep apnea syndrome (OSA) is accompanied by oxygen desaturation and arousal from sleep. Free oxygen radicals are highly reactive molecules which could be produced by the OSA phenomenon of hypoxia/reoxygenation: cyclical alterations of arterial oxygen saturation with oxygen desaturation developing in response to apneas followed by resumption of oxygen saturation during hyperventilation. On the basis of these considerations, it was hypothesized that OSA may be linked to increased oxidative stress. Twenty-six participants gave an interview during which a physician asked them about their age, smoking habits, and symptoms such as excessive daytime sleepiness and snoring. Physical examination and polysomnography were performed during their hospitalization. Reactive oxygen metabolites (ROMs) were measured in blood samples by the diacron reactive oxygen metabolites (D-ROM) test. Twenty-one out of 26 subjects had an apnea/hypopnea index greater than 5 (OSA group). The measurement of free radicals was high in OSA patients. Furthermore, ROMs values in OSA patients were linearly correlated with the apnea/hypopnea index (R = 0.426; p = 0.042). The predictive value of a positive D-ROM test is 81%. ROMs were elevated in patients with OSA. When OSA was severe, similarly the value of ROMs in blood samples was enhanced, and the probable underlying mechanism for these events is the hypoxia/reoxygenation phenomenon.

Upper Airway Elasticity Estimation in Pediatric Down Syndrome Sleep Apnea Patients Using Collapsible Tube Theory.

PubMed

Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith; Fleck, Robert J; Shott, Sally R; Amin, Raouf S; Gutmark, Ephraim J

2016-05-01

Elasticity of the soft tissues surrounding the upper airway lumen is one of the important factors contributing to upper airway disorders such as snoring and obstructive sleep apnea. The objective of this study is to calculate patient specific elasticity of the pharynx from magnetic resonance (MR) images using a 'tube law', i.e., the relationship between airway cross-sectional area and transmural pressure difference. MR imaging was performed under anesthesia in children with Down syndrome (DS) and obstructive sleep apnea (OSA). An airway segmentation algorithm was employed to evaluate changes in airway cross-sectional area dilated by continuous positive airway pressure (CPAP). A pressure-area relation was used to make localized estimates of airway wall stiffness for each patient. Optimized values of patient specific Young's modulus for tissue in the velopharynx and oropharynx, were estimated from finite element simulations of airway collapse. Patient specific deformation of the airway wall under CPAP was found to exhibit either a non-linear 'hardening' or 'softening' behavior. The localized airway and tissue elasticity were found to increase with increasing severity of OSA. Elasticity based patient phenotyping can potentially assist clinicians in decision making on CPAP and airway or tissue elasticity can supplement well-known clinical measures of OSA severity.

[Arousal of respiratory origin and upper airway resistance syndrome: pathophysiological and diagnostic aspects].

PubMed

Puertas, F J; Ondzé, B; Carlander, B; Billiard, M

The description of Upper Airway Resistance Syndrome (UARS) let us to recognize the importance of the pair 'respiratory effort-arousal' on sleep-disordered breathing pathophysiology. First part of this paper reviews knowledge about respiratory arousal pathophysiology. Arousal response is normally needed to end obstructive respiratory episodes, but it is also the cause of sleep fragmentation. Among respiratory stimuli able to provoke arousal (respiratory effort, hypoxemia and hypercapnia), respiratory effort is the most constant. Neurophysiological mechanisms involved in arousal, sleep and vegetative consequences, and the possible role of non visible arousals, are also discussed. In UARS, because of the absence of apnea/hypopnea and significative O2 desaturations, arousals are induced by the increased respiratory effort. Diagnosis needs the simultaneous recording of polysomnography and esophageal pressure. Some symptoms and signs of UARS are similar to those of Obstructive Sleep Apnea Syndrome. However, UARS shows any differences: a lower Body Mass Index, less constant snoring, males and females are similarly affected or higher frequency of craniofacial abnormalities. Diagnostic difficulties may be due to confusion between hypopneas and episodes of increased resistance of upper airway, or to the lack of definitive diagnostic criteria. Finally, differential diagnosis needs a broad knowledge of disorders of excessive daytime sleepiness.

Adenotonsillar hypertrophy as a risk factor of dentofacial abnormality in Korean children.

PubMed

Kim, Dong-Kyu; Rhee, Chae Seo; Yun, Pil-Young; Kim, Jeong-Whun

2015-11-01

No studies for the role of adenotonsillar hypertrophy in development of dentofacial abnormalities have been performed in Asian pediatric population. Thus, we aimed to investigate the relationship between adenotonsillar hypertrophy and dentofacial abnormalities in Korean children. The present study included consecutive children who visited a pediatric clinic for sleep-disordered breathing due to habitual mouth breathing, snoring or sleep apnea. Their palatine tonsils and adenoids were graded by oropharyngeal endoscopy and lateral cephalometry. Anterior open bite, posterior crossbite, and Angle's class malocclusions were evaluated for dentofacial abnormality. The receiver-operating characteristic curve analysis was used to identify age cutoffs to predict dentofacial abnormality. A total of 1,083 children were included. The presence of adenotonsillar hypertrophy was significantly correlated with the prevalence of dentofacial abnormality [adjusted odds ratio = 4.587, 95% CI (2.747-7.658)] after adjusting age, sex, body mass index, allergy, and Korean version of obstructive sleep apnea-18 score. The cutoff age associated with dentofacial abnormality was 5.5 years (sensitivity = 75.5%, specificity = 67%) in the children with adenotonsillar hypertrophy and 6.5 years (sensitivity = 70.6%, specificity = 57%) in those without adenotonsillar hypertrophy. In conclusion, adenotonsillar hypertrophy may be a risk factor for dentofacial abnormalities in Korean children and early surgical intervention could be considered with regards to dentofacial abnormality.

Sleep apnoea is a common occurrence in females.

PubMed

Franklin, Karl A; Sahlin, Carin; Stenlund, Hans; Lindberg, Eva

2013-03-01

Obstructive sleep apnoea (OSA) is primarily regarded as a male disorder, presenting with snoring, daytime sleepiness and cardiovascular disease. We aimed to determine the frequency of sleep apnoea among females in the general population. We investigated 400 females from a population-based random sample of 10,000 females aged 20-70 yrs. They answered a questionnaire and performed overnight polysomnography. OSA (apnoea/hypopnoea index (AHI) ≥5) was found in 50% (95% CI 45-55%) of females aged 20-70 yrs. Sleep apnoea was related to age, obesity and hypertension, but not to daytime sleepiness. Severe sleep apnoea (AHI ≥30) was present in 14% (95% CI 8.1-21%) of females aged 55-70 yrs and in 31% (95% CI 12-50%) of obese females with a body mass index of ≥30 kg·m(-2) aged 55-70 yrs. Sleep apnoea with daytime sleepiness and sleep apnoea with hypertension were observed as two different phenotypes of OSA. OSA occurs in 50% of females aged 20-70 yrs. 20% of females have moderate and 6% severe sleep apnoea. Sleep apnoea in females is related to age, obesity and hypertension, but not to daytime sleepiness. When searching for sleep apnoea in females, females with hypertension or obesity should be investigated.

Sleep In Older Adults: Normative Changes, Sleep Disorders, and Treatment Options

PubMed Central

Gooneratne, Nalaka S.; Vitiello, Michael V.

2014-01-01

1 Synopsis Sleep disorders are common in older adults: Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. When considering insomnia symptoms, it is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter distinguished by the presence of significant daytime symptoms such as fatigue. Evaluation with a sleep diary and screening for comorbid conditions, especially mood disorders, is essential. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective and have sustained benefit. A broad range of pharmacologic therapies are also available but can have unwanted psychomotor effects. If left untreated, insomnia can be associated with increased risk of depression and significant impairments in quality of life. In regards to sleep apnea, a high index of suspicion is crucial for effective diagnosis because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients. Diagnosis and management is fairly similar across age groups, except that a more nuanced approach to weight loss is warranted in older adults. The increasing use of home-based portable polysomnography and auto-titrating positive-airway pressure therapy can reduce barriers to treatment. PMID:25037297

A Quality Improvement Project: Using the STOP-BANG Tool in a Military Population to Improve Equity in Preoperative Screening.

PubMed

Dixon, Samuel E; Haas, Shelia A; Klopp, Audrey; Carlson, Judy

2016-10-01

The lack of a preoperative screening tool to detect obstructive sleep apnea (OSA) may lead to an increase in postoperative complications. The aim of the study was to implement a prescreening tool to identify diagnosed or undiagnosed OSA before a surgical procedure. The study was conducted in the surgical admission center and postanesthesia care unit at a military treatment facility in Hawaii. Participants of the study included military personnel, military family members, veterans, and veteran beneficiaries. The STOP-BANG (snore/tired/obstruction/pressure-body mass index/age/neck/gender) tool was used between April and June 2013 to identify and stratify 1,625 patients into low-risk, intermediate-risk, high-risk, and known OSA categories. The STOP-BANG tool confirmed the diagnosed OSA rate to be 13.48%, and increased at-risk OSA detection by 24.69%. Hawaiians/Pacific Islanders were more frequently found to be at risk with known OSA, likely to have complications, and be transferred to PACU 23-hour extended stay compared to other races and intermediate-risk and high-risk categories. The STOP-BANG tool identified and stratified surgical patients at risk for OSA and standardized OSA assessments. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Sleep Disordered Breathing and White Matter Hyperintensities in Community-Dwelling Elders.

PubMed

Rostanski, Sara K; Zimmerman, Molly E; Schupf, Nicole; Manly, Jennifer J; Westwood, Andrew J; Brickman, Adam M; Gu, Yian

2016-04-01

To examine the association between markers of sleep-disordered breathing (SDB) and white matter hyperintensity (WMH) volume in an elderly, multiethnic, community-dwelling cohort. This is a cross-sectional analysis from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based epidemiological study of older adults. Structural magnetic resonance imaging was obtained starting in 2004; the Medical Outcomes Study-Sleep Scale (MOS-SS) was administered to participants starting in 2007. Linear regression models were used to assess the relationship between the two MOS-SS questions that measure respiratory dysfunction during sleep and quantified WMH volume among WHICAP participants with brain imaging. A total of 483 older adults had both structural magnetic resonance imaging and sleep assessment. Self-reported SDB was associated with WMH. After adjusting for demographic and vascular risk factors, WMH volumes were larger in individuals with frequent snoring (β = 2.113, P = 0.004) and among those who reported waking short of breath or with headache (β = 1.862, P = 0.048). In community-dwelling older adults, self-reported measures of SDB are associated with larger WMH volumes. The cognitive effects of SDB that are increasingly being recognized may be mediated at the small vessel level. © 2016 Associated Professional Sleep Societies, LLC.

[Acute confusional syndrome associated with obstructive sleep apnea aggravated by acidosis secondary to oral acetazolamide treatment].

PubMed

Miguel, E; Güell, R; Antón, A; Montiel, J A; Mayos, M

2004-06-01

Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn. During the admission examination infectious, toxic, and neurologic causes, or those related to metabolic or heart disease were ruled out. Arterial blood gases measured during one of the nighttime episodes of acute confusional syndrome showed mild hypoxia and hypercapnia with mixed acidosis. Signs and symptoms suggestive of OSAS had been developing over the months prior to admission, with snoring, sleep apnea, and moderate daytime drowsiness. Polysomnography demonstrated severe OSAS with an apnea-hypopnea index of 38. Mean arterial oxygen saturation was 83%; time oxygen saturation remained below 90% was 44%. The attending physician ordered the withdrawal of oral acetazolamide, which was considered the cause of the metabolic component of acidosis. Treatment with continuous positive airway pressure was initiated at 9 cm H2O, after a titration polysomnographic study. The patient continued to improve.OSAS, for which very effective treatment is available, should be included among diseases that may trigger acute confusional syndrome.

Concurrent respiratory resistance training and changes in respiratory muscle strength and sleep in an individual with spinal cord injury: case report

PubMed Central

Russian, Chris; Litchke, Lyn; Hudson, John

2011-01-01

Context Quality sleep possesses numerous benefits to normal nighttime and daytime functioning. High-level spinal cord injury (SCI) often impacts the respiratory muscles that can lead to poor respiratory function during sleep and negatively affect sleep quality. The impact of respiratory muscle training (RMT) on sleep quality, as assessed by overnight polysomnography (PSG), is yet to be determined among the spinal cord-injured population. This case report describes the effects of 10 weeks of RMT on the sleep quality of a 38-year-old male with cervical SCI. Methods Case report. Findings/results The subject completed overnight PSG, respiratory muscle strength assessment, and subjective sleepiness assessment before and after 10 weeks of RMT. The post-test results indicated improvements in sleep quality (e.g. fewer electroencephalographic (EEG) arousals during sleep) and daytime sleepiness scores following RMT. Conclusion/clinical relevance Respiratory activity has been proven to impact EEG arousal activity during sleep. Arousals during sleep lead to a fragmented sleeping pattern and affect sleep quality and daytime function. Our subject presented with a typical sleep complaint of snoring and excessive sleepiness. The subject's pre-test PSG demonstrated a large number of arousals during sleep. It is important for all individuals complaining of problems during sleep or daytime problems associated with sleep (i.e. excessive daytime sleepiness) to seek medical attention and proper evaluation. PMID:21675365

Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome.

PubMed

Kim, Kyung Soo; Kim, Jun Hee; Park, Sung Yoon; Won, Ho-Ryun; Lee, Hyun-Jin; Yang, Hoon Shik; Kim, Hyun Jik

2012-08-15

Smoking is a known risk factor for snoring, and is reported to be associated with an increased prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this was to determine the relationship of smoking to the severity of OSAS and examine what local histological changes in the uvular mucosa of OSAS patients might influence this relationship. Fifty-seven OSAS subjects were included and classified according to smoking history and OSAS severity. Twenty-eight subjects were heavy smokers and 29 were nonsmokers; these 57 patients were divided according to moderate or severe OSAS. Histologic changes in the uvular mucosa were evaluated in all subjects as well as smoking duration and OSAS severity. Among smokers, moderate-to-severe OSAS was more common, and apnea, hypopnea, and oxygen desaturation indices were higher. Moreover, smoking duration and OSAS severity were significantly correlated. Increased thickness and edema of the uvular mucosa lamina propria were observed in moderate and severe OSAS patients, and only smokers had significant changes in uvular mucosa histology. Positive staining for calcitonin gene-related peptide (CGRP), a neuroinflammatory marker for peripheral nerves, was increased in the uvular mucosa of smokers. Our results suggest that smoking may worsen OSAS through exacerbation of upper airway collapse at the level of the uvula, and that histological changes of the uvular mucosa correlated with smoking might be due to increased CGRP-related neurogenic inflammation.

A case of sleep apnea syndrome manifesting severe hypertension with high plasma norepinephrine levels.

PubMed

Makino, Shinya; Iwata, Masanobu; Fujiwara, Masayoshi; Ike, Shinpei; Tateyama, Hitone

2006-06-01

A 55-year-old female was admitted to our hospital with severe hypertension (274/140 mmHg). Endocrinological examination revealed that her plasma levels of norepinephrine (NE) was elevated with high levels of urinary NE, normetanephrine and vanillylmandelic acid (VMA), suggesting the presence of pheochromocytoma. However, neither computed tomography nor MIBG scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. She was screened with full polysomnography because of heavy snoring, and the diagnosis of severe obstructive sleep apnea syndrome (OSAS) was made. She was treated with calcium channel blocker for three weeks, but severe hypertension persisted. After treatment with nasal continuous positive airway pressure (CPAP) was added, her blood pressure gradually lowered week by week. Concomitantly, the levels of plasma and urinary NE, urinary normetanephrine and urinary VMA were normalized following nasal CPAP therapy for 2 weeks. Additional treatments with alpha-adrenergic blocker further decreased her home blood pressure. After a year, she continued nasal CPAP therapy and her blood pressure was nearly below 160/100 mmHg. Urinary NE level was slightly above normal range and other catecholamines stayed within the normal range. This case shows that patients with OSAS could develop severe hypertension through elevated sympathetic tone, mimicking pheochromocytoma. Nasal CPAP therapy is recommended not only to improve hypertension and catecholamine excess but also to distinguish the condition from pheochromocytoma.

Risk factors for automobile accidents caused by falling asleep while driving in obstructive sleep apnea syndrome.

PubMed

Arita, Aki; Sasanabe, Ryujiro; Hasegawa, Rika; Nomura, Atsuhiko; Hori, Reiko; Mano, Mamiko; Konishi, Noriyuki; Shiomi, Toshiaki

2015-12-01

We examined the risk factors for automobile accidents caused by falling asleep while driving in subjects with obstructive sleep apnea syndrome (OSAS). We asked licensed drivers with history of snoring and excessive daytime sleepiness who had undergone polysomnography (PSG) at the Department of Sleep Medicine/Sleep Disorders Center at Aichi Medical University Hospital to complete the questionnaires on accidents caused by falling asleep while driving. As a subjective measure of sleepiness, we used the Epworth sleepiness scale (ESS). Based on PSG results, 2387 subjects diagnosed with OSAS were divided into three groups according to apnea-hypopnea index (AHI): mild-to-moderate (5 ≤ AHI < 30), severe (30 ≤ AHI < 60), and very severe (AHI ≥ 60). We performed univariate and multivariate logistic regression on variables that might explain falling asleep at the wheel. We compared results between each group and simple snorers (394 subjects with AHI < 5) and found the group with very severe OSAS reported significantly higher rates of driving when drowsy and having accidents in the past 5 years due to falling asleep. Our multivariate analysis suggests that scores on the ESS and patient-reported frequency of feeling drowsy while regular driving and working are related to automobile accidents caused by falling asleep while driving.

Sleep quality in children: questionnaires available in Brazil.

PubMed

Cavalheiro, Maria Gabriela; Corrêa, Camila de Castro; Maximino, Luciana Paula; Weber, Silke Anna Theresa

2017-01-01

The purpose of this paper was to evaluate and compare the questionnaires regarding sleep quality among children aged up to 12 years old, used in the Portuguese language in Brazil. A search at the literature databases of Lilacs, Scielo and Pubmed was performed using keywords "sleep quality" and "children". Selected Articles were analysed for age of the studied population, the number of questions and the issues addressed thereby, who realized the application, the analysis of the results, and content. Out of 9377 titles, 11 studies were included, performing 7 different questionnaires: Questionnaire to measure quality of life among children with enlarged palatine and pharyngeal tonsils (translation of OSD-6) (1); Inventory of Sleep Habits for Preschool Children (2); the Questionnaire on Obstructive Sleep Apnoea-18 (OSA-18) (3), Sleep Questionnaire by Reimão and Lefévre - QRL (4); the Questionnaire on Sleep Behaviour Patterns (5) and the translation of the Sleep Disturbance Scale for Children (6); Brief Infant Sleep Questionnaire - BISQ (7) . Six of the questionnaires have covered the following issues: snoring and daytime sleepiness. A total of 7 protocols were found to be available in Brazil, the most commonly mentioned being OSA-18 and OSD-6. The use of protocols as a guided interview helps to define diagnosis and treatment among the paediatric population, but its large variability makes it difficult to compare a standardised monitoring process.

Relationships between Sleep Behaviors and Unintentional Injury in Southern Chinese School-Aged Children: A Population-Based Study.

PubMed

Tan, Yafei; Ma, Di; Chen, Ying; Cheng, Fuyuan; Liu, Xiangxiang; Li, Liping

2015-10-16

The purpose of this study is to explore the relationships between sleep behaviors and injury occurrence among Chinese school-aged children. Data were collected with self-administered questionnaires of a cross-sectional survey which covered the school-aged children from southeastern Chinese urban and rural areas in April 2010. Information was collected on unintentional injury in the past year, sleep duration, napping and daytime fatigue, sleeping pill use, and social-demographic variables. Multivariable logistic regression analyses, controlling for confounding factors, were conducted to assess sleep-related variables that were associated with injuries. Students who slept for less than 8 h had a 30% increased risk of injury (OR: 1.30; 95%CI: 1.01-1.69) compared with those who slept for 8-9 h. Lack of napping, snoring and use of sleeping pills were significantly associated with injury. Among different genders, the slight difference in sleep behaviors predicted the occurrence of injury. Rural children displayed more sleep behaviors associated with injury than urban children. The sleep behaviors of primary school students were more negatively correlated with injury occurrence than junior/senior high school children. Consideration should be given to the prevention of problematic sleep behaviors as a potential risk factor in order to decrease injury rates and promote the health of school-aged children.

Relationships between Sleep Behaviors and Unintentional Injury in Southern Chinese School-Aged Children: A Population-Based Study

PubMed Central

Tan, Yafei; Ma, Di; Chen, Ying; Cheng, Fuyuan; Liu, Xiangxiang; Li, Liping

2015-01-01

The purpose of this study is to explore the relationships between sleep behaviors and injury occurrence among Chinese school-aged children. Data were collected with self-administered questionnaires of a cross-sectional survey which covered the school-aged children from southeastern Chinese urban and rural areas in April 2010. Information was collected on unintentional injury in the past year, sleep duration, napping and daytime fatigue, sleeping pill use, and social-demographic variables. Multivariable logistic regression analyses, controlling for confounding factors, were conducted to assess sleep-related variables that were associated with injuries. Students who slept for less than 8 h had a 30% increased risk of injury (OR: 1.30; 95%CI: 1.01–1.69) compared with those who slept for 8–9 h. Lack of napping, snoring and use of sleeping pills were significantly associated with injury. Among different genders, the slight difference in sleep behaviors predicted the occurrence of injury. Rural children displayed more sleep behaviors associated with injury than urban children. The sleep behaviors of primary school students were more negatively correlated with injury occurrence than junior/senior high school children. Consideration should be given to the prevention of problematic sleep behaviors as a potential risk factor in order to decrease injury rates and promote the health of school-aged children. PMID:26501305

Cigarette smoking and sleep disturbance.

PubMed

Phillips, B A; Danner, F J

1995-04-10

Individuals with sleep complaints often exhibit unhealthy lifestyles, including obesity, excessive alcohol use, lack of physical exercise, and cigarette smoking. We sought to explore the relationship between cigarette smoking, poor sleep habits, and sleep complaints. Several lines of evidence suggest a relationship between cigarette smoking and sleep disturbance, including the effects of nicotine and nicotine withdrawal on sleep, a tendency for nonsmokers to be more alert in the morning, an association between cigarette smoking and snoring, and a tendency for individuals who engage in one unhealthy behavior also to engage in others. A total of 484 individuals aged 14 to 84 years completed a comprehensive sleep and health questionnaire. There were 99 high school students from grades 9 through 12 (45 boys and 54 girls, of whom 38 [38%] were smokers), who completed an in-class survey. In addition, 385 adults aged 20 to 84 years (122 men and 263 women, of whom 77 [20%] were smokers) from a random sample of 1000 completed a mail survey. The effects of age and smoking status on sleep, health, and daytime function were assessed by multivariate analysis of variance. Cigarette smokers were significantly more likely than nonsmokers to report problems going to sleep, problems staying asleep, daytime sleepiness, minor accidents, depression, and high daily caffeine intake. Individuals with sleep complaints should be queried about tobacco use. Those who are smokers should be advised that there is a relationship between cigarette smoking and sleep disturbance.

Prevalence of bruxism in children with episodic migraine--a case-control study with polysomnography.

PubMed

Masuko, Alice Hatsue; Villa, Thais Rodrigues; Pradella-Hallinan, Marcia; Moszczynski, Alexander Joseph; Carvalho, Deusvenir de Souza; Tufik, Sergio; do Prado, Gilmar Fernandes; Coelho, Fernando Morgadinho Santos

2014-05-14

Parents of children with migraine have described a higher prevalence of sleep bruxism and other sleep disturbances in their children. The objective of this study was to use polysomnography to investigate the prevalence of bruxism during sleep in children with episodic migraine relative to controls. Controls and patients were matched by sex, age, years of formal education, presence of snoring, arousals per hour, and respiratory events per hour.A total of 20 controls, between 6 and 12 years old, with no history of headache, recruited from public schools in Sao Paulo between 2009 and 2012, and 20 patients with episodic migraine recruited from the Headache Clinic at the Federal University of Sao Paulo between 2009 and 2012 underwent polysomnography.No intervention was performed before sleep studies.Among migraine patients, 27.5% experienced aura prior to migraine onset. The sleep efficiency, sleep latency, REM sleep latency, arousals per hour, percentage of sleep stages, and breathing events per hour were similar between groups. Five children (25%) with episodic migraine exhibited bruxism during the sleep study while this finding was not observed in any control (p = 0.045). Our data demonstrate that bruxism during sleep is more prevalent in children with episodic migraine. Further prospective studies will help elucidate the underlying shared pathogenesis between bruxism and episodic migraine in children.

Prevalence of bruxism in children with episodic migraine - a case–control study with polysomnography

PubMed Central

2014-01-01

Background Parents of children with migraine have described a higher prevalence of sleep bruxism and other sleep disturbances in their children. The objective of this study was to use polysomnography to investigate the prevalence of bruxism during sleep in children with episodic migraine relative to controls. Findings Controls and patients were matched by sex, age, years of formal education, presence of snoring, arousals per hour, and respiratory events per hour. A total of 20 controls, between 6 and 12 years old, with no history of headache, recruited from public schools in Sao Paulo between 2009 and 2012, and 20 patients with episodic migraine recruited from the Headache Clinic at the Federal University of Sao Paulo between 2009 and 2012 underwent polysomnography. No intervention was performed before sleep studies. Among migraine patients, 27.5% experienced aura prior to migraine onset. The sleep efficiency, sleep latency, REM sleep latency, arousals per hour, percentage of sleep stages, and breathing events per hour were similar between groups. Five children (25%) with episodic migraine exhibited bruxism during the sleep study while this finding was not observed in any control (p = 0.045). Conclusions Our data demonstrate that bruxism during sleep is more prevalent in children with episodic migraine. Further prospective studies will help elucidate the underlying shared pathogenesis between bruxism and episodic migraine in children. PMID:24886343

Role of Cholestyramine in Refractory Hyperthyroidism: A Case Report and Literature Review

PubMed Central

Alswat, Khaled A.

2015-01-01

Patient: Female, 52 Final Diagnosis: Refractory iodine induced hyperthyroidism Symptoms: Neck swelling • shortness of breath Medication: Cholestyramine Clinical Procedure: Total thyroidectomy Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Hyperthyroidism is a common disease that usually responds to the conventional therapy of anti-thyroidal medications (methimazole or PTU) and beta-blocker. Refractory hyperthyroidism is a rare condition in which hyperthyroidism fails to respond to the above therapy. Cholestyramine has been shown to decrease thyroid hormone level when added to the ongoing anti-thyroidal medications. Case Report: A 52-year-old woman with past medical history of enlarging goiter presented with obstructive symptoms of worsening shortness of breath and snoring. Admission thyroid function test showed mild hyperthyroidism (suppressed TSH, slightly high FT4, and high normal FT3) that worsened after she received a CT scan with contrast and failed to respond to a 3-week course of high-dose dexamethasone, high-dose carbimazole, and up-titrated propranolol. Five days after cholestyramine was added, her FT4 decreased by 30% and normalized after 12 days. The patient underwent total thyroidectomy as definitive treatment for the hyperthyroidism and for the obstructive symptoms. Conclusions: Cholestyramine is an effective additional treatment for hyperthyroidism and may be an effective treatment for refractory iodine-induced hyperthyroidism. The possibility of self-remission (natural course) is less likely given the dramatic and rapid response to cholestyramine. PMID:26207323

Sleep problems and internet addiction among children and adolescents: a longitudinal study.

PubMed

Chen, Yi-Lung; Gau, Susan Shur-Fen

2016-08-01

Although the literature has documented associations between sleep problems and internet addiction, the temporal direction of these relationships has not been established. The purpose of this study is to evaluate the bidirectional relationships between sleep problems and internet addiction among children and adolescents longitudinally. A four-wave longitudinal study was conducted with 1253 children and adolescents in grades 3, 5 and 8 from March 2013 to January 2014. The sleep problems of the student participants were measured by parental reports on the Sleep Habit Questionnaire, which catalogues early insomnia, middle insomnia, disturbed circadian rhythm, periodic leg movements, sleep terrors, sleepwalking, sleep talking, nightmares, bruxism, snoring and sleep apnoea. The severity of internet addiction was measured by students' self-reports on the Chen Internet Addiction Scale. Based on the results of time-lag models, dyssomnias (odds ratio = 1.31), especially early and middle insomnias (odds ratio = 1.74 and 2.24), sequentially predicted internet addiction, and internet addiction sequentially predicted disturbed circadian rhythm (odds ratio = 2.40), regardless of adjustment for gender and age. This is the first study to demonstrate the temporal relationship of early and middle insomnia predicting internet addiction, which subsequently predicts disturbed circadian rhythm. These findings imply that treatment strategies for sleep problems and internet addiction should vary according to the order of their occurrence. © 2016 European Sleep Research Society.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

PubMed Central

da Silva, Kenia Vieira; Rosa, Maria Luiza Garcia; Jorge, Antônio José Lagoeiro; Leite, Adson Renato; Correia, Dayse Mary Silva; Silva, Davi de Sá; Cetto, Diego Bragatto; Brum, Andreia da Paz; Netto, Pedro Silveira; Rodrigues, Gustavo Domingos

2016-01-01

Background Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS. PMID:27142651

Factors Associated with Successful Treatment by Radiofrequency Treatment of the Soft Palate in Obstructive Sleep Apnea as the First-Line Treatment

PubMed Central

Sonsuwan, Nuntigar; Rujimethabhas, Kongsak

2015-01-01

Background. Radiofrequency ablation (RFA) is recommended as the second-line treatment for obstructive sleep apnea (OSA). This study aims to study the factors associated with successful treatment by RFA in OSA patients as the first-line treatment. Methods. All patients diagnosed as mild to moderate OSA were enrolled prospectively and treated with RFA. Three points of soft palate were ablated: midline, left, and right paramedian sites. Baseline characteristics and clinical factors including snoring score (SS), Epworth Sleepiness Scale (ESS), and apnea-hypopnea index (AHI), with minimal oxygen saturation, were recorded at baseline and three months after treatment. Results. During the study period, there were 51 patients who met the study criteria and received RFA treatment. At three months, the SS, ESS, and AHI were significantly lower than baseline values, while the minimal oxygenation was significantly increased from the baseline values. There were 16 patients (31.37%) who had an AHI of < 5 times/h. Only baseline AHI was significantly associated with an AHI of < 5 times/h at three months after RFA treatment. The adjusted odds ratio was 0.804 (95% CI: 0.699, 0.924). Conclusion. Transoral RFA treatment may be effective in mild to moderate OSA as the first-line treatment. Baseline AHI is associated with preferable outcome by RFA treatment. PMID:26339508

Overview of smartphone applications for sleep analysis.

PubMed

Ong, Adrian A; Gillespie, M Boyd

2016-03-01

To review and assess the current selection of sleep analysis smartphone applications (apps) available for download. The iOS and Google Play mobile app store were searched for sleep analysis apps targeted for consumer use. Alarm clock, sleep-aid, snoring and sleep-talking recorder, fitness tracker apps, and apps geared towards health professionals were excluded. App information and features were obtained from in-store descriptions, and the app developer website. A total of 51 unique sleep apps in both iOS and Google Play stores were included. The apps were rated 3.8/5 in both stores, and had an average price of $1.12 in the iOS store and $0.58 in the Google Play store. >65% of sleep apps report on sleep structure, including duration, time awake, and time in light/deep sleep, while reporting of REM was limited. The availability of extra features was variable, ranging from 4% to 73% of apps. There are a variety of sleep analysis apps with a range of functionality. The apps with the most reviews from the each store are featured. Many apps provide data on sleep structure; however the algorithms are not validated by scientific literature or studies. Since patients may inquire about their sleep habits from these apps, it is necessary for physicians to be aware of the most common apps and the features offered and their limitations in order to properly counsel patients.

High prevalence of diabetes among migrants in the United Arab Emirates using a cross-sectional survey.

PubMed

Sulaiman, Nabil; Albadawi, Salah; Abusnana, Salah; Mairghani, Maisoon; Hussein, Amal; Al Awadi, Fatheya; Madani, Abdulrazak; Zimmet, Paul; Shaw, Jonathan

2018-05-01

In 2011, the United Arab Emirates (UAE) had the 10th highest diabetes prevalence globally, but this was based on data that excluded migrants who comprise 80% of the population. This study assessed diabetes prevalence across the UAE population. A random sample of migrants was recruited from the visa renewal centers. Data were collected using interviews, anthropometric measurements and fasting blood for glucose, lipids and genetic analyses. 2724 adults completed the questionnaires and blood tests. Of these, 81% were males, 65% were ≤40 years old and 3% were above 60 years. Diabetes, based on self-report or fasting plasma glucose ≥7.0 mmol/l, showed a crude prevalence of 15.5%, of whom 64.2% were newly diagnosed. Overall age- and sex-adjusted diabetes prevalence, according to the world mid-year population of 2013, was 19.1%. The highest prevalence was in Asians (16.4%) and non-Emirati Arabs (15.2%) and lowest in Africans and Europeans (11.9%). It increased with age: 6.3% in 18-30 years and 39.7% in 51 to 60 years. Lower education, obesity, positive family history, hypertension, dyslipidemia, snoring, and low HDL levels, all showed significant associations with diabetes. The high diabetes prevalence among migrants in the UAE, 64% of which was undiagnosed, necessitates urgent diabetes prevention and control programs for the entire UAE population.

Sleep disturbances in Angelman syndrome: a questionnaire study.

PubMed

Bruni, Oliviero; Ferri, Raffaele; D'Agostino, Gaetana; Miano, Silvia; Roccella, Michele; Elia, Maurizio

2004-06-01

Only few studies are available on sleep disorders in Angelman syndrome (AS), a neurodevelopmental disorder with several behavior disturbances. The aim of this study was to determine the prevalence of sleep disorders in a relatively large group of AS subjects, compared to that of age-matched controls. Forty-nine consecutive parents of patients with AS (26 males and 23 females aged 2.3-26.2 years) were interviewed and filled out a comprehensive sleep questionnaire. Based on their genetic etiology, four groups were defined: deletion of chromosome 15q11-13 (25 subjects); methylation imprinting mutation (six subjects), UBE3A mutations (seven subjects) and paternal uniparental disomy (five subjects). In the remaining cases genetic testings were negative. A significantly high frequency of disorders of initiating and maintaining sleep, prolonged sleep latency, prolonged wakefulness after sleep onset, high number of night awakenings and reduced total sleep time were found in our AS patients, as compared to age-matched controls. We also found other types of sleep disorders, never reported before, such as enuresis, bruxism, sleep terrors, somnambulism, nocturnal hyperkinesia, and snoring. No differences were found between the four genetic aetiology groups. Moreover, we did not find important improvement of sleep disturbances from pre-pubertal to post-pubertal ages. Our data confirm the significant presence of sleep/wake rhythms fragmentation, peculiar of AS, and also demonstrate the presence of several other types of sleep disturbances in this syndrome.

Obstructive sleep apnea and oral language disorders.

PubMed

Corrêa, Camila de Castro; Cavalheiro, Maria Gabriela; Maximino, Luciana Paula; Weber, Silke Anna Theresa

Children and adolescents with obstructive sleep apnea (OSA) may have consequences, such as daytime sleepiness and learning, memory, and attention disorders, that may interfere in oral language. To verify, based on the literature, whether OSA in children was correlated to oral language disorders. A literature review was carried out in the Lilacs, PubMed, Scopus, and Web of Science databases using the descriptors "Child Language" AND "Obstructive Sleep Apnea". Articles that did not discuss the topic and included children with other comorbidities rather than OSA were excluded. In total, no articles were found at Lilacs, 37 at PubMed, 47 at Scopus, and 38 at Web of Science databases. Based on the inclusion and exclusion criteria, six studies were selected, all published from 2004 to 2014. Four articles demonstrated an association between primary snoring/OSA and receptive language and four articles showed an association with expressive language. It is noteworthy that the articles used different tools and considered different levels of language. The late diagnosis and treatment of obstructive sleep apnea is associated with a delay in verbal skill acquisition. The professionals who work with children should be alert, as most of the phonetic sounds are acquired during ages 3-7 years, which is also the peak age for hypertrophy of the tonsils and childhood OSA. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea.

PubMed

Kang, Kun-Tai; Chiu, Shuenn-Nan; Weng, Wen-Chin; Lee, Pei-Lin; Hsu, Wei-Chung

2017-03-01

To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA). Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses. In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables. Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP. Copyright © 2016 Elsevier Inc. All rights reserved.

Upper airway resistance syndrome.

PubMed

Montserrat, J M; Badia, J R

1999-03-01

This article reviews the clinical picture, diagnosis and management of the upper airway resistance syndrome (UARS). Presently, there is not enough data on key points like the frequency of UARS and the morbidity associated with this condition. Furthermore, the existence of LIARS as an independent sleep disorder and its relation with snoring and obstructive events is in debate. The diagnosis of UARS is still a controversial issue. The technical limitations of the classic approach to monitor airflow with thermistors and inductance plethysmography, as well as the lack of a precise definition of hypopnea, may have led to a misinterpretation of UARS as an independent diagnosis from the sleep apnea/hypopnea syndrome. The diagnosis of this syndrome can be missed using a conventional polysomnographic setting unless appropriate techniques are applied. The use of an esophageal balloon to monitor inspiratory effort is currently the gold standard. However, other sensitive methods such as the use of a pneumotachograph and, more recently, nasal cannula/pressure transducer systems or on-line monitoring of respiratory impedance with the forced oscillation technique may provide other interesting possibilities. Recognition and characterization of this subgroup of patients within sleep breathing disorders is important because they are symptomatic and may benefit from treatment. Management options to treat UARS comprise all those currently available for sleep apnea/hypopnea syndrome (SAHS). However, the subset of patients classically identified as LIARS that exhibit skeletal craneo-facial abnormalities might possibly obtain further benefit from maxillofacial surgery.

The correlation between tonsil size and academic performance is not a direct one, but the results of various factors.

PubMed

Kargoshaie, A A; Najafi, M; Akhlaghi, M; Khazraie, H R; Hekmatdoost, A

2009-10-01

Chronic upper airway obstruction most often occurs when both tonsils and adenoid are enlarged but may occur when either is enlarged. Obstructive sleep syndrome in young children has been reported to be associated with an adverse effect on learning and academic performance. The aim of this study was to evaluate the effect of relative size of the tonsil on academic performance in 4th grade school children. In 320 children, physical examination to determine the size of tonsils was performed by the otorhinolaryngologist. A questionnaire was developed to assess sleep patterns and problems, and socio-demographic data for the student participants. Furthermore, their school performance was assessed using their grade in mathematics, science, reading, spelling, and handwriting. No association between tonsil size and academic performance was found. Snoring frequency, body mass index and body weight showed a positive relation with tonsil size. There was no association between tonsil size and sleepiness during the day, sleeping habits, hyperactivity, enuresis, history of tonsillectomy in children and parental cigarette smoking and education. In conclusion, this study did not show any significant relationship between tonsil size and academic performance in 4th grade students. Further studies are recommended with a larger sample size, cognitive exams for evaluation of attention, and follow-up of the students until high school, when the discrepancy of the students' academic performance is more obvious.

The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis.

PubMed

Acar, Mustafa; Cingi, Cemal; Sakallioglu, Oner; San, Turhan; Fatih Yimenicioglu, Mehmet; Bal, Cengiz

2013-01-01

Allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) are worldwide prevalent diseases. These diseases impair patient quality of life. The aim of this study was to investigate and compare the efficacy of treatment of AR on OSAS by objective and subjective methods. The study group was composed of 80 OSAS patients with AR between the ages of 30 and 50 years. The patients were admitted with the complaint of snoring, and they were asked about AR-related symptoms (nasal discharge, nasal itching, sneeze, and nasal obstruction). Daytime somnolence was measured by the Epworth sleepiness scale (ESS). Sleep parameters on polysomnography tests before and after treatment were compared, and the effects of different AR treatment protocols on sleep quality were evaluated. When pretreatment and posttreatment apnea-hypopnea index (AHI) values of the groups were compared, the most significant difference was observed in the nasal steroid (Ns) + antihistamine (Ah) group (p < 0.05). The ESS results were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). AHI oxygen saturation <90% were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). Nasal obstruction due to nasal congestion causes increases in airway resistance and can lead to development of OSAS. We concluded that treating AR with Ns has both positive effects on OSAS and daily activity. However, adding Ah to this treatment did not show improved effects compared with placebo treatment.

A clinical decision rule to prioritize polysomnography in patients with suspected sleep apnea.

PubMed

Rodsutti, Julvit; Hensley, Michael; Thakkinstian, Ammarin; D'Este, Catherine; Attia, John

2004-06-15

To derive and validate a clinical decision rule that can help to prioritize patients who are on waiting lists for polysomnography, Prospective data collection on consecutive patients referred to a sleep center. The Newcastle Sleep Disorders Centre, University of Newcastle, NSW, Australia. Consecutive adult patients who had been scheduled for initial diagnostic polysomnography. Eight hundred and thirty-seven patients were used for derivation of the decision rule. An apnea-hypopnoea index of at least 5 was used as the cutoff point to diagnose sleep apnea. Fifteen clinical features were included in the analyses using logistic regression to construct a model from the derivation data set. Only 5 variables--age, sex, body mass index, snoring, and stopping breathing during sleep--were significantly associated with sleep apnea. A scoring scheme based on regression coefficients was developed, and the total score was trichotomized into low-, moderate-, and high-risk groups with prevalence of sleep apnea of 8%, 51%, and 82%, respectively. Color-coded tables were developed for ease of use. The clinical decision rule was validated on a separate set of 243 patients. Receiver operating characteristic analysis confirmed that the decision rule performed well, with the area under the curve being similar for both the derivation and validation sets: 0.81 and 0.79, P =.612. We conclude that this decision rule was able to accurately classify the risk of sleep apnea and will be useful for prioritizing patients with suspected sleep apnea who are on waiting lists for polysomnography.

Obesity-hypoventilation syndrome and associated factors.

PubMed

Espínola Rodríguez, Ana; Lores Obradors, Luis; Parellada Esquius, Neus; Rubio Muñoz, Felisa; Espinosa Gonzalez, Neus; Arellano Marcuello, Elisabet

2018-02-23

Obesity causes important alterations in the respiratory physiology like sleep obstructive apnoea (SOA) and obesity-hypoventilation syndrome (OHS), both associated with high morbidity and mortality. Also, these entities are clearly infradiagnosed and in the case of OHS the prevalence is unknown in the general obese population. To determine the prevalence of OHS in the population of patients with morbid obesity and to know the comorbidity related with OHS, the associated respiratory symptoms and the pulse oximetry alterations. Descriptive study. Selection of 136 adult patients with morbid obesity (BMI >40). Collected were, anthropometric data, toxic habits, concomitant disease, symptom data, analytic data, dyspnoea grade, sleepiness scale (Epworth Test), electrocardiogram, chest X-ray, spirometry, nocturne ambulatory pulse oximetry and arterial gasometry. 136 were studied, mean age 60 years old (SD 12.9 years), 73% (98) were women; 6.6% of patients presented diurnal hypercapnia indicative of OHS; 72% presented high blood pressure, 44% dyslipidaemia, 18% presented cardiovascular disease, 83% snored and 46% had apnoea; 30% presented stageII dyspnoea and 10% stageIII. The desaturation/hour index was above 3% ≥30 of occasions in 28.6% of patients and the percentage of patients with saturations <90% more than 30% of the time was 23.5%. The results were worse in patients with OHS. The prevalence of OHS was lower than expected. Noteworthy was the high comorbidity of cardiovascular disease and the high frequency of respiratory symptoms associated with important alterations of pulse oximetry. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

[Diagnosis of obstructive sleep apnea syndrome using pulse oximeter derived photoplethysmographic signals].

PubMed

Pan, H; Huang, G P; Ren, R; Lei, F; Tang, X D

2016-05-24

To evaluate the diagnosis value of photoplethysmography (PPG)-based device for detecting obstructive sleep apnea syndrome. Patients who visited sleep medicine center in West China hospital from March 2014 to March 2015 with a main complain of snoring were selected into this study, and they were simultaneously monitored with the PPG-based device while undergoing polysomnography (PSG). Using PSG as"gold standard", the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as corresponding areas under the receiver operator curves for an apnea hypopnea index (AHI) ≥5/h, ≥15/h and ≥30/h were calculated for PPG. Valid results were available for 93 subjects, among them there were 64 men and 29 women with a mean age of (44±13) years old.There were no significant difference between total sleep time, wake time after sleep onset, AHI and oxygen saturation derived by PPG and PSG.Positive correlation was found between PPG-derived and PSG-derived AHI (r=0.945). For AHI≥5/h, ≥15/h and ≥30/h respectively according PSG, sensitivity was 93%, 88%, 92%, specificity was 79%, 93%, 95%, PPV was 95%, 97%, 96%, NPV 75%, 76%, 91% for PPG. The corresponding areas under the receiver operator characteristic curves were 0.981, 0.996 and 0.995 respectively. PPG-derived data is consistent with simultaneous in-lab PSG in the diagnosis of obstructive sleep apnea syndrome.

Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort

PubMed Central

Elwood, Peter; Hack, Melissa; Pickering, Janet; Hughes, Janie; Gallacher, John

2006-01-01

Objective To test the hypothesis that sleep disorders are relevant to the risk of ischaemic stroke and ischaemic heart disease events in older men. Design A cohort study. Setting The Caerphilly cohort, a representative population sample of older men in South Wales, UK. Participants 1986 men aged 55–69 years completed a questionnaire on sleep patterns with help from their partners. This asked about symptoms of disturbed sleep: insomnia, snoring, restless legs, obstructive sleep apnoea, and about daytime sleepiness. During the following 10 years 107 men experienced an ischaemic stroke and 213 had an ischaemic heart disease event. Main results Up to one third of the men reported at least one symptom suggestive of sleep disturbance, and one third reported daytime sleepiness. Compared with men who reported no such symptoms, the adjusted relative odds of an ischaemic stroke were significantly increased in men with any sleep disturbance, the strongest association being with sleep apnoea (relative odds 1.97; 1.26 to 3.09). The association with daytime sleepiness was not significant for stroke. Relations with ischaemic heart disease events were all raised in men with symptoms of sleep disturbance, but none was significant, other than daytime sleepiness (relative odds: 1.41; 1.04 to 1.92). There were no significant relations with blood pressure. Conclusion The risk of an ischaemic stroke is increased in men whose sleep is frequently disturbed, and daytime sleepiness is associated with a significant increase in ischaemic heart disease events. PMID:16361457

Treatment success with titratable thermoplastic mandibular advancement devices for obstructive sleep apnea: A comparison of patient characteristics.

PubMed

Wang, Tang-Chuan; Tsou, Yung-An; Wu, Yi-Fan; Huang, Chia-Chang; Lin, Wesley Wen-Yang; Li, Yu-Fen; Chen, Michael Yuan-Chien; Tai, Chih-Jaan; Tsai, Ming-Hsui

2017-03-01

A titratable thermoplastic mandibular advancement device (MAD) is clearly an effective treatment option in some patients with obstructive sleep apnea (OSA). Determining which patients may be more likely to respond to treatment with thermoplastic MADs and to adhere to treatment would be of obvious clinical relevance. This was an experimental descriptive study (N = 60). Patients with OSA were instructed to wear a titratable thermoplastic MAD for 3 months. Treatment success was defined as a ≥50% reduction from baseline in the apnea-hypopnea index (AHI) or AHI <10 when wearing MAD. Adherence was defined as MAD use ≥5 nights/week. Treatment was successful in 66.7% of patients and 60.0% were adherent. All polysomnographic parameters and visual analogue scale scores (sleep quality, snoring, waking refreshed) were significantly improved after treatment. The patients in whom treatment failed had significantly higher neck circumferences (39.3 cm vs. 37.5 cm, p = 0.014), higher baseline AHI values (26.6 vs. 18.0, p = 0.016), and smaller AHI reduction (-31.8 vs -53.1, p < 0.001) than those in the group in whom treatment succeeded. There were no significant differences in polysomnographic, cephalometric, or visual analogue scale measures between patients for whom treatment was and was not successful, regardless of baseline values or the change rates after the MAD was placed. Titratable thermoplastic MADs can improve indicators of sleep quality, even in patients in whom treatment is considered to have failed.

Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment.

PubMed

Sánchez, Trinidad; Castro-Rodríguez, José A; Brockmann, Pablo E

2016-01-01

The objective was to perform a systematic review in order to describe the relationship between asthma and sleep-disordered breathing (SDB) in children, especially regarding the impact of treatment and management. We performed an electronic search in MEDLINE, EMBASE, and LILACS database. Study inclusion criteria were the following: 1) studies that examined the relationship between asthma/wheezing and SDB/obstructive sleep apnea (OSA); and 2) studies conducted in children <18 years of age. Primary outcomes were the prevalence of asthma and SDB, the tests used for diagnosis, and the influence of their treatment and management. One thousand and twenty studies were identified, among which 32 were selected (n=143,343 children; 51% males; age [mean ± standard deviation] 8.4±2.5 years). Most studies (n=26) diagnosed SDB using questionnaires or clinical history. Nine studies performed a sleep study for diagnosing OSA. The diagnosis of asthma was based on clinical history (n=16), previous medical diagnosis (n=4), questionnaires (n=12), and spirometry (n=5). Children with asthma were more likely to develop habitual snoring and OSA, and children with SDB were more likely to develop asthma. Moreover, asthma was associated with more severe OSA, and the presence of SDB was associated with severe asthma. Treatment of SDB with adenotonsillectomy was associated with significant asthma improvement. The relationship between asthma and SDB appears to be bidirectional, and adenotonsillectomy appears to improve asthma control. Future trials on how asthma treatment could impact on SDB are needed.

Is "poor sleep" too vague a concept for rational treatment?

PubMed

Declerck, A C

1994-01-01

Poor sleep is a common complaint, accounting for 4-5% of all general practitioner consultations. Disorders of initiating sleep are overrated by patients compared with disorders of maintaining sleep, despite the greater effect of the latter on daytime performance. There is frequently a discrepancy between subjective observations and objective measurements of sleep. General practitioners should pay attention to sleep disorders lasting more than three weeks and should bear in mind that poor sleep is a symptom, the underlying cause of which needs to be determined. Good coordination of endogenous biorhythms and external life and working circumstances can positively influence sleeping patterns. Sleep onset latency determines the amount of deep sleep and, thus, the duration and stability of core sleep. General practitioners usually prescribe a single type of benzodiazepine drug with a half-life of 5-10 h for sleep disorders. Such drugs cause the patient to fall asleep quickly, to have a considerable period of uninterrupted sleep with little waking and to wake in the morning with a subjective feeling of having slept well. A number of less desirable changes can occur, however, that may produce, for example, anxiety dreams, increased snoring and sleep apnoea periods at night, and weakness of muscles during the day. The third generation of hypnotic agents produce less undesirable changes than the second generation. Zolpidem (an imidazoypridine), one such agent, seems to provide an effective treatment for insomnia without inducing undesirable side-effects.

Diseases in Patients Coming to a Sleep Center with Symptoms Related to Restless Legs Syndrome

PubMed Central

Kao, Kuo-Chin; Yang, Cheng-Ta; Chuang, Li-Pang; Chou, Yu-Ting; Lai, Szu-Chia; Chen, Rou-Shayn; Chen, Ning-Hung

2013-01-01

Study Objective To explore the profile of patients who visit a sleep center with symptoms that fulfill the four essential criteria for restless legs syndrome (RLS). Design A prospective study. Setting Outpatients from one sleep disorders clinic in Taiwan. Participants 1,200 consecutive patients visit sleep disorders clinic with any sleep complaints. Interventions After completing a history and physical examination, all participants answered the RLS questionnaire. Subjects who fulfilled the four essential criteria for RLS were referred to a special clinic. A work-up including blood tests, polysomnography, and specialized neurological tests etc. was performed to make the final diagnosis. Measurements and Results A total of 1,185 participants were enrolled, and, of these, 131(11.1%) fulfilled the four essential criteria for RLS, and 121 completed the supplemental work-up. Their mean age was 47.6±13.3 and 52.9% were male. Insomnia and snoring were the most common chief complaints. Obstructive sleep apnea syndrome and other diseases were found in 103 patients. Only 18 (14.9%) patients had no comorbid condition and were diagnosed with primary RLS. Conclusions Symptoms of RLS are common in patients with sleep complaints. Even in a sleep clinic, using a questionnaire approach for identification of RLS has a low positive predictive value. Clinicians should pay attention to the limitations of the 4-item questionnaire in diagnosis of RLS and also the importance of a careful differential diagnosis to identify possible secondary causes of RLS. PMID:23977057

Prevalence of Sleep Disorders Among Primary School Children.

PubMed

Gupta, Ravi; Goel, Deepak; Kandpal, S D; Mittal, Nidhi; Dhyani, Mohan; Mittal, Manish

2016-11-01

To screen symptoms of sleep disorders among primary school children. Four schools from urban area and four rural schools were included in this study. Symptoms of sleep disorders were assessed using the validated Hindi version of Childhood Sleep Habit Questionnaire in 8-13 y old children. Comparison was made between urban and rural group and between boys and girls. Descriptive statistics was calculated. Mean age of the subjects included in this study was 8.9 ± 1.5 y. Boys and girls were equally distributed, however, rural sample was smaller. More than one awakening each night was found in 12.2 % children. In the whole group, prevalence of bed-wetting was 8.7 %, sleep-talking 20.9 %, sleep-walking 3.2 %, teeth grinding 15.4 % and night terrors 8.4 %. Daytime sleepiness was reported by 25.5 % and napping by 56.4 %. 17.3 % used to fall asleep in unusual circumstances and the teacher or the friend in 6.9 % students noticed it. Snoring was reported by 11.4 % children, and 6.3 % reportedly struggled to breathe during sleep. Domicile and gender did not affect prevalence of parasomnia, however, symptoms of sleep apnea were more frequent among rural children. Daytime sleepiness was more common among rural children as compared to urban. Symptoms of sleep disorders are prevalent among primary school children. Common disorders are parasomnia, sleep apnea and daytime sleepiness.

Nigerian sleep study found that children slept less and had more problems than children in other countries.

PubMed

Senbanjo, Idowu O; Salisu, Mohammed A; Oshikoya, Kazeem A; Adediji, Uchechukwu O; Akinola, Ayodeji O

2018-03-12

We studied sleep patterns, sleep problems and associated socio-demographic factors among children aged one year to 12 years in Lagos, Nigeria. This prospective hospital-based study involved 432 children (55% males) who came for routine paediatric care at the Lagos State University Teaching Hospital. Information on socio-demographics, sleeping patterns and specific sleep disorders was obtained. The mean age of the subjects was 5.4 ± 3.3 years. Night sleep duration decreased significantly with age from 9.6 ± 1.3 hours at one to four years to 8.7 ± 1.0 hours at nine years to 12 years (p < 0.001). There was no significant gender difference in bedtimes (p = 0.057), rise times (p = 0.095) and night sleep duration (p = 0.191). Most (70%) napped during the day, and 26% of these did so on a regular basis. The most common sleep problems were enuresis (42%), afraid of sleeping alone (38%), snoring (28%) and sleep talking (24%). There was no significant association between sleep duration (p > 0.05), sleep problems (p > 0.05) and socio-demographic characteristics. Comparisons with other studies showed that the children had shorter sleep duration than peers in other countries and regions and a higher prevalence of sleep disorders. Children in Nigeria had shorter sleep duration and more sleep problems than children in other international studies. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Sleep quality in children: questionnaires available in Brazil

PubMed Central

Cavalheiro, Maria Gabriela; Corrêa, Camila de Castro; Maximino, Luciana Paula; Weber, Silke Anna Theresa

2017-01-01

Introduction The purpose of this paper was to evaluate and compare the questionnaires regarding sleep quality among children aged up to 12 years old, used in the Portuguese language in Brazil. Material and methods A search at the literature databases of Lilacs, Scielo and Pubmed was performed using keywords “sleep quality” and “children”. Selected Articles were analysed for age of the studied population, the number of questions and the issues addressed thereby, who realized the application, the analysis of the results, and content. Results Out of 9377 titles, 11 studies were included, performing 7 different questionnaires: Questionnaire to measure quality of life among children with enlarged palatine and pharyngeal tonsils (translation of OSD-6) (1); Inventory of Sleep Habits for Preschool Children (2); the Questionnaire on Obstructive Sleep Apnoea-18 (OSA-18) (3), Sleep Questionnaire by Reimão and Lefévre - QRL (4); the Questionnaire on Sleep Behaviour Patterns (5) and the translation of the Sleep Disturbance Scale for Children (6); Brief Infant Sleep Questionnaire - BISQ (7) . Six of the questionnaires have covered the following issues: snoring and daytime sleepiness. Conclusions A total of 7 protocols were found to be available in Brazil, the most commonly mentioned being OSA-18 and OSD-6. The use of protocols as a guided interview helps to define diagnosis and treatment among the paediatric population, but its large variability makes it difficult to compare a standardised monitoring process. PMID:29410747

The impact of laronidase treatment in otolaryngological manifestations of patients with mucopolysaccharidosis.

PubMed

Dualibi, Ana Paula Fiuza Funicello; Martins, Ana Maria; Moreira, Gustavo Antônio; de Azevedo, Marisa Frasson; Fujita, Reginaldo Raimundo; Pignatari, Shirley Shizue Nagata

2016-01-01

Mucopolysaccharidosis (MPS) is a lysosomal storage disease caused by deficiency of α-l-iduronidase. The otolaryngological findings include hearing loss, otorrhea, recurrent otitis, hypertrophy of tonsils and adenoid, recurrent rhinosinusitis, speech disorders, snoring, oral breathing and nasal obstruction. To evaluate the impact of enzymatic replacement therapy with laronidase (Aldurazyme(®)) in patients with mucopolysaccharidosis (MPS I), regarding sleep and hearing disorders, and clinical manifestations in the upper respiratory tract (URT). Nine patients with MPS I (8 Hurler-Scheie, and 1 Scheie phenotypes) of both sexes, ages ranging between 3 and 20 years, were included in this study. Patients were evaluated between seven and 11 months before the treatment and between 16 and 22 months after the onset of the enzymatic replacement. They were all submitted to a clinical and otolaryngological evaluation, including nasofibroscopical, polysomnographic and audiologic exams. The results' data showed decreasing of the frequency of ear, nose and throat infections, with improvement of the rhinorrhea and respiratory quality. No remarkable changes were observed regarding macroglossia and tonsil and adenoid hypertrophy. Audiometric and polysomnographic evaluations did not show statistical significance. Enzymatic replacement therapy in patients with mucopolysaccharidosis I provides control of recurrent URT infections, rhinorrhea and respiratory quality, however it is does not seem to improve audiologic and polisomnographic parameters, with no effect on adenoid and tonsils hypertrophy and macroglossia. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint.

PubMed

Yadav, Rahul; Bhutia, Ongkila; Shukla, Garima; Roychoudhury, Ajoy

2014-07-01

To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea.

PubMed

Chabolle, F; Wagner, I; Blumen, M B; Séquert, C; Fleury, B; De Dieuleveult, T

1999-08-01

To describe a surgical procedure for the treatment of severe obstructive sleep apnea syndrome (OSAS), the procedure's indications, and its results. A retrospective study of 10 male patients with OSAS treated by tongue base reduction with hyoepiglottoplasty (TBRHE) at the Foch Hospital (Suresnes, France) between 1994 and 1997. Patients had a mean body mass index (BMI) of 32 kg/m2, a mean respiratory disturbance index (RDI) of 70 events/h, and a mean minimal oxygen saturation of 78%. They had refused positive airway pressure therapy or wished to discontinue it. Subtotal tongue base reduction preceded by lingual neurovascular bundle identification and derouting, epiglottal verticalization, mouth floor horizontalization, and hyoid bone repositioning was performed, associated in some cases to uvulopalatopharyngoplasty (UPPP). Indications were based on a site-related obstruction, on the absence of craniofacial deficiencies, and on the presence of hyolingual abnormalities determined by cephalometry and magnetic resonance imaging. TBRHE associated to UPPP in most cases had an 80% success rate, based on a postoperative RDI below 20 events/h and a reduction of the preoperative RDI of more than 50%. Snoring and excessive daytime sleepiness decreased or disappeared, respectively, in 100% and 90% of the cases. No neurovascular complications occurred. TBRHE is a safe procedure for the neurovascular bundle. Associated to a pharyngotomy, it is an effective treatment for severe OSAS attributable to tongue base obstruction. These results require confirmation in a larger series of patients.

Work organisation and unintentional sleep: results from the WOLF study

PubMed Central

Akerstedt, T; Knutsson, A; Westerholm, P; Theorell, T; Alfredsson, L; Kecklund, G

2002-01-01

Background: Falling asleep at work is receiving increasing attention as a cause of work accidents. Aims: To investigate which variables (related to work, lifestyle, or background) are related to the tendency to fall asleep unintentionally, either during work hours, or during leisure time. Methods: 5589 individuals (76% response rate) responded to a questionnaire. A multiple logistic regression analysis of the cross sectional data was used to estimate the risk of falling asleep. Results: The prevalence for falling asleep unintentionally at least once a month was 7.0% during work hours and 23.1% during leisure time. The risk of unintentional sleep at work was related to disturbed sleep, having shift work, and higher socioeconomic group. Being older, being a woman, and being a smoker were associated with a reduced risk of unintentionally falling asleep at work. Work demands, decision latitude at work, physical load, sedentary work, solitary work, extra work, and overtime work were not related to falling asleep at work. Removing "disturbed sleep" as a predictor did not change the odds ratios of the other predictors in any significant way. With respect to falling asleep during leisure time, disturbed sleep, snoring, high work demands, being a smoker, not exercising, and higher age (>45 years) became risk indicators. Conclusion: The risk of involuntary sleep at work is increased in connection with disturbed sleep but also with night work, socioeconomic group, low age, being a male, and being a non-smoker. PMID:12205231

[Investigation of sleep patterns and sleep disorders in Uigur and Hui children in Xinjiang].

PubMed

Abuzhare, Tajiguli; Xu, Pei-Ru; Tiemuer, Amanguli; Zhang, Ji-Hong

2011-07-01

To study the sleep quality and quantity and their influencing factors in Uigur and Hui children in Xinjiang Province. From March to December of 2007, 912 Uigur and 1019 Hui school children (6 to 14 years) were randomly sampled from 6 cities of Xinjing Province. The questionnaire on children's sleep states and sleep environments was filled in by children's parents. The mean sleep time of Uigur and Hui children was 10.1±1.4 hrs. The sleep time in Uigur children was significantly less than that in Hui children (9.7±1.2 hrs vs 10.4±1.5 hrs; P<0.05). The mean incidence of sleep disorders was 23.56%. The Uigur children had a lower incidence of sleep disorders compared with the Hui children (18.42% vs 28.16%; P<0.001). Ethnic group, sleep latency, use of a swing bed, family history of snore, watching TV before sleeping, hypertrophy of tonsils, eating before sleeping, feeding patterns and recurrent upper respiratory tract infection were the factors associated with the sleep quality and quantity. The influencing factors of sleep quality and quantity are multifactorial in Uigur and Hui children in Xinjiang Province. Pediatrician, child health care doctors and parents should pay more attention to children's sleep. The incidence of sleep disorders is different between Uigur and Hui children, suggesting that more research for the prevention and treatment of sleep disorders should be performed in different ethic groups.

Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome.

PubMed

Lin, Shih-Wei; Chen, Yen-Lung; Kao, Kuo-Chin; Yang, Cheng-Ta; Chuang, Li-Pang; Chou, Yu-Ting; Lai, Szu-Chia; Chen, Rou-Shayn; Chen, Ning-Hung

2013-01-01

To explore the profile of patients who visit a sleep center with symptoms that fulfill the four essential criteria for restless legs syndrome (RLS). A prospective study. Outpatients from one sleep disorders clinic in Taiwan. 1,200 consecutive patients visit sleep disorders clinic with any sleep complaints. After completing a history and physical examination, all participants answered the RLS questionnaire. Subjects who fulfilled the four essential criteria for RLS were referred to a special clinic. A work-up including blood tests, polysomnography, and specialized neurological tests etc. was performed to make the final diagnosis. A total of 1,185 participants were enrolled, and, of these, 131(11.1%) fulfilled the four essential criteria for RLS, and 121 completed the supplemental work-up. Their mean age was 47.6±13.3 and 52.9% were male. Insomnia and snoring were the most common chief complaints. Obstructive sleep apnea syndrome and other diseases were found in 103 patients. Only 18 (14.9%) patients had no comorbid condition and were diagnosed with primary RLS. Symptoms of RLS are common in patients with sleep complaints. Even in a sleep clinic, using a questionnaire approach for identification of RLS has a low positive predictive value. Clinicians should pay attention to the limitations of the 4-item questionnaire in diagnosis of RLS and also the importance of a careful differential diagnosis to identify possible secondary causes of RLS.

A prospective controlled study of sleep respiratory events in patients with craniovertebral junction malformation.

PubMed

Botelho, Ricardo Vieira; Bittencourt, Lia Rita Azeredo; Rotta, José Marcos; Tufik, Sergio

2003-12-01

Craniovertebral junction malformation (CVJM) or Chiari malformation in adults, with or without syringomyelia and basilar invagination, produces neuronal dysfunction of the brainstem, cerebellum, cranial nerves, and upper spinal cord. The respiratory center and some of its afferent and efferent components can be altered in these diseases. The authors studied patients with and without CVJM to determine whether this physical feature contributed to sleep disturbances. Respiratory manifestations during sleep were studied prospectively, by using whole-night polysomnography, in 32 symptomatic patients (CVJM group) and 16 healthy volunteers (control group). Patients with CVJM presented with more sleep disturbances (reports of snoring and apnea) than those in the control group. The apnea/hypopnea index values were higher in patients with CVJMs than in the control group (13 +/- 15 compared with 3 +/- 6; p = 0.007) and the rate of central sleep apneas was higher in the CVJM than in the control group (22 +/- 30 compared with 4 +/- 8%; p = 0.009). The apnea/hypopnea index was highest in the subgroup with basilar invagination than in the other subgroups. The central apneic episodes were more frequent in the patients with basilar invagination (35 +/- 40%; p = 0.001) and in those with syringomyelia (17.6 +/- 24.6%; p = 0.003) than in the control group (4 +/- 8%). Patients with symptomatic CVJM, especially those with basilar invagination, presented with more sleep respiratory compromise than did those in the control group. The incidence of sleep apnea/hypopnea syndrome is significantly higher in patients with CVJM.

Use of high-frequency peak in spectral analysis of heart rate increment to improve screening of obstructive sleep apnoea.

PubMed

Poupard, Laurent; Court-Fortune, Isabelle; Pichot, Vincent; Chouchou, Florian; Barthélémy, Jean-Claude; Roche, Frédéric

2011-12-01

Several studies have correlated the ratio of the very low frequency power spectral density of heart rate increment (%VLFI) with obstructive sleep apnoea syndrome (OSAS). However, patients with impaired heart rate variability may exhibit large variations of heart rate increment (HRI) spectral pattern and alter the screening accuracy of the method. To overcome this limitation, the present study uses the high-frequency increment (HFI) peak in the HRI spectrum, which corresponds to the respiratory influence on RR variations over the frequency range 0.2 to 0.4 Hz. We evaluated 288 consecutive patients referred for snoring, observed nocturnal breathing cessation and/or daytime sleepiness. Patients were classified as OSAS if their apnoea plus hypopnoea index (AHI) during polysomnography exceeded 15 events per hour. Synchronized electrocardiogram Holter monitoring allowed HRI analysis. Using a %VLFI threshold >2.4% for identifying the presence of OSAS, sensitivity for OSAS was 74.9%, specificity 51%, positive predictive value 54.9% and negative predictive value 71.7% (33 false negative subjects). Using threshold for %VLFI >2.4% and HFI peak position >0.4 Hz, negative predictive value increased to 78.2% while maintaining specificity at 50.6%. Among 11 subjects with %VLFI <2.4% and HFI peak >0.4 Hz, nine demonstrated moderate to severe OSAS (AHI >30). HFI represents a minimal physiological criterion for applying %VLFI by ensuring that heart rate variations are band frequency limited.

Association between Breast Feeding and Paediatric Sleep Disordered Breathing: a Systematic Review.

PubMed

Ponce-Garcia, Cecilia; Hernandez, Ivonne Angelica; Major, Paul; Flores-Mir, Carlos

2017-07-01

Breast feeding has been suggested as a potential protective factor against childhood snoring and sleep disordered breathing (SDB). SDB can have major health consequences. The objective of this systematic review is to synthesise the available literature concerning any potential association between infant feeding methods and SDB in young children. Five electronic databases were searched. All searches were inclusive until August 5, 2016. Two authors independently reviewed potentially relevant articles for eligibility. Any prospective or retrospective study, case-control study, cohort study, clinical trial, and cross-sectional study that evaluated the association between infant feeding methods and SDB were included. Data on study design, aim of study, sample size, study population, assessment tool, infant feeding methods, and outcome measures were extracted. Nine studies fulfilled the criteria to be finally included in this review, only cohorts and cross-sectional studies were identified. While seven of the selected studies reported a statistically significant association between breast feeding and reduced risk of SDB, the remaining two studies did not report any association. The main methodological limitation was high heterogeneity in the diagnostic criteria and assessment tools to identify SDB and limited data collection on infant feeding methods. The current evidence may point to a protective association, however, as uncertainty is moderate, any suggestion that breast feeding may or may not decrease the risk of SDB is currently unwarranted. More research on the topic is required to resolve some of the contradictions between included studies. © 2017 John Wiley & Sons Ltd.

Birth prevalence and initial treatment of Robin sequence in Germany: a prospective epidemiologic study

PubMed Central

2014-01-01

Background We conducted a monthly epidemiological survey to determine the birth prevalence of Robin sequence (RS) and the use of various therapeutic approaches for it. Methods Between August 2011 and July 2012, every pediatric department in Germany was asked to report new admissions of infants with RS to the Surveillance Unit for Rare Pediatric Diseases in Germany. RS was defined as retro- or micrognathia and at least one of the following: clinically evident upper airway obstruction including recessions, snoring or hypoxemia; glossoptosis; feeding difficulties; failure to thrive; cleft palate or RS-associated syndrome. Hospitals reporting a case were asked to return an anonymized questionnaire and discharge letter. Results Of 96 cases reported, we received detailed information on 91. Of these, 82 were included; seven were duplicates and two erroneous reports. Given 662,712 live births in Germany in 2011, the birth prevalence was 12.4 per 100,000 live births. Therapeutic approaches applied included prone positioning in 50 infants, followed by functional therapy in 47. Conventional feeding plates were used in 34 infants and the preepiglottic baton plate (PEBP) in 19. Surgical therapy such as mandibular traction was applied in 2 infants, tracheotomy in 3. Conclusion Compared to other cohort studies on RS, surgical procedures were relatively rarely used as an initial therapy for RS in Germany. This may be due to differences in phenotype or an underrecognition of upper airway obstruction in these infants. PMID:24433508

Public health implications of sleep loss: the community burden.

PubMed

Hillman, David R; Lack, Leon C

2013-10-21

Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of $5.1 billion per year. This comprises $270 million for health care costs for the conditions themselves, $540 million for care of associated medical conditions attributable to sleep disorders, and about $4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.

Sleep patterns and sleep-related complaints of Brazilian interstate bus drivers.

PubMed

Mello, M T; Santana, M G; Souza, L M; Oliveira, P C; Ventura, M L; Stampi, C; Tufik, S

2000-01-01

Sleep-related complaints have become a highlight for physicians as well as public health administrators. Studies of sleep patterns and sleep-related complaints of shift workers have been useful in minimizing reduction in the quality of life due to the warping of the sleep-wake cycle. The objective of the present study was to assess patterns of sleep, sleep-related complaints as well as physical activity and scoring rates for depression and anxiety in interstate bus drivers. Data were obtained with a sleep questionnaire, with the Beck inventory for depression, and the State-Trait Anxiety Inventory (STAI). A total of 400 interstate bus drivers from the northern, southern, central-western and south-eastern regions of Brazil were interviewed. Sixty percent of the subjects interviewed presented at least one sleep-related complaint, 16% admitted to have dozed at the wheel while on duty, and 41% stated that they exercised on a regular basis. Other sleep disturbance complaints reported were: sleep latency 29'17"; physical fatigue, 59.8%; mental fatigue, 45.4%; sleepiness, 25.8%; irritability, 20.6%; insomnia, 37.5%, respiratory disturbances, 19. 25% and snoring, 20.75%. Scores for anxiety and depression were not in the pathological range. The present data reinforce the view that bus drivers are generally discontent with shift work and its effects on sleep. Consequently, it is very important to establish an appropriate work schedule for drivers, besides implementing photo-therapy and physical activities in order to minimize sleepiness when driving.

Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers: a 5- to 9-year follow-up of 400 consecutive patients.

PubMed

Lysdahl, M; Haraldsson, P O

2000-09-01

Heavy snoring and the obstructive sleep apnea syndrome are associated with increased morbidity and mortality in patients with cardiovascular disease. The effect of uvulopalatopharyngoplasty on mortality has been questioned. To investigate long-term survival after palatal surgery. An observational retrospective case-control study with a 5- to 9-year follow-up. A university medical center. Four hundred consecutive heavy snorers (median age, 47 years), 256 of whom had obstructive sleep apnea syndrome. The mean +/- SD body mass index (calculated as weight in kilograms divided by the square of height in meters) of all included patients was 27.1+/-4.2. Comparison was made with 744 control patients (median age, 43 years) who underwent nasal surgery during the same period and a matched general control population. Uvulopalatopharyngoplasty or laser uvulopalatoplasty between 1986 and 1990. Mortality and causes of death up to 9 years after surgery. High blood pressure at the time of surgery and subsequent death due to cardiovascular disease were 3 times more frequent in the patients with obstructive sleep apnea syndrome than in both control groups (P<.01), but the overall long-term mortality was not increased either in snorers or in persons with sleep apnea. The cumulative survival rate was more than 96% for the 400 patients, the 744 controls, and the matched general population. No increased mortality was seen following palatal surgery in this long-term follow-up of 400 consecutive, on average, nonobese snorers, 256 of whom had obstructive sleep apnea syndrome. This might indicate a positive survival effect of surgery.

Contemporary Surgery for Obstructive Sleep Apnea Syndrome

PubMed Central

2009-01-01

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

Lung function, diagnosis, and treatment of sleep-disordered breathing in children with achondroplasia.

PubMed

Julliand, Sébastien; Boulé, Michèle; Baujat, Geneviève; Ramirez, Adriana; Couloigner, Vincent; Beydon, Nicole; Zerah, Michel; di Rocco, Federico; Lemerrer, Martine; Cormier-Daire, Valérie; Fauroux, Brigitte

2012-08-01

Children with achondroplasia are at risk of sleep-disordered breathing. The aim of the study was to evaluate lung function and sleep-disordered breathing in children with achondroplasia. An interview, clinical examination, lung function tests with blood gases, and a polygraphic sleep study were obtained as part of routine annual evaluation in consecutive children with achondroplasia. We included 30 children (median age 3.0 years, range: 0.4-17.1) over a period of 21 months. Habitual snoring and witnessed apneas were observed in 77% and 33% of the patients, respectively. Prior to the sleep study, 10/29 (34%) patients had undergone upper airway surgery and 5/29 (17%) craniocervical decompression operation. Arterial blood gases were abnormal in two (7%) patients. Sleep findings were abnormal in 28/30 (93%) patients. Eleven (37%) patients had an apnea index≥1 event/hr and 26 (87%) had an apnea-hypopnea index≥5 events/hr. The ≥3% desaturation index was >5/hr in 22 (73%) patients. Sixteen (53%) patients had a minimal pulse oximetry<90% but only two (7%) patients had a maximal transcutaneous carbon dioxide pressure>50 mmHg during sleep. As a consequence, the following therapeutic interventions were performed: upper airway surgery in four patients and noninvasive positive pressure ventilation (NPPV) in five other patients, resulting in an improvement in sleep studies in all nine patients. Systematic sleep studies are recommended in children with achondroplasia because of the high prevalence of sleep-disordered breathing. Upper airway surgery and NPPV are effective treatments of sleep-disordered breathing. Copyright © 2012 Wiley Periodicals, Inc.

Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists.

PubMed

Alam, Abdulkader; Chengappa, Kadiamada Nanaiah Roy

2011-10-01

Alam A, Chengappa KNR. Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists Objective: The main objective of this review is to improve psychiatric clinician awareness of obstructive sleep apnoea (OSA) and its potential consequences in patients with schizophrenia. This article will also discuss the diagnosis and treatment options for OSA while considering the significant role psychiatrists can play in facilitating the diagnosis and treatment of OSA. Ovid, Medline and PsychInfo databases were searched for articles between 1960 and 2010. Search terms used were Sleep apnoea or apnoea and schizophrenia or psychosis. The number of articles retrieved was 38. Articles were carefully reviewed for any data pertinent to OSA in patients with schizophrenia. OSA is a common disorder that is frequently unrecognised. As a chronic breathing condition, OSA is associated with adverse health outcomes and high mortality. OSA may co-occur with schizophrenia or evolve over time, especially with weight gain. The diagnosis should be considered whenever a patient presents with risk factors or clinical manifestations that are highly suggestive of OSA. Those who report snoring, daytime sleepiness and are obese or have a large neck circumference should be considered for an OSA diagnosis. Appropriate diagnosis and treatment of OSA can reduce daytime sleepiness, improve cardiovascular and other medical conditions, as well as reduce mortality. Psychiatrists can play very important role in suspecting OSA in their patients and making the initial referral. Furthermore, behavioural management, especially promoting weight loss and smoking cessation, are effective components of OSA treatment that psychiatrists are positioned to facilitate with their patients.

Association between sleep problems and symptoms of attention-deficit/hyperactivity disorder in young adults.

PubMed

Gau, Susan S F; Kessler, Ronald C; Tseng, Wan-Ling; Wu, Yu-Yu; Chiu, Yen-Nan; Yeh, Chin-Bin; Hwu, Hai-Gwo

2007-02-01

To examine the association between sleep-related problems and symptoms of attention-deficit/hyperactivity disorder (ADHD) in a community sample of young adults in Taiwan. A college-based cross-sectional survey. Two thousand two hundred eighty-four first-year college students (aged 18-20) in a university in Taiwan. Each student completed a questionnaire regarding sleep schedule (self-estimated total sleep duration and sleep need), sleep problems (dyssomnia, parasomnia, and snoring), and the Chinese version of the Adult ADHD Self-Report Scale. Subjects were grouped separately for the inattention and hyperactivity subscales into highly likely ADHD (2.3%, 0.7%), probable ADHD (21.3%, 5.7%), and probably non-ADHD (76.4%, 93.6%) groups according to the scoring scheme of the subscales of the Adult ADHD Self-Report Scale. Results showed that, for both inattention and hyperactivity symptoms, the highly likely ADHD and probable ADHD groups were more likely than the non-ADHD group to have a variety of current and lifetime sleep problems. No significant difference in sleep problems was found between the highly likely ADHD and probable ADHD groups. Inattention, but not hyperactivity, was associated with greater sleep need and greater difference between sleep need and self-estimated nocturnal sleep duration. Hyperactivity, but not inattention, was associated with decreased nocturnal sleep duration. Consistent with prior findings from children and adolescents, ADHD symptoms in young adults are related to sleep problems. Further studies on adults with ADHD should help to refine our understanding of the causal basis for any implications of this association.

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.

Associations of allostatic load with sleep apnea, insomnia, short sleep duration, and other sleep disturbances: findings from the National Health and Nutrition Examination Survey 2005 to 2008.

PubMed

Chen, Xiaoli; Redline, Susan; Shields, Alexandra E; Williams, David R; Williams, Michelle A

2014-08-01

To examine whether allostatic load (AL), a measure of cumulative physiologic dysregulation across biological systems, was associated with sleep apnea, insomnia, and other sleep disturbances. Data from the National Health and Nutrition Examination Survey 2005-2008 were used. AL was measured using nine biomarkers representing cardiovascular, inflammatory, and metabolic system functioning. A total of 3330 US adults aged 18 years and older were included in this study. The prevalence of high AL (AL score  ≥3) was the highest among African Americans (26.3%), followed by Hispanic Americans (20.3%), whites (17.7%), and other racial/ethnic group (13.8%). After adjustment for sociodemographic and lifestyle factors, high AL was significantly associated with sleep apnea (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.40-2.63), snoring (OR, 2.20; 95% CI, 1.79-2.69), snorting/stop breathing (OR, 2.16; 95% CI, 1.46-3.21), prolonged sleep latency (OR, 1.42; 95% CI, 1.08-1.88), short sleep duration (<6 hours) (OR, 1.35; 95% CI, 1.00-1.82), and diagnosed sleep disorder (OR, 2.26; 95% CI, 1.66-3.08). There was no clear evidence that observed associations varied by sociodemographic characteristics. This study suggests significant associations of high AL with sleep apnea, sleep apnea symptoms, insomnia component, short sleep duration, and diagnosed sleep disorder among US adults. Copyright © 2014 Elsevier Inc. All rights reserved.

[Primary mucosal tuberculosis of head and neck region: a clinicopathologic analysis of 47 cases].

PubMed

Wang, Shu-yi; Zhu, Jia-xing

2013-10-01

To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region. Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature. The patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients. Primary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.

Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics.

PubMed

Pagel, James F; Forister, Natalie; Kwiatkowki, Carol

2007-02-15

To assess how selected socioeconomic variables known to affect school performance alter the association between reported sleep disturbance and poor school performance in a contiguous middle school/high school population. A school district/college IRB approved questionnaire was distributed in science and health classes in middle school and high school. This questionnaire included a frequency scaled pediatric sleep disturbance questionnaire for completion by students and a permission and demographic questionnaire for completion by parents (completed questionnaires n = 238 with 69.3% including GPA). Sleep complaints occur at high frequency in this sample (sleep onset insomnia 60% > 1 x /wk.; 21.2% every night; sleepiness during the day (45.7% > 1 x /wk.; 15.2 % every night), and difficulty concentrating (54.6% > 1 x /wk.; 12.9% always). Students with lower grade point averages (GPAs) were more likely to have restless/aching legs when trying to fall asleep, difficulty concentrating during the day, snoring every night, difficulty waking in the morning, sleepiness during the day, and falling asleep in class. Lower reported GPAs were significantly associated with lower household incomes. After statistically controlling for income, restless legs, sleepiness during the day, and difficulty with concentration continued to significantly affect school performance. This study provides additional evidence indicating that sleep disturbances occur at high frequencies in adolescents and significantly affect daytime performance, as measured by GPA. The socioeconomic variable of household income also significantly affects GPA. After statistically controlling for age and household income, the number and type of sleep variables noted to significantly affect GPA are altered but persistent in demonstrating significant effects on school performance.

Internet overuse and excessive daytime sleepiness in adolescents.

PubMed

Choi, Kwisook; Son, Hyunsook; Park, Myunghee; Han, Jinkyu; Kim, Kitai; Lee, Byungkoo; Gwak, Hyesun

2009-08-01

The purpose of this study was to examine the association of Internet overuse with excessive daytime sleepiness (EDS). A total of 2336 high school students in South Korea (boys, 57.5%; girls, 42.5%) completed the structured questionnaire. The severity of Internet addiction was evaluated using Young's Internet addiction test. The proportions of boys who were classified as Internet addicts and possible Internet addicts were 2.5% and 53.7%, respectively. For girls, the corresponding proportions were 1.9% and 38.9%, respectively. The prevalence of EDS was 11.2% (boys, 11.2%; girls, 11.1%). When Internet addicts were compared with non-addicts, they consisted of more boys, drank alcohol more, and considered their own health condition as poor. But smoking was not related with Internet addiction. The prevalence rate of EDS for Internet addicts was 37.7%, whereas that for possible Internet addicts and non-addicts was 13.9% and 7.4%, respectively. The prevalence of insomnia, witnessed snoring, apnea, teeth grinding, and nightmares was highest in Internet addicts, middle in possible addicts, and lowest in non-addicts. With adjustment for duration of Internet use, duration of sleep time, age, gender, smoking, taking painkillers due to headache, insomnia symptoms, witnessed apnea, and nightmares, the odds of EDS were 5.2-fold greater (95% confidence interval [CI]: 2.7-10.2) in Internet addicts and 1.9-fold greater (95%CI: 1.4-2.6) in possible Internet addicts compared to non-addicts. Internet addiction is strongly associated with EDS in adolescents. Clinicians should consider examining Internet addiction in adolescent cases of EDS.

Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial.

PubMed

Johal, Ama; Haria, Priya; Manek, Seema; Joury, Easter; Riha, Renata

2017-02-15

To compare the effectiveness of a custom-made (MRDc) versus ready-made (MRDr) mandibular repositioning devices (MRD) in the management of obstructive sleep apnea (OSA). A randomized crossover trial design was adopted in which patients with a confirmed diagnosis of OSA were randomly allocated to receive either a 3-month period of ready-made or custom-made MRD, with an intervening washout period of 2 weeks, prior to crossover. Treatment outcomes included both objective sleep monitoring and patient-centered measures (daytime sleepiness, partner snoring and quality of life). Twenty-five patients, with a mild degree of OSA (apnea-hypopnea index of 13.3 [10.9-25] events/h) and daytime sleepiness (Epworth Sleepiness Scale of 11 [6-16]), completed both arms of the trial. The MRDc achieved a complete treatment response in 64% of participants, compared with 24% with the MRDr (p < 0.001). A significant difference was observed in treatment failures, when comparing the MRDr (36%) with the MRDc (4%). Excessive daytime sleepiness (Epworth Sleepiness Scale ≥ 10) persisted in 33% (MRDc) and 66% (MRDr) of OSA subjects, following treatment. A statistically significant improvement was observed in quality of life scales following MRDc therapy only. Significant differences were observed in relation to both the number of nights per week (p = 0.004) and hours per night (p = 0.006) between the two different designs of device. The study demonstrates the significant clinical effectiveness of a custom-made mandibular repositioning device, particularly in terms of patient compliance and tolerance, in the treatment of OSA. © 2017 American Academy of Sleep Medicine

Obstructive sleep apnea in obese community-dwelling children: the NANOS study.

PubMed

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

2014-05-01

Obesity in children is assumed to serve as a major risk factor in pediatric obstructive sleep apnea syndrome (OSAS). However, the prevalence of OSAS in otherwise healthy obese children from the community is unknown. To determine the prevalence of OSAS in obese children identified and recruited from primary care centers. A cross-sectional, prospective, multicenter study. Spanish children ages 3-14 y with a body mass index (BMI) greater than or equal to the 95th percentile for age and sex were randomly selected, and underwent medical history, snoring, and Pediatric Sleep Questionnaire (PSQ) assessments, as well as physical examination, nasopharyngoscopy, and nocturnal polysomnography (NPSG) recordings. Two hundred forty-eight children (54.4% males) with mean age of 10.8 ± 2.6 y were studied with a BMI of 28.0 ± 4.7 kg/m(2) corresponding to 96.8 ± 0.6 percentile when adjusted for age and sex. The mean respiratory disturbance index (RDI), obstructive RDI (ORDI), and obstructive apnea-hypopnea index (OAHI) were 5.58 ± 9.90, 5.06 ± 9.57, and 3.39 ± 8.78/h total sleep time (TST), respectively. Using ≥ 3/h TST as the cutoff for the presence of OSAS, the prevalence of OSAS ranged from 21.5% to 39.5% depending on whether OAHI, ORDI, or RDI were used. The prevalence of obstructive sleep apnea syndrome (OSAS) in obese children from the general population is high. Obese children should be screened for the presence of OSAS. ClinicalTrials.gov identifier: NCT01322763.

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

PubMed

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

2015-01-01

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

Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening.

PubMed

Yusoff, M Fadhli Mohd; Baki, Marina Mat; Mohamed, Norlen; Mohamed, A Sani; Yunus, M Razif Mohamad; Ami, Mazita; Othman, Ilhamah; Ishak, Azlan I

2010-12-01

Obstructive sleep apnea (OSA) has been identified as one of the significant risk factors for motor vehicle crashes (MVCs). In the interest of public safety, this study was conducted to determine the prevalence of OSA and its associated factors among express bus drivers in Malaysia. Identifying factors or conditions related with OSA is very important because they can be used as indicators to subject a person to a confirmatory diagnosis using polysomnography testing. Two hundred eighty-nine randomly selected express bus drivers from 5 express bus companies participated in the study. Information on demography, medical history, clinical symptoms, and signs of OSA were collected by a designated medical officer and the diagnosis of OSA was done based on the Apnea Hypopnoea Index (AHI) from polysomnography testing. Based on AHI, 128 (44.3%) subjects were diagnosed as having OSA with 83 (28.7%), 26 (9.0%), and 26 (6.6%) classified as mild, moderate, and severe OSA, respectively. Multiple logistic regression analysis results showed that age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.01-1.09), snoring (OR = 3.54, 95% CI 1.91-6.57), body mass index (BMI; OR = 1.17, 95% CI 1.09-1.25), hypertension (OR = 1.87, 95% CI 1.02-3.40), and neck circumference (OR = 1.31, 95% CI 1.18-1.46) were significantly associated with OSA status. The results supported the need for identifying the risk group for OSA among express bus drivers and the need to diagnose them early for an early intervention.

[Therapeutic consequences of obstructive sleep apnea syndrome--results of drug, mechanical and surgical treatment].

PubMed

Fietze, I; Warmuth, R; Quispe-Bravo, S; Waschke, K

1993-12-01

The therapeutical strategy of the obstructive sleep apnoea syndrome depends on the differential diagnosis of the sleep disorder, the subjective complaints and the patients' individual cardiopulmonary risk profile. Basic requirements for a successful treatment are stepped concepts for therapy. Initial therapeutical methods are preventive measures such as adequate sleep hygiene, weight loss, and reduction of alcoholic intake. We investigated the effectiveness of following therapeutical methods: drug treatment, nasal CPAP therapy and surgical approach. We present the results of the first 151 treated patients aged between 15 and 88 years (mean: 50.8 +/- 11.5 SD). 20 patients with an apnoea index below 20 per hour were treated with theophylline. After 4 weeks with theophylline there were no significant changes in apnoea index, O2 saturation and snoring level. 24 patients themselves preferred the Uvulopalatopharyngoplasty (UPPP). 8 weeks after surgical approach we couldn't find significant changes in the apnoea index although 11 of these patients reported on a better sleep quality. 107 patients were treated with nasal CPAP. The effective CPAP pressures were between 6 and 14.5 mbar. Long term compliance with CPAP was studied in a survey of 70 patients who underwent a CPAP trial. After 6 months 97% were complaint, 17% of them additionally were using a humidifier. Our data show that effective therapy can be achieved with nCPAP objectively and subjectively. Other methods--theophylline and UPPP--are less successful. CPAP is likely to remain the first choice for treatment of sleep related breathing disorders and it should be applied more generously.

Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment

PubMed Central

Sánchez, Trinidad; Castro-Rodríguez, José A; Brockmann, Pablo E

2016-01-01

Background The objective was to perform a systematic review in order to describe the relationship between asthma and sleep-disordered breathing (SDB) in children, especially regarding the impact of treatment and management. Methods We performed an electronic search in MEDLINE, EMBASE, and LILACS database. Study inclusion criteria were the following: 1) studies that examined the relationship between asthma/wheezing and SDB/obstructive sleep apnea (OSA); and 2) studies conducted in children <18 years of age. Primary outcomes were the prevalence of asthma and SDB, the tests used for diagnosis, and the influence of their treatment and management. Results One thousand and twenty studies were identified, among which 32 were selected (n=143,343 children; 51% males; age [mean ± standard deviation] 8.4±2.5 years). Most studies (n=26) diagnosed SDB using questionnaires or clinical history. Nine studies performed a sleep study for diagnosing OSA. The diagnosis of asthma was based on clinical history (n=16), previous medical diagnosis (n=4), questionnaires (n=12), and spirometry (n=5). Children with asthma were more likely to develop habitual snoring and OSA, and children with SDB were more likely to develop asthma. Moreover, asthma was associated with more severe OSA, and the presence of SDB was associated with severe asthma. Treatment of SDB with adenotonsillectomy was associated with significant asthma improvement. Conclusion The relationship between asthma and SDB appears to be bidirectional, and adenotonsillectomy appears to improve asthma control. Future trials on how asthma treatment could impact on SDB are needed. PMID:27143940

Sleep quality and effects of position on sleep apnea in East Asian children.

PubMed

Kim, Hyo Yeol; Dhong, Hun-Jong; Lee, Jae-Kwon; Chung, Seung-Kyu; Jung, Soo-Chan

2011-04-01

To assess whether obstructive sleep apnea syndrome (OSAS) affects sleep architecture and quality in East Asian children, and also to assess the effects of body position during sleep on respiratory disturbance during sleep. We enrolled 50 consecutive East Asian children with habitual snoring between 2007 and 2009. Nineteen children had OSAS (apnea-hypopnea index, AHI≥5; OSAS group) and 31 children were simple snorers (control group). They underwent polysomnography and physical examination of their nasal and oral cavities with a roentgenogram of the nasopharynx. Sleep architecture and other polysomnographic variables were compared between the OSAS and control groups. The effect of body position during sleep on respiratory disturbance was examined, and also in relation to obesity and adeno-tonsillar size. There was a decrease in total sleep time and in sleep efficiency, as well as increased arousal and heart rate (P<0.05) in the OSAS group. Sub-analysis of AHI according to sleep posture showed that AHI is higher when the patient is in the supine position than in the non-supine position (P=0.032). The presence of OSAS and kissing tonsils were contributing factors to the positional difference in AHI (P<0.05). Obesity and adenoid hypertrophy did not affect the positional difference of AHI. OSAS may have a greater influence on the sleep architecture of East Asian children, and East Asian children may have a higher AHI when sleeping in the supine position. Tonsillar hypertrophy and the presence of OSAS are possible contributing factors for positional difference of AHI in East Asian children. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Association between allergic disease, sleep-disordered breathing, and childhood nocturnal enuresis: a population-based case-control study.

PubMed

Tsai, Jeng-Dau; Chen, Hsuan-Ju; Ku, Min-Sho; Chen, Shan-Ming; Hsu, Chih-Chuan; Tung, Min-Che; Lin, Che-Chen; Chang, Hsing-Yi; Sheu, Ji-Nan

2017-12-01

Little is known about the associations between allergic disease, sleep-disordered breathing (SDB), and childhood nocturnal enuresis (NE). We examined whether allergic disease and SDB were associated with childhood NE. Data were assessed from the 2007-2012 Taiwan National Health Insurance Research Database. We enrolled 4308 children aged 5-18 years having NE diagnosis and age- and sex-matched 4308 children as the control group. The odds ratios of NE were calculated to determine an association with preexisting allergic disease and SDB. A total of 8616 children were included in the analysis. Prevalence of allergic diseases and SDB was significantly higher for the NE group than the control group (all p < 0.001). After adjusting odds ratios for potential confounding factors, except asthma, children with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and obstructive sleep apnea (OSA) had significantly higher odds of NE compared with children never diagnosed. With stratification for sex, girls with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, OSA, and snoring had significantly higher odds of NE, compared with girls never diagnosed. Only boys with allergic rhinitis and OSA were associated with increased odds of NE. With stratification for age, children aged 5-12 years with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and OSA had significantly higher odds of NE compared with those never diagnosed. Odds of NE increased with the number of comorbid allergic diseases. Allergic diseases and SDB are associated with increased odds of childhood NE. The odds of NE increased with the number of comorbid allergic diseases present.

Prevalence of poor sleep quality, sleepiness and obstructive sleep apnoea risk factors in athletes.

PubMed

Swinbourne, Richard; Gill, Nicholas; Vaile, Joanna; Smart, Daniel

2016-10-01

Despite the perceived importance of sleep for athletes, little is known regarding athlete sleep quality, their prevalence of daytime sleepiness or risk factors for obstructive sleep apnoea (OSA) such as snoring and witnessed apnoeic episodes. The purpose of the present study was to characterise normative sleep quality among highly trained team sport athletes. 175 elite or highly trained rugby sevens, rugby union and cricket athletes completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS) and Quality of Life questionnaires and an OSA risk factor screen. On average, athletes reported 7.9 ± 1.3 h of sleep per night. The average PSQI score was 5.9 ± 2.6, and 50% of athletes were found to be poor sleepers (PSQI > 5). Daytime sleepiness was prevalent throughout the population (average global score of 8.5) and clinically significant (ESS score of ≥10) in 28% of athletes. OSA may be an important clinical consideration within athletic populations, as a considerable number of athletes (38%) defined themselves as snorers and 8% reported having a witnessed apnoeic episode. The relationship between self-rated sleep quality and actual PSQI score was strong (Pearson correlation of 0.4 ± 0.1, 90% confidence limits). These findings suggest that this cohort of team sport athletes suffer a preponderance of poor sleep quality, with associated high levels of daytime sleepiness. Athletes should receive education about how to improve sleep wake schedules, extend total sleep time and improve sleep quality.

Complaints of Poor Sleep and Risk of Traffic Accidents: A Population-Based Case-Control Study.

PubMed

Philip, Pierre; Chaufton, Cyril; Orriols, Ludivine; Lagarde, Emmanuel; Amoros, Emmanuelle; Laumon, Bernard; Akerstedt, Torbjorn; Taillard, Jacques; Sagaspe, Patricia

2014-01-01

This study aimed to determine the sleepiness-related factors associated with road traffic accidents. A population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents. As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57-63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30-8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00-2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: 1.03-3.97, p<0.05), and 3.29 times higher in subjects reporting taking more than 2 medications in the last 24 h (CI 95%: 1.14-9.44, p<0.05). Chronic daytime sleepiness measured by the Epworth Sleepiness Scale, expressed heavy snoring and nocturnal leg movements did not explain traffic accidents. Physicians should be attentive to complaints of poor sleep quality and quantity, symptoms of anxiety-nervousness and/or drug consumption in regular car drivers.

Effects of desmopressin for the treatment of nocturnal polyuria in elderly women: impact on related sleep quality

PubMed Central

Mun, Jong-Hyeon; Kim, Sun-Ouck; Yu, Ho Song; Chung, Ho Suck; Kwon, Dongdeuk

2015-01-01

Introduction: We investigated the efficacy, safety, and impact of desmopressin on quality of sleep in treating nocturnal polyuria in elderly women. Methods: We recruited 60 women over 60 years old with lower urinary tract symptoms (LUTS), including nocturia, and with nocturnal polyuria. Nocturnal polyuria was defined as nighttime urine production exceeding 33% of the 24-hour total urine volume determined by a frequency volume (FV) chart. All patients failed to respond to treatment of their underlying disease and evening fluid restriction. Desmopressin 0.1 mg was administered orally at bedtime for 12 weeks. The participants completed a series of questionnaires on the Medical Outcomes Study (MOS) sleep scale and FV chart before and after treatment. Results: The patient population had a mean age of 69.2 ± 9.4 years (range: 61–81). The mean duration of symptoms was 61.2 ± 45.1 months. Significant decreases were evident after desmopressin treatment in the number of nocturia episodes (3.63 ± 1.61 to 2.00 ± 1.13, p = 0.01), nocturnal urine volume (p = 0.01), nocturnal polyuria index (NPI) (p = 0.01), and nocturia index (NI) p = 0.01). Among the categories of the MOS sleep scale, sleep index (p = 0.003), sleep disturbance (p = 0.001), snoring (p = 0.028), and shortness of breath (p = 0.036) significantly changed, with a decreased number of nocturia episodes. Adverse events were mild. Conclusions: Desmopressin is an effective treatment for nocturnal polyuria in elderly women, where conservative treatment has failed. Sleep quality is also improved. PMID:26600882

Methods for increasing upper airway muscle tonus in treating obstructive sleep apnea: systematic review.

PubMed

Valbuza, Juliana Spelta; de Oliveira, Márcio Moysés; Conti, Cristiane Fiquene; Prado, Lucila Bizari F; de Carvalho, Luciane Bizari Coin; do Prado, Gilmar Fernandes

2010-12-01

Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods. The design used was a systematic review of randomized controlled trials. Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved. This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments. Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant. There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.

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

PubMed Central

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

2015-01-01

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

Sleep quality during pregnancy: associations with depressive and anxiety symptoms.

PubMed

Polo-Kantola, Päivi; Aukia, Linda; Karlsson, Hasse; Karlsson, Linnea; Paavonen, E Juulia

2017-02-01

Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms. A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory. Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too-early morning awakenings increased in late pregnancy compared with mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow up. In late pregnancy, depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy. We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectionally associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Effect of changes in periodic limb movements under cpap on adherence and long term compliance in obstructive sleep apnea.

PubMed

Mwenge, Gimbada B; Rougui, Ihsan; Rodenstein, Daniel

2017-11-20

Purpose of the study Periodic leg movements (PLMs) are found in 30% of patients suffering from OSA. Under CPAP, we observed that PLMs can increase, decrease, or remain unchanged. The predictors of these changes are not well established. Objective To determine the predictors of PLMs change under CPAP and its impact on long-term adherence. Materials and method The patients were referred to the sleep laboratory for snoring or sleepiness. A single PSG night has been performed before and after CPAP treatment. Data on medication used, comorbidities and ferritin level were collected. Results A total of 160 patients were recruited with a severe OSA. About 32.5% (52/160) patients had emerging PLM i.e. that appeared after the disappearance of respiratory events. By comparing patients with emerging-PLMs to others, we found that only the blood ferritin level was significantly different between groups. Moreover, after one-year follow-up, a significant difference in adherence and long-term compliance was observed between patients without PLM at both screening and CPAP polysomnographies or emerging PLM at the second study (56%) vs. patients with baseline PLM, whether PLM remained stable or decreased under CPAP treatment (75%) (p-value 0.028). Serum ferritin and presence of diabetes mellitus predicted the evolution of PLM observed. Patients with low ferritin levels demonstrated an increase of PLM after initiation of nasal CPAP treatment. Conclusion The emergence of PLM negatively impacts long-term adherence to nasal CPAP treatment in OSA. Blood ferritin level is a predictor of the evolution of PLM under CPAP therapy.

Dad's Snoring May Have Left Molecular Scars in Your DNA: the Emerging Role of Epigenetics in Sleep Disorders.

PubMed

Morales-Lara, Daniela; De-la-Peña, Clelia; Murillo-Rodríguez, Eric

2018-04-01

The sleep-wake cycle is a biological phenomena under the orchestration of neurophysiological, neurochemical, neuroanatomical, and genetical mechanisms. Moreover, homeostatic and circadian processes participate in the regulation of sleep across the light-dark period. Further complexity of the understanding of the genesis of sleep engages disturbances which have been characterized and classified in a variety of sleep-wake cycle disorders. The most prominent sleep alterations include insomnia as well as excessive daytime sleepiness. On the other side, several human diseases have been linked with direct changes in DNA, such as chromatin configuration, genomic imprinting, DNA methylation, histone modifications (acetylation, methylation, ubiquitylation or sumoylation, etc.), and activating RNA molecules that are transcribed from DNA but not translated into proteins. Epigenetic theories primarily emphasize the interaction between the environment and gene expression. According to these approaches, the environment to which mammals are exposed has a significant role in determining the epigenetic modifications occurring in chromosomes that ultimately would influence not only development but also the descendants' physiology and behavior. Thus, what makes epigenetics intriguing is that, unlike genetic variation, modifications in DNA are altered directly by the environment and, in some cases, these epigenetic changes may be inherited by future generations. Thus, it is likely that epigenetic phenomena might contribute to the homeostatic and/or circadian control of sleep and, possibly, have an undescribed link with sleep disorders. An exciting new horizon of research is arising between sleep and epigenetics since it represents the relevance of the study of how the genome learns from its experiences and modulates behavior, including sleep.

PREOXYGENATION: COULD SAFETY MEASURE BE MADE LESS DANGEROUS?.

PubMed

Kamenskaya, L U; Lebedinskiy, K M

2016-11-01

While providing reserve time for dificult airway management, preoxygenation with pure oxygen increases the risk of pulmonary complications due to absorption atelectases. The authors explored when it could be appropriate to prevent atelectases by preoxygenation with decreased FiO₂. ASA I-II elective gynecological surgery patients were randomized among five groups (n = 22 each) with preoxygenation using FiO₂ 100, 70, 60, 60% + PEEP 5 mbar and 50%. Even FiO₂ 70% led to decrease. in safe apnea time (i.e. time interval to Sp²O₂ 95%) by two, while FiO₂ 50% - by more than three times. Furthermore, in five similar additional groups of women with same techniques ofpreoxygenation (n = 10 each) it was shown that for FiO₂ 5 70% very fast pattern of SpO2 fall after the first change ofpulseoxymeter figure (100% by 99%) is typical: interval to SpO2 90% was less than 1 min, while for FiO₂ 100% it lasts for 200 s. Since critical problem is "Cannot intubate, cannot ventilate", the authors tried to focus on the difficultfacemask ventilation prognosis. In the group of 71 elective general surgery patients (31 males, 40 females, ASA I-III) original prognostic model based on seven simple bedside tests (removable dentures, beard, snoring, Mallampati class 2-4, age > 50 y.o., BM > 30 kg/m², sternomental distance < 12 cm) demonstrated the reliability of difficult facemask ventilation negative prognosis of 97,5%. The authors suggest that only in patients with reliable prognosis of easy facemask ventilation prevention ofpulmonary complications by preoxygenation with FiO₂ 50-60% could be safely recommended.

Derivation and validation of a discharge disposition predicting model after acute stroke.

PubMed

Tseng, Hung-Pin; Lin, Feng-Jenq; Chen, Pi-Tzu; Mou, Chih-Hsin; Lee, Siu-Pak; Chang, Chun-Yuan; Chen, An-Chih; Liu, Chung-Hsiang; Yeh, Chung-Hsin; Tsai, Song-Yen; Hsiao, Yu-Jen; Lin, Ching-Huang; Hsu, Shih-Pin; Yu, Shih-Chieh; Hsu, Chung-Y; Sung, Fung-Chang

2015-06-01

Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

A nationwide cross-sectional study on congenital heart diseases and symptoms of sleep-disordered breathing among Japanese Down's syndrome people.

PubMed

Sawatari, Hiroyuki; Chishaki, Akiko; Nishizaka, Mari; Matsuoka, Fumio; Yoshimura, Chikara; Kuroda, Hiromi; Rahmawati, Anita; Hashiguchi, Nobuko; Miyazono, Mami; Ono, Junji; Ohkusa, Tomoko; Ando, Shin-Ichi

2015-01-01

It is well known that people with Down's syndrome (DS) frequently complicate with congenital heart diseases (CHDs). Patients with heart diseases often have sleep-disordered breathing as a co-morbidity (SDB) which worsens the heart diseases. However, the relationship between SDB and CHDs in DS people has not yet been fully elucidated. The aim of this study was to establish the association between SDB and CHDs in DS people using data from a large nationwide questionnaire survey in Japan. We conducted a cross-sectional questionnaire survey of a randomly selected sample of 2,000 DS people and their caregivers throughout Japan to examine the associations between observed signs of SDB and CHDs in DS people. The questionnaire included the presence of SDB symptoms (snoring, apnea, arousal, nocturia, and napping) and CHDs (the presence and types of CHDs). Of the 1,222 replies received from the caregivers, 650 reported complications of some type of CHDs. The observed apnea tended to be higher among DS people with CHDs than those without CHDs (OR=1.28, 95% CI=0.97-1.70, p=0.09). DS people with tetralogy of Fallot reported significantly more frequent apnea than those without CHDs (OR=3.10, 95% CI=1.36-7.05, p<0.01). SDB prevailed among DS people with severe CHDs, such as tetralogy of Fallot. Careful attention to the signs of SDB in such patients may lead to earlier clinical intervention removing the vicious cycle between SDB and CHDs.

Long-term changes in neurocognition and behavior following treatment of sleep disordered breathing in school-aged children.

PubMed

Biggs, Sarah N; Vlahandonis, Anna; Anderson, Vicki; Bourke, Robert; Nixon, Gillian M; Davey, Margot J; Horne, Rosemary S C

2014-01-01

Sleep disordered breathing (SDB) in children is associated with detrimental neurocognitive and behavioral consequences. The long term impact of treatment on these outcomes is unknown. This study examined the long-term effect of treatment of SDB on neurocognition, academic ability, and behavior in a cohort of school-aged children. Four-year longitudinal study. Children originally diagnosed with SDB and healthy non-snoring controls underwent repeat polysomnography and age-standardized neurocognitive and behavioral assessment 4y following initial testing. Melbourne Children's Sleep Centre, Melbourne, Australia. Children 12-16 years of age, originally assessed at 7-12 years, were categorized into Treated (N = 12), Untreated (N = 26), and Control (N = 18) groups. Adenotonsillectomy, Tonsillectomy, Nasal Steroids. Decision to treat was independent of this study. Changes in sleep and respiratory parameters over time were assessed. A decrease in obstructive apnea hypopnea index (OAHI) from Time 1 to Time 2 was seen in 63% and 100% of the Untreated and Treated groups, respectively. The predictive relationship between change in OAHI and standardized neurocognitive, academic, and behavioral scores over time was examined. Improvements in OAHI were predictive of improvements in Performance IQ, but not Verbal IQ or academic measures. Initial group differences in behavioral assessment on the Child Behavior Checklist did not change over time. Children with SDB at baseline continued to exhibit significantly poorer behavior than Controls at follow-up, irrespective of treatment. After four years, improvements in SDB are concomitant with improvements in some areas of neurocognition, but not academic ability or behavior in school-aged children.

Sleep medicine content in dental hygiene education.

PubMed

Minichbauer, Brittany C; Sheats, Rose D; Wilder, Rebecca S; Phillips, Ceib L; Essick, Gregory K

2015-05-01

According to the National Research Council, 70 million Americans chronically suffer from approximately 60 medically recognized sleep disorders. With most clinicians unaware of these disorders, many individuals remain undiagnosed. To effectively address this issue, health care professionals must work collaboratively to educate, identify, and treat patients with sleep disorders. However, medical and dental clinicians do not receive adequate education in sleep medicine. On the frontline regarding prevention and counseling, dental hygienists play an important role in patient education, screening, and management of sleep disorders. The aim of this study was to assess the amount of sleep medicine content in U.S. dental hygiene programs. An electronic survey was emailed to all 334 accredited U.S. dental hygiene programs. The 18-question survey assessed the sleep medicine content presented during the 2012-13 academic year. A total of 35.3% (n=118) of the programs responded. The mean number of hours devoted to sleep medicine in their curricula was 1.55 hours (SD=1.37). Although 69% (n=79) of the responding programs reported spending time on sleep bruxism (mean=1.38 hours, SD=0.85), only 28% (n=32) reported spending time on other topics such as snoring and obstructive sleep apnea (mean=1.39 hours, SD=0.72). These results suggest that sleep medicine is included in the majority of U.S. dental hygiene programs, but the content is limited and focused on sleep bruxism. This level of training is inadequate to prepare dental hygienists for their potential role in patient education, screening, and management of sleep-related breathing disorders.

Treatment of obstructive sleep apnoea patients in community dental care: knowledge and attitudes among general dental practitioners and specialist dentists.

PubMed

Vuorjoki-Ranta, T-R; Lobbezoo, F; Vehkalahti, M; Tuomilehto, H; Ahlberg, J

2016-12-01

Obstructive sleep apnoea (OSA) is an increasing problem worldwide. Yet, a large number of patients may remain undiagnosed. Dentists could suspect OSA, but little is known about their knowledge and attitudes towards the topic. An email questionnaire was sent to dentists working in Helsinki Health Centre, Helsinki, Finland (n = 226). It consisted of demographic data, items on dentists' overall knowledge of OSA and factors associated with it, and their possibilities and willingness to take part in the recognition and treatment of OSA patients. Altogether, 70·9% (n = 134) of dentists eligible for the study completed the questionnaire. Of them, 79·1% (n = 106) were general practitioners and 20·9% (n = 28) dentists with specialty training. Continuous positive airway pressure (CPAP) (99·3%) and weight control (99·3%) were both generally acknowledged as effective methods to treat OSA. Regarding the efficacy of other treatment modalities, significant differences were found between general practitioners' and specialists' opinions. For example, mandibular advancement devices (MAD) were less often reported by general practitioners (69·8%) than specialists (89·3%) (P < 0·05). The possible risk factors, signs and symptoms, and consequences of OSA were overall well recognised regardless the years in dental profession, but specialists saw more often that nocturnal sweating (P < 0·01) and snoring (P < 0·05) may signify OSA. Dentists could play an important role in suspecting OSA, but they may need more education to cope with that. © 2016 John Wiley & Sons Ltd.

Predicting respiratory hospital admissions in young people with cerebral palsy.

PubMed

Blackmore, Amanda Marie; Bear, Natasha; Blair, Eve; Langdon, Katherine; Moshovis, Lisa; Steer, Kellie; Wilson, Andrew C

2018-03-19

To determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP). A 3-year prospective cohort study using linked data. Children and young people with CP, aged 1 to 26 years. Self-reported and carer-reported respiratory symptoms were linked to respiratory hospital admissions (as defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes) during the following 3 years. 482 participants (including 289 males) were recruited. They were aged 1 to 26 years (mean 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastro-oesophageal reflux disease, at least two courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms and nightly snoring. Most risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Study of Image Quality From CT Scanner Multi-Detector by using Americans College of Radiology (ACR) Phantom

NASA Astrophysics Data System (ADS)

Mulyadin; Dewang, Syamsir; Abdullah, Bualkar; Tahir, Dahlang

2018-03-01

In this study, the image quality of CT scan using phantom American College of Radiology (ACR) was determined. Scanning multidetector CT is used to know the image quality parameters by using a solid phantom containing four modules and primarily from materials that are equivalent to water. Each module is 4 cm in diameter and 20 cm in diameter. There is white alignment marks painted white to reflect the alignment laser and there are also “HEAD”, “FOOT”, and “TOP” marks on the phantom to help align. This test obtains CT images of each module according to the routine inspection protocol of the head. Acceptance of image quality obtained for determination: CT Number Accuracy (CTN), CT Number Uniformity and Noise, Linearity CT Number, Slice Technique, Low Contrast Resolution and High Contrast Resolution represent image quality parameters. In testing CT Number Accuracy (CTN), CT Uniform number and Noise are in the range of tolerable values allowed. In the test, Linearity CT Number obtained correlation value above 0.99 is the relationship between electron density and CT Number. In a low contrast resolution test, the smallest contrast groups are visible. In contrast, the high resolution is seen up to 7 lp/cm. The quality of GE CT Scan is very high, as all the image quality tests obtained are within the tolerance brackets of values permitted by the Nuclear Power Control Agency (BAPETEN). Image quality test is a way to get very important information about the accuracy of snoring result by using phantom ACR.

Sleep habits, insomnia, and daytime sleepiness in a large and healthy community-based sample of New Zealanders.

PubMed

Wilsmore, Bradley R; Grunstein, Ronald R; Fransen, Marlene; Woodward, Mark; Norton, Robyn; Ameratunga, Shanthi

2013-06-15

To determine the relationship between sleep complaints, primary insomnia, excessive daytime sleepiness, and lifestyle factors in a large community-based sample. Cross-sectional study. Blood donor sites in New Zealand. 22,389 individuals aged 16-84 years volunteering to donate blood. N/A. A comprehensive self-administered questionnaire including personal demographics and validated questions assessing sleep disorders (snoring, apnea), sleep complaints (sleep quantity, sleep dissatisfaction), insomnia symptoms, excessive daytime sleepiness, mood, and lifestyle factors such as work patterns, smoking, alcohol, and illicit substance use. Additionally, direct measurements of height and weight were obtained. One in three participants report < 7-8 h sleep, 5 or more nights per week, and 60% would like more sleep. Almost half the participants (45%) report suffering the symptoms of insomnia at least once per week, with one in 5 meeting more stringent criteria for primary insomnia. Excessive daytime sleepiness (evident in 9% of this large, predominantly healthy sample) was associated with insomnia (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.50 to 2.05), depression (OR 2.01, CI 1.74 to 2.32), and sleep disordered breathing (OR 1.92, CI 1.59 to 2.32). Long work hours, alcohol dependence, and rotating work shifts also increase the risk of daytime sleepiness. Even in this relatively young, healthy, non-clinical sample, sleep complaints and primary insomnia with subsequent excess daytime sleepiness were common. There were clear associations between many personal and lifestyle factors-such as depression, long work hours, alcohol dependence, and rotating shift work-and sleep problems or excessive daytime sleepiness.

Association between sleeping difficulty and type 2 diabetes in women.

PubMed

Li, Yanping; Gao, Xiang; Winkelman, John W; Cespedes, Elizabeth M; Jackson, Chandra L; Walters, Arthur S; Schernhammer, Eva; Redline, Susan; Hu, Frank B

2016-04-01

Sleeping difficulty has been associated with type 2 diabetes in some prior studies. Whether the observed associations are independent of health behaviours, other cardiovascular risk factors or other sleep disorders is unclear. We analysed data from 133,353 women without diabetes, cardiovascular disease and cancer at baseline in the Nurses' Health Study (NHS, 2000-2010) and the NHSII (2001-2011). Sleeping difficulty was assessed as having difficulty falling or staying asleep 'all of the time' or 'most of the time' at baseline (2000 in NHS and 2001 in NHSII). We documented 6,407 incident cases of type 2 diabetes during up to 10 years of follow-up. After adjustment for lifestyle factors at baseline, comparing women with and without sleeping difficulty, the multivariate-adjusted HR (95% CI) for type 2 diabetes was 1.45 (95% CI 1.33, 1.58), which changed to 1.22 (95% CI 1.12, 1.34) after further adjustment for hypertension, depression and BMI based on the updated repeated measurements. Women who reported all four sleep conditions (sleeping difficulty, frequent snoring, sleep duration ≤6 h and sleep apnoea in NHS or rotating shift work in NHSII) had more than a fourfold increased likelihood of type 2 diabetes (HR 4.17, 95% CI 2.93, 5.91). Sleeping difficulty was significantly associated with type 2 diabetes. This association was partially explained by associations with hypertension, BMI and depression symptoms, and was particularly strong when combined with other sleep disorders. Our findings highlight the importance of sleep disturbance in the development and prevention of type 2 diabetes.

Relationships Between Smoking and Sleep Problems in Black and White Adolescents.

PubMed

Bellatorre, Anna; Choi, Kelvin; Lewin, Daniel; Haynie, Denise; Simons-Morton, Bruce

2017-01-01

The relationship between sleeping and smoking during adolescence remains unclear and is likely complex. We aim to evaluate the longitudinal reciprocal associations between sleep problems, sleep duration, and smoking among non-Hispanic white (NHW) and non-Hispanic black (NHB) youth. Prospective cohort study. NEXT Generation Health Study. A national sample (N = 1394) of NHB and NHW 10th graders were surveyed annually between 2009 (Wave 1) and 2012 (Wave 3). N/A. Past 30-day smoking, chronic difficulty falling asleep, recent difficulty falling asleep, difficulty staying asleep, and weekday and weekend sleep duration were measured at each wave. Using structural equation models, we observed significant autocorrelations over time for sleep problems and sleep duration. We found significant reciprocal, prospective relationships between smoking and sleep problems. The strengths of the relationships differed by race, with a stronger association between sleep problems and subsequent smoking for NHB than NHW youth. Conversely, a stronger association between smoking and subsequent sleep problems for NHW than NHB youth was observed. These association were independent of demographics, snoring or sleep apnea, body mass index, depressive symptoms, alcohol use, and soda consumption. Reciprocal and prospective relationships exist for youth smoking and sleep problems and duration in both NHW and NHB youth. Further research is needed to unravel the complex relationship between the direct effects of nicotine, lifestyle choices that may link smoking and sleep problems, and racial differences. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients.

PubMed

Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang

2017-05-01

Obstructive sleep apnea (OSA) is very common in stroke survivors. It potentially worsens the cognitive dysfunction and inhibits their functional recovery. However, whether OSA independently damages the cognitive function in stroke patients is unclear. A simple method for evaluating OSA-induced cognitive impairment is also missing. Forty-four stroke patients six weeks after onset and 24 non-stroke patients with snoring were recruited for the polysomnographic study of OSA and sleep architecture. Their cognitive status was evaluated with a validated Chinese version of Cambridge Prospective Memory Test. The relationship between memory deficits and respiratory, sleeping, and dementia-related clinical variables were analyzed with correlation and multiple linear regression tests. OSA significantly and independently damaged time- and event-based prospective memory in stroke patients, although it had less power than the stroke itself. The impairment of prospective memory was correlated with increased apnea-hypopnea index, decreased minimal and mean levels of peripheral oxygen saturation, and disrupted sleeping continuity (reduced sleep efficiency and increased microarousal index). The further regression analysis identified minimal levels of peripheral oxygen saturation and sleep efficiency to be the two most important predictors for the decreased time-based prospective memory in stroke patients. OSA independently contributes to the cognitive dysfunction in stroke patients, potentially through OSA-caused hypoxemia and sleeping discontinuity. The prospective memory test is a simple but sensitive method to detect OSA-induced cognitive impairment in stroke patients. Proper therapies of OSA might improve the cognitive function and increase the life quality of stroke patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Sleep and sickness absence: a nationally representative register-based follow-up study.

PubMed

Lallukka, Tea; Kaikkonen, Risto; Härkänen, Tommi; Kronholm, Erkki; Partonen, Timo; Rahkonen, Ossi; Koskinen, Seppo

2014-09-01

We aimed to examine various sleep measures as determinants of sickness absence while considering confounders. Nationally representative Health 2000 Survey linked with sickness absence data from the Finnish Social Insurance Institution. Finland. Working-aged women (n = 1,875) and men (n = 1,885). N/A. Insomnia-related symptoms, early morning awakenings, being more tired during daytime than other people of same age, use of sleeping pills, excessive daytime sleepiness, probable sleep apnea (4 items about snoring/apnea), and reporting that sleep duration varies between different seasons were examined as determinants of sickness absence over a 7.2 year follow-up. Poisson and gamma regression models were fitted. After adjusting age, all examined sleep disturbances except excessive daytime sleepiness were associated with sickness absence among men (RRs 1.3-2.5). Among women, after adjusting for age, insomnia-related symptoms, early morning awakenings, being more tired than others, and use of sleeping pills were associated with sickness absence (RRs 1.4-1.8). After further adjustments for education, working conditions, health behaviors, and objectively measured mental and somatic health, the associations somewhat attenuated but mainly remained. The optimal sleep duration with the lowest risk of sickness absence was 7.6 hours for women and 7.8 hours for men. Although persistence of other health problems could affect the estimates, direct costs due to sickness absence could decrease by up to 28% if sleep disturbances could be fully addressed. This study highlights the need for prevention of sleep disturbances and promotion of optimal sleep length to prevent sickness absence. © 2014 Associated Professional Sleep Societies, LLC.

Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007.

PubMed

Lecomte, P; Criniere, L; Fagot-Campagna, A; Druet, C; Fuhrman, C

2013-04-01

This study estimated the prevalence of symptoms evocative of obstructive sleep apneoa (OSA) in patients with type 2 diabetes and the proportion of those with evidence of a previous diagnosis or diagnostic procedure. In ENTRED 2007, 8926 people reimbursed for at least three antidiabetic agents within the last 12 months were randomly selected, and 3894 answered a self-administered questionnaire. Symptoms evocative of OSA were defined as frequent snoring with excessive daytime sleepiness and/or witnessed sleep apneoa. Patients were considered to have evidence of a previous diagnostic procedure if they reported an OSA diagnosis or had a sleep recording done, or if a sleep recording was found in the hospital discharge or medical claims database, or if they were currently being treated with nocturnal ventilation. The patients' mean age was 66 years. Around 8.5% reported being diagnosed with OSA, 4.2% were treated with nocturnal ventilation and 16% had symptoms evocative of OSA. Being male, obesity, high blood pressure, insulin treatment, living with a partner, lower educational level and financial difficulties were all associated with symptoms suggestive of OSA. Overall, 13% had evidence of a previous diagnostic procedure, and the rate was 35% among those with symptoms evocative of OSA. OSA is underdiagnosed in French diabetic patients, while the prevalence of symptoms is high. Only 13% of the study population and 35% of those with symptoms suggestive of OSA had benefited from a diagnostic procedure. It is of the utmost importance to better diagnose OSA in the diabetic population. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Are sleep duration and sleep quality associated with diet quality, physical activity, and body weight status? A population-based study of Canadian children.

PubMed

Khan, Mohammad K A; Chu, Yen Li; Kirk, Sara F L; Veugelers, Paul J

2015-04-30

To describe sleep duration and sleep characteristics, and to examine the associations between sleep duration and characteristics and body weight status, diet quality, and physical activity levels among grade 5 children in Nova Scotia. A provincially representative sample of 5,560 grade 5 children and their parents in Nova Scotia was surveyed. Parents were asked to report their child's bedtime and wake-up time, and to indicate how often their child snored or felt sleepy during the day. Dietary intake and physical activity were selfreported by children using the Harvard Youth/Adolescent Food Frequency Questionnaire and the Physical Activity Questionnaire for Children respectively. Body weight status was determined using measured heights and weights. Linear and logistic random effects models with children nested within schools were used to test for associations. Approximately half of the surveyed parents reported that their children were not getting adequate sleep at night. Longer sleep duration was statistically significantly associated with decreased risk for overweight and obesity independent of other sleep characteristics (OR = 0.82, 95% CI: 0.73, 0.91). Longer sleep duration was also associated with better diet quality and higher levels of physical activity. These findings indicate a need for health promotion strategies to encourage adequate sleep and to promote healthy sleep environments among children. Given the links among sleep, body weight status and lifestyle behaviours, these messages should be included in public health interventions aimed at preventing obesity and promoting health among children.

Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea.

PubMed

Sico, Jason J; Yaggi, H Klar; Ofner, Susan; Concato, John; Austin, Charles; Ferguson, Jared; Qin, Li; Tobias, Lauren; Taylor, Stanley; Vaz Fragoso, Carlos A; McLain, Vincent; Williams, Linda S; Bravata, Dawn M

2017-08-01

Screening instruments for obstructive sleep apnea (OSA), as used routinely to guide clinicians regarding patient referral for polysomnography (PSG), rely heavily on symptomatology. We sought to develop and validate a cerebrovascular disease-specific OSA prediction model less reliant on symptomatology, and to compare its performance with commonly used screening instruments within a population with ischemic stroke or transient ischemic attack (TIA). Using data on demographic factors, anthropometric measurements, medical history, stroke severity, sleep questionnaires, and PSG from 2 independently derived, multisite, randomized trials that enrolled patients with stroke or TIA, we developed and validated a model to predict the presence of OSA (i.e., Apnea-Hypopnea Index ≥5 events per hour). Model performance was compared with that of the Berlin Questionnaire, Epworth Sleepiness Scale (ESS), the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender instrument, and the Sleep Apnea Clinical Score. The new SLEEP Inventory (Sex, Left heart failure, ESS, Enlarged neck, weight [in Pounds], Insulin resistance/diabetes, and National Institutes of Health Stroke Scale) performed modestly better than other instruments in identifying patients with OSA, showing reasonable discrimination in the development (c-statistic .732) and validation (c-statistic .731) study populations, and having the highest negative predictive value of all in struments. Clinicians should be aware of these limitations in OSA screening instruments when making decisions about referral for PSG. The high negative predictive value of the SLEEP INventory may be useful in determining and prioritizing patients with stroke or TIA least in need of overnight PSG. Published by Elsevier Inc.

Myofunctional therapy improves adherence to continuous positive airway pressure treatment.

PubMed

Diaféria, Giovana; Santos-Silva, Rogerio; Truksinas, Eveli; Haddad, Fernanda L M; Santos, Renata; Bommarito, Silvana; Gregório, Luiz C; Tufik, Sergio; Bittencourt, Lia

2017-05-01

Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence. The study was registered at ClinicalTrials.gov (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation. The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m 2 , ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the "washout" period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group. Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.

The STOP-BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation.

PubMed

Abumuamar, Asmaa M; Dorian, Paul; Newman, David; Shapiro, Colin M

2018-04-22

Obstructive sleep apnea (OSA) is a sleep disorder associated with significant cardiovascular comorbidities, including cardiac arrhythmia. The STOP-BANG questionnaire is an eight-item self-report questionnaire designed to screen patients for OSA and was validated in preoperative surgical patients. The STOP items are snoring, daytime tiredness, observed apneas and high blood pressure. The BANG items are body mass index >35 kg/m 2 , age >50 years, neck circumference >40 cm and male gender. We aimed to determine the screening properties of the STOP-BANG questionnaire in patients with arrhythmia. Non-selected consecutive patients were recruited from arrhythmia clinics. Patients with previously diagnosed and/or treated OSA were excluded. The STOP-BANG questionnaire was self-administered. Patients underwent two consecutive nights of home sleep recording. OSA was defined as an apnea-hypopnea index score of ≥5/hr of sleep. The screening properties of the STOP-BANG questionnaire were analysed compared with the objective diagnosis of OSA by ambulatory testing. Ninety-five patients were included in the final analysis. Eighty-five percent were found to have OSA. The STOP-BANG score of ≥3 was 89% sensitive and 36% specific for diagnosis of OSA. The STOP-BANG questionnaire had fair performance, as indicated by an area under the curve of 0.74 (p = .004). In conclusion, the STOP-BANG questionnaire is sensitive; however, it has a low specificity with a high false positive rate. Given that a large number of atrial fibrillation patients need testing for OSA, we recommend the use of a level II sleep study regardless of the results of the screening questionnaire. This approach accurately identifies OSA and may limit the cost of unnecessary level-I sleep studies. © 2018 European Sleep Research Society.

A description of sleep behaviour in healthy late pregnancy, and the accuracy of self-reports.

PubMed

McIntyre, Jordan P R; Ingham, Cayley M; Hutchinson, B Lynne; Thompson, John M D; McCowan, Lesley M; Stone, Peter R; Veale, Andrew G; Cronin, Robin; Stewart, Alistair W; Ellyett, Kevin M; Mitchell, Edwin A

2016-05-18

The importance of maternal sleep and its contribution to maternal and fetal health during pregnancy is increasingly being recognised. However, the ability to accurately recall sleep practices during pregnancy has been questioned. The aim of this study is to test the accuracy of recall of normal sleep practices in late pregnancy. Thirty healthy women between 35 and 38 weeks of gestation underwent level III respiratory polysomnography (PSG) with infrared digital video recordings in their own homes. Data regarding sleep positions, number of times getting out of bed during the night and respiratory measures were collected. A sleep questionnaire was administered the morning after the recorded sleep. Continuous data were assessed using Spearman's Rho and Bland-Altman. Cohen's Kappa was used to assess recall in the categorical variables. Two-thirds of participants went to sleep on their left side. There was good agreement in sleep onset position between video and questionnaire data (Kappa 0.52), however the there was poor agreement on position on wakening (Kappa 0.24). The number of times getting out of bed during the night was accurately recalled (Kappa 0.65). Twenty five out of 30 participants snored as recorded by PSG. Questionnaire data was inaccurate for this measure. Bland-Altman plots demonstrated acceptable agreement between video and questionnaire data for estimated sleep duration, but not the time taken to fall asleep (sleep latency). One participant had mild obstructive sleep apnoea and another probable high upper airways resistance. Sleep onset position, sleep duration and the number of times getting out of bed during the night were accurately recalled, but sleep latency and sleep position on waking were not. This study identifies the sleep variables that can be accurately obtained by questionnaire and those that cannot.

Mandible behaviour interpretation during wakefulness, sleep and sleep-disordered breathing.

PubMed

Maury, Gisèle; Senny, Frédéric; Cambron, Laurent; Albert, Adelin; Seidel, Laurence; Poirrier, Robert

2014-12-01

The mandible movement (MM) signal provides information on mandible activity. It can be read visually to assess sleep-wake state and respiratory events. This study aimed to assess (1) the training of independent scorers to recognize the signal specificities; (2) intrascorer reproducibility and (3) interscorer variability. MM was collected in the mid-sagittal plane of the face of 40 patients. The typical MM was extracted and classified into seven distinct pattern classes: active wakefulness (AW), quiet wakefulness or quiet sleep (QW/S), sleep snoring (SS), sleep obstructive events (OAH), sleep mixed apnea (MA), respiratory related arousal (RERA) and sleep central events (CAH). Four scorers were trained; their diagnostic capacities were assessed on two reading sessions. The intra- and interscorer agreements were assessed using Cohen's κ. Intrascorer reproducibility for the two sessions ranged from 0.68 [95% confidence interval (CI): 0.59-0.77] to 0.88 (95% CI: 0.82-0.94), while the between-scorer agreement amounted to 0.68 (95% CI: 0.65-0.71) and 0.74 (95% CI: 0.72-0.77), respectively. The overall accuracy of the scorers was 75.2% (range: 72.4-80.7%). CAH MMs were the most difficult to discern (overall accuracy 65.6%). For the two sessions, the recognition rate of abnormal respiratory events (OAH, CAH, MA and RERA) was excellent: the interscorer mean agreement was 90.7% (Cohen's κ: 0.83; 95% CI: 0.79-0.88). The discrimination of OAH, CAH, MA characteristics was good, with an interscorer agreement of 80.8% (Cohen's κ: 0.65; 95% CI: 0.62-0.68). Visual analysis of isolated MMs can successfully diagnose sleep-wake state, normal and abnormal respiration and recognize the presence of respiratory effort. © 2014 European Sleep Research Society.

Clonidine premedication in patients with sleep apnea syndrome: a randomized, double-blind, placebo-controlled study.

PubMed

Pawlik, Michael T; Hansen, Ernil; Waldhauser, Daniela; Selig, Christoph; Kuehnel, Thomas S

2005-11-01

Patients with sleep apnea often present with cardiac diseases and breathing difficulties, with a high risk of postoperative respiratory depression. We conducted a randomized, double-blind, prospective study in 30 adult patients with obstructive sleep apnea, undergoing elective ear-nose-throat surgery. The patients were randomly assigned to receive placebo or clonidine (2 microg/kg oral) the night before and the next morning 2 h before surgery. Spo2, heart rate, mean arterial blood pressure, snoring, and oronasal airflow were monitored for 36 h. A standard anesthesia was used consisting of propofol and remifentanil. Anesthetic drug consumption, postoperative analgesics, and pain score were recorded. In the clonidine group, mean arterial blood pressures were significantly lower during induction, operation, and emergence from anesthesia. Both propofol dose required for induction (190 +/- 32.2 mg) and anesthesia (6.3 +/- 1.3 mg . kg(-1).h(-1)) during surgery were significantly reduced in the clonidine group compared with the placebo group (induction 218 +/- 32.4, anesthesia 7.70 +/- 1.5; P < 0.05). Piritramide consumption (7.4 +/- 5.1 versus 14.2 +/- 8.5 mg; P < 0.05) and analgesia scores were significantly reduced in the clonidine group. Apnea and desaturation index were not different between the groups, whereas the minimal postoperative oxygen saturation on the day of surgery was significantly lower in the placebo than in the clonidine group (76.7% +/- 8.0% versus 82.4% +/- 5.8%; P < 0.05). We conclude that oral clonidine premedication stabilizes hemodynamic variables during induction, maintenance, and emergence from anesthesia and reduces the amount of intraoperative anesthetics and postoperative opioids without deterioration of ventilation.

Nocturnal cerebral hemodynamics in snorers and in patients with obstructive sleep apnea: a near-infrared spectroscopy study.

PubMed

Pizza, Fabio; Biallas, Martin; Wolf, Martin; Werth, Esther; Bassetti, Claudio L

2010-02-01

Sleep disordered breathing (SDB) of the obstructive type causes hemodynamic consequences, leading to an increased cerebrovascular risk. The severity of SDB at which detrimental circulatory consequences appear is matter of controversy. Aim of the present study is the investigation of cerebral hemodynamics in patients with SDB of variable severity using near-infrared spectroscopy (NIRS). N/A. Sleep laboratory. Nineteen patients with SDB. N/A. Patients underwent nocturnal videopolysomnography (VPSG) coupled with cerebral NIRS. NIRS data were averaged for each patient, and a new method (integral) was applied to quantify cerebral hemodynamic alterations. Nocturnal VPSG disclosed various severities of SDB: snoring (7 patients, apnea-hypopnea index [AHI] = 2 +/- 2/h, range: 0.5-4.5); mild SDB (7 patients, AHI = 14 +/- 8/h, range: 6.3-28.6); and severe obstructive sleep apnea syndrome (5 patients, AHI = 79 +/- 20/h, range: 39.6-92.9). Relative changes of NIRS parameters were significantly larger during obstructive apneas (compared with hypopneas; mean deoxygenated hemoglobin [HHb] change of 0.72 +/- 0.23 and 0.13 +/- 0.08 micromol/L per sec, p value = 0.048) and in patients with severe SDB (as compared with patients with mild SDB and simple snorers; mean HHb change of 0.84 +/- 0.24, 0.02 +/- 0.09, and 0.2 +/- 0.08 micromol/L per sec, respectively, p value = 0.020). In this group, NIRS and concomitant changes in peripheral oxygen saturation correlated. The results of this study suggest that acute cerebral hemodynamic consequences of SDB lead to a failure of autoregulatory mechanisms with brain hypoxia only in the presence of frequent apneas (AHI > 30) and obstructive events.

Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology.

PubMed

Nunes, Heloisa Sobreira; Pinto, José Antonio; Zavanela, Adma Roberta; Cavallini, André Freitas; Freitas, Gabriel Santos; Garcia, Fabiola Esteves

2016-07-01

The Gastroesophageal Reflux Disease has a prevalence of ∼12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR. We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). The RSI and RFS can easily be included in ENT routines as objective parameters, with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests.

Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology

PubMed Central

Nunes, Heloisa Sobreira; Pinto, José Antonio; Zavanela, Adma Roberta; Cavallini, André Freitas; Freitas, Gabriel Santos; Garcia, Fabiola Esteves

2016-01-01

Introduction  The Gastroesophageal Reflux Disease has a prevalence of ∼12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). Objective  The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Methods  Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR. We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. Results  The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). Conclusion  The RSI and RFS can easily be included in ENT routines as objective parameters, with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests. PMID:27413402

Parents are poor at labelling wheeze in children: a cross-sectional study.

PubMed

Shanmugam, Shalini; Nathan, Anna Marie; Zaki, Rafdzah; Tan, Kian Eng; Eg, Kah Peng; Thavagnanam, Surendran; de Bruyne, Jessie Anne

2016-06-23

Noisy breathing is a common presenting symptom in children. The purpose of this study is to (a) assess parental ability to label wheeze, (b) compare the ability of parents of children with and without asthma to label wheeze and (c) determine factors affecting parental ability to label wheeze correctly. This cross-sectional study in a tertiary hospital in Kuala Lumpur, Malaysia involved parents of children with asthma. Parents of children without asthma were the control group. Eleven validated video clips showing wheeze, stridor, transmitted noises, snoring or normal breathing were shown to the parents. Parents were asked, in English or Malay, "What do you call the sound this child is making?" and "Where do you think the sound is coming from?" Two hundred parents participated in this study: 100 had children with asthma while 100 did not. Most (71.5 %) answered in Malay. Only 38.5 % of parents correctly labelled wheeze. Parents were significantly better at locating than labelling wheeze (OR 2.4, 95 % CI 1.64-3.73). Parents with asthmatic children were not better at labelling wheeze than those without asthma (OR1.04, 95 % CI 0.59-1.84). Answering in English (OR 3.4, 95 % CI 1.69-7.14) and having older children with asthma (OR 9.09, 95 % CI 3.13-26.32) were associated with correct labelling of wheeze. Other sounds were mislabelled as wheeze by 16.5 % of respondents. Parental labelling of wheeze was inaccurate especially in the Malay language. Parents were better at identifying the origin of wheeze rather than labelling it. Physicians should be wary about parental reporting of wheeze as it may be inaccurate.

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.

Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing.

PubMed

Shusterman, Dennis; Baroody, Fuad M; Craig, Timothy; Friedlander, Samuel; Nsouli, Talal; Silverman, Bernard

Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance. To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps. Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources. Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity. Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study.

PubMed

Wannamethee, S Goya; Papacosta, Olia; Lennon, Lucy; Whincup, Peter H

2016-09-01

To examine the associations between self-reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD). Population-based prospective study. General practices in 24 British towns. Men aged 60-79 without prevalent HF followed for 9 years (N = 3,723). Information on incident HF cases was obtained from primary care records. Assessment of sleep was based on self-reported sleep duration at night and daytime napping. Self-reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self-reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06-2.71) than in those who reported no daytime napping. Self-reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (<6 hours: aHR = 2.91, 95% CI = 1.31-6.45; 6 hours: aHR = 1.89, 95% CI = 0.89-4.03; 8 hours: aHR = 1.29, 95% CI = 0.61-2.71; ≥9 hours: aHR = 1.80, 905% CI = 0.71-4.61 vs nighttime sleep of 7 hours). Snoring was not associated with HF risk. Self-reported daytime napping of longer than 1 hour is associated with greater risk of HF in older men. Self-reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Associations of impaired sleep quality, insomnia, and sleepiness with epilepsy: A questionnaire-based case-control study.

PubMed

Im, Hee-Jin; Park, Seong-Ho; Baek, Shin-Hye; Chu, Min Kyung; Yang, Kwang Ik; Kim, Won-Joo; Yun, Chang-Ho

2016-04-01

The purpose of this study was to document the frequency of sleep problems including poor sleep quality, excessive daytime sleepiness, and insomnia in subjects with epilepsy compared with healthy controls and to determine the factors associated with these sleep disturbances. We recruited 180 patients with epilepsy (age: 43.2 ± 15.6 years, men: 50.0%) and 2836 healthy subjects (age: 44.5 ± 15.0 years, men: 49.8%). Sleep and the anxiety/mood profiles were measured using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Goldberg Anxiety Scale, and Patient Health Questionnaire-9 depression scale. Associations of sleep problems with epilepsy and other factors were tested by multiple logistic regression analysis, adjusted for age, gender, body mass index, alcohol intake, smoking, perceived sleep insufficiency, and habitual snoring. Sleep disturbances were more common in the group with epilepsy than in the controls (53.3% vs. 25.5%; p<0.001). Poor sleep quality, excessive daytime sleepiness, and insomnia were significantly associated with epilepsy (odds ratio [95% confidence interval]: 3.52 [2.45-5.05], 2.10 [1.41-3.12], 5.91 [3.43-10.16], respectively). Depressive mood, anxiety, and perceived sleep insufficiency contributed to the presence of sleep disturbances. In the group with epilepsy, seizure remission for the past year related to a lower frequency of insomnia, whereas age, sex, type of epilepsy, and number of antiepileptic drugs were not correlated with sleep problems. Epilepsy was significantly associated with the higher frequency of sleep disturbances, which supports the importance of screening sleep problems in patients with epilepsy and providing available intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects.

PubMed

Hein, Matthieu; Lanquart, Jean-Pol; Loas, Gwénolé; Hubain, Philippe; Linkowski, Paul

2017-07-06

Several studies have investigated the prevalence and risk factors of insomnia in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of insomnia sufferers. Data from 1311 insomnia sufferers who were recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as the cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers. The prevalence of moderate to severe obstructive sleep apnea syndrome in our sample of insomnia sufferers was 13.88%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower maintenance insomnia complaint, presence of metabolic syndrome, age ≥ 50 & <65 years, age ≥ 65 years, BMI ≥ 25 & <30 kg/m 2 , BMI >30 kg/m 2 , and CRP >7 mg/L were significant risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers. Moderate to severe obstructive sleep apnea syndrome is a common pathology in insomnia sufferers. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.

Treatment efficacy of a titratable oral appliance in obstructive sleep apnea patients: a prospective clinical trial.

PubMed

Van Haesendonck, G; Dieltjens, M; Hamans, E; Braem, M J; Vanderveken, O M

2016-01-01

This prospective clinical trial assessed the therapeutic outcomes of patients with obstructive sleep apnea (OSA) treated with a novel duobloc custom-made titratable mandibular advancement device (OAm). The modular Somnomed G2® OAm (Somnomed Europe AG, Zurich, Switzerland) with 'click-to-fit' adjustability provides instant feedback on the mandibular advancement. 161 consecutive patients with established diagnoses of OSA. Dental impressions were made and a bite registration in 75% of the maximal protrusion being the starting protrusion. Treatment response was defined as ≥ 50% decrease in apnea-hypopnea index (AHI). Treatment success was defined as 1a) AHI with OAm < 5 events/h sleep or 1b) AHI with OAm < 10 events/h. Treatment success and response were combined to define additional criteria: 2a) reduction in AHI ≥ 50% and AHI < 5 events/h; and 2b) reduction in AHI ≥ 50% and AHI <10 events/h. In 112 patients AHI decreased significantly from 25 ± 18/h sleep at baseline to 12 ± 13/h with the OAm (p < 0.001). The visual analogue scoring for snoring (VAS) decreased significantly from 7 ± 3 to 2 ± 2 (p < 0.001). Treatment response was achieved in 65 of 112 patients (58%); 31% and 57% of patients were treated successfully according to criteria 1a and 1b, respectively. Furthermore, 31% and 50% of patients were treated successfully according to criteria 2a and 2b, respectively. This clinical trial indicates that treatment with a novel custom-made OAm can reduce the severity of sleep-disordered breathing by significantly decreasing the AHI and VAS scores.

When to Suspect Sleep Apnea and What to Do About It.

PubMed

Kimoff, R John

2015-07-01

Obstructive sleep apnea (OSA), which is characterized by recurrent upper airway obstruction during sleep with resultant hypoxia-reoxygenation and sleep fragmentation, is prevalent among patients with cardiovascular disease. Refractory hypertension, nocturnal angina or arrhythmias, and stroke in particular should prompt consideration of OSA. The symptoms of OSA include snoring and excessive daytime sleepiness; risk factors include obesity and reduced upper airway dimensions. Up to 50% of patients with congestive heart failure (CHF) may manifest OSA, central sleep apnea-Cheyne-Stokes respiration (CSA-CSR), or both. Patients with CSA-CSR may present with fatigue, disrupted sleep, and paroxysmal nocturnal dyspnea. Objective sleep recording is required to document the nature and severity of sleep apnea. The gold standard is in-laboratory overnight polysomnography (PSG), including monitoring of electroencephalography and other signals to determine sleep-wake state, and recording of body position, airflow, respiratory effort, and pulse oximetry. Portable cardiorespiratory recorders are now approved for diagnosis in patients without comorbidities. Full PSG is recommended for diagnosis in all other cases, although OSA and CSA-CSR can be identified from portable recorders in some patients with CHF and other conditions. The objectives of treatment are to improve symptoms, quality of life, and cardiovascular outcomes. The mainstay of treatment for moderate-to-severe OSA is positive airway pressure (PAP). Automated PAP devices may be used in uncomplicated OSA, whereas continuous fixed PAP is the treatment of choice for other patients with OSA, and may also treat a proportion of patients with CSA-CSR. A form of bi-level PAP known as adaptive servoventilation is effective in treating a majority of patients with CSA-CSR. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study.

PubMed

Jalilolghadr, Shabnam; Yazdi, Zohreh; Mahram, Manoochehr; Babaei, Farkhondeh; Esmailzadehha, Neda; Nozari, Hoormehr; Saffari, Fatemeh

2016-05-01

Obesity and biochemical parameters of metabolic disorders are both closely related to obstructive sleep apnea (OSA). The aim of this study was to compare sleep architecture and OSA in obese children with and without metabolic syndrome. Forty-two children with metabolic syndrome were selected as case group and 38 children without metabolic syndrome were matched for age, sex, and BMI as control group. The standardized Persian version of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring (BEARS) and Children's Sleep Habits Questionnaires were completed, and polysomnography (PSG) was performed for all study subjects. Scoring was performed using the manual of American Academy of Sleep Medicine for children. Data were analyzed using chi-square test, T test, Mann-Whitney U test, and logistic regression analysis. Non-rapid eye movement (NREM) sleep and N1 stage in the case group were significantly longer than the control group, while REM sleep was significantly shorter. Waking after sleep onset (WASO) was significantly different between two groups. Severe OSA was more frequent in the control group. Multivariate logistic regression analysis showed that severe OSA (OR 21.478, 95 % CI 2.160-213.600; P = 0.009) and REM sleep (OR 0.856, 95 % CI 0.737-0.994; P = 0.041) had independent association with metabolic syndrome. Obese children with metabolic syndrome had increased WASO, N1 sleep stage, and severe OSA. But the results regarding sleep architecture are most likely a direct result of OSA severity. More longitudinal studies are needed to confirm the association of metabolic syndrome and OSA.

Sleep Disordered Breathing in Early Childhood: Quality of Life for Children and Families

PubMed Central

Jackman, Angela R.; Biggs, Sarah N.; Walter, Lisa M.; Embuldeniya, Upeka S.; Davey, Margot J.; Nixon, Gillian M.; Anderson, Vicki; Trinder, John; Horne, Rosemary S. C.

2013-01-01

Objectives: To characterize health-related quality of life (QOL) in preschool children with sleep disordered breathing (SDB) and their families compared with nonsnoring control patients in the community. It was hypothesized that children with SDB and their families would have poorer QOL than control children, that a relationship would be found between SDB severity and QOL, and that even children with mild SDB and their families would have reduced QOL. Participants and Methods: A clinical sample of preschool children (3-5 y) with SDB diagnosed by gold standard polysomnography (primary snoring, PS = 56, mild obstructive sleep apnea, OSA = 35, moderate/severe OSA = 24) and control children recruited from the community (n = 38) were studied. Parents completed health-related QOL and parenting stress questionnaires. Results: Children and families in the PS and mild OSA groups had consistently poorer QOL than control children (both P < 0.05-0.001), based on parent ratings, and parents of children with PS had elevated stress ratings relative to control children (P < 0.05-0.001). The moderate/severe OSA group differed from the control group on select measures of parent and family QOL (worry, P < 0.001 and total family impact, P < 0.05). Conclusions: Our findings demonstrate that sleep disordered breathing is associated with reduced quality of life in preschool children and their families. These results support previous quality of life findings in older children and in samples with broader age ranges. Furthermore, clinically referred preschool children with mild forms of sleep disordered breathing may be at greatest risk. Citation: Jackman AR; Biggs SN; Walter LM; Embuldeniya US; Davey MJ; Nixon GM; Anderson V; Trinder J; Horne RSC. Sleep disordered breathing in early childhood: quality of life for children and families. SLEEP 2013;36(11):1639-1646. PMID:24179296

Treatment of Sleep Disorders after Traumatic Brain Injury

PubMed Central

Castriotta, Richard J.; Atanasov, Strahil; Wilde, Mark C.; Masel, Brent E.; Lai, Jenny M.; Kuna, Samuel T.

2009-01-01

Study Objectives: Determine whether treatment of sleep disorders identified in brain injured adults would result in resolution of those sleep disorders and improvement of symptoms and daytime function. Methods: Prospective evaluation of unselected traumatic brain injury patients with nocturnal polysomnography (NPSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS), and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ) before and after treatment with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA), modafinil (200 mg) for narcolepsy and posttraumatic hypersomnia (PTH), or pramipexole (0.375 mg) for periodic limb movements in sleep (PLMS). Setting: Three academic medical centers. Participants: Fifty-seven (57) adults ≥ 3 months post traumatic brain injury (TBI). Measurements And Results: Abnormal sleep studies were found in 22 subjects (39%), of whom 13 (23%) had OSA, 2 (3%) had PTH, 3 (5%) had narcolepsy, 4 (7%) had PLMS, and 12 had objective excessive daytime sleepiness with MSLT score < 10 minutes. Apneas, hypopneas, and snoring were eliminated by CPAP in OSA subjects, but there was no significant change in MSLT scores. Periodic limb movements were eliminated with pramipexole. One of 3 narcolepsy subjects and 1 of 2 PTH subjects had resolution of hypersomnia with modafinil. There was no significant change in FOSQ, POMS, or PVT results after treatment. Conclusions: Treatment of sleep disorders after TBI may result in polysomnographic resolution without change in sleepiness or neuropsychological function. Citation: Castriotta RJ; Atanasov S; Wilde MC; Masel BE; Lai JM; Kuna ST. Treatment of sleep disorders after traumatic brain injury. J Clin Sleep Med 2009;5(2):137-144. PMID:19968047

Dynamic behaviour of the soft palate during nasal positive pressure ventilation under anaesthesia and paralysis: comparison between patients with and without obstructive sleep-disordered breathing.

PubMed

Okuyama, M; Kato, S; Sato, S; Okazaki, J; Kitamura, Y; Ishikawa, T; Sato, Y; Isono, S

2018-01-01

Difficult mask ventilation is common and is known to be associated with sleep-disordered breathing (SDB). It is our hypothesis that the incidence of expiratory retropalatal (RP) airway closure (primary outcome) during nasal positive pressure ventilation (PPV) is more frequent in patients with SDB (apnea hypopnea index ≥5 h -1 ) than non-SDB subjects. The severity of SDB was assessed before surgery using a portable sleep monitor. In anaesthetized and paralysed patients with (n=11) and without SDB (n=9), we observed the behaviour of the RP airway endoscopically during nasal PPV with the mouth closed and determined the dynamic RP closing pressure, which was defined as the highest airway pressure above which the RP airway closure was reversed. The static RP closing pressure was obtained during cessation of mechanical ventilation in patients with dynamic RP closure during nasal PPV. The expiratory RP airway closure accompanied by expiratory flow limitation occurred more frequently in SDB patients (9/11, 82%) than in non-SDB subjects (2/9, 22%; exact logistic regression analysis: P=0.022, odds ratio 3.6, 95% confidence interval 1.1-15.4). Receiver operating characteristic curve analyses indicated AHI >10h -1 and presence of habitual snoring as clinically useful predictors for the occurrence of RP closure during PPV. Dynamic RP closing pressure was greater than the static RP closing pressure by approximately 4-5 cm H 2 O. Valve-like dynamic RP closure that limits expiratory flow during nasal PPV occurs more frequently in SDB patients. Copyright © 2017. Published by Elsevier Ltd.

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

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

PubMed

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

2012-01-01

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. 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 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. 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.

Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre.

PubMed

Svystun, Orysya; Johannsen, Wendy; Persad, Rabin; Turner, Justine M; Majaesic, Carina; El-Hakim, Hamdy

2017-08-01

Whereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. We undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. From 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5-124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3-88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. a significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of metabolic syndrome with growing epidemic syndrome Z in terms of risk factors and gender differences.

PubMed

Uyar, Meral; Davutoğlu, Vedat; Aydın, Neriman; Filiz, Ayten

2013-05-01

The aim of this study is to compare metabolic syndrome with syndrome Z growing epidemic in terms of risk factors, demographic variables, and gender differences in our large cohort at southeastern area in Turkey. Data of patients admitted to sleep clinic in University of Gaziantep from January 2006 to January 2011 were retrospectively evaluated. ATP III and JNC 7 were used for defining metabolic syndrome and hypertension. Data of 761 patients were evaluated. Hypertension, diabetes mellitus, coronary artery disease, pulmonary hypertension, and left ventricular hypertrophy were more common in patients with syndrome Z than in patients without metabolic syndrome. Age, waist/neck circumferences, BMI, triglyceride, glucose, and Epworth sleepiness scale score were detected higher, whereas the minimum oxygen saturation during sleep was lower in patients with syndrome Z. Metabolic syndrome was more common in sleep apneic subjects than in controls (58 versus 30 %). Female sleep apneics showed higher rate of metabolic syndrome than those of males (74 versus 52 %). Hypertension, diabetes mellitus, coronary artery disease, and left ventricular hypertrophy were detected higher in males with syndrome Z than in males without metabolic syndrome. Snoring and excessive daytime sleepiness were detected higher in females with syndrome Z than in females without metabolic syndrome. Systemic/pulmonary hypertension, diabetes mellitus, and left ventricular hypertrophy were more common in females with syndrome Z than in females without metabolic syndrome. Complaints of headache and systemic/pulmonary hypertension were more common among females than males with syndrome Z. Female syndrome Z patients had lower minimum oxygen saturation than male patients with syndrome Z. Metabolic syndrome in sleep apneic patients is more prevalent than in controls. All metabolic syndrome parameters were significantly different among obstructive sleep apneic patients with respect to gender with more severe coronary risk factors in males.

AB003. Validation of a two-stage screening model to predict moderate to severe obstructive sleep apnea in chronic tetraplegia

PubMed Central

Graco, Marnie; Cross, Susan; Thiyagarajan, Chinnaya; Shafazand, Shirin; Ayas, Najib; Schembri, Rachel; Booker, Lauren; Nicholls, Carmel; Burns, Patricia; Nash, Mark; Green, Sally; Berlowitz, David J.

2018-01-01

Background Prevalence of obstructive sleep apnea (OSA) in people with chronic spinal cord injury (SCI) is estimated at between 28% and 77%. Current guidelines recommend polysomnography (PSG) for all people with SCI and symptoms of OSA. However, PSG is a resource intensive and frequently inaccessible test, especially in SCI. A two-stage model of questionnaire followed by overnight oximetry has been found to accurately detect moderate to severe OSA in the able-bodied. To determine whether a similar two-stage model can detect moderate to severe OSA in chronic tetraplegia. Methods An existing dataset of 78 people with tetraplegia was examined to determine predictors of OSA for inclusion in a new questionnaire. Cut-offs for the model were estimated with receiver operating characteristics (ROC) curve analysis. Model accuracy was evaluated prospectively in 100 participants with chronic, traumatic tetraplegia across four international SCI units. Results Multivariate analysis identified injury completeness, age, sleepiness, self-reported snoring and apneas for the new questionnaire [ROC area under curve (AUC) 0.87 (95% CI: 0.79–0.95)]. Oxygen desaturation index was also highly predictive [0.93 (0.87–0.98)]. The two-stage model had a sensitivity and specificity of 83% (66–93%) and 88% (75–94%) in the development group (n=78), and 77% (65–87%) and 81% (68–90%) in the validation group (n=100). Conclusions The two-stage screening model provides an accurate and translatable alternative to full PSG for identifying moderate to severe OSA in people with chronic tetraplegia. Implementation of this screening model could substantially increase the detection of OSA in tetraplegia and improve access to treatments.

Pathological laughter as prodromal manifestation of transient ischemic attacks--case report and brief review.

PubMed

Dulamea, Adriana O; Matei, Costel; Mindruta, Ioana; Ionescu, Virgil

2015-10-12

Based on a case report, the authors reviewed the data about involuntary emotional expression disorder (IEED). IEED includes the syndromes of pathological laughing and crying (PLC) and emotional lability (EL). PLC is a rare disorder of emotional expression characterized by relatively uncontrollable episodes of laughter and crying or both that do not have an apparent motivating stimulus. Authors report the case of a 59-year-old man who presented with recurrent episodes of PLC of approximately 2 min duration, consisting of accelerated breathing, emission of guttural, snoring sounds, frowning of the eyebrows, followed by laughter accompanied by motor restlessness of all four limbs. PLC episodes preceded left carotid transient ischemic attacks (TIA's) manifested by reversible aphasia and right hemiparesis. Electroencephalography performed during PLC episodes revealed no spike-wave activity. Brain magnetic resonance imaging showed lacunar infarcts in the left lenticulo-capsulo-thalamic area and multiple round lesions in the cortical-subcortical and in the deep white matter of frontal-parietal-occipital lobes bilaterally, with T2 hyperintensity, T1 isointensity and no diffusion changes. The episodes were interpreted as transient ischemic attacks although gelastic seizures could not be excluded. The etiological investigations revealed unstable plaques on the left carotid artery bulb and the aortic arch and a degenerative mitral valve stenosis. The patient was treated first with antiplatelet therapy and antiepileptic drugs but PLC stopped only after anticoagulation was started. During follow-up the patient continued to have left carotid and vertebrobasilar TIA's being on oral anticoagulation. The patient became asymptomatic only after mitral valve replacement was performed. This case illustrates the difficulty distinguishing between gelastic epilepsy and TIA's in cases of PLC episodes and discuss the neuroanatomic bases and pathophysiology of this rare condition.

Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/disorders.

PubMed

Chiang, Huey-Ling; Gau, Susan Shur-Fen; Ni, Hsing-Chang; Chiu, Yen-Nan; Shang, Chi-Yung; Wu, Yu-Yu; Lin, Liang-Ying; Tai, Yueh-Ming; Soong, Wei-Tsuen

2010-12-01

This study aimed to investigate the association between attention-deficit hyperactivity disorder (ADHD) symptoms and subtypes, and sleep schedules, daytime inadvertent napping, and sleep problems/disorders in children and adolescents with and without ADHD. The sample included 325 patients with ADHD, aged 10-17 years [male: 81.5%; combined type (ADHD-C): 174; predominantly inattentive type (ADHD-I): 130; predominantly hyperactive-impulsive type (ADHD-HI): 21], and 257 children and adolescents without lifetime ADHD (non-ADHD). We conducted psychiatric interviews with the participants and their mothers before making the diagnoses of ADHD, other psychiatric disorders, and sleep problems or disorders. We also collected the medication treatment data and parent and teacher reports of ADHD symptoms. Multi-level models were used for data analyses controlling for sex, age, psychiatric comorbidities, and treatment with methylphenidate. The ADHD-C and ADHD-I groups had more daytime inadvertent napping. In general, the three subtypes were associated with increased rates of sleep problems/disorders. Specifically, ADHD-C rather than ADHD-I was associated with circadian rhythm problems, sleep-talking, nightmares (also ADHD-HI), and ADHD-I was associated with hypersomnia. The most-related sleep schedules and problems for inattention and hyperactivity-impulsivity were earlier bedtime, later rise time, longer nocturnal sleep, more frequent daytime napping, insomnia, sleep terrors, sleep-talking, snoring, and bruxism across informants. The findings imply that in addition to the dichotomous approach of ADHD and considering the psychiatric comorbid conditions, ADHD subtypes and symptom dimensions need to be considered in clinical practice and in the research regarding the association between ADHD and sleep problems/disorders. © 2010 European Sleep Research Society.

Regional Cerebral Blood Flow during Wakeful Rest in Older Subjects with Mild to Severe Obstructive Sleep Apnea.

PubMed

Baril, Andrée-Ann; Gagnon, Katia; Arbour, Caroline; Soucy, Jean-Paul; Montplaisir, Jacques; Gagnon, Jean-François; Gosselin, Nadia

2015-09-01

To evaluate changes in regional cerebral blood flow (rCBF) during wakeful rest in older subjects with mild to severe obstructive sleep apnea (OSA) and healthy controls, and to identify markers of OSA severity that predict altered rCBF. High-resolution (99m)Tc-HMPAO SPECT imaging during wakeful rest. Research sleep laboratory affiliated with a University hospital. Fifty untreated OSA patients aged between 55 and 85 years, divided into mild, moderate, and severe OSA, and 20 age-matched healthy controls. N/A. Using statistical parametric mapping, rCBF was compared between groups and correlated with clinical, respiratory, and sleep variables. Whereas no rCBF change was observed in mild and moderate groups, participants with severe OSA had reduced rCBF compared to controls in the left parietal lobules, left precentral gyrus, bilateral postcentral gyri, and right precuneus. Reduced rCBF in these regions and in areas of the bilateral frontal and left temporal cortex was associated with more hypopneas, snoring, hypoxemia, and sleepiness. Higher apnea, microarousal, and body mass indexes were correlated to increased rCBF in the basal ganglia, insula, and limbic system. While older individuals with severe obstructive sleep apnea (OSA) had hypoperfusion in the sensorimotor and parietal areas, respiratory variables and subjective sleepiness were correlated with extended regions of hypoperfusion in the lateral cortex. Interestingly, OSA severity, sleep fragmentation, and obesity correlated with increased perfusion in subcortical and medial cortical regions. Anomalies with such a distribution could result in cognitive deficits and reflect impaired vascular regulation, altered neuronal integrity, and/or undergoing neurodegenerative processes. © 2015 Associated Professional Sleep Societies, LLC.

Smoking Induces Oropharyngeal Narrowing and Increases the Severity of Obstructive Sleep Apnea Syndrome

PubMed Central

Kim, Kyung Soo; Kim, Jun Hee; Park, Sung Yoon; Won, Ho-Ryun; Lee, Hyun-Jin; Yang, Hoon Shik; Kim, Hyun Jik

2012-01-01

Objective: Smoking is a known risk factor for snoring, and is reported to be associated with an increased prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this was to determine the relationship of smoking to the severity of OSAS and examine what local histological changes in the uvular mucosa of OSAS patients might influence this relationship. Study Design and Methods: Fifty-seven OSAS subjects were included and classified according to smoking history and OSAS severity. Twenty-eight subjects were heavy smokers and 29 were nonsmokers; these 57 patients were divided according to moderate or severe OSAS. Histologic changes in the uvular mucosa were evaluated in all subjects as well as smoking duration and OSAS severity. Results: Among smokers, moderate-to-severe OSAS was more common, and apnea, hypopnea, and oxygen desaturation indices were higher. Moreover, smoking duration and OSAS severity were significantly correlated. Increased thickness and edema of the uvular mucosa lamina propria were observed in moderate and severe OSAS patients, and only smokers had significant changes in uvular mucosa histology. Positive staining for calcitonin gene-related peptide (CGRP), a neuroinflammatory marker for peripheral nerves, was increased in the uvular mucosa of smokers. Conclusions: Our results suggest that smoking may worsen OSAS through exacerbation of upper airway collapse at the level of the uvula, and that histological changes of the uvular mucosa correlated with smoking might be due to increased CGRP-related neurogenic inflammation. Citation: Kim KS; Kim JH; Park SY; Won HR; Lee HJ; Yang HS; Kim HJ. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med 2012;8(4):367-374. PMID:22893766

Relationship between serum substance P levels and daytime sleepiness in obstructive sleep apnea syndrome.

PubMed

Ursavas, Ahmet; Karadag, Mehmet; Ilcol, Yesim Ozarda; Burgazlioglu, Basak; Ercan, Ilker; Gozu, R Oktay

2007-05-01

We hypothesized that intermittent hypoxia might influence serum substance P levels, and that this effect might in turn contribute in excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS). Fifty-five patients with newly diagnosed OSAS and 15 age-matched nonapneic control subjects were enrolled in this study. Full polysomnography was performed in all patients. Single blood samples were drawn between 8:00 am and 9:00 am after the sleep study. Substance P levels were analyzed with a competitive enzyme immunoassay (substance P EIA kit; Cayman Chemical; Ann Arbor, MI). There were no significant differences in age, gender, body mass index, smoking habit, and snoring between the two groups. Serum substance P levels in the OSAS group were significantly lower than that in the control group (p < 0.0001). Serum substance P levels were positively correlated with rapid eye movement sleep (r = 0.330, p = 0.049) and slow-wave sleep (r = 0.324, p = 0.049) phases. Serum substance P levels were negatively correlated with Epworth sleepiness scale score (r = - 0.253, p = 0.048), number of total apneas during the night (r = - 0.247, p = 0.036), number of respiratory events during the night (r = - 0.266, p = 0.024), apnea-hypopnea index (r = - 0.287, p = 0.015), respiratory arousal index (r = - 0.267, p = 0.026), time spent in apnea and hypopnea (r = - 0.307, p = 0.01), average oxygen desaturation (r = - 0.265, p = 0.026), and oxygen desaturation index (r = - 0.254, p = 0.031). We concluded that EDS seen in some of the OSAS patients might be associated with various pathophysiologic mechanisms including substance P levels.

Pediatric Home Sleep Apnea Testing

PubMed Central

Tan, Hui-Leng; Kheirandish-Gozal, Leila

2015-01-01

Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel. PMID:26270608

Patients with a high risk for obstructive sleep apnea syndrome: postoperative respiratory complications.

PubMed

Pereira, H; Xará, D; Mendonça, J; Santos, A; Abelha, F J

2013-01-01

STOP-BANG score (snore; tired; observed apnea; arterial pressure; body mass index; age; neck circumference and gender) can predict the risk of a patient having Obstructive Syndrome Apnea (OSA). The aim of this study was to evaluate the incidence STOP-BANG score≥3, in surgical patients admitted to the Post-Anesthesia Care Unit (PACU). Observational, prospective study conducted in a post-anesthesia care unit (PACU) during three weeks (2011). The study population consisted of adult patients after noncardiac and non-neurological surgery. Patients were classified as high risk of OSA (HR-OSA) if STOP-BANG score≥3 and Low-risk of OSA (LR-OSA) if STOP-BANG score<3 (LR-OSA). Patient demographics, intraoperative and postoperative data were collected. Patient characteristics were compared using Mann-Whitney U-test, t-test for independent groups, and chi-square or Fisher's exact test. A total of 357 patients were admitted to PACU; 340 met the inclusion criteria. 179 (52%) were considered HR-OSA. These patients were older, more likely to be masculine, had higher BMI, higher ASA physical status, higher incidence of ischemic heart disease, heart failure, hypertension, dyslipidemia and underwent more frequently insulin treatment for diabetes. These patients had more frequently mild/moderated hypoxia in the PACU (9% vs. 3%, p=0.012) and had a higher incidence of residual neuromuscular blockade (NMB) (20% vs. 16%, p=0.035). Patients with HR-OSA had a longer hospital stay. Patients with HR-OSA had an important incidence among patients scheduled for surgery in our hospital. These patients had more co-morbidities and were more prone to post-operative complications. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

The possibility of clinical application of the solid state lasers: Nd:YAG, Ho:YAG, and Er:YAG in otolaryngology - head and neck surgery

NASA Astrophysics Data System (ADS)

Tomaszewska, M.; Kukwa, A.; Tulibacki, M.; Wójtowicz, P.; Olędzka, I.; Jeżewska, E.

2007-02-01

The purpose of this study was to summarize our experiences in clinical application of Nd:YAG, Ho:YAG and Er:YAG in otolaryngology- head and neck surgery. Choosing the laser type and parameters for the particular procedures was based on our previous research on tissue effects of those lasers. During the period of 1993-2006 we performed 3988 surgical procedures with the Nd:YAG laser. Over 87% of those were made for the nasal cavity pathologies as polyps, hyperplasia of inferior nasal turbinate, granulation tissue, postoperative adhesions, vascular malformations, under the local anesthesia conditions. In our experience Nd:YAG laser gives the possibility of good clinical control and low risk of side effects for disorders of high recurrence and frequent interventions necessity, as nasal polyps or respiratory papillomatosis. Nd:YAG assisted uvulopalatoplasty gives an interesting alternative for surgical procedures for snoring and slight/mild OSA-recognized patients. Due to its good hemostatic properties, it is a perfect tool for removal of the chemodectoma from meddle ear. During the period of 1995-2006 we performed 229 surgical procedures with the Ho:YAG laser, mostly for larynx pathologies (adhesion and scar tissue removal). In our experience Ho:YAG laser can serve as a precise laser knife for both soft and bony tissue. The ER:YAG laser still remain under clinical trial. Since 2001 year we performed 24 procedures of removing stone deposits from salivary glands. We believe it may become a promising method to cope with sialolithiasis which allows for glandule function preservation. All of the laser types mentioned above, can be easily coupled with endoscopes, what makes them available for all of the head and necklocalized disorders.

Detection of sleep apnea by case-finding and home monitoring with Somnolter®: a pilot study.

PubMed

Cattrysse, Fabienne; Peeters, Mathias; Calaerts, Sanne; Ferson, Karen; Degryse, Jean-Marie

2014-09-08

Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a disorder that causes clinical symptoms (e.g. snoring, excessive daytime sleepiness and impaired concentration) that may increase the risk of traffic accidents, cardiovascular disease, type 2 diabetes and reduce the quality of life. A recently developed device (Somnolter®) detects apneas and hypopneas in a home setting, allowing to detect OSAHS in a more comfortable environment compared to the gold standard polysomnography. The aim of our study was to investigate whether the Somnolter® is useful in family practice to identify patients with OSAHS. Questionnaires were offered to patients in five general practitioner (GP) practices.Based on the questionnaire and body mass index, patients with an increased risk of OSAHS were contacted to collaborate in the study. In this convenience sample, 18 patients were successfully tested with the Somnolter® measuring SaO2, mandibular movements, body position, heart rate, nasal air flow and thoracic and abdominal breathing movements. The Somnolter® automatically analyses the data and different parameters to detect OSAHS. Afterwards, the data were manually revised by the researchers. Out of 365 subjects, 31 met the inclusion criteria and 18 were successfully tested at home. Sixteen out of 18 patients had an Apnea Hypopnea Index (AHI) ≥ 5, ten of them had mild OSAHS, 3 were categorized as moderate OSAHS and finally 3 matched the criteria of severe OSAHS. The proposed case-finding strategy still needs optimization, but is considered helpful in selecting patients at high risk of OSAHS. OSAHS was detected in 14 out of 18 patients tested with the Somnolter®. In the future the Somnolter® might be a feasible alternative to diagnose OSAHS.

Clinical observations and risk factors for tinnitus in a Sicilian cohort.

PubMed

Martines, Francesco; Sireci, Federico; Cannizzaro, Emanuele; Costanzo, Roberta; Martines, Enrico; Mucia, Mariana; Plescia, Fulvio; Salvago, Pietro

2015-10-01

The aims of this study were to determine the distribution of risk factors associated with tinnitus analysing their role in the development of tinnitus and the effects of their interaction; to evidence the importance of a suitable and adequate clinical and audiologic assessment to avoid those modifiable risk factors responsible for cochlear dysfunction and tinnitus onset. 46 subjects with tinnitus and 74 controls were studied according to: age, sex, Body Mass Index (BMI), neck circumference, tobacco smoking, feeling fatigue or headache, self reporting snoring, hypertension, diabetes, coronary heart disease, and/or hyperlipidemia, and laboratory finding as lipid profile and levels of reactive oxygen metabolites (d-ROM). Audiological assessment was performed by multi-frequency audiometry (PTA(0.5-16 kHz)) and transient-evoked otoacoustic emissions (TEOAE diagnostic). Univariate analysis was performed to examine the association between determinants and occurrence of tinnitus; Mantel-Haenszel test (G.or) was used to investigate the joint effect of determinants on tinnitus. Tinnitus was more frequent among males with age >50 years; BMI >30 kg/m(2), neck circumference >40 cm, headache, hypertension, hypercholesterolemia resulted significant risk factors for tinnitus (P < 0.0001). Tinnitus group had more comorbidity (P < 0.0001) and worse audiometric thresholds (60.87 Vs 21.62% hearing loss; P < 0.0001) with respect to control group. The interaction between hypertension-BMI ≥ 30 kg/m(2) (G.or = 8.45) and smoking-hypercholesterolemia (G.or = 5.08) increases the risk of tinnitus (P < 0.0001). Our results underline that several factors either individually or jointly contribute to tinnitus onset; a comprehensive knowledge about tinnitus risk factors and associated clinical conditions could contribute to minimizing this disorder.

Neck Circumference and Incidence of Diabetes Mellitus over 10 Years in the Korean Genome and Epidemiology Study (KoGES)

PubMed Central

Cho, Nam H.; Oh, Tae Jung; Kim, Kyoung Min; Choi, Sung Hee; Lee, Jae Ho; Park, Kyong Soo; Jang, Hak Chul; Kim, Jong Yeol; Lee, Hong Kyu; Lim, Soo

2015-01-01

Neck circumference, a proxy for upper-body fat, may be a unique fat depot that indicates metabolic risk beyond whole body fat. We investigated whether neck circumference is associated with development of diabetes mellitus (DM) in a subset of data with Korean Genome and Epidemiology Study (n = 3521, age range = 42–71 years). Nondiabetic subjects at the baseline were categorized into 4 groups (Q1–Q4) according to their neck circumference. Parameters related with β-cell function and insulin resistance including Epworth sleepiness scale and snoring habit were examined. The development of DM was confirmed biannually based on a 75-g oral glucose tolerance test. Over the 10 years, 2623 (74.5%) among 3521 subjects were followed-up. Among them, 632 (24.1%) developed DM. The incidence of DM increased from 17.6% in Q1 to 18.2% in Q2, to 25.4% in Q3, and to 36.0% in Q4 (P < 0.001). After adjusting for most risk factors related with DM, the relative risks of DM development were 0.989 (95% confidence interval, 0.638–1.578), 1.660 (1.025–2.687), and 1.746 (1.037–2.942) in men and 0.939 (0.540–1.769), 1.518 (0.808–2.853), and 2.077 (1.068–4.038) in women in Q2, Q3, and Q4, respectively when compared to Q1. This finding indicates negative impact from large neck circumference in the development of DM. PMID:26681338

Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma.

PubMed

Balbay, Ege G; Balbay, Oner; Annakkaya, Ali N; Suner, Kezban O; Yuksel, Harun; Tunç, Murat; Arbak, Peri

2014-10-01

To investigate the prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. Case series. School of Medicine, Düzce University, Turkey. Twenty-one consecutive primary open-angle glaucoma patients (12 females and 9 males) who attended the out-patient clinic of the Department of Ophthalmology between July 2007 and February 2008 were included in this study. All patients underwent polysomnographic examination. The prevalence of obstructive sleep apnoea syndrome was 33.3% in patients with primary open-angle glaucoma; the severity of the condition was mild in 14.3% and moderate in 19.0% of the subjects. The age (P=0.047) and neck circumference (P=0.024) in patients with obstructive sleep apnoea syndrome were significantly greater than those without the syndrome. Triceps skinfold thickness in glaucomatous obstructive sleep apnoea syndrome patients reached near significance versus those without the syndrome (P=0.078). Snoring was observed in all glaucoma cases with obstructive sleep apnoea syndrome. The intra-ocular pressure of patients with primary open-angle glaucoma with obstructive sleep apnoea syndrome was significantly lower than those without obstructive sleep apnoea syndrome (P=0.006 and P=0.035 for the right and left eyes, respectively). There was no significant difference in the cup/disc ratio and visual acuity, except visual field defect, between primary open-angle glaucoma patients with and without obstructive sleep apnoea syndrome. Although it does not provide evidence for a cause-effect relationship, high prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma in this study suggests the need to explore the long-term results of coincidence, relationship, and cross-interaction of these two common disorders.

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

PubMed Central

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

2014-01-01

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

Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing - an exploratory pilot study.

PubMed

Anderson, S; Alsufyani, N; Isaac, A; Gazzaz, M; El-Hakim, H

2018-06-04

Drug induced sleep endoscopy (DISE) is hoped to identify reasons of failure of adenotonsillectomy (AT) in treating pediatric sleep disordered breathing (SDB). Maxillomandibular disproportion has been studied as another association which may explain alternative pathogenesis of SDB. We aimed to explore the relation between the size of the gonial angle and inclination of the epiglottis measured from cone beam CT (CBCT) and tongue base collapse based on DISE in children with SDB. A retrospective chart review was conducted at a tertiary pediatric center. Children (6-17 years old) assessed at a multi-disciplinary Upper Airway Clinic, diagnosed with SDB and maxillo-mandibular disproportion (MMD), and who underwent DISE were eligible. Variables obtained from the electronic medical records of the clinic and prospective database included demographics, comorbidities, surgeries performed, investigations, DISE findings and CBCT findings. The gonial angle of subjects with and without tongue base collapse (TBC) on SNP were compared. In total 29 patients (13 male, 8 female) age 6-17 (median= 9) were eligible for the study from January 2009 - July 2016. We included 11 subjects, and 10 comparators. The mean gonial angle of the TBC group was 139.3°± 7.6°, while that of the comparison group was 129.4°±3.5 (mean difference -9.937, 95% CI of -15.454 to - 4.421, P = 0.001, power of test 0.95). Additionally, the mean inclination of the epiglottis had a mild positive correlation (r=0.32, p<0.05) with the gonial angle, in the whole cohort. This pilot study suggests that TBC may be mediated by a wider gonial angle in children with SDB patients. The posterior tilt of the epiglottis on CBCT may be a surrogate sign of TBC.

Mother's Work Status on Children's Bruxism in a Subset of Saudi Population

PubMed Central

Alouda, Rana; Alshehri, Maram; Alnaghmoosh, Shoog; Shafique, Maryam; Al-Khudhairy, May Wathiq

2017-01-01

Aims and Objectives: The aims and objectives of this study were to determine if an association exists between mothers work status and her children's incidence of bruxism and habits related to bruxism. Materials and Methods: A cross-sectional study was conducted through data collection of a questionnaire answered by 561 mothers’ about their working status and their child's habits and behaviors. The survey consisted of 5 parts with a total of 34 questions: mother's information, child's behavior, child's sleeping pattern, mother's knowledge about bruxism, and child's medical history. Odds ratios, Chi-square, and their corresponding 95% confidence intervals are reported. Statistical significance was set at P ≤ 0.05. Results: The work status of the mother was not statistically significant in increasing the incidence of a child to have bruxism. However, this study clearly elucidates that 7 of the 15 habits correlate significantly with a status of bruxism. According to this sample, a child, that is, reported to be aggressive is more than twice as likely to have nocturnal bruxism. Likewise, any child that bites their nails, complains of headaches, drools in their sleep, snores, complains of muscle cramps, and colic is more than twice as likely to be a nocturnal bruxer than a child that does not have these habits. Conclusion: The prevalence of children's bruxism in this convenient sample was 34.5% (n = 141). The concerning habits related to bruxism can serve the pediatric dentist, general dentist, general practitioner, and primary care provider of children having these red flags as indicators of bruxism. It is imperative that parents of these children be made aware these habits that may occur together, alone or even simultaneously with bruxism. PMID:29285473

Description of Abnormal Breathing Is Associated With Improved Outcomes and Delayed Telephone Cardiopulmonary Resuscitation Instructions.

PubMed

Fukushima, Hidetada; Panczyk, Micah; Hu, Chengcheng; Dameff, Christian; Chikani, Vatsal; Vadeboncoeur, Tyler; Spaite, Daniel W; Bobrow, Bentley J

2017-08-29

Emergency 9-1-1 callers use a wide range of terms to describe abnormal breathing in persons with out-of-hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process. We conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein-style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P <0.0001), with an odds ratio of 1.63 (95% confidence interval, 1.17-2.25). After exclusions, 379 of 459 cases were eligible for process analysis. When callers described abnormal breathing, the rates of telecommunicator OHCA recognition, CPR instruction, and telephone CPR were lower than when callers did not use a breathing descriptor (79.7% versus 93.0%, P <0.0001; 65.4% versus 72.5%, P =0.0078; and 60.2% versus 66.9%, P =0.0123, respectively). The time interval between call receipt and OHCA recognition was longer when the caller used a breathing descriptor (118.5 versus 73.5 seconds, P <0.0001). Descriptors of abnormal breathing are associated with improved outcomes but also with delays in the identification of OHCA. Familiarizing telecommunicators with these descriptors may improve the telephone CPR process including OHCA recognition for patients with increased probability of survival. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Complaints of Poor Sleep and Risk of Traffic Accidents: A Population-Based Case-Control Study

PubMed Central

Philip, Pierre; Chaufton, Cyril; Orriols, Ludivine; Lagarde, Emmanuel; Amoros, Emmanuelle; Laumon, Bernard; Akerstedt, Torbjorn; Taillard, Jacques; Sagaspe, Patricia

2014-01-01

Introduction This study aimed to determine the sleepiness-related factors associated with road traffic accidents. Methods A population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents. Results As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57–63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30–8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00–2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: 1.03–3.97, p<0.05), and 3.29 times higher in subjects reporting taking more than 2 medications in the last 24 h (CI 95%: 1.14–9.44, p<0.05). Chronic daytime sleepiness measured by the Epworth Sleepiness Scale, expressed heavy snoring and nocturnal leg movements did not explain traffic accidents. Conclusion Physicians should be attentive to complaints of poor sleep quality and quantity, symptoms of anxiety-nervousness and/or drug consumption in regular car drivers. PMID:25494198

[Efficacy and longterm compliance of the vest preventing the supine position in patients with obstructive sleep apnea].

PubMed

Wenzel, S; Smith, E; Leiacker, R; Fischer, Y

2007-08-01

Treating the positional obstructive sleep apnea with a vest preventing the supine position is well known to be riskless and inexpensive. It was the aim of this study to test the efficacy and, for the first time, the longterm compliance of this treatment. 14 patients with positional obstructive sleep apnea (age 48.2 +/- 12.1 years; body-mass-index: 28.1 +/- 4.6 kg/m2 mean, +/- SD) were investigated polysomnographically without and with a vest preventing the supine position. 13.7 +/- 15.9 months later the patients were asked about the comfort of the vest and the nocturnal using time using the Likert-scale, and data about the latest Epworth Sleepiness Scale (ESS) was collected. The respiratory disturbance index (RDI) was reduced statistically significant from 31.3 +/- 12.9/h to 13.8 +/- 9.0/h by wearing the vest (p < 0.001). Total sleep time at an oxygen saturation below 90% decreased from 8.2 +/- 7.1% to 3.8 +/- 4.5% (p < 0.001), the snoring time from 15.4 +/-19.6 % to 9.8 +/-13.1% (p < 0.05) of the total sleep time (TST) and the arousal index from 23.1 +/-16.0/h to 18.6 +/-11.4/h (p < 0.05). 24 +/-28.8 months later 28.6% of the patients were still using the vest. Of these patients the ESS decreased from 8.5 +/-3.2 to 6.5 +/-2.9 (p < 0.05). 72.4% of the patients refused the longterm therapy with the vest because of its low wearing comfort. Although the vest approved to be effective against positional obstructive sleep apnea, the longterm compliance is low because of its need getting used to.

The effect of obstructive sleep apnea syndrome and hypothyroidism to intima-media thickness of carotid artery.

PubMed

Bozkus, Fulsen; Dikmen, Nursel; Güngör, Gülay; Samur, Anıl

2017-03-01

Obstructive sleep apnea syndrome (OSAS) is a common disorder and in subjects with OSAS the prevalence of hypothyroidism is approximately 1.2-11 %. The episodes of hypoxia/reoxygenation associated with the respiratory disturbances observed in subjects with OSAS increases the risk of cardiovascular diseases. Hypothyroidism; primary or subclinical, has several effects on cardiovascular system. In our study, we investigated carotid artery intima-media thickness (IMT) which is an early sign of atherosclerosis, in OSAS subjects with hypothyroidism. Subjects who admitted to Kahramanmaras Necip Fazıl City State Hospital Chest Diseases out-patient clinic between May 2014 and January 2016 for snoring and had polysomnographic evaluation at the sleep laboratory were included in this study. Each subject was evaluated for serum thyroid function tests and carotid artery IMT was measured by a Doppler ultrasound. Mean carotid artery IMT values in the isolated OSAS, OSAS plus hypothyroidism, and control groups were 0.67 ± 0.12, 0.8 ± 0.12, and 0.54 ± 0.08 mm, respectively; difference between groups was statistically significant (p < .05). A poXsitive correlation was found between thyroid stimulating hormone levels and IMT (r = 0.426, p = .002), while free T3 levels and IMT were negatively correlated (r = -0.463, p = .001). IMT and apnea-hypopnea index were also positively correlated (r = 0.403, p = .003). We suggest, physicians should be alert for hypothyroidism comorbidity in OSAS, and suspected subjects with OSAS should be screened for hypothyroidism considering the potential cardiovascular complications.

Serum Progesterone Levels in Pregnant Women with Obstructive Sleep Apnea: A Case Control Study.

PubMed

Lee, Jennifer; Eklund, Elizabeth E; Lambert-Messerlian, Geralyn; Palomaki, Glenn E; Butterfield, Kristen; Curran, Patrizia; Bourjeily, Ghada

2017-03-01

Pregnancy is a risk factor for sleep disordered breathing, including obstructive sleep apnea (OSA). Progesterone, one of the key hormones in pregnancy, a known respiratory drive stimulant, increases ventilation and may protect against OSA. We aimed to examine the relationship between circulating progesterone and OSA, after accounting for body weight and gestational age. A case control study was conducted of pregnant women with OSA and those at low risk for the disorder. Cases were identified by ICD-9 code and review of medical record. Controls were identified if they scored zero (never) for snoring, apnea, and gasping on the multivariable apnea prediction index questionnaire immediately following delivery. Subjects with available stored first and/or second trimester residual serum samples were then included in this study and serum analyzed for progesterone. Raw progesterone levels were adjusted for the effects of gestational age and maternal weight. Twenty-seven cases and 64 controls with available serum were identified. Women with OSA had greater maternal weight and higher rates of related comorbidities, compared to controls. Progesterone levels correlated positively with gestational age and negatively with greater weight. Progesterone levels, adjusted for gestational age and maternal weight and expressed as multiples of median (MoM), were significantly lower in OSA cases compared to controls in both the first trimester (MoM = 0.71, confidence interval [95% CI] 0.60-0.83) relative to the MoM in controls of 1.00. In the second trimester levels were also lower in OSA cases (MoM = 0.84, 95% CI 0.73-0.96) compared to the MoM of 1.00 in controls. Progesterone levels, after accounting for weight and gestational age, were lower in women with OSA than controls. Progesterone may play a protective role against OSA.

Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents.

PubMed

Liu, Xianchen; Chen, Hua; Bo, Qi-Gui; Fan, Fang; Jia, Cun-Xian

2017-03-01

Non-suicidal self-injury (NSSI) is prevalent and is associated with increased risk of suicidal behavior in adolescents. This study examined which sleep variables are associated with NSSI, independently from demographics and mental health problems in Chinese adolescents. Participants consisted of 2090 students sampled from three high schools in Shandong, China and had a mean age of 15.49 years. Participants completed a sleep and health questionnaire to report their demographic and family information, sleep duration and sleep problems, impulsiveness, hopelessness, internalizing and externalizing problems, and NSSI. A series of regression analyses were conducted to examine the associations between sleep variables and NSSI. Of the sample, 12.6 % reported having ever engaged in NSSI and 8.8 % engaged during the last year. Univariate logistic analyses demonstrated that multiple sleep variables including short sleep duration, insomnia symptoms, poor sleep quality, sleep insufficiency, unrefreshed sleep, sleep dissatisfaction, daytime sleepiness, fatigue, snoring, and nightmares were associated with increased risk of NSSI. After adjusting for demographic and mental health variables, NSSI was significantly associated with sleeping <6 h per night, poor sleep quality, sleep dissatisfaction, daytime sleepiness, and frequent nightmares. Stepwise logistic regression model demonstrated that poor sleep quality (OR = 2.18, 95 % CI = 1.37-3.47) and frequent nightmares (OR = 2.88, 95 % CI = 1.45-5.70) were significantly independently associated with NSSI. In conclusion, while multiple sleep variables are associated with NSSI, poor sleep quality and frequent nightmares are independent risk factors of NSSI. These findings may have important implications for further research of sleep self-harm mechanisms and early detection and prevention of NSSI in adolescents.