... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ...
Full Text Available ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ...
Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing ... an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or ...
Sleep apnea - central; Obesity - central sleep apnea; Cheyne-Stokes - central sleep apnea; Heart failure - central sleep apnea ... Central sleep apnea results when the brain temporarily stops sending signals to the muscles that control breathing. The condition ...
... Safe Videos for Educators Search English Español Obstructive Sleep Apnea KidsHealth / For Parents / Obstructive Sleep Apnea What's ... How Is Sleep Apnea Treated? Print What Is Sleep Apnea? Brief pauses in breathing during sleep are ...
... Page You are here Home » Disorders » All Disorders Sleep Apnea Information Page Sleep Apnea Information Page What research is being done? ... Institutes of Health (NIH) conduct research related to sleep apnea in laboratories at the NIH, and also ...
Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...
Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...
An apnea monitor checks the heart rate and respiration of the baby to make sure he or she is ... When either one falls below normal levels, the apnea monitor beeps to notify the care provider that ...
Full Text Available ... the position of the jaw. The cessation of breathing, or “apnea,” brought about by these factors initiates ... wake the person just enough to restart the breathing process. Sleep apnea is generally defined as the ...
Full Text Available ... Apnea (OSA) Download Download the ebook for further information Obstructive sleep apnea (OSA) is a serious and ... that can create the necessary air passageway. The information provided here is not intended as a substitute ...
... this page: //medlineplus.gov/ency/article/007227.htm Apnea of prematurity To use the sharing features on this page, ... that slows down or stops from any cause. Apnea of prematurity refers to short episodes of stopped breathing in ...
Full Text Available ... sleep apnea (OSA) is a serious and even life-threatening condition. The risks of undiagnosed OSA are ... sleep apnea (OSA) is a serious and even life-threatening condition. The risks of undiagnosed OSA are ...
Fernández Martínez, Francisco de Asís
Tras la ruptura de la respiración, comienzan a producirse una sucesión de procesos encaminados a adaptar el organismo a la heterostasis provocada. Los diferente factores de rendimiento de la "Apnea Indoor" (apnea estática y apnea dinámica, con y sin aletas) han sido estudiados con anterioridad. En esta Tesis doctoral se estudia el grado de correlación existente entre algunos de los factores de rendimiento de la Apnea Indoor - almacenaje total de O2/CO2, metabolismo basal y tolerancia a la asf...
Muhammad Talha Khan
Full Text Available Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour persist or emerge when obstructive events are extinguished with positive airway pressure (PAP and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous cositive airway pressure (CPAP related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therap, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs.
Full Text Available ... can also invite bacteria that lead to gum disease. Click here to find out more. Obstructive Sleep Apnea (OSA) Download Download the ebook for further ... more than 30 apneas during a seven-hour sleep. In severe cases, periods of not breathing may last for as long as 60 to ... on whether your OSA is mild, moderate ...
Hoekema, A.; Stegenga, B.; Wijkstra, P. J.; van der Hoeven, J. H.; Meinesz, A. F.; de Bont, L. G. M.
In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned
Weiss, Miriam; Owens, Judith
Obstructive sleep apnea is a common condition in childhood and has a significant impact on health, learning, academic performance, and quality of life. The purpose of this article is to review the epidemiology, etiology, risk factors, clinical presentation, diagnostic procedures, and treatment of obstructive sleep apnea.
Eichenwald, Eric C
Apnea of prematurity is one of the most common diagnoses in the NICU. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful. Research into the development of respiratory control in immature animals and preterm infants has facilitated our understanding of the pathogenesis and treatment of apnea of prematurity. However, the lack of consistent definitions, monitoring practices, and consensus about clinical significance leads to significant variation in practice. The purpose of this clinical report is to review the evidence basis for the definition, epidemiology, and treatment of apnea of prematurity as well as discharge recommendations for preterm infants diagnosed with recurrent apneic events. Copyright © 2016 by the American Academy of Pediatrics.
Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...
Full Text Available ... Other Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons ...
Full Text Available ... The National Sleep Foundation estimates that 18 million adults have obstructive sleep apnea and it is likely ... Maxillofacial Surgeon (OMS). An estimated 18-20 million adults in the US suffer from OSA. What Is ...
... include being overweight and having a large neck. Losing even 10 percent of body weight can help reduce the number of times a person with sleep apnea stops breathing during sleep. African-Americans, Pacific ...
... this page: //medlineplus.gov/ency/patientinstructions/000755.htm Home apnea monitor use - infants To use the sharing ... portable. Why is an Apnea Monitor Used at Home? A monitor may be needed when: Your baby ...
Full Text Available Juan Wang,1,* Yan Wang,1,* Jing Feng,1,2 Bao-yuan Chen,1 Jie Cao1 1Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People's Republic of China; 2Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA *The first two authors contributed equally to this work Abstract: Complex sleep apnea syndrome (CompSAS is a distinct form of sleep-disordered breathing characterized as central sleep apnea (CSA, and presents in obstructive sleep apnea (OSA patients during initial treatment with a continuous positive airway pressure (CPAP device. The mechanisms of why CompSAS occurs are not well understood, though we have a high loop gain theory that may help to explain it. It is still controversial regarding the prevalence and the clinical significance of CompSAS. Patients with CompSAS have clinical features similar to OSA, but they do exhibit breathing patterns like CSA. In most CompSAS cases, CSA events during initial CPAP titration are transient and they may disappear after continued CPAP use for 4–8 weeks or even longer. However, the poor initial experience of CompSAS patients with CPAP may not be avoided, and nonadherence with continued therapy may often result. Treatment options like adaptive servo-ventilation are available now that may rapidly resolve the disorder and relieve the symptoms of this disease with the potential of increasing early adherence to therapy. But these approaches are associated with more expensive and complicated devices. In this review, the definition, potential plausible mechanisms, clinical characteristics, and treatment approaches of CompSAS will be summarized. Keywords: complex sleep apnea syndrome, obstructive sleep apnea, central sleep apnea, apnea threshold, continuous positive airway pressure, adaptive servo-ventilation
Egeberg, Alexander; Khalid, Usman; Gislason, Gunnar Hilmar
STUDY OBJECTIVES: Psoriasis and sleep apnea are associated with significant morbidity and mortality. Although both diseases have been linked with systemic inflammation, studies on their potential bidirectional association are lacking. We investigate the potential association between psoriasis...... and sleep apnea. METHODS: All Danish citizens age 18 y or older between January 1, 1997 and December 31, 2011 (n = 5,522,190) were linked at individual level in nationwide registries. Incidence rates (IRs) per 10,000 person-years were calculated and incidence rate ratios (IRRs) adjusted for age, sex......, socioeconomic status, smoking history, alcohol abuse, medication, and comorbidity were estimated by Poisson regression. RESULTS: There were 53,290, 6,885, 6,348, and 39,908 incident cases of mild psoriasis, severe psoriasis, psoriatic arthritis, and sleep apnea, respectively. IRRs (95% confidence interval...
Egeberg, Alexander; Khalid, Usman; Gislason, Gunnar Hilmar
STUDY OBJECTIVES: Psoriasis and sleep apnea are associated with significant morbidity and mortality. Although both diseases have been linked with systemic inflammation, studies on their potential bidirectional association are lacking. We investigate the potential association between psoriasis...... and sleep apnea. METHODS: All Danish citizens age 18 y or older between January 1, 1997 and December 31, 2011 (n = 5,522,190) were linked at individual level in nationwide registries. Incidence rates (IRs) per 10,000 person-years were calculated and incidence rate ratios (IRRs) adjusted for age, sex......, socioeconomic status, smoking history, alcohol abuse, medication, and comorbidity were estimated by Poisson regression. RESULTS: There were 53,290, 6,885, 6,348, and 39,908 incident cases of mild psoriasis, severe psoriasis, psoriatic arthritis, and sleep apnea, respectively. IRRs (95% confidence interval...
Anil Kumar Nagarajappa
Full Text Available Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is recognized as a public health problem and shows detrimental effects on health, such as hypertension, cardiovascular disease, and death. The prevalence rate is 19.5% among men and 7.5% among women in India. Polysomnography remains the gold standard method for diagnosis of sleep apnea and assessment of sleep apnea. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities include lifestyle modification, upper airway surgery, and use of an oral appliance. This article reviews the available data on management of sleep apnea.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Apnea monitor. 868.2377 Section 868.2377 Food and... ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2377 Apnea monitor. (a) Identification. An apnea monitor is a... breath. The apnea monitor also includes indirect methods of apnea detection such as monitoring of heart...
Jennum, Poul; Tønnesen, Philip; Ibsen, Rikke
OBJECTIVE: Most studies have used cardiovascular and cerebrovascular disease (CVD) end-points to measure the effect of continuous positive airway pressure (CPAP), but pre-diagnostic morbidities involve a range of comorbidities that may influence the consequences of obstructive sleep apnea (OSA). We...
... in treating sleep apnea. Another effective treatment is nasal continuous positive airway pressure (CPAP), which requires the child to wear a mask while he sleeps. The mask delivers steady air pressure through the child's nose, allowing him to breathe comfortably. Continuous positive airway ...
Full Text Available ... can also invite bacteria that lead to gum disease. Click here to find out more. Obstructive Sleep Apnea (OSA) Download Download the ebook for further information Obstructive sleep ... high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime ...
... Stimulation (UAS) System. What is Sleep Apnea? The Greek word "apnea" literally means "without breath." With sleep ... being over age 40, smoking, having a family history of sleep apnea, and having a nasal obstruction ...
Full Text Available Apnea of prematurity (AOP is one of the most frequent pathologies in the Neonatal Intensive Care Unit, with an incidence inversely related to gestational age. Its etiology is often multi factorial and diagnosis of idiopathic forms requires exclusion of other underlying diseases. Despite being a self-limiting condition which regresses with the maturation of the newborn, possible long-term effects of recurring apneas and the degree of desaturation and bradycardia who may lead to abnormal neurological outcome are not yet clarified. Therefore AOP needs careful evaluation of its etiology and adequate therapy that can be both pharmacological and non-pharmacological. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research
Holzrichter, John F
An implanted stimulation device or air control device are activated by an external radar-like sensor for controlling apnea. The radar-like sensor senses the closure of the air flow cavity, and associated control circuitry signals (1) a stimulator to cause muscles to open the air passage way that is closing or closed or (2) an air control device to open the air passage way that is closing or closed.
Steven D. Brass
Full Text Available Obstructive sleep apnea (OSA affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual’s risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.
Moriette, G; Lescure, S; El Ayoubi, M; Lopez, E
Prematurity apnea remains a major clinical problem that requires treatment choices which are sometimes difficult. Prematurity apnea occurs in most infants of gestational age at birth less than 33 weeks. It is a developmental disorder which usually reflects a "physiological" immaturity of respiratory control. However, neonatal diseases may be associated and play an additive role, resulting in an increased incidence of apnea. Careful screening should therefore be performed in order to make sure that no other factor than immaturity is involved in the occurrence of apnea. Short apnea (less than 10s, without hypoxemia and bradycardia), due to immaturity, are not clinically relevant. More prolonged apnea, that last for more than 15 or 20s, and / or apnea associated with bradycardia or oxygen desaturation, results in short-term disturbances of cerebral haemodynamics and oxygenation, which may negatively impact on neurodevelopmental outcome. Evaluating the immediate severity of apnea and the risks that apnea may affect long-term outcome remains a challenge. The choice of treatments is based on a few evidences. Caffeine citrate, which reduces the incidence of apnea, has been used for decades. However, a thorough evaluation of risks and benefits of this medication has been performed only recently. Caffeine citrate was found to be safe and resulted in unexpected benefits. In treated infants, compared with controls, indeed, a decreased incidence of the following complications was recorded: bronchopulmonary dysplasia at 36 weeks of conceptional age, patent ductus arteriosus, cerebral palsy at 18 months of age. Nasal CPAP can be used in association with caffeine citrate, when the latter is not effective enough. Copyright 2009. Published by Elsevier SAS.
... care for apnea of prematurity in the hospital's neonatal intensive care unit (NICU) . Right after they're ... and caregivers also will be trained in infant CPR , even though it's unlikely they'll ever have ...
... increases the risk of pregnancy complications such as preeclampsia and diabetes. The NHLBI and NICHD are now studying whether the treatment of sleep apnea during pregnancy reduces these risks. ...
Amin, Sanjiv B.; Bhutani, Vinod K.; Watchko, Jon F.
Central apnea, defined as cessation of breathing for ≥ 20 seconds, is frequent in premature infants born apnea in neonates. This paper explores the reported association between acute bilirubin encephalopathy and symptomatic apneic events in newborns and the possible mechanisms involved in the pathogenesis of this phenomenon. The prevalence of symptomatic apneic events in reports of acute bilirubin encephalopathy suggests this clinical finding should be considered a sign of bilirubin neurotoxicity. PMID:25239473
Full Text Available Obstructive sleep apnea syndrome (OSAS is a potentially serious disorder attacking millions of people around the world. Many of these individuals are undiagnosed, and even though diagnosed often exhibit a poor compliance with the use of continuous positive airway pressure at nights, a very effective nonsurgical treatment. A variety of surgical procedures have been proposed to manage and treat OSA. This article throws insights into assessing the sites of obstruction and a number of surgical procedures designed to address OSA. The scope of this article is to provide information to dentists which enables them to identify the patients who have OSAS and to guide these patients in making informed decisions regarding treatment options.
Full Text Available Obstructive sleep apnea (OSA is a common condition in childhood and can result insevere complications if left untreated. It is showing a rising trend in India. A significantassociation with obesity has been observed; however, some children with enlargedtonsils and/or adenoids may even be underweight. The patient usually presents withsnoring and other respiratory problems like mouth breathing, choking and gaspingepisodes in night. Poor school performance and neurocognitive deficits have beenreported. Pulmonary hypertension and cor pulmonale are seen in severe cases. Besidesthe history and clinical examination, for definitive diagnosis an overnightpolysomnographic evaluation is the gold standard. In all cases, the specific treatmentranges from simple lifestyle modifications and medications to surgeries likeadenotonsillectomy. Early diagnosis is vital.Key words: Childhood OSA, Obesity, adenotonsillar hypertrophy
... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Sleep Apnea and Heart Disease, Stroke Updated:Mar 16, ... be life-threatening. It’s a condition known as sleep apnea, in which the person may experience pauses ...
Prosthodontic Approach to Treat Obstructive Sleep Apnea. ... Annals of Medical and Health Sciences Research ... disordered breathing represents a continuum, ranging from simple snoring sans sleepiness, upper‑airway resistance syndrome, obstructive sleep apnea (OSA) syndrome, to hypercapnic respiratory failure.
Bhatt-Mehta, Varsha; Schumacher, Robert E
In the last decade, knowledge regarding the neurodevelopment and functional aspects of the respiratory centers during postnatal maturation has increased substantially. However, an increase in such knowledge has not provided a basis for change in practice. The diagnosis of apnea of prematurity (AOP) is one of exclusion. All causes of secondary apnea must be ruled out before initiating treatment for AOP. Treatment will depend on the etiology as well as effectiveness and tolerability of the treatment by the patient. The primary goal of any treatment of AOP is to prevent the frequency of apnea lasting >20 seconds, and/or those that are shorter, but associated with cyanosis and bradycardia. The clinical management of AOP is not much different today than it was two decades ago, with pharmacologic and nonpharmacologic treatment options remaining the mainstay of therapy. Methylxanthines are still the most widely used pharmacologic agents. Due to the wider therapeutic index of caffeine and ease of once daily administration, it should be the preferred agent. Doxapram, or nonpharmacologic treatment measures such as nasal continuous positive airway pressure, may be considered in infants who are unresponsive to methylxanthine treatment alone. Treatment should be continued until there is complete resolution of apnea, and for some time thereafter. The choice of method for weaning treatment remains one of individual physician preference. Discharge from hospital after apnea requires close monitoring and some infants will require home apnea monitors. The decision to provide a home apnea monitor should be individualized for each patient, depending on the effectiveness of treatment and clinical response.
Tamim, Hala; Khogali, Mustafa; Beydoun, Hind; Melki, Imad; Yunis, Khalid
Consanguinity, marriage between relatives, has been associated with perinatal mortality and morbidity. Apnea of prematurity is defined as the cessation of breathing for longer than 20 seconds or that of any duration if accompanied by cyanosis and sinus bradycardia, for infants born before 37 weeks of gestation. The objective of the study was to examine the association between consanguinity and apnea of prematurity in Greater Beirut, an area having a relatively high prevalence rate of consanguineous marriages. The study was cross-sectional. Between September 1, 1998, and March 31, 2001, 21723 newborn infants were admitted to the National Collaborative Perinatal Neonatal Network in Greater Beirut, Lebanon. The inclusion criteria were infants less than 37 weeks of gestation who were admitted to the intensive care unit, with no congenital malformations, sepsis, or neurologic disorders. Analysis was based on 597 infants of whom 66 had apnea of prematurity. With adjustment for weeks and type of gestation, pregnancy complications, and Apgar score, the odds ratio of apnea of prematurity for first-degree consanguineous parents as compared with other marriages was 2.9 (95% confidence interval: 1.3, 6.4). In addition to the recognized etiologic factors for apnea of prematurity, this study suggests a role played by genetic factors.
Hillarp, B.; Rosen, I.; Wickstroem, O.; Malmoe Allmaenna Sjukhus
Percutaneous submental electrical stimulation during sleep may be a new therapeutic method for patients with obstructive sleep apnea syndrome (OSAS). Electrical stimulation to the submental region during obstructive apnea is reported to break the apnea without arousal and to diminish apneic index, time spent in apnea, and oxygen desaturation. The mode of breaking the apnea by electrical stimulation has not yet been shown. However, genioglossus is supposed to be the muscle responsible for breaking the apnea by forward movement of the tongue. To visualize the effect of submental electrical stimulation, one patient with severe OSAS has been examined with videoradiography. Submental electrical stimulation evoked an immediate complex muscle activity in the tongue, palate, and hyoid bone. This was followed by a forward movement of the tongue which consistently broke obstructive apnea without apparent arousal. Time spent in apnea was diminished but intervals between apnea were not affected. (orig.)
Hillarp, B.; Rosen, I.; Wickstroem, O. (Malmoe Allmaenna Sjukhus (Sweden). Dept. of Diagnostic Radiology Malmoe Allmaenna Sjukhus (Sweden). Dept. of Clinical Neurophysiology)
Percutaneous submental electrical stimulation during sleep may be a new therapeutic method for patients with obstructive sleep apnea syndrome (OSAS). Electrical stimulation to the submental region during obstructive apnea is reported to break the apnea without arousal and to diminish apneic index, time spent in apnea, and oxygen desaturation. The mode of breaking the apnea by electrical stimulation has not yet been shown. However, genioglossus is supposed to be the muscle responsible for breaking the apnea by forward movement of the tongue. To visualize the effect of submental electrical stimulation, one patient with severe OSAS has been examined with videoradiography. Submental electrical stimulation evoked an immediate complex muscle activity in the tongue, palate, and hyoid bone. This was followed by a forward movement of the tongue which consistently broke obstructive apnea without apparent arousal. Time spent in apnea was diminished but intervals between apnea were not affected. (orig.).
Mansbach, Jonathan M.; Stevenson, Michelle; Macias, Charles G.; Fisher, Erin Stucky; Barcega, Besh; Sullivan, Ashley F.; Espinola, Janice A.; Piedra, Pedro A.; Camargo, Carlos A.
OBJECTIVE: To identify risk factors for inpatient apnea among children hospitalized with bronchiolitis. METHODS: We enrolled 2207 children, aged apnea was ascertained by daily chart review, with outcome data in 2156 children (98%). Age was corrected for birth apnea. RESULTS: Inpatient apnea was identified in 108 children (5%, 95% confidence interval [CI] 4%–6%). Statistically significant, independent predictors of inpatient apnea included: corrected ages of apnea during this bronchiolitis episode (OR 3.63); preadmission respiratory rates of 70 (OR 2.26), compared with 40 to 49; and having a preadmission room air oxygen saturation Apnea risk was similar across the major viral pathogens. CONCLUSIONS: In this prospective, multicenter study of children hospitalized with bronchiolitis, inpatient apnea was associated with younger corrected age, lower birth weight, history of apnea, and preadmission clinical factors including low or high respiratory rates and low room air oxygen saturation. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens. PMID:24101759
Obstructive sleep apnea hypopnea syndrome (OSAHS) is an important medical condition brought to limelight in the last five decades. It is a major cause of morbidity and significant cause of mortality worldwide, including developed and developing nations. A survey done in Abuja, Nigeria, showed that OSAHS may be a ...
Stokowski, Laura A
Apnea, the cessation of respiratory airflow, can begin in many preterm infants in the first week of life and can last until the day of discharge or beyond. This article provides an overview of the complex anatomic, physiological, and developmental mechanisms related to immaturity of both the central nervous system and musculature of the pulmonary system, that contribute to apnea of prematurity. Apnea of prematurity is a diagnosis of exclusion; an array of other conditions and stimuli can also cause apnea, including infections, pulmonary disease, and intracranial pathology. The standard clinical management of apnea, including cutaneous stimulation, methylxanthine therapy, and continuous positive airway pressure or ventilatory support, are discussed as well as newer investigational therapies, such as olfactory stimulation. Emerging evidence on the long-term neurodevelopmental impact of apnea is reviewed. Nursing measures to prevent and manage apnea are reviewed with an emphasis on parent education and preparation for discharge. Apnea resolves in most preterm infants as they approach term corrected gestational age; however, if it does not, options include continued hospitalization or, for infants with stable apnea, discharge with a home apnea monitor.
Kraaijenga, Juliette V.; Hutten, Gerard J.; de Waal, Cornelia G.; de Jongh, Frans H.; Onland, Wes; van Kaam, Anton H.
Background: Treatment of apnea is highly dependent on the type of apnea. Chest impedance (CI) has inaccuracies in monitoring respiration, which compromises accurate apnea classification. Electrical activity of the diaphragm measured by transcutaneous electromyography (EMG) is feasible in preterm
Full Text Available Simonetta Picone, Roberto Aufieri, Piermichele PaolilloDivision of Neonatology and Neonatal Intensive Care, Department of Maternal and Child Health, Casilino General Hospital, Rome, ItalyAbstract: Apnea of prematurity is a developmental disorder that frequently affects preterm infants, especially those with lower gestational age. Even if apnea of prematurity is by definition a self-limiting condition, it can cause serious problems during the hospital stay and can potentially have long-term neurological and cognitive consequences depending on the severity and intensity of the episodes. The diagnosis of apnea of prematurity can be made only after excluding a number of diseases of the preterm infant in which apnea may be an epiphenomenon. Etiological diagnosis is essential for selection of appropriate treatment, which may be nonpharmacological or involve use of drugs.Keywords: apnea of prematurity, idiopathic and secondary apnea, caffeine
Lee-Iannotti J; Parish JM
No abstract available. Article truncated at 150 words. A common conundrum faced by sleep medicine practitioners is how to manage the large group of patients with mild sleep apnea. Many patients are referred for sleep evaluation, with symptoms thought to be due to obstructive sleep apnea (OSA). Often polysomnography demonstrates only mild sleep apnea, and the clinician and patient are faced with the dilemma of whether to use continuous positive airway pressure (CPAP) therapy or an oral applian...
Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.
Full Text Available BACKGROUND: Obstructive sleep apnea (OSA is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity.
Full Text Available Craig L Phillips,1–3 Denise M O'Driscoll4,51Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; 2National Health and Medical Research Council Center for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; 3Discipline of Sleep Medicine, Sydney Medical School, University of Sydney, Sydney, Australia; 4Monash Lung and Sleep, Monash Medical Centre, Monash University, Melbourne, Australia; 5Department of Medicine, Southern Clinical School, Monash University, Melbourne, AustraliaAbstract: Obstructive sleep apnea (OSA is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.Keywords: obstructive sleep apnea, hypertension, intermittent hypoxia, ambulatory blood pressure, sympathetic activation
NECESSARY TREATMENT: Sleep apnea syndrome requires treatment because it affects cardiovascular and cerebrovascular morbidity and mortality and has important neuropsychological consequences with the risk of accidents due to impaired wakefulness. The patientís quality of life is greatly altered. GENERAL MEASURES: Patients should be informed of the risk due to the lack of sleep, advised that alcohol tranquilizers and hypnotic drugs are contraindicated, and counseled about loosing weight, the most difficult problem for obese patients. POSITIVE PRESSURE VENTILATION: Continuous positive pressure ventilation with a facial mask acts like a pneumatic prosthesis holding the airways open during sleep. Sleep can be reconstructed by eliminating the recorded pathological nocturnal events and thus reducing diurnal hypersomnia. Quality of life is improved and accidents related to diminished wakefulness are avoided. Death rate in treated patients is significantly lower than in non-treated patients. In France, the national health care system will reimburse positive pressure ventilation for sleep apnea syndromes recognized to cause more than 30 events per hour of recording or fragmented sleep due to respiratory impairment. OTHER TREATMENTS: Indications for other treatments in case of moderately severe sleep apnea syndrome (or if health care benefits are not recognized for positive pressure ventilation) are currently debated. No medication has been proven to be effective. Mandibular advancement ortheses are in the development stage and require multidisiplinary cooperation to verify their efficacy. Velar surgery has been proposed but is usually disappointing except for young patients actively participating in an integrated surgical treatment strategy.
succinylcholine-induced apnea was responsible for the desaturation. Our hypothesis was that avoiding succinylcholine by using propofol and remifentanil to facilitate tracheal intubation would prevent prolonged apnea and subsequent desaturation. We attempted to identify a dose of remifentanil which, in combination with ...
Obstructive sleep apnea (OSA) is the most common sleep disorder in stroke, but is often left unrecognized and untreated. When left untreated, OSA is thought to contribute to decreased recovery from stroke. The main objectives of this thesis were 1) to improve early recognition of sleep apnea in
Su, Vincent Yi-Fong; Chen, Yung-Tai; Lin, Wei-Chen; Wu, Li-An; Chang, Shi-Chuan; Perng, Diahn-Warng; Su, Wei-Juin; Chen, Yuh-Min; Chen, Tzeng-Ji; Lee, Yu-Chin; Chou, Kun-Ta
Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear. Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder. A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68-2.81; P panic disorder. © 2015 Annals of Family Medicine, Inc.
Calik, Michael W.
Objective To review the efficacy of current treatment options for adults with obstructive sleep apnea (OSA). Methods Review of the literature. Results OSA, characterized by repetitive ≥ 10-second interruptions (apnea) or reductions (hypopnea) in airflow, is initiated by partial or complete collapse in the upper airway despite respiratory effort. When left untreated, OSA is associated with comorbid conditions, such as cardiovascular and metabolic diseases. The current “gold standard” treatment for OSA is continuous positive air pressure (CPAP), which pneumatically stabilizes the upper airways. CPAP has proven efficacy and potential cost savings via decreases in health comorbidities and/or motor-vehicle crashes. However, CPAP treatment is not well-tolerated due to various side effects, and adherence among OSA subjects can be as low as 50% in certain populations. Other treatment options for OSA include improving CPAP tolerability, increasing CPAP adherence through patient interventions, weight loss/exercise, positional therapy, nasal expiratory positive airway pressure, oral pressure therapy, oral appliances, surgery, hypoglossal nerve stimulation, drug treatment, and combining 2 or more of the aforementioned treatments. Despite the many options available to treat OSA, none of them are as efficacious as CPAP. However, many of these treatments are tolerable, and adherence rates are higher than those of the CPAP, making them a more viable treatment option for long-term use. Conclusion Patients need to weigh the benefits and risks of available treatments for OSA. More large randomized controlled studies on treatments or combination of treatments for OSA are needed that measure parameters such as treatment adherence, apnea-hypopnea index, oxygen desaturation, subjective sleepiness, quality of life, and adverse events. PMID:27134515
Vergales, Brooke D; Paget-Brown, Alix O; Lee, Hoshik; Guin, Lauren E; Smoot, Terri J; Rusin, Craig G; Clark, Matthew T; Delos, John B; Fairchild, Karen D; Lake, Douglas E; Moorman, Randall; Kattwinkel, John
In 2006 the apnea of prematurity (AOP) consensus group identified inaccurate counting of apnea episodes as a major barrier to progress in AOP research. We compare nursing records of AOP to events detected by a clinically validated computer algorithm that detects apnea from standard bedside monitors. Waveform, vital sign, and alarm data were collected continuously from all very low-birth-weight infants admitted over a 25-month period, analyzed for central apnea, bradycardia, and desaturation (ABD) events, and compared with nursing documentation collected from charts. Our algorithm defined apnea as > 10 seconds if accompanied by bradycardia and desaturation. Of the 3,019 nurse-recorded events, only 68% had any algorithm-detected ABD event. Of the 5,275 algorithm-detected prolonged apnea events > 30 seconds, only 26% had nurse-recorded documentation within 1 hour. Monitor alarms sounded in only 74% of events of algorithm-detected prolonged apnea events > 10 seconds. There were 8,190,418 monitor alarms of any description throughout the neonatal intensive care unit during the 747 days analyzed, or one alarm every 2 to 3 minutes per nurse. An automated computer algorithm for continuous ABD quantitation is a far more reliable tool than the medical record to address the important research questions identified by the 2006 AOP consensus group. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Zagol, Kelley; Lake, Douglas E; Vergales, Brooke; Moorman, Marion E; Paget-Brown, Alix; Lee, Hoshik; Rusin, Craig G; Delos, John B; Clark, Matthew T; Moorman, J Randall; Kattwinkel, John
To compare the frequency and severity of apneic events in very low birth weight (VLBW) infants before and after blood transfusions using continuous electronic waveform analysis. We continuously collected waveform, heart rate, and oxygen saturation data from patients in all 45 neonatal intensive care unit beds at the University of Virginia for 120 weeks. Central apneas were detected using continuous computer processing of chest impedance, electrocardiographic, and oximetry signals. Apnea was defined as respiratory pauses of >10, >20, and >30 seconds when accompanied by bradycardia (apnea rates for the previous 12 hours were quantified and differences for 12 hours before and after transfusion were compared. In the hematocrit cohort, 1453 hematocrit values from all VLBW infants admitted and breathing spontaneously during the time period were retrieved, and the association of hematocrit and apnea in the next 12 hours was tested using logistic regression. Sixty-seven infants had 110 blood transfusions during times when complete monitoring data were available. Transfusion was associated with fewer computer-detected apneic events (P apnea occurring within 12 hours increased with decreasing hematocrit values (P apnea in VLBW infants, and apneas are less frequent at higher hematocrits. Copyright © 2012 Mosby, Inc. All rights reserved.
Full Text Available No abstract available. Article truncated at 150 words. A common conundrum faced by sleep medicine practitioners is how to manage the large group of patients with mild sleep apnea. Many patients are referred for sleep evaluation, with symptoms thought to be due to obstructive sleep apnea (OSA. Often polysomnography demonstrates only mild sleep apnea, and the clinician and patient are faced with the dilemma of whether to use continuous positive airway pressure (CPAP therapy or an oral appliance. In making this important decision the clinician incorporates the commonly used definition of mild sleep apnea as an apnea-hypopnea index of between 5 and 14 apneas or hypopneas per hour of sleep. Moderate sleep apnea is defined as 15-29 events per hour, and severe is 30 and above events per hour. These arbitrary thresholds originated in the early 1980s when knowledge of this condition was in its infancy and little was known about the long term health effects. The definition ...
Abhijit Ricky Pal MBBChir, MA, MD, FRCS(ORL-HNS
Full Text Available The mucopolysaccharidoses (MPSs are a group of inherited, metabolic disorders characterized by progressive multisystem accumulation of partially degraded glycosaminoglycans. This manifests with multilevel airway obstruction, presenting with obstructive sleep apnea (OSA. We systematically reviewed the literature to determine the severity and prevalence of OSA in MPS based on polysomnography analysis. Fifteen studies with 294 participants met the inclusion criteria for review. The pretreatment prevalence of OSA in MPS was 81% with a mean apnea–hypopnea index (AHI of 10.4. Patients with MPS I are most significantly affected, with 75% suffering with moderate to severe OSA (mean AHI, 16.6. Enzyme replacement therapy (ERT results in an almost significant reduction in OSA in MPS I ( P = .06, while adenotonsillar surgery significantly improves AHI ( P = .002. Obstructive sleep apnea least affects MPS III. There is a lack of long-term post-ERT and hematopoietic stem cell transplant data relating to OSA outcomes in this population, with further prospective studies required to determine the ongoing response to treatment.
Full Text Available Obstructive sleep apnea (OSA is a sleep-related breathing disorder characterized by repetitive episodes of airflow cessation resulting in brief arousals and intermittent hypoxemia. Several studies have documented significant daytime cognitive and behavioral dysfunction that seems to extend beyond that associated with simple sleepiness and that persists in some patients after therapeutic intervention. A still unanswered question is whether cognitive symptoms in OSA are primarily a consequence of sleep fragmentation and hypoxemia, or whether they coexist independently from OSA. Moreover, very little is known about OSA effects on cognitive performances in the elderly in whom an increased prevalence of OSA is present.In this review we will consider recent reports in the association between sleep apnea and cognition, with specific interest in elderly subjects, in whom sleep disturbances and age-related cognitive decline naturally occur. This will allow us to elucidate the behavioral and cognitive functions in OSA patients and to gain insight into age differences in the cognitive impairment.Clinically, these outcomes will aid clinicians in the evaluation of diurnal consequences of OSA and the need to propose early treatment.
Sleep apnea is a condition in which a narrowing or closure of the upper airway during sleep causes repeated sleep disturbances, and possible complete awakenings, leading to poor sleep quality and excessive daytime sleepiness. The primary objectives o...
Motamedi, Kevin K.; McClary, Andrew C.; Amedee, Ronald G.
Obstructive sleep apnea is an underrecognized and underdiagnosed medical condition, with a myriad of negative consequences on patients' health and society as a whole. Symptoms include daytime sleepiness, loud snoring, and restless sleep. While the “gold standard” of diagnosis is by polysomnography, a detailed history and focused physical examination may help uncover previously undiagnosed cases. Undetected obstructive sleep apnea can lead to hypertension, heart disease, depression, and even d...
Picone, Simonetta; Aufieri,Roberto; Paolillo,Piermichele
Simonetta Picone, Roberto Aufieri, Piermichele PaolilloDivision of Neonatology and Neonatal Intensive Care, Department of Maternal and Child Health, Casilino General Hospital, Rome, ItalyAbstract: Apnea of prematurity is a developmental disorder that frequently affects preterm infants, especially those with lower gestational age. Even if apnea of prematurity is by definition a self-limiting condition, it can cause serious problems during the hospital stay and can potentially have long-term ne...
Qiao, Yi-Xian; Xiao, Yi
To get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology, pathophysiology, and clinical manifestation and then summarizing the latest progress on diagnosis and treatment. Articles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms "OSA" and "asthma" as the main keywords. Highly regarded older publications were also included. Information about the features of the two diseases in common, the pathophysiologic association between them and their current treatments from the literature search were identified, retrieved, and summarized. Both OSA and asthma are very prevalent conditions. The incidences of them have kept on rising in recent years. Asthma is often accompanied by snoring and apnea, and OSA often combines with asthma, as well. They have many predisposing and aggravating factors in common. Possible shared direct mechanistic links between them include mechanical effects, intermittent hypoxia, nerve reflex, inflammation, leptin, etc. Indirect mechanistic links include medication, nose diseases, smoking, obesity, and gastroesophageal reflux disease. Since OSA presents many similar features with nocturnal asthma, some scholars termed them as a sole syndrome - "alternative overlap syndrome," and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure. OSA and asthma are closely associated in pathogenesis, symptoms, and therapies. With the growing awareness of the relationship between them, we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients. Further studies are still needed to guide the clinical works.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration Proposed Recommendations on Obstructive Sleep Apnea AGENCY... withdrawing its proposed regulatory guidance for obstructive sleep apnea (OSA) and request for comment as...
Vergales, Brooke D.; Lee, Hoshik; Clark, Matthew T.; Lake, Douglas E.; Mennen, Anne C.; Kattwinkel, John; Sinkin, Robert A.; Moorman, J. Randall; Fairchild, Karen D.; Delos, John B.
Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation. PMID:25549762
Mohr, Mary A; Vergales, Brooke D; Lee, Hoshik; Clark, Matthew T; Lake, Douglas E; Mennen, Anne C; Kattwinkel, John; Sinkin, Robert A; Moorman, J Randall; Fairchild, Karen D; Delos, John B
Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation. Copyright © 2015 the American Physiological Society.
Armanian, Amir-Mohammad; Iranpour, Ramin; Faghihian, Eiman; Salehimehr, Nima
Apnea intervals frequently occur in premature infants. Periods of apnea occur more often with decreases in gestational age. Periods of apnea can cause damage to the infant's developing brain and other organs. This study was designed to investigate the preventive effects of caffeine on apnea incidence in higher-risk neonates. Methods: In this single-center randomized control trial study, premature infants with a birth weight of ≤1200 g were eligible for enrollment. Twenty-six infants were r...
Richard, Wietske; Kox, Dennis; den Herder, Cindy; Laman, Martin; van Tinteren, Harm; de Vries, Nico
We analyzed the role of sleep position in obstructive sleep apnea syndrome (OSAS). The polysomnograms of 120 patients with sleep apnea syndrome were analyzed. We associated the apnea hypopnea index (AHI) of the supine position with the AHI of the other positions. Patients were stratified in a group
MacFarlane, Peter M; Ribeiro, Ana P; Martin, Richard J
The premature transition from fetal to neonatal life is accompanied by an immature respiratory neural control system. Most preterm infants exhibit recurrent apnea, resulting in repetitive oscillations in O(2) saturation (intermittent hypoxia, IH). Numerous factors are likely to play a role in the etiology of apnea including inputs from the carotid chemoreceptors. Despite major advances in our understanding of carotid chemoreceptor function in the early neonatal period, however, their contribution to the initiation of an apneic event and its eventual termination are still largely speculative. Recent findings have provided a detailed account of the postnatal changes in the incidence of hypoxemic events associated with apnea, and there is anecdotal evidence for a positive correlation with carotid chemoreceptor maturation. Furthermore, studies on non-human animal models have shown that chronic IH sensitizes the carotid chemoreceptors, which has been proposed to perpetuate the occurrence of apnea. An alternative hypothesis is that sensitization of the carotid chemoreceptors could represent an important protective mechanism to defend against severe hypoxemia. The purpose of this review, therefore, is to discuss how the carotid chemoreceptors may contribute to the initiation and termination of an apneic event in the neonate and the use of xanthine therapy in the prevention of apnea. Published by Elsevier B.V.
Full Text Available Abstract Objective Biomarkers of adipose tissue may affect glucose and lipid metabolism and present pro-inflammatory properties, thus could be involved in the pathobiochemistry of cardiovascular disease (CVD. The coexistence of sleep apnea syndrome (OSA and metabolic risk factors of CVD is worth explaining. The aim of the study was to compare the serum adipocytokines in subjects with and without OSA, who had all elevated body mass index (BMI. Methods Overweight (BMI: 25.0-29.9 kg/m2 and obese (BMI: 30.0-39.9 kg/m2 OSA-suspected Caucasian males, aged 30-63, with no acute disease or chronic disorder underwent polysomnographic evaluation to select OSA-positive (AHI ≥ 5 and OSA-negative (AHI Results A decreased resistin level was observed in Over-OSA-Pos vs. Over-OSA-Neg subjects (P = 0.037 as well as in Obese-OSA-Pos vs. Obese-OSA-Neg (P = 0.045. No differences in leptin concentrations were observed. A positive correlation between leptin and BMI was in both overweight subgroups and a negative one between resistin and fasting glucose was in both obese subgroups. Conclusions OSA may decrease the serum resistin level in subjects with excess body mass and also may contribute to glucose metabolism, but has no influence on the leptin level.
McNicholas, Walter T
The pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS) is not fully understood but is likely multifactorial in origin. Inflammatory processes play an important role in the pathogenesis of atherosclerosis, and circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These include cell adhesion molecules such as intercellular adhesion molecule-1 and selectins, cytokines such as tumour necrosis factor alpha and interleukin 6, chemokines such as interleukin 8, and C-reactive protein. There is also increasing evidence that inflammatory processes play an important role in the cardiovascular pathophysiology of OSAS and many of the inflammatory markers associated with cardiovascular risk have been reported as elevated in patients with OSAS. Furthermore, animal and cell culture studies have demonstrated preferential activation of inflammatory pathways by intermittent hypoxia, which is an integral feature of OSAS. The precise role of inflammation in the development of cardiovascular disease in OSAS requires further study, particularly the relationship with oxidative stress, metabolic dysfunction, and obesity.
V K Vijayan
Full Text Available Obstructive Sleep Apnea (OSA is an important public health problem and is associatedwith considerable morbidity and mortality. Therefore, treatment of this condition is ofparamount importance. The treatment of OSA includes general and behaviouralmeasures, mechanical measures including continuous positive airway pressure(CPAP, Bilevel positive airway pressure (BiPAP and Oral Appliances (OA,pharmacological treatment and surgical procedures. Continuous positive airwaypressure (CPAP treatment reverses the repetitive upper airway obstruction of sleepapnea and associated daytime sleepiness and is the most effective treatment for OSA.However maintaining patient adherence to CPAP therapy is a challenge. Weight lossshould be recommended to overweight patients with OSA, as it has been shown thatweight reduction has additional health benefits. Treatment of underlying medicalconditions such as hypothyroidism or acromegaly has profound effect onapnea/hypopnea index. A subset of patients with OSA may benefit from supplementaloxygen and positional therapy. Presently, there are no effective pharmacotherapeuticagents for treatment of patients with OSA and the role of surgical treatment in OSA iscontroversial. However, pharmacological treatment of persisting residual sleepiness,despite adequate positive airway pressure therapy delivery and adherence, is indicatedand may improve daytime sleepiness.Key words : CPAP, Oral appliances, Modafinil, CPAP complianceUvulopalatopharyngoplasty, positional therapy
Guul, Martin Kjær; Jennum, Poul; Sørensen, Helge Bjarup Dissing
Obstructive sleep apnea (OSA) occurs in more than 4 % of the adult population. Diagnoses for OSA in sleep clinics are costly and more than half of those submitted to a sleep clinic do not have OSA. A simple, easy, and portable homebased monitoring system to evaluate who are in high- or low risk...... for sleep apnea is at high risk or low risk of having OSA. A new test setup was developed containing an Android based smartphone, the built in accelerometer, and a microphone. To ease the clinical analysis of the data a MATLAB based graphical user interface has been developed visualizing the data allowing...... the user to navigate through the data and the detected apnea events. The events are classified using both features from the audio and the signal from the accelerometer placed on sternum. Furthermore using the accelerometer data the sleep position is estimated and the morphology from the respiratory pattern...
Mathew, O P
Apnea of prematurity (AOP) is a significant clinical problem manifested by an unstable respiratory rhythm reflecting the immaturity of respiratory control systems. This review will address the pathogenesis of and treatment strategies for AOP. Although the neuronal mechanisms leading to apnea are still not well understood, recent decades have provided better insight into the generation of the respiratory rhythm and its modulation in the neonate. Ventilatory responses to hypoxia and hypercarbia are impaired and inhibitory reflexes are exaggerated in the neonate. These unique vulnerabilities predispose the neonate to the development of apnea. Treatment strategies attempt to stabilize the respiratory rhythm. Caffeine remains the primary pharmacological treatment modality and is presumed to work through blockade of adenosine receptors A(1) and A(2). Recent evidences suggest that A(2A) receptors may have a greater role than previously thought. AOP typically resolves with maturation suggesting increased myelination of the brainstem.
Reiher, Alexandra E; Mazeh, Haggi; Schaefer, Sarah; Chen, Herbert; Sippel, Rebecca S
Patients with goiter often complain of compressive symptoms, which may contribute to symptoms of obstructive sleep apnea (OSA). However, the impact of thyroid enlargement on these symptoms is not clear. Therefore, we sought to evaluate whether symptoms of sleep apnea resolved after thyroidectomy by using a validated questionnaire. The Berlin Questionnaire, a validated sleep apnea assessment tool, was provided to patients at a single academic institution before and after thyroidectomy. Patients who admitted to symptoms of snoring were asked to complete the questionnaire before and 8 weeks after surgery to assess for improvement in symptoms. The questionnaire uses 3 categories of questions to determine risk of sleep apnea. Two symptom categories must be positive for a patient to be considered high risk for sleep apnea. Forty-five patients completed both pre- and postoperative questionnaires. The average age of patients completing the questionnaire was 53±2 years, and 78% of patients were female. Average body mass index was 33.3±1.4 kg/m(2). Based on their preoperative questionnaire score, 71% of patients were considered to be high risk for OSA, and this decreased to 51% after surgery (p=0.002). Overall scores significantly improved after surgery (mean 2.0 vs. 1.6, psymptoms, gland weight at resection, presence of thyroiditis, or the largest dimension of the gland at resection. Thyroid surgery appears to significantly improve symptoms of OSA in patients who screened positive for symptoms before surgery. Evaluation of patients with OSA should include evaluation of thyroid disease, as symptoms of sleep apnea may improve with thyroidectomy.
Arter, Jim L; Chi, David S; M, Girish; Fitzgerald, S Matthew; Guha, Bhuvana; Krishnaswamy, Guha
Obstructive sleep apnea (OSA) occurs commonly in the U.S. population and is seen in both obese as well as non-obese individuals. OSA is a disease characterized by periodic upper airway collapse during sleep, which then results in either apnea, hypopnea, or both. The disorder leads to a variety of medical complications. Neuropsychiatric complications include daytime somnolence, cognitive dysfunction, and depression. Increased incidence of motor vehicle accidents has been documented in these patients and probably reflects disordered reflex mechanisms or excessive somnolence. More importantly, vascular disorders such as hypertension, stroke, congestive cardiac failure, arrhythmias, and atherosclerosis occur frequently in these patients. The lungs may be affected by pulmonary hypertension and worsening of asthma. Recent data from several laboratories demonstrate that obstructive sleep apnea is characterized by an inflammatory response. Cytokines are elaborated during the hypoxemic episodes leading to inflammatory responses as marked clinically by elevated C-reactive protein (CRP). As elevated CRP levels are considered markers of the acute phase response and characterize progression of vascular injury in coronary artery disease, it is likely that obstructive sleep apnea could lead to worsening of vasculopathy. Moreover, as inflammatory mechanisms regulate bronchial asthma, it is also likely that cytokines and superoxide radicals generated during hypoxemic episodes could exacerbate reactive airway disease. Patients with Cough, Obstructive sleep apnea, Rhinosinusitis, and Esophageal reflux clustered together can be categorized by the acronym, "CORE", syndrome. The purpose of this manuscript is to review the inflammatory responses that occur in patients with obstructive sleep apnea and relate them to the occurrence of cardiopulmonary disease.
Esteller, E; Villatoro, J C; Agüero, A; Lopez, R; Matiñó, E; Argemi, J; Girabent-Farrés, M
Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from
Kraaijenga, Juliette V; Hutten, Gerard J; de Waal, Cornelia G; de Jongh, Frans H; Onland, Wes; van Kaam, Anton H
Treatment of apnea is highly dependent on the type of apnea. Chest impedance (CI) has inaccuracies in monitoring respiration, which compromises accurate apnea classification. Electrical activity of the diaphragm measured by transcutaneous electromyography (EMG) is feasible in preterm infants and might improve the accuracy of apnea classification. To compare the accuracy of apnea classification based on diaphragmatic EMG (dEMG) and CI tracings in preterm infants. Fifteen cases of central apnea, 5 of obstructive apnea, and 10 of mixed apnea were selected from recordings containing synchronized continuous tracings of respiratory inductive plethysmography (RIP), airway flow, heart rate (HR), oxygen saturation (SpO2), and breathing activity measured by dEMG and CI. Twenty-two assessors (neonatologists, pediatricians-in-training, and nurses) classified each apnea twice; once based on dEMG, HR, and SpO2 tracings, and once based on CI, HR, and SpO2. The assessors were blinded to the type of respiratory tracing (dEMG or CI) and to the RIP and flow tracings. In total 1,320 assessments were performed, and in 71.1% the apnea was classified correctly. Subgroup analysis based on respiratory tracing showed that 74.8% of the dEMG tracings were classified correctly compared to 67.3% of the CI tracings (p apnea classification based on dEMG was present for central (86.7 vs. 80.3%, p apnea. The improved apnea classification based on dEMG tracing was independent of the type of assessor. Transcutaneous dEMG improves the accuracy of apnea classification when compared to CI in preterm infants, making this technique a promising candidate for future monitoring systems. © 2017 S. Karger AG, Basel.
Jan 16, 2014 ... The presence of risk factors such as age, gender and obesity increases the incidence of .... compared with the middle aged individuals[12,48,49]. Obstructive sleep apnea ..... The journal issue has a unique new feature for reaching to the journal's website without typing a single letter. Each article on its first ...
Doumit, Jimmy; Prasad, Bharati
IN BRIEF Obstructive sleep apnea (OSA) alters glucose metabolism, promotes insulin resistance, and is associated with development of type 2 diabetes. Obesity is a key moderator of the effect of OSA on type 2 diabetes. However, chronic exposure to intermittent hypoxia and other pathophysiological effects of OSA affect glucose metabolism directly, and treatment of OSA can improve glucose homeostasis.
Schmidt, Barbara; Roberts, Robin S; Davis, Peter; Doyle, Lex W; Barrington, Keith J; Ohlsson, Arne; Solimano, Alfonso; Tin, Win; Pfister, Riccardo
Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight.
Barrington, K J; Finer, N N
The relationship between periodic breathing and idiopathic apnea of prematurity was investigated. We recorded respiratory impedance, heart rate, pulse oximetry and end-tidal CO2 from 68 untreated infants of less than or equal to 34 wk gestation with a diagnosis of idiopathic apnea of prematurity. Mean birth wt was 1476 g (SD 420) and mean gestational age was 29.9 wk (SD 2.6). Apneas of more than 15 s duration that were associated with hypoxemia or bradycardia were identified by semiautomated analysis of computerized records. A total of 1116 significant apneic spells were identified, only one of which occurred during an epoch of periodic breathing, five others occurred within 2 min of the end of an epoch of periodic breathing. Less than 0.6% of significant apneic spells occur within 2 min of periodic breathing. In all of the 12 infants that were monitored starting in the first 12 h of life, significant apneic spells were identified before 36 h of age and no precipitating factors were identified. Periodic breathing did not occur during the first 48 h of life, a finding that supports the concept that the peripheral chemoreceptor is inactive in the first 48 h of life. Periodic breathing in the premature infant is not a precursor to significant apnea.
Vaessen, T.J.A.; Overeem, S.; Sitskoorn, M.M.
Obstructive sleep apnea (OSA) is associated with impairments in cognitive functioning. Although cognitive complaints are related to quality of life, work productivity and health care expenditures, most research and all reviews have focused exclusively on objective cognitive functioning so far. In
Guul, Martin Kjær; Jennum, Poul; Sørensen, Helge Bjarup Dissing
for sleep apnea is at high risk or low risk of having OSA. A new test setup was developed containing an Android based smartphone, the built in accelerometer, and a microphone. To ease the clinical analysis of the data a MATLAB based graphical user interface has been developed visualizing the data allowing...
Henderson-Smart, D; Steer, P
Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia which may be severe enough to require resuscitation including use of positive pressure ventilation. Doxapram has been used to stimulate breathing and so prevent apnea and its consequences. In preterm infants with recurrent apnea, does treatment with Doxapram lead to a clinically important reduction in apnea and use of intermittent positive airways pressure (IPPV), without clinically important side effects? Searches were made of the Oxford Database of Perinatal trials, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004), MEDLINE from 1966 - June 2004, EMBASE from 1980 - June 2001, CINAHL from 1982- June 2004. Text words 'doxapram', 'apnea or apnoea' and the MeSH term 'infant, premature' were used. Previous reviews including cross references, abstracts from conferences and symposia proceedings were also examined. Abstracts of the Society for Pediatric Research were searched from 1996 - 2004 inclusive. All trials utilising random or quasi-random patient allocation, in which doxapram was used for the treatment of apnea in preterm infants were included. Each author evaluated the papers for quality and inclusion criteria. Independent data extraction was carried out. Only one trial, which randomized 11 infants to intravenous doxapram and 10 infants to placebo, was found. There were fewer treatment failures after 48 hours in the group of preterm infants treated with doxapram (4/11) compared with the group treated with placebo (8/10). The wide confidence intervals made this result non-significant [RR 0.45 (0.20, 1.05)]. Only one infant, who was from the placebo group, was given IPPV. Of the seven responders by 48 hours in the group of 11 who received doxapram, five failed to respond between 48 hours and seven days after commencement of therapy. This gives a
Parish, James M; Somers, Virend K
Obstructive sleep apnea (OSA) is a common medical condition that occurs in approximately 5% to 15% of the population. The pathophysiology of OSA is characterized by repetitive occlusions of the posterior pharynx during sleep that obstruct the airway, followed by oxyhemoglobin desaturation, persistent inspiratory efforts against the occluded airway, and termination by arousal from sleep. Obstructive sleep apnea is associated with daytime sleepiness and fatigue, likely due to fragmented sleep from recurrent arousals. Substantial evidence shows that patients with OSA have an increased incidence of hypertension compared with individuals without OSA and that OSA is a risk factor for the development of hypertension. Recent studies show that OSA may be implicated in stroke and transient ischemic attacks. Obstructive sleep apnea appears to be associated with coronary heart disease, heart failure, and cardiac arrhythmias. Pulmonary hypertension may be associated with OSA, especially in patients with preexisting pulmonary disease. Although the exact cause that links OSA with cardiovascular disease is unknown, there is evidence that OSA is associated with a group of proinflammatory and prothrombotic factors that have been identified to be important in the development of atherosclerosis. Obstructive sleep apnea is associated with increased daytime and nocturnal sympathetic activity. Autonomic abnormalities seen in patients with OSA include increased resting heart rate, decreased R-R interval variability, and increased blood pressure variability. Both atherosclerosis and OSA are associated with endothelial dysfunction, increased C-reactive protein, interleukin 6, fibrinogen, and plasminogen activator inhibitor, and reduced fibrinolytic activity. Obstructive sleep apnea has been associated with enhanced platelet activity and aggregation. Leukocyte adhesion and accumulation on endothelial cells are common in both OSA and atherosclerosis. Clinicians should be aware that OSA may be
... about medicines. Some medications can help open your nasal passages. Links Explore Sleep Apnea: What Is Sleep Apnea? Sleep Apnea Information Page Brain Basics: Understanding Sleep CPAP Your Guide to Healthy Sleep What Happens When ...
Tang, Alice L; Cohen, Aliza P; Benke, James R; Stierer, Kevin D; Stanley, James; Ishman, Stacey L
Given that 30% to 40% of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we evaluated whether children with hypopnea-predominant OSA were more likely to have complete disease resolution after adenotonsillectomy than those with apnea-predominant disease. We also identified risk factors that might modify the relationship between disease resolution and polysomnographic event type (ie, hypopnea vs apnea). Case series with chart review. Tertiary pediatric hospital. Consecutive 1- to 18-year-old typically developing children diagnosed with OSA from March 2011 to December 2012 underwent adenotonsillectomy and completed pre- and postoperative polysomnography within 1 year of surgery. Fifty-eight children were included (27 female; mean ± SD: age, 5.6 ± 3.1 years; body mass index z score, 1.1 ± 1.7). Overall, adenotonsillectomy resulted in significant improvement in obstructive apnea-hypopnea index (oAHI) from 23.3 ± 40.0 to 4.3 ± 8.2 events per hour (P apnea index (5.1 ± 7.4 to 0.4 ± 0.8, P prematurity, age, oxygen saturation nadir, oHI, obstructive apnea index, and oAHI were predictive. Event type was not significant, even in a model controlling for age, race, sex, prematurity, asthma, body mass index, and baseline polysomnographic variables. This small study demonstrated no difference in disease resolution between children with hypopnea- and apnea-predominant OSA who underwent adenotonsillectomy. Additionally, adenotonsillectomy significantly improved OSA in most children, and high preoperative oAHI was associated with persistent postoperative OSA. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Osborn, D A; Henderson-Smart, D J
This section is under preparation and will be included in the next issue. Main question: in preterm infants with apnea, does the use of kinesthetic stimulation lead to clinically important reductions in clinical apnea and bradycardia (>50% reduction in number of episodes), use of mechanical ventilation (IPPV) or continuous positive airways pressure (CPAP), and neurodevelopmental disability, without clinically important side effects. The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants, and journal handsearching mainly in the English language. All trials using random or quasi-random patient allocation in which kinesthetic stimulation in preterm infants was compared to placebo or no treatment for apnea of prematurity were included. Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality, data extraction by both authors and synthesis of data using relative risk and weighted mean difference. As all three trials were crossover trials, the data were extracted from all exposure periods and combined where appropriate. Measures of severity of apnea as well as the response to treatment were consistent with an evaluation of 'clinical apnea', as defined by the American Academy of Pediatrics (Nelson 1978). Three crossover studies (Korner 1978, Tuck 1982 and Jirapaet 1993) were identified that compared a form of kinesthetic stimulation to control for the treatment of apnea of prematurity. Clinically significant apnea: None of the three studies showed an important reduction (>50%) in clinical apnea. Using a lower threshold (>25%), the study by Korner 1978 found less apnea and bradycardia in infants receiving kinesthetic stimulation. Tuck 1982 demonstrated reductions in the
Lee, Hoshik; Rusin, Craig G.; Lake, Douglas E.; Clark, Matthew T.; Guin, Lauren; Smoot, Terri J.; Paget-Brown, Alix O.; Vergales, Brooke D.; Kattwinkel, John; Moorman, J. Randall; Delos, John B.
Apnea of prematurity (AOP) is an important and common clinical problem, and is often the rate-limiting process in NICU discharge. Accurate detection of episodes of clinically important neonatal apnea using existing chest impedance monitoring is a clinical imperative. The technique relies on changes in impedance as the lungs fill with air, a high impedance substance. A potential confounder, however, is blood coursing through the heart. Thus the cardiac signal during apnea might be mistaken for breathing. We report here a new filter to remove the cardiac signal from the chest impedance that employs a novel resampling technique optimally suited to remove the heart rate signal, allowing improved apnea detection. We also develop an apnea detection method that employs the chest impedance after cardiac filtering. The method has been applied to a large database of physiological signals, and we prove that, compared to the presently-used monitors, the new method gives substantial improvement in apnea detection. PMID:22156193
Lee, Hoshik; Delos, John B; Rusin, Craig G; Lake, Douglas E; Guin, Lauren; Smoot, Terri J; Moorman, J Randall; Clark, Matthew T; Paget-Brown, Alix O; Vergales, Brooke D; Kattwinkel, John
Apnea of prematurity is an important and common clinical problem, and is often the rate-limiting process in NICU discharge. Accurate detection of episodes of clinically important neonatal apnea using existing chest impedance (CI) monitoring is a clinical imperative. The technique relies on changes in impedance as the lungs fill with air, a high impedance substance. A potential confounder, however, is blood coursing through the heart. Thus, the cardiac signal during apnea might be mistaken for breathing. We report here a new filter to remove the cardiac signal from the CI that employs a novel resampling technique optimally suited to remove the heart rate signal, allowing improved apnea detection. We also develop an apnea detection method that employs the CI after cardiac filtering. The method has been applied to a large database of physiological signals, and we prove that, compared to the presently used monitors, the new method gives substantial improvement in apnea detection. (paper)
Finer, N N; Higgins, R; Kattwinkel, J; Martin, R J
Apnea of prematurity (AOP) is found in >50% of premature infants and is almost universal in infants who are 20 seconds or for >10 seconds if associated with bradycardia or oxygen desaturation), but there is no consensus about the duration of apnea, the degree of change in oxygen saturation, or severity of bradycardia that should be considered pathologic. Although caregivers are able to respond successfully to apnea events with drugs (as well as physical and mechanical interventions) in the NI...
Gabriel, M; Witolla, C; Albani, M
The influence of short-term aminophylline treatment on sleep behaviour was studied in six preterms infants with recurrent apnea. The incidence of apnea, respiratory pauses, and bradycardias which were closely related to the phases of active sleep, decreased during aminophylline treatment. However, the amount of active sleep remained unaffected. The mode of action of aminophylline is discussed in view of the previously proposed neurophysiological concept of apnea of prematurity.
Full Text Available We describe the case of a 12-year-old boy who developed temporal lobe epilepsy (TLE with daily complex partial seizures (CPS and monthly generalized seizures. Moreover, he frequently snored while asleep since early childhood. Polysomnography (PSG revealed severe obstructive sleep apnea with apnea–hypopnea index (AHI of 37.8/h. Video-PSG with simultaneous electroencephalography (EEG recording captured two ictal apneic episodes during sleep, without any motor manifestations. The onset of rhythmic theta activity in the midtemporal area on EEG was preceded by the onset of apnea by several seconds and disappeared soon after cessation of central apnea. One episode was accompanied by ictal bradycardia of <48 beats/min which persisted for 50 s beyond the end of epileptic activity. After treatment with carbamazepine and tonsillectomy/adenoidectomy, the seizures were well controlled and AHI decreased to 2.5/h. Paroxysmal discharges also disappeared during this time. Uncontrolled TLE complicated by sleep apnea should be evaluated for the presence of ictal central apnea/bradycardia.
Williams, Stephen K; Ravenell, Joseph; Jean-Louis, Girardin; Zizi, Ferdinand; Underberg, James A; McFarlane, Samy I; Ogedegbe, Gbenga
Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep apnea-associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiologic data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered.
Armanian, Amir-Mohammad; Iranpour, Ramin; Faghihian, Eiman; Salehimehr, Nima
Apnea intervals frequently occur in premature infants. Periods of apnea occur more often with decreases in gestational age. Periods of apnea can cause damage to the infant's developing brain and other organs. This study was designed to investigate the preventive effects of caffeine on apnea incidence in higher-risk neonates. In this single-center randomized control trial study, premature infants with a birth weight of ≤1200 g were eligible for enrollment. Twenty-six infants were randomly assigned to receive 20 mg/kg caffeine, as the loading dose, which was followed by 5 mg/kg daily as the maintenance dose until the 10 th day of life; these infants were compared with 26 infants in the control group. Primary outcomes were incidence of apnea, bradycardia, and cyanosis. Fifty-two infants were enrolled (26 in the caffeine group and 26 in the control group). The preventive effect of caffeine on apnea was significant in these infants. The relative risk for incidence of apnea in preterm neonates with a birth weight of apnea, compared with 16 (61.5%) in the control group (p = 0.001). It seems that preventative effects of caffeine on apnea become apparent by using the drug in very premature infants. Copyright © 2016. Published by Elsevier B.V.
Martínez-García, Miguel Ángel; Campos-Rodríguez, Francisco; Almendros, Isaac; Farré, Ramón
In the light of relationships reported between hypoxemia (tissue hypoxia) and cancer, Abrams et al. concluded in 2008 that sleep apnea-hypopnea syndrome (SAHS) and its main consequence, intermittent hypoxia, could be related with increased susceptibility to cancer or poorer prognosis of a pre-existing tumor. This pathophysiological association was confirmed in animal studies. Two large independent historical cohort studies subsequently found that the degree of nocturnal hypoxia in patients with SAHS was associated with higher cancer incidence and mortality. This finding has been confirmed in almost all subsequent studies, although the retrospective nature of some requires that they be considered as hypothesis-generating only. The relationship between sleep apnea and cancer, and the pathophysiological mechanisms governing it, could be clarified in the near future in a currently on-going study in a large group of melanoma patients. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.
Zhao, Jing; Gonzalez, Fernando; Mu, Dezhi
Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a "physiologic" immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO(2) inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment.
Rasche, K; Keller, T; Tautz, B; Hader, C; Hergen?, G; Antosiewicz, J; Di Giulio, C; Pokorski, M
Type 2 diabetes and obstructive sleep apnea (OSA) are diseases with high prevalence and major public health impact. There is evidence that regular snoring and OSA are independently associated with alterations in glucose metabolism. Thus, OSA might be a risk factor for the development of type 2 diabetes. Possible causes might be intermittent hypoxia and sleep fragmentation, which are typical features of OSA. OSA might also be a reason of ineffective treatment of type 2 diabetes. There is furth...
Jorge Vale; Paula Manuel; Eurico Oliveira; Ana Rita Oliveira; Eloisa Silva; Vitor Melo; Marta Sousa; João Carlos Alexandre; Isabel Gil; Amparo Sanchez; Edite Nascimento; António Simões Torres
Background: There is convincing evidence that obstructive sleep apnea (OSA) is highly associated with impaired glucose metabolism. Objectives: Analyze the prevalence of OSA in type 1 and type 2 diabetes mellitus (DM) patients. Evaluate the influence of OSA on glycemic control. Methods: The adult patients with diabetes mellitus (DM) followed in the department of internal medicine were referred to our Sleep Unit. A home respiratory polygraphy was then performed on all patients with body mass in...
Zhao, Jing; Gonzalez, Fernando; Mu, Dezhi
Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a “physiologic” immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent...
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.
De Backer, W
Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by recurrent episodes of partial or complete upper airway collapse during sleep that is highlighted by a reduction in, or complete cessation of, airflow despite documented on going inspiratory efforts. Due to the lack of adequate alveolar ventilation that results from the upper airway narrowing, oxygen saturation may drop and partial pressure of CO2 may occasionally increase. The events are mostly terminated by arousals. Clinical consequences are excessive daytime sleepiness related to the sleep disruption. Minimal diagnostic criteria have been defined for OSAHS. Patients should have excessive daytime sleepiness that can not be better explained by other factors, or experience two or more of the following symptoms, again that are not better explained by other factors: choking or gasping during sleep; recurrent awakenings from sleep; un-refreshing sleep; daytime fatigue; and impaired concentration. All patients should have more than five obstructed breathing events per hour during sleep. An obstructive apnea or hypopnoea can be defined as an event that lasts for ≥ 10 s and is characterized by an absence or a decrease from baseline in the amplitude of a valid measure of breathing during sleep that either reaches >50% with an oxygen desaturation of 3% or an arousal (alternatively a 30% reduction with 4% desaturation). The American Academy of Sleep Medicine (AASM) recommends these definitions. The Task Force of the AASM also states that there are common pathogenic mechanisms for obstructive apnea syndrome, central apnea syndrome, sleep hypoventilation syndrome and Cheyne-Stokes breathing. It was more preferable to discuss each of these separately; although, they could be placed under the common denominator of "sleep-disordered breathing syndrome". The definition of OSAHS using two components, daytime symptoms and breathing pattern disturbances during sleep, may suggest that there is a tight correlation
van den Aardweg, J. G.; Karemaker, J. M.
Periodic increases in blood pressure (BP) can occur in the sleep apnea syndrome (SAS) during recurrent apneas. To investigate the mechanisms causing this periodic hypertension, we simulated SAS by imposing a matching breathing pattern on seven healthy awake male volunteers. Continuous finger
Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra‑city commercial drivers. Setting and Design: A descriptive cross‑sectional study in three ...
Vandenplas, Yvan; Denayer, Etienne; Vandenbossche, Thierry; Vermet, Luc; Hauser, Bruno; Deschepper, Jean; Engelen, Agnes
Obstructive apnea is a sleep disorder characterized by pauses in breathing during sleep: breathing is interrupted by a physical block to airflow despite effort. The purpose of this study was to test if osteopathy could influence the incidence of obstructive apnea during sleep in infants. Thirty-four healthy infants (age: 1.5-4.0 months) were recruited and randomized in two groups; six infants dropped out. The osteopathy treatment group (n = 15 infants) received 2 osteopathic treatments in a period of 2 weeks and a control group (n = 13 infants) received 2 non-specific treatments in the same period of time. The main outcome measure was the change in the number of obstructive apneas measured during an 8-hour polysomnographic recording before and after the two treatment sessions. The results of the second polysomnographic recordings showed a significant decrease in the number of obstructive apneas in the osteopathy group (p = 0.01, Wilcoxon test), in comparison to the control group showing only a trend suggesting a gradual physiologic decrease of obstructive apneas. However, the difference in the decline of obstructive apneas between the groups after treatment was not significant (p = 0.43). Osteopathy may have a positive influence on the incidence of obstructive apneas during sleep in infants with a previous history of obstructive apneas as measured by polysomnography. Additional research in this area appears warranted.
Molloy, Eleanor J; Di Fiore, Juliann M; Martin, Richard J
Gastroesophageal reflux (GER) and apnea are both common occurrences in premature infants but their relationship is controversial. We present the evidence for and against an association between GER and apnea and discuss the merits and limitations of the various methodologies employed in characterizing such a relationship. Overall, GER and apnea do not appear temporally related in preterm infants, despite strong physiologic evidence that stimulation of laryngeal afferents elicits central apnea and laryngeal adduction. In a subpopulation of infants with neurodevelopmental compromise, there may be an increased incidence of both apnea and GER, although the direct association between GER and apnea in this population is unclear. Therefore, we believe there is no evidence to support widespread use of anti-reflux medications in the treatment of apnea in preterm infants. Further studies are needed to clarify the existence of a small subpopulation of infants who may have GER-induced apnea, to identify potential triggering mechanisms, and to document benefit from newer pharmacological approaches. Copyright 2005 S. Karger AG, Basel
Jayaraj, Rajeswari; Mohan, Jagannath; Kanagasabai, Adalarasu
This paper presents a review on detection and treatment methods of sleep apnea. Sleep apnea is the most common type of breathing-related sleep disorder. It manifests in a variety of behaviours from teeth grinding to night terrors as involuntary night-time events. The most common sleep disorders are narcolepsy, hypersomnia, sleep talking, sleep walking, and bedwetting. Sleep apnea (somnipathy) is a serious sleep disorder that pauses breathing while sleeping. Breathing pauses occur 30 times or more during sleep and it lasts for few seconds to minutes, when normal breathing starts after this pause. Untreated sleep apnea patients stop breathing, which happens up to hundreds of times during sleep that ultimately results in atrial fibrillation, cardiac arousal, stroke, brain tumor and other vascular diseases at the age of 65 that causes death. Smokers are at a greater threat for sleep apnea. Several studies have suggested that a person who smokes more than two packs a day has 40 times the risk of sleep apnea then nonsmokers. This review includes the discussion about detection of sleep apnea from heart rate and respiratory events. The published literature of sleep apnea and methods of treatment are also discussed.
Obstructive sleep apnea hypopnea syndrome (OSAHS) is an important medical condition which is on the increase in the past 50 years. It causes significant morbidity and mortality in both developed and developing nations of the world. To review the relevant literature on obstructive sleep apnea. Literature review was ...
H. Boot (Hendrik)
textabstractAlmost twenty years ago obstmctive sleep apnea was considered to be a medical curiosity that was of little importance, and snoring was merely the subject of humor than one of serious investigation. Although the clinical manifestations of sleep apnea syndrome have been described as early
Herlihy, J.P.; Whitlock, W.L.; Dietrich, R.A.; Shaw, T.
After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema
Herlihy, J.P.; Whitlock, W.L.; Dietrich, R.A.; Shaw, T. (Pulmonary Disease Service, Presidio of San Francisco, CA (USA))
After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema.
Petersen, Marian; Kristensen, Ellids; Berg, Søren
. Female Sexual Function Index, Female Sexual Distress Scale and four questions from Life Satisfaction-11 (Lisat-11). Results. Female Sexual Function Index indicated that obstructive sleep apnea patients were at a higher risk for having sexual difficulties. Female Sexual Distress Scale showed significantly...... more sexual distress in the obstructive sleep apnea group. Manifest Female Sexual Dysfunction (combined data from Female Sexual Function Index and Female Sexual Distress Scale) showed that female patients with obstructive sleep apnea also had more sexual dysfunction. Severity of sleep apnea was......, however, not related to any of these indices but consumption of psychopharmaca was. In Lisat-11, we found that obstructive sleep apnea females scored lower than women in the population sample regarding life as a whole but not regarding domains of closeness. Conclusions. This study indicates that sexuality...
Full Text Available Aim: We aimed to investigate the eff ect of obstructive sleep apnea treatment on sexual performance in the case of obstructive sleep apnea in men with erectile dysfunction. Material and Methods: IIEF (international index of erectile function form was fi lled for 141 male patients who admitted with obstructive sleep apnea and with erectile dysfunction and investigated in polysomnography laboratory. All patients were examined at ENT (Ear Nose and Throat clinic. Patients in the treatment of surgery and CBAP (continuous positive airway pressure were evaluated according to the apnehipopne index (AHI. Preliminary report has been done at the 3. month aﬅ er the OSAS(Obstructive Sleep Apnea Syndrome therapy for the 23 patients. IIEF form was fi lled again and symptom scoring has been updated for 23 patients who could be followed aﬅ er sleep apnea treatment. The age of these patients ranged from 26 to 65 years. Wilcoxon signed ranks, Kruskal Wallis, and Spearman’s rho tests were used to evaluate diff erences in IIEF scores before and aﬅ er the treatment. Results: Signifi cant improvement were confi rmed at IIEF scores of 23 patients with obstructive sleep apnea who could be followed and treated statistically (p0.05. Discussion: Sexual performance may decline in patients with obstructive sleep apnea and a signifi cant improvement was detected on sexual performance with apnea treatment in this group of patients.
Farsi, Sara H
Intrathecal narcotics have proven to be invaluable in providing pain relief following a cesarean section. They also aid in earlier mobilization. Unfortunately, they come at the risk of delayed apnea requiring close monitoring for a prolonged period of time. Physicians may sometimes underestimate the risk of these delayed complications. This especially a big concern in hospitals that cannot provide the necessary postoperative monitoring required for these women. I present a case where it took more than 6 h after injection of narcotics before the complication occurred.
Javaheri, Shahrokh; Barbe, Ferran; Campos-Rodriguez, Francisco; Dempsey, Jerome A; Khayat, Rami; Javaheri, Sogol; Malhotra, Atul; Martinez-Garcia, Miguel A; Mehra, Reena; Pack, Allan I; Polotsky, Vsevolod Y; Redline, Susan; Somers, Virend K
Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Waldemark, Karina E.; Agehed, Kenneth I.; Lindblad, Thomas
Sleep apnea is characterized by frequent prolonged interruptions of breathing during sleep. This syndrome causes severe sleep disorders and is often responsible for development of other diseases such as heart problems, high blood pressure and daytime fatigue, etc. After diagnosis, sleep apnea is often successfully treated by applying positive air pressure (CPAP) to the mouth and nose. Although effective, the (CPAP) equipment takes up a lot of space and the connected mask causes a lot of inconvenience for the patients. This raised interest in developing new techniques for treatment of sleep apnea syndrome. Several studies indicated that electrical stimulation of the hypoglossal nerve and muscle in the tongue may be a useful method for treating patients with severe sleep apnea. In order to be able to successfully prevent the occurrence of apnea it is necessary to have some technique for early and fast on-line detection or prediction of the apnea events. This paper suggests using measurements of respiratory airflow (mouth temperature). The signal processing for this task includes the use of a window short-FFT technique and uses an artificial back propagation neural net to model or predict the occurrence of apneas. The results show that early detection of respiratory interruption is possible and that the delay time for this is small.
Semelka, Michael; Wilson, Jonathan; Floyd, Ryan
Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep. This results in fragmented, nonrestful sleep that can lead to symptoms such as morning headache and daytime sleepiness. Obstructive sleep apnea affects persons of all ages, with an increasing prevalence in those older than 60 years. The exact prevalence is unknown but is estimated to be between 2% and 14%. There are many health conditions associated with obstructive sleep apnea, including hypertension, coronary artery disease, cardiac arrhythmias, and depression. Loud snoring, gasping during sleep, obesity, and enlarged neck circumference are predictive clinical features. Screening questionnaires can be used to assess for sleep apnea, although their accuracy is limited. The diagnostic standard for obstructive sleep apnea is nocturnal polysomnography in a sleep laboratory. Home sleep apnea tests can be performed for certain patients but are generally considered less accurate. Continuous positive airway pressure is the first-line treatment; adherence rates are variable and seem to improve with early patient education and support. Other treatment modalities include weight reduction, oral appliance therapy, and surgery to correct anatomic obstructions, although there is insufficient evidence to support these types of surgeries. Bariatric surgery can improve sleep parameters and symptoms in obese patients with obstructive sleep apnea and can result in remission in many patients.
Full Text Available Alyssa Cairns,1 Greg Poulos,1 Richard Bogan,1-3 1Research Division, SleepMed, Inc., 2School of Medicine, The University of South Carolina Medical School, Columbia, 3School of Medicine, The Medical University of South Carolina, Charleston, SC, USA Study objectives: To evaluate sex differences in predictors of obstructive sleep apnea (OSA as per outcomes from home sleep apnea testing. Design: This was a retrospective analysis of a large repository of anonymous test results and pretest risk factors for OSA. Setting and patients: A total of 272,705 patients were referred for home sleep apnea testing from a variety of clinical practices for suspected sleep disordered breathing across North America from 2009 to 2013. Interventions: Not applicable. Measurements and results: Predictors of OSA (apnea hypopnea index4%≥5 were evaluated by multiple logistic regression; sex differences were evaluated by interaction effects. Middle age was the single most robust predictor of OSA for both sexes and was particularly foretelling for females (P<0.001 even after controlling for measures of adiposity and medical conditions. Females over the age of 45 years were much more likely to have OSA compared to their younger counterparts (78.7% vs 42.5%, respectively; odds ratio: 5.0 versus males (88.1% vs 68.8%, respectively; odds ratio: 3.4. Snoring, although more frequently reported by males, was similarly predictive of OSA for both sexes. Witnessed apneas and measures of adiposity were better predictors of OSA for males than females. Insomnia, depression, and use of sleep medication, although more commonly reported in females, did not predict OSA. Hypertension, although equally reported by both sexes, performed better as a predictor in females (P<0.001, even after controlling for age, measures of adiposity, and other medical conditions. Diabetes, heart disease, stroke, and sleepiness did not contribute unique variance in OSA in adjusted models. Conclusion: This study
Srinivasan, Lakshmi; Escobar, Gabriel J.
BACKGROUND: There is little epidemiologic evidence to assess the maturation of respiratory control in premature infants. OBJECTIVE: To measure the success rate or the percentage of infants who have no additional events of various apnea- or bradycardia-free intervals after correcting for gestational age, postmenstrual age of the last apnea or bradycardia event, and the severity of the event. METHODS: This was a retrospective cohort study of infants born at 34 weeks' gestational age or earlier at 1 of 5 Kaiser Permanente Medical Care Program hospitals between 1998 and 2001. The success rates of various apnea- or bradycardia-free intervals were calculated after stratifying according to gestational age, postmenstrual age of the last event, or event severity. RESULTS: Among the 1403 infants identified in this study, 84.2% did not have an apnea event and 78.5% did not have a bradycardia event after they were otherwise ready for discharge. For the entire cohort, a 95% success rate was statistically reached, with a 7-day apnea- or bradycardia-free interval. Infants with a gestational age of 30 weeks or less had a 5% to 15% lower success rate than infants with a gestational age more than 30 weeks for any given apnea- or bradycardia-free interval. The success rate was reduced by an additional 5% to 10% if the last apnea or bradycardia event occurred at a postmenstrual age of more than 36 weeks. Including only the most severe events slightly improved the success rate of a given interval. CONCLUSIONS: The risk of recurrence for apnea or bradycardia differs depending on the gestational age of the infant and the postmenstrual age of the last apnea or bradycardia event. PMID:21746726
Type 2 diabetes and obstructive sleep apnea (OSA) are diseases with high prevalence and major public health impact. There is evidence that regular snoring and OSA are independently associated with alterations in glucose metabolism. Thus, OSA might be a risk factor for the development of type 2 diabetes. Possible causes might be intermittent hypoxia and sleep fragmentation, which are typical features of OSA. OSA might also be a reason of ineffective treatment of type 2 diabetes. There is further evidence that the treatment of OSA by continuous positive airway pressure (CPAP) therapy might correct metabolic abnormalities in glucose metabolism. It is assumed that this depends on therapy compliance to CPAP. On the other hand, there are also hints in the literature that type 2 diabetes per se might induce sleep apnea, especially in patients with autonomic neuropathy. Pathophysiological considerations open up new insights into that problem. Based on the current scientific data, clinicians have to be aware of the relations between the two diseases, both from the sleep medical and the diabetological point of view. The paper summarizes the most important issues concerning the different associations of OSA and type 2 diabetes. PMID:21147644
Full Text Available Objective: This study aimed at assessing the relationship between facial morphological patterns (I, II, III, Long Face and Short Face as well as facial types (brachyfacial, mesofacial and dolichofacial and obstructive sleep apnea (OSA in patients attending a center specialized in sleep disorders. Methods: Frontal, lateral and smile photographs of 252 patients (157 men and 95 women, randomly selected from a polysomnography clinic, with mean age of 40.62 years, were evaluated. In order to obtain diagnosis of facial morphology, the sample was sent to three professors of Orthodontics trained to classify patients' face according to five patterns, as follows: 1 Pattern I; 2 Pattern II; 3 Pattern III; 4 Long facial pattern; 5 Short facial pattern. Intraexaminer agreement was assessed by means of Kappa index. The professors ranked patients' facial type based on a facial index that considers the proportion between facial width and height. Results: The multiple linear regression model evinced that, when compared to Pattern I, Pattern II had the apnea and hypopnea index (AHI worsened in 6.98 episodes. However, when Pattern II was compared to Pattern III patients, the index for the latter was 11.45 episodes lower. As for the facial type, brachyfacial patients had a mean AHI of 22.34, while dolichofacial patients had a significantly statistical lower index of 10.52. Conclusion: Patients' facial morphology influences OSA. Pattern II and brachyfacial patients had greater AHI, while Pattern III patients showed a lower index.
Cristian Papuzinski Aguayo
Full Text Available Introduction. Obstructive sleep apnea hypopnea syndrome (OSAHS in children is associated with numerous adverse cognitive and behavioral consequences. The most common risk factor identified for OSAHS is tonsillar enlargement, and primary treatment is adenotonsillectomy. Aim. To compare the efficacy of early adenotonsillectomy versus watchful waiting, on cognitive, behavioral, quality of life and sleep outcomes in children with OSAHS. Patients and Methods. We critically appraised the Marcus (2013 article, a multicenter, single masked, randomized, controlled study in seven sleep centers. Results. After a seven month follow-up, the rate of spontaneous remission in polysomnographic parameters control group shows that 46% of children spontaneously revert untoward outcomes, compared to 79% of children in the intervention group. Reviewer’s conclusion. Adenotonsillar surgery for the treatment of obstructive sleep apnea in school-age children does not significantly improve attention or executive function, but it does improve some behavioral outcomes, quality of life, and polysomnographic variables. However, this improvement was also observed in a high proportion of children who received no treatment, mainly regarding polysomnographic variables. Thus surgery does not appear to be necessary to reduce symptoms.
Schmidt, Barbara; Roberts, Robin S; Davis, Peter; Doyle, Lex W; Barrington, Keith J; Ohlsson, Arne; Solimano, Alfonso; Tin, Win
Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight. We randomly assigned 2006 infants with birth weights of 500 to 1250 g during the first 10 days of life to receive either caffeine or placebo, until drug therapy for apnea of prematurity was no longer needed. We evaluated the short-term outcomes before the first discharge home. Of 963 infants who were assigned to caffeine and who remained alive at a postmenstrual age of 36 weeks, 350 (36 percent) received supplemental oxygen, as did 447 of the 954 infants (47 percent) assigned to placebo (adjusted odds ratio, 0.63; 95 percent confidence interval, 0.52 to 0.76; Papnea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312.). Copyright 2006 Massachusetts Medical Society.
Di Fiore, Juliann M; Martin, Richard J; Gauda, Estelle B
With increased survival of preterm infants as young as 23 weeks gestation, maintaining adequate respiration and corresponding oxygenation represents a clinical challenge in this unique patient cohort. Respiratory instability characterized by apnea and periodic breathing occurs in premature infants because of immature development of the respiratory network. While short respiratory pauses and apnea may be of minimal consequence if oxygenation is maintained, they can be problematic if accompanied by chronic intermittent hypoxemia. Underdevelopment of the lung and the resultant lung injury that occurs in this population concurrent with respiratory instability creates the perfect storm leading to frequent episodes of profound and recurrent hypoxemia. Chronic intermittent hypoxemia contributes to the immediate and long term co-morbidities that occur in this population. In this review we discuss the pathophysiology leading to the perfect storm, diagnostic assessment of breathing instability in this unique population and therapeutic interventions that aim to stabilize breathing without contributing to tissue injury. Copyright © 2013. Published by Elsevier B.V.
Michels, Daniel de Sousa; Rodrigues, Amanda da Mota Silveira; Nakanishi, Márcio; Sampaio, André Luiz Lopes; Venosa, Alessandra Ramos
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
White, David P
A strong demand for new obstructive sleep apnea (OSA) therapies exists and several are emerging. Hypoglossal nerve stimulation is designed to activate upper airway muscles. The initial study from Inspire (Maple Grove, MN) suggests that the device will work well in a very selective group of OSA patients. However, it is likely to be quite expensive. The Winx device (ApniCure, Redwood City, CA) works by establishing a vacuum in the oral cavity, which pulls the uvula and soft palate forward and stabilizes the tongue position. The current device works in approximately 40% of patients and the early data suggest adherence may be quite good. The Provent device( Theravent, San Jose, CA) has been available for several years and is disposable. It is to be attached to the nares nightly and establishes substantial expiratory resistance. Multiple studies suggest that Provent can successfully treat OSA in about 35 to 50% of the patients. However, acceptance and adherence may be a problem. OSA phenotyping is not a therapy, but a way to determine exactly what causes airway collapse in each patient, which can vary substantially. This may allow for individualization of apnea therapy. New methods to prevent supine sleep and surgically implantable devices to treat OSA are also evolving. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
We reviewed the cases of 27 young children from 27 different families who were suffocated by their mothers. The certainty, or near certainty, of suffocation was based on reliable observation or recording of the suffocation, maternal confession, or successful prosecution in a criminal court. Eighteen of the children are alive, although one has severe brain damage; nine are dead. Twenty-four were reported to have had previous episodes of apnea, cyanosis, or seizure, and 11 had had 10 or more such episodes that were either invented or caused by the mother. Repetitive suffocation usually began between the ages of 1 and 3 months and continued until it was discovered, or the child died, 6 to 12 months later. The 27 children had 15 live elder siblings and 18 who had died suddenly and unexpectedly in early life; 13 of the dead siblings had had recurrent apnea, cyanosis, or seizures, and, although most of them at the time of death were certified as having sudden infant death syndrome, it is probable that some were suffocated. Repetitive suffocation has a characteristic clinical presentation that should allow identification before brain damage or death occurs. The characteristics should also allow the cause of death of some cases of sudden infant death to be established more accurately.
Full Text Available Obstructive sleep apnea (OSA is a disease of multicasual etiology. The risk factors include obesity, among other issues. Hence, it is extremely important to determine the effect of body weight on the severity of OSA. The aim of the study was to evaluate the influence of the body weight expressed as body mass index (BMI, on the value of upper airways diameter and on the AHI (Apnea-Hypopnea Index value. The study was comprised of 41 patients diagnosed with OSA by way of polysomnography. Each patient was first examine via a lateral cephalometric image of the skull, which served to measure the upper and lower diameter of the upper airways. BMI was also calculated for each patient. Statistical analysis was carried out in accordance with Pearson’s correlation coefficient test. Our work demonstrated a negative correlation between BMI and the diameter of the upper airways, and a positive correlation between BMI and AHI value. We thus put forward that the increase in body weight in patients with OSA can contribute to the severity of the disease, regardless of the fact that it may not lead to a reduction of the lumen of the upper airways.
Full Text Available The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA, occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG, is characterised by snoring, recurrent partial (hypopneas or complete (apneas obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.
Weninger, M; Saletu, B; Popow, C; Götz, M; Haschke, F
We report about polysomnographic studies including EEG, EOG, EMG, ECG, measurement of oropharyngeal airflow, recording of chest wall movements and transcutaneous measurements of pO2 and pCO2 in a 4-year-old girl with severe obstructive sleep apnea. Her sleep profile was characterized by a disturbed cyclic pattern of sleep stages with onset of sleep at stage 4, shortening of REM-sleep periods and of sleep stages 1 and 2, and an increased quantity of sleep stage 4. The total time spent in apneic episodes was 11.3% of the total sleep period (only obstructive events). Apneic attacks were recorded mainly in REM and light NREM sleep states. Tonsillectomy and adenoidectomy resulted in marked improvement without further evidence of abnormal sleeping pattern or of sleep apneas.
Di Fiore, Juliann M; Arko, Marina; Whitehouse, Meghan; Kimball, Amy; Martin, Richard J
To examine the temporal relationship between apnea and gastroesophageal reflux (GER) and to assess the effect of GER on apnea duration. A total of 119 preterm infants underwent 12-hour cardiorespiratory monitoring studies using respiratory inductance plethysmography, heart rate, oxygen saturation (SaO2), and esophageal pH. The studies were scored for GER (pH or =5 seconds) and apnea > or =15 seconds or > or =10 seconds that occurred within 30 seconds of GER. Apnea > or =10 seconds was used to assess whether GER would prolong apnea duration. There were 6255 episodes of GER. Only 1% of GER episodes were associated with apnea > or =15 seconds, and there was no difference in apnea rate before, during, or after GER. There was also no difference in rate of apnea > or =10 seconds before versus during GER; however, there was a decrease in apnea rate immediately after GER. The presence of GER during apnea did not prolong apnea duration, and GER had no effect on the lowest SaO2 or heart rate during apnea. There is no evidence of a temporal relationship between acid-based GER and apnea in preterm infants. In addition, GER does not prolong apnea duration and does not exacerbate the resultant decrease in heart rate and SaO2.
Pagel, J F; Kwiatkowski, Carol
To clarify the association of reported nightmare recall with polysomnographically defined obstructive sleep apnea (OSA) in a sleep laboratory population. This study included 393 individuals undergoing clinical polysomnography including a general intake questionnaire with questions on dream and nightmare recall frequency. Mean age was 50.5 and a range of 13 to 82 years, with 33% of the sample female and 67% male. Reported dream and nightmare recall were classified as infrequent when reported at less than once a month, or frequent when reported at a frequency greater than once per week. Mean Apnea-hypopnea Index AHI was 34.9 (std. 32.0) indicating a high frequency of severe (AHI > 30) OSA in this clinical study population. Both AHI and Apnea Index (AI) were significantly higher (p = 0.000) for the grouping reporting infrequent nightmare recall. As the AHI score increased, the percent of participants with frequent nightmare recall decreased linearly. Patients with higher AHI report a lower nightmare frequency, indicating that significant OSA suppresses the cognitive experience of nightmare recall. Depressed nightmare recall may occur secondary to the REMS suppression know to occur in patients with significant OSA.
Full Text Available PURPOSE: The aim of this study was to evaluate markers of systemic oxidative stress and antioxidant capacity in subjects with and without OSAS in order to investigate the most important factors that determine the oxidant-antioxidant status. METHODS: A total of 66 subjects referred to our Sleep laboratory were examined by full polysomnography. Oxidative stress and antioxidant activity were assessed by measurement of the derivatives of reactive oxygen metabolites (d-ROMs and the biological antioxidant capacity (BAP in blood samples taken in the morning after the sleep study. Known risk factors for oxidative stress, such as age, sex, obesity, smoking, hypelipidemia, and hypertension, were investigated as possible confounding factors. RESULTS: 42 patients with OSAS (Apnea-Hypopnea index >15 events/hour were compared with 24 controls (AHI<5. The levels of d-ROMS were significantly higher (p = 0.005 in the control group but the levels of antioxidant capacity were significantly lower (p = 0.004 in OSAS patients. The most important factors predicting the variance of oxidative stress were obesity, smoking habit, and sex. Parameters of sleep apnea severity were not associated with oxidative stress. Minimal oxygen desaturation and smoking habit were the most important predicting factors of BAP levels. CONCLUSION: Obesity, smoking, and sex are the most important determinants of oxidative stress in OSAS subjects. Sleep apnea might enhance oxidative stress by the reduction of antioxidant capacity of blood due to nocturnal hypoxia.
Full Text Available Marco Carotenuto,1 Maria Esposito,1 Lucia Parisi,2 Beatrice Gallai,3 Rosa Marotta,4 Antonio Pascotto,1 Michele Roccella21Sleep Clinic for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Naples, Italy; 2Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy; 3Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, 4Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, ItalyBackground: The relationship between sleep and mood regulation is well known, and some reports suggest a key role of sleep-related breathing disorders (SRBD in the development of the symptomatology of depression, even if no conclusive data are actually found in the clinical literature. The aim of this study was to assess the relationship between SRBD and depressive symptoms in a population of school-aged children.Methods: The study population comprised 94 children affected by SRBD and 107 healthy children. To identify the severity of SRBD, an overnight respiratory evaluation was performed. All subjects filled out the Italian version of the Children Depression Inventory (CDI to screen for the presence of depressive symptoms.Results: The group with SRBD showed higher CDI scores than the group without SRBD, with a positive correlation found between CDI scores, apnea-hypopnea index, and oxygen desaturation index values. Logistic regression showed that an apnea-hypopnea index ≥ 3 and an oxygen desaturation index ≥ 1 could be risk factors for development of depressive symptoms. According to receiver-operating characteristic curve analysis, the cutoff point for the apnea-hypopnea index that could cause a pathological CDI score (≥19 was >5.66, and the cutoff point for the oxygen desaturation index was >4.2. The limitations of this study are that our data are derived from one single psychometric test and not from a complete psychiatric evaluation, and our
Recently, the socio-medical importance of obstructive sleep apnea in infancy and childhood increases worldwide. The present investigation aims at analyzing the dynamic science internationalization in this narrow field as reflected in three data-bases and at outlining the most significant scientists, institutions and primary information sources. A scientometric study of data from a retrospective problem-oriented search on pediatric sleep apnea in three data-bases such as Web of Science, MEDLINE and Scopus was carried out. A set of parameters of publication output and citations was followed-up. Several scientometric distributions were created and enabled the identification of some essential peculiarities of the international scientific communications. There was a steady world publication output increase. In 1972-2010, 4192 publications from 874 journals were abstracted in MEDLINE. In 1985-2010, more than 8100 authors from 64 countries published 3213 papers in 626 journals and 256 conference proceedings abstracted in Web of Science. In 1973-2010, 152 authors published 687 papers in 144 journals in 19 languages abstracted in Scopus. USA authors dominated followed by those from Australia and Canada. Sleep, Int. J. Pediatr. Otorhinolaryngol., Pediatr. Pulmonol. and Pediatrics belonged to 'core' journals concerning Web of Science and MEDLINE while Arch. Dis. Childh. and Eur. Respir. J. dominated in Scopus. Nine journals being currently published in 5 countries contained the terms of 'sleep' or 'sleeping' in their titles. David Gozal, Carole L. Marcus and Christian Guilleminault presented with most publications and citations to them. W.H. Dietz' paper published in Pediatrics in 1998 received 764 citations. Eighty-four authors from 11 countries participated in 16 scientific events held in 12 countries which were immediately devoted to sleep research. Their 13 articles were cited 170 times in Web of Science. Authors from the University of Louisville, Stanford University, and
Bohlman, M.E. (Johns Hopkins Univ. School of Medicine, Baltimore, MD); Haponik, E.F.; Smith, P.L.; Allen, R.P.; Bleecker, E.R.; Goldman, S.M.
Sleep apnea is a major cause of daytime hypersomnolence. Among the proposed etiologies, focal obstruction of the airways at the level of the pharynx has been suggested but not proven. Using computed tomography, the cross-sectional area of the airway can be readily assessed. Thirty-three adults with clinically proven sleep apnea and 12 normal adults underwent systematic computed tomography of the neck. Significant airway narrowing was demonstrated in all the patients with obstructive sleep apnea, whereas no such narrowing was seen in the controls. In 11, the narrowing was at a single level, whereas in 22 patients two or more levels were affected. This study has shown that a structurally abnormal airway may serve as an anatomic substrate for the development of sleep apnea. On the basis of this evidence, uvulopalatopharyngoplasty has been performed in two patients with relief of symptoms in one.
Mueni, Eunice; Opiyo, Newton; English, Mike
Summary Considerable uncertainty persists regarding the efficacy and safety of methylxanthines (caffeine, theophylline – in intravenous form named aminophylline) for the prevention and treatment of infant apnea. To help inform national guideline development in Kenya we undertook structured literature searches to identify current evidence on caffeine therapy for infant apnea. Available evidence shows that caffeine is as effective as intravenous theophylline (aminophylline), but is safer and easier to give and has better therapeutic properties. It is therefore recommended for the treatment of apnea of prematurity. Caffeine is also the preferred drug if clinicians plan to provide apnea prophylaxis. As prematurity is likely to result in more than 1 million deaths a year, mostly in resource-poor settings, greater efforts need to be made to ensure interventions such as caffeine, currently unavailable in countries such as Kenya, are made more widely available. PMID:20676238
Bohlman, M.E.; Haponik, E.F.; Smith, P.L.; Allen, R.P.; Bleecker, E.R.; Goldman, S.M.
Sleep apnea is a major cause of daytime hypersomnolence. Among the proposed etiologies, focal obstruction of the airways at the level of the pharynx has been suggested but not proven. Using computed tomography, the cross-sectional area of the airway can be readily assessed. Thirty-three adults with clinically proven sleep apnea and 12 normal adults underwent systematic computed tomography of the neck. Significant airway narrowing was demonstrated in all the patients with obstructive sleep apnea, whereas no such narrowing was seen in the controls. In 11, the narrowing was at a single level, whereas in 22 patients two or more levels were affected. This study has shown that a structurally abnormal airway may serve as an anatomic substrate for the development of sleep apnea. On the basis of this evidence, uvulopalatopharyngoplasty has been performed in two patients with relief of symptoms in one
De Dios, Jose Angelo A; Brass, Steven D
Although continuous positive airway pressure, oral appliances and surgical modifications of the airway are considered as part of the routine management of patients with obstructive sleep apnea, many new and unconventional therapies exist. Many of the trials using these new alternatives have been limited by insufficient data, poor trial design, small sample size, unclear inclusion criteria, lack of randomization, and lack of blinding, and on occasion are biased by retrospective design. Bariatric surgery, positional therapy, auto-titrating positive airway pressure, serotonin agents, wake promoting agents, genioglossus stimulation surgery, supplemental oxygen, nasal dilators, nasal expiratory resistor devices and oropharyngeal exercises will be reviewed. As obstructive sleep apnea impacts the individual and society at large, further research is needed to explore new therapeutic treatment options for obstructive sleep apnea. Therapeutic trials for obstructive sleep apnea must be of rigorous design to prove clinical effectiveness while taking into account both patient satisfaction and cost effectiveness.
Schears, Gregory; Creed, Jennifer; Antoni, Diego; Zaitseva, Tatiana; Greeley, William; Wilson, David F.; Pastuszko, Anna
Repetitive apnea is associated with a significant increase in extracellular dopamine, generation of free radicals as determined by o-tyrosine formation and increase in Fluoro-Jade staining of degenerating neurons. This increase in extracellular dopamine and of hydroxyl radicals in striatum of newborn brain is likely to be at least partly responsible for the neuronal injury and neurological side effects of repetitive apnea.
Fatima Dumas Cintra
Full Text Available Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart® system. Results: A total of 767 participants (461 men with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001. After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.
Mueni, Eunice; Opiyo, Newton; English, Mike
Considerable uncertainty persists regarding the efficacy and safety of methylxanthines (caffeine, theophylline – in intravenous form named aminophylline) for the prevention and treatment of infant apnea. To help inform national guideline development in Kenya we undertook structured literature searches to identify current evidence on caffeine therapy for infant apnea. Available evidence shows that caffeine is as effective as intravenous theophylline (aminophylline), but is safer and easier to ...
Pochat, M D; Ferber, C; Lemoine, P
The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative
Full Text Available The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT perfomed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.
Clark, Matthew T.; Delos, John B.; Lake, Douglas E.; Lee, Hoshik; Fairchild, Karen D.; Kattwinkel, John; Moorman, J. Randall
Summary A near-ubiquitous pathology in very low birth weight infants is neonatal apnea, breathing pauses with slowing of the heart and falling blood oxygen. Events of substantial duration occasionally occur after an infant is discharged from the NICU. It is not known whether apneas result from a predictable process or from a stochastic process, but the observation that they occur in seemingly random clusters justifies the use of stochastic models. We use a hidden-Markov model to analyze the distribution of durations of apneas and the distribution of times between apneas. The model suggests the presence of four breathing states, ranging from very stable (with an average lifetime of 12 hours) to very unstable (with an average lifetime of 10 seconds). Although the states themselves are not visible, the mathematical analysis gives estimates of the transition rates among these states. We have obtained these transition rates, and shown how they change with post-menstrual age; as expected, the residence time in the more stable breathing states increases with age. We also extrapolated the model to predict the frequency of very prolonged apnea during the first year of life. This paradigm – stochastic modeling of cardiorespiratory control in neonatal infants to estimate risk for severe clinical events – may be a first step toward personalized risk assessment for life threatening apnea events after NICU discharge. PMID:26963049
Meyer, J S; Sakai, F; Karacan, I; Derman, S; Yamamoto, M
Regional cerebral flow after inhalation of xenon 133 as well as polysomnography were recorded during daytime sleep and the awake state in patients with narcolepsy and sleep apnea. Brainstem-cerebellar (BSC) gray matter blood flow (Fg) values in the awake state were reduced below normal (p less than 0.05) in both narcolepsy and sleep apnea; in sleep apnea, bihemispheric Fg values were also reduced in the awake state. After sleep onset, Fg paradoxically increased in narcolepsy but decreased further in sleep apnea. Maximal regional Fg changes occurred in BSC regions in both groups of patients. Oral administration of methylphenidate hydrochloride (Ritalin) increased resting Fg values in awake narcoleptics, particularly in BSC regions, but attentuated Fg increases during sleep onset. Regional Fg values during visual dreaming or hypnagogic hallucinations in narcoleptics were maximally increased in right parietooccipital regions. In narcoleptics, impaired control of sleep-wake and REM mechanisms is attentuated by methylphenidate. In patients with sleep apnea, brainstem functional activity is low in the awake state but becomes critically reduced during sleep, culminating in apnea-stimulated arousal followed by repetitive cycles as sleep recurs.
Clark, Matthew T; Lake, Douglas E; Randall Moorman, J; Delos, John B; Lee, Hoshik; Fairchild, Karen D; Kattwinkel, John
A near-ubiquitous pathology in very low birth weight infants is neonatal apnea, breathing pauses with slowing of the heart and falling blood oxygen. Events of substantial duration occasionally occur after an infant is discharged from the neonatal intensive care unit (NICU). It is not known whether apneas result from a predictable process or from a stochastic process, but the observation that they occur in seemingly random clusters justifies the use of stochastic models. We use a hidden-Markov model to analyze the distribution of durations of apneas and the distribution of times between apneas. The model suggests the presence of four breathing states, ranging from very stable (with an average lifetime of 12 h) to very unstable (with an average lifetime of 10 s). Although the states themselves are not visible, the mathematical analysis gives estimates of the transition rates among these states. We have obtained these transition rates, and shown how they change with post-menstrual age; as expected, the residence time in the more stable breathing states increases with age. We also extrapolated the model to predict the frequency of very prolonged apnea during the first year of life. This paradigm—stochastic modeling of cardiorespiratory control in neonatal infants to estimate risk for severe clinical events—may be a first step toward personalized risk assessment for life threatening apnea events after NICU discharge. (paper)
Jennum, Poul Jørgen; Larsen, Preben; Cerqueira, Charlotte
Aim: The aim of the Danish National Database for Obstructive Sleep Apnea (NDOSA) was to evaluate the clinical quality (diagnostic, treatment, and management) for obstructive sleep apnea and obesity hypoventilation syndrome in Denmark using a real-time national database reporting to the Danish Nat...... departments was involved in the management of sleep apnea in Denmark for the purpose of quality improvement. Conclusion: The NDOSA has proven to be a real-time national database using diagnostic and treatment procedures reported to the Danish National Patient Registry.......Aim: The aim of the Danish National Database for Obstructive Sleep Apnea (NDOSA) was to evaluate the clinical quality (diagnostic, treatment, and management) for obstructive sleep apnea and obesity hypoventilation syndrome in Denmark using a real-time national database reporting to the Danish...... National Patient Registry. Study population: All patients diagnosed with obstructive sleep apnea or obesity hypoventilation syndrome at public and private in- and out-hospital departments in Denmark were included. Main variables: The NDOSA contains information about baseline characteristics, comorbidity...
Clark, Matthew T; Delos, John B; Lake, Douglas E; Lee, Hoshik; Fairchild, Karen D; Kattwinkel, John; Moorman, J Randall
A near-ubiquitous pathology in very low birth weight infants is neonatal apnea, breathing pauses with slowing of the heart and falling blood oxygen. Events of substantial duration occasionally occur after an infant is discharged from the neonatal intensive care unit (NICU). It is not known whether apneas result from a predictable process or from a stochastic process, but the observation that they occur in seemingly random clusters justifies the use of stochastic models. We use a hidden-Markov model to analyze the distribution of durations of apneas and the distribution of times between apneas. The model suggests the presence of four breathing states, ranging from very stable (with an average lifetime of 12 h) to very unstable (with an average lifetime of 10 s). Although the states themselves are not visible, the mathematical analysis gives estimates of the transition rates among these states. We have obtained these transition rates, and shown how they change with post-menstrual age; as expected, the residence time in the more stable breathing states increases with age. We also extrapolated the model to predict the frequency of very prolonged apnea during the first year of life. This paradigm-stochastic modeling of cardiorespiratory control in neonatal infants to estimate risk for severe clinical events-may be a first step toward personalized risk assessment for life threatening apnea events after NICU discharge.
Guilleminault, Christian; Abad, Vivien C; Chiu, Hsiao-Yean; Peters, Brandon; Quo, Stacey
Missing teeth in early childhood can result in abnormal facial morphology with narrow upper airway. The potential association between dental agenesis or early dental extractions and the presence of obstructive sleep apnea (OSA) was investigated. We reviewed clinical data, results of polysomnographic sleep studies, and orthodontic imaging studies of children with dental agenesis (n = 32) or early extraction of permanent teeth (n = 11) seen during the past 5 years and compared their findings to those of age-, gender-, and body mass index-matched children with normal teeth development but tonsilloadenoid (T&A) hypertrophy and symptoms of OSA (n = 64). The 31 children with dental agenesis and 11 children with early dental extractions had at least 2 permanent teeth missing. All children with missing teeth (n = 43) had clinical complaints and signs evoking OSA. There was a significant difference in mean apnea-hypopnea indices (AHI) in the three dental agenesis, dental extraction, and T&A studied groups (p dental agenesis group. In the children with missing teeth (n = 43), aging was associated with the presence of a higher AHI (R (2) = 0.71, p dental agenesis in the studied children was not part of a syndrome and was an isolated finding. Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep, and presented with OSA recognized at a later age. Due to the low-grade initial symptomatology, sleep-disordered breathing may be left untreated for a prolonged period with progressive worsening of symptoms over time.
Full Text Available Background: There is convincing evidence that obstructive sleep apnea (OSA is highly associated with impaired glucose metabolism. Objectives: Analyze the prevalence of OSA in type 1 and type 2 diabetes mellitus (DM patients. Evaluate the influence of OSA on glycemic control. Methods: The adult patients with diabetes mellitus (DM followed in the department of internal medicine were referred to our Sleep Unit. A home respiratory polygraphy was then performed on all patients with body mass index (BMI 30/h. The mean CT90 was 5.3 ± 12.5 and the mean AHI was 13.6 ± 18.3. The mean AHI was similar between type 1 and type 2 DM (15.7 ± 24.5 Vs 11.6 ± 8.9; p = 0.46. The AHI was not correlated with the BMI. Type 2 DM patients with poor glycemic control (HbA1c > 7.5% had a significantly higher mean AHI (14.3 ± 9.0 vs 6.4 ± 6.2; p = 0.038. This difference did not remain significant after adjustment for BMI (p = 0.151. Conclusions: The prevalence of OSA in type 1 DM is similar to that found in type 2 DM. We note the high prevalence of OSA in younger patients with type 1 DM. Keywords: Obstructive sleep apnea syndrome, Diabetes mellitus, Glycemic control
Francart, Suzanne J; Allen, Megan K; Stegall-Zanation, Jennifer
The primary objective was to evaluate the correlation between maintenance dose and response rates in neonates less than 28 weeks gestational age. Secondary objectives included clinical indicators of response (number of weight adjustments, dose increases, and mini-loads) and tachycardia associated with caffeine therapy. This study was a retrospective analysis of neonates admitted to the North Carolina Children's Hospital from August 2009 to August 2011. Patients included were less than 28 weeks postmenstrual age and were treated with caffeine for apnea of prematurity. Patients were excluded if they were older than 28 weeks postmenstrual age, receiving caffeine therapy for other indications, or experiencing apnea from other conditions, or if therapy was initiated more than 7 days after birth. A total of 89 neonates with a mean birth weight of 0.844 kg (range: 0.391 to 1.306 kg) and median gestational age of 26 2/7 weeks (range: 23 to 27 6/7 weeks) were evaluated. The median initial maintenance dose of caffeine citrate was 7.9 mg/kg/day, and 94.1% of neonates receiving ≤7.9 mg/kg/day required a clinical intervention during therapy compared with 76.3% in those receiving >7.9 mg/kg/day. Absolute incidence of tachycardia was low, and caffeine levels collected ranged from 16.6 to 34.4 μg/mL. In neonates less than 28 weeks gestational age, doses of caffeine citrate greater than 7.9 mg/kg/day are safe and are associated with a decreased need for clinical interventions.
Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic bas...
Victor, Lyle D
Obstructive sleep apnea should be suspected in patients who are overweight snore loudly, and have chronic daytime sleepiness. The diagnosis of sleep apnea may be confirmed by sleep laboratory studies. Patients' symptoms and the frequency of respiratory events on laboratory testing are important factors in determining the severity of disease. In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep. Continuous positive airway pressure (CPAP) is the most consistently effective treatment for clinically significant obstructive sleep apnea. In general, heavier patients with thicker necks require higher pressure settings. As patients age or gain weight, additional pressure may be necessary. Bilevel pressure machines or machines that slowly ramp up the pressure may increase patient acceptance of CPAP therapy. Complications of CPAP use include nasal dryness and congestion, claustrophobia, facial skin abrasions, air leaks, and conjunctivitis. Strategies to improve patient compliance include allowing patients to try a number of masks to find the most comfortable fit, adding humidification, treating nasal disease and, most importantly, providing close follow-up and encouragement. Oral appliances are inconsistently effective in the management of obstructive sleep apnea but may be an option in patients with mild disease who cannot tolerate CPAP. Palatal surgery often decreases snoring but may not reduce the occurrence of sleep apnea. Patients with severe disease and intolerance of CPAP may be candidates for more invasive surgical procedures. Supplemental oxygen and drug therapy may have limited, adjunctive roles in the treatment of obstructive sleep apnea.
Kumar, M; Kabra, N S; Paes, B
Apnea of prematurity is a common problem in preterm infants in the neonatal intensive care setting (NICU), often delaying their discharge home or transfer to a step down unit. Premature infants are at increased risk of carnitine deficiency. Carnitine supplementation has been used for both prevention and treatment of apnea. To determine whether treatment with carnitine will reduce the frequency of apnea, the duration of ventilation and the duration of hospital stay in preterm infants with recurrent apnea. Computerised searches were carried out by two reviewers independently. Searches were made of MEDLINE (1966 to May 2004), EMBASE (1980 to May 2004), CINAHL (1982-2004 June 2004,1st week), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), abstracts of annual meetings of the Society for Pediatric Research (1995-2004), and contacts were made with the subject experts. Only randomized or quasi-randomized treatment trials of preterm infants with a diagnosis of recurrent apnea of prematurity were considered. Trials were included if they involved treatment with carnitine compared to placebo or no treatment, and measured at least one of the following outcomes: failure of resolution of apneas, the duration of ventilation and the duration of hospital stay. Two reviewers evaluated the papers for inclusion criteria and quality. Corresponding authors were contacted for further information where needed. No eligible trials were identified. Despite the plausible rationale for the treatment of apnea of prematurity with carnitine, there are insufficient data to support its use for this indication. Further studies are needed to determine the role of this treatment in clinical practice.
Results: Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea.
Amin, Sanjiv B.; Burnell, Erica
Objective To compare apnea events recorded by bedside cardiorespiratory monitor and nursing documentation with those detected by visual inspection of continuous electronic cardiorespiratory waveform. Methods In a prospective observational study, 20 nonventilated infants of 28 to 33 weeks’ gestational age were monitored for apnea during the first 2 postnatal weeks. Apnea was defined as a respiratory pause > 20 seconds or > 15 seconds if associated with a heart rate apnea was defined as one for which visual inspection of continuous electronic cardiorespiratory waveform on the central monitor verified apnea. Results The number of apnea episodes recorded by nursing documentation and bedside monitors were 207 and 418, respectively. Only 7.7% of apnea events recorded by nursing documentation were confirmed as true apnea compared with 50.4% of apnea recorded by bedside monitors and the difference was statistically significant. Of true apnea (n = 211) episodes recorded on central monitors, 99% were recorded by bedside monitors but only 7.6% of apnea occurrences were recorded by nursing personnel. Conclusions Nursing documentation does not provide accurate monitoring of apnea. Although bedside monitors have better sensitivity and specificity than nursing documentation, future research should be directed to improve the specificity of bedside monitoring. PMID:23254381
Amin, Sanjiv B; Burnell, Erica
To compare apnea events recorded by bedside cardiorespiratory monitor and nursing documentation with those detected by visual inspection of continuous electronic cardiorespiratory waveform. In a prospective observational study, 20 nonventilated infants of 28 to 33 weeks' gestational age were monitored for apnea during the first 2 postnatal weeks. Apnea was defined as a respiratory pause > 20 seconds or > 15 seconds if associated with a heart rate apnea was defined as one for which visual inspection of continuous electronic cardiorespiratory waveform on the central monitor verified apnea. The number of apnea episodes recorded by nursing documentation and bedside monitors were 207 and 418, respectively. Only 7.7% of apnea events recorded by nursing documentation were confirmed as true apnea compared with 50.4% of apnea recorded by bedside monitors and the difference was statistically significant. Of true apnea (n = 211) episodes recorded on central monitors, 99% were recorded by bedside monitors but only 7.6% of apnea occurrences were recorded by nursing personnel. Nursing documentation does not provide accurate monitoring of apnea. Although bedside monitors have better sensitivity and specificity than nursing documentation, future research should be directed to improve the specificity of bedside monitoring. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Itani, Y.; Niitsu, N.; Oono, T.; Fujioka, M.; Nishimura, G.
Upper gastrointestinal examinations with simultaneous cardiorespiratory monitoring were performed in 39 older premature infants with persistent apnea. Swallowing incoordination was documented to be causatively related to persistent apnea in such infants, especially with feeding. Direct relationship between apnea and gastroesophageal reflux was not documented in this study. (orig.)
Carlos A. Nigro
Full Text Available Portable sleep studies may play an important role to take decisions on patients referred for suspicion of Sleep Apnea-Hypopnea Syndrome (SAHS. The aim of this study was to evaluate the diagnostic accuracy of automated analysis of ApneaLinkT in patients with suspicion of SAHS. All participants (75 performed the ApneaLink and polysomnography (PSG simultaneously in the sleep laboratory. The two recordings were interpreted blindly. The ApneaLink software calculated: (1 risk indicator (RI-a combination of apnea/hypopnea index (AHI plus inspiratory flow limitation events and (2 the AHI. ApneaLinkT and SAHS were defined in three ways: AHI or respiratory disturbance index (RDI = 5, 10 and 15 respectively. ROC curves analysis was performed. The sensitivity (S, specificity (E and positive and negative likelihood ratio (LR+, LR- for the different thresholds for RI or AHI were calculated; 66 patients were included (47 men, mean age 51, median RDI 10.6, mean BMI 29.3 kg/m². The best cut off points of RI were: SAHS = RDI = 5: RI > 9 (S 80%, E 100%, LR- 0.20; SAHS = RDI = 10: RI > 13 (S 92%, E 93%, LR+ 13.7 LR- 0.089; SAHS = RDI = 15 =: RI > 16 (S 93.5%, E 91%, LR+ 10.9, LR- 0.071. The AHI had a similar diagnostic accuracy to RI for the different definitions of SAHS. The RI and AHI obtained from automated analysis of ApneaLinkT were highly sensitive and specific to diagnose moderate to severe SAHS.Los equipos portátiles para estudios del sueño pueden tener un rol importante para tomar decisiones en pacientes con sospecha de Síndrome Apneas-Hipopneas del Sueño (SAHS. El objetivo del estudio fue evaluar la exactitud diagnóstica del análisis automático del ApneaLinkT en pacientes con sospecha de SAHS. Setenta y cinco sujetos realizaron simultáneamente el ApneaLinkT y una polisomnografía (PSG en el laboratorio de sueño. Los dos registros fueron interpretados en forma ciega. Un programa calculó: (1 el índice apnea/hipopnea (IAH, (2 el indicador de
Henderson-Smart, David J; Steer, Peter A
Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation. Two forms of methylxanthine (caffeine and theophylline) have been used to stimulate breathing in order to prevent apnea and its consequences. To evaluate the effect of caffeine compared with theophylline treatment on the risk of apnea and use of mechanical ventilation in preterm infants with recurrent apnea. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases in August 2009: Oxford Database of Perinatal Trials; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2009); MEDLINE (1966 to April 2009); and EMBASE Drugs and Pharmacology (1990 to April 2009), previous reviews including cross references. Randomized and quasi-randomized trials comparing caffeine to theophylline for treating apnea in preterm infants and reporting effects on apnea event rates. Each author assessed eligibility and trial quality, extracted data separately and compared and resolved differences. Study authors were contacted for additional information. Five trials involving a total of 108 infants were included. The quality of most of these small trials was fair to good. No difference in treatment failure rate (less than 50% reduction in apnea/bradycardia) was found between caffeine and theophylline after one to three days treatment (based on two studies) or five to seven days treatment (based on one study). There was no difference in mean apnea rate between caffeine and theophylline groups after one to three days treatment (based on five trials) and five to seven days treatment (based on four trials).Adverse effects, indicated by tachycardia or feed intolerance leading to change in dosing, were lower in the caffeine
Sankari, Abdulghani; Bascom, Amy T; Chowdhuri, Susmita; Badr, M Safwan
Sleep-disordered breathing (SDB) is highly prevalent in patients with spinal cord injury (SCI); the exact mechanism(s) or the predictors of disease are unknown. We hypothesized that patients with cervical SCI (C-SCI) are more susceptible to central apnea than patients with thoracic SCI (T-SCI) or able-bodied controls. Sixteen patients with chronic SCI, level T6 or above (8 C-SCI, 8 T-SCI; age 42.5 ± 15.5 years; body mass index 25.9 ± 4.9 kg/m(2)) and 16 matched controls were studied. The hypocapnic apneic threshold and CO2 reserve were determined using noninvasive ventilation. For participants with spontaneous central apnea, CO2 was administered until central apnea was abolished, and CO2 reserve was measured as the difference in end-tidal CO2 (PetCO2) before and after. Steady-state plant gain (PG) was calculated from PetCO2 and VE ratio during stable sleep. Controller gain (CG) was defined as the ratio of change in VE between control and hypopnea or apnea to the ΔPetCO2. Central SDB was more common in C-SCI than T-SCI (63% vs. 13%, respectively; P tetraplegia is a risk factor for central sleep apnea. Sleep-related hypoventilation may play a significant role in the mechanism of SDB in higher SCI levels.
Full Text Available Sleep disorders are a major risk factor for cardiovascular diseases. Sleep apnea is the most common sleep disturbance and its detection relies on a polysomnography, i.e., a combination of several medical examinations performed during a monitored sleep night. In order to detect occurrences of sleep apnea without the need of combined recordings, we focus our efforts on extracting a quantifier related to the events of sleep apnea from a cardiovascular time series, namely systolic blood pressure (SBP. Physiologic time series are generally highly nonstationary and entrap the application of conventional tools that require a stationary condition. In our study, data nonstationarities are uncovered by a segmentation procedure which splits the signal into stationary patches, providing local quantities such as mean and variance of the SBP signal in each stationary patch, as well as its duration L. We analysed the data of 26 apneic diagnosed individuals, divided into hypertensive and normotensive groups, and compared the results with those of a control group. From the segmentation procedure, we identified that the average duration , as well as the average variance , are correlated to the apnea-hypoapnea index (AHI, previously obtained by polysomnographic exams. Moreover, our results unveil an oscillatory pattern in apneic subjects, whose amplitude S* is also correlated with AHI. All these quantities allow to separate apneic individuals, with an accuracy of at least 79%. Therefore, they provide alternative criteria to detect sleep apnea based on a single time series, the systolic blood pressure.
Rod, Naja Hulvej; Kjeldgaard, Linnea; Åkerstedt, Torbjörn
Sleep apnea is a common problem affecting daily functioning and health. We evaluated associations between sleep apnea and receipt of a disability pension and mortality in a prospective study of 74,543 cases of sleep apnea (60,125 outpatient, 14,418 inpatient) from the Swedish Patient Register (2000......–2009 inclusive). Cases were matched to 5 noncases (n = 371,592) and followed from diagnosis/inclusion to December 31, 2010, via nationwide registers. During a mean follow-up period of 5.1 (standard deviation, 2.7) years, 13% of men and 21% of women with inpatient sleep apnea received a disability pension....... Inpatient sleep apnea was associated with higher total mortality (for men, hazard ratio (HR) = 1.71, 95% confidence interval (CI): 1.59, 1.84; for women, HR = 2.33, 95% CI: 2.04, 2.67), with associations being strongest for deaths due to ischemic heart disease (for men, HR = 2.27, 95% CI: 1.94, 2...
Chen, Chao; Shu, Xian-Xiao; Yang, Xiao-Yan; Shi, Jing; Tang, Jun; Mu, De-Zhi
To investigate the current status of studies on drug therapy for apnea of prematurity (AOP) in the past decade in China and abroad, and to describe the research trends in the field. CNKI and MEDLINE were searched with the key words "apnea of prematurity" and "treatment" for articles published in the past decade (January 2006 to December 2015). The articles were screened and the key words were extracted to establish the co-occurrence matrix. Ucinet 6.2 was used to plot the knowledge map. A total of 26 Chinese key words and 20 English key words were included. Those in the center of the co-existent knowledge map of Chinses keywords were "preterm infants", "apnea", "primary apnea", "naloxone" and "aminophylline"; while "apnea", "preterm infants" and "caffeine" located in the central place of the co-existent knowledge map of English keywords. Methylxanthines are still the major drugs for AOP; however, aminophylline is mainly used in China, while caffeine is mainly used in foreign countries. Other drugs such as naltrexone are also used in the clinical treatment of AOP.
Full Text Available Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001, oxygen desaturation index (p<0.001 and sleep time with SpO2<90% (p<0.001 were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001 and lowest SpO2 (p<0.001 were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high
Demirkol ćakmak, Duygu; Eyüboǧlu, B. Murat
Obstructive sleep apnea syndrome is becoming a prevalent disease for both adults and children. It is described as the cessation of breath for at least 10 seconds during sleep. Detecting sleep apnea is considered as a troublesome and timeconsuming method, which requires the patients to stay one or more nights in dedicated sleep disorder rooms with sensors physically attached to their body. Undiagnosed thereby untreated sleep apnea patients are under high risk of hypertension, heart attack, traffic accident through fatigue and sleeplessness. In this project, nasal and oral respiratory information is obtained with utilizing thermocouple and oxygen saturation in the blood is obtained with utilizing pulse oximeter. An analog hardware circuit is designed to readout thermocouple and pulse oximeter signals. According to this respiratory and pulse oximetry signals, obstructive sleep apnea is detected in real time with using a software implemented into an ARM based processor. An Android mobile application is developed to record and display the oxygen saturation, heart rate and respiratory signal data during sleep. ARM based processor and mobile application communication is established via Bluetooth interface to reduce cabling on the patient. In summary, a portable, low cost and user friendly device to detect obstructive sleep apnea which is able to share the necessary information to the patients and doctors for the duration of the whole sleep cycle is developed.
Thaler, Erica R; Rassekh, Christopher H; Lee, Jonathan M; Weinstein, Gregory S; O'Malley, Bert W
This study evaluates the outcomes of multilevel surgery for patients with obstructive sleep apnea (OSA) who underwent transoral robotic surgery (TORS) (i.e., posterior glossectomy and limited lateral pharyngectomy) with uvulopalatopharyngoplasty (UPPP). Prospective, nonrandomized trial with historical controls. All patients underwent pre- and postoperative polysomnography, preoperative magnetic resonance imaging of the neck, preoperative drug-induced sleep endoscopy, surgery, including UPPP if this had not occurred previously, and OSA TORS. Outcomes measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), O2 saturation nadir, and total sleep time spent at response rate of 73%. Patients with prior pharyngeal surgery achieved an AHI reduction from 55.0 to 45 (24%, P = .19), a surgical success rate of 30%, and a surgical response rate of 40%. Total sleep time spent at multilevel approach for the surgical management of OSA. The benefit of the current surgical approach is most significant for previously unoperated patients. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Full Text Available Hypertension (HTN is a modifiable, highly prevalent risk factor for cardiovascular morbidity and renal dysfunction worldwide. In the United States, HTN affects one in three adults, contributes to one out of every seven deaths and to nearly half of all cardiovascular disease-related deaths. HTN is considered resistant when the blood pressure remains above goal despite lifestyle modification and administration of three antihypertensive agents of different classes including a diuretic. Large population-based studies have suggested that obstructive sleep apnea (OSA is a risk factor for resistant HTN. The mechanism proposed is a pattern of intermittent hypoxia associated with hyperaldosteronism, increased sympathetic tone, endothelial dysfunction, and inflammation. In this review we discuss the association between OSA and resistant HTN, the physiologic mechanisms linking OSA with resistant HTN, and the effect of continuous positive airway pressure therapy (CPAP on blood pressure in patients with resistant HTN. While the reduction in blood pressure with CPAP is usually modest in patients with OSA, a decrease of only a few mmHg in blood pressure can significantly reduce cardiovascular risk. Patients presenting to a center specializing in management of hypertension should be screened and treated for OSA as a potentially modifiable risk factor.
Obstructive sleep apnea (OSA) is a prevalent disorder that may cause cardiovascular disease and fatal traffic accidents but the pathophysiology remains incompletely understood. Increased fatigability of the genioglossus (the principal upper airway dilator muscle) might be important in OSA pathophysiology but the existing literature is uncertain. We hypothesized that the genioglossus in OSA subjects would fatigue more than in controls. In 9 OSA subjects and 9 controls during wakefulness we measured maximum voluntary tongue protrusion force (Tpmax). Using surface electromyography arrays we measured the rate of decline in muscle fiber conduction velocity (MFCV) during an isometric fatiguing contraction at 30% Tpmax. The rate of decline in MFCV provides an objective means of quantifying localized muscle fatigue. Linear regression analysis of individual subject data demonstrated a significantly greater decrease in MFCV in OSA subjects compared to control subjects (29.2 ± 20.8% [mean ± SD] versus 11.2 ± 20.8%; p=0.04). These data support increased fatigability of the genioglossus muscle in OSA subjects which may be important in the pathophysiology of OSA.
Muraki, Isao; Wada, Hiroo; Tanigawa, Takeshi
The aim of this review is to clarify the association between obstructive sleep apnea (OSA) and type 2 diabetes, and discuss the therapeutic role of continuous positive airway pressure (CPAP) in type 2 diabetes. OSA patients are more likely than non-OSA populations to develop type 2 diabetes while more than half of patients with type 2 diabetes suffer from OSA. Similarly to the Western countries, in the East Asian population, the association between these two disorders has also been reported. CPAP is the primary treatment for OSA, but the effect of CPAP on comorbid diabetes has not been established. CPAP improved glucose metabolism determined by the oral glucose tolerance test in OSA patients, and several studies have shown that CPAP improves insulin resistance, particularly in obese populations undergoing long-term CPAP. Diabetes is associated with other sleep-related manifestations as well, such as snoring and excessive daytime sleepiness. Snoring is associated with the development of diabetes, and excessive daytime sleepiness appears to modify insulin resistance. Well-designed studies are needed to clarify the therapeutic effect of CPAP on diabetes. Since both diabetes and OSA lead to cardiovascular disease, clinicians and healthcare professionals should be aware of the association between diabetes and OSA, and should take CPAP and health-related behaviors into consideration when treating patients with diabetes and/or OSA. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Afsar, Gulgun Cetintas; Oruc, Ozlem; Sarac, Sema; Topçuoğlu, Özgür Bilgin; Salturk, Cuneyt; Tepetam, Fatma Merve; Bulut, Ismet
Obstructive sleep apnea (OSA) is the most common sleep disorder affecting 2-4 % of the adult population. In addition to several potential mechanisms, inflammation is one of the suggested etiological factors in OSA. Fractalkine/CX3CL1 which is detected in activated or stressed endothelium, smooth muscle cells, skeletal muscle cells, macrophages, neurons, and hepatocytes is an inflammatory marker and attracts attention of sleep specialists in OSA pathogenesis. In this study, we had two goals. The first one was to investigate the role of fractalkine in OSA pathogenesis while the second one was to detect the impact of OSA treatment with positive airway pressure (PAP) on serum fractalkine levels. This study included 34 patients (6 females, 28 males) diagnosed as OSA and 20 healthy controls (4 females, 16 males). Initial serum fractalkine levels of both groups were first evaluated in order to demonstrate any potential relation of OSA with fractalkine. Subsequently, serum fractalkine levels of the OSA patients were evaluated following 1 week of PAP treatment to demonstrate the impact of PAP treatment on serum fractalkine levels. Although there was no significant difference between OSA patients and healthy controls by means of plasma fractalkine levels (p, 0.67) statistically, plasma fractalkine levels significantly decreased in OSA patients after 1 week of PAP treatment (p, 0.001). This study showed that fractalkine, a potential mediator of chronic inflammation, was not sensitive in diagnosing OSA but might be an indicator of the success of OSA treatment.
Gaayathri, N.; Kalthum, U.; Jemaima, C.H.
We report a diagnostically challenging case of papilloedema in a morbidly obese, 25 year old male who presented to us with blurring of vision of both eyes, but more marked in the right. Fundus examination revealed severe papilloedema, with corresponding visual field and colour vision defects. He was worked up for possible life threatening causes of papilloedema like intracranial space occupying lesion but his CT scan was normal. As his hematocrit was in the polycythemic range, multiple venesections were performed in fear that the hyperviscosity picture could be a contributing factor. However there was no change in symptoms or the fundus appearance. We could not come to a diagnosis of idiopathic intracranial hypertension too because he refused lumbar puncture. A sleep study was done as he did give symptoms of mild obstructive sleep apnea but the results were that of severe disease. He was given therapeutic nocturnal oxygen by CPAP to prevent further cardiovascular and respiratory complications and interestingly enough it helped in treating the papilloedema. He was seen 2 months after commencement of continuous positive airway pressure (CPAP) with good functional and anatomical recovery. (author)
Goryniak, Aleksandra; Szczęśniak, Angelika; Śleboda, Daria; Dołęgowska, Barbara
Apnea of prematurity (AOP) can affect even 85-100% of premature newborns and is related to lack of full maturity of organs. AOP is manifesting by 15-20 seconds cessations of breathing accompanied by bradycardia and oxygen desaturation, what can lead to hypoxia or death. Therefore it is very important to implement the effective and safe treatment immediately after birth. Widely used caffeine citrate, which stimulates the respiratory system, improving the working of the respiratory muscles. However the metabolism of caffeine citrate is difficult in preterm infants due to the immaturity of the hepatic enzyme system, what can lead to the occurrence of side effects and toxicity. To avoid the toxic effects of caffeine, and at the same time the lack of efficacy associated with administration of too low doses, this therapy should be monitored by measuring the concentration of caffeine in the plasma of treated infants. This would provide the maintenance of therapeutic levels of caffeine and optimization of the treatment.
McClelland, J.H.; Storm, B.H. Jr.; Ahearn, J.
The human interface software for the Lockheed Martin Specialty Components (LMSC) Active/Passive Neutron Examination ampersand Analysis System (APENA) provides a user friendly operating environment for the movement and analysis of waste drums. It is written in Microsoft Visual C++ on a Windows NT platform. Object oriented and multitasking techniques are used extensively to maximize the capability of the system. A waste drum is placed on a loading platform with a fork lift and then automatically moved into the APNEA chamber in preparation for analysis. A series of measurements is performed, controlled by menu commands to hardware components attached as peripheral devices, in order to create data files for analysis. The analysis routines use the files to identify the pertinent radioactive characteristics of the drum, including the type, location, and quantity of fissionable material. At the completion of the measurement process, the drum is automatically unloaded and the data are archived in preparation for storage as part of the drum's data signature. 3 figs
Amaddeo, A; de Sanctis, L; Olmo Arroyo, J; Giordanella, J-P; Monteyrol, P-J; Fauroux, B
Obesity, along with hypertrophy of the adenoids and the tonsils, represents one of the major risk factors for obstructive sleep apnea (OSA) in children. Obesity is associated with an increase in the prevalence and the severity of OSA and is a major factor in the persistence and aggravation of OSA over time. Neurocognitive dysfunction and abnormal behavior are the most important and frequent end-organ morbidities associated with OSA in children. Other deleterious consequences such as cardiovascular stress and metabolic syndrome are less common in children than in adults with OSA. Defining the exact role of obesity in OSA-associated end-organ morbidity in children is difficult because of the complex and multidimensional interactions between sleep in general, OSA, obesity, and metabolic dysregulation. This may explain why obesity itself has not been shown to be associated with a significant increase in OSA-associated end-organ morbidity. Obesity is linked to a decreased treatment efficacy and, in particular, of adenotonsillectomy. Peri- and postoperative complications are more common and more severe in obese children as compared with normal-weight controls. Continuous positive airway pressure (CPAP) is frequently needed, but compliance with CPAP is less optimal in obese children than in non-obese children. In conclusion, obesity represents a major public health problem worldwide; its prevention is one of the most efficient tools for decreasing the incidence and the morbidity associated with OSA in children. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Oh, Sechang; Kwon, Hyeokjun; Varadan, Vijay K.
Sleep plays the important role of rejuvenating the body, especially the central nervous system. However, more than thirty million people suffer from sleep disorders and sleep deprivation. That can cause serious health consequences by increasing the risk of hypertension, diabetes, heart attack and so on. Apart from the physical health risk, sleep disorders can lead to social problems when sleep disorders are not diagnosed and treated. Currently, sleep disorders are diagnosed through sleep study in a sleep laboratory overnight. This involves large expenses in addition to the inconvenience of overnight hospitalization and disruption of daily life activities. Although some systems provide home based diagnosis, most of systems record the sleep data in a memory card, the patient has to face the inconvenience of sending the memory card to a doctor for diagnosis. To solve the problem, we propose a wireless sensor system for sleep apnea, which enables remote monitoring while the patient is at home. The system has 5 channels to measure ECG, Nasal airflow, body position, abdominal/chest efforts and oxygen saturation. A wireless transmitter unit transmits signals with Zigbee and a receiver unit which has two RF modules, Zigbee and Wi-Fi, receives signals from the transmitter unit and retransmits signals to the remote monitoring system with Zigbee and Wi-Fi, respectively. By using both Zigbee and Wi-Fi, the wireless sensor system can achieve a low power consumption and wide range coverage. The system's features are presented, as well as continuous monitoring results of vital signals.
Seetho, Ian W; Parker, Robert J; Craig, Sonya; Duffy, Nick; Hardy, Kevin J; Wilding, John P H
Obstructive sleep apnea is associated with obesity and metabolic syndrome, leading to greater cardiovascular risk. Severely obese patients with obstructive sleep apnea may still be at risk of adverse health outcomes, even without previous cardiovascular disease. Pulse wave analysis non-invasively measures peripheral pulse waveforms and derives measures of haemodynamic status, including arterial stiffness, augmentation pressure and subendocardial viability ratio. We hypothesized that the presence of obstructive sleep apnea in severe obesity, even in the absence of an antecedent history of cardiovascular disease, would affect measurements derived from pulse wave analysis. Seventy-two severely obese adult subjects [obstructive sleep apnea 47 (body mass index 42 ± 7 kg m(-2) ), without obstructive sleep apnea (non-OSA) 25 (body mass index 40 ± 5 kg m(-2) )] were characterised using anthropometric, respiratory and cardio-metabolic parameters. Groups were similar in age, body mass index and gender. More subjects with obstructive sleep apnea had metabolic syndrome [obstructive sleep apnea 60%, without obstructive sleep apnea (non-OSA) 12%]. Those with obstructive sleep apnea had greater arterial stiffness, augmentation pressure and decreased subendocardial viability ratio (all P arterial pressures (P = 0.004) than patients without obstructive sleep apnea (non-OSA). Arterial stiffness correlated with mean arterial blood pressure (P = 0.003) and obstructive sleep apnea severity (apnea-hypopnea index; P arterial stiffness in multiple regression analysis, but components of the metabolic syndrome did not. Thus, patients with obstructive sleep apnea with severe obesity have increased arterial stiffness that may potentially influence cardiovascular risk independently of metabolic abnormalities. The presence of obstructive sleep apnea in severe obesity identifies a group at high cardiovascular risk; clinicians should ensure that risk factors are managed
Full Text Available Sleep apnea is a syndrome that affects multiple systems and produces varied symptoms. This article reviews the most frequent psychiatric illnesses associated with this condition, as well as the need for an adequate diagnosis and an interdisciplinary treatment. The most common entity observed in patients with sleep apnea is depression, probably caused by sleep fragmentation, which alters the production of neurotransmitters in the brain. Anxiety is the second most common entity, perhaps, due to the release of catecholamines at night. Other symptoms associated with sleep apnea can be found, and should be reviewed and improved with appropriate treatment; addressing such symptoms could also improve the quality of life of patients, since attention, concentration and memory would increase or decrease irritability and other symptoms.
Laub, Rasmus R; Tønnesen, Philip; Jennum, Poul J
We tested the effect of the Sleep Position Trainer, a vibrational device, for positional sleep apnea in an open, randomized controlled trial with 101 patients, where 52 patients were allocated to Sleep Position Trainer and 49 patients to a non-treatment control group for 2 months (Part 1). All...... patients were then followed as a cohort for a period of 6 months with use of the Sleep Position Trainer (Part 2). The participants were assessed with polygraphy at entry, and after 2 and 6 months. The mean apnea-hypopnea index supine was 35 per h (SD, 18) in the Sleep Position Trainer group and 38 per h...... (SD, 15) in the control group at entry. In a per protocol analysis, the mean total apnea-hypopnea index at entry and after 2 months in the Sleep Position Trainer group was 18 per h (SD, 10) and 10 per h (SD, 9; P
Paiva, Teresa; Attarian, Hrayr
Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity. © 2014 Elsevier B.V. All rights reserved.
Matsuda, Fumiaki; Asakura, Kohji; Nakano, Yuji; Shintani, Tomoko; Akita, Nobuto; Kataura, Akikatsu
The obstructive sleep apnea syndrome (OSAS) is characterized by recurrent obstruction of the upper airway during sleep. In this study, we performed CT scans in 20 adult OSAS patients and 6 control subjects, and measured the airspaces in the nasopharynx, mesopharynx and hypopharynx, using an image analyzer. The airspaces were significantly smaller at all sites of the pharynx in OSAS patients than in the control subjects, but they did not show a positive correlation with the apnea index or the body mass index. In good responders whose apnea indexes improved more than 50% after uvulo-palato-pharyngoplasty (UPPP), the nasopharyngeal and mesopharyngeal airspaces were significantly smaller, and the hypopharyngeal space tended to be larger than in poor responders. Our results suggest that CT scan is a helpful method for analyzing the area of the upper airway, especially in relation to the response to UPPP in adults with OSAS. (author)
Abu Jawdeh, Elie G; Martin, Richard J
Apnea of prematurity and gastroesophageal reflux (GER) are both common occurrences in preterm infants and widely perceived to be causally related. We seek in this review to provide a potential guideline for neonatal GER non-pharmacologic and pharmacologic therapy. Available physiologic data suggest that when there is a temporal relationship apnea may be more likely to predispose to GER via esophageal sphincter relaxation than vice versa. Measurement of multiple intraluminal impedance via esophageal catheter in addition to esophageal pH has enhanced our understanding of GER, although it also did not demonstrate a causal relationship between apnea and GER. The incidence of GER may be modified by thickening feeds and position change without adverse effects. In contrast, pharmacotherapy including acid suppression therapy may have adverse effects and should only be used in infants with clear evidence of clinical benefit. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Kim, Andrew M.; Keenan, Brendan T.; Jackson, Nicholas; Chan, Eugenia L.; Staley, Bethany; Poptani, Harish; Torigian, Drew A.; Pack, Allan I.; Schwab, Richard J.
Study Objectives: The objective of this study was to determine whether tongue fat is increased in obese sleep apneics compared to obese subjects without sleep apnea. We hypothesized that excess fat is deposited in the tongue in obese patients with sleep apnea. Design: Case-control design. Setting: Academic medical center. Patients: We examined tongue fat in 31 obese controls (apnea-hypopnea index, 4.1 ± 2.7 events/h) and 90 obese apneics (apnea-hypopnea index, 43.2 ± 27.3 events/h). Analyses were repeated in a subsample of 18 gender-, race-, age-, and BMI-matched case-control pairs. Interventions: All subjects underwent a MRI with three-point Dixon magnetic resonance imaging. We used sophisticated volumetric reconstruction algorithms to study the size and distribution of upper airway fat deposits in the tongue and masseter muscles within apneics and obese controls. Measurements and Results: The data supported our a priori hypotheses that after adjustment for age, BMI, gender, and race, the tongue in apneics was significantly larger (P = 0.001) and had an increased amount of fat (P = 0.002) compared to controls. Similar results were seen in our matched sample. Our data also demonstrate that within the apneic and normal tongue, there are regional differences in fat distribution, with larger fat deposits at the base of the tongue. Conclusions: There is increased tongue volume and deposition of fat at the base of tongue in apneics compared to controls. Increased tongue fat may begin to explain the relationship between obesity and obstructive sleep apnea. Citation: Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, Torigian DA, Pack AI, Schwab RJ. Tongue fat and its relationship to obstructive sleep apnea. SLEEP 2014;37(10):1639-1648. PMID:25197815
Finer, Neil N; Higgins, Rosemary; Kattwinkel, John; Martin, Richard J
Apnea of prematurity (AOP) is found in >50% of premature infants and is almost universal in infants who are apnea in infants (breathing pauses that last for >20 seconds or for >10 seconds if associated with bradycardia or oxygen desaturation), but there is no consensus about the duration of apnea, the degree of change in oxygen saturation, or severity of bradycardia that should be considered pathologic. Although caregivers are able to respond successfully to apnea events with drugs (as well as physical and mechanical interventions) in the NICU, it remains unproven whether such interventions have any long-term effects. One of the most effective drugs, caffeine citrate, is currently labeled for short-term use only and within a limited gestational-age population. Clinicians often use off-label drugs that have been approved for gastroesophageal reflux disease, which is common in premature infants, with the belief that such treatments also have an impact on AOP, although this link has never been demonstrated. Key treatment issues include (1) lack of standardization for definition, diagnosis, and treatment of AOP, (2) unproven benefit of intervention, (3) lack of real-time data documenting AOP events, (4) unevaluated sustained treatment improvement at 7 days or later, (5) failure to address confounding conditions, (6) unsubstantiated AOP-gastroesophageal reflux disease relationship, and (7) undetermined role of AOP affecting long-term neurodevelopmental outcomes. In addressing study-design issues, the pulmonary group identified (1) key questions about neonatal apnea, (2) methodologic requirements for study, (3) appropriate outcome measures, and (4) ethical considerations for future studies. This article describes a sample framework for the study of apnea in neonates and identifies future research needs. Plenary-session discussion points are also listed.
Xu, Limei; Ivanov, Plamen Ch.; Chen, Zhi; Hu, Kun; Paydarfar, David; Stanley, H. Eugene
Findings indicate a dynamical coupling between respiratory and cardiac function. However, the nature of this nonlinear interaction remains not well understood. We investigate transient patterns in the cardio-pulmonary interaction under healthy conditions by means of cross-correlation and nonlinear synchronization techniques, and we compare how these patterns change under pathologic conditions such as obstructive sleep apnea --- a periodic cessation of breathing during sleep. We find that during apnea episodes the nonlinear features of cardio-pulmonary interaction change intermittently, and can exhibit variations characterized by different time delays in the phase synchronization between breathing and heartbeat dynamics.
Full Text Available The treatment of the obstructive sleep apnea syndrome (OSAHS seeks to solve the signs and symptoms related to the disease, as well as to reduce the apnea-hypopnea index (AHI and the desaturations, to achieve a decrease of associated risks and comorbidities. However, this disease requires long-term treatment, with combined therapies developed by a multidisciplinary team. Medical treatment should be performed on all patients, even if additional therapies are necessary. In addition, this syndrome may be associated with other diseases that need specific treatment.
Chou, Courtney T; Siegel, Bianca; Mehta, Deepak
We present a previously undescribed case of stridor and apnea as the initial presentation of primary hypoparathyroidism. A neonate presenting with these symptoms was initially diagnosed with laryngopharyngeal reflux and laryngomalacia. After failing medical management, she underwent supraglottoplasty with improvement of stridor, but persistent apneic events. Further work-up showed severe hypocalcemia due to hypoparathyroidism. Subsequent genetic testing revealed a diagnosis of Bartter Syndrome Type V, a rare cause of primary hypoparathyroidism. Although uncommon, hypocalcemic tetany can present as apneic episodes in the setting of unrecognized primary hypoparathyroidism. Electrolyte abnormalities should be explored in neonates with recurrent apnea of unknown etiology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Pressman, M R; Meyer, T J; Kendrick-Mohamed, J; Figueroa, W G; Greenspon, L W; Peterson, D D
Parasomnias are generally described as disorders of arousal that arise out of stage 3 and 4 nonrapid eye movement (NREM) sleep without identifiable cause. We present a case of a 35-year-old man who during nasal continuous positive airway pressure (nCPAP) treatment for severe obstructive sleep apnea experienced an intense night terror triggered by a residual obstructive apnea during rebound deep sleep. The role of rebound deep sleep was thought to be essential in creating a state of sleep with a high arousal threshold hypothesized to be important for the occurrence of parasomnias. This case supports the clinical wisdom that identifiable sources of arousal can trigger parasomnias.
Raunio, Antti; Mattila, Pauli; Huuskonen, Usko; Oikarinen, Kyösti; Sándor, George K
The purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective. A total of 68 patients with obstructive sleep apnea syndrome (OSAS) including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD) and monitored with polysomnography. 25 of the 31 mild, 15 of the 23 moderate and 2 of the 14 severe OSAS patients were cured of their OSAS if a post treatment apnea-hypopnea index of less than 5 is regarded as cured. The odds ratios for success with MAD therapy are 3 for women over men, 14.9 for mild obstructive sleep apnea, 5.42 for moderate obstructive sleep apnea if severe obstructive sleep apnea is assigned an odds ratio of 1. The use of the apnea-hypopnea index alone is useful in mild and moderate disease to predict the effectiveness of mandibular advancement device. Treatment with a mandibular advancement device is very effective in treating mild and moderate obstructive sleep apnea. Conservative treatment with a mandibular advancement device can be successful in less severe grades of sleep apnea and may be an alternative for non-surgical patients with severe obstructive sleep apnea intolerant of Continuous Positive Airway Pressure management.
Full Text Available Objectives: The purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective. Material and Methods: A total of 68 patients with obstructive sleep apnea syndrome (OSAS including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD and monitored with polysomnography. Results: 25 of the 31 mild, 15 of the 23 moderate and 2 of the 14 severe OSAS patients were cured of their OSAS if a post treatment apnea-hypopnea index of less than 5 is regarded as cured. The odds ratios for success with MAD therapy are 3 for women over men, 14.9 for mild obstructive sleep apnea, 5.42 for moderate obstructive sleep apnea if severe obstructive sleep apnea is assigned an odds ratio of 1. Conclusions: The use of the apnea-hypopnea index alone is useful in mild and moderate disease to predict the effectiveness of mandibular advancement device. Treatment with a mandibular advancement device is very effective in treating mild and moderate obstructive sleep apnea. Conservative treatment with a mandibular advancement device can be successful in less severe grades of sleep apnea and may be an alternative for non-surgical patients with severe obstructive sleep apnea intolerant of Continuous Positive Airway Pressure management.
Ogunlesi, T A; Ogunfowora, O B
To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting. Retrospective study. Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis. Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight apnea. Case fatality rate was 82.2% among apneic babies. Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings.
Lal, Chitra; Strange, Charlie; Bachman, David
Obstructive sleep apnea syndrome (OSAS) is a common disorder with far-reaching health implications. One of the major consequences of OSAS is an impact on neurocognitive functioning. Several studies have shown that OSAS has an adverse effect on inductive and deductive reasoning, attention, vigilance, learning, and memory. Neurocognitive impairment can be measured objectively with tests such as the Wechsler Adult Intelligence Scale-Revised, the Psychomotor Vigilance Task, the Steer Clear Performance Test, and tests of repetitive finger tapping. In children, OSAS may cause attention-deficit hyperactivity disorder in addition to behavioral problems and learning disabilities. Risk factors for cognitive impairment include increasing age, male sex, apolipoprotein E ε4 allele positivity, current cigarette smoking, obesity, hypertension, diabetes mellitus, metabolic syndrome, Down syndrome, hypothyroidism, significant alcohol consumption, stroke, and the use of psychoactive medications. At a cellular level, OSAS likely causes cognitive impairment through intermittent hypoxia, hormonal imbalance, and/or systemic inflammation, either independently or via the resultant endothelial dysfunction that occurs. Excessive daytime sleepiness should be measured and minimized in all studies of neurocognitive impairment. Recent studies have used functional and structural neuroimaging to delineate the brain areas affected in patients with OSAS with neurocognitive dysfunction. A common finding in several of these studies is decreased hippocampal volume. Other affected brain areas include the frontal and parietal lobes of the brain, which show focal reductions in gray matter. These changes can be reversed at least partially with the use of CPAP, which highlights the importance of early recognition and treatment of OSAS. The currently available data in this field are quite limited, and more research is needed.
Full Text Available BACKGROUND Since the original classification of the obstructive nature of obstructive sleep apnea syndrome (OSAS in 1965, much has been learned about the disorder. In 1990 respiratory disturbances during sleep have come to be recognized as extremely common disorders with important clinical consequences. DISCUSSION It is a condition with high prevalence of obesity as a major risk factor. Premenopausal women are relatively protected from the disorder: its prevalence in women rises after menopause. Although OSAS is a risk factor for excessive daytime sleepiness, there is developing evidence that it is also a risk factor for hypertension, acute cardiovascular events, and insulin resistance. Definitive diagnosis still depends on in-laboratory polysomnography. This involves recording of multiple variables during sleep, including electroencephalogram. There is a considerable interest in the role of unattended home sleep-monitoring and some evidence of its usefulness has yet to be established. The first line of therapy is nasal continuous positive airway pressure (CPAP. Data into the efficacy of CPAP in severe OSAS have come from randomized, placebo-controlled clinical trials the endpoints of which being sleepiness, quality of life, and 24-h ambulatory blood pressure. Data are currently less convincing for treatment outcomes in mild to moderate OSAS, and new clinical trails to assess outcomes in this group are underway. CONCLUSION The field of sleep medicine has now firmly entered the mainstream of clinical practice, substantial progress has been made, and OSAS has increasingly emerged as a major public health concern. The Internal Medicine specialist has to recognize this clinical entity.
Full Text Available Abstract For over two decades clinical studies have been conducted which suggest the existence of a relationship between depression and Obstructive Sleep Apnea (OSA. Recently, Ohayon underscored the evidence for a link between these two disorders in the general population, showing that 800 out of 100,000 individuals had both, a breathing-related sleep disorder and a major depressive disorder, with up to 20% of the subjects presenting with one of these disorders also having the other. In some populations, depending on age, gender and other demographic and health characteristics, the prevalence of both disorders may be even higher: OSA may affect more than 50% of individuals over the age of 65, and significant depressive symptoms may be present in as many as 26% of a community-dwelling population of older adults. In clinical practice, the presence of depressive symptomatology is often considered in patients with OSA, and may be accounted for and followed-up when considering treatment approaches and response to treatment. On the other hand, sleep problems and specifically OSA are rarely assessed on a regular basis in patients with a depressive disorder. However, OSA might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to appropriate pharmacological treatment. Furthermore, an undiagnosed OSA might be exacerbated by adjunct treatments to antidepressant medications, such as benzodiazepines. Increased awareness of the relationship between depression and OSA might significantly improve diagnostic accuracy as well as treatment outcome for both disorders. In this review, we will summarize important findings in the current literature regarding the association between depression and OSA, and the possible mechanisms by which both disorders interact. Implications for clinical practice will be discussed.
Attal, Pierre; Chanson, Philippe
Some endocrine and metabolic disorders are associated with a high frequency of obstructive sleep apnea (OSA), and treatment of the underlying endocrine disorder can improve and occasionally cure OSA. On the other hand, epidemiological and interventional studies suggest that OSA increases the cardiovascular risk, and a link between OSA and glucose metabolism has been suggested, via reduced sleep duration and/or quality. We reviewed the medical literature for key articles through June 2009. Some endocrine and metabolic conditions (obesity, acromegaly, hypothyroidism, polycystic ovary disease, etc.) can be associated with OSA. The pathophysiological mechanisms of OSA in these cases are reviewed. In rare instances, OSA may be improved or even cured by treatment of underlying endocrine disorders: this is the case of hypothyroidism and acromegaly, situations in which OSA is mainly related to upper airways narrowing due to reversible thickening of the pharyngeal walls. However, when irreversible skeletal defects and/or obesity are present, OSA may persist despite treatment of endocrine disorders and may thus require complementary therapy. This is also frequently the case in patients with obesity, even after substantial weight reduction. Given the potential neurocognitive consequences and increased cardiovascular risk associated with OSA, specific therapy such as continuous positive airway pressure is recommended if OSA persists despite effective treatment of its potential endocrine and metabolic causes. "Apropos of sleep, that sinister adventure of all our nights, we might say that men go to bed daily with an audacity that would be incomprehensible if we did not know that it is the result of ignorance of the danger." Charles Baudelaire, in "Fusées, IX"
Introduction: Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening ...
Haraldsson, P O; Carenfelt, C; Diderichsen, Finn
Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by ca...
Full Text Available No abstract available. Article truncated after first page. What is the estimated prevalence of insomnia symptoms in patients with obstructive sleep apnea? 1. Less than 1% 2. 5%-10% 3. 20-30% 4. 40%-60% 5. Greater than 80%
Gozal, David; Almendros, Isaac; Hakim, Fahed
The presence of obstructive sleep apnea (OSA) in patients with cancer appears to be accompanied by poorer outcomes. However, the mechanisms underlying such association are unknown. We hypothesize that the constitutive characteristics of OSA, namely, intermittent hypoxia and sleep fragmentation, promote changes in the tumor microenvironment that ultimately lead to a disadvantageous immunosurveillance, thereby accelerating tumor proliferation and enhancing its invasiveness.
Nov 29, 2014 ... Objectives: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. Materials and Methods: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic. Department archives between the years of 2009 and ...
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 ...
Impact of Obstructive Sleep Apnea and Snoring on Left Ventricular Mass and Diastolic Function in. Hypertensive Nigerians. Akintunde AA1,2, Kareem L1, Bakare A1, Audu M1. 1Department of Medicine, Division of Cardiology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso,. Nigeria, 2Goshen ...
Introduction: The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting. Methods: The STOP BANG questionnaire and the Epworth Sleepiness scale ...
Background: Systemic hypertension (HTN) and obstructive sleep apnea (OSA) are individually associated with left ventricular structural and functional adaptations. However, little is known about the impact of OSA on the left ventricle in Africans with HTN. Aim: The aim of this study is to determine the association between ...
Objectives: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. Materials and Methods: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic Department archives between the years of 2009 and 2011.
Hoekema, A.; Doff, M. H. J.; de Bont, L. G. M.; van der Hoeven, J. H.; Wijkstra, P. J.; Pasma, H. R.; Stegenga, B.
Oral appliance therapy is an alternative to continuous positive airway pressure (CPAP) for treating the obstructive sleep apnea-hypopnea syndrome. However, the ability to pre-select suitable candidates for either treatment is limited. The aim of this study was to assess the value of relevant
Dukhovny, Dmitry; Lorch, Scott A.; Schmidt, Barbara; Doyle, Lex W.; Kok, Joke H.; Roberts, Robin S.; Kamholz, Karen L.; Wang, Na; Mao, Wenyang; Zupancic, John A. F.; van Wassenaer, Aleid G.
OBJECTIVE: To determine the cost-effectiveness of treatment with caffeine compared with placebo for apnea of prematurity in infants with birth weights less than 1250 g, from birth through 18 to 21 months' corrected age. METHODS: We undertook a retrospective economic evaluation of the cost per
Vliegenthart, Roseanne J. S.; ten Hove, Christine H.; Onland, Wes; van Kaam, Anton H. L. C.
Apnea of prematurity (AOP) is a common complication of preterm birth, for which caffeine is the first treatment of choice. In case of persistent AOP, doxapram has been advocated as an additional therapy. To identify and appraise all existing evidence regarding efficacy and safety of doxapram use for
Ferini-Strambi, L; Zucconi, M; Castronovo, [No Value; Garancini, P; Oldani, A; Smirne, S
The aim of this cross-sectional study was to evaluate the prevalence of sleep-disordered breathing by means of a validated portable instrument (MESAM IV) and to investigate the relationship between snoring and sleep apnea in a sample of Italian middle-aged female population. We randomly chose 750
... of various systemic diseases. This article summarizes the etiopathogenesis, epidemiology, associated systemic diseases such as cardiovascular diseases, diabetes, and dental diseases with OSA and the influence of tongue on oropharyngeal airway in OSA patients. Key words: Apnea, breathlessness, snoring ...
I. A. Kelmanson
Full Text Available Obstructive sleep breathing disorders in children encompasses a wide range of pathological conditions, among which obstructive sleep apnea is the most severe disorder. The paper gives data on a relationship of the above disorder to the higher risk for childhood cardiovascular disease. It indicates the link of obstructive sleep apnea to impaired autonomic regulation, which manifests itselfas hypersympaticotonia determined by cardiac rhythm characteristics, metabolic parameters, and blood pressure levels. Myocardial electrical instability is detected, which appears as increased QT interval dispersion on ECG. The observed changes raise the risk of cardiac arrhythmias. Obstructive sleep apnea in children is accompanied by increases in vascular tone and blood pressure, change in the endothelial structure, and activation of a systemic inflammatory response, which contributes to atherogenetic processes. The above disorders can be persistent if timely treatment is absent. The diagnosis and correction of obstructive sleep apnea in children are constituents in the prevention of cardiovascular disease.
Karem Josefina Parejo-Gallardo
Full Text Available Obstructive sleep apnea-hypopnea syndrome (OSAHS is one of the most prevalent sleep disorders in the general population, and is associated with different biological alterations that can trigger important cognitive, metabolic and cardiovascular problems. This article aims at defining and providing the minimum diagnostic criteria, both clinical and polysomnographic, currently in use.
Videoradiography of patients with habitual snoring and/or sleep apnea. Technical description and presentation of videoradiographic results during sleep concerning occurrence of apnea, type of apnea, and site of obstruction
Hillarp, B.; Nylander, G.; Rosen, I.; Wickstroem, O.
The videoradiographic examination described was designed for habitual snorers and sleep apnea syndrome (SAS) patients and was performed during wakefulness and sleep. During wakefulness the purpose was to reveal any dysfunction in deglutiton and speech as well as morphologic abnormalities. The purpose during sleep, which usually was induced by low-dose midazolam intravenously, was to reveal the site and form of obstruction in obstructive sleep apnea patients and the site of snoring in habitual snorers. The preoperative results of 104 patients are presented. In 57 patients who had apneas, the occurrence and type of apnea could be determined. A continuous recording over some minutes gave a rough estimate of the degree of SAS and mean duration of apnea. Although much information on SAS can be obtained by this method, it cannot replace polygraphic sleep recording in the investigation of habitual snorers and SAS patients. However, these 2 methods are complementary and can be performed simultaneously as polygraphic videoradiography. (orig.)
Videoradiography of patients with habitual snoring and/or sleep apnea. Technical description and presentation of videoradiographic results during sleep concerning occurrence of apnea, type of apnea, and site of obstruction
Hillarp, B. [Dept. of Diagnostic Radiology, Malmoe Univ. Hospital (Sweden); Nylander, G. [Dept. of Diagnostic Radiology, Malmoe Univ. Hospital (Sweden); Rosen, I. [Dept. of Neurophysiology, Malmoe Univ. Hospital (Sweden); Wickstroem, O. [Dept. of Neurophysiology, Malmoe Univ. Hospital (Sweden)
The videoradiographic examination described was designed for habitual snorers and sleep apnea syndrome (SAS) patients and was performed during wakefulness and sleep. During wakefulness the purpose was to reveal any dysfunction in deglutiton and speech as well as morphologic abnormalities. The purpose during sleep, which usually was induced by low-dose midazolam intravenously, was to reveal the site and form of obstruction in obstructive sleep apnea patients and the site of snoring in habitual snorers. The preoperative results of 104 patients are presented. In 57 patients who had apneas, the occurrence and type of apnea could be determined. A continuous recording over some minutes gave a rough estimate of the degree of SAS and mean duration of apnea. Although much information on SAS can be obtained by this method, it cannot replace polygraphic sleep recording in the investigation of habitual snorers and SAS patients. However, these 2 methods are complementary and can be performed simultaneously as polygraphic videoradiography. (orig.).
Angheben, Juliana M. M.; Schoorlemmer, Guus H. M.; Rossi, Marcio V.; Silva, Thiago A.; Cravo, Sergio L.
Spontaneously hypertensive rats (SHR), like patients with sleep apnea, have hypertension, increased sympathetic activity, and increased chemoreceptor drive. We investigated the role of carotid chemoreceptors in cardiovascular responses induced by obstructive apnea in awake SHR. A tracheal balloon and vascular cannulas were implanted, and a week later, apneas of 15 s each were induced. The effects of apnea were more pronounced in SHR than in control rats (Wistar Kyoto; WKY). Blood pressure increased by 57±3 mmHg during apnea in SHR and by 28±3 mmHg in WKY (papneas were induced two days later. The inactivation of chemoreceptors reduced the responses to apnea and abolished the difference between SHR and controls. The apnea-induced hypertension was 11±4 mmHg in SHR and 8±4 mmHg in WKY. The respiratory effort was 15±2 mmHg in SHR and 15±2 mmHg in WKY. The heart rate fell 63±18 bpm in SHR and 52±14 bpm in WKY. Similarly, when the chemoreceptors were unloaded by the administration of 100% oxygen, the responses to apnea were reduced. In conclusion, arterial chemoreceptors contribute to the responses induced by apnea in both strains, but they are more important in SHR and account for the exaggerated responses of this strain to apnea. PMID:24466272
Eichenwald, Eric C; Zupancic, John A F; Mao, Wen-Yang; Richardson, Douglas K; McCormick, Marie C; Escobar, Gabriel J
Apnea of prematurity is one of the most common diagnoses in the NICU. Because resolution of apnea is a usual precondition for discharge from the hospital, different monitoring practices might affect length of stay for premature infants. Our objective was to compare the proportion of 33 to 34 weeks' gestational age infants diagnosed with apnea in different NICUs and to assess whether variability in length of stay would be affected by the rate of documented apnea. This was a prospective cohort study of moderately preterm infants who survived to discharge in 10 NICUs in Massachusetts and California. The study population comprised 536 infants born between 33 and 34/7 weeks of which 264 (49%) were diagnosed with apnea. The mean postmenstrual age at discharge was higher in infants diagnosed with apnea compared with those without apnea (36.4 ± 1.3 vs 35.7 ± 0.8; P apnea (range: 24%-76%; P apnea. NICUs vary in the proportion of moderately preterm infants diagnosed with apnea, which significantly affects length of stay. Standardization of monitoring practices and definition of clinically significant cardiorespiratory events could have a significant impact on reducing the length of stay in moderately preterm infants.
Full Text Available Obstructive sleep apnea (OSA has long been recognized as a disorder characterized by snoring and frequent cessations of breathing resulting in fragmentation of sleep, which eventually leads to cumulative sleep debt in affected patients. Until two decades ago, snoring and apneas drew attention mainly as a social curiosity and sleep apnea was not thought of as a serious disorder with multisystem involvement. Impairment of quality of work and high incidence of motor vehicle accidents associated with OSA were recognized toward the end of the last century. Since the turn of this millennium physicians have become increasingly aware of the various cardiovascular complications, metabolic disturbances, and neuropsychologic deficits. It has become very clear in the last decade that patients with OSA have a high recurrence of atrial fibrillation after elective cardioversion if their sleep apnea is not treated with continuous positive airway pressure (CPAP. Poor control of diabetes mellitus and resistant hypertension in the setting of OSA has also been recognized and significant progress in our understanding in this area has been accomplished. Unless physicians include sleep in their system review, many cases will go undiagnosed, which will eventually result in cardiovascular complications. Patients are also not readily forthcoming with the symptoms of sleep apnea, as they often assume that symptoms, such as snoring and daytime sleepiness, are not something serious to be discussed with their physician. In this review, the characteristics, the pathophysiology, and epidemiology of OSA are discussed. Furthermore, the mechanisms by which OSA affects the cardiovascular, endocrine, and metabolic functions have been explored.
Gammoudi, Nouha; Ben Cheikh, Ridha; Saafi, Mohamed Ali; Sakly, Ghazi; Dogui, Mohamed
The sympathetic activation is considered to be the main mechanism involved in the development of cardiovascular diseases in obstructive sleep apnea (OSA). The heart rate variability (HRV) analysis represents a non-invasive tool allowing the study of the autonomic nervous system. The impairment of HRV parameters in OSA has been documented. However, only a few studies tackled the dynamics of the autonomic nervous system during sleep in patients having OSA. To analyze the HRV over sleep stages and across sleep periods in order to clarify the impact of OSA on cardiac autonomic modulation. The second objective is to examine the nocturnal HRV of OSA patients to find out which HRV parameter is the best to reflect the symptoms severity. The study was retrospective. We have included 30 patients undergoing overnight polysomnography. Subjects were categorized into two groups according to apnea-hypopnea index (AHI): mild-to-moderate OSAS group (AHI: 5-30) and severe OSAS group (AHI>30). The HRV measures for participants with low apnea-hypopnea indices were compared to those of patients with high rates of apnea-hypopnea across the sleep period and sleep stages. HRV measures during sleep stages for the group with low rates of apnea-hypopnea have indicated a parasympathetic activation during non-rapid eye movement (NREM) sleep. However, no significant difference has been observed in the high AHI group except for the mean of RR intervals (mean RR). The parasympathetic activity tended to increase across the night but without a statistical difference. After control of age and body mass index, the most significant correlation found was for the mean RR (p=0.0001, r=-0.248). OSA affects sympathovagal modulation during sleep, and this impact has been correlated to the severity of the disease. The mean RR seemed to be a better index allowing the sympathovagal balance appreciation during the night in OSA.
Kreutzer, K; Bassler, D
Caffeine, a methylxanthine and nonspecific inhibitor of adenosine receptors, is an example of a drug that has been in use for more than 40 years. It is one of the most commonly prescribed drugs in neonatal medicine. However, until 2006, it had only a few relatively small and short-term studies supporting its use. It is thanks to the efforts of Barbara Schmidt and the Caffeine for Apnea of Prematurity (CAP) Trial Group that we now have high-quality and reliable data not only on short-term but also long-term outcomes of caffeine use for apnea of prematurity. CAP was an international, multicenter, placebo-controlled randomized trial designed to determine whether survival without neurodevelopmental disability at a corrected age of 18 months is improved if apnea of prematurity is managed without methylxanthines in infants at a high risk of apneic attacks. CAP was kept simple and pragmatic in order to allow for maximum generalizability and applicability. Infants with birth weights of 500-1,250 g were enrolled during the first 10 days of life if their clinicians considered them to be candidates for methylxanthine therapy. The most frequent indication for therapy reported in CAP was treatment of documented apnea, followed by the facilitation of the removal of an endotracheal tube. Only about 20% of the neonatologists in the trial started caffeine for the prevention of apnea and the findings of CAP cannot automatically be extrapolated to an exclusive prophylactic indication. However, recent data suggest that the administration of prophylactic methylxanthine by neonatologists is now common practice.
Bianchi, M T; Goparaju, B; Moro, M
Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles. We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire. More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk. Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available Qing Wang,1,* Qi Wu,2,* Jing Feng,3,4 Xin Sun5 1The Second Respiratory Department of the First People's Hospital of Kunming, Yunnan, People's Republic of China; 2Tianjin Haihe Hospital, Tianjin, People's Republic of China; 3Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People's Republic of China; 4Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA; 5Respiratory Department of Tianjin Haihe Hospital, Tianjin, People's Republic of China *These authors contributed equally to this work Background: Obstructive sleep apnea (OSA occurs in 4% of middle-aged men and 2% of middle-aged women in the general population, and the prevalence is even higher in specific patient groups. OSA is an independent risk factor for a variety of cardiovascular diseases. Endothelial injury could be the pivotal determinant in the development of cardiovascular pathology in OSA. Endothelial damage ultimately represents a dynamic balance between the magnitude of injury and the capacity for repair. Bone marrow–derived endothelial progenitor cells (EPCs within adult peripheral blood present a possible means of vascular maintenance that could home to sites of injury and restore endothelial integrity and normal function. Methods: We summarized pathogenetic mechanisms of OSA and searched for available studies on numbers and functions of EPCs in patients with OSA to explore the potential links between the numbers and functions of EPCs and OSA. In particular, we tried to elucidate the molecular mechanisms of the effects of OSA on EPCs. Conclusion: Intermittent hypoxia cycles and sleep fragmentation are major pathophysiologic characters of OSA. Intermittent hypoxia acts as a trigger of oxidative stress, systemic inflammation, and sympathetic activation. Sleep fragmentation is associated with a burst of sympathetic activation and systemic inflammation. In most studies, a reduction in circulating EPCs has
Fairchild, Karen; Mohr, Mary; Paget-Brown, Alix; Tabacaru, Christa; Lake, Douglas; Delos, John; Moorman, J. Randall; Kattwinkel, John
Background Apnea of prematurity (AOP) is nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied in a large consecutive cohort. Methods We analyzed continuous bedside monitor chest impedance and electrocardiographic waveforms and oxygen saturation data collected on all NICU patients 50 infant-years of data). “ABDs”, defined as central apnea ≥10 sec associated with both bradycardia apnea events decreased with increasing gestational age (GA) and post-menstrual age (PMA). ABDs were more frequent in infants apnea events is a function of GA and PMA in infants born preterm, and increased apnea is associated with acute but not with chronic pathologic conditions. PMID:26959485
Fairchild, Karen; Mohr, Mary; Paget-Brown, Alix; Tabacaru, Christa; Lake, Douglas; Delos, John; Moorman, Joseph Randall; Kattwinkel, John
Apnea of prematurity (AOP) is nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied in a large consecutive cohort. We analyzed continuous bedside monitor chest impedance and electrocardiographic waveforms and oxygen saturation data collected on all neonatal intensive care unit (NICU) patients 50 infant-years of data). Apneas, with bradycardia and desaturation (ABDs), defined as central apnea ≥10 s associated with both bradycardia hemorrhage (IVH) after accounting for GA. In the day before diagnosis of late-onset septicemia and necrotizing enterocolitis, ABD events were increased in some infants. Many infants continued to experience short ABD events in the week prior to discharge home. Frequency of apnea events is a function of GA and PMA in infants born preterm, and increased apnea is associated with acute but not with chronic pathologic conditions.
Apnea after awake-regional and general anesthesia in infants: The General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnea and neurodevelopmental outcomes, a randomized controlled trial
Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; de Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen
Background Post-operative apnea is a complication in young infants. Awake-regional anesthesia (RA) may reduce the risk; however the evidence is weak. The General Anesthesia compared to Spinal anesthesia (GAS) study is a randomized, controlled, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods Infants ≤ 60 weeks postmenstrual age scheduled for inguinal herniorraphy were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born < 26 weeks’ gestation. The primary outcome of this analysis was any observed apnea up to 12 hours post-operatively. Apnea assessment was unblinded. Results 363 patients were assigned to RA and 359 to GA. Overall the incidence of apnea (0 to 12 hours) was similar between arms (3% in RA and 4% in GA arms, Odds Ratio (OR) 0.63, 95% Confidence Intervals (CI): 0.31 to 1.30, P=0.2133), however the incidence of early apnea (0 to 30 minutes) was lower in the RA arm (1% versus 3%, OR 0.20, 95%CI: 0.05 to 0.91, P=0.0367). The incidence of late apnea (30 minutes to 12 hours) was 2% in both RA and GA arms (OR 1.17, 95%CI: 0.41 to 3.33, P=0.7688). The strongest predictor of apnea was prematurity (OR 21.87, 95% CI 4.38 to 109.24) and 96% of infants with apnea were premature. Conclusions RA in infants undergoing inguinal herniorraphy reduces apnea in the early post-operative period. Cardio-respiratory monitoring should be used for all ex-premature infants. PMID:26001033
Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial.
Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen
Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.
Krachman, Samuel L; Tiwari, Rachna; Vega, Maria Elena; Yu, Daohai; Soler, Xavier; Jaffe, Fredric; Kim, Victor; Swift, Irene; D'Alonzo, Gilbert E; Criner, Gerard J
The presence of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) is referred to as the OSA-COPD overlap syndrome. While lung inflation has been shown to be an important factor in determining upper airway stability, its role in determining OSA severity in smokers, including those with emphysema, has not been evaluated. To evaluate the importance of lung inflation on OSA severity (apnea-hypopnea index [AHI]) in smokers with suspected OSA. Fifty-one smokers (18 males; mean [±SD] age, 59 ± 9 yr; body mass index [BMI], 32 ± 9 kg/m(2)) who were part of the Genetic Epidemiology of COPD (COPDGene) project were studied. Patients underwent a full-night polysomnography for suspected OSA. Other testing included spirometry and volumetric chest computed tomography (CT) for quantitative measurement of CT-derived percent emphysema and CT-derived percent gas trapping. For the group overall, there was evidence of obstructive airway disease by spirometry (FEV1, 1.4 ± 0.5 L, 58 ± 14% predicted) and emphysema by quantitative CT (CT-derived percent emphysema, 11 ± 13%; CT-derived percent gas trapping, 31.6 ± 24.1%). Twenty-nine (57%) of the patients had OSA (AHI, 18 ± 12 events/h). Patients with OSA had a higher BMI but were younger than those without OSA (BMI, 35 ± 9 kg/m(2) vs. 29 ± 7 kg/m(2), respectively [P = 0.007]; age, 56 ± 8 yr vs. 62 ± 9 yr, respectively [P = 0.01]). There was an inverse correlation between the AHI and the CT-derived percent emphysema and CT-derived percent gas trapping, both for the entire group (r = -0.41 [P smokers with OSA, increased gas trapping and emphysema as assessed by CT are associated with a decreased AHI. Along with sex and BMI, these measurements may be important in determining the severity of OSA in patients with COPD and may offer a protective mechanism in patients with more advanced disease.
Full Text Available Sleep Apnea Syndrome (SAS is a common sleep-related breathing disorder, which affects about 4-7% males and 2-4% females all around the world. Different approaches have been adopted to diagnose SAS and measure its severity, including the gold standard Polysomnography (PSG in sleep study field as well as several alternative techniques such as single-channel ECG, pulse oximeter and so on. However, many shortcomings still limit their generalization in home environment. In this study, we aim to propose an efficient approach to automatically assess the severity of sleep apnea syndrome based on the ballistocardiogram (BCG signal, which is non-intrusive and suitable for in home environment.We develop an unobtrusive sleep monitoring system to capture the BCG signals, based on which we put forward a three-stage sleep apnea syndrome severity assessment framework, i.e., data preprocessing, sleep-related breathing events (SBEs detection, and sleep apnea syndrome severity evaluation. First, in the data preprocessing stage, to overcome the limits of BCG signals (e.g., low precision and reliability, we utilize wavelet decomposition to obtain the outline information of heartbeats, and apply a RR correction algorithm to handle missing or spurious RR intervals. Afterwards, in the event detection stage, we propose an automatic sleep-related breathing event detection algorithm named Physio_ICSS based on the iterative cumulative sums of squares (i.e., the ICSS algorithm, which is originally used to detect structural breakpoints in a time series. In particular, to efficiently detect sleep-related breathing events in the obtained time series of RR intervals, the proposed algorithm not only explores the practical factors of sleep-related breathing events (e.g., the limit of lasting duration and possible occurrence sleep stages but also overcomes the event segmentation issue (e.g., equal-length segmentation method might divide one sleep-related breathing event into
Dujic, Zeljko; Hoiland, Ryan L.; Barak, Otto F.; Madden, Dennis; Drvis, Ivan; Stembridge, Mike; MacLeod, David B.; MacLeod, Douglas M.; Ainslie, Philip N.
The purpose of this study was to determine the impact of peripheral chemoreflex inhibition with low-dose dopamine on maximal apnea time, and the related hemodynamic and cerebrovascular responses in elite apnea divers. In a randomized order, participants performed a maximal apnea while receiving either intravenous 2 μg·kg−1·min−1 dopamine or volume-matched saline (placebo). The chemoreflex and hemodynamic response to dopamine was also assessed during hypoxia [arterial O2 tension, (PaO2) ∼35 mmHg] and mild hypercapnia [arterial CO2 tension (PaCO2) ∼46 mmHg] that mimicked the latter parts of apnea. Outcome measures included apnea duration, arterial blood gases (radial), heart rate (HR, ECG), mean arterial pressure (MAP, intra-arterial), middle (MCAv) and posterior (PCAv) cerebral artery blood velocity (transcranial ultrasound), internal carotid (ICA) and vertebral (VA) artery blood flow (ultrasound), and the chemoreflex responses. Although dopamine depressed the ventilatory response by 27 ± 41% (vs. placebo; P = 0.01), the maximal apnea duration was increased by only 5 ± 8% (P = 0.02). The PaCO2 and PaO2 at apnea breakpoint were similar (P > 0.05). When compared with placebo, dopamine increased HR and decreased MAP during both apnea and chemoreflex test (P all apnea and chemoreflex test, conductance of the cerebral vessels (ICA, VA, MCAv, PCAv) was increased with dopamine; however, flow (ICA and VA) was similar. At least in elite apnea divers, the small increase in apnea time and similar PaO2 at breakpoint (∼31 mmHg) suggest the apnea breakpoint is more related to PaO2, rather than peripheral chemoreflex drive to breathe. PMID:26290106
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.
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 o...
Antti Raunio; Pauli Mattila; Usko Huuskonen; Kyösti Oikarinen; George K. Sándor
Objectives: The purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective. Material and Methods: A total of 68 patients with obstructive sleep apnea syndrome (OSAS) including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD) and monitored wi...
Raunio, Antti; Mattila, Pauli; Huuskonen, Usko; Oikarinen, Ky?sti; S?ndor, George K.
ABSTRACT Objectives The purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective. Material and Methods A total of 68 patients with obstructive sleep apnea syndrome (OSAS) including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD) and monitored...
Bianchi, Matt; Gannon,Karen; Lovell,Kathy; Merlino,Margaret; Mojica,James; Moro,Marilyn
Marilyn Moro,1 Karen Gannon,1 Kathy Lovell,1 Margaret Merlino,1 James Mojica,2 Matt T Bianchi,1,3 1Neurology Department, 2Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Purpose: Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%–15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not w...
Jung, Da Woon; Hwang, Su Hwan; Lee, Yu Jin; Jeong, Do-Un; Park, Kwang Suk
The most widely used methods for predicting obstructive sleep apnea are based on clinical or anatomico-functional features. To improve exactitude in obstructive sleep apnea screening, this study aimed to devise a new predictor of apnea-hypopnea index. We hypothesized that less irregular respiration cycles would be observed in the patients with more severe obstructive sleep apnea during the sleep-onset period. From each of the 156 and 70 single-lead electrocardiograms collected from the internal polysomnographic database and from the Physionet Apnea-ECG database, respectively, the 150-s sleep-onset period was determined and the respiration cycles during this period were detected. Using the coefficient of variation of the respiration cycles, obtained from the internal dataset, as a predictor, the apnea-hypopnea index predictive model was developed through regression analyses and k-fold cross-validations. The apnea-hypopnea index predictability of the regression model was tested with the Physionet Apnea-ECG database. The regression model trained and validated from the 143 and 13 data, respectively, produced an absolute error (mean ± SD) of 3.65 ±2.98 events/h and a Pearson's correlation coefficient of 0.97 (P < 0.01) between the apnea-hypopnea index predictive values and the reference values for the 70 test data. The new predictor of apnea-hypopnea index has the potential to be utilized in making more reasoned clinical decisions on the need for formal diagnosis and treatment of obstructive sleep apnea. Our study is the first study that presented the strategy for providing a reliable apnea-hypopnea index without overnight recording.
Fairchild, Karen; Mohr, Mary; Paget-Brown, Alix; Tabacaru, Christa; Lake, Douglas; Delos, John; Moorman, J. Randall; Kattwinkel, John
Background Apnea of prematurity (AOP) is nearly universal among very preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied in a large consecutive cohort. Methods We analyzed continuous bedside monitor chest impedance and electrocardiographic waveforms and oxygen saturation data collected on all NICU patients 50 infant-years of data). ?ABDs?, defined as central apnea ?10 sec associated with both bradycardia
Sands, Scott Aaron
Apnea, defined as cessation of breathing, is one of the most common clinical problems in neonatal intensive care, occurring in virtually all preterm infants. Given the brain and growth impairment that accompanies apnea and arterial desaturation (blood oxygen lack), the primary motivation for the studies carried out in this thesis was to explain the strikingly rapid desaturation that develops during cyclic apnea in preterm infants, where oxygen levels are halved in just 6-7 seconds. The first ...
Tsai, Ming-Shao; Lee, Li-Ang; Tsai, Yao-Te; Yang, Yao-Hsu; Liu, Chia-Yen; Lin, Meng-Hung; Hsu, Cheng-Ming; Chen, Chin-Kuo; Li, Hsueh-Yu
To investigate the risk of vertigo in patients with sleep apnea. Retrospective cohort study. This study used data from the National Health Insurance Research Database of Taiwan, a population-based database. A total of 5,025 patients who were newly diagnosed with sleep apnea between January 1, 1997, and December 31, 2012, were identified from the Longitudinal Health Insurance Database 2000, a nationally representative database of 1 million randomly selected patients. Moreover, 20,100 patients without sleep apnea were matched at a 1:4 ratio by age, sex, socioeconomic status, and urbanization level. Patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of vertigo. Patients with sleep apnea had a significantly higher cumulative incidence of vertigo than those without sleep apnea (P vertigo (hazard ratio, 1.71; 95% confidence interval [CI], 1.48-1.97; P diabetes mellitus, hypertension, stroke, and obesity. Sleep apnea was demonstrated to be an independent risk factor for vertigo. This is the first nationwide population-based cohort study to investigate the association between sleep apnea and vertigo. The findings strongly support that sleep apnea is an independent risk factor for vertigo. Based on the study results, physicians should be aware of potential vertigo occurrence following sleep apnea. 4. Laryngoscope, 128:763-768, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Uznańska, Barbara; Trzos, Ewa; Rechciński, Tomasz; Kasprzak, Jarosław D; Kurpesa, Małgorzata
There is a significant relationship between obstructive sleep apnea (OSA) and cardiovascular diseases. Reliability of new methods evaluating apnea in Holter ECG monitoring is still the matter of investigators' studies. In 48-hour Holter ECG monitoring recordings of 63 patients, we assessed repeatability, comparing the results from both sleep periods. We found good repeatability in evaluation of apnea-hypopnea index value. There was moderate agreement in three categories, that is, normal or bordeline or apneic assignment. Assignment to "healthy" (normal and borderline) or apneic subgroup during consecutive sleep periods showed high repeatability. Holter ECG monitoring is a repetitive method of preliminary diagnosis in patients evaluated for sleep apnea syndrome.
Steinhorst, Ana P; Gonçalves, Sandro C; Oliveira, Ana T; Massierer, Daniela; Gus, Miguel; Fuchs, Sandra C; Moreira, Leila B; Martinez, Denis; Fuchs, Flávio D
Obstructive sleep apnea (OSA) is a risk factor for the development of hypertension and cardiovascular disease. Apnea overloads the autonomic cardiovascular control system and may influence blood pressure variability, a risk for vascular damage independent of blood pressure levels. This study investigates the hypothesis that blood pressure variability is associated with OSA. In a cross-sectional study, 107 patients with hypertension underwent 24-h ambulatory blood pressure monitoring and level III polysomnography to detect sleep apnea. Pressure variability was assessed by the first derivative of blood pressure over time, the time rate index, and by the standard deviation of blood pressure measurements. The association between the apnea-hypopnea index and blood pressure variability was tested by univariate and multivariate methods. The 57 patients with apnea were older, had higher blood pressure, and had longer duration of hypertension than the 50 patients without apnea. Patients with apnea-hypopnea index (AHI) ≥ 10 had higher blood pressure variability assessed by the standard deviation than patients with AHI variability assessed by the time rate index presented a trend for association during sleep (P = 0.07). Daytime blood pressure variability was not associated with the severity of sleep apnea. Sleep apnea increases nighttime blood pressure variability in patients with hypertension and may be another pathway linking sleep abnormalities to cardiovascular disease.
Levin, Jonathan C; Jang, Jisun; Rhein, Lawrence M
To describe the prevalence of apnea in otherwise healthy term newborns, identify attributable length of stay (LOS) and healthcare utilization (cost) of apnea, and measure hospital variation in attributable LOS and cost of apnea in this population. We conducted a secondary analysis of a national administrative dataset, the 2012 Kids' Inpatient Database, which included 3.4 million newborn discharges in the US. The birth hospitalizations of approximately 2.6 million otherwise healthy, full-term newborns were included for analysis. Attributable LOS and cost of apnea were calculated using multivariate analyses. Apnea was diagnosed in 1 in 1000 healthy full-term newborns. Multivariate analyses showed that newborns with apnea had 0.6 days longer LOS (P apnea plus hypoxia and/or bradycardia had 1.4 days longer LOS (P apnea varied between individual hospitals and differed by hospital region. Apnea is associated with higher LOS and cost in the newborn hospitalization, with variation in hospital practice. This suggests the need for better comprehension of the underlying physiology and standardization of practice in its management in the term newborn. Copyright © 2016 Elsevier Inc. All rights reserved.
Cramer, Sophie J E; Dekker, Janneke; Dankelman, Jenny; Pauws, Steffen C; Hooper, Stuart B; Te Pas, Arjan B
Apnea of prematurity (AOP) is one of the most common diagnoses in preterm infants. Severe and recurrent apneas are associated with cerebral injury and adverse neurodevelopmental outcome. Despite pharmacotherapy and respiratory support to prevent apneas, a proportion of infants continue to have apneas and often need tactile stimulation, mask, and bag ventilation and/or extra oxygen. The duration of the apnea and the concomitant hypoxia and bradycardia depends on the response time of the nurse. We systematically reviewed the literature with the aim of providing an overview of what is known about the effect of manual and mechanical tactile stimulation on AOP. Tactile stimulation, manual or mechanical, has been shown to shorten the duration of apnea, hypoxia, and or bradycardia or even prevent an apnea. Automated stimulation, using closed-loop pulsating or vibrating systems, has been shown to be effective in terminating apneas, but data are scarce. Several studies used continuous mechanical stimulation, with pulsating, vibrating, or oscillating stimuli, to prevent apneas, but the reported effect varied. More studies are needed to confirm whether automated stimulation using a closed loop is more effective than manual stimulation, how and where the automated stimulation should be performed and the potential side effects.
Sophie J. E. Cramer
Full Text Available Apnea of prematurity (AOP is one of the most common diagnoses in preterm infants. Severe and recurrent apneas are associated with cerebral injury and adverse neurodevelopmental outcome. Despite pharmacotherapy and respiratory support to prevent apneas, a proportion of infants continue to have apneas and often need tactile stimulation, mask, and bag ventilation and/or extra oxygen. The duration of the apnea and the concomitant hypoxia and bradycardia depends on the response time of the nurse. We systematically reviewed the literature with the aim of providing an overview of what is known about the effect of manual and mechanical tactile stimulation on AOP. Tactile stimulation, manual or mechanical, has been shown to shorten the duration of apnea, hypoxia, and or bradycardia or even prevent an apnea. Automated stimulation, using closed-loop pulsating or vibrating systems, has been shown to be effective in terminating apneas, but data are scarce. Several studies used continuous mechanical stimulation, with pulsating, vibrating, or oscillating stimuli, to prevent apneas, but the reported effect varied. More studies are needed to confirm whether automated stimulation using a closed loop is more effective than manual stimulation, how and where the automated stimulation should be performed and the potential side effects.
Tourneux, Pierre; Cardot, Virginie; Museux, Nathanaëlle; Chardon, Karen; Léké, André; Telliez, Frédéric; Libert, Jean-Pierre; Bach, Véronique
The incidence of apnea in neonates depends on a number of factors, including sleep state and thermoregulation. To assess the role of thermal drive (body heat loss [BHL]) in the mechanisms underlying short episodes of central apnea during active and quiet sleep in neonates. Twenty-two neonates (postconceptional age: 36.3 +/- 0.9 weeks) were exposed at thermoneutral (incubator temperature: 32.5 degrees C), warm (34.2 degrees C), and cool (30.4 degrees C) conditions during 3 consecutive morning naps. Oxygen consumption (VO2), skin and rectal temperatures, and central apnea were scored during active sleep and quiet sleep. The thermal drive was expressed as BHL calculated using indirect partitional calorimetry. As expected, apnea occurred more frequently in active sleep than in quiet sleep (P apnea in active sleep was higher in the warm condition (P apnea episodes were less frequent (P apnea were correlated with the BHL: the greater the BHL (body cooling), the less frequent and the shorter the apnea episodes. In contrast, no relationship between apnea and mean skin or rectal temperature was observed. Apneic events were more closely related to BHL than to body temperatures. In cool exposure, the decreases in the duration and frequency of apneic episodes suggest that these events depend on the metabolic drive (which is proportional to energy expenditure).
Niimi, Taiga; Itoh, Yushi; Natori, Michiya; Aoki, Yoshimitsu
Cheyne-Stokes respiration is especially prevalent in preterm newborns, but its severity may not be recognized. It is characterized by apnea and cyclical weakening and strengthening of the breathing. We developed a method for detecting apnea and this abnormal respiration and for estimating its malignancy. Apnea was detected based on a "difference" feature (calculated from wavelet coefficients) and a modified maximum displacement feature (related to the respiratory waveform shape). The waveform is calculated from vertical motion of the thoracic and abdominal region during respiration using a vision sensor. Our proposed detection method effectively detects apnea (sensitivity 88.4%, specificity 99.7%).
Cramer, Sophie J. E.; Dekker, Janneke; Dankelman, Jenny; Pauws, Steffen C.; Hooper, Stuart B.; te Pas, Arjan B.
Apnea of prematurity (AOP) is one of the most common diagnoses in preterm infants. Severe and recurrent apneas are associated with cerebral injury and adverse neurodevelopmental outcome. Despite pharmacotherapy and respiratory support to prevent apneas, a proportion of infants continue to have apneas and often need tactile stimulation, mask, and bag ventilation and/or extra oxygen. The duration of the apnea and the concomitant hypoxia and bradycardia depends on the response time of the nurse. We systematically reviewed the literature with the aim of providing an overview of what is known about the effect of manual and mechanical tactile stimulation on AOP. Tactile stimulation, manual or mechanical, has been shown to shorten the duration of apnea, hypoxia, and or bradycardia or even prevent an apnea. Automated stimulation, using closed-loop pulsating or vibrating systems, has been shown to be effective in terminating apneas, but data are scarce. Several studies used continuous mechanical stimulation, with pulsating, vibrating, or oscillating stimuli, to prevent apneas, but the reported effect varied. More studies are needed to confirm whether automated stimulation using a closed loop is more effective than manual stimulation, how and where the automated stimulation should be performed and the potential side effects. PMID:29552548
McKay, Mary Pat
This special report describes the findings of the National Transportation Safety Board's investigation into the probable cause of the derailment of a Metro-North passenger train in the Bronx, New York on December 1, 2013, that resulted in 4 deaths and injuries to 59 additional persons. A key finding in the medical investigation was the engineer's post-accident diagnosis of severe, obstructive sleep apnea, and the probable cause of the accident was determined to be the result of the engineer having fallen asleep while operating the train. This accident highlights the importance of screening, evaluating, and ensuring adequate treatment of obstructive sleep apnea, particularly among patients working in positions where impairment of physical or cognitive function or sudden incapacitation may result in serious harm to the public. © 2015 Annals of Family Medicine, Inc.
In order to treat sleep apnea, that patients know the characteristics of the disease and the treatment is important since they become aware of it, thus achieving greater adherence to the treatments. There are several types of therapy: individual therapy, which is characterized as support provided by mental health professionals to the patient; couple and family therapy, which offer psychological help for the management of sleep apnea and its side effects, and group therapy, which educates about the entity and its treatment by sharing positive experiences with the group. Field intervention at work and progressive desensitization and relaxation techniques are also used to improve the adhesion to positive pressure in the airway (PAP therapy.
Full Text Available Pregnancy is a temporary condition of life during which important changes in the physiology of women occur; such changes are resolved, to a large extent, after childbirth. Physical, hormonal and psychological changes can be observed as weight increases progressively. These factors may predispose to a respiratory sleep disorder or exacerbate an existing sleep disorder. The scientific literature suggests a higher prevalence of snoring in pregnant women, although databases show the diagnosis code of sleep apnea in less than 1% of pregnancies. The presence of both snoring and apnea during pregnancy has been associated with some adverse outcomes discussed in this article, which seeks to sensitize physicians to consider this diagnosis during pregnancy.
Mak Adam Daulatzai
Full Text Available Obstructive sleep apnea (OSA, characterized by recurrent upper airway (UA collapse during sleep, is associated with significant morbidity and disorders. Polysomnogram is employed in the evaluation of OSA and apnea-hypopnea number per hour reflects severity. For normal breathing, it is essential that the collapsible UA is patent. However, obstruction of the UA is quite common in adults and infants. Normally, important reflex mechanisms defend against the UA collapse. The muscle activity of UA dilators, including the genioglossus, tensor palatini (TP, and pharyngeal constrictors, is due to the integrated mechanism of afferent sensory input → to motor function. Snoring is harsh breathing to prevent UA obstruction. Unfortunately, snoring vibrations, pharyngeal suction collapse, negative pressure, and hypoxia cause pathological perturbations including dysfunctional UA afferent sensory activity. The current paper posits that peripheral sensory stimulation paradigm, which has been shown to be efficacious in improving several neurological conditions, could be an important therapeutic strategy in OSA also.
Rizzi, Camila F; Cintra, Fatima; Mello-Fujita, Luciane; Rios, Lais F; Mendonca, Elisangela T; Feres, Marcia C; Tufik, Sergio; Poyares, Dalva
The aim of this study was to evaluate cardiopulmonary exercise performance in lean and obese patients with obstructive sleep apnea (OSA) compared with controls. Case-control study. The study was carried out in Sao Paulo Sleep Institute, Sao Paulo, Brazil. INDIVIDUALS WITH SIMILAR AGES WERE ALLOCATED INTO GROUPS: 22 to the lean OSA group, 36 to the lean control group, 31 to the obese OSA group, and 26 to the obese control group. The participants underwent a clinical evaluation, polysomnography, a maximum limited symptom cardiopulmonary exercise test, two-dimensional transthoracic echocardiography, and spirometry. The apnea-hypopnea index, arousal index, lowest arterial oxygen saturation (SaO2) and time of SaO2 exercise cardiorespiratory function.
Ponganis, Paul J; Kreutzer, Ulrike; Sailasuta, Napapon; Knower, Torre; Hurd, Ralph; Jue, Thomas
1H NMR solution-state study of elephant seal (Mirounga angustirostris) myoglobin (Mb) and hemoglobin (Hb) establishes the temperature-dependent chemical shifts of the proximal histidyl N(delta)H signal, which reflects the respective intracellular and vascular PO2 in vivo. Both proteins exist predominantly in one major isoform and do not exhibit any conformational heterogeneity. The Mb and Hb signals are detectable in M. angustirostris tissue in vivo. During eupnea M. angustirostris muscle maintains a well-saturated MbO2. However, during apnea, the deoxymyoglobin proximal histidyl N(delta)H signal becomes visible, reflecting a declining tissue PO2. The study establishes a firm methodological basis for using NMR to investigate the metabolic responses during sleep apnea of the elephant seal and to secure insights into oxygen regulation in diving mammals.
Hassani, Somayeh; Rahnama, Nooshin; Seyedmehdi, Seyed Mohammad; Yazdanparast, Taraneh; Roozbahani, Rahim; Attarchi, Mirsaeed; Adimi Naghan, Parisa; Jamaati, Hamidreza
Obstructive sleep apnea syndrome (OSAS) is a common disorder in which instability of the upper airways leads to a reduction or cessation of airflow during sleep. Sleep disorders such as OSAS increase the risk of occupational accidents and impaired work performance. Sleep deprivation during shift increases the risk of occupational accidents among health care employees. The purpose of this study was to determine the association between occupational injuries in hospital staff and the risk of sleep apnea. This cross-sectional study was conducted on hospital staff of Masih Daneshvari Hospital in 2012. In this study, the hospital staff's (715) response to the Berlin questionnaire plus additional information including a history of an occupational accident, night shifts, less than four hours of night sleep, history of smoking, chronic disease and quality of sleep were assessed. Information obtained was analyzed using SPSS 15. In general, 27.6% reported a history of occupational accidents. The incidence of occupational accidents in the high-risk group for sleep apnea was significantly higher than the low-risk group (OR=2.736, CI=1.522-4.917, P=0.001). The results of logistic regression analysis also showed a statistically significant association between occupational accidents and risk of sleep apnea (OR = 2.247, CI = 1.194-4.231, P= 0.012). This study showed that the incidence of occupational accidents in the hospital employees is strongly related to the probability of OSA. Therefore, special attention should be directed to respiratory sleep disorders in order to reduce occupational injuries at hospitals.
Hassani, Somayeh; Rahnama, Nooshin; Seyedmehdi, Seyed Mohammad; Yazdanparast, Taraneh; Roozbahani, Rahim; Attarchi, Mirsaeed; Adimi Naghan, Parisa; Jamaati, Hamidreza
Background: Obstructive sleep apnea syndrome (OSAS) is a common disorder in which instability of the upper airways leads to a reduction or cessation of airflow during sleep. Sleep disorders such as OSAS increase the risk of occupational accidents and impaired work performance. Sleep deprivation during shift increases the risk of occupational accidents among health care employees. The purpose of this study was to determine the association between occupational injuries in hospital staff and the...
Park, John G.; Ramar, Kannan; Olson, Eric J.
Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and...
Full Text Available 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.
Shiomi,Fabio Koiti; Pisa,Ivan Torres; Campos,Carlos José Reis de
The International Classification of Sleep Disorders lists 90 disorders. Manifestations, such as snoring, are important signs in the diagnosis of the Obstructive Sleep Apnea Syndrome; they are also socially undesirable. OBJECTIVE: The aim of this paper was to present and evaluate a computerized tool that automatically identifies snoring and highlights the importance of establishing the duration of each snoring event in OSA patients. MATERIAL AND METHODS: The low-sampling (200 Hz) electrical si...
Ayalon, Liat; Ancoli-Israel, Sonia; Drummond, Sean PA
This study examined response inhibition during a Go-NoGo task in individuals with obstructive sleep apnea (OSA). Fourteen OSA patients and 14 controls were studied with functional magnetic resonance imaging (FMRI). Compared to Controls, the OSA group showed more false positives (error of commission) during the NoGo trials with decreased brain activation in the left postcentral gyrus, cingulate gyrus, and inferior parietal lobe, as well as right insula and putamen. This is consistent with prev...
Bukkapatnam, Satish T. S.
Recent advances in sensor technologies and predictive analytics are fueling the growth in point-of-care (POC) therapies for obstructive sleep apnea (OSA) and other sleep disorders. The effectiveness of POC therapies can be enhanced by providing personalized and real-time prediction of OSA episode onsets. Previous attempts at OSA prediction are limited to capturing the nonlinear, nonstationary dynamics of the underlying physiological processes. This paper reports an investigation into heart rate dynamics aiming to predict in real time the onsets of OSA episode before the clinical symptoms appear. A prognosis method based on a nonparametric statistical Dirichlet-Process Mixture-Gaussian-Process (DPMG) model to estimate the transition from normal states to an anomalous (apnea) state is utilized to estimate the remaining time until the onset of an impending OSA episode. The approach was tested using three datasets including (1) 20 records from 14 OSA subjects in benchmark ECG apnea databases (Physionet.org), (2) records of 10 OSA patients from the University of Dublin OSA database and (3) records of eight subjects from previous work. Validation tests suggest that the model can be used to track the time until the onset of an OSA episode with the likelihood of correctly predicting apnea onset in 1 min to 5 mins ahead is 83.6 ± 9.3%, 80 ± 8.1%, 76.2 ± 13.3%, 66.9 ± 15.4%, and 61.1 ± 16.7%, respectively. The present prognosis approach can be integrated with wearable devices, enhancing proactive treatment of OSA and real-time wearable sensor-based of sleep disorders. PMID:27835632
Smith, Simon S.; Doyle, Geoffrey; Pascoe, Thomas; Douglas, James A; Jorgensen, Greg
Obstructive sleep apnea (OSA) is a common and serious health issue that is strongly associated with excess weight. Exercise may be an effective mechanism for reducing the severity of OSA both in association with, and independent of, reduction in body weight. As such, increased exercise has been suggested as a potential intervention for OSA, particularly for patients with mild to moderate clinical severity. However, it is unknown how ready to engage in exercise patients with OSA are. Self-repo...
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome.
Trung Q Le
Full Text Available Recent advances in sensor technologies and predictive analytics are fueling the growth in point-of-care (POC therapies for obstructive sleep apnea (OSA and other sleep disorders. The effectiveness of POC therapies can be enhanced by providing personalized and real-time prediction of OSA episode onsets. Previous attempts at OSA prediction are limited to capturing the nonlinear, nonstationary dynamics of the underlying physiological processes. This paper reports an investigation into heart rate dynamics aiming to predict in real time the onsets of OSA episode before the clinical symptoms appear. A prognosis method based on a nonparametric statistical Dirichlet-Process Mixture-Gaussian-Process (DPMG model to estimate the transition from normal states to an anomalous (apnea state is utilized to estimate the remaining time until the onset of an impending OSA episode. The approach was tested using three datasets including (1 20 records from 14 OSA subjects in benchmark ECG apnea databases (Physionet.org, (2 records of 10 OSA patients from the University of Dublin OSA database and (3 records of eight subjects from previous work. Validation tests suggest that the model can be used to track the time until the onset of an OSA episode with the likelihood of correctly predicting apnea onset in 1 min to 5 mins ahead is 83.6 ± 9.3%, 80 ± 8.1%, 76.2 ± 13.3%, 66.9 ± 15.4%, and 61.1 ± 16.7%, respectively. The present prognosis approach can be integrated with wearable devices, enhancing proactive treatment of OSA and real-time wearable sensor-based of sleep disorders.
The first of these reviews described the physiological factors defining the limits of static apnea, while the second examined performance in apneic distance swimming. This paper reviews the factors determining performance in depth disciplines, where hydrostatic pressure is added to the stressors associated with apnea duration and physical work. Apneic duration is essential for performance in all disciplines, and is prolonged by any means that increases gas storage or tolerance to asphyxia or reduces metabolic rate. For underwater distance swimming, the main challenge is to restrict metabolism despite the work of swimming, and to redirect blood flow to allow the most vital functions. Here, work economy, local tissue energy and oxygen stores, anaerobic capacity of the muscles, and possibly technical improvements will be essential for further development. In the depth disciplines, direct pressure effects causing barotrauma, the narcotic effects of gases, decompression sickness (DCS) and possibly air embolism during ascent need to be taken into account, as does the risk of hypoxia when the dive cannot be rapidly interrupted before the surface is reached again. While in most deep divers apneic duration is not the main limitation thus far, greater depths may call for exceptionally long apneas and slower ascents to avoid DCS. Narcotic effects may also affect the ultimate depth limit, which the divers currently performing 'constant weight with fins' dives predict to be around 156 metres' sea water. To reach these depths, serious physiological challenges have to be met, technical developments needed and safety procedures developed concomitantly.
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome. RECENT FINDINGS: The severity of obstructive ventilatory impairment and hyperinflation, especially the inspiratory capacity to total lung capacity (TLC) ratio, correlates with the severity of sleep-related breathing disturbances. Early treatment with continuous positive airway pressure (CPAP) improves survival, reduces hospitalization and pulmonary hypertension, and also reduces hypoxemia. Evidence of systemic inflammation and oxidative stress in COPD and sleep apnea provides insight into potential interactions between both disorders that may predispose to cardiovascular disease. Long-term outcome studies of overlap patients currently underway should provide further evidence of the clinical significance of the overlap syndrome. SUMMARY: Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.
Full Text Available Obstructive Sleep Apnea Syndrome (OSAS is a sleep disorder characterised by repetitive episodes of upper airway obstruction (apnea or reduced airflow (hypopnoea despite persistent respiratory effort. Apnea is defined as the cessation of breathing for at least 10 seconds during sleep, while hypopnoea is defined as at least 30% reduction in airflow for 10 seconds associated with oxygen desaturation and sleep fragmentation. The presence in the general population is about 4%. The principal symptoms are: excessive daytime sleepiness (EDS, snoring, dry throat, morning headache, night sweats, gastro-esophageal reflux, and increased blood pressure.Long term complications can be: increased cardio-cerebrovascular risk and cognitive impairment such as deficiency in attention, vigilance, visual abilities, thought, speech, perception and short term memory.Continuous Positive Airway Pressure (CPAP is currently the best non-invasive therapy for OSAS.CPAP guarantees the opening of upper airways using pulmonary reflexive mechanisms increasing lung volume during exhalation and resistance reduction, decreasing electromyografical muscular activity around airways.The causes of cognitive impairments and their possible reversibility after CPAP treatment have been analysed in numerous studies. The findings, albeit controversial, show that memory, attention and executive functions are the most compromised cognitive functions.The necessity of increasing the patient compliance with ventilotherapy is evident, in order to prevent cognitive deterioration and, when possible, rehabilitate the compromised functions, a difficult task for executive functions.
Dukhovny, Dmitry; Lorch, Scott A; Schmidt, Barbara; Doyle, Lex W; Kok, Joke H; Roberts, Robin S; Kamholz, Karen L; Wang, Na; Mao, Wenyang; Zupancic, John A F
To determine the cost-effectiveness of treatment with caffeine compared with placebo for apnea of prematurity in infants with birth weights less than 1250 g, from birth through 18 to 21 months' corrected age. We undertook a retrospective economic evaluation of the cost per survivor without neurodevelopmental impairment by using individual-patient data from the Caffeine for Apnea of Prematurity clinical trial (N = 1869). We included direct medical costs either to the insurance payer or the hospital but excluded costs to parents and society, such as lost productivity. We used a price of $0.21/mg of generic caffeine citrate for our base-case analysis. All costs were expressed in 2008 Canadian dollars and discounted at 3%. The time horizon for this analysis extended through 18 to 21 months' corrected age to match the clinical trial. The mean cost per infant was $124 466 in the caffeine group and $133 505 in the placebo group (difference: $9039 [-14 749 to -3375]; adjusted P = .014). Cost-effectiveness analysis showed caffeine to be a dominant or "win-win" therapy: in >99% of 1000 bootstrap replications of the analysis, caffeine-treated infants had simultaneously better outcomes and lower mean costs. These results were robust to a 1000% increase in the individual resource items, including the price of caffeine citrate. In comparison with placebo, caffeine therapy for apnea of prematurity in infants weighing less than 1250 g is economically appealing for infants up to 18 to 21 months' corrected age.
Wong, H T; Chee, K H; Chong, A W
Obstructive sleep apnea (OSA) is a growing health hazard in the United States and worldwide. OSA is now recognized as a disorder with systemic manifestations and its association with obesity and adverse cardiovascular consequences. There is increasing evidence that OSA may be associated with systemic hypertension and an increased incidence of stroke, heart failure, myocardial infarction, and arrhythmias. Less information is available about the association between OSA and pulmonary hypertension (PH). We therefore conduct this study to look at the prevalence of the pulmonary hypertension in obstructive sleep apnea patient and to identify risk factors leading to pulmonary hypertension among OSA patient. We studied and analyzed all OSA patient confirmed by polysomnograph in the year 2015. Twenty-five patients with OSA were included in this study with prevalence of pulmonary hypertension of 16%. Univariate analysis of various factors revealed a statistically significant association between having the lowest SpO 2 of pulmonary hypertension (p = 0.016). There were no statistically significant associations between age, gender, smoking status, hypertension, body mass index (BMI), or apnea-hypopnea index (AHI) with occurrence of pulmonary hypertension. AHI is not a good predictor for pulmonary hypertension. The real value of using AHI to predict the health risk of OSA is doubtful. We recommend routine echocardiogram among OSA patient. The objective information in the echocardiogram provides evidence for counseling of patient with disease of OSA and hence hopefully can improve compliance of patient to treatment especially usage of CPAP.
Jehan, Shazia; Zizi, Ferdinand; Pandi-Perumal, Seithikurippu R; Wall, Steven; Auguste, Evan; Myers, Alyson K; Jean-Louis, Girardin; McFarlane, Samy I
Obstructive sleep apnea (OSA) is a global disease with a rising incidence along with its comorbidities, especially with metabolic syndrome. One of the main components contributing to sleep apnea is obesity; as well as diabetes mellitus type 2 (T2DM), hypercholesterolemia, and hypertension. OSA is a condition that requires management and the disease can be treated by using CPAP therapy. The awareness of this global issue is rising, and health care systems are providing preventive measures, diagnosis and the treatment options. The major preventable risk factors to decrease obesity are the awareness of lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise. If these lifestyle modifications are widely applied, then not only will the consequences of obesity and sleep apnea be reduced, but also the incidence of cardiovascular disease will decrease greatly. Public awareness of the importance of weight loss by lifestyle modification or bariatric surgery to improve the quality of life is needed. These preventive actions, screening measures, and treatment strategies for obesity and OSA can significantly reduce the incidence of obesity, as well as OSA and the related comorbidities such as cardiovascular disease, atherosclerosis, and depression. Finally, health care costs will also be reduced.
Bazurto Zapata, Maria Angelica; Martinez-Guzman, William; Vargas-Ramirez, Leslie; Herrera, Karen; Gonzalez-Garcia, Mauricio
The occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this. Patients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed. We included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49-8.16]), history of heart failure (OR: 2.53 [1.58-4.07]), and male sex (OR: 1.68 [1.06-2.69]). The prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG. Copyright © 2014 Elsevier B.V. All rights reserved.
Yilmaz Avci, Aynur; Avci, Suat; Lakadamyali, Huseyin; Can, Ufuk
We determined whether hypoxia parameters are associated with C-reactive protein (CRP), mean platelet volume (MPV), white matter hyperintensity (WMH), and the severity of obstructive sleep apnea (OSA), and also evaluated whether hypoxia parameters, CRP, MPV, and WMH differ in patients with similar apnea-hypopnea index (AHI) scores. A total of 297 patients, who were evaluated using polysomnography, were assessed retrospectively. The measured hypoxia parameters included total sleep time with oxygen saturation 0.05). Above the hypoxia threshold (CT 90 ≥ 10%) of CRP, MPV increased significantly and the presence of WMH increased twofold. These data suggest that increased hypoxia severity may mediate increased inflammation and activation of platelets and contribute to the pathogenesis of WMH in patients with OSA. In addition, patients with severe OSA may show significant variability in inflammation and vascular risk. Further prospective data are needed.
Lee, V Vien; Trinder, John; Jackson, Melinda L
Obstructive sleep apnea is associated with memory impairments, and higher rates of depressive symptoms and major depressive disorder compared with community estimates. Autobiographical memory overgenerality, a behaviour characterized by difficulty recalling specific memories from one's own life, is recognized as a marker of depression. Previous studies have demonstrated the predictive quality of specific autobiographical memory recall on the course of depression in patients with obstructive sleep apnea. However, it remains unclear whether impaired autobiographical memory is simply a feature of depression, or whether it is also impaired in patients with obstructive sleep apnea without depression. This study aimed to investigate whether autobiographical memory impairments can be observed in patients with obstructive sleep apnea, independent of the severity of depressive symptoms. Twenty-one patients with obstructive sleep apnea symptomatic for depressive symptoms (mean age = 43.43 years, SD = 9.97), 17 patients with obstructive sleep apnea asymptomatic for depressive symptoms (mean age = 40.65 years, SD = 9.39), and 20 healthy controls without sleep-disordered breathing (mean age = 32.80 years, SD = 6.69) completed an Autobiographical Memory Test. Patients with obstructive sleep apnea symptomatic for depressive symptoms recalled significantly fewer specific memories when compared with healthy controls (P = 0.010). No difference in the recall of specific autobiographical memory was observed between symptomatic and asymptomatic patients with obstructive sleep apnea. With regard to valence, symptomatic patients with obstructive sleep apnea recalled significantly fewer negative specific memories when compared with controls (P = 0.010). Impairment in specific autobiographical memory recall can be observed in patients with obstructive sleep apnea, regardless of the severity of depressive symptoms; however, this effect may not be as prominent in younger
Bensouda, Brahim; Tarazi, Samar El; Ali, Nabeel; Mandel, Romain; Sant'Anna, Guilherme M
To investigate for any association between episodes of apnea, desaturation and bradycardia and necrotizing enterocolitis (NEC). Case-control study in infants of gestational age apneas & bradycardias or severe episodes of desaturation & bradycardia between the 2 groups. No association between episodes of apnea, severe desaturations or bradycardia and development of NEC was observed in this preterm population.
Pijpers, M.; Poels, P.J.P.; Vaandrager, J.M.; Hoog, M. de; Berg, S.W. van den; Hoeve, H.J.; Joosten, K.F.
Children with syndromal craniofacial synostosis have a high risk for obstructive sleep apnea syndrome. Early diagnosis and treatment can relieve symptoms and morbidity. Little is known about the development and natural history of obstructive sleep apnea syndrome through life. The aim of this study
Mar 6, 2011 ... in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings. Key words: Apnea, hypothermia, newborn ...
Kitagawa, Kiyotaka; Hayasaka, Seiji; Nagaki, Yasunori
A 55-year-old woman complained of visible floaters in the right eye. The patient had a cotton-wool spot in the right fundus and sleep apnea syndrome. After treatment with nasal continuous positive airway pressure during sleep, the cotton-wool spot disappeared. Sleep apnea syndrome should be added to the list of causes of cotton-wool spots.
Davis, Peter G.; Schmidt, Barbara; Roberts, Robin S.; Doyle, Lex W.; Asztalos, Elizabeth; Haslam, Ross; Sinha, Sunil; Tin, Win; Schmidt, B.; D'Ilario, J.; Cairnie, J.; Dix, J.; Adams, B.; Faber, B.; Callanan, K.; Davis, N.; Duff, J.; Ford, G.; Golec, L.; Lacy, M.; Hohn, D.; Barnett, C.; Goodchildt, L.; Lontis, R.; Fraser, S.; Keng, J.; Saunders, K.; Opie, G.; Kelly, E.; Bairam, A.; Ferland, S.; Laperriere, L.; Bélanger, S.; St Amand, P.; Blayney, M.; Davis, D.; Frank, J.; Lemyre, L.; Solimano, A.; Singh, A.; Chalmers, M.; Ramsay, K.; Synnes, A.; Whitfield, M.; Rogers, M.; Tomlinson, J.; Offringa, M.; Nuytemans, D.; Vermeulen, E.; Kok, J.; van Wassenaer, A.; Arnon, S.; Chalaf, A.; Regev, R.; Netter, I.; Ohlsson, A.; Nesbitt, K.; O'Brien, K.; Hamilton, A. M.; Sankaran, K.; Morgan, S.; Proctor, P.; LaCorte, M.; LeBlanc, P.; Braithwaite, A.; Golan, A.; Barabi, T.; Goldstein, E.; Reynolds, G.; Dromgool, B.; Meskell, S.; McMillan, D.; Schaab, D.; Spellen, L.; Sauve, R.; Christianson, H.; Anseeuw-Deeks, D.; Alvaro, R.; Chiu, A.; Porter, C.; Turner, G.; Moddemann, D.; Granke, N.; Penner, K.; Mulder, T.; Ghys, A.; van der Hoeven, M.; Clarke, M.; Parfitt, J.; MacLean, H.; Nwaesei, C.; Kuhn, L.; Ryan, H.; Saunders, C.; Schulze, A.; Pudenz, P.; Muller, M.; Lagercrantz, H.; Bhiladvala, M.; Legneval, L.; Herlenius, E.; Matthew, D.; Amos, W.; Tulsiani, S.; Tan-Dy, C.; Turner, M.; Shinwell, E.; Levine, R.; Juster-Reicher, A.; Barrington, K.; Kokkotis, T.; Khairy, M.; Grier, P.; Vachon, J.; Tin, W.; Fritz, S.; Walti, H.; Royer, D.; Halliday, H.; Millar, D.; Berry, A.; Mayes, C.; Cummings, C.; Fahnenstich, H.; Philipp, K.; Tillmann, B.; Weber, P.; Canning, R.; Wariyar, U.; Embleton, N.; Bucher, H.-U.; Fauchere, J.-C.; Pfister, R.; Launoy, V.; Huppi, P.; Poets, C.; Urschitz-Duprat, P.; Davis, P.; Doyle, L. W.; Gent, M.; Fraser, W.; Hey, E.; Perlman, M.; Thorpe, K.; Gray, S.; Roberts, R. S.; Chambers, C.; Costantini, L.; McGean, L.; Scapinello, L.
OBJECTIVE: To determine whether the benefits of caffeine vary in three subgroups of 2006 participants in the Caffeine for Apnea of Prematurity (CAP) trial. STUDY DESIGN: Post-hoc subgroup analyses were performed on the basis of: (1) indication for commencement of study drug: treat apnea, prevent
Full Text Available Obstructive sleep apnea is increasingly recognized as an important contributor to cognitive impairment, metabolic derangements and cardiovascular disease and mortality. Identifying the mechanisms by which this prevalent disorder influences health outcomes is now of utmost importance. As the prevalence of this disorder steadily increases, therapies are needed to prevent or reverse sleep apnea morbidities now more than ever before. Oxidative stress is implicated in cardiovascular morbidities of sleep apnea. What role oxidative stress plays in neural injury and cognitive impairments has been difficult to understand without readily accessible tissue to biopsy in persons with and without sleep apnea. An improved understanding of the role oxidative stress plays in neural injury in sleep apnea may be developed by integrating information gained examining neural tissue in animal models of sleep apnea with key features of redox biochemistry and clinical sleep apnea studies where extra-neuronal oxidative stress characterizations have been performed. Collectively, this information sets the stage for developing and testing novel therapeutic approaches to treat and prevent, not only central nervous system injury and dysfunction in sleep apnea, but also the cardiovascular and potentially metabolic conditions associated with this prevalent, disabling disorder.
Narang, Indra; Al-Saleh, Suhail; Amin, Reshma; Propst, Evan J; Bin-Hasan, Saadoun; Campisi, Paolo; Ryan, Clodagh; Kendzerska, Tetyana
Objectives To determine whether neck:height ratio combined with adenoid and tonsillar size is a good predictive tool for obstructive sleep apnea in obese youth. Study Design Cross-sectional study. Setting Sleep clinics at the Hospital for Sick Children, Toronto, Canada. Subjects and Methods Consented obese individuals aged 8 to 18 years were recruited between 2013 and 2015. Anthropometric measures were obtained by a trained research coordinator in a standardized manner. Otolaryngologists evaluated adenoid and tonsil sizes. Obstructive sleep apnea was diagnosed with an overnight polysomnogram as an obstructive apnea-hypopnea index ≥2. Multivariable logistic regressions investigated the relationship between potential predictors and obstructive sleep apnea. The C-statistic measured the predictive ability. Results Of the 53 subjects (median age, 13 years; 55% males), 28 (53%) were diagnosed with obstructive sleep apnea, with a median index of 10.6 per hour. In a logistic regression controlling for adenoid size, enlarged tonsils were significantly associated with the presence of obstructive sleep apnea ( P Controlling for tonsil and adenoid sizes, an increase in neck:height ratio was significantly associated with the presence of obstructive sleep apnea ( P = .01). Conclusion Our study suggests that neck:height ratio combined with tonsillar hypertrophy may have a strong predictive ability for obstructive sleep apnea and may be useful in an ambulatory setting to screen obese youth at high risk. These findings should be confirmed in a larger study.
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
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
Crisalli, Joseph A; McConnell, Keith; Vandyke, Rhonda D; Fenchel, Matthew C; Somers, Virend K; Shamszumann, A; Chini, Barbara; Daniels, Stephen R; Amin, Raouf S
Children with obstructive sleep apnea have blunted baroreflex sensitivity and increased blood pressure variability. The aim of the study was to test the hypothesis that treatment of sleep apnea by adenotonsillectomy results in significant improvement of baroreflex sensitivity, lowering of blood pressure and blood pressure variability and increase vagal heart rate modulation. One hundred ninety-four children aged 9.6 ± 2.3 years were enrolled; 133 had obstructive sleep apnea and 61 were healthy controls. For children with sleep apnea, polysomnography with 3-lead electrocardiography and continuous blood pressure was performed before adenotonsillectomy, then 6 weeks and 6 months postoperatively. Controls underwent the same assessment at study entry and 6 months later. Spontaneous baroreflex sensitivity was measured in the time and frequency domains. Data analyses were performed for available and complete cases. Children with sleep apnea experienced postoperatively an increase in baroreflex sensitivity and decrease in blood pressure variability during wakefulness and sleep. A decrease in blood pressure during sleep and in heart rate during wakefulness was also measured. The improvement in baroreflex sensitivity was predicted by the change in the apnea-hypopnea and arousal indices. A normal pattern of rising baroreflex sensitivity during the night was restored in children with severe apnea after surgery. However, baroreceptor sensitivity did not completely normalize after treatment. Treatment of obstructive sleep apnea in children by adenotonsillectomy is associated with gradual improvement in known risk factors for cardiovascular disease. Complete normalization of baroreceptor sensitivity was not achieved 6 months postoperatively.
Gandotra, Kamal; Golish, Joseph; Rosenberg, Carl; Strohl, Kingman
We present a case of a patient with dissociative identity disorder and symptomatic sleep apnea who was treated with continuous positive airway pressure (CPAP). CPAP use depended upon which personality the patient exhibited but apnea reduction did not. This case illustrates in one individual how personality can positively or negatively affect CPAP adherence. Copyright © 2018 American Academy of Sleep Medicine. All rights reserved.
Yang, Yi; Qin, Yong; Haung, Weining; Peng, Hao; Xu, Huijie
To investigate the acoustic characteristics of snoring sound in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Thirty-one patients with OSAHS were included in this study. Natural overnight snoring was digitally recorded and polysomnography (PSG) was performed simultaneously. Thirty hundred and ten snores which after obstructive apnea and 310 continuous snores which not after obstructive apnea were extracted and peak frequency, maximal frequency, mean frequency,central frequency and power ratio were analyzed. The maximal frequency, peak frequency, mean frequency and central frequency of the snores which after obstructive apnea was higher than that of the continuous snores. But 800 Hz power ratio of the snores which after obstructive apnea was lower than those of the continuous snores. The differences of all parameters were of statistical significance (Psnores of OSAHS patients. It indicates that it is feasible to study the OSAHS by way of snore monitoring and analyzing technique employed in this study.
Jorge Marques do Vale
Full Text Available The Chiari malformation type I (CM-I has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.
Almendros, Isaac; Farré, Ramon; Planas, Anna M.; Torres, Marta; Bonsignore, Maria R.; Navajas, Daniel; Montserrat, Josep M.
Study Objectives: To test the hypotheses that the dynamic changes in brain oxygen partial pressure (PtO2) in response to obstructive apneas or to intermittent hypoxia differ from those in other organs and that the changes in brain PtO2 in response to obstructive apneas is a source of oxidative stress. Design: Prospective controlled animal study. Setting: University laboratory. Participants: 98 Sprague-Dawley rats. Interventions: Cerebral cortex, skeletal muscle, or visceral fat tissues were exposed in anesthetized animals subjected to either obstructive apneas or intermittent hypoxia (apneic and hypoxic events of 15 s each and 60 events/h) for 1 h. Measurements and Results: Arterial oxygen saturation (SpO2) presented a stable pattern, with similar desaturations during both stimuli. The PtO2 was measured by a microelectrode. During obstructive apneas, a fast increase in cerebral PtO2 was observed (38.2 ± 3.4 vs. 54.8 ± 5.9 mm Hg) but not in the rest of tissues. This particular cerebral response was not found during intermittent hypoxia. The cerebral content of reduced glutathione was decreased after obstructive apneas (46.2% ± 15.2%) compared to controls (100.0% ± 14.7%), but not after intermittent hypoxia. This antioxidant consumption after obstructive apneas was accompanied by increased cerebral lipid peroxidation under this condition. No changes were observed for these markers in the other tissues. Conclusions: These results suggest that cerebral cortex could be protected in some way from hypoxic periods caused by obstructive apneas. The increased cerebral PtO2 during obstructive apneas may, however, cause harmful effects (oxidative stress). The obstructive apnea model appears to be more adequate than the intermittent hypoxia model for studying brain changes associated with OSA. Citation: Almendros I; Farre R; Planas AM; Torres M; Bonsignore MR; Navajas D; Montserrat JM. Tissue oxygenation in brain, muscle, and fat in a rat model of sleep apnea: differential
Botros, Nader; Concato, John; Mohsenin, Vahid; Selim, Bernardo; Doctor, Kervin; Yaggi, Klar
PURPOSE Cross-sectional studies have documented the co-occurrence of obstructive sleep apnea (hereafter sleep apnea) with glucose intolerance, insulin resistance, and type II diabetes mellitus (hereafter diabetes). It has not been determined, however, whether sleep apnea is independently associated with the subsequent development of diabetes, accounting for established risk factors. METHODS This observational cohort study examined 1233 consecutive patients in the Veteran Affairs Connecticut Health Care System referred for evaluation of sleep-disordered breathing; 544 study participants were free of preexisting diabetes and completed a full, attended, diagnostic polysomnogram. The study population was divided into quartiles based on severity of sleep apnea as measured by the apnea-hypopnea index. The main outcome was incident diabetes defined as fasting glucose level > 126 mg/dL and a corresponding physician diagnosis. Compliance with positive airway pressure therapy, and its impact on the main outcome, was also examined. RESULTS In unadjusted analysis, increasing severity of sleep apnea was associated with an increased risk of diabetes (P for linear trend < 0.001). After adjusting for age, sex, race, baseline fasting blood glucose, body mass index (BMI), and weight change, an independent association was found between sleep apnea and incident diabetes (hazard ratio per quartile 1.43; CI 1.10 – 1.86). Among patients with more severe sleep apnea (upper two quartiles of severity), 60% had evidence of regular positive airway pressure use, and this treatment was associated with an attenuation of the risk of diabetes (log-rank test P=0.04). CONCLUSION Sleep apnea increases the risk of developing diabetes, independent of other risk factors. Among patients with more severe sleep apnea, regular positive airway pressure use may attenuate this risk. PMID:19958890
Welborn, L G; Rice, L J; Hannallah, R S; Broadman, L M; Ruttimann, U E; Fink, R
Thirty-six former preterm infants undergoing inguinal hernia repair were studied. All were less than or equal to 51 weeks postconceptual age at the time of operation. Patients were randomly assigned to receive general or spinal anesthesia. Group 1 patients received general inhalational anesthesia with neuromuscular blockade. Group 2 patients received spinal anesthesia using 1% tetracaine 0.4-0.6 mg/kg in conjunction with an equal volume of 10% dextrose and 0.02 ml epinephrine 1:1000. In the first part of the study, infants randomized to receive spinal anesthesia also received sedation with im ketamine 1-2 mg/kg prior to placement of the spinal anesthetic (group 2 A). The remainder of group 2 patients did not receive sedation (group 2 B). Respiratory pattern and heart rate were monitored using an impedance pneumograph for at least 12 h postoperatively. Tracings were analyzed for evidence of apnea, periodic breathing and/or bradycardia by a pulmonologist unaware of the anesthetic technique utilized. None of the patients who received spinal anesthesia without ketamine sedation developed postoperative bradycardia, prolonged apnea, or periodic breathing. Eight of nine infants (89%) who received spinal anesthesia and adjunct intraoperative sedation with ketamine developed prolonged apnea with bradycardia. Two of the eight infants had no prior history of apnea. Five of the 16 patients (31%) who received general anesthesia developed prolonged apnea with bradycardia. Two of these five infants had no prior history of apnea. When infants with no prior history of apnea were analyzed separately, there was no statistically significant increased incidence of apnea in children receiving general versus spinal anesthesia with or without ketamine sedation. Because of the small numbers of patients studied, and the multiple factors that may influence the incidence of postoperative apnea (e.g., prior history of neonatal apnea), standard postoperative respiratory monitoring of these high
Alameri, Hatem; Al-Kabab, Yusra; BaHammam, Ahmed
Several studies have used the cardiopulmonary exercise test to assess patients with obstructive sleep apnea (OSA). However, no report has investigated the use of the 6-min walk test (6MWT) in this group of patients. We studied consecutive, newly diagnosed, OSA patients (aged >18 years). The control group was composed of matched healthy subjects with no clinical history indicative of sleep breathing disorders. The study population was divided into three groups: an OSA group, a control obese group, and a control lean group. The obese controls were gender-, age- (+/-2 years), height- (+/-5 cm), and weight- (+/-2 kg) matched to the OSA patients, while the lean controls were matched in gender, age, and height, but not weight. All patients underwent sleep study at our Sleep Disorders Center. Each subject underwent a single 6MWT within 1 week of the sleep study. A total of 55 patients were recruited to the OSA group (age 36.7 +/- 7.9 years, body mass index 38.7 +/- 8.6 kg/m(2), and apnea hypopnea index 66.6 +/- 34.8/h), 32 subjects to the control obese group, and 30 to the control lean group. There was no difference in distance walked (6-min walk distance (6MWD)) between the OSA group (389 +/- 70 m) and the obese group (408 +/- 66 m). In the OSA group, the 6MWD results did not correlate with patient age, apnea hypopnea index, or other polysomnographic variables. At the end of the test, heart rate, systolic and diastolic blood pressure, and dyspnea perception were significantly increased in the OSA group compared with healthy subjects. The 6MWT is easy to perform and well tolerated by patients with OSA. There were no correlations between the 6MWD and the severity of OSA or other polysomnographic parameters. However, patients with OSA exhibited abnormal hemodynamic responses to submaximal exercise.
Weaver, Terri E; Calik, Michael W; Farabi, Sarah S; Fink, Anne M; Galang-Boquiren, Maria T; Kapella, Mary C; Prasad, Bharati; Carley, David W
Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone.
Pinto, José Antonio
Full Text Available Introduction Obstructive sleep apnea (OSA is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history. Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA. Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013. Results We evaluated 100 patients with OSA (84 men and 16 women with a mean age of 50.05 years (range 19–75 years. The prevalence of comorbidities were hypertension (39%, obesity (34%, depression (19%, gastroesophageal reflux disease (GERD (18%, diabetes mellitus (15%, hypercholesterolemia (10%, asthma (4%, and no comorbidities (33%. Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA. Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations.
Patt, Brian T.; Jarjoura, David; Lambert, Lynn; Roy, Sashwati; Gordillo, Gayle; Schlanger, Richard; Sen, Chandan K.; Khayat, Rami N.
Study Objectives: Chronic non-healing wounds are a major human and economic burden. Obstructive sleep apnea (OSA) is prevalent in patients with obesity, diabetes, aging, and cardiovascular disease, all of which are risk factors for chronic wounds. We hypothesized that OSA would have more prevalence in patients of a wound center than the general middle-aged population. Methods: Consecutive patients of the Ohio State University Comprehensive Wound Center (CWC) were surveyed with the Berlin and Epworth questionnaires. In the second stage of the protocol, 50 consecutive unselected CWC patients with lower extremity wounds underwent home sleep studies. Results: In 249 patients of the CWC who underwent the survey study, OSA had been previously diagnosed in only 22%. The prevalence of high-risk status based on questionnaires for OSA was 46% (95% CI 40%, 52%). In the 50 patients who underwent home sleep studies, and using an apnea hypopnea index of 15 events per hour, the prevalence of OSA was 57% (95% CI 42%, 71%). There was no difference between the Berlin questionnaire score and weight between patients with OSA and those without. Conclusions: The prevalence of OSA in patients with chronic wounds exceeds the estimated prevalence of OSA in the general middle aged population. This study identifies a previously unrecognized population with high risk for OSA. Commonly used questionnaires were not sufficiently sensitive for the detection of high risk status for OSA in this patient population. Citation: Patt BT; Jarjoura D; Lambert L; Roy S; Gordillo G; Schlanger R; Sen CK; Khayat RN. Prevalence of obstructive sleep apnea in patients with chronic wounds. J Clin Sleep Med 2010;6(6):541-544. PMID:21206743
Leticia Viana Sales
Full Text Available OBJECTIVES: The aim of this study was to investigate neuropsychological performance and biomarkers of oxidative stress in patients with obstructive sleep apnea and the relationships between these factors. METHODS: This was an observational, cross-sectional study of 14 patients (36.0±6.5 years old with obstructive sleep apnea and 13 controls (37.3±6.9 years old. All of the participants were clinically evaluated and underwent full-night polysomnography as well as neuropsychological tests. Blood samples were used to assay superoxide dismutase, catalase, glutathione and homocysteine, as well as vitamins E, C, B11 and B12. RESULTS: The patients performed poorly relative to the controls on several neuropsychological tests, such as the attention test and tests of long-term memory and working memory/executive function. They also had lower levels of vitamin E (p<0.006, superoxide dismutase (p<0.001 and vitamin B11 (p<0.001, as well as higher concentrations of homocysteine (p<0.02. Serum concentrations of vitamin C, catalase, glutathione and vitamin B12 were unaltered. Vitamin E levels were related to performance in the backward digit span task (F = 15.9; p = 0.002 and this correlation remained after controlling for age and body mass index (F = 6.3, p = 0.01. A relationship between superoxide dismutase concentrations and executive non-perseveration errors in the Wisconsin Card Sorting Test (F = 7.9; p = 0.01 was also observed. CONCLUSIONS: Decreased levels of antioxidants and lower performance on the neuropsychological tasks were observed in patients with obstructive sleep apnea. This study suggests that an imbalance between antioxidants and pro-oxidants may contribute to neuropsychological alterations in this patient population.
Weaver, Terri E; Calik, Michael W; Farabi, Sarah S; Fink, Anne M; Galang-Boquiren, Maria T; Kapella, Mary C; Prasad, Bharati; Carley, David W
Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone. PMID:25429246
Full Text Available Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA. Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI <5 (n=25 and OSA group with an AHI ≥5 (n=25. Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%, p=0.034. There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol. Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism.
Vliegenthart, Roseanne J S; Ten Hove, Christine H; Onland, Wes; van Kaam, Anton H L C
Apnea of prematurity (AOP) is a common complication of preterm birth, for which caffeine is the first treatment of choice. In case of persistent AOP, doxapram has been advocated as an additional therapy. To identify and appraise all existing evidence regarding efficacy and safety of doxapram use for AOP in infants born before 34 weeks of gestational age. All studies reporting on doxapram use for AOP were identified by searching electronic databases, references from relevant studies, and abstracts from the Societies for Pediatric Research. Two reviewers independently assessed study eligibility and quality, and extracted data on study design, patient characteristics, efficacy and safety outcomes. The randomized controlled trials showed less apnea during doxapram treatment when compared to placebo, but no difference in treatment effect when compared to theophylline. No serious adverse effects were reported. We identified 28 observational studies consisting mainly of cohort studies and case series (n = 1,994). There was considerable heterogeneity in study design and quality. Most studies reported a positive effect of doxapram on apnea rate. A few studies reported on long-term outcomes with conflicting results. A range of possible doxapram-related short-term adverse effects were reported, sometimes associated with the use of higher doses. Based on the limited number of studies and level of evidence, no firm conclusions on the efficacy and safety of doxapram in preterm infants can be drawn. For this reason, routine use cannot be recommended. A large multicenter randomized controlled trial is urgently needed to provide more conclusive evidence. © 2016 The Author(s) Published by S. Karger AG, Basel.
Javaheri, Shahrokh; Smith, Jason; Chung, Eugene
Central sleep apnea (CSA) may occasionally occur in patients with obstructive sleep apnea during titration with a continuous positive airway pressure (CPAP) device. To determine the prevalence and the natural history of CPAP-emergent CSA. This is a retrospective study of 1286 patients with a diagnosis of OSAwho underwent titration with a positive airway device during a 1-year period. Patients were seen in consultation and underwent full-night attended polysomnography followed by full-night attended CPAP titration. Four weeks after CPAP therapy, patients returned to the clinic for follow-up, and objective adherence to CPAP was recorded. In patients who had CSA on CPAP, a second full-night attended CPAP titration was recommended. Eighty-four of the 1286 patients developed a central apnea index (CAI) of 5 or greater per hour while on CPAP. The incidence of CSA varied from 3% to 10% monthly, with an overall incidence of 6.5%. Forty-two of the 84 patients returned for a second CPAP titration. In 33 patients, CSA was eliminated. In each of the remaining 9 patients, the CAI remained at 5 or greater per hour, with an average of 13 per hour. These patients characteristically had the most severe OSA, and 5 had a CAI of 5 or more per hour at baseline. Two of the 9 patients were on opioids In this large retrospective study of 1286 patients with a diagnosis of OSA, 6.5% had CPAP-emergent or persistent CSA. However, CPAP-emergent CSA was generally transitory and was eliminated within 8 weeks after CPAP therapy. The prevalence of CPAP-persistent CSA was about 1.5%. Severity of OSA, a CAI of 5 or greater per hour, and use of opioids were potential risk factors.
Susarla, Srinivas M; Mundinger, Gerhard S; Kapadia, Hitesh; Fisher, Mark; Smartt, James; Derderian, Christopher; Dorafshar, Amir; Hopper, Richard A
Obstructive sleep apnea (OSA) is a common problem in patients with achondroplasia. The purpose of this study was to assess changes in airway volumes following various degrees of facial skeletal advancement. This was a retrospective evaluation of patients with achondroplasia who underwent facial skeletal advancement for obstructive sleep apnea. Patients were treated with either an isolated Le Fort III distraction (LF3) or Le Fort II distraction with or without subsequent Le Fort I and bilateral sagittal split osteotomies (LF2 ± LF1/BSSO). Demographic, cephalometric, volumetric, and polysomnographic variables were recorded pre- and postoperatively. Six patients with achondroplasia underwent midface advancement for treatment of OSA (2 LF2 + LF1/BSSO, 2 LF2, 2 LF3). Patients undergoing LF2 + LF1/BSSO had consistent volumetric improvements at the nasopharyngeal and oropharyngeal levels (Δ ≥ +347% and ≥+253%, respectively). Patients undergoing LF2 alone had consistent improvement in the nasopharyngeal airway alone (Δ ≥ +214%). Patients undergoing LF3 alone had consistent, but less dramatic, changes in nasopharyngeal volume (Δ ≥ +97.1%). All patients undergoing LF2 distraction (with or without LF1/BSSO) had a ≥50% reduction in the apnea-hypopnea index (AHI) postoperatively; there was no improvement in AHI with LF3 alone. In patients with achondroplasia-associated OSA there are variable improvements in airway volume. This preliminary report suggests that LF2 distraction, with or without subsequent LF1/BSSO, may provide consistent reductions in AHI relative to LF3 distraction. Copyright © 2017. Published by Elsevier Ltd.
Richalet, Jean-Paul; Chenivesse, Cécile; Larmignat, Philippe; Meille, Laurent
A 24-year-old adult with a Down syndrome was admitted in December 2006 at the Moutiers hospital in the French Alps for an acute inaugural episode of high altitude pulmonary edema (HAPE) that occurred in the early morning of day 3 after his arrival to La Plagne (2000 m). This patient presented an interventricular septal defect operated on at the age of 7, a hypothyroidism controlled by 50 microg levothyrox, a state of obesity (BMI 37.8 kg/m(2)), and obstructive sleep apneas with a mean of 42 obstructive apneas or hypopneas per hour, treated with continuous positive airway pressure (CPAP). The patient refused to use his CPAP during his stay in La Plagne. At echocardiography, resting parameters were normal, with a left ventricular, ejection fraction of 60%, a normokinetic right ventricle, and an estimated systolic pulmonary artery pressure (sPAP) of 30 mmHg. At exercise, sPAP rose to 45 mmHg and the right ventricle was still normokinetic and not dilated. An exercise hypoxic tolerance test performed at 60 W and at the equivalent altitude of 3300 m revealed a severe drop in arterial oxygen saturation down to 60%, with an abnormal low ventilatory response to hypoxia, suggesting a defect in peripheral chemosensitivity to hypoxia. In conclusion, patients with Down syndrome, including adults with no cardiac dysfunction and regular physical activity, are at risk of HAPE even at moderate altitude when they suffer from obstructive sleep apneas associated with obesity and low chemoresponsiveness. This observation might be of importance since an increasing number of young adults with Down syndrome participate in recreational or sport activities, including skiing and mountaineering.
Full Text Available Introduction: Obstructive Sleep Apnea (OSA is characterized by recurrent episodes of apnea and hypopnea, secondary to collapse of the upper airways during sleep. OSA is frequently associated to cardiovascular complications. In Portugal, its magnitude is unknown. Methods: In 2014 a cross-sectional study was performed using the Portuguese General Practitioner (GP Sentinel Network (Rede MÃ©dicos Sentinela. Participants GP reported all OSA cases diagnosed and registered in their lists of users on the 31 December 2013.Frequency of OSA has been estimated by sex and age. OSA patients were also characterized by method of diagnosis, treatment, and underlying conditions.Association between risk factors and severe OSA (odds ratio was calculated using a logistic regression model adjusting confounding. Results: Prevalence of OSA on the population aged 25 years or more was 0.89% (95 CI: 0.80â1.00%; it was higher in males 1.47% (95 CI: 1.30â1.67% and in those aged between 65 and 74 (2.35%. Most had severe OSA (48.4%. Hypertension (75.9%, obesity (74.2% and diabetes mellitus (34.1% were the most frequent comorbidities. Being a male (OR: 2.6; 95 CI: 1.2â5.8 and having obesity (OR: 4.0; 95 CI: 1.8â8.6 were associated with an increased risk of severe OSA. Conclusion: Found frequency of OSA was lower than other countries estimates, which may be explained by differences on case definition but can also suggest underdiagnosis of this condition as reported by other authors. Keywords: Sleep apnea, Public health, Prevalence, Portugal
In order for a source of fissile material to be useful as a calibration instrument, it is necessary to know not only how much fissile material is in the source but also what the effective fissile content is. Because uranium and plutonium absorb thermal neutrons so Efficiently, material in the center of a sample is shielded from the external thermal flux by the surface layers of the material. Differential dieaway measurements in the APNea System of five different sets of cylindrical fissile sources show the various self shielding effects that are routinely encountered. A method for calculating the self shielding effect is presented and its predictions are compared with the experimental results
Full Text Available Sleep disordered breathing is a term which includes simple snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA. Simple snoring is a common complaint affecting 45% of adults occasionally and 25% of adults habitually and is a sign of upper airway obstruction. Snoring has also been identified as a possible risk factor for hypertension, ischemic heart disease, and stroke. The role of dentistry in sleep disorders is becoming more significant, especially in co-managing patients with simple snoring and mild to moderate OSA. The practicing dental professional has the opportunity to assist patients at a variety of levels, starting with the recognition of a sleep-related disorder, referring patients to a physician for evaluation, and assisting in the management of sleep disorders. Obesity is the main predisposing factor for OSA. In nonobese patients, craniofacial anomalies like micrognathia and retrognathia may also predispose to OSA. Diagnosis of OSA is made on the basis of the history and physical examination and investigations such as polysomnography, limited channel testing, split-night testing, and oximetry. Nocturnal attended polysomnography, which requires an overnight stay in a sleep facility, is the standard diagnostic modality in determining if a patient has OSA. As far as treatment is concerned, the less invasive procedures are to be preferred to the more invasive options. The first and simplest option would be behavior modification, followed by insertion of oral devices suited to the patient, especially in those with mild to moderate OSA. Continuous positive airway pressure (CPAP and surgical options are chosen for patients with moderate to severe OSA. The American Academy of Sleep Medicine (AAOSM has recommended oral appliances for use in patients with primary snoring and mild to moderate OSA. It can also be used in patients with a lesser degree of oxygen saturation, relatively less day time sleepiness, lower frequency
Obstructive sleep apnea (OSA) is a main cause of excessive daytime sleepiness and increases the risk for driving accidents, which can be normalized by treatment with continuous positive airway pressure ventilation. Since it is estimated that OSA is not diagnosed in about 80% of cases, recognition of patients at risk for driving accidents is a problem from both medical and societal points of view. Strategies to screen and identify subjects at high risk for driving accidents are under study in order to improve safety on the road, especially for commercial drivers, who show a high prevalence of OSA.
Full Text Available Obstructive sleep apnea (OSA and chronic obstructive pulmonary disease (COPD are common disorders in clinical practice and are associated with significant cardiovascular morbidity. The simultaneous occurrence of OSA and COPD happens frequently and is referred to as an overlap syndrome. These patients often have very poor quality sleep and more nocturnal hypoxemia. This combination may increase the severity of metabolic complications and cardiovascular disease, and these patients have increased mortality when compared to patients with either COPD or OSA alone. The treatment of overlap syndrome should focus on both coexisting diseases and includes continuous positive airway pressure, oxygen supplementation, and medications for chronic lung disease.
Salerno, F G; Carpagnano, E; Guido, P; Bonsignore, M R; Roberti, A; Aliani, M; Vignola, A M; Spanevello, A
Obstructive sleep apnea syndrome (OSAS) has been shown to be associated to upper airway inflammation. The object of the present study was to establish the presence of bronchial inflammation in OSAS subjects. In 16 subjects affected by OSAS, and in 14 healthy volunteers, airway inflammation was detected by the cellular analysis of the induced sputum. OSAS patients, as compared to control subjects, showed a higher percentage of neutrophils (66.7+/-18.9 vs. 25.8+/-15.6) (Pbronchial inflammation characterized by a significant increase in neutrophils.
M. V. Gorbunova
Full Text Available Since the moment when the obstructive nature of sleep apnea was first revealed, many new in-formation on this disease have been obtained. Now obstructive sleep apnea (OSA recognized as an independent predictor of the development of impaired glucose tolerance (insulin resistance, fasting hyperglycaemia, type 2 diabetes mellitus (DM2, resistant arterial hypertension, cardio- vascular death. The problem of identifying and treating patients with OSA is still actual. In real clinical practice, there is a need for an integrated approach to the diagnosis and therapy of comorbid OSA patients with metabolic impairment and cardiovascular diseases.The aim of this review is to assess the clinical and pathogenesis features of metabolic impaired, carbohydrate metabolism, basic metabolism, eating behavior, body weight fluctuations in patients with ob-structive sleep apnea syndrome. Methods. In our work, we used a retrospective analysis of pub-lished clinical research data of domestic and foreign authors over the past 20 years. The review included studies with adequate design from the standpoint of «good clinical practice» (GCP and evidence-based medicine.The conclusion. According to modern interpretation, obstructive sleep apnea is considered as an independent disease that has its pathogenic mechanisms, clinical and functional manifestations. There are several main causes of the effect of OSA on the metabolic component and the work of the cardiovascular system. Among them, intermittent hypoxemia, endothelial dysfunction, fluctuations in intrathoracic pressure, increased activity of the sympathetic nervous system, disturbance of the structure of sleep are leading. OSA is considered as a disease capable of disabling patients of working age, dramatically changing the quality of life, leading to early mortality due to cardiovascular disasters. Timely detection of clinical symptoms of OSA and the strategy of early
Mello Junior, Carlos Fernando de; Guimaraes Filho, Helio Antonio; Gomes, Camila Albuquerque de Brito; Paiva, Camila Caroline de Amorim, E-mail: firstname.lastname@example.org [Universidade Federal da Paraiba UFPB, Joao Pessoa (Brazil)
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction occurring at the level of the pharynx during sleep. Although cephalometric analysis is an important method in the diagnosis of craniofacial deformities, CT and magnetic resonance imaging have been highlighted as the major imaging methods to investigate the possible causes of OSA, which, in most cases, is multifactorial. Magnetic resonance and CT both allow an excellent evaluation of the various anatomical planes of the site of obstruction, which enables better clinical assessment and surgical approach. This pictorial essay aims to describe the aspects that must be evaluated in the diagnostic imaging of patients presenting with the major predisposing factors for OSA. (author)
Lack, Leon; Sweetman, Alexander
Insomnia is often comorbid with obstructive sleep apnea. It reduces positive airway pressure (PAP) therapy acceptance and adherence. Comorbid patients show greater daytime impairments and poorer health outcomes. The insomnia often goes undiagnosed, undertreated, or untreated. Pharmacotherapy is not recommended for long-term treatment. Although care should be taken administering behavioral therapies to patients with elevated sleepiness, cognitive behavior therapy for insomnia (CBTi) is an effective and durable nondrug therapy that reduces symptoms and may increase the effectiveness of PAP therapy. Sleep clinics should be alert to comorbid insomnia and provide adequate diagnostic tools and clinicians with CBTi expertise. Copyright © 2016 Elsevier Inc. All rights reserved.
Mello Junior, Carlos Fernando de; Guimaraes Filho, Helio Antonio; Gomes, Camila Albuquerque de Brito; Paiva, Camila Caroline de Amorim
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction occurring at the level of the pharynx during sleep. Although cephalometric analysis is an important method in the diagnosis of craniofacial deformities, CT and magnetic resonance imaging have been highlighted as the major imaging methods to investigate the possible causes of OSA, which, in most cases, is multifactorial. Magnetic resonance and CT both allow an excellent evaluation of the various anatomical planes of the site of obstruction, which enables better clinical assessment and surgical approach. This pictorial essay aims to describe the aspects that must be evaluated in the diagnostic imaging of patients presenting with the major predisposing factors for OSA. (author)
Kreutzer, K; Bassler, D
Caffeine, a methylxanthine and nonspecific inhibitor of adenosine receptors, is an example of a drug that has been in use for more than 40 years. It is one of the most commonly prescribed drugs in neonatal medicine. However, until 2006, it had only a few relatively small and short-term studies supporting its use. It is thanks to the efforts of Barbara Schmidt and the Caffeine for Apnea of Prematurity (CAP) Trial Group that we now have high-quality and reliable data not only on short-term but ...
Kikuchi, Makoto; Higurashi, Naoki; Miyazaki, Soichiro
The roles of dentistry in obstructive sleep apnea syndrome (OSAS) are mainly: Craniofacial skeletal diagnosis, Treatment by oral appliance, Prevention of craniofacial skeletal problem. We use cephalometrics, CT and MRI to diagnose craniofacial skeleton of the patients and treat the OSAS patient by the oral appliance. We could make the airway of the OSAS patients bigger by the orthodontic treatment and ENT doctor could make the airway of the patient's patency by removing tonsils and adenoids. If the patient has the airway patency, the mandible of the patient could grow naturally in advanced position and have the airway bigger, consequently the patient could avoid OSAS in his future. (author)
Stanson, A.W.; Sheedy, P.F.; Westbrook, P.R.; Shepard, J.W.; Welch, T.J.
Sleep apnea affects 3%-4% of the adult male population. Fifty percent of these patients fail to respond to uvulopalatopharyngoplasty (UPP), which increases the patency of the oropharynx. Failure to respond to surgery may result from collapse in the hypopharynx. Fast CT (50-msec scan duration) was performed in 20 patients to demonstrate the regions of narrowing and collapsibility of the upper airway with tidal ventilation during wakefulness. While 67% of the patients showed narrowing ( 2 ) confined to the oropharynx, 33% additionally showed narrowing of the hypopharynx. Patients in this latter group may be poor candidates for UPP, which does not increase hypopharynx patience
Park, John G; Ramar, Kannan; Olson, Eric J
Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field.
Full Text Available Terri E Weaver,1,2 Michael W Calik,1,2 Sarah S Farabi,1,2 Anne M Fink,1,2 Maria T Galang-Boquiren,2,3 Mary C Kapella,1,2 Bharati Prasad,2,4 David W Carley1,21Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago; 2Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, 3Department of Orthodontics, University of Illinois at Chicago College of Dentistry, 4Sleep Center, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USAAbstract: Obstructive sleep apnea (OSA affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical
Baertsch, N.A.; Baker, T.L.
Two critical parameters that influence breathing stability are the levels of arterial pCO2 at which breathing ceases and subsequently resumes – termed the apneic and recruitment thresholds (AT and RT, respectively). Reduced respiratory neural activity elicits a chemoreflex-independent, long-lasting increase in phrenic burst amplitude, a form of plasticity known as inactivity-induced phrenic motor facilitation (iPMF). The physiological significance of iPMF is unknown. To determine if iPMF and neural apnea have long-lasting physiological effects on breathing, we tested the hypothesis that patterns of neural apnea that induce iPMF also elicit changes in the AT and RT. Phrenic nerve activity and end-tidal CO2 were recorded in urethane-anesthetized, ventilated rats to quantify phrenic nerve burst amplitude and the AT and RT before and after three patterns of neural apnea that differed in their duration and ability to elicit iPMF: brief intermittent neural apneas, a single brief “massed” neural apnea, or a prolonged neural apnea. Consistent with our hypothesis, we found that patterns of neural apnea that elicited iPMF also resulted in changes in the AT and RT. Specifically, intermittent neural apneas progressively decreased the AT with each subsequent neural apnea, which persisted for at least 60 min. Similarly, a prolonged neural apnea elicited a long-lasting decrease in the AT. In both cases, the magnitude of the AT decrease was proportional to iPMF. In contrast, the RT was transiently decreased following prolonged neural apnea, and was not proportional to iPMF. No changes in the AT or RT were observed following a single brief neural apnea. Our results indicate that the AT and RT are differentially altered by neural apnea and suggest that specific patterns of neural apnea that elicit plasticity may stabilize breathing via a decrease in the AT. PMID:27474512
Mutlu, L C; Tülübaş, F; Alp, R; Kaplan, G; Yildiz, Z D; Gürel, A
Obstructive sleep apnea syndrome (OSAS) has been associated with elevated biochemical markers of inflammation. Although the exact mechanism is unknown, both sleep deprivation and hypoxemia are believed to be important causative factors. YKL-40, also known as chitinase-like protein, has been shown to be related to various inflammatory conditions including atherosclerosis, diabetes, cancer, and asthma. The present study aimed to evaluate the relationship between YKL-40 levels and the Apnea Hypopnea Index (AHI) in patients with obstructive sleep apnea syndrome. The study was conducted at the Sleep Unit of the Namik Kemal University Research Center. From January 2013 to December 2013, 120 patients diagnosed with OSAS by polysomnography and 40 subjects without OSAS were recruited. Patients in both groups were matched by age, sex, and body mass index (BMI). They were further divided into groups of mild, moderate and severe OSAS based on their AHI value. Serum YKL-40 concentrations were measured by the enzyme-linked immunosorbent assay (ELISA). OSAS patients showed significantly elevated YKL-40 levels compared to the control group; 102,05 (23.14) pg/ml in the control group vs. 144.81 (65.53) pg/ml in the OSAS group. A Spearman correlation analysis showed that serum YKL-40 levels were significantly and positively correlated with AHI (r = 0.434, p < 0.001) and oxygen desaturation index (r = 0.374, p < 0.001). The study demonstrated that high serum YKL-40 levels correlated with the severity of OSAS and might serve as a nonspecific biomarker for prediction and progression of the disease.
Patel, Namita; Raissi, Afsaneh; Elias, Sara; Kamra, Maneesha; Kendzerska, Tetyana; Murray, Brian J; Boulos, Mark I
Home sleep apnea testing (HSAT) underestimates obstructive sleep apnea (OSA) severity. Overnight oxygen desaturation has been shown to be a strong predictor of incident stroke, and may be helpful in determining which patients with lower apnea-hypopnea indices (AHIs) should be offered treatment. To examine whether a modified definition for OSA that uses oxygen desaturation (i.e., AHI 5-14.9 per hour and lowest O 2 desaturation ≤88%), as compared to an AHI ≥ 15 per hour, would impact: (1) changes in Epworth Sleepiness Scale scores post-continuous positive airway pressure (CPAP) initiation; (2) CPAP compliance rates; and (3) the accuracy of automated versus manual scoring of HSAT. One hundred and six patients with a prior stroke or transient ischemic attack (TIA) underwent HSAT. Epworth Sleepiness Scale and CPAP compliance were measured at baseline and 3-6 months. Median age was 67.5 years, 57.5% male, and 76.4% presented with stroke. Fifty-nine patients were diagnosed with OSA; of these 54.2% met criteria for the "modified definition" for OSA (AHI 5-14.9 per hour with oxygen desaturation) and 45.8% met criteria for the "classic definition" for OSA (AHI ≥15). The modified (versus classic) definition had: (1) a greater decrease in ESS (P = .05) post-CPAP initiation; (2) comparable CPAP compliance rates; and (3) comparable automatically versus manually scored AHIs (Spearman's rho = .96, Cohen's Kappa ≥ .75 for both definitions, P definition of OSA that uses a lower AHI cutoff and includes an oxygen desaturation cutoff in the setting of HSAT for stroke or transient ischemic attack (TIA) patients may improve daytime sleepiness post-CPAP initiation, while not significantly affecting CPAP compliance rates nor the accuracy of automated scoring. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Donovan, Lucas M; Liu, Yuzhen; Weiss, J Woodrow
Chronic hypoxia increases the hypoxic ventilatory response (HVR). Augmented HVR contributes to central apneas seen in heart failure and complex sleep apnea. Endothelin receptor (ETR) antagonism decreases carotid body afferent activity following chronic intermittent hypoxia (CIH). We speculated ETR antagonism would reduce HVR and apneas following CIH. HVR and apneas were measured after exposure to CIH and room air sham (SHAM). ETR blocker Ambrisentan was administered via the chow of CIH-exposed animals from days 1 to 12 of CIH (CIH/AMB). A separate crossover group was exposed to CIH and fed normal chow (placebo) days 1-6, and Ambrisentan days 7-12 (CIH/PLA-AMB). SHAM and CIH/PLA animals were fed placebo days 1-12. The CIH/AMB and CIH/PLA-AMB rats had reduced HVR compared to CIH/PLA, similar HVR compared to sham exposed animals, and reduced apnea frequency compared to CIH/PLA animals. The reduced HVR and post-hypoxic apneas resulting from Ambrisentan administration suggests ETR antagonists may have utility in reducing central apneas following CIH. Copyright © 2014 Elsevier B.V. All rights reserved.
Borges, Paulo de Tarso Moura; Silva, Benedito Borges da; Moita Neto, José Machado; Borges, Núbia Evangelista de Sá; Li, Li M
Patients with obstructive sleep apnea syndrome usually present with changes in upper airway morphology and/or body fat distribution, which may occur throughout life and increase the severity of obstructive sleep apnea syndrome with age. To correlate cephalometric and anthropometric measures with obstructive sleep apnea syndrome severity in different age groups. A retrospective study of cephalometric and anthropometric measures of 102 patients with obstructive sleep apnea syndrome was analyzed. Patients were divided into three age groups (≥20 and <40 years, ≥40 and <60 years, and ≥60 years). Pearson's correlation was performed for these measures with the apnea-hypopnea index in the full sample, and subsequently by age group. The cephalometric measures MP-H (distance between the mandibular plane and the hyoid bone) and PNS-P (distance between the posterior nasal spine and the tip of the soft palate) and the neck and waist circumferences showed a statistically significant correlation with apnea-hypopnea index in both the full sample and in the ≥40 and <60 years age group. These variables did not show any significant correlation with the other two age groups (<40 and ≥60 years). Cephalometric measurements MP-H and PNS-P and cervical and waist circumferences correlated with obstructive sleep apnea syndrome severity in patients in the ≥40 and <60 age group. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Paulo de Tarso Moura Borges
Full Text Available Introduction: Patients with obstructive sleep apnea syndrome usually present with changes in upper airway morphology and/or body fat distribution, which may occur throughout life and increase the severity of obstructive sleep apnea syndrome with age. Objective: To correlate cephalometric and anthropometric measures with obstructive sleep apnea syndrome severity in different age groups. Methods: A retrospective study of cephalometric and anthropometric measures of 102 patients with obstructive sleep apnea syndrome was analyzed. Patients were divided into three age groups (≥20 and <40 years, ≥40 and <60 years, and ≥60 years. Pearson's correlation was performed for these measures with the apnea-hypopnea index in the full sample, and subsequently by age group. Results: The cephalometric measures MP-H (distance between the mandibular plane and the hyoid bone and PNS-P (distance between the posterior nasal spine and the tip of the soft palate and the neck and waist circumferences showed a statistically significant correlation with apnea-hypopnea index in both the full sample and in the ≥40 and <60 years age group. These variables did not show any significant correlation with the other two age groups (<40 and ≥60 years. Conclusion: Cephalometric measurements MP-H and PNS-P and cervical and waist circumfer- ences correlated with obstructive sleep apnea syndrome severity in patients in the ≥40 and <60 age group.
Waldemark, Karina E.; Agehed, Kenneth I.; Lindblad, Thomas; Waldemark, Joakim T. A.
Sleep apnea is characterized by frequent prolonged interruptions of breathing during sleep. This syndrome causes severe sleep disorders and is often responsible for development of other diseases such as heart problems, high blood pressure and daytime fatigue, etc. After diagnosis, sleep apnea is often successfully treated by applying positive air pressure (CPAP) to the mouth and nose. Although effective, the (CPAP) equipment takes up a lot of space and the connected mask causes a lot of inconvenience for the patients. This raised interest in developing new techniques for treatment of sleep apnea syndrome. Several studies have indicated that electrical stimulation of the hypoglossal nerve and muscle in the tongue may be a useful method for treating patients with severe sleep apnea. In order to be able to successfully prevent the occurrence of apnea it is necessary to have some technique for early and fast on-line detection or prediction of the apnea events. This paper suggests using measurements of respiratory airflow (mouth temperature). The signal processing for this task includes the use of a short window FFT technique and uses an artificial back propagation neural net to model or predict the occurrence of apneas. The results show that early detection of respiratory interruption is possible and that the delay time for this is small.
Camargo, Vania Carla; Honorato da Silva, Sandra; Freitas de Amorim, Mardson; Nohama, Percy
Apnea of prematurity is very frequent in premature newborns (PNB). If the apnea episode is not interrupted in time, it can cause several damages to the newborn's central nervous system. In this paper, we introduce a novel technology for detecting apnea of prematurity episodes, based on cardiac pulse frequency (PF) and arterial oxygen saturation (SpO2) simultaneously, and using vibrotactile stimulation to interrupt such episodes. The thresholds of the newborns' PF and SpO2 had been established to identify the apnea episode automatically through the proposed system: for babies ≤ 35 weeks gestation, PF is ≤ 100 bpm and SpO2 ≤ 80%; for babies > 35 weeks gestation, PF is ≤ 80 bpm and SpO2 ≤ 80%. The system used vibrotactile stimuli at 250 Hz for 4 s. To manage the system that activates the vibratory device automatically and registers those parameters, a program had been developed. It registers apnea occurrence, period of manual stimulation and vibratory stimulation duration. This technique was tested on 4 PNB. It was observed 10 apnea episodes and the device was successful in the detection of all of them. The vibrotactile stimulation was capable of promoting the return of respiratory movements in 9 of the 10 detected events of apnea and seemed to be a promising means of handling them.
Grady, Anthony J; Hankins, Jane S; Haberman, Brent; Schoumacher, Robert; Stocks, Rose Mary
While hydroxyurea is the mainstay of treatment for many of the comorbidities associated with sickle cell disease, its effect on obstructive sleep apnea has not been fully investigated. The purpose of this project is to help characterize the effects of hydroxyurea on obstructive sleep apnea in children with sickle cell disease and determine its therapeutic role in the condition. Chart review was conducted on two pediatric patients with sickle cell disease who experienced resolution of obstructive sleep apnea following hydroxyurea administration. After undergoing approximately 11 months of hydroxyurea therapy, sleep apnea symptoms improved and obstructive sleep apnea resolution was confirmed by repeat polysomnography in both cases. This resolution was largely secondary to a reduction in the obstructive component of the apnea hypopnea index, highlighting a previously unreported association. As adenotonsillectomy is associated with significant risks in patients with sickle cell disease, it appears reasonable to consider a period of observation for improvement of obstructive sleep apnea following hydroxyurea administration rather than directly proceeding with surgery.
Xu, Huijie; Huang, Weining; Yu, Lisheng; Chen, Lan
This study demonstrates that there is a significant difference in sound spectrum between first snoring sound after upper level and lower level obstructive apneas, and it is possible to use sound spectrum analysis as a supplementary method to determine the obstructive site of a patient with obstructive sleep apnea syndrome (OSAS). To investigate the difference in sound spectrum between the first snoring sounds after upper level (above the free margin of soft palate) obstructive apneas and lower level (below the free margin of soft palate) obstructive apneas in patients with OSAS. Thirty male patients with OSAS were included in this study. Overnight snoring sound was recorded and continuous upper airway pressure measurement was performed simultaneously on each subject. The first snores after upper level and lower level obstructive apneas were identified and analyzed acoustically. The mean of peak frequencies, central frequencies, and proportions of energy from 800 Hz to 2000 Hz and above 2000 Hz of the first snoring sounds after lower level obstructive apneas were higher and the proportion of energy below 800 Hz was lower than those after upper level obstructive apneas. The differences of all the parameters were of significance. The power spectrum of the two types of snoring sounds also exhibited different characters.
Kanabar, Gorande; Boyd, Stewart; Schugal, Anna; Bhate, Sanjay
Apneic episodes have not previously been described in children with 1p36 deletion syndrome with seizures. Having encountered one such patient, we reviewed our experience of breathing difficulties in this syndrome, with particular attention to evidence of ictal apnea. We describe four children with 1p36 deletion syndrome, seizures and apneic episodes. Retrospective analysis of clinical features, seizure semiology and video-EEG data. All patients showed characteristic craniofacial features, mental retardation, and diffuse hypotonia and apnea. Seizure semiology included focal motor, ± secondary generalized tonic clonic and tonic events. All had histories of status epilepticus; three showed clustering of their habitual seizures. Assessment of apnea was complicated by the presence of multiple other potential causes including obesity, reflux, respiratory, and cardiac problems Epileptic apneas were confirmed in one child by video-telemetry. In three other children, an epileptic basis for apneas was inferred from their clinical histories and treatment response supported by EEG findings. In three children, epileptiform discharges occurred over fronto-centro-temporal regions. Epileptic apnea is a feature of 1p36 deletion syndrome, though episodic apnea is multifactorial in these children, and may need repeated re-appraisal. Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Nuding, Sarah C.; Segers, Lauren S.; Iceman, Kimberly E.; O'Connor, Russell; Dean, Jay B.; Bolser, Donald C.; Baekey, David M.; Dick, Thomas E.; Shannon, Roger; Morris, Kendall F.
Hyperventilation is a common feature of disordered breathing. Apnea ensues if CO2 drive is sufficiently reduced. We tested the hypothesis that medullary raphé, ventral respiratory column (VRC), and pontine neurons have functional connectivity and persistent or evoked activities appropriate for roles in the suppression of drive and rhythm during hyperventilation and apnea. Phrenic nerve activity, arterial blood pressure, end-tidal CO2, and other parameters were monitored in 10 decerebrate, vagotomized, neuromuscularly-blocked, and artificially ventilated cats. Multielectrode arrays recorded spiking activity of 649 neurons. Loss and return of rhythmic activity during passive hyperventilation to apnea were identified with the S-transform. Diverse fluctuating activity patterns were recorded in the raphé-pontomedullary respiratory network during the transition to hypocapnic apnea. The firing rates of 160 neurons increased during apnea; the rates of 241 others decreased or stopped. VRC inspiratory neurons were usually the last to cease firing or lose rhythmic activity during the transition to apnea. Mayer wave-related oscillations (0.04–0.1 Hz) in firing rate were also disrupted during apnea. Four-hundred neurons (62%) were elements of pairs with at least one hyperventilation-responsive neuron and a correlational signature of interaction identified by cross-correlation or gravitational clustering. Our results support a model with distinct groups of chemoresponsive raphé neurons contributing to hypocapnic apnea through parallel processes that incorporate disfacilitation and active inhibition of inspiratory motor drive by expiratory neurons. During apnea, carotid chemoreceptors can evoke rhythm reemergence and an inspiratory shift in the balance of reciprocal inhibition via suppression of ongoing tonic expiratory neuron activity. PMID:26203111
Bin, Yu Sun; Cistulli, Peter A; Roberts, Christine L; Ford, Jane B
Sleep apnea in pregnancy is known to adversely affect birth outcomes. Whether in utero exposure to maternal sleep apnea is associated with long-term childhood consequences is unclear. Population-based longitudinal study of singleton infants born during 2002-2012 was conducted using linked birth, hospital, death, developmental, and educational records from New South Wales, Australia. Maternal sleep apnea during pregnancy was identified from hospital records. Outcomes were mortality and hospitalizations up to age 6, developmental vulnerability in the first year of school (aged 5-6 years), and performance on standardized tests in the third year of school (aged 7-9 years). Cox proportional hazards and modified Poisson regression models were used to calculate hazard and risk ratios for outcomes in children exposed to maternal apnea compared with those not exposed. Two hundred nine of 626188 singleton infants were exposed to maternal sleep apnea. Maternal apnea was not significantly associated with mortality (Fisher's exact p = .48), developmental vulnerability (adjusted RR 1.29; 95% CI 0.75-2.21), special needs status (1.58; 0.61-4.07), or low numeracy test scores (1.03; 0.63-1.67) but was associated with low reading test scores (1.55; 1.08-2.23). Maternal apnea significantly increased hospitalizations in the first year of life (adjusted HR 1.81; 95% CI 1.40-2.34) and between the first and sixth birthdays (1.41; 1.14-1.75). This is partly due to admissions for suspected pediatric sleep apnea. Maternal sleep apnea during pregnancy is associated with poorer childhood health. Its impact on developmental and cognitive outcomes warrants further investigation. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail email@example.com.
Michel Burihan Cahali
Full Text Available OBJECTIVES: The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION: Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS: We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS: We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS: There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.
Skouroliakou, Maria; Bacopoulou, Flora; Markantonis, Sophia L
To compare standard doses of theophylline and caffeine for apnea of prematurity in terms of apnea frequency and assess the need for therapeutic drug monitoring. Seventy neonates less than 33 weeks gestation, breathing spontaneously, were randomly assigned (open-label) to receive either theophylline or caffeine for treatment or prevention of apnea. The primary outcome measure was the difference in apnea frequency between theophylline and caffeine patient groups. Methylxanthine serum levels were measured on the 1st, 3rd and 7th days of therapy and every 7 days thereafter. Thirty-seven neonates received theophylline (T) and 33 caffeine (C) for treatment (8 T/10 C) or prevention of apnea (29 T/23 C). Treatment with either methylxanthine significantly decreased apnea events (T, P= 0.012; C, P= 0.005) while only C prophylaxis appeared to control apnea in infants at risk. Analysis of combined (treatment plus prophylaxis) data showed a significant decrease in apnea frequency only in those infants receiving caffeine (P= 0.001). However, there was no sustained benefit of C over T beyond the first week of therapy. T and C concentrations (2.2-13.9 mg/L; 5.5-23.7 mg/L, respectively) in the majority of cases fell within the recommended therapeutic ranges and were not significantly associated with apnea events. This study shows an advantage of C over T for premature infants <33 weeks gestation during the first week of therapy. Standard regimens of both methylxanthines do not seem to require routine concentration monitoring in the first 3 weeks of treatment unless indicated by clinical effect.
Debora Petrungaro Migueis
Full Text Available ABSTRACT INTRODUCTION: Obstructive sleep apnea syndrome (OSAS is a common disorder that can lead to cardiovascular morbidity and mortality, as well as to metabolic, neurological, and behavioral consequences. It is currently believed that nasal obstruction compromises the quality of sleep when it results in breathing disorders and fragmentation of sleep. However, recent studies have failed to objectively associate sleep quality and nasal obstruction. OBJECTIVE: The aim of this systematic review is to evaluate the influence of nasal obstruction on OSAS and polysomnographic indices associated with respiratory events. METHODS: Eleven original articles published from 2003 to 2013 were selected, which addressed surgical and non-surgical treatment for nasal obstruction, performing polysomnography type 1 before and after the intervention. RESULTS/CONCLUSIONS: In most trials, nasal obstruction was not related to the apnea-hypopnea index (AHI, indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation.
Foster, Gary D.; Sanders, Mark H.; Millman, Richard; Zammit, Gary; Borradaile, Kelley E.; Newman, Anne B.; Wadden, Thomas A.; Kelley, David; Wing, Rena R.; Pi Sunyer, F. Xavier; Darcey, Valerie; Kuna, Samuel T.
OBJECTIVE To assess the risk factors for the presence and severity of obstructive sleep apnea (OSA) among obese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Unattended polysomnography was performed in 306 participants. RESULTS Over 86% of participants had OSA with an apnea-hypopnea index (AHI) ≥5 events/h. The mean AHI was 20.5 ± 16.8 events/h. A total of 30.5% of the participants had moderate OSA (15 ≤ AHI <30), and 22.6% had severe OSA (AHI ≥30). Waist circumference (odds ratio 1.1; 95% CI 1.0–1.1; P = 0.03) was significantly related to the presence of OSA. Severe OSA was most likely in individuals with a higher BMI (odds ratio 1.1; 95% CI 1.0–1.2; P = 0.03). CONCLUSIONS Physicians should be particularly cognizant of the likelihood of OSA in obese patients with type 2 diabetes, especially among individuals with higher waist circumference and BMI. PMID:19279303
Lombardi, Carolina; Tobaldini, Eleonora; Montano, Nicola; Losurdo, Anna; Parati, Gianfranco
There is increasing evidence of a relationship between Obstructive Sleep Apnea (OSA) and cardiovascular diseases. The strong association between OSA and arterial hypertension, in particular in patients with resistant hypertension and/or a non-dipping profile, has been extensively reported. The relationship between OSA and high blood pressure (BP) has been found independent from a number of confounders, but several factors may affect this relationship, including age and sex. It is thus important to better assess pathophysiologic and clinical interactions between OSA and arterial hypertension, also aimed at optimizing treatment approaches in OSA and hypertensive patients with co-morbidities. Among possible mechanisms, cardiovascular autonomic control alterations, altered mechanics of ventilation, inflammation, endothelial dysfunction, and renin-angiotensin-aldosterone system should be considered with particular attention. Additionally, available studies also support the occurrence of a bidirectional association between OSA and cardiovascular alterations, in particular heart failure, stroke and cardiac arrhythmias, emphasizing that greater attention is needed to both identify and treat sleep apneas in patients with cardiovascular diseases. However, a number of aspects of such a relationship are still to be clarified, in particular with regard to gender differences, effect of sleep-related breathing disorders in childhood, and influence of OSA treatment on cardiovascular risk, and they may represent important targets for future studies.
Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications
Martins, Carlos Henrique; Castro Júnior, Ney de; Costa Filho, Orozimbo Alves; Souza Neto, Osmar Mesquita de
The obstructive sleep apnea syndrome (OSAS) reduces attention span, memory and concentration capacities, all associated with cognition. The analysis of the auditory P300 parameters could help infer cognitive dysfunction. To compare the data from polysomnography and the auditory P300 in adults, primary snorers with OSAS patients. Prospective study with primary snorers (N=12) and in OSAS patients (N=54), submitted to polysomnography, defined by the apnea-hypopnea index (AHI). The polysomnography and P300 variables were compared by the t-Student test, the Exact Fisher's Test, logistic regression and analysis of correlation with a significance level of 5%. AIH had an inverse correlation with the oximetry in both groups. The P300 prevalence was lower in the OSAS group (Fisher's Exact Test, p=0.027). Patient age did not influence the P300 prevalence (regression analysis; p=0.232). The P300 amplitude was lower in the OSAS group (t-Student test; p=0.003) and the P300 latency was similar in both groups (t-Student test; p=0.89). The reduction in the P300 amplitude in patients with OSAS suggests cognitive dysfunction induced by a reduction in auditory memory.
Tal, A.; Leiberman, A.; Margulis, G.; Sofer, S.
Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.
Tzur-Gadassi, L; Hevroni, A; Gross, M; Davidovich, E
Sleep disturbed breathing in children, is a general term describing a wide range of respiratory disorders that occur during sleep, ranging from snoring to Obstructive Sleep apnea syndrome (OSAS). In recent years, the role of OSAS in a vast range of morbidities has been recognized, namely metabolic, neuro-cognitive and cardio-vascular disorders, thus emphasizing the importance of early detection. The recommended initial treatment for pediatric OSAS consists of surgical removal of adenoids and tonsils. However, today it is clear that there are other factors involved in the etiology of the syndrome. An association is believed to exist between the airway and craniofacial development and vice versa. The structure of the face and jaws has been shown to play an important role in the pathophysiology of OSAS, thus, the orthodontist plays a substantial role in the diagnosis and treatment of these children. Moreover, OSAS is believed to have a direct and indirect effect on oral health. Obstructive Sleep apnea syndrome is also common in adults, but is defined as a separate entity being different in terms of pathophysiology, clinical presentation and treatment. This paper reviews the pathophysiology, diagnosis, clinical implications and available treatment options for pediatric OSAS. Moreover, we will review the impact of the condition on the structures of the face, jaws, mouth and teeth and discuss the dentist's critical role in identifying and treating these problems.
Montenegro, Brian L; Amberson, Michael; Veit, Lauren; Freiberger, Christina; Dukhovny, Dmitry; Rhein, Lawrence M
Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness. Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified. In-patient costs for discharge-delaying ABD events were compared with hypothetical out-patient management. Out-patient costs took into account 4-10 d of in-patient observation for ABD events before caffeine initiation, 3-5 d of additional in-patient observation before discharge, daily caffeine until 43 weeks corrected gestational age, home pulse oximetry monitoring until 44 weeks corrected gestational age, and consideration of variable readmission rates ranging from 0 to 10%. A total of 425 late preterm and term infants were included in our analysis. Utilization of hypothetical out-patient management resulted in cost savings per eligible patient ranging from $2,422 to $62, dependent upon variable periods of in-patient observation. Sensitivity analysis demonstrated few instances of decreased relative cost-effectiveness. Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation. Copyright © 2017 by Daedalus Enterprises.
Jose E. Barrera
Full Text Available Objective: Determine if anatomic dimensions of airway structures are associated with airway obstruction in obstructive sleep apnea (OSA patients. Methods: Twenty-eight subjects with (n = 14 and without (n = 14 OSA as determined by clinical symptoms and sleep studies; volunteer sample. Skeletal and soft tissue dimensions were measured from radiocephalometry and magnetic resonance imaging. The soft palate thickness, mandibular plane-hyoid (MP-H distance, posterior airway space (PAS diameters and area, and tongue volume were calculated. Results: Compared to controls, the OSA group demonstrated a significantly longer MP-H distance (P = 0.009 and shorter nasal PAS diameter (P = 0.02. The PAS area was smaller (P = 0.002 and tongue volume larger in the OSA group (P = 0.004. The MP-H distance, PAS measurements, and tongue volume are of clinical relevance in OSA patients. Conclusions: A long MP-H distance, and small PAS diameters and area are significant anatomic measures in OSA; however the most substantial parameter found was a large tongue volume. Keywords: Obstructive sleep apnea, Anatomy, Anatomic measurement, Posterior airway space, Tongue volume, Hyoid position
B. M. Ester Hidalgo, Dra.
Full Text Available Desde la década de los 80, los odontólogos de las especialidades de Ortodoncia y Cirugía Maxilofacial, integrados a un equipo multidisciplinario, juegan un rol importante en la terapia del ronquido y del Síndrome Apnea-Hipoapnea Obstructiva del Sueño (SAHOS. Este artículo describe los Dispositivos de Avance Mandibular (DAM como tratamiento del SAHOS, las consideraciones anatómicas, estudios sobre su efectividad y control de su eficiencia. Se clasifican y detalla su mecanismo de acción, criterios de elección y sus efectos secundarios. Se presentan 2 casos clínicos que utilizaron un DAM de diseño nacional durante un mes, donde previo y posterior al uso de este aparato se midió el Índice Apnea e Hipoapnea, ronquidos y saturación de oxígeno con el Apnealink. Como resultado, se obtuvo una disminución en los valores de todos estos índices, calificando el tratamiento con DAM como exitoso en la terapia del SAHOS.
Azarbarzin, Ali; Moussavi, Zahra
Snoring sounds vary significantly within and between snorers. In this study, the variation of snoring sounds and its association with obstructive sleep apnea (OSA) are quantified. Snoring sounds of 42 snorers with different degrees of obstructive sleep apnea and 15 non-OSA snorers were analyzed. The sounds were recorded by a microphone placed over the suprasternal notch of trachea, simultaneously with polysomnography (PSG) data over the entire night. We hypothesize that snoring sounds vary significantly within a subject depending on the level of obstruction, and thus the level of airflow. We also hypothesize that this variability is associated with the severity of OSA. For each individual, we extracted snoring sound segments from the respiratory recordings, and divided them into three classes: non-apneic, hypopneic, and post-apneic using their PSG information. Several features were extracted from the snoring sound segments, and compared using a nonparametric statistical test. The results show significant shift in the median of features among the snoring sound classes (psnoring sounds did not vary significantly over time in non-apneic class. Therefore, we used the total variation norm of each subject to classify the participants as OSA and non-OSA snorers. The results showed 92.9% sensitivity, 100% specificity and 96.4% accuracy. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.
Full Text Available Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP among Hispanics with obstructive sleep apnea (OSA. Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53±11 yrs; body mass index (BMI=45±9 kg/m2 with apnea-hypopnea index (AHI 33±30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P=0.006, income level (P<0.001, and employment status (P=0.03 between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P=0.03, P=0.004, and P=0.001, resp., as well as in Hispanics (P=0.02, P=0.02, P=0.03, resp.. Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.
Tal, A.; Leiberman, A.; Margulis, G.; Sofer, S.
Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present
Dell'Aquila, C. R.; Cañadas, G. E.; Correa, L. S.; Laciar, E.
This work describes the design of an algorithm for detecting apnea episodes, based on analysis of thorax respiratory effort signal. Inspiration and expiration time, and range amplitude of respiratory cycle were evaluated. For range analysis the standard deviation statistical tool was used over respiratory signal temporal windows. The validity of its performance was carried out in 8 records of Apnea-ECG database that has annotations of apnea episodes. The results are: sensitivity (Se) 73%, specificity (Sp) 83%. These values can be improving eliminating artifact of signal records.
A V Dreval'
Full Text Available Aims. To assess the risk for sleep apnea in patients with various types of glycemic disorders by means of Epworth Sleepiness Scale andSleep Apnea Screening Questionnaire.Materials and Methods. We examined 744 residents of Mozhaisk Region, that were considered to have high risk for development of type2 diabetes mellitus (T2DM, as estimated by FINDRISK Questionnaire. Patients, who scored 12+ were cleared for participation in this study. Combined score from Epworth Sleepiness Scale and Sleep Apnea Screening Questionnaire was applied for diagnosis of sleep apnea, supplemented with specific questions about snoring and episodes of apnea. Glycemic disorders were diagnosed with standard glucose tolerance test.Results. 42.7% of examined patients (n=318 were diagnosed with various types of glucose disorders. Prevalence of abdominal obe- sity (according to waist circumference measurement comprised 59.3% in male patients and 54.1% in females. We observed positive correlation between body mass index (BMI and snoring – 0.3 (p=0.0001, BMI and apnea – 0.2 (p=0.0001, BMI and daytime sleepiness – 0.1 (p=0.007; we also observed direct correlation between age and snoring – 0.2 (p=0.0001, as well as age and sleep apnea – 0.1 (p=0.028. Risk for sleep apnea was found to be 4.7 times higher in patients with arterial hypertension. After adjustment71Диагностика, контроль и лечениеСахарный диабет. 2013;(1:71–77Сахар ный диабетfor age risk of apnea remained 2.8 times higher in patients with T2DM, 1.9 times higher in subjects with impaired glucose tolerance and1.6 times higher in subjects with impaired fasting glycaemia. Relative risk for snoring in patients with various types of glycemic disorders was 1.1-1.2 against normoglycemic controls. We estimated that all types of glycemic disorders increase risk for apnea 1.2–1.6 times. Conclusion. Glycemic disorders, body weight excess, obesity and arterial
Wang, Jinfeng; Xie, Yuping; Ma, Wei
Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by repeated episodes of upper airway obstruction that results in brief periods of breathing cessation (apnea) or a marked reduction in airflow (hypopnea) during sleep. Asthma is a chronic inflammatory disease of the airways characterized by revesible air-flow obstruction and bronchial hyperresponsiveness. This article reviewed related reseaches progress of relationship between the obstructive sleep apnea hypopnea syndrom and asthma in the vascular endothelial growth factor, systemic inflammation, leptin, obesity, gastroesophageal reflux disease and upper airway diseases, excessive daytime sleepiness and asthma control.
Full Text Available Obstructive sleep apnea (OSA is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI=25.2 and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI were considerably improved after six months (IAH =6.7 and one year of treatment (IAH=0.2.
Ferraz, Otávio; Guimarães, Thais M; Rossi, Rowdley R; Cunali, Paulo A; Fabbro, Cibele Dal; Chaves, Cauby M; Maluly, Milton; Bittencourt, Lia; Tufik, Sergio
Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).
Hein, Matthieu; Lanquart, Jean-Pol; Loas, Gwénolé; Hubain, Philippe; Linkowski, Paul
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 & 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.
Full Text Available Apnea test is a crucial requirement for determining the diagnosis of brain death (BD. There are few reports considering clinical complications during this procedure. We describe a major complication during performing the apnea test. We also analyse their practical and legal implications, and review the complications of this procedure in the literature. A 54 year-old man was admitted for impaired consciousness due to a massive intracerebral hemorrhage. Six hours later, he had no motor response, and all brainstem reflexes were negative. The patient fulfilled American Academy of Neurology (AAN criteria for determining BD. During the apnea test, the patient developed pneumothorax, pneumoperitoneum, and finally cardiac arrest. Apnea test is a necessary requirement for the diagnosis of brain death. However, it is not innocuous and caution must be take in particular clinical situations. Complications during the apnea test could be more frequent than reported and may have practical and legal implications. Further prospective studies are necessary to evaluate the frequency and nature of complications during this practice.El test de apnea (AT es un requerimiento esencial para el diagnóstico de muerte encefálica. Hay pocos estudios que consideren complicaciones clínicas relacionadas con este procedimiento. Describimos un paciente que desarrolló una complicación mayor mientras se efectuaba el test de apnea. Realizamos una revisión de las complicaciones relacionadas con este procedimiento en la literatura. CASO CLÍNICO: Un hombre de 54 años fue admitido por deterioro del sensorio debido a una hemorragia intracerebral. Seis horas posteriores, el paciente no tenía respuesta motora, y todos los reflejos del tronco cerebral estaban abolidos. El paciente cumplía con los criterios diagnósticos de Muerte Encefálica de acuerdo a lo establecido por la Academia Americana de Neurología. Durante el test de apnea, el paciente desarrolla s
Nigro, Carlos Alberto; González, Sergio; Arce, Anabella; Aragone, María Rosario; Nigro, Luciana
Patients under treatment with continuous positive airway pressure (CPAP) may have residual sleep apnea (RSA). The main objective of our study was to evaluate a novel auto-CPAP for the diagnosis of RSA. All patients referred to the sleep laboratory to undergo CPAP polysomnography were evaluated. Patients treated with oxygen or noninvasive ventilation and split-night polysomnography (PSG), PSG with artifacts, or total sleep time less than 180 min were excluded. The PSG was manually analyzed before generating the automatic report from auto-CPAP. PSG variables (respiratory disturbance index (RDI), obstructive apnea index, hypopnea index, and central apnea index) were compared with their counterparts from auto-CPAP through Bland-Altman plots and intraclass correlation coefficient. The diagnostic accuracy of autoscoring from auto-CPAP using different cutoff points of RDI (≥5 and 10) was evaluated by the receiver operating characteristics (ROCs) curve. The study included 114 patients (24 women; mean age and BMI, 59 years old and 33 kg/m(2); RDI and apnea/hypopnea index (AHI)-auto median, 5 and 2, respectively). The average difference between the AHI-auto and the RDI was -3.5 ± 3.9. The intraclass correlation coefficient (ICC) between the total number of central apneas, obstructive, and hypopneas between the PSG and the auto-CPAP were 0.69, 0.16, and 0.15, respectively. An AHI-auto >2 (RDI ≥ 5) or >4 (RDI ≥ 10) had an area under the ROC curve, sensitivity, specificity, positive likelihood ratio, and negative for diagnosis of residual sleep apnea of 0.84/0.89, 84/81%, 82/91%, 4.5/9.5, and 0.22/0.2, respectively. The automatic analysis from auto-CPAP (S9 Autoset) showed a good diagnostic accuracy to identify residual sleep apnea. The absolute agreement between PSG and auto-CPAP to classify the respiratory events correctly varied from very low (obstructive apneas, hypopneas) to moderate (central apneas).
Pressman, Gregg S; Figueredo, Vincent M; Romero-Corral, Abel; Murali, Ganesan; Kotler, Morris N
Obstructive apneas produce high negative intrathoracic pressure that imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no obstructive sleep apnea (OSA; AHI <15) and moderate/severe OSA (AHI ≥15). Mitral valve tenting height and area, left ventricular (LV) long and short axes, and LV end-diastolic volume were measured in addition to tissue Doppler parameters. Comparisons of measurements at baseline and follow-up between and within groups were obtained; correlations between absolute changes (Δ) in echocardiographic parameters were also performed. After a mean follow-up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 to 1.28 ± 0.17 cm, p = 0.001) in moderate/severe OSA as did tenting area (2.30 ± 0.41 to 2.66 ± 0.60 cm(2), p = 0.0002); Δtenting height correlated with ΔLV end-diastolic volume (rho 0.43, p = 0.01) and Δtenting area (rho 0.35, p = 0.04). In patients with mild/no OSA there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 to 2.31 ± 0.43 cm(2), p = 0.05). Septal tissue Doppler early diastolic wave decreased (8.04 ± 2.49 to 7.10 ± 1.83 cm/s, p = 0.005) in subjects with moderate/severe OSA but not in in those with mild/no OSA. In conclusion, in patients with moderate/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry. Copyright Â© 2012 Elsevier Inc. All rights reserved.
...") from a single test procedure. Respiration, heart rate, continuous blood pressure and other polysomnographic variables were monitored in 9 normals and 8 untreated patients with obstructive sleep apnea (OSA...
Masumeh Hemmati Maslakpak
in patients with diabetes, using of screening methods for diagnose of sleep apnea in diabetic patients is necessary.* Corresponding Author: Uremia University of Medical Sciences, Department of Nursing and Midwifery.Email: Hemmati_m@umsu.ac.ir
Miśkowiec, I; Klawe, J J; Tafil-Klawe, M; Jeske, K; Laudencka, A; Bielicka, B; Manitius, J; Zlomańczuk, P
The majority of hemodialyzed patients suffer from sleep disturbances. In the present study the prevalence of sleep apnea syndrome in hemodialyzed patients with end-stage renal disease (ESRD-patients) was investigated by the survey, Epworth Sleepiness Scale (ESS), and polysomnography (PSG). Sixty-one patients: 24 women and 37 men were involved in the study. All subjects participated in the first part of the study consisting of the survey and ESS. The second and third parts consisted of nighttime PSG, performed the night after hemodialysis (17 patients) and between hemodialyses (11 patients). Eleven out of the 61 patients had the symptoms of sleep apnea and heavy daily sleepiness. Eleven subjects were involved in the double PSG study: after and between hemodialyses. Obstructive sleep apnea was found in 7 of those patients during both nights analyzed. Our results confirm the occurrence of sleep disorders in ESRD-patients. Hemodialysis does not change the prevalence of obstructive sleep apnea in chronic renal disease.
Mohammed, Sameh; Nour, Islam; Shabaan, Abd Elazeez; Shouman, Basma; Abdel-Hady, Hesham; Nasef, Nehad
The optimum caffeine dose in preterm infants has not been well investigated. We aimed to compare the efficacy and safety of high versus low-dose caffeine citrate on apnea of prematurity (AOP) and successful extubation of preterm infants from mechanical ventilation. We compared high-dose (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) versus low-dose (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) caffeine citrate in preterm infants apnea (papnea (papnea of prematurity has been well established over the past few years. The optimal loading and maintenance dose of caffeine in preterm infants is not well-studied. What is New: • This double blind randomized controlled trial demonstrated that using a higher, than current standard, loading and maintenance doses of caffeine for treatment of apnea in preterm infants is well tolerated and significantly decrease the frequency of apnea.
Yu, Mei; Huang, Jin-Hua; Zhu, Rong; Zhang, Xu-Zhong; Wu, Wan-Yun; Wen, Xiao-Hong
To investigate the effect of caffeine citrate treatment on early pulmonary function in preterm infants with apnea. Forty preterm infants with apnea were randomly divided into aminophylline treatment group (20 infants) and caffeine citrate treatment group (20 infants). When the preterm infants experienced apnea after birth, they were given aminophylline or caffeine citrate in addition to assisted ventilation with continuous positive airway pressure (NCPAP). After drug discontinuation, pulmonary function was measured and compared between the two groups. After treatment, compared with the aminophylline treatment group, the caffeine citrate treatment group had significantly higher tidal volume, minute ventilation volume, ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume to peak tidal expiratory flow to total expiratory volume, peak expiratory flow, and breathing flow at 75%, 50%, and 25% of tidal volume (Papnea attacks (Papnea in preterm infants, caffeine citrate can improve early pulmonary function and reduce the incidence of apnea.
Obstructive sleep apnea has been associated with a high risk for motor vehicle accidents, probably the highest of all risks due to medical conditions. Treatment of sleep apnea with nasal continuous positive airway pressure appears to reduce the risk of traffic accidents to the one of the general population. The risk for accidents may also be increased in untreated patients in the home and work environment. The increased risk seems unrelated to the symptom of daytime excessive sleepiness, and in many studies lacks a clear dose-response relationship with respect to the severity of apneas and hypopneas. The association of sleep apnea, chronic sleep deprivation and consumption of hypnotics or alcohol has not been thoroughly studied, although alcohol has been considered as a confounding variable in some studies. The cost of traffic accidents due to sleep apnea has been estimated to be so high that diagnosing and treating all drivers with sleep apnea in the USA would be cost saving and result in a decrease in society costs related to the disease. Driving licenses are delivered according to national legislations. These are all but uniform, especially concerning sleep apnea. Even within the European Union, where a minimum set of rules is mandatory for all countries, sleep apnea is not included in the minimum. Therefore, drivers are left in a very uncomfortable position, behaving according to the law in one country but being unlawful once the border with the neighbor country is crossed. Physicians are also in a very difficult position if they have to counsel their patients on the best attitude when travelling by car. The situation is even worse for commercial drivers, for whom the legislation is more severe but leaves sleep apnea uncovered in many countries. This is all the more disturbing if one considers that sleep apnea can be suspected, screened and diagnosed with relative ease, and that once diagnosed the adequate treatment allows for safe driving. The inclusion of
McNicholas, Walter T
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome represent two of the most prevalent chronic respiratory disorders in clinical practice, and cardiovascular diseases represent a major comorbidity in each disorder. The two disorders coexist (overlap syndrome) in approximately 1% of adults but asymptomatic lower airway obstruction together with sleep-disordered breathing is more prevalent. Although obstructive sleep apnea syndrome has similar prevalence in COPD as the general population, and vice versa, factors such as body mass index and smoking influence relationships. Nocturnal oxygen desaturation develops in COPD, independent of apnea\\/hypopnea, and is more severe in the overlap syndrome, thus predisposing to pulmonary hypertension. Furthermore, upper airway flow limitation contributes to nocturnal desaturation in COPD without apnea\\/hypopnea. Evidence of systemic inflammation in COPD and sleep apnea, involving C-reactive protein and IL-6, in addition to nuclear factor-kappaB-dependent pathways involving tumor necrosis factor-alpha and IL-8, provides insight into potential basic interactions between both disorders. Furthermore, oxidative stress develops in each disorder, in addition to activation and\\/or dysfunction of circulating leukocytes. These findings are clinically relevant because systemic inflammation may contribute to the pathogenesis of cardiovascular diseases and the cell\\/molecular pathways involved are similar to those identified in COPD and sleep apnea. However, the pathophysiological and clinical significance of systemic inflammation in COPD and sleep apnea is not proven, and thus, studies of patients with the overlap syndrome should provide insight into the mechanisms of systemic inflammation in COPD and sleep apnea, in addition to potential relationships with cardiovascular disease.
Full Text Available The paper assesses the combined effect of high Mallampati score, obesity and obstructive sleep apnea (OSA on lung function as measured by spirometry. Our results showed that the combination of sleep apnea, obesity and high Mallampati score resulted in a degree of restriction that was significantly greater than that produced by each factor alone. These observations underscore the importance of factoring in the Mallampati score in the assessment of respiratory disease.
Ping-Ying Chiang, Rayleigh; Lin, Chia-Mo; Powell, Nelson; Chiang, Yuh-Chyun; Tsai, Yih-Jeng
This study was designed to systematically analyze the relationship between a cephalometric analysis and the apnea-hypopnea index in a group of Asian children with obstructive sleep apnea. Retrospective study. Data were collected from 56 children with obstructive sleep apnea who were between 3 and 13 years old. Each child underwent attended overnight polysomnography and cephalometry. We measured nine angles, 10 lines, and two ratios as well as adenoid size on each cephalometric film. Data included five segments of the upper airway: nasal cavity (segment 1), nasopharyngeal space (segment 2), retropalatal space (segment 3), retroglossal space and hyoid (segment 4), and oral cavity-related space (segment 5). Four cephalometric anthropomorphic findings (Gn-Go-H, MP-H, MPH/GnGo, Ad/Na) were related to the apnea-hypopnea index. Three of the four parameters belonged to segment 4, indicating the importance of hyoid position in pediatric obstructive sleep apnea. This study showed that segment 4 was the most important segment affecting the apnea-hypopnea index. Most of the cephalometric parameters in segment 4 did not show a difference from the results of Caucasian groups, except that mandibular length and position appeared to have more positive findings in the Caucasian results. In segment 2, the apnea-hypopnea index was less affected by the skull base-related parameters in our data. The reason why the other segments appeared to play a lesser role in pediatric obstructive sleep apnea might due to the limitations of two-dimensional imaging. Further cephalometric studies with anterior-posterior view and on the differences between Caucasian and Asian children are mandatory. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
CONCLUSIONS: Overall, TECSA developed in 3.5%–19.8% of PAP-treated patients with OSA. The vast majority will experience complete resolution of central apneas over a few weeks to months. Unfortunately, about a third of patients with TECSA may continue to exhibit persistence of central sleep apnea on reevaluation. A small proportion may experience D-TECSA after few weeks to several months of initial exposure to PAP therapy.
Nigam, Gaurav; Riaz, Muhammad; Chang, Edward T; Camacho, Macario
Treatment-emergent central sleep apnea (TECSA) is observed in some patients when they are treated with positive airway pressure (PAP) after significant resolution of the preexisting obstructive events in patients with obstructive sleep apnea. The objective of this study was to systematically review the literature for studies describing the natural history of TECSA. PubMed, Medline, Scopus, Web of Science, and Cochran Library databases were searched through June 29, 2017. Five studies were identified that discussed the natural history of TECSA. TECSA developed in 3.5%-19.8% of PAP-treated patients. Treatment-persistent central sleep apnea (TPCSA), representing protracted periods of PAP therapy-related central apneas, was noted in 14.3%-46.2% of patients with TECSA. Delayed-TECSA (D-TECSA) represents an anomalous TECSA entity appearing weeks to months after initial PAP therapy. D-TECSA was observed in 0.7%-4.2% of OSA patients undergoing PAP treatment (after at least 1 month). In patients with TECSA, a higher apnea-hypopnea index (AHI) and central apnea index at their baseline study or a higher residual AHI at their titration study may be associated with an increased likelihood of conversion to TPCSA. Overall, TECSA developed in 3.5%-19.8% of PAP-treated patients with OSA. The vast majority will experience complete resolution of central apneas over a few weeks to months. Unfortunately, about a third of patients with TECSA may continue to exhibit persistence of central sleep apnea on reevaluation. A small proportion may experience D-TECSA after few weeks to several months of initial exposure to PAP therapy.
Haskova K; Javorka K; Javorka M; Matasova K; Zibolen M
Apnea, especially in preterm newborns (AoP) is one of the common problems encountered at neonatal units. Numerous factors are likely to play a role in the etiology of apnea. Recent data sugest a role for genetic predisposition of AoP. It seems, that physiological rather than pathological immaturity of the respiratory, or cardiorespiratory control, play a major part in the pathophysiology of AoP. Immaturity of the brainstem, cerebral cortex, receptors of the lungs and the airways a...
Full Text Available Since obstructive sleep apnea-hypopnea syndrome (OSAHS is a multisystemic disease, it also affects the endocrine system. Normal production of hormones can be influenced by the presence of intermittent hypoxia, inflammation, and oxidative stress; for example, subjects with obesity and OSAHS have much higher leptin levels than obese subjects without OSAHS. This article discusses the relationship between sleep apnea and obesity, metabolic syndrome (MS, diabetes mellitus type 2 (DM2, neuroendocrine disorders and osteoporosis.
G .M. Fomych
Full Text Available Obstructive sleep apnea syndrome is a common chronic syndrome that significantly affects the quality of life of patients and often requires lifelong care. This review deals with modern ideas about the prevalence, causes, clinical presentation, diagnosis and treatment of obstructive sleep apnea syndrome. Using modern methods of diagnosis and the correct approach to such patients helps prevent unwanted effects and significantly improves quality of life.
Full Text Available Obstructive sleep apnea-hypopnea syndrome (OSAHS is a pathology with frequent systemic repercussions. One of the most affected organs is the brain, as well as the central nervous system, thus becoming a cerebrovascular risk factor regardless of other factors. This syndrome may increase the frequency and severity of primary central nervous system diseases such as epilepsy and dementia syndromes. A cardinal symptom of OSAHS is headache, which has specific characteristics; in addition, different pathophysiological mechanisms involved in its development have been identified such as frequent micro-arousals from sleep, secondary daytime sleepiness, altered attention capacity, concentration, motor reaction, affection, among others. Together, these mechanisms affect other higher mental functions including judgment, reasoning or memory. Factors like hypoxemia, hypercapnia, increased heart rate and blood pressure, adrenaline secretion, noradrenaline or cortisol during sleep contribute to the endothelial alteration responsible for cerebrovascular disease.
Hood, Megan M; Nackers, Lisa M; Kleinman, Brighid; Corsica, Joyce; Katterman, Shawn N
Self-monitoring of food intake is a cornerstone of behavioral weight loss interventions, but its use has not been evaluated in the treatment of obese patients with obstructive sleep apnea (OSA). This pilot study described patterns of adherence to dietary self-monitoring in obese patients with OSA and determined associations between self-monitoring and weight loss, psychosocial functioning, and adherence to continuous positive airway pressure treatment. Participants completed a 6-week behavioral weight loss intervention focused on dietary self-monitoring. Approximately one-third of participants were adherent to self-monitoring throughout the course of the intervention and experienced more weight loss than those who did not self-monitor regularly. More frequent dietary self-monitoring also appeared to be associated with adherence to other health behaviors. These preliminary data suggest that use of dietary self-monitoring may be beneficial for promoting weight loss and adherence to other important health behaviors in OSA patients.
Full Text Available Obstructive sleep apnea-hypopnea syndrome (OSAHS is a disease characterized by recurrent upper airway obstruction (UAO, with decreased airflow, intermittent hypoxemia, and awakening during sleep. Two essential factors are related to the pathophysiology of OSAHS: anatomical alterations and reduction or absence of neural control. While studying OSAHS, the site or sites of obstruction of the UA should be identified; they may extend from the nasal wings to the hypopharynx. Another important factor in this syndrome is the nervous influence on muscle tone of the hypopharynx, as well as the changes in blood pH, which are secondary to micro-arousals. Body position and sleep stage determine the severity. The pathophysiology of OSAHS should be understood to properly study a patient and provide the best treatment option.
Full Text Available History. We report about the course of central sleep apnea (CSA in 3 patients (70.3±15.2 years with severe aortic stenosis (AS (AVA≤1.0 cm2, NYHA 2.7±1.4. Investigations. Every patient received echocardiography, left/right-heart catheterization, and cardiorespiratory polygraphy before and 6 months after surgical aortic valve replacement (without right-heart catheterization during follow up. Course. Preoperatively all patients demonstrated reduced systolic left ventricular function (EF <55%. They had elevated pulmoraryarterialy pressures and severe CSA. After valve replacement left ventricular function and exercise capacity improved, as well as the severity of CSA. Conclusion. Patients with severe AS can develop CSA, which seems to improve after surgery. Patients with severe AS should be screened for CSA, because CSA might be an additional risk factor and hint that myocardial adaptation is exhausting.
Full Text Available Obstructive sleep apnea (OSA is a prevalent sleep disorder as is hypertension (HTN in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN. The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities.
Boudewyns, A; Abel, F; Alexopoulos, E; Evangelisti, M; Kaditis, A; Miano, S; Villa, M P; Verhulst, S L
Although adenotonsillectomy is the first line treatment for children with obstructive sleep apnea syndrome (0SAS), 1 improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease. Early recognition and treatment of children with persistent OSAS is required to prevent long-term morbidity. The management of these children is frequently complex and a multidisciplinary approach is required as most of them have additional risk factors for OSAS and comorbidities. In this paper, we first provide an overview of children at risk for persistent disease following adenotonsillectomy. Thereafter, we discuss different diagnostic modalities to evaluate the sites of persistent upper airway obstruction and the currently available treatment options. Pediatr Pulmonol. 2017;52:699-709. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Ayalon, Liat; Ancoli-Israel, Sonia; Drummond, Sean Pa
This study examined response inhibition during a Go-NoGo task in individuals with obstructive sleep apnea (OSA). Fourteen OSA patients and 14 controls were studied with functional magnetic resonance imaging. Compared to controls, the OSA group showed more false positives (error of commission) during the NoGo trials with decreased brain activation in the left postcentral gyrus, cingulate gyrus and inferior parietal lobe, as well as right insula and putamen. This is consistent with previous findings of impaired performance and decreased brain activation in OSA patients during a working memory task, suggesting that compromised brain function in response to cognitive challenges may underlie some of the cognitive deficits seen in patients with OSA.
Full Text Available Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51- year-old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three-drop-method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2-year follow-up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function.
Di Pauli, Franziska; Stefani, Ambra; Holzknecht, Evi; Brandauer, Elisabeth; Mitterling, Thomas; Holzinger, Brigitte; Högl, Birgit
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.
Full Text Available Introduction: Obstructive sleep apnea has been associated with higher cancer incidence and mortality. Increased melanoma aggressivity was reported in obstructive sleep apnea patients. Mice exposed to intermittent hypoxia (IH mimicking sleep apnea show enhanced melanoma growth. Markers of melanoma progression have not been investigated in this model. Objective: The present study examined whether IH affects markers of melanoma tumor progression. Methods: Mice were exposed to isocapnic IH to a nadir of 8% oxygen fraction for 14 days. One million B16F10 melanoma cells were injected subcutaneously. Immunohistochemistry staining for Ki-67, PCNA, S100-beta, HMB-45, Melan-A, TGF-beta, Caspase-1, and HIF-1alpha were quantified using Photoshop. Results: Percentage of positive area stained was higher in IH than sham IH group for Caspase-1, Ki-67, PCNA, and Melan-A. The greater expression of several markers of tumor aggressiveness, including markers of ribosomal RNA transcription (Ki-67 and of DNA synthesis (PCNA, in mice exposed to isocapnic IH than in controls provide molecular evidence for a apneaâcancer relationship. Conclusions: These findings have potential repercussions in the understanding of differences in clinical course of tumors in obstructive sleep apnea patients. Further investigation is necessary to confirm mechanisms of these descriptive results. Keywords: Apnea, Melanoma, Biological markers
Full Text Available Objective: To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome. Data sources: PubMed database for English-language studies with no start date restrictions and with an end date of September 2014. Methods: A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences. There were 106 studies that formed the basis of this analysis. Conclusions: Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death. These consequences result in significant economic burden. Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea. Implications for practice: Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies. Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed. Keywords: Obstructive sleep apnea syndrome, Cost, Continuous positive airway pressure, Mandibular advancement device
Eysteinsdottir, Bjorg; Gislason, Thorarinn; Pack, Allan I; Benediktsdottir, Bryndís; Arnardottir, Erna S; Kuna, Samuel T; Björnsdottir, Erla
The objective of this study was to evaluate the determinants of long-term adherence to positive airway pressure treatment among patients with obstructive sleep apnea, with special emphasis on patients who stop positive airway pressure treatment within 1 year. This is a prospective long-term follow-up of subjects in the Icelandic Sleep Apnea Cohort who were diagnosed with obstructive sleep apnea between 2005 and 2009, and started on positive airway pressure treatment. In October 2014, positive airway pressure adherence was obtained by systematically evaluating available clinical files (n = 796; 644 males, 152 females) with moderate to severe obstructive sleep apnea (apnea-hypopnea index ≥15 events per h). The mean follow-up time was 6.7 ± 1.2 years. In total, 123 subjects (15.5%) returned their positive airway pressure device within the first year, 170 (21.4%) returned it later and 503 (63.2%) were still using positive airway pressure. The quitters within the first year had lower body mass index, milder obstructive sleep apnea, less sleepiness, and more often had symptoms of initial and late insomnia compared with long-term positive airway pressure users at baseline. Both initial and late insomnia were after adjustment still significantly associated with being an early quitter among subjects with body mass index insomnia are associated with early quitting on positive airway pressure among non-obese subjects. © 2016 European Sleep Research Society.
Hentges, Cláudia Regina; Guedes, Renata Rostirola; Silveira, Rita C; Procianoy, Renato S
To determine the influence of presence of caffeine in umbilical cord blood on apnea occurrence. A prospective cohort study with preterm newborns with birth weight lower than 2,000 g was undertaken. Exclusion criteria were: mothers who received opioids; mechanical ventilation during the first 4 days of life; cerebral and major cardiac malformations; perinatal asphyxia; severe periintraventricular hemorrhage; exchange transfusion before the fourth day of life; and those who received methylxanthine prior to extubation. Neonates were divided into detectable and undetectable caffeine in umbilical cord blood. Newborns were followed for the first 4 days for occurrence of apnea spells. Eighty-seven newborns with and 40 without detectable caffeine in umbilical cord blood were studied. Median caffeine concentration of the 87 patients with detectable caffeine in umbilical blood was 2.3 microg/mL (0.2-9.4 microg/mL). There was no association between occurrence of apnea spells and presence of caffeine in umbilical cord blood. Neonates with detectable caffeine in umbilical blood had borderline later apnea (66.3+/-4.14 hours) than those with undetectable levels (54.2+/-6.26 hours). Detected levels of caffeine in umbilical cord blood did not decrease occurrence of apnea of prematurity, but it had a borderline effect delaying its occurrence, suggesting that even a low level of caffeine in umbilical cord blood might delay occurrence of apnea spells.
Full Text Available Patients with Down syndrome (DS are at risk for both obstructive sleep apnea (OSA and central sleep apnea (CSA; however, it is unclear how these components evolve as patients age and whether patients are also at risk for hypoventilation. A retrospective review of 144 diagnostic polysomnograms (PSG in a tertiary care facility over 10 years was conducted. Descriptive data and exploratory correlation analyses were performed. Sleep disordered breathing was common (seen in 78% of patients with an average apnea-hypopnea index (AHI = 10. The relative amount of obstructive apnea was positively correlated with age and body mass index (BMI. The relative amount of central sleep apnea was associated with younger age in the very youngest group (0–3 years. Hypoventilation was common occurring in more than 22% of patients and there was a positive correlation between the maximum CO2 and BMI. Sleep disordered breathing, including hypoventilation, was common in patients with DS. The obstructive component increased significantly with age and BMI, while the central component occurred most in the very young age group. Due to the high risk of hypoventilation, which has not been previously highlighted, it may be helpful to consider therapies to target both apnea and hypoventilation in this population.
Alencar, Adriano M.; da Silva, Diego Greatti Vaz; Oliveira, Carolina Beatriz; Vieira, André P.; Moriya, Henrique T.; Lorenzi-Filho, Geraldo
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.
Armanian, Amir Mohammad; Badiee, Zohreh; Afghari, Raha; Salehimehr, Nima; Hassanzade, Akbar; Sheikhzadeh, Soghra; Sharif Tehrani, Maryam; Rezvan, Gohar
A few studies have been carried on preventive drugs for apnea of preterm neonates. This study aimed to assess the safety and prophylactic effects of aminophylline on the incidence of apnea in premature neonates. This study was a randomized clinical trial (RCT) research. The prophylactic effect of aminophylline on apnea was investigated in premature babies in our NICU (IRAN-Isfahan). In the study group (A), 5 mg/kg aminophylline was initially administered as a loading dose. Then, every 8 hours, 1.5 mg/kg was given as maintenance dose for the next 10 days. In the control group (C), no aminophylline was used during the first ten days of life. Fifty-two neonates were randomized for the study and all of them completed it. Primary outcomes were clearly different between the two groups. Only 2 infants (7.7%) who had been placed in aminophylline group developed apnea, as compared to 16 infants (61.5%) in the control group (P 0.999). Median time of hospitalization was shorter in aminophylline group (P = 0.04). This study supports the preventative effects of aminophylline on apnea in extreme premature infants. In other words, the more premature an infant, the greater the preventative effect of aminophylline on the incidence of apnea and bradycardia.
Scott, Brian; Johnson, Romaine F; Mitchell Md, Ron B
The severity of obstructive sleep apnea in children determines perioperative management and is an indication for postoperative polysomnography. The relationship between increasing weight and sleep apnea severity in children remains unclear. To compare demographic, clinical, and polysomnography parameters in normal-weight, overweight, obese, and morbidly obese children, as well as identify demographic factors that predict sleep apnea severity. Case series with chart review. Academic children's hospital. A retrospective chart review of 290 children aged 2 to 18 years who underwent polysomnography at an academic children's hospital was performed. Demographics, clinical findings, and polysomnographic parameters were recorded. Children were categorized as normal weight, overweight, obese, or morbidly obese. Differences were assessed using linear and logistical regression models. Significance was set at P preterm), or tonsil size between normal-weight, overweight, obese, and morbidly obese children. Sleep efficiency and percentage of time in rapid eye movement were decreased in morbidly obese compared with other children (P apnea-hypopnea index was positively correlated with increasing body mass index z score only as a function of increasing age (P apnea severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe obstructive sleep apnea. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Bravata, Dawn M; Lightner, Nancy; Yaggi, H Klar; Miech, Edward J
A dilemma faced by health-care administrators is that need greatly outstrips capacity for diagnosing and treating sleep apnea, with such decisions carrying significant economic consequences. Our objective was to develop an economic model to estimate the relative costs of 4 approaches for diagnosis and initial treatment of sleep apnea. The analysis consisted of developing a mathematical model depicting possible diagnostic and treatment approaches to the care of patients with sleep apnea; developing 4 clinical scenarios to describe distinct approaches to the management of sleep apnea patients (in-laboratory, unattended, direct-to-autotitrating PAP [auto-PAP], and mixed); and identifying costs associated with each scenario. We created a hypothetical cohort of 1,000 patients with 85% prevalence of sleep apnea to generate cost estimates. The driver of per-patient costs was the total number of sleep studies, which varied widely across scenarios: from 425 for the direct-to-auto-PAP approach to 1,441 in the unattended approach. The scenarios also differed in per-patient costs: Per-patient costs excluding facility startup costs were $456 for direct-to-auto-PAP, $913 for in-laboratory, $991 for mixed, and $1,090 for unattended. Approaches to diagnosing and treating sleep apnea that emphasized early application of auto-PAP had lower per-patient costs. Copyright © 2018 by Daedalus Enterprises.
Rizzi, Christopher J; Amin, Julian D; Isaiah, Amal; Valdez, Tulio A; Jeyakumar, Anita; Smart, Suzanne E; Pereira, Kevin D
Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study. Data on patient characteristics, polysomnographic findings, comorbidities, and perioperative events and outcomes were collected and analyzed. Results Twenty-nine patients were included. Mean age at tracheostomy was 2.0 years (95% CI, -2.2 to 6.2). Mean body mass index z score was -1.2 (95% CI, -4.9 to -2.5). Mean preoperative AHI was 60.2 (95% CI, -15.7 to 136.1). Mean postoperative intensive care unit stay was 23.2 days (95% CI, 1.44-45.0). One procedure was complicated by bronchospasm. Thirteen patients had craniofacial abnormalities; 10 had a neurologic disorder resulting in hypotonia; and 5 had a diagnosis of laryngomalacia. Mean follow-up was 30.6 months (95% CI, -10.4 to 71.6). Six patients were decannulated, with a mean time to decannulation of 40.8 months (95% CI, 7.9-73.7). Five patients underwent capped sleep study prior to decannulation with a mean AHI of 6.6 (95% CI, -9.9 to 23.1) and a mean oxygen nadir of 90.0% (95% CI, 80%-100%). Conclusion OSA is an uncommon indication for tracheostomy in children. Patients who require the procedure usually have an associated syndromic diagnosis resulting in upper airway obstruction. The majority of children who undergo tracheostomy for OSA will remain dependent at 24 months.
Wanitcharoenkul, Ekasitt; Chirakalwasan, Naricha; Amnakkittikul, Somvang; Charoensri, Suranut; Saetung, Sunee; Chanprasertyothin, Suwannee; Chailurkit, La-Or; Panburana, Panyu; Bumrungphuet, Sommart; Ongphiphadhanakul, Boonsong; Reutrakul, Sirimon
Obstructive sleep apnea (OSA) was shown to be associated with gestational diabetes mellitus (GDM). However, prevalence of OSA in GDM women, its relationship to metabolic control, and predictive factors have not been studied. Eighty-two obese pregnant women with diet-controlled GDM between 24 and 34 weeks of gestation participated. The Berlin questionnaire was used to assess OSA symptoms. OSA was diagnosed using an overnight monitor. Fasting glucose and hemoglobin A1c (HbA1c) were obtained. Those with OSA underwent meal tolerance test (MTT) to assess their metabolic parameters. Classification tree analysis was used to develop a screening tool for OSA. At a median gestational age of 29 weeks, OSA was diagnosed in 52.4% of the women, with a median apnea hypopnea index of 9.4 (interquartile range 6.4, 12.4). More severe OSA was significantly correlated with higher fasting glucose but not HbA1c. For those with OSA, sleep parameters related to oxygen desaturation significantly correlated with higher fasting insulin resistance and more severe β-cell dysfunction, as evaluated by MTT. A screening tool involving two variables, neck circumference and Berlin Questionnaire score, was developed. The sensitivity and specificity were 86% and 51%, respectively. The overall accuracy was 70%. OSA is prevalent in obese pregnant women with diet-controlled GDM in the late second to early third trimester. OSA severity, especially the degree of oxygen desaturation, correlated with fasting glucose, insulin resistance, and β-cell function. A simple screening tool involving the Berlin Questionnaire and neck circumference can aid in predicting OSA in this patient group. Copyright © 2017 Elsevier B.V. All rights reserved.
Mihaela Alexandra POP
Full Text Available OSAHS is a chronic, multifactorial disease, accompanied by significant and complex symptoms. The aim of this study was to evaluate the relationship between OSAHS and dorsal AHI in order to improve early diagnosis of dorsal sleep apnea-hypopnea syndrome. There were significant statistical differences between: the dorsal AHI Mean of the group without excessive daytime sleepiness as opposed to the dorsal AHI Mean of the group with excessive daytime sleepiness; the dorsal AHI Mean of the group without snoring as opposed to the dorsal AHI Mean of the group with snoring; the dorsal AHI Mean of the group without restless sleep as opposed to the dorsal AHI Mean of the group with restless sleep; the dorsal AHI Mean of the group without dyspnea as opposed to the dorsal AHI Mean of the group with dyspnea; the dorsal AHI Mean of the group without night sweats as opposed to the dorsal AHI Mean of the group with night sweats; the dorsal AHI Mean of the group without irritability as opposed to the dorsal AHI Mean of the group with irritability and the dorsal AHI Mean of the group without nightmares as opposed to the dorsal AHI Mean of the group with nightmares. Through this study we highlighted that excessive daytime sleepiness and snoring are prevalent symptoms in dorsal OSAHS. The presence of these symptoms in patients with sleep disorders may improve early diagnosis and the choice of an appropriate treatment for dorsal sleep apnea- hypopnea syndrome, thus participating in improving the patient’s life quality
Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang
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.
Full Text Available Stefania Mariani,1 Daniela Fiore,1 Laura Varone,2 Sabrina Basciani,1 Agnese Persichetti,1 Mikiko Watanabe,1 Maurizio Saponara,3 Giovanni Spera,1 Costanzo Moretti,4 Lucio Gnessi11Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, Italy; 2Department of Environmental Biology, Sapienza University of Rome, Italy; 3Department of Otolaryngology, Audiology and Phonation, Sapienza University of Rome, Italy; 4Division of Endocrinology, Department of System Medicine, Section of Reproductive Endocrinology University of TorVergata, Fatebenefratelli Hospital "San Giovanni Calibita" Rome, ItalyContext: Obesity and its co-morbidities may adversely affect bone mineral density (BMD. Obstructive sleep apnea (OSA is a major complication of obesity. To date, the effects of OSA on BMD in obese patients have been poorly studied.Objective: To examine whether the severity of OSA independently correlates with BMD in obese patients.Methods: One hundred and fifteen obese subjects with OSA (Apnea/Hypopnea Index [AHI] ≥5 events per hour were included in the study. BMD was measured at lumbar spine, total hip, and femoral neck by dual energy X-ray absorptiometry. Body mass index, lean mass, and representative measures of metabolic syndrome (waist circumference, fasting plasma glucose, blood pressure, HDL-cholesterol, triglycerides and inflammation (ESR, CRP, fibrinogen were also evaluated.Results: BMD did not differ among obese individuals regardless of OSA severity. Correlation coefficient analysis for all the covariates showed a lack of association between AHI and BMD that was strongly influenced by age and weight.Conclusion: Our study does not support an independent association between AHI and BMD in obese patients. Controlled studies involving a greater number of patients are warranted.Keywords: obesity, polysomnography, metabolic syndrome
Mutlu, Murad; Bayır, Ömer; Yüceege, Melike B; Karagöz, Tuğba; Fırat, Hikmet; Özdek, Ali; Akın, İstemihan; Korkmaz, Hakan
Obstructive sleep apnea syndrome (OSAS) provokes oxidative stress and ischemia, which affects the central nervous system. The degeneration of neurons in the brainstem due to periodic hypoxia can be evaluated by vestibular and audiologic tests. The objective of this study is to determine brainstem damage in severe OSAS patients with the help of vestibular evoked myogenic potential (VEMP) responses. Prospective, randomize, double-blind. Research-training hospital. We compared cervical vestibular evoked myogenic potential (cVEMP) responses between severe OSAS patients and a control group. 54 patients were included and divided into the OSAS group, with severe OSAS (apnea-hypopnea index, AHI >70), and a control group with snoring without OSAS (AHI <5). Both groups underwent cVEMP. Bilateral recordings with simultaneous binaural logon stimulations were used during VEMP recordings. The existing p1n1 and n2p2 responses, p1, n1, n2, and p2 latencies and amplitudes, and p1n1 and n2p2 intervals were measured. Statistically significant differences were revealed between patients and controls for the response rate of the p1n1, n2p2 and p1n1, n2p2 amplitudes. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, or the p1n1 and n2p2 intervals. The VEMP response rate was lower in severe OSAS patients, and all amplitudes were shorter than in healthy subjects. VEMP recordings in severe OSAS subjects demonstrates abnormalities in brainstem pathways. It appears that brainstem damage in severe OSAS can be detected by cVEMP recordings.
Köseoğlu, Nalan; Köseoğlu, Hikmet; Itil, Oya; Oztura, Ibrahim; Baklan, Bariş; Ikiz, Ahmet Omer; Esen, Ahmet Adil
Several co-morbid diseases have been shown to affect sexual functions in both genders. In the literature, sexual function status in men with obstructive sleep apnea syndrome (OSAS) has been studied; however, sexual functions in women with OSAS have not yet been studied. In this prospective study, we aimed to determine sexual function status in women with OSAS and its relationship with the disease parameters of OSAS. Women, who were diagnosed with OSAS with polysomnography performed in the sleep center of our university hospital, formed the study population. Women with any genital deformity, postmenopausal women, and women without a regular partner were excluded from the study. General demographic properties, medical histories, polysomnography parameters, and frequency of intercourse per month were noted for each patient. Patients completed the Sexual Function Questionnaire Version 2 (SFQ-V2) and Epworth Sleepiness Scale. The patients were grouped as mild, moderate, and severe OSAS according to the level of respiratory disturbance index (RDI). Scores of sexual function domains were determined from SFQ, and their relationships with parameters of polysomnography and demographics were studied. Twenty-five patients were included in the study. Mean age was 48.1 +/- 2.7 years. All were married with a mean marriage duration of 25.6 +/- 3.3 years. Mean frequency of intercourse per month was 3.3 +/- 1.8. All domains of sexual functions except pain and enjoyment significantly decreased with increasing severity of OSAS. When we controlled for factors of age and co-morbid diseases, correlation analyses showed significant negative correlation between levels of RDI and all domains of sexual functions except pain and enjoyment (P < 0.05). Obstructive sleep apnea syndrome negatively impacts sexual function in women independent of age and associated co-morbid diseases.
Piccin, Chaiane Facco
Full Text Available Introduction Obstructive Sleep Apnea (OSA is characterized by repeated episodes of upper airway obstruction during sleep. Objective The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI. Methods This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG, and 21 healthy subjects, who constituted the control group (CG. Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. Results The groups were homogeneous regarding gender (12 men and 9 women in each group, age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years, and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2. We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. Conclusion OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.
Zafar, Subooha; Ayappa, Indu; Norman, Robert G; Krieger, Ana C; Walsleben, Joyce A; Rapoport, David M
Current Medicare guidelines include an apnea-hypopnea index (AHI) > or = 15 events per hour, in which all hypopneas must be associated with 4% desaturation, to qualify for reimbursement for therapy with continuous positive airway pressure (CPAP). The present data demonstrate the effect of pulse oximeter differences on AHI. Prospective study, blinded analysis. Academic sleep disorder center. One hundred thirteen consecutive patients (84 men and 29 women) undergoing diagnostic sleep studies and being evaluated for CPAP based on the Medicare indications for reimbursement. Patients had two of four commonly used oximeters with signal averaging times of 4 to 6 s placed on different digits of the same hand during nocturnal polysomnography. Apneas and candidate hypopneas (amplitude reduction, > 30%) were scored from the nasal cannula airflow signal without reference to oximetry. Candidate hypopneas then were reclassified as hypopneas by each oximeter if they were associated with a 4% desaturation. Although the use of three oximeters resulted in a similar AHI (bias, oximeter showed an overall increase in AHI of 3.7 events per hour. This caused 7 of 113 patients to have an AHI of > or = 15 events per hour (meeting the Medicare criteria for treatment) by one oximeter but not when a different oximeter was used. More importantly, when our analysis was limited to those patients whose number of candidate hypopneas made them susceptible to the threshold value of 15 events per hour, 7 of 35 patients who did not meet the Medicare AHI standard for treatment by one oximeter were reclassified when a different oximeter was used. In the present study, oximeter choice affected whether the AHI reached the critical cutoff of 15 events per hour, particularly in those with disease severity that was neither very mild nor very severe. As oximetry is not a technique that produces a generic result, there are significant limitations to basing the definition of hypopnea on a fixed percentage of
Al-Aif, S; Alvaro, R; Manfreda, J; Kwiatkowski, K; Cates, D; Rigatto, H
Apnea of prematurity is common and none of the treatments being used are fully effective and free of significant adverse side effects. We hypothesized that low concentrations of CO2 (apnea without causing discomfort from an increase in ventilation. We studied 10 preterm infants at a gestational age of 32+/-1 wk (mean +/- SEM) and birthweight 1.8+/-0.2 kg. After a control period of 1 hour, concentrations of CO2 were given (0.5%, 1%, and 1.5%) for 1 hour each, followed by a recovery period of 1 hour. Apnea number significantly decreased from 2.0+/-0.3 apneas/min during control to 1.0+/-0.1 apneas/min (0.5% CO2; P apnea time significantly decreased from 14.2+/-2.5 s/min during control to 5.2+/-0.8 (0.5% CO2; P apnea 1) decreases the number and time of apneas, 2) improves oxygenation, 3) increases ventilation, and 4) is effective even in such low concentrations as 0.5%. We speculate that inhalation of CO2 (treatment of apnea of prematurity.
Keenan, Brendan T; Li, Junxin; Khan, Tanya; Elkassabany, Nabil; Walsh, Colleen M; Williams, Noel N; Pack, Allan I; Gurubhagavatula, Indira
Abstract Study Objective To validate that the symptomless Multi-Variable Apnea Prediction index (sMVAP) is associated with Obstructive Sleep Apnea (OSA) diagnosis and assess the relationship between sMVAP and adverse outcomes in patients having elective surgery. We also compare associations between Bariatric surgery, where preoperative screening for OSA risk is mandatory, and non-Bariatric surgery groups who are not screened routinely for OSA. Methods Using data from 40 432 elective inpatient surgeries, we used logistic regression to determine the relationship between sMVAP and previous OSA, current hypertension, and postoperative complications: extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications (pulmonary embolism, acute respiratory distress syndrome, and/or aspiration pneumonia). Results Higher sMVAP was associated with increased likelihood of previous OSA, hypertension and all postoperative complications (p complications compared to the bottom quintile. For ELOS, ICU-stay, and respiratory complications, respective odds ratios (95% CI) were: 1.83 (1.62, 2.07), 1.44 (1.32, 1.58), and 1.85 (1.37, 2.49). Compared against age-, gender- and BMI-matched patients having Bariatric surgery, sMVAP was more strongly associated with postoperative complications in non-Bariatric surgical groups, including: (1) ELOS (Orthopedics [p complications (Orthopedics [p =.037] and Otorhinolaryngology [p =.011]). Conclusions OSA risk measured by sMVAP correlates with higher risk for select postoperative complications. Associations are stronger for non-Bariatric surgeries, where preoperative screening for OSA is not routinely performed. Thus, preoperative screening may reduce OSA-related risk for adverse postoperative outcomes. PMID:28364424
Levendowski, Daniel J; Morgan, Todd; Westbrook, Philip
Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances, however, are expensive, must be fitted by a dentist, and the likelihood of successful outcomes are difficult to predict. An inexpensive trial appliance, if proven efficacious, might be used to predict custom appliance outcomes or to provide temporary therapeutic benefit. The aim of this initial study was to assess the treatment efficacy of a novel titration oral appliance with that of an optimized custom appliance. Seventeen patients, treated with a custom oral appliance for at least one year, successfully completed a three-night home sleep test. The baseline obstructive sleep apnea severity was established on Night 1 with seven patients exhibiting severe, six moderate and four mild apnea/hypopnea indexes. Patients were randomly assigned to wear their custom appliance or the titration appliance on Nights 2 and 3. Significant reductions in the mean overall and supine apnea indexes (p titration and custom appliances. The proportion of patients who exhibited at least a 50% reduction in the overall apnea index and supine apnea/hypopnea were similar for the titration and custom appliance (~60%). The custom appliance reduced the overall apnea/hypopnea index by 50% in a greater proportion of the patients compared to the titration appliance (77% vs. 53%). The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p titration appliance, but preferred the titration appliance to no therapy. The titration appliance may be useful in assessing oral appliance treatment efficacy. When set to 70% of maximum protrusion, the titration appliance may provide immediate, temporary therapeutic benefit.
Thomas, Robert Joseph; Mietus, Joseph E.; Peng, Chung-Kang; Gilmartin, Geoffrey; Daly, Robert W.; Goldberger, Ary L.; Gottlieb, Daniel J.
Study Objectives: Complex sleep apnea is defined as sleep disordered breathing secondary to simultaneous upper airway obstruction and respiratory control dysfunction. The objective of this study was to assess the utility of an electrocardiogram (ECG)-based cardiopulmonary coupling technique to distinguish obstructive from central or complex sleep apnea. Design: Analysis of archived polysomnographic datasets. Setting: A laboratory for computational signal analysis. Interventions: None. Measurements and Results: The PhysioNet Sleep Apnea Database, consisting of 70 polysomnograms including single-lead ECG signals of approximately 8 hours duration, was used to train an ECG-based measure of autonomic and respiratory interactions (cardiopulmonary coupling) to detect periods of apnea and hypopnea, based on the presence of elevated low-frequency coupling (e-LFC). In the PhysioNet BIDMC Congestive Heart Failure Database (ECGs of 15 subjects), a pattern of “narrow spectral band” e-LFC was especially common. The algorithm was then applied to the Sleep Heart Health Study–I dataset, to select the 15 records with the highest amounts of broad and narrow spectral band e-LFC. The latter spectral characteristic seemed to detect not only periods of central apnea, but also obstructive hypopneas with a periodic breathing pattern. Applying the algorithm to 77 sleep laboratory split-night studies showed that the presence of narrow band e-LFC predicted an increased sensitivity to induction of central apneas by positive airway pressure. Conclusions: ECG-based spectral analysis allows automated, operator-independent characterization of probable interactions between respiratory dyscontrol and upper airway anatomical obstruction. The clinical utility of spectrographic phenotyping, especially in predicting failure of positive airway pressure therapy, remains to be more thoroughly tested. Citation: Thomas RJ; Mietus JE; Peng CK; Gilmartin G; Daly RW; Goldberger AL; Gottlieb DJ
Suárez-Morán, Edgardo; Morales-Fuentes, Gerardo Alfonso; Inzunza-González, Jesús Alejandro; Cedillo-Ley, Ivonne; Gerardo-del Hoyo, Moisés; Silva-Ramírez, Horacio
Gastroesophageal reflux occurs frequently in newborns. A relationship has been suspected between reflux and apnea of prematurity. The objective of this study is to determine this relationship, owing to the fact that premature newborns have immaturity of structures, especially esophageal smooth muscle. We conducted a longitudinal, analytical, comparative, and observational case/control study. The study was carried out at the Neonatal Intensive Care Unit and in the Gastrointestinal Physiology Department of the Hospital Español (Mexico City) between January 2002 and December 2004. We included 22 patients: 11 females and 11 males. Mean age was 17.8 ± 8.4 days. Premature newborns represented 72.72% (n = 16). Mean gestational age was 33.1 ± 4.18 weeks. All cases were suspicious for central apnea except for three patients with a mixed cause of apnea. All were submitted to a 24-h pHmetry and a simultaneous polysomnography. Polysomnography was positive in 59% (n = 13) and pHmetry was positive in 50% (n = 11). Prematurity had a strong positive relation with central apnea of the newborn (odds ratio: 15 (p = 0.0154)). Odds ratio for association of central apnea and gastroesophageal reflux was 3.2 (p = 0.2037). We demonstrate that central apnea in the premature newborn is not a cause of gastroesophageal reflux. However, these patients are more likely to have gastroesophageal reflux in the first days of extrauterine life. It is recommended to exclude pathological gastroesophageal reflux when the newborn presents a clinical scenario compatible with central apnea.
Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial
Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick
Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia
Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial
Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony
BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia
Full Text Available Background Apnea of prematurity (AOP is a developmental disorder that affects the premature newborns frequently. One of the new non-drug methods for controlling apnea attacks is olfactory stimulation. The aim of this study was to determine the effect of olfactory stimulation by vanilla on the rate of apnea attacks in neonates with AOP. Materials and Methods: This study is a single-blind randomized clinical trial study. The study samples included a total of 40 premature neonates with AOP who were admitted to the neonatal Intensive care unit (NICU of Shahid Sadoughi hospital in Yazd, Iran, in 2016 and were assigned randomly in experimental (n=20, and control (n=20 groups. The experimental group was exposed to cotton impregnated with 2ml of vanillin extractfor 24 hours. The number of apnea attacks, heart rate, and arterial oxygen saturation (SaO2 level were measured before, during and after intervention for three consecutive days. Data analysis was performed using statistical analysis in SPSS version 22.0 software. Results: The results showed that there was no significant difference between the two groups in terms of mean number of apnea attacks (p>0.05. However, there was a significant difference between in the experimental group on the first day (2.84 ± 1.25, and second day (1.63 ± 1.01 in terms of the mean number of attacks. Also, there was a significant difference between the mean heart rate and SaO2 level in both the experimental and control groups (p
Arnardottir, Erna S.; Maislin, Greg; Schwab, Richard J.; Staley, Bethany; Benediktsdottir, Bryndis; Olafsson, Isleifur; Juliusson, Sigurdur; Romer, Micah; Gislason, Thorarinn; Pack, Allan I.
Study Objectives: To assess the relative roles and interaction of obstructive sleep apnea (OSA) severity and obesity on interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Design: Cross-sectional cohort. Setting: The Icelandic Sleep Apnea Cohort. Participants: 454 untreated OSA patients (380 males and 74 females), mean ± standard deviation age 54.4 ± 10.6 yr. Interventions: N/A. Measurements and Results: Participants underwent a sleep study, abdominal magnetic resonance imaging to measure total abdominal and visceral fat volume, and had fasting morning IL-6 and CRP levels measured in serum. A significantly higher correlation was found for BMI than visceral fat volume with CRP and IL-6 levels. Oxygen desaturation index, hypoxia time, and minimum oxygen saturation (SaO2) significantly correlated with IL-6 and CRP levels, but apnea-hypopnea index did not. When stratified by body mass index (BMI) category, OSA severity was associated with IL-6 levels in obese participants only (BMI > 30 kg/m2). A multiple linear regression model with interaction terms showed an independent association of OSA severity with IL-6 levels and an interaction between OSA severity and BMI, i.e., degree of obesity altered the relationship between OSA and IL-6 levels. An independent association of OSA severity with CRP levels was found for minimum SaO2 only. A similar interaction of OSA severity and BMI on CRP levels was found for males and postmenopausal women. Conclusions: OSA severity is an independent predictor of levels of IL-6 and CRP but interacts with obesity such that this association is found only in obese patients. Citation: Arnardottir ES; Maislin G; Schwab RJ; Staley B; Benediktsdottir B; Olafsson I; Juliusson S; Romer M; Gislason T; Pack AI. The interaction of obstructive sleep apnea and obesity on the inflammatory markers c-reactive protein and interleukin-6: the Icelandic Sleep Apnea Cohort. SLEEP 2012;35(7):921-932. PMID:22754038
Arnardottir, Erna S.; Maislin, Greg; Jackson, Nick; Schwab, Richard J.; Benediktsdottir, Bryndis; Teff, Karen; Juliusson, Sigurdur; Pack, Allan I.; Gislason, Thorarinn
Objectives To assess whether sleep apnea severity has an independent relationship with leptin levels in blood after adjusting for different measures of obesity and whether the relationship between OSA severity and leptin levels differs depending on obesity level. Methods Cross-sectional study of 452 untreated obstructive sleep apnea (OSA) patients (377 males and 75 females), in the Icelandic Sleep Apnea Cohort (ISAC), age 54.3±10.6 (mean±SD), BMI 32.7±5.3 kg/m2 and apnea-hypopnea index (AHI) 40.2 ± 16.1 events/hour. A sleep study and magnetic resonance imaging of abdominal visceral and subcutaneous fat volume were performed as well as fasting serum morning leptin levels measured. Results Leptin levels were more highly correlated with body mass index (BMI), total abdominal and subcutaneous fat volume than visceral fat volume per se. No relationship was found between sleep apnea severity and leptin levels, assessed within three BMI groups (BMI35 kg/m2). In a multiple linear regression model, adjusted for gender, BMI explained 38.7% of the variance in leptin levels, gender explained 21.2% but OSA severity did not have a significant role and no interaction was found between OSA severity and BMI on leptin levels. However, hypertension had a significant effect on the interaction between OSA severity and obesity (p=0.04). In post-hoc analysis for nonhypertensive OSA subjects (n=249), the association between leptin levels and OSA severity explained a minor but significant variance (3.2%) in leptin levels. This relationship was greatest for nonobese nonhypertensive subjects (significant interaction with obesity level). No relationship of OSA severity and leptin levels was found for hypertensive subjects (n=199). Conclusion Obesity and gender are the dominant determinants of leptin levels. OSA severity is not related to leptin levels except to a minor degree in nonhypertensive nonobese OSA subjects. PMID:22964793
Full Text Available Obstructive sleep apnea is a well-known clinical manifestation of Prader-Willi syndrome. The aim of our study is to evaluate the efficacy of adenotonsillectomy for the treatment of the disorder as well as the improvement of their post-operative quality of life. Five patients with moderate to severe obstructive sleep apneas and adenotonsillar hypertrophy of grade III-IV underwent adenotonsillectomy. Pre- and postoperative apneas and Quality of Life were assessed respectively with a polysomnography with multi-sleep latency test and with the pediatric Quality of Life questionnaire, performed before and 6 months after surgery. A decrease of apnea/hypopnea index values has been detected between pre- and post-surgery (t=2.64, P=0.005, as well as oxygen desaturation index values (t=5.51, P=0.005, multi-sleep latency test (t=4.54, P=0.01, and of the values of pediatric Quality of Life questionnaire. No correlation has been detected between body mass index and apnea/hypopnea index, oxygen desaturation index and multi-sleep latency test values pre- and post-adenotonsillectomy. A correlation has been found between multi-sleep latency test and oxygen desaturation index values post-surgery (P=0.04. No post-operative complications were observed. Our data underline the efficacy of surgery in Prader-Willi patients with adenotonsillar hypertrophy in order to improve their quality of life.
Carreras, Alba; Almendros, Isaac; Acerbi, Irene; Montserrat, Josep M.; Navajas, Daniel; Farré, Ramon
Study Objectives: To investigate whether noninvasive application of recurrent airway obstructions induces early release of mesenchymal stem cells into the circulating blood in a rat model of obstructive sleep apnea. Design: Prospective controlled animal study. Setting: University laboratory. Patients or Participants: Twenty male Sprague-Dawley rats (250–300 g). Interventions: A specially designed nasal mask was applied to the anesthetized rats. Ten rats were subjected to a pattern of recurrent obstructive apneas (60 per hour, lasting 15 seconds each) for 5 hours. Ten anesthetized rats were used as controls. Measurements and Results: Mesenchymal stem cells from the blood and bone marrow samples were isolated and cultured to count the total number of colony-forming unit fibroblasts (CFU-F) of adherent cells after 9 days in culture. The number of CFU-F from circulating blood was significantly (P = 0.02) higher in the rats subjected to recurrent obstructive apneas (5.00 ± 1.16; mean ± SEM) than in controls (1.70 ± 0.72). No significant (P = 0.54) differences were observed in CFU-F from bone marrow. Conclusions: Application of a pattern of airway obstructions similar to those experienced by patients with sleep apnea induced an early mobilization of mesenchymal stem cells into circulating blood. Citation: Carreras A; Almendros I; Acerbi I; Montserrat JM; Navajas D; Farré R. Obstructive apneas induce early release of mesenchymal stem cells into circulating blood. SLEEP 2009;32(1):117-119. PMID:19189787
Amelard, Robert; Pfisterer, Kaylen J.; Jagani, Shubh; Clausi, David A.; Wong, Alexander
Obstructive sleep apnea (OSA) affects 20% of the adult population, and is associated with cardiovascular and cognitive morbidities. However, it is estimated that up to 80% of treatable OSA cases remain undiagnosed. Cur- rent methods for diagnosing OSA are expensive, labor-intensive, and involve uncomfortable wearable sensors. This study explored the feasibility of non-contact biophotonic assessment of OSA cardiovascular biomarkers via photoplethysmography imaging (PPGI). In particular, PPGI was used to monitor the hemodynamic response to obstructive respiratory events. Sleep apnea onset was simulated using Muller's maneuver in which breathing was obstructed by a respiratory clamp. A custom PPGI system, coded hemodynamic imaging (CHI), was positioned 1 m above the bed and illuminated the participant's head with 850 nm light, providing non-intrusive illumination for night-time monitoring. A video was recorded before, during and following an apnea event at 60 fps, yielding 17 ms temporal resolution. Per-pixel absorbance signals were extracted using a Beer-Lambert derived light transport model, and subsequently denoised. The extracted hemodynamic signal exhibited dynamic temporal modulation during and following the apnea event. In particular, the pulse wave amplitude (PWA) decreased during obstructed breathing, indicating vasoconstriction. Upon successful inhalation, the PWA gradually increased toward homeostasis following a temporal phase delay. This temporal vascular tone modulation provides insight into autonomic and vascular response, and may be used to assess sleep apnea using non-contact biophotonic imaging.
Abu Jawdeh, E G; O'Riordan, M; Limrungsikul, A; Bandyopadhyay, A; Argus, B M; Nakad, P E; Supapannachart, S; Yunis, K A; Davis, P G; Martin, R J
A recent multinational clinical trial in preterm infants has demonstrated pulmonary and neurodevelopmental benefits from caffeine therapy. Indications for caffeine use in that study were predominantly for treatment of apnea and facilitation of extubation rather than prophylaxis. There are no recent studies that describe current practice of neonatologists and regional differences in regards to indications for starting, monitoring and discontinuing methylxanthine therapy in premature infants. To characterize the spectrum of current practice and demonstrate the extent to which methylxanthine therapy varies by location. A cross-sectional survey of all neonatologists in Thailand, Lebanon, Australia, and a representative sample in the USA regarding management of apnea of prematurity. The response rate was 50% (342/681). The methylxanthine of choice varied greatly across study locations. Prophylactic methylxanthine use is common (62%) among neonatologists in all four study locations. Significant variation exists in almost all aspects of apnea pharmacotherapy practice among neonatologists in different international locations. Prophylactic use of methylxanthine therapy for apnea of prematurity is widespread. We speculate that this expanded use is possibly attributed to the beneficial effects of caffeine therapy in the Caffeine for Apnea of Prematurity (CAP) Trial.
Background Retinopathy of prematurity (ROP) is the most common reason behind surgical procedures in premature newborns. Anesthesia in these patients is life-threatening due to post-operative apnea of prematurity (POA). This study aimed to determine the predisposing factors to POA in premature infants and to explore the role of prophylactic aminophylline in decreasing the incidence of POA. Materials and Methods Fifty patients with prematurity who were candidates for elective eye surgery (less than one hour) were selected and received aminophylline (3 mg/kg) 5 minutes after the induction of anesthesia with sevoflurane. Patients were kept in the recovery room for 2 hours post-operation in an incubator and were monitored for SPO2, apnea, bradycardia and other signs of desaturation and apnea. Results There were no statistically significant differences in the gestational age and weight, sex, postconceptual age and weight and other demographic characteristics between the experimental and control groups. Gestational ageapnea. Treatment with aminophylline as compared with the placebo was associated with a significantly decreased risk of post-operative apnea (OR=0.53; 95% CI 0.28–0.98; P=0.034). Conclusion Aminophylline can be used prophylactically to decrease the risk of postoperative apnea with no major adverse effects. PMID:25713589
Lee, Hoshik; Vergales, Brooke; Paget-Brown, Alix; Rusin, Craig; Moorman, Randall; Kattwinkel, John; Delos, John
Apnea is a very common problem for premature infants: apnea of prematurity (AOP) occurs in >50% of babies whose birth weight is less than 1500 g, and AOP is found in almost all babies who are apnea, and also give many false alarms. We have created a new algorithm for detection of apnea. Respiration is monitored by continuous measurement of chest impedance (CI). However, the pulsing of the heart also causes fluctuations in CI. We developed a new adaptive filtering system to remove heart activity from CI, thereby giving much more reliable measurements of respiration. The new approach is to rescale the impedance measurement to heartbeat-time, sampling 30 times per interbeat interval. We take the Fourier transform of the rescaled signal, bandstop filter at 1 per beat to remove fluctuations due to heartbeats, and then take the inverse transform. The filtered signal retains all properties except the impedance changes due to cardiac filling and emptying. We convert the variance of CI into an estimated likelihood of apnea. This work is supported by NICHD 5RCZHD064488.
Mohajerani, Seyed Amir; Roodneshin, Fatemeh
Retinopathy of prematurity (ROP) is the most common reason behind surgical procedures in premature newborns. Anesthesia in these patients is life-threatening due to post-operative apnea of prematurity (POA). This study aimed to determine the predisposing factors to POA in premature infants and to explore the role of prophylactic aminophylline in decreasing the incidence of POA. Fifty patients with prematurity who were candidates for elective eye surgery (less than one hour) were selected and received aminophylline (3 mg/kg) 5 minutes after the induction of anesthesia with sevoflurane. Patients were kept in the recovery room for 2 hours post-operation in an incubator and were monitored for SPO2, apnea, bradycardia and other signs of desaturation and apnea. There were no statistically significant differences in the gestational age and weight, sex, postconceptual age and weight and other demographic characteristics between the experimental and control groups. Gestational ageapnea. Treatment with aminophylline as compared with the placebo was associated with a significantly decreased risk of post-operative apnea (OR=0.53; 95% CI 0.28-0.98; P=0.034). Aminophylline can be used prophylactically to decrease the risk of postoperative apnea with no major adverse effects.
Chen, Lili; Zhang, Xi; Wang, Hui
Obstructive sleep apnea (OSA) is a common sleep disorder that often remains undiagnosed, leading to an increased risk of developing cardiovascular diseases. Polysomnogram (PSG) is currently used as a golden standard for screening OSA. However, because it is time consuming, expensive and causes discomfort, alternative techniques based on a reduced set of physiological signals are proposed to solve this problem. This study proposes a convenient non-parametric kernel density-based approach for detection of OSA using single-lead electrocardiogram (ECG) recordings. Selected physiologically interpretable features are extracted from segmented RR intervals, which are obtained from ECG signals. These features are fed into the kernel density classifier to detect apnea event and bandwidths for density of each class (normal or apnea) are automatically chosen through an iterative bandwidth selection algorithm. To validate the proposed approach, RR intervals are extracted from ECG signals of 35 subjects obtained from a sleep apnea database ( http://physionet.org/cgi-bin/atm/ATM ). The results indicate that the kernel density classifier, with two features for apnea event detection, achieves a mean accuracy of 82.07 %, with mean sensitivity of 83.23 % and mean specificity of 80.24 %. Compared with other existing methods, the proposed kernel density approach achieves a comparably good performance but by using fewer features without significantly losing discriminant power, which indicates that it could be widely used for home-based screening or diagnosis of OSA.
Lee, Sang-Ahm; Lee, Gha-Hyun; Chung, Yoo-Sam; Kim, Woo Sung
To determine whether obstructive sleep apnea syndrome (OSAS) patients with mixed sleep apnea (MSA) have different clinical, polysomnographic, and continuous positive airway pressure (CPAP) titration findings compared to OSAS patients without MSA. We retrospectively reviewed the records of OSAS patients who had undergone CPAP titration and categorized them into pure-OSA and mixed-OSA groups. Demographic features, daytime sleepiness, and apnea severity were compared between the two groups using univariate and multivariate analyses. CPAP titration findings were also compared between the two groups. One hundred and ninety-five subjects (n=126 pure-OSA; n=69 mixed-OSA) were included in the analysis. Compared to the pure-OSA group, the mixed-OSA group had a higher percentage of males (p=0.003) and a higher body mass index (p=0.044), Epworth Sleepiness Scale score (p=0.028), and apnea-hypopnea index (AHI) (ptitration, and a higher titrated pressure than the pure-OSA group. Severe OSA, older age, male sex, obesity, and daytime sleepiness were related to mixed-OSA. Complex sleep apnea, less optimal titration, and a higher titrated CPAP were also associated with MSA in OSAS patients. Copyright © 2015 Elsevier B.V. All rights reserved.
Naismith, Sharon L; Winter, Virginia R; Hickie, Ian B; Cistulli, Peter A
This study aimed to assess the efficacy of a custom-made mandibular advancement splint for the treatment of obstructive sleep apnea with respect to neuropsychological functioning and mood state. A randomized controlled crossover design was used in which 73 participants (mean age = 48.4, SD = 11.0, % men = 80.8) with at least 2 symptoms of obstructive sleep apnea and an apnea hypopnea index > or = 10 per hour underwent treatment with both mandibular advancement splint and an inactive oral device. Polysomnographic, neuropsychological and self-report measures were conducted at baseline and repeated after each of the two 4-week treatment phases. MAS treatment was associated with improvements on the somatic component of the Beck Depression Inventory and the Vigor-Activity and Fatigue-Inertia scales of the Profile of Mood States. While there were no improvements within the neuropsychological domains of attention/working memory, verbal memory, visuospatial or executive functioning, treatment with the mandibular advancement splint was associated with faster performance on a test of vigilance/psychomotor speed. These changes, however, did not correspond to the improved subjective sleepiness or apnea-hypopnea index during treatment. Treatment with the mandibular advancement splint results in improvements in self-reported sleepiness, fatigue/energy levels and vigilance/psychomotor speed in patients with obstructive sleep apnea.
Bhat, Ravindra Y; Rafferty, Gerrard F; Hannam, Simon; Greenough, Anne
Concerns regarding gastroesophageal reflux (GER) and associated apnea episodes result in some practitioners having convalescent, prematurely born infants sleep in the prone position. We have tested the hypothesis that such infants would not suffer from clinically important acid GER or associated apnea episodes more in the supine compared with the prone position. Lower esophageal pH was measured and videopolysomnographic recordings of nasal airflow, chest and abdominal wall movements, electrocardiographic activity, and oxygen saturation were made on two successive days of 21 premature infants (median gestational age 28 wk) at a median postmenstrual age (PMA) of 36 wk. On each day, the infants were studied prone and supine. The acid reflux index was higher in the supine compared with the prone position (median 3% versus 0%, p = 0.002), but was low in both positions. The number of obstructive apnea episodes per hour was higher in the supine position (p = 0.008). There were, however, no statistically significant correlations between the amount of acid GER and the number of either obstructive or total apnea episodes in either the supine or prone position. Supine compared with prone sleeping neither increases clinically important acid GER nor obstructive apnea episodes associated with acid GER in asymptomatic, convalescent, prematurely born infants.
Bin, Yu Sun; Cistulli, Peter A; Ford, Jane B
To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth from 2002 to 2012 (n = 636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.43; 95% CI 1.18-1.73), planned delivery (1.15; 1.07-1.23), preterm birth (1.50; 1.21-1.84), 5-minute Apgar apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history. © 2016 American Academy of Sleep Medicine.
Bandyopadhyay, Anuja; Harmon, Heidi; Slaven, James E; Daftary, Ameet S
Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown. A retrospective chart review was performed for all preterm infants (apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores. Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO 2 (median 47 mm Hg [25-60]) negatively correlated with cognitive scores ( P = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores. The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO 2 , independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA. A commentary on this article appears in this issue on page 1233. © 2017 American Academy of Sleep Medicine
Itzhaki, Sarah; Lavie, Lena; Pillar, Giora; Tal, Galit; Lavie, Peretz
The aim of this study was to investigate endothelial functioning in sleep apnea patients using a novel plethysmographic device that monitors peripheral arterial tone response in the finger to reactive hyperemia induced by forearm ischemia. Forty-six sleep apnea patients, 74.0% men, mean age 46.8 +/- 9.3 years, and 17 control subjects without sleep apnea, 64.7% men, mean age 47.1 +/- 6.7 years. Eight-bed Technion Sleep Medicine Center in Haifa, Israel. Endothelial functioning assessed by the reactive hyperemia peripheral arterial tone index was measured twice, before sleep and after waking from sleep monitored by polysomnography in the laboratory. The reactive hyperemia peripheral arterial tone index was calculated as the average amplitude of the peripheral arterial tone signal after the cuff deflation divided by the average amplitude before the cuff inflation. Morning index of endothelial functioning was significantly lower in patients with moderate to severe sleep apnea (apnea-hypopnea index > or = 30) than in patients with mild sleep apnea (30 disease had significantly lower morning and evening indexes of endothelial functioning than patients without such a history. Multivariate analysis revealed that apnea-hypopnea index and sleep efficiency were significant predictors of the morning index. Measurements of the response of the peripheral arterial tone in the finger to reactive hyperemia can be used as a substitute for the brachial artery ultrasound technique to measure endothelial functioning in patients with sleep apnea.
Goucham, Amin B.; Coblijn, Usha K.; Hart-Sweet, Helga B.; de Vries, Nico; Lagarde, Sjoerd M.; van Wagensveld, Bart A.
Obstructive sleep apnea (OSA) occurs in 70-80% of bariatric surgery patients. Patients with severe OSA (apnea/hypopnea index (AHI) >30/h) are postoperatively admitted to an intensive care unit (ICU) for continuous monitoring, to prevent complications. The aim of this study was to assess the
Camacho, Macario; Zaghi, Soroush; Chang, Edward T.; Song, Sungjin A.; Szelestey, Blake; Certal, Victor
Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed. PMID:26925105
Full Text Available Obstructive Sleep Apnea (OSA Syndrome is a relatively frequent sleep disorder characterized by disrupted sleep patterns. It is a well-established fact that sleep has beneficial effect on memory consolidation by enhancing neural plasticity. Implicit sequence learning is a prominent component of skill learning. However, the formation and consolidation of this fundamental learning mechanism remains poorly understood in OSA. In the present study we examined the consolidation of different aspects of implicit sequence learning in patients with OSA. We used the Alternating Serial Reaction Time task to measure general skill learning and sequence-specific learning. There were two sessions: a learning phase and a testing phase, separated by a 10-hour offline period with sleep. Our data showed differences in offline changes of general skill learning between the OSA and control group. The control group demonstrated offline improvement from evening to morning, while the OSA group did not. In contrast, we did not observe differences between the groups in offline changes in sequence-specific learning. Our findings suggest that disrupted sleep in OSA differently affects neural circuits involved in the consolidation of sequence learning.
Pinto, José Antonio; Godoy, Luciana Ballester de Mello; Marquis, Valéria Wanderley Pinto Brandão; Sonego, Thiago Branco; Leal, Carolina de Farias Aires; Artico, Marina Spadari
The Obstructive Sleep Apnea Syndrome is a chronic disease characterized by episodes upper airway collapse, and has been associated with increased cardiovascular morbidity. To correlate the neck, abdominal and pelvic circumference with the AHI and oxyhemoglobin saturation in OSA patients, and to correlate these values with disease severity. A prospective descriptive study of 82 patients evaluated complaints suggesting OSA, from July 2008 to March 2010. All patients underwent polysomnography, an ENT clinical exam, measures of the BMI, abdominal, pelvic, and cervical circumferences. The mean, standard deviations and Spearman's correlations were analyzed. The mean AHI in men was 39 events/hr; in women it was 21 events/hr in women. The mean neck circumference was 34. 5 cm in women and 41. 3 cm in men, the mean abdominal circumference was 94. 3 cm in women and 101. 5 cm in men, and the pelvic circumference was 105. 7 cm in men and 108. 7 cm in women. The neck circumference correlated more closely to the AHI in men (r = + 0. 389 p = 0. 001). The relationship between the abdominal circumference correlated more with AHI than with the BMI in men (AbC r = + 0. 358 p = 0. 003 BMI r = + 0. 321 p = 0. 009). The neck circumference is the best anthropometric measurement of respiratory disorder severity compared to the AbC or the BMI.
Full Text Available Obstructive sleep apnea syndrome (OSAS is a serious, prevalent condition that has significant morbidity and mortality when untreated. It is strongly associated with obesity and is characterized by changes in the serum levels or secretory patterns of several hormones. Obese patients with OSAS show a reduction of both spontaneous and stimulated growth hormone (GH secretion coupled to reduced insulin-like growth factor-I (IGF-I concentrations and impaired peripheral sensitivity to GH. Hypoxemia and chronic sleep fragmentation could affect the sleep-entrained prolactin (PRL rhythm. A disrupted Hypothalamus-Pituitary-Adrenal (HPA axis activity has been described in OSAS. Some derangement in Thyroid-Stimulating Hormone (TSH secretion has been demonstrated by some authors, whereas a normal thyroid activity has been described by others. Changes of gonadal axis are common in patients with OSAS, who frequently show a hypogonadotropic hypogonadism. Altogether, hormonal abnormalities may be considered as adaptive changes which indicate how a local upper airway dysfunction induces systemic consequences. The understanding of the complex interactions between hormones and OSAS may allow a multi-disciplinary approach to obese patients with this disturbance and lead to an effective management that improves quality of life and prevents associated morbidity or death.
Sutherland, Kate; Vanderveken, Olivier M; Tsuda, Hiroko; Marklund, Marie; Gagnadoux, Frederic; Kushida, Clete A; Cistulli, Peter A
Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.
Bruno Caldin da Silva
Full Text Available Sleep apnea (SA, a condition associated with increased cardiovascular risk, has been traditionally associated with obesity and aging. However, in patients with fluid-retaining states, such as congestive heart failure and end-stage renal disease, both prevalence and severity of SA are increased. Recently, fluid shift has been recognized to play an important role in the pathophysiology of SA, since the fluid retained in the legs during the day shifts rostrally while recumbent, leading to edema of upper airways. Such simple physics, observed even in healthy individuals, has great impact in patients with fluid overload. Correction of the excess fluid volume has risen as a potential target therapy to improve SA, by attenuation of nocturnal fluid shift. Such strategy has gained special attention, since the standard treatment for SA, the positive airway pressure, has low compliance rates among its users and has failed to reduce cardiovascular outcomes. This review focuses on the pathophysiology of edema and fluid shift, and summarizes the most relevant findings of studies that investigated the impact of treating volume overload on SA. We aim to expand horizons in the treatment of SA by calling attention to a potentially reversible condition, which is commonly underestimated in clinical practice.
Pillekamp, F; Hermann, C; Keller, T; von Gontard, A; Kribs, A; Roth, B
Apnea and bradycardia of prematurity (ABP) are possible risks towards damage of the developing brain. To characterize the influence of neonatal factors on ABP and to determine the relationship of ABP to neurodevelopmental outcome. ABP was described in very low birth weight infants (n = 83) using the frequency and severity of ABP episodes with a clinical score considering heart rate, oxygenation, duration and interventions performed during each episode. Neonatal factors were analyzed for their relationship to ABP using regression analysis. Neurodevelopment was investigated using the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development II at a corrected age of 13 months. Power of ABP parameters to predict outcome was assessed by logistic regression analysis. ABP typically started within the first week after birth. Spontaneous resolution occurred at a postmenstrual age (PMA) of 36.0 +/- 2.2 (31.1-44.1) weeks. A delayed resolution (>36 weeks PMA) and a higher average daily ABP score during a defined developmental period (31-37 weeks PMA) were associated with a higher incidence of unfavorable outcome (MDI or PDI <69 or death). ABP is an age-specific phenomenon. However, more severe courses than expected for PMA or the resolution at a later PMA indicated an increased risk of neurodevelopmental disturbances at a corrected age of 13 months. Copyright (c) 2007 S. Karger AG, Basel.
Bloch-Salisbury, Elisabeth; Hall, Mei Hua; Sharma, Priya; Boyd, Theonia; Bednarek, Francis; Paydarfar, David
Apnea of prematurity (AOP) is a disturbance in respiratory rhythm defined by idiopathic pauses in breathing that reduce blood oxygen levels and/or heart rate. It is a major clinical problem among preterm infants. The primary goal of this study was to estimate the genetic susceptibility to AOP in a cohort of preterm twins. A secondary aim was to identify risk factors associated with AOP in this cohort. A single-center, retrospective study (2000-2008) was performed by using data from 317 premature twin pairs (premature twins were assessed by using mixed-effects logistic regression. The heritability of AOP was 87% (95% confidence interval [CI]: 0.64-0.97) among same-gender twins. A gender-dependent model revealed that genetic factors accounted for 99% of the variance in male twins (95% CI: 0.89-1.00) and 78% of the variance in female twins (95% CI: 0.49-0.94). Significant risk factors for AOP were low gestational age (P<.001), cesarean delivery (P=.017), and conception through assisted reproductive technologies (P=.008). These findings suggest that AOP has an important genetic basis underlying this developmental-related disorder of respiratory control. Future genomic studies may provide information on pathophysiological mechanisms that underlie AOP.
Obesity and obstructive sleep apnea (OSA) have a reciprocal relationship. Sleep disruptions characteristic of OSA may promote behavioral, metabolic, and/or hormonal changes favoring weight gain and/or difficulty losing weight. The regulation of energy balance (EB), i.e., the relationship between energy intake (EI) and energy expenditure (EE), is complex and multi-factorial, involving food intake, hormonal regulation of hunger/satiety/appetite, and EE via metabolism and physical activity (PA). The current systematic review describes the literature on how OSA affects EB-related parameters. OSA is associated with a hormonal profile characterized by abnormally high leptin and ghrelin levels, which may encourage excess EI. Data on actual measures of food intake are lacking, and not sufficient to make conclusions. Resting metabolic rate appears elevated in OSA vs. Findings on PA are inconsistent, but may indicate a negative relationship with OSA severity that is modulated by daytime sleepiness and body weight. A speculative explanation for the positive EB in OSA is that the increased EE via metabolism induces an overcompensation in the drive for hunger/food intake, which is larger in magnitude than the rise in EI required to re-establish EB. Understanding how OSA affects EB-related parameters can help improve weight loss efforts in these patients. Copyright © 2016 Elsevier Ltd. All rights reserved.
Mario Francesco Damiani
Full Text Available Background and Aims. It is widely accepted that obstructive sleep apnea (OSA is independently associated with atherosclerosis. Similar to OSA, hypertension (HTN is a condition associated with atherosclerosis. However, to date, the impact of the simultaneous presence of OSA and HTN on the risk of atherosclerosis has not been extensively studied. The aim of this study was to evaluate the consequences of the coexistence of OSA and HTN on carotid intima-media thickness (IMT and on inflammatory markers of atherosclerosis (such as interleukin- [IL-] 6 and pentraxin- [PTX-] 3. Methods. The study design allowed us to define 4 groups: (1 controls (n=30; (2 OSA patients without HTN (n=30; (3 HTN patients without OSA (n=30; (4 patients with OSA and HTN (n=30. In the morning after portable monitoring (between 7 am and 8 am, blood samples were collected, and carotid IMT was measured. Results. Carotid IMT, IL-6, and PTX-3 in OSA normotensive patients and in non-OSA HTN subjects were significantly higher compared to control subjects; in addition, in OSA hypertensive patients they were significantly increased compared to OSA normotensive, non-OSA HTN, or control subjects. Conclusions. OSA and HTN have an additive role in the progression of carotid atherosclerosis and in blood levels of inflammatory markers for atherosclerosis, such as interleukin-6 and pentraxin-3.
Poirrier, Anne-Lise; Pire, Sylvie; Raskin, Sylviane; Limme, Michel; Poirrier, Robert
Lateral cephalometry has been widely used to characterize facial and maxillary morphology in obstructive sleep apnea (OSA) patients. It is a useful tool to assess orthodontic and maxillofacial procedures, but transverse dimensions of the airway (e.g., nasal framework) have not been well described yet by cephalometry. We explored whether postero-anterior cephalometry could refine the analysis of the facial morphology, with a special attention paid to nasal morphology. We validated cephalometric measurements relevant to the diagnosis of OSA. Controlled study. We explored postero-anterior and lateral cephalometric bony structures in OSA patients and in control subjects to determine which were predictive of an association with OSA. Healthy volunteers paired for age and sex to OSA patients underwent polysomnography and cephalometry. Data were analyzed by Shapiro-Wilk, Fisher, Wilcoxon, and paired t tests where appropriate. Nasal fossae and maxillary bone proportions were positively and independently associated with the absence of OSA. Measurements of maxillary width, nasal fossae angle, and anterior skull base contributed to the characterization of OSA patients. Postero-anterior cephalometry is an easy, rapid, informative, and reliable technique, which is complementary to the lateral cephalometry in the assessment of OSA patients. Our study may also suggest the negative impact of the nasal resistance on the upper airway resistance in sleep disorders. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Laxmi, Nimma Vijaya; Talla, Harshavardhan; Meesala, Deepika; Soujanya, Shakuntala; Naomi, Nithya; Poosa, Manasa
Introduction: Obstructive sleep apnea (OSA) is considered to be a potentially life threatening disorder, which is characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The cephalometric method despite being a static, two-dimensional evaluation of dynamic three-dimensional structures of the head and neck is useful in diagnosing patients with OSA, as they have shown that significant differences exist between asymptomatic controls and patients with OSA. Aims and Objectives: This study is designed to compare and validate the craniofacial morphology in patients with OSA using lateral cephalometry in both upright and supine position. Materials and Methods: Sixty subjects participated in the study of which 30 were patients with OSA diagnosed by questionnaire and 30 were healthy control group with age range of 25–45 years. Results: The study group demonstrated an increased ANB, mandibular plane angles (GoGn-SN), lower anterior facial height which are statistically significant with a significant P cephalometry helps in recognizing the morphological changes induced by altered sleep pattern and for appropriate treatment planning. PMID:26604577
Jurado-Gámez, Bernabé; Guglielmi, Ottavia; Gude, Francisco; Buela-Casal, Gualberto
Obstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity. One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results. Patients with OSAHS had more sick leave lasting longer than 30days (16.6% vs. 7%, P=.049) and lower productivity (63.80% vs. 83.20%, P=.000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P>.050). None of the OSAHS-related variables was associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity. OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.
Shiomi, Fabio Koiti; Pisa, Ivan Torres; Campos, Carlos José Reis de
The International Classification of Sleep Disorders lists 90 disorders. Manifestations, such as snoring, are important signs in the diagnosis of the Obstructive Sleep Apnea Syndrome; they are also socially undesirable. The aim of this paper was to present and evaluate a computerized tool that automatically identifies snoring and highlights the importance of establishing the duration of each snoring event in OSA patients. The low-sampling (200 Hz) electrical signal that indicates snoring was measured during polysomnography. The snoring sound of 31 patients was automatically classified by the software. The Kappa approach was applied to measure agreement between the automatic detection software and a trained observer. Student's T test was applied to evaluate differences in the duration of snoring episodes among simple snorers and OSA snorers. Of a total 43,976 snoring episodes, the software sensitivity was 99. 26%, the specificity was 97. 35%, and Kappa was 0. 96. We found a statistically significant difference (p snoring episodes (simple snoring x OSA snorers). This computer software makes it easier to generate quantitative reports of snoring, thereby reducing manual labor.
Full Text Available Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes in adult obstructive sleep apnea (OSA patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed.
Barceló, Antonia; Esquinas, Cristina; Robles, Juan; Piérola, Javier; De la Peña, Mónica; Aguilar, Irene; Morell-Garcia, Daniel; Alonso, Alberto; Toledo, Nuria; Sánchez-de la Torre, Manuel; Barbé, Ferran
Obstructive sleep apnea (OSA) is now being recognized as an additional contributing factor to the pathogenesis of obesity-related comorbidities. At the same time, there is now increasing evidence to suggest that intestinal wall permeability plays a role in the development of metabolic syndrome. In the present study, circulating zonulin and fatty acid binding protein (I-FABP) were measured in association with metabolic, hepatic, and inflammatory parameters. Compared with controls, plasma I-FABP levels were significantly higher in patients with OSA (571 pg/mL [IQR 290-950] vs 396 pg/mL [IQR 234-559], p = 0.04). Zonulin levels were similar between groups. Significant relationships were observed between zonulin levels and waist circumference (p zonulin levels correlated negatively with the mean nocturnal oxygenation saturation (p zonulin and ALT, AST, and hs-CRP were attenuated, but not eliminated, after adjustment for other variables. The results of this study suggest that OSA is a risk factor for intestinal damage, regardless of metabolic profile, and that intestinal permeability might be a possible contributor to nonalcoholic fatty liver disease in patients with OSA. Copyright © 2016 Elsevier B.V. All rights reserved.
Adedayo, Ajibola Monsur; Olafiranye, Oladipupo; Smith, David; Hill, Alethea; Zizi, Ferdinand; Brown, Clinton; Jean-Louis, Girardin
Over the past half century, evidence has been accumulating on the emergence of obstructive sleep apnea (OSA), the most prevalent sleep-disordered breathing, as a major risk factor for cardiovascular disease. A significant body of research has been focused on elucidating the complex interplay between OSA and cardiovascular risk factors, including dyslipidemia, obesity, hypertension, and diabetes mellitus that portend increased morbidity and mortality in susceptible individuals. Although a clear causal relationship of OSA and dyslipidemia is yet to be demonstrated, there is increasing evidence that chronic intermittent hypoxia, a major component of OSA, is independently associated and possibly the root cause of the dyslipidemia via the generation of stearoyl-coenzyme A desaturase-1 and reactive oxygen species, peroxidation of lipids, and sympathetic system dysfunction. The aim of this review is to highlight the relationship between OSA and dyslipidemia in the development of atherosclerosis and present the pathophysiologic mechanisms linking its association to clinical disease. Issues relating to epidemiology, confounding factors, significant gaps in research and future directions are also discussed.
Na-Rungsri, Kunyalak; Lertmaharit, Somrat; Lohsoonthorn, Vitool; Totienchai, Surachart; Jaimchariyatam, Nattapong
The aim of this study was to evaluate the risk of obstructive sleep apnea (OSA) to preterm delivery (PTD), using the Berlin Questionnaire (BQ). This was a large, prospective cohort study among pregnant Thai women. The BQ was employed for symptom-based OSA screening during the second trimester, and PTD was recorded in 1345 pregnant women. Multivariate models were applied in controlling for potential confounders. The overall prevalence of the high risk of OSA was 10.1 %, and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio for PTD in women with a high risk of OSA was 2.00 (95 % confidence intervals (CIs) = 1.20, 3.34). Stratified analyses, after adjusting for confounding factors, indicated that a high risk of OSA was associated with an increased risk of spontaneous preterm delivery (odds ratio (OR) = 2.45, 95 % CI = 1.20, 5.02), but not with preterm premature rupture of membranes (OR = 1.61, 95 % CI = 0.61, 4.26), and medically indicated preterm delivery (OR = 1.83, 95 % CI = 0.72, 4.64). Pregnant women with a high risk of OSA are at an increased risk of having PTD, compared with pregnant women with a low risk of OSA.
Huang, Yu-Shu; Guilleminault, Christian
Pediatric obstructive sleep apnea (OSA) was initially described in 1976. In 1981, Dr. Guilleminault emphasized that pediatric OSA was different from the clinical presentation reported in adults. It was characterized by more disturbed nocturnal sleep than excessive daytime sleepiness, and presented more behavioral problems, particularly school problems, hyperactivity, nocturnal enuresis, sleep terrors, depression, insomnia, and psychiatric problems. The underlying causes of pediatric OSA are complex. Such factors as adenotonsillar hypertrophy, obesity, anatomical and neuromuscular factors, and hypotonic neuromuscular disease are also involved. Adenotonsillectomy (T&A) has been the recommended treatment for pediatric OSA, but in the recent past this practice has been placed very much in question. Therefore, we will discuss the mechanism of pediatric OSA and investigate obese and nonobese pediatric sleep-disordered breathing. Moreover, the important concept that dysfunction leads to the dysmorphism that impacts on the size of the upper airway has been advanced recently. Finally, the treatments of pediatric OSA, such as T&A, medication, the orthodontic approaches (rapid maxillary expansion, or mandibular advancement with functional appliances), positive airway pressure, and noninvasive treatment, such as myofunctional therapy (MFT), will be investigated. A "passive MFT" has been tried recently, but very few results exist. In conclusion, we have made progress in our understanding of pediatric OSA, and we can even recognize factors leading to its development or worsening. However, pediatricians and pediatric subspecialists are often unaware of the advances and the remedies available. © 2017 S. Karger AG, Basel.
Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S
Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.
Full Text Available Judgment and early danger warning of obstructive sleep apnea (OSA is meaningful to the diagnosis of sleep illness. This paper proposed a novel method based on wavelet information entropy spectrum to make an apnea judgment of the OSA respiratory signal detected by bio-radar in wavelet domain. It makes full use of the features of strong irregularity and disorder of respiratory signal resulting from the brain stimulation by real, low airflow during apnea. The experimental results demonstrated that the proposed method is effective for detecting the occurrence of sleep apnea and is also able to detect some apnea cases that the energy spectrum method cannot. Ultimately, the comprehensive judgment accuracy resulting from 10 groups of OSA data is 93.1%, which is promising for the non-contact aided-diagnosis of the OSA.
Ravelo-García, A. G.; Saavedra-Santana, P.; Juliá-Serdá, G.; Navarro-Mesa, J. L.; Navarro-Esteva, J.; Álvarez-López, X.; Gapelyuk, A.; Penzel, T.; Wessel, N.
Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p apnea. In addition, the processing of the HRV is a well established low cost and robust technique.
Stalford, Catherine B
Recent epidemiological research places the incidence of obstructive sleep apnea as high as 16% in the general population. Serious postoperative respiratory complications and death have been reported in this population. Anesthetic drugs contribute to these complications secondary to acute and residual influences on the complex orchestration of airway muscles and reflexes involved in airway patency. The Starling resistor model is a theoretical model that has application in explaining upper airway dynamics and the treatment and management of obstructive sleep apnea. The model postulates the oropharynx as a collapsible tube. The oropharynx remains open or partially or completely closed as a result of pressure upstream at the nose and mouth, pressure downstream at the trachea and below, or tissue pressure surrounding the oropharynx. This AANA Journal course provides an overview of the Starling resistor model, its application to obstructive sleep apnea, and preoperative and postoperative anesthetic considerations.
Matsuda, Fumiaki; Asakura, Kohji; Nakano, Yuji; Shintani, Tomoko; Akita, Nobuto; Kataura, Akikatsu (Sapporo Medical Coll. (Japan))
The obstructive sleep apnea syndrome (OSAS) is characterized by recurrent obstruction of the upper airway during sleep. In this study, we performed CT scans in 20 adult OSAS patients and 6 control subjects, and measured the airspaces in the nasopharynx, mesopharynx and hypopharynx, using an image analyzer. The airspaces were significantly smaller at all sites of the pharynx in OSAS patients than in the control subjects, but they did not show a positive correlation with the apnea index or the body mass index. In good responders whose apnea indexes improved more than 50% after uvulo-palato-pharyngoplasty (UPPP), the nasopharyngeal and mesopharyngeal airspaces were significantly smaller, and the hypopharyngeal space tended to be larger than in poor responders. Our results suggest that CT scan is a helpful method for analyzing the area of the upper airway, especially in relation to the response to UPPP in adults with OSAS. (author).
Ducrocq, S; Biran-Mucignat, V; Boelle, P-Y; Lebas, F; Baudon, J-J; Gold, F
Apnea of prematurity develop during the first days of life and usually resolve by the time the infant reaches 36-37 weeks postmenstrual age. In a few cases, they persist beyond term, especially in infants delivered at the youngest gestational ages (24-28 GA), and require specific care. In our unit, those preterm babies are discharged home with caffeine citrate treatment. Discontinuing the treatment is performed in hospital when they achieve a postmenstrual age of at least 42 weeks. To identify predictive factors of persistent apnea in preterm babies. Retrospective study comparing a population of 41 preterm infants discharged with treatment to 123 preterm babies discharged without treatment to identify predictors of persistent apnea. Factors significantly associated were: birth weightapnea can be responsible for prolonged hospitalization. Risk factors can be identified in some children. Discharging with treatment can be an alternative to their hospitalization.
Schmidt, Barbara; Roberts, Robin S; Davis, Peter; Doyle, Lex W; Barrington, Keith J; Ohlsson, Arne; Solimano, Alfonso; Tin, Win
Methylxanthine therapy is commonly used for apnea of prematurity but in the absence of adequate data on its efficacy and safety. It is uncertain whether methylxanthines have long-term effects on neurodevelopment and growth. We randomly assigned 2006 infants with birth weights of 500 to 1250 g to receive either caffeine or placebo until therapy for apnea of prematurity was no longer needed. The primary outcome was a composite of death, cerebral palsy, cognitive delay (defined as a Mental Development Index score of apnea of prematurity improves the rate of survival without neurodevelopmental disability at 18 to 21 months in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.
Gauda, Estelle B; Shirahata, Machiko; Mason, Ariel; Pichard, Luis E; Kostuk, Eric W; Chavez-Valdez, Raul
Breathing is a complex function that is dynamic, responsive, automatic and often unstable during early development. The carotid body senses dynamic changes in arterial oxygen and carbon dioxide tension and reflexly alters ventilation and plays an essential role in terminating apnea. The carotid body contributes 10-40% to baseline ventilation in newborns and has the greatest influence on breathing in premature infants who characteristically have unstable breathing leading to apnea of prematurity. In this review, we will discuss how both excessive and minimal contributions from the carotid body destabilizes breathing in premature infants and how exposures to hypoxia or infection can lead to changes in the sensitivity of the carotid body. We propose that inflammation/infection during a critical period of carotid body development causes acute and chronic changes in the carotid body contributing to a protracted course of intractable and severe apnea known to occur in a subset of premature infants. Copyright © 2012. Published by Elsevier B.V.
Full Text Available A sleepy man without sleep apnea at 1609m (5280 feet had disturbed sleep at his home altitude of 3200m (10500 feet. In addition to common disruptors of sleep such as psychophysiologic insomnia, restless leg syndrome, alcohol and excessive caffeine use, central sleep apnea with periodic breathing can be a significant cause of disturbed sleep at altitude. In symptomatic patients living at altitude, a sleep study at their home altitude should be considered to accurately diagnose the presence and magnitude of sleep disordered breathing as sleep studies performed at lower altitudes may miss this diagnosis. Treatments options differ from those to treat obstructive apnea. Supplemental oxygen is considered by many to be first-line therapy.
Altuve, M; Carrault, G; Cruz, J; Beuchae, A; Pladys, P; Hernandez, A
This work presents an analysis of the information content of new features derived from the electrocardiogram (ECG) for the characterization of apnea-bradycardia events in preterm infants. Automatic beat detection and segmentation methods have been adapted to the ECG signals from preterm infants, through the application of two evolutionary algorithms. ECG data acquired from 32 preterm infants with persistent apnea-bradycardia have been used for quantitative evaluation. The adaptation procedure led to an improved sensitivity and positive predictive value, and a reduced jitter for the detection of the R-wave, QRS onset, QRS offset, and iso-electric level. Additionally, time series representing the RR interval, R-wave amplitude and QRS duration, were automatically extracted for periods at rest, before, during and after apnea-bradycardia episodes. Significant variations (papnea-bradycardia episodes, which could be potentially useful for the early detection and characterization of these episodes.
Se Joong Kim
Full Text Available Although continuous positive airway pressure is the treatment of choice for obstructive sleep apnea, its compliance is low. Therefore, alternative therapeutic strategies are often required. High flow nasal cannula therapy uses an air compressor to deliver a constant flow of oxygen via the nasal cannula at a maximum of 60 L/m. It can produce positive end expiratory pressure and increase end expiratory pharyngeal pressure, which can help to alleviate upper airway obstruction. This is a case report of high flow nasal cannula therapy for a 71 year-old man. He had an obstructive sleep apnea and severe desaturation but failed to use continuous positive airway pressure. He underwent titration with high flow nasal cannula under polysomnography. Using high flow nasal cannula at an airflow of 45 L/m, his apnea-hypopnea, respiratory arousal and oxygen desaturation were improved. Importantly, he is very compliant with high flow nasal cannula therapy.
Galvin, J.R.; Rooholamini, S.A.; Stanford, W.
With sleep there is normally a decrease in neural output to upper airway muscles. If this decrease is superimposed on a structurally abnormal airway, then sleep apnea may result. Ultrafast CT axially images the upper airway in near real time. The authors compared 11 awake patients with sleep apnea with 24 healthy volunteers during quiet tidal breathing. They found that apneic patients have a small oropharyngeal airway (31.3 mm 2 +- 30.2 vs 134.2 mm 2 +- 46.6[P=<.0001]). Apneic patients also have significant collapsibility of the nasopharynx (75% +- 18% vs 27% +- 14% [P=<.0001]). Ultrafast CT gives dynamic anatomic definition of the upper airway and provides a means to eulcidate further the pathogenesis of sleep apnea
Mari A. Watanabe
Full Text Available Background Patients with obstructive sleep apnea are reported to have a peak of sudden cardiac death at night, in contrast to patients without apnea whose peak is in the morning. We hypothesized that ventricular premature contraction (VPC frequency would correlate with measures of apnea and sympathetic activity.Methods Electrocardiograms from a sleep study of 125 patients with coronary artery disease were evaluated. Patients were categorized by apnea-hypopnea index (AHI into Moderate (AHI 15 apnea groups. Sleep stages studied were Wake, S1, S2, S34, and rapid eye movement (REM. Parameters of a potent autonomically-based risk predictor for sudden cardiac death called heart rate turbulence were calculated.Results There were 74 Moderate and 51 Severe obstructive sleep apnea patients. VPC frequency was affected significantly by sleep stage (Wake, S2 and REM, F=5.8, p<.005 and by AHI (F=8.7, p<.005. In Severe apnea patients, VPC frequency was higher in REM than in Wake (p=.011. In contrast, patients with Moderate apnea had fewer VPCs and exhibited no sleep stage dependence (p=.19. Oxygen desaturation duration per apnea episode correlated positively with AHI (r2=.71, p<.0001, and was longer in REM than in non-REM (p<.0001. The heart rate turbulence parameter TS correlated negatively with oxygen desaturation duration in REM (r2=.06, p=.014.Conclusions Higher VPC frequency coupled with higher sympathetic activity caused by longer apnea episodes in REM sleep may be one reason for increased nocturnal death in apneic patients.
Chantel D Sloan
Full Text Available Rates of Sudden Unexplained Infant Death (SUID, bronchiolitis, and central apnea increase in winter in temperate climates. Though associations between these three conditions are suggested, more work is required to establish if there is a causal pathway linking bronchiolitis to SUID through inducing central apnea. Utilizing a large population-based cohort of infants studied over a 20-year period (n = 834,595, from birth years 1989-2009, we analyzed ecological associations between timing of SUID cases, bronchiolitis, and apnea healthcare visits. Data were analyzed between 2013 and 2015. We used a Cox Proportional Hazards model to analyze possible interactions between maternal smoking and maternal asthma with infant bronchiolitis on time to SUID. SUID and bronchiolitis both occurred more frequently in winter. An increase in bronchiolitis clinical visits occurred within a few days prior to apnea visits. We found a temporal relationship between infant bronchiolitis and apnea. In contrast, no peak in SUID cases was seen during peaks of bronchiolitis. Among those without any bronchiolitis visits, maternal smoking was associated with an increased risk of SUID: Hazard Ratio (HR of 2.38 (95% CI: 2.11, 2.67, p-value <0.001. Maternal asthma was associated with an increased risk of SUID among infants with at least one bronchiolitis visit: HR of 2.40 (95% CI: 1.04, 5.54, p-value = 0.04. Consistent trends between bronchiolitis, apnea, and SUID were not established due to small numbers of SUID cases. However, interaction analysis revealed potential differential associations of bronchiolitis and SUID by maternal smoking, maternal asthma status.
Xará, Daniela; Mendonça, Júlia; Pereira, Helder; Santos, Alice; Abelha, Fernando José
Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann-Whitney test, the chi-square test and the Fisher exact test were used for comparisons. Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24kg/m(2), p<0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p<0.001), dyslipidemia (46% versus 17%, p<0.001) and insulin-treated diabetes mellitus (17% versus 2%, p=0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p=0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p<0.001), mild to moderate desaturation (15% versus 0%, p=0.001) and inability to breathe deeply (34% versus 9%, p=0.001). After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Xará, Daniela; Mendonça, Júlia; Pereira, Helder; Santos, Alice; Abelha, Fernando José
Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann-Whitney test, the chi-square test and the Fisher exact test were used for comparisons. Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24kg/m(2), p<0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p<0.001), dyslipidemia (46% versus 17%, p<0.001) and insulin-treated diabetes mellitus (17% versus 2%, p=0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p=0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p<0.001), mild to moderate desaturation (15% versus 0%, p=0.001) and inability to breathe deeply (34% versus 9%, p=0.001). After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Maricoto, Tiago; Silva, Eurico Alves Rodrigues; Damião, Pedro; Bastos, José Mesquita
Ambulatory blood pressure monitoring by automatic device is the best blood pressure evaluation method and sleep apnea syndrome is the leading cause of poor control. Oximetry allows screening these individuals but its usefulness has been poorly explored in Primary Health Care. The aim was to evaluate the blood pressure control at the office and with ambulatory blood pressure monitoring by automatic device and to relate it to sleep apnea syndrome. We selected a sample of 50 participants, representative of 3036 hypertensive patients. The variables were: blood pressure value at the office and blood pressure with ambulatory blood pressure monitoring by automatic device; presence of criteria of sleep apnea syndrome in oximetry. The prevalence of uncontrolled blood pressure was 56% on office evaluation and 68% on ambulatory blood pressure monitoring by automatic device. It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. Blood pressure in ambulatory blood pressure monitoring by automatic device and blood pressure in office showed no statistically significant association (p = 0.761). We found a statistically significant association between sleep apnea syndrome and daytime hypertension (p = 0.019) and non-dipper profile (p = 0.005). Ambulatory blood pressure monitoring by automatic device detected more 12% of uncontrolled hypertension than office blood pressure. Sleep apnea syndrome is strongly associated with uncontrolled hypertension and oximetry may be a good screening method, but should be studied further.
V. E. Oleynikov
Full Text Available Aim. To assess the impact of metabolic abnormalities in combination with obstructive sleep apnea on endothelial function and vascular stiffness parameters in patients with arterial hypertension 1-2 degrees. Material and methods. Patients (n=74 with metabolic syndrome and obstructive sleep apnea were included into the study. All patients underwent cardiorespiratory monitoring of sleep using SomnoCheck2 device (Wiennmann, Germany and were divided into two groups based on its results. Patients with apnea-hypopnea index (AHI <30 episodes per hour were included into group 1 and patients with AHI >30 episodes per hour – into group 2. Monitoring of ambulatory blood pressure (BP and arterial stiffness was performed by the device BPLab ("Peter Telegin", Russia. Endothelial function was assessed in a probe of flow-mediated dilation by the ultrasound device MyLab 90 (Esaote, Italy. Diameter of the common carotid artery (DCCA and the intima-media thickness (IMT were determined. Results. Patients with AHI >30 episodes per hour had higher mean daily and night systolic BP and pulse BP in aorta and brachial artery. Pulse wave velocity in aorta in per day averaged was also higher in these patients (8.2±0.8 vs 9.1±1.1 m/sec; p<0.05. Mean level of flow-mediated dilation was significantly lower in patients with severe sleep apnea> (8.8% (5.6; 13.1 vs 4.5% (2.2; 8.0; p<0.05. Prevalence of negative index of reactivity in group 2 was 2 times higher than this in group 1. An increase in IMT and DCCA in patients with severe obstructive sleep apnea was also revealed. Conclusion. Severe sleep apnea in patients with metabolic syndrome in combination with hypertension aggravates structural changes and endothelial dysfunction of the main arteries, as well as contributes to the progression of atherosclerosis.
Jong Gyun Ha
Full Text Available INTRODUCTION: We hypothesized that the size of the hyoid bone itself may affect the severity of sleep apnea. The aim of this study was to identify the relationship between hyoid bone dimensions and the severity of sleep apnea using computerized tomography (CT axial images. METHODS: We retrospectively measured the hyoid bone in axial images of neck CTs and correlated these measurements with results of polysomnography in a total of 106 male patients. The new hyoid bone parameters studied in this study were as follows: distance between bilateral lesser horns (LH-d, distance between bilateral greater horns (GH-d, distance from the most anterior end of the hyoid arch to GH-d (AP, distance from the greater to the lesser horn on right and left sides (GH-LH, and the anterior angle between bilateral extensive lines from the greater to the lesser horn (H-angle. Data was analyzed using univariate and multivariate logistic regression, and Pearson correlation tests. RESULTS: We found a significant inverse correlation between the apnea-hypopnea index (AHI and GH-d or AP. Neither the LH-d, GH-LH, nor H-angle were associated with the AHI. The patient group that met the criteria of both GH-d<45.4 and AP<33.4 demonstrated the most severe AHI. CONCLUSION: The lateral width or antero-posterior length of hyoid bone was associated with AHI and predicted the severity of sleep apnea in male patients. This finding supports the role of expansion hyoidplasty for treatment of sleep apnea. Pre-operative consideration of these parameters may improve surgical outcomes in male patients with sleep apnea.
Bin, Yu Sun; Cistulli, Peter A.; Ford, Jane B.
Study Objectives: To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. Methods: Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth from 2002 to 2012 (n = 636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. Results: Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.43; 95% CI 1.18–1.73), planned delivery (1.15; 1.07–1.23), preterm birth (1.50; 1.21–1.84), 5-minute Apgar apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history. Citation: Bin YS, Cistulli PA, Ford JB. Population-based study of sleep apnea in pregnancy and maternal and infant outcomes. J Clin Sleep Med 2016;12(6):871–877. PMID:27070246
Klein, Mitchel; Flanders, W. Dana; Mulholland, James A.; Freed, Gary; Tolbert, Paige E.
Background: Evidence suggests that increased ambient air pollution concentrations are associated with health effects, although relatively few studies have specifically examined infants. Objective: We examined associations of daily ambient air pollution concentrations with central apnea (prolonged pauses in breathing) and bradycardia (low heart rate) events among infants prescribed home cardiorespiratory monitors. Methods: The home monitors record the electrocardiogram, heart rate, and respiratory effort for detected apnea and bradycardia events in high-risk infants [primarily premature and low birth weight (LBW) infants]. From August 1998 through December 2002, 4,277 infants had 8,960 apnea event-days and 29,450 bradycardia event-days in > 179,000 days of follow-up. We assessed the occurrence of apnea and bradycardia events in relation to speciated particulate matter and gaseous air pollution levels using a 2-day average of air pollution (same day and previous day), adjusting for temporal trends, temperature, and infant age. Results: We observed associations between bradycardia and 8-hr maximum ozone [odds ratio (OR) = 1.049 per 25-ppb increase; 95% confidence interval (CI), 1.021–1.078] and 1-hr maximum nitrogen dioxide (OR =1.025 per 20-ppb increase; 95% CI, 1.000–1.050). The association with ozone was robust to different methods of control for time trend and specified correlation structure. In secondary analyses, associations of apnea and bradycardia with pollution were generally stronger in infants who were full term and of normal birth weight than in infants who were both premature and LBW. Conclusions: These results suggest that higher air pollution concentrations may increase the occurrence of apnea and bradycardia in high-risk infants. PMID:21447453
Moro, Marilyn; Gannon, Karen; Lovell, Kathy; Merlino, Margaret; Mojica, James; Bianchi, Matt T
Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%-15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management. We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split-night; n=306 two-night). Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG) data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI) ≥5 during split-night PSG (SN-PSG) versus full-night PSG (FN-PSG) titrations. CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients. Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the laboratory setting, even as PSG remains the gold standard for characterizing primary central apnea and TECSA.
Regenbogen, Elliot; Zhang, Shouling; Yang, Jie; Shroyer, Annie; Zhu, Chencan; DeCristofaro, Joseph
This study sought to characterize trends in the diagnosis of apnea, associated comorbidities and complications, and 30-day readmission rates in preterm singleton infants. The study design was a retrospective, longitudinal, observational study. 2003-2014 New York State Statewide Planning and Research Cooperative System and New York City Vital Statistics databases were merged identifying preterm live singleton births. Hospitalizations of preterm newborns with and without apnea were compared; multivariable logistic regression and log-linear Poisson regression models applied. Of 1,384,013 singleton births, 7.5% were identified as preterm. While relative risk of preterm birth rates declined (RR = 0.987, 95% CI = 0.982-0.991), the diagnosis of apnea increased significantly (RR = 1.069, 95% CI = 1.049-1.089). Multivariable analysis identified two apnea predictors, gastric reflux (OR = 3.19, 95% CI = 2.80-3.63) and early gestational age (OR = 0.83 for 1 week GA increase, 95% CI = 0.82-0.84). Preterm newborns with apnea were more likely to be readmitted within the first 30 days and total charges were 5.4 times higher. While the preterm birth rate has declined the rate of diagnosis of apnea with associated comorbidities and complications has increased. Given the additional findings of higher 30-day readmission rates and charges, more multidisciplinary research appears warranted to identify ways to optimize the quality of high risk newborn care. Copyright © 2018 Elsevier B.V. All rights reserved.
Marcus, Carole L; Meltzer, Lisa J; Roberts, Robin S; Traylor, Joel; Dix, Joanne; D'ilario, Judy; Asztalos, Elizabeth; Opie, Gillian; Doyle, Lex W; Biggs, Sarah N; Nixon, Gillian M; Narang, Indra; Bhattacharjee, Rakesh; Davey, Margot; Horne, Rosemary S C; Cheshire, Maureen; Gibbons, Jeremy; Costantini, Lorrie; Bradford, Ruth; Schmidt, Barbara
Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain. We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep. A total of 201 ex-preterm children aged 5-12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography. There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of -6.7 [95% confidence interval (CI) = -15.3 to 2.0 min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea-hypopnea index of 0.89 [95% CI = 0.55-1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups. Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood.
Benetti, Thaís Helena; Santos, Maria Fernanda; Mergulhão, Melissa Eichenberger Alves; Fagundes, João José; Ayrizono, Maria de Lourdes Setsuko; Coy, Cláudio Saddy Rodrigues
Intestinal constipation--a common symptom among the general population--is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation. To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation. Twenty-one patients (19 females--90.4%) with a mean age of 47.5 years old (23-72) were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1) and distal (2) portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea. The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007), independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06). The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008), either at the proximal portion or at the distal portion of the anal orifice. The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides lower elevation of anal pressure at rest by the parameter area
Kryger, M H
Although the relationship between breathing and sleep has only recently been "discovered" by the medical community, excellent literary descriptions of what we know to be the sleep apnea syndrome were made long ago. Although ancient Greek writings described probable sleep apnea, the most important literary contributions in this area are by Charles Dickens. His description of Joe the fat boy in the Pickwick Papers is an example of his brilliant skills of observation and description. It was not until about 140 years after Pickwick Papers was published that we understood what he was describing.
Full Text Available Abstract Background Cognitive impairment is one of the main consequences of obstructive sleep apnea (OSA and is usually attributed in part to the oxidative stress caused by intermittent hypoxia in cerebral tissues. The presence of oxygen-reactive species in the brain tissue should be produced by the deoxygenation-reoxygenation cycles which occur at tissue level during recurrent apneic events. However, how changes in arterial blood oxygen saturation (SpO2 during repetitive apneas translate into oxygen partial pressure (PtO2 in brain tissue has not been studied. The objective of this study was to assess whether brain tissue is partially protected from intermittently occurring interruption of O2 supply during recurrent swings in arterial SpO2 in an animal model of OSA. Methods Twenty-four male Sprague-Dawley rats (300-350 g were used. Sixteen rats were anesthetized and non-invasively subjected to recurrent obstructive apneas: 60 apneas/h, 15 s each, for 1 h. A control group of 8 rats was instrumented but not subjected to obstructive apneas. PtO2 in the cerebral cortex was measured using a fast-response oxygen microelectrode. SpO2 was measured by pulse oximetry. The time dependence of arterial SpO2 and brain tissue PtO2 was carried out by Friedman repeated measures ANOVA. Results Arterial SpO2 showed a stable periodic pattern (no significant changes in maximum [95.5 ± 0.5%; m ± SE] and minimum values [83.9 ± 1.3%]. By contrast, brain tissue PtO2 exhibited a different pattern from that of arterial SpO2. The minimum cerebral cortex PtO2 computed during the first apnea (29.6 ± 2.4 mmHg was significantly lower than baseline PtO2 (39.7 ± 2.9 mmHg; p = 0.011. In contrast to SpO2, the minimum and maximum values of PtO2 gradually increased (p 2 were significantly greater relative to baseline and the first apnea dip, respectively. Conclusions These data suggest that the cerebral cortex is partially protected from intermittently occurring interruption of
Full Text Available Marilyn Moro,1 Karen Gannon,1 Kathy Lovell,1 Margaret Merlino,1 James Mojica,2 Matt T Bianchi,1,3 1Neurology Department, 2Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Purpose: Treatment-emergent central sleep apnea (TECSA, also called complex apnea, occurs in 5%–15% of sleep apnea patients during positive airway pressure (PAP therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management.Methods: We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split night; n=306 two-night. Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI ≥5 during split PSG (SN-PSG versus full-night PSG (FN-PSG titrations.Results: CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients.Conclusion: Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the
Kilpinen, R; Saunamäki, T; Jehkonen, M
To provide a comprehensive review of studies on information processing speed in patients with obstructive sleep apnea syndrome (OSAS) as compared to healthy controls and normative data, and to determine whether continuous positive airway pressure (CPAP) treatment improves information processing speed. A systematic review was performed on studies drawn from Medline and PsycINFO (January 1990-December 2011) and identified from lists of references in these studies. After inclusion criteria, 159 articles were left for abstract review, and after exclusion criteria 44 articles were fully reviewed. The number of patients in the studies reviewed ranged from 10 to 157 and the study samples consisted mainly of men. Half of the studies reported that patients with OSAS showed reduced information processing speed when compared to healthy controls. Reduced information processing speed was seen more often (75%) when compared to norm-referenced data. Psychomotor speed seemed to be particularly liable to change. CPAP treatment improved processing speed, but the improvement was marginal when compared to placebo or conservative treatment. Patients with OSAS are affected by reduced information processing speed, which may persist despite CPAP treatment. Information processing is usually assessed as part of other cognitive functioning, not as a cognitive domain per se. However, it is important to take account of information processing speed when assessing other aspects of cognitive functioning. This will make it possible to determine whether cognitive decline in patients with OSAS is based on lower-level or higher-level cognitive processes or both. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Flávio Maciel Dias de Andrade
Full Text Available ABSTRACT Obstructive sleep apnea (OSA is a common clinical condition, with a variable and underestimated prevalence. OSA is the main condition associated with secondary systemic arterial hypertension, as well as with atrial fibrillation, stroke, and coronary artery disease, greatly increasing cardiovascular morbidity and mortality. Treatment with continuous positive airway pressure is not tolerated by all OSA patients and is often not suitable in cases of mild OSA. Hence, alternative methods to treat OSA and its cardiovascular consequences are needed. In OSA patients, regular physical exercise has beneficial effects other than weight loss, although the mechanisms of those effects remain unclear. In this population, physiological adaptations due to physical exercise include increases in upper airway dilator muscle tone and in slow-wave sleep time; and decreases in fluid accumulation in the neck, systemic inflammatory response, and body weight. The major benefits of exercise programs for OSA patients include reducing the severity of the condition and daytime sleepiness, as well as increasing sleep efficiency and maximum oxygen consumption. There are few studies that evaluated the role of physical exercise alone for OSA treatment, and their protocols are quite diverse. However, aerobic exercise, alone or combined with resistance training, is a common point among the studies. In this review, the major studies and mechanisms involved in OSA treatment by means of physical exercise are presented. In addition to systemic clinical benefits provided by physical exercise, OSA patients involved in a regular, predominantly aerobic, exercise program have shown a reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss.
Bulcun, Emel; Ekici, Mehmet; Ekici, Aydanur; Tireli, Gökhan; Karakoç, Tülay; Şentürk, Erol; Altınkaya, Volkan
The relationship between obstructive sleep apnea syndrome (OSAS) and bronchial hyperresponsiveness (BHR) is not well known. In this study, we investigated the association between BHR and disease severity in patients with OSAS. Fourty seven (37 male/10 female) OSAS patients admitted with polysomnography enrolled to the study. Histamine bronchial challenge test was performed and body mass index (BMI, kg/m2) was calculated. Presence of BHR was diagnosed as positivity of bronchial provocative test (BPT) (PD values ≤ 16 mg/mL). Patients were questioned with Epworth sleepiness scale (ESS). Histamine bronchial challenge test was positive in 21 of 47 patients. There were significant negative correlations between PD 20 value and AHI (r= -0.47, p= 0.03), BMI (r= -0.45, p= 0.03), and ESS score (r= -0.45, p= 0.03) in the patients with BHR. In addition, AHI (p= 0.03), BMI (p= 0.02), ESS scores (p= 0.03) were higher in patients with BHR (21 patients) than in patients not having BHR (26 patients). Significant negative relation was found between PD 20 value and AHI (b=-0.45, p= 0.03) and significant positive relation was found between presence of BHR and AHI (p= 0.04), BMI (p= 0.03) independently of age and sex in multiple regression analysis. BHR is common in patients with OSAS. As severity of OSAS increased, severity of BHR increased. In addition, obesity may trigger presence of BHR in patients with OSAS.
Daurat, Agnès; Sarhane, Majdouline; Tiberge, Michel
Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder characterized by repetitive episodes of airflow cessation, resulting in brief arousals and intermittent hypoxemia. OSAS is associated with a number of adverse health consequences, and cognitive difficulties. The overall pattern of cognitive impairment in OSAS is complex, and research in this field is mixed. On balance, OSAS have negative effects on cognition, most likely in the domain of attention/vigilance, verbal and visual delayed long-term memory, and executive functions. A still unanswered question is whether these deficits are primarily a consequence of sleep fragmentation and/or hypoxemia, or whether they coexist independently from OSAS. Continuous positive airway pressure (CPAP) is the most effective and widely used treatment of OSAS. No consistent effect of CPAP use on cognitive performance was evident. This may be due, in part, to variability in study design and sampling methodology across studies. Structural changes have been reported in different brain regions, particularly in hippocampus and frontal cortex. Recent evidence suggests that the OSAS-related structural changes may improve with CPAP treatment. However, one of the challenges is to interpret the findings in light of comorbid conditions that also cause neural lesions. Animal models will be specifically useful to disentangle the different potential contributors to cognitive impairment in OSAS. The purpose of this article is to provide a review of the literature on cognition and neuroimaging in OSAS patients before and after CPAP treatment. We also discuss the mechanisms that have been proposed to explain cognitive deficits in OSAS patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Full Text Available Introduction: The sympathetic activation is considered to be the main mechanism involved in the development of cardiovascular diseases in obstructive sleep apnea (OSA. The heart rate variability (HRV analysis represents a non-invasive tool allowing the study of the autonomic nervous system. The impairment of HRV parameters in OSA has been documented. However, only a few studies tackled the dynamics of the autonomic nervous system during sleep in patients having OSA. Aims: To analyze the HRV over sleep stages and across sleep periods in order to clarify the impact of OSA on cardiac autonomic modulation. The second objective is to examine the nocturnal HRV of OSA patients to find out which HRV parameter is the best to reflect the symptoms severity. Methods: The study was retrospective. We have included 30 patients undergoing overnight polysomnography. Subjects were categorized into two groups according to apnea–hypopnea index (AHI: mild-to-moderate OSAS group (AHI: 5–30 and severe OSAS group (AHI>30. The HRV measures for participants with low apnea–hypopnea indices were compared to those of patients with high rates of apnea–hypopnea across the sleep period and sleep stages. Results: HRV measures during sleep stages for the group with low rates of apnea–hypopnea have indicated a parasympathetic activation during non-rapid eye movement (NREM sleep. However, no significant difference has been observed in the high AHI group except for the mean of RR intervals (mean RR. The parasympathetic activity tended to increase across the night but without a statistical difference. After control of age and body mass index, the most significant correlation found was for the mean RR (p=0.0001, r=−0.248. Conclusion: OSA affects sympathovagal modulation during sleep, and this impact has been correlated to the severity of the disease. The mean RR seemed to be a better index allowing the sympathovagal balance appreciation during the night in OSA.
Bercea, Raluca Mihaela; Mihaescu, Traian; Cojocaru, Cristian; Bjorvatn, Bjørn
Obstructive sleep apnea (OSA)-related fatigue is a common understudied symptom. Fatigue is associated with low serum testosterone level in non-OSA patients. No data are available about this association in OSA patients. To investigate in adult obese males affected by OSA, the relationship between fatigue and serum testosterone in order to identify predictors for OSA-related fatigue. Fifteen OSA patients and 15 control subjects participated. The parameters analyzed were serum testosterone morning concentration, polysomnography parameters, daytime sleepiness (Epworth Sleepiness Scale) and fatigue (Multidimensional Fatigue Inventory). Regression test was applied in order to show predictors of fatigue. Kruskal-Wallis test followed by post-hoc analysis was performed to test for differences between controls and OSA subgroups for testosterone, fatigue components and sleepiness. Mean testosterone level was 3.55 ± 0.7 ng/mL in the OSA group, significantly lower than in controls (4.26 ± 1.1 ng/mL, P = 0.049). An inverse correlation was found between testosterone and fatigue scores (P testosterone was the only independent significant predictor of physical fatigue (t = -2.56, P = 0.033, R = 0.978, R(2) = 0.958) and reduced activity (t = -4.41, P = 0.002, R = 0.966, R(2) = 0.934) in the OSA patients. OSA-related fatigue was strongly associated with serum testosterone, together with OSA severity. © 2014 John Wiley & Sons Ltd.
Bayó Llibre, J; Riel Cabrera, R; Mellado Breña, E; Filomena Paci, J; Priego Artero, M; García Alfaro, F J; Grau Granero, J M; Vázquez González, D; López Solana, J; Fernández San Martín, M I
Sleep apnea hypopnea syndrome (SAHS) is frequent in hypertensive patients and plays a role in a greater incidence of cardiovascular morbidity-mortality. This study aims to know the clinical profile of hypertensive patients with SAHS compared to hypertensive patients without SAHS to know which variables should be used to orient their screening from primary care. An observational, descriptive, retrospective study of cases (hypertensive patients with SAHS) and controls (hypertensive patients without) was performed in an urban health care center. Based on a computerized registry of the site, patients diagnosed of SAHS and hypertension over 30 years of age were selected. For each case, one control case of hypertensive patients without SAHS paired by age and gender was randomly obtained. A total of 64 cases and 64 controls were selected. Standing out in the bivariate analysis were greater BMI (34.3±12.8 vs. 28.6±3.6), predominance of obesity (70.3 vs. 35.9%), metabolic syndrome (77.3 vs. 42.2%), consumption of psychopharmaceuticals (19.7 vs. 7.8%) and anithypertensive drugs (26.5 vs. 14.0%), ischemic heart disease (20.3 vs. 9.4%) in the case group versus control group (P<.05 for all the variables). The multivariate analysis showed that only the presence of metabolic syndrome was related with the presence of SAHS in hypertensive patients (OR 4.65; 95% CI: 2.03-10.64; P<.001). Screening for SAHS should be performed in hypertensive patients seen in primary care if they have metabolic syndrome criteria. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.
Schindler, Antonio; Mozzanica, Francesco; Sonzini, Giulia; Plebani, Daniela; Urbani, Emanuele; Pecis, Marica; Montano, Nicola
Although previous studies demonstrated that patients with obstructive sleep apnea syndrome (OSAS) may present subclinical manifestations of dysphagia, in not one were different textures and volumes systematically studied. The aim of this study was to analyze the signs and symptoms of oropharyngeal dysphagia using fiberoptic endoscopic evaluation of swallowing (FEES) with boluses of different textures and volumes in a large cohort of patients with OSAS. A total of 72 OSAS patients without symptoms of dysphagia were enrolled. The cohort was divided in two groups: 30 patients with moderate OSAS and 42 patients with severe OSAS. Each patient underwent a FEES examination using 5, 10 and 20 ml of liquids and semisolids, and solids. Spillage, penetration, aspiration, retention, and piecemeal deglutition were considered. The penetration-aspiration scale (PAS), pooling score (PS), and dysphagia outcome and severity scale (DOSS) were used for quantitative analysis. Each patient completed the SWAL-QOL questionnaire. Forty-six patients (64 %) presented spillage, 20 (28 %) piecemeal deglutition, 26 (36 %) penetration, and 30 (44 %) retention. No differences were found in the PAS, PS, and DOSS scores between patients with moderate and severe OSAS. Patients with severe OSAS scored higher General Burden and Food selection subscales of the SWAL-QOL. Depending on the DOSS score, the cohort of patients was divided into those with and those without signs of dysphagia. Patients with signs of dysphagia scored lower in the General Burden and Symptoms subscales of the SWAL-QOL. OSAS patients show signs of swallowing impairment in about half of the population; clinicians involved in the management of these patients should include questions on swallowing when taking the medical history.
Atik, Anzari; Harding, Richard; De Matteo, Robert; Kondos-Devcic, Delphi; Cheong, Jeanie; Doyle, Lex W; Tolcos, Mary
Caffeine is a methylxanthine that is widely used to treat apnea of prematurity (AOP). In preterm infants, caffeine reduces the duration of respiratory support, improves survival rates and lowers the incidence of cerebral palsy and cognitive delay. There is, however, little evidence relating to the immediate and long-term effects of caffeine on brain development, especially at the cellular and molecular levels. Experimental data are conflicting, with studies showing that caffeine can have either adverse or benefical effects in the developing brain. The aim of this article is to review current understanding of how caffeine ameliorates AOP, the cellular and molecular mechanisms by which caffeine exerts its effects and the effects of caffeine on brain development. A better knowledge of the effects of caffeine on the developing brain at the cellular and/or molecular level is essential in order to understand the basis for the impact of caffeine on postnatal outcome. The studies reviewed here suggest that while caffeine has respiratory benefits for preterm infants, it may have adverse molecular and cellular effects on the developing brain; indeed a majority of experimental studies suggest that regardless of dose or duration of administration, caffeine leads to detrimental changes within the developing brain. Thus there is an urgent need to assess the impact of caffeine, at a range of doses, on the structure and function of the developing brain in preclinical studies, particularly using clinically relevant animal models. Future studies should focus on determining the maximal dose of caffeine that is safe for the preterm brain. Copyright © 2017 Elsevier B.V. All rights reserved.
Bourne, Michael H; Scanlon, Paul D; Schroeder, Darrell R; Olson, Eric J
The sawtooth sign in spirometry is associated with redundant upper airway tissue and snoring, but its predictive value for identifying obstructive sleep apnea (OSA) is disputed. We retrospectively assessed the predictive value of the spirometric sawtooth sign in terms of the odds ratio (OR) of association with a diagnosis of OSA compared to those without the sign. Consecutive spirometry reports showing a sawtooth sign were identified from our laboratory. We identified 50 subjects with sawtooth sign and 100 control subjects without sawtooth sign, matched for age, BMI, and gender. The electronic medical record of each patient was queried for a diagnosis of OSA based on physician-reported diagnoses. Of the 50 subjects with sawtooth sign, 22 were found to have a current diagnosis of OSA (44%). Twenty-seven of the 100 controls (27%) also had OSA. From logistic regression analysis, sawtooth sign was associated with an increased likelihood of OSA (OR = 2.12, 95% C.I. 1.04 to 4.35). Similar results were obtained after adjustment for age, gender, pack years, and BMI (OR = 2.61, 95% C.I. 1.13 to 6.21). Patients with the sawtooth sign have greater odds of having a diagnosis of OSA compared with those without the sign. If prospectively evaluated, as a result of improved identification, we hypothesize that the sawtooth sign may show an even stronger association with OSA. This relatively common finding, which adds no cost to routine spirometry, may serve as an indicator for OSA workup for some individuals not already identified as having OSA.
Full Text Available Abstract Background Sleep spindles, as detected on scalp electroencephalography (EEG, are considered to be markers of thalamo-cortical network integrity. Since obstructive sleep apnea (OSA is a known cause of brain dysfunction, the aim of this study was to investigate sleep spindle frequency distribution in OSA. Seven non-OSA subjects and 21 patients with OSA (11 mild and 10 moderate were studied. A matching pursuit procedure was used for automatic detection of fast (≥13Hz and slow (Hz spindles obtained from 30min samples of NREM sleep stage 2 taken from initial, middle and final night thirds (sections I, II and III of frontal, central and parietal scalp regions. Results Compared to non-OSA subjects, Moderate OSA patients had higher central and parietal slow spindle percentage (SSP in all night sections studied, and higher frontal SSP in sections II and III. As the night progressed, there was a reduction in central and parietal SSP, while frontal SSP remained high. Frontal slow spindle percentage in night section III predicted OSA with good accuracy, with OSA likelihood increased by 12.1%for every SSP unit increase (OR 1.121, 95% CI 1.013 - 1.239, p=0.027. Conclusions These results are consistent with diffuse, predominantly frontal thalamo-cortical dysfunction during sleep in OSA, as more posterior brain regions appear to maintain some physiological spindle frequency modulation across the night. Displaying changes in an opposite direction to what is expected from the aging process itself, spindle frequency appears to be informative in OSA even with small sample sizes, and to represent a sensitive electrophysiological marker of brain dysfunction in OSA.
Full Text Available Objective: In this study, we aimed to search the possible association between Obstructive Sleep Apnea Syndrome’s (OSAS severity and thyroid gland malfunctions, and the effects of hypothyroidism on the mode of sleep in patients with OSAS. Methods:Demographic features and thyroid function tests of 211 patients (59, 28% female with a mean age of 50.9 ± 10.4 years (ranging from 30 to 75 who underwent polysomnography between September 2010 and September 2011 were retrospectively evaluated. Results: Hypothyroidism was detected in 8.3% of the patients with simple snoring and 10.6% of those with OSAS (9.1% in mild OSAS, 20.3% in moderate OSASand 6.3% in severe OSAS. There was no correlation between the severity of OSAS and the rate of hypothyroidism (p=0.620. The incidence of ypothyroidism was 16.9% in women and 6.6% in men and this difference was statistically significant (p=0.024. The polysomnographic findings did not differ between the patients with hypothyroidism and the others (table 5. However, in patients with elevated TSH levels, the rate of desaturation during sleep was high despite a lower AHI (r=0.126, p=0.05. Conclusion: No correlation was seen between the severity of OSAS and the rate of hypothyroidism. Women with OSAS had higher incidence of hypothyroidism. The polysomnographic findings did not differ whether the patient had hypothyroidism or not. The rate of desaturation during sleep was relatively high in patients with elevated TSH levels.
Baertsch, N. A.
Reduced respiratory neural activity elicits a rebound increase in phrenic and hypoglossal motor output known as inactivity-induced phrenic and hypoglossal motor facilitation (iPMF and iHMF, respectively). We hypothesized that, similar to other forms of respiratory plasticity, iPMF and iHMF are pattern sensitive. Central respiratory neural activity was reversibly reduced in ventilated rats by hyperventilating below the CO2 apneic threshold to create brief intermittent neural apneas (5, ∼1.5 min each, separated by 5 min), a single brief massed neural apnea (7.5 min), or a single prolonged neural apnea (30 min). Upon restoration of respiratory neural activity, long-lasting (>60 min) iPMF was apparent following brief intermittent and prolonged, but not brief massed, neural apnea. Further, brief intermittent and prolonged neural apnea elicited an increase in the maximum phrenic response to high CO2, suggesting that iPMF is associated with an increase in phrenic dynamic range. By contrast, only prolonged neural apnea elicited iHMF, which was transient in duration (apnea all elicited a modest transient facilitation of respiratory frequency. These results indicate that iPMF, but not iHMF, is pattern sensitive, and that the response to respiratory neural inactivity is motor pool specific. PMID:23493368
Bailes, Sally; Fichten, Catherine S; Rizzo, Dorrie; Baltzan, Marc; Grad, Roland; Pavilanis, Alan; Creti, Laura; Amsel, Rhonda; Libman, Eva
The purpose of this study was to examine the sleep characteristics, metabolic syndrome disease and likelihood of obstructive sleep apnea in a sample of older, family medicine patients previously unsuspected for sleep apnea. A total of 295 participants, minimum age 45, 58.7% women, were recruited from two family medicine clinics. None previously had been referred for sleep apnea testing. All participants completed a sleep symptom questionnaire and were offered an overnight polysomnography study, regardless of questionnaire results. 171 followed through with the sleep laboratory component of the study. Health data regarding metabolic syndrome disease (hypertension, hyperlipidemia, diabetes and obesity) were gathered by chart review. Overall, more women than men enrolled in the study and pursued laboratory testing. Of those who underwent polysomnography testing, 75% of the women and 85% of the men were diagnosed with sleep apnea based on an apnea/hypopnea index of 10 or greater. Women and men had similar polysomnography indices, the majority being in the moderate to severe ranges. In those with OSA diagnosis, gender differences in sleep symptom severity were not significant. We conclude that greater gender equality in sleep apnea rates can be achieved in family practice if sleep apnea assessments are widely offered to older patients. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Vié, Anne-Laure; Kodjikian, Laurent; Agard, Emilie; Voirin, Nicolas; El Chehab, Hussam; Denis, Philippe; Coste, Olivier; Dot, Corinne
To evaluate the association between obstructive sleep apnea and diabetic macular edema (DME) in patients with Type II diabetes, using the apnea-hypopnea index and other nocturnal hypoxemia parameters. This cross-sectional, case-control study included 99 patients with Type II diabetes: the first group included patients with DME (DME+ group) and the second patients without DME (DME- group). Polysomnography was performed in all patients. The two groups were compared, and the risk factors were studied using logistic regression. The DME+ group comprised 38 patients, and the DME- group comprised 61 patients, aged a mean 68.8 years and 66.3 years (P = 0.27), respectively; mean body mass index was 29.7 and 30.9 (P = 0.16), respectively. The mean apnea-hypopnea index was significantly higher in the DME+ group (43.95 [13.5-87.3]) than in the DME- group (35.18 [3.55-90.7]) (P = 0.034). Patients with DME had more severe obstructive sleep apnea (apnea-hypopnea index >30) than the others: 71% versus 50.8% (P = 0.049). Cumulative time of SPO2 below 90% (CT90%) was independently associated with DME after adjusting for confounding factors, whereas there was no difference between the oxygen desaturation index and minimum O2 saturation. Severe obstructive sleep apnea (apnea-hypopnea index >30) and parameters of nocturnal hypoxemia (cumulative time of SPO2 below 90%) are associated with DME.
Jumpertz, R; Wiesner, T; Blüher, M; Engeli, S; Bátkai, S; Wirtz, H; Bosse-Henck, A; Stumvoll, M
The endocannabinoid system promotes diverse effects on fat and glucose metabolism as well as on energy balance and sleep regulation. The role of N-acylethanolamides like oleoylethanolamide (OEA) and other endocannabinoids such as anandamide (AEA) and 2-arachidonyl-glycerol (2-AG) has not yet been investigated in patients with sleep apnea. We measured circulating OEA, AEA and 2-AG in patients with sleep apnea (n = 20) and healthy control subjects (n = 57). Respiratory distress index (RDI) as measured by polysomnography was used as a quantitative index of sleep apnea. In patients with sleep apnea OEA serum concentrations were significantly higher than in control subjects (8.4 pmol/ml (95% CI 6.9;9.9) vs. 4.0 (3.5;4.5); psleep apnea and control subjects after adjustment. In the sleep apnea group, OEA serum concentrations were associated with RDI (r (2) = 0.28, p = 0.02) and BMI (r (2) = 0.32, p = 0.01). However, OEA was not associated with BMI in the control group (p = 0.10). These results indicate that among the three analyzed fatty acid derivatives, OEA plays a specific role in patients with sleep apnea. Together with animal data, the 2-fold elevation of OEA serum concentrations could be interpreted as a neuroprotective mechanism against chronic oxidative stressors and a mechanism to promote wakefulness in patients with nocturnal sleep deprivation and daytime hypersomnolence. © Georg Thieme Verlag KG Stuttgart · New York.
Methylxanthine therapy reduces the frequency of apnea and the need for mechanical ventilation. Recent research has raised concerns about the safety of methylxanthines in very preterm infants. Possible adverse effects include poor growth, worsening of hypoxic-ischemic brain damage and abnormal childhood behavior. Over 2,000 infants with birth weights 500-1,250 g have been randomized in the international placebo-controlled Caffeine for Apnea of Prematurity (CAP) trial to examine the long-term efficacy and safety of methylxanthine therapy for the management of apnea of prematurity. Additional therapies such as continuous positive airway pressure were used as necessary to control apneic attacks. At 18 months we measure the combined rate of death or survival with one or more of the following impairments: cerebral palsy, cognitive deficit, blindness and deafness. This outcome was chosen because of the need to evaluate the impact of common neonatal therapies beyond discharge from the intensive care unit. However, several potential long-term consequences of methylxanthine therapy may not become apparent until the study cohort reaches pre-school age. We will therefore extend the follow-up to age 5 years. The main outcome at 5 years will be a composite of death or survival with severe disability in at least one of six domains: cognition, neuromotor function, vision, hearing, behavior, and general health. Once this project is completed, caffeine will be one of the most rigorously evaluated neonatal therapies. Copyright (c) 2005 S. Karger AG, Basel.
Dalmases, Mireia; Torres, Marta; Márquez-Kisinousky, Leonardo; Almendros, Isaac; Planas, Anna M; Embid, Cristina; Martínez-Garcia, Miguel Ángel; Navajas, Daniel; Farré, Ramon; Montserrat, Josep Maria
To test the hypotheses that brain oxygen partial pressure (PtO2) in response to obstructive apneas changes with age and that it might lead to different levels of cerebral tissue oxidative stress. Prospective controlled animal study. University laboratory. Sixty-four male Wistar rats: 32 young (3 mo old) and 32 aged (18 mo). Protocol 1: Twenty-four animals were subjected to obstructive apneas (50 apneas/h, lasting 15 sec each) or to sham procedure for 50 min. Protocol 2: Forty rats were subjected to obstructive apneas or sham procedure for 4 h. Protocol 1: Real-time PtO2 measurements were performed using a fast-response oxygen microelectrode. During successive apneas cerebral cortex PtO2 presented a different pattern in the two age groups; there was a fast increase in young rats, whereas it remained without significant changes between the beginning and the end of the protocol in the aged group. Protocol 2: Brain oxidative stress assessed by lipid peroxidation increased after apneas in young rats (1.34 ± 0.17 nmol/mg of protein) compared to old ones (0.63 ± 0.03 nmol/mg), where a higher expression of antioxidant enzymes was observed. The results suggest that brain oxidative stress in aged rats is lower than in young rats in response to recurrent apneas, mimicking obstructive sleep apnea. This could be due to the different PtO2 response observed between age groups and the increased antioxidant expression in aged rats. Dalmases M, Torres M, Márquez-Kisinousky L, Almendros I, Planas AM, Embid C, Martínez-Garcia MA, Navajas D, Farré R, Montserrat JM. Brain tissue hypoxia and oxidative stress induced by obstructive apneas is different in young and aged rats.
Zhao, Ying Y; Blackwell, Terri; Ensrud, Kristine E; Stone, Katie L; Omachi, Theodore A; Redline, Susan
To evaluate the association between obstructive airway disease (OAD) and sleep apnea in older men. A community-based cross-sectional study of 853 community-dwelling older men (mean age 80.7 ± 4.1 years [range 73 to 90]) across 6 centers in the United States from the Outcomes of Sleep Disorders in Older Men Study. Sleep was objectively measured using full in-home polysomnography and lung function was objectively measured using spirometry. The association of OAD (pre-bronchodilator FEV1/FVC ratio sleep apnea (apnea-hypopnea index [AHI] ≥ 15 events/hour) was assessed using logistic regression. OAD and sleep apnea were identified in 111 (13.0%) and 247 (29.0%) men, respectively. In univariate analysis, participants with OAD had a lower AHI (mean ± SD; 8.7 ± 11.7 vs. 12.7 ± 13.8, P = 0.0009) and a lower prevalence of sleep apnea (14.4 vs. 31.1%, P = 0.0003) compared to participants without OAD. OAD remained independently associated with a lower odds of sleep apnea (odds ratio 0.30, 95% CI 0.16 to 0.55, P = 0.0001) after adjustment for demographics, body composition, smoking, and potential mediators (arousal index, time spent in rapid eye movement sleep). Individuals with OAD and sleep apnea (n = 16) had an increased arousal index and lower oxygen saturation level as compared to individuals with OAD alone (P values sleep apnea in a cohort of community-dwelling elderly men, and unexplained by differences in adiposity or sleep architecture. Although uncommon in this cohort, coexisting sleep apnea and OAD was associated with increased sleep fragmentation and nocturnal oxygen desaturation compared to OAD alone. © 2016 Associated Professional Sleep Societies, LLC.
Martínez Cerón, Elisabet; Casitas Mateos, Raquel; García-Río, Francisco
Epidemiological data suggest that sleep apnea-hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of SAHS in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate-severe SAHS is associated with an increased risk of DM2 (relative risk=1.63 [1.09 to 2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea-hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic-pituitary-adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant SAHS seems to increase DM2 severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, SAHS may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.
Zhu, Y Q; Long, Q; Wang, C; Shuai, X J; Chen, B; Kong, J; Wei, Y L
To investigate sleep architecture and blood pressure dynamic change in patients with Sleep apnea syndrome by electrocardiogram-based cardiopulmonary coupling analysis system. Seventy-nine sleep disorder participants (PSQI≥8) were enrolled. Electrocardiogram-based cardiopulmonary coupling analysis device and ambulatory blood pressure monitoring were synchronously used to evaluate sleep architecture and blood pressure circadian rhythm. The patients were divided into SAS group (47 participants) and non-SAS group (32 participants) according to the Apnea Hypopnea Index (AHI) that calculated by CPC device. The data of sleep architecture and blood pressure variability were compared between two groups. Compared with non-SAS group, SAS group have less proportion of deep sleep, more proportion of light sleep, higher mean blood pressure in 24 hours and daytime, lower nocturnal blood pressure dipping, faster mean heart rate in night time (Pdream time (-0.6≤rApnea Syndrome. The severity of Sleep Apnea Syndrome has a positive correlation with the severity of abnormal sleep architecture and the degree of blood pressure elevation.
Iranzo, Alex; Santamaría, Joan
To describe the clinical and video-polysomnographic (VPSG) features of a group of subjects with severe obstructive sleep apnea/hypopnea (OSAH) mimicking the symptoms of REM sleep behavior disorder (RBD). Evaluation of clinical and VPSG data. University hospital sleep laboratory unit. Sixteen patients that were identified during routine first evaluation visits. Patients' PSG measures were compared with those of 20 healthy controls and 16 subjects with idiopathic RBD of similar age and sex distribution and apnea/hypopnea index lower than 10. NA. Sixteen subjects were identified presenting with dream-enacting behaviors and unpleasant dreams suggesting the diagnosis of RBD, in addition to snoring and excessive daytime sleepiness. VPSG excluded RBD showing REM sleep with atonia and without increased phasic EMG activity, and was diagnostic of severe OSAH with a mean apnea-hypopnea index of 67.5 +/- 18.7 (range, 41-105) demonstrating that the reported abnormal sleep behaviors occurred only during apnea-induced arousals. Continuous positive airway pressure therapy eliminated the abnormal behaviors, unpleasant dreams, snoring and daytime hypersomnolence. Our study shows that severe OSAH may mimick the symptoms of RBD and that VPSG is mandatory to establish the diagnosis of RBD, and identify or exclude other causes of dream-enacting behaviors.
Schredl, Michael; Schmitt, Judith; Hein, Gerhard; Schmoll, Tina; Eller, Sabine; Haaf, Janina
In the 19th century, several authors held the view that nightmares are caused by oxygen shortage. The present study was designed to study nightmare frequency in patients with obstructive sleep apnea syndrome and its relationship to respiratory parameters. A brief questionnaire was administered to 323 patients with sleep apnea syndrome before their first laboratory night. The reduction in nightmare frequency in the sleep apnea group was explained by the reduced dream recall frequency. Despite some illustrative examples of a correlation between oxygen desaturation and dream content, the respiratory parameters as measures of sleep apnea syndrome severity did not correlate substantially with nightmare frequency. Psychiatric comorbidity and an intake of psychotropic medication were associated with heightened nightmare frequency in this sample. It must be concluded that the oxygen hypothesis did not play a major role in explaining the occurrence of nightmares. As this might be partly explained by adaptation to the nightly desaturation periods, it will be fruitful to apply experimental procedures that interrupt airflow during (rapid eye movement) REM sleep for short periods in a systematic way without the knowledge of the sleeper and to then study their effects on dream content. Some patients reported a correlation between daytime stressors and nightmares, which is in line with modern etiological models of nightmares.
Full Text Available A high P-wave duration and dispersion (Pd have been reported to be a prognostic factor for the occurrence of paroxysmal atrial fibrillation (PAF, a condition linked to obstructive sleep apnea (OSA. We tested the hypothesis of whether a short-term increase of P-wave duration and Pd can be induced by respiratory manoeuvres simulating OSA in healthy subjects and in patients with PAF.12-lead-electrocardiography (ECG was recorded continuously in 24 healthy subjects and 33 patients with PAF, while simulating obstructive apnea (Mueller manoeuvre, MM, obstructive hypopnea (inspiration through a threshold load, ITH, central apnea (AP, and during normal breathing (BL in randomized order. The P-wave duration and Pd was calculated by using dedicated software for ECG-analysis.P-wave duration and Pd significantly increased during MM and ITH compared to BL in all subjects (+13.1 ms and +13.8 ms during MM; +11.7 ms and +12.9 ms during ITH; p<0.001 for all comparisons. In MM, the increase was larger in healthy subjects when compared to patients with PAF (p<0.05.Intrathoracic pressure swings through simulated obstructive sleep apnea increase P-wave duration and Pd in healthy subjects and in patients with PAF. Our findings imply that intrathoracic pressure swings prolong the intra-atrial and inter-atrial conduction time and therefore may represent an independent trigger factor for the development for PAF.
Carolina Castro Porto Silva Janovsky
Full Text Available Sleep apnea in type 1 diabetes mellitus (T1DM is a crescent theme of discussion. In obese patient, it is explained by the excessive central adiposity, including large neck circumference. Its presence in nonobese patients, however, brings back its possible correlation with autonomic neuropathy. The aim of this study was to compare the prevalence of OSA in young and lean T1DM, with and without cardiovascular autonomic neuropathy (CAN. We studied 20 adult, nonobese, type 1 diabetic patients, divided in two groups according to the results of the cardiovascular autonomic reflex tests (CARTs. These two groups (9 with CAN and 11 without CAN were compared to a control group of 22 healthy individuals, matched by age and BMI. A polysomnography was performed and sleep was analyzed. The CAN+ group presented significantly higher prevalence of sleep apnea compared to the other groups (67% CAN+; 23% CAN-; 4,5% controls: CAN+ vs Control; p=0.00017 and CAN+ vs CAN-; p=0.02. As it was expected, the incidence of sleep apnea was correlated with more microarousals during sleep and excessive daytime sleepiness. The CAN- group showed a better sleep efficiency compared to the CAN+ group, demonstrating impaired sleep architecture in diabetics with this chronic complication. In conclusion, sleep apnea could not only be an indication of presence of CAN, but also a contributor to diabetic neuropathy impairment, causing both worse prognosis and reduced quality of life for these patients when not treated.
Mar 6, 2011 ... The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. ... in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the ... The identified determinants can be used to draw up effective preventive measures.
Heidsieck, David S. P.; de Ruiter, Maurits H. T.; de Lange, Jan
A high prevalence of obstructive sleep apnea (OSA) is seen in edentulous individuals. Treatment options for edentulous OSA patients however are limited with continuous positive airway pressure therapy (CPAP) remaining the current therapy of choice. As CPAP is associated with high non-adherence rates
Svanholt, Palle; Petri, Niels; Wildschiødtz, Gordon
INTRODUCTION: The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology. METHODS: Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies b...
Udwadia, Z.F.; Athale, S.; Misra, V.P.; Wadia, N.H.
A patient operated upon for a midline cerebellar hemangioblastoma developed failure of automatic respiration during sleep, together with central sleep apnea syndrome, approximately two years after receiving radiation therapy to the brain. Clinical and CT scan findings were compatible with a diagnosis of radiation necrosis as the cause of his abnormal respiratory control
Eijsvogel, Michiel M.; Ubbink, Rinse; Dekker, Janita; Mos-Oppersma, Eline; de Jongh, Franciscus H.C.; van der Palen, Jacobus Adrianus Maria; Brusse-Keizer, Marjolein G.J.
Study Objective Positional therapy (PT) is an effective therapy in positional obstructive sleep apnea syndrome (POSAS) when used, but the compliance of PT is low. The objective of this study was to investigate whether a new kind of PT is effective and can improve compliance. Methods 29 patients were