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Sample records for sleep apnoea osa

  1. Can you die from obstructive sleep apnoea syndrome (OSAS)?

    LENUS (Irish Health Repository)

    O'Carroll, G

    2015-02-01

    Studies suggest an independent association between Obstructive Sleep Apnoea Syndrome (OSAS) and cardiovascular death. The purpose of our study is to examine doctors\\' awareness of this association and to determine whether this correlates with recording of OSAS on death certificates. We contacted the Central Statistics Office (CSO) and obtained relevant mention of OSAS on death certificates. We surveyed doctors on their view of OSAS-related deaths, CSO data from 2008-2011 reveal two deaths with OSAS documented as a direct cause and 52 deaths with OSAS as a contributory cause. Seventy-five doctors\\' surveyed (41%) believe OSAS can be a direct cause of death and 177 (96%) believe OSAS can be an indirect cause of death. Only 22 (12%) had putdown OSAS as a cause of death. OSAS is seldom recorded on death certificates. This is at odds with epidemiological forecasts and contrary to an opinion poll from a selection of doctors.

  2. Obstructive Sleep Apnoea

    African Journals Online (AJOL)

    Cheyne-Stokes respiration), obstructive sleep apnoea and mixed or complex sleep apnoea.1. Obstructive sleep apnoea (OSA) is the most common of these three disorders and is defined as airway obstruction during sleep, accompanied by at least ...

  3. Predicting uptake of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA)

    DEFF Research Database (Denmark)

    Skinner, Timothy; McNeil, Lindsay; Olaithe, Michelle

    2013-01-01

    diagnosed with OSA. Epworth sleepiness scale (ESS), Fatigue Severity Scale, Depression Anxiety Stress Scale and Illness Perception Questionnaire-Revised (IPQ-R) were administered at time of sleep study. These, patient demographics and sleep study variables were used to determine factors predicting patient......Purpose: Obstructive sleep apnoea (OSA) is a common disorder, for which continuous positive airway pressure (CPAP) therapy is a standard treatment. Despite its well-established efficacy, many patients choose not to initiate CPAP treatment. The present study investigated the degree to which...

  4. A Surgical Treatment of Obstructive Sleep Apnoea (OSA)

    African Journals Online (AJOL)

    Snoring is now seen as one end of sleep-related breathing disorder resulting ultimately in obstructive sleep apnea. Uvulopalatopharyngoplasty (UPPP) is the first surgical procedure specifically designed to alleviate the abnormalities, although the use of laser appears to be the new trend. We present a case of Obstructive ...

  5. Obstructive sleep apnoea (OSA) - a silent killer in anaesthesia ...

    African Journals Online (AJOL)

    Sleep-disordered breathing (SDB) encompasses a wide range of disorders that afflict both adults and children. These disorders are often unrecognised preoperatively and the pathophysiological consequences may impact severely on the patient in the peri-operative period.

  6. Snoring and obstructive sleep apnoea syndrome among ...

    African Journals Online (AJOL)

    Background: Obstructive sleep apnoea (OSA) syndrome is a common disorder in the community. Association between hypertension and sleep apnoea and /or snoring has been described. The Berlin questionnaire is a validated instrument that is used to identify individuals who are at risk for OSA. The study aim to describe ...

  7. Mandibular advancement appliance for obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petri, Niels; Svanholt, Palle; Solow, Beni

    2008-01-01

    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non...

  8. SLEEP APNOEA!!! : SNORING & BEYOND

    Indian Academy of Sciences (India)

    SLEEP APNOEA!!! : SNORING & BEYOND · Slide 2 · Snoring · Introduction · Identifiable causes of hypertension · Crucial areas for Snoring & Obstructive Sleep Apnea · Slide 7 · Slide 8 · Slide 9 · Slide 10 · Slide 11 · Slide 12 · Slide 13 · Slide 14 · Slide 15 · Slide 16 · Epidemiology (contd.) Slide 18 · Am I at risk??? Slide 20.

  9. Office management of obstructive sleep apnoea: appliances.

    Science.gov (United States)

    Johnson, Matthew D

    2015-08-01

    Oral appliances are becoming increasingly common in the treatment of obstructive sleep apnoea (OSA). They work by advancing the mandible and opening the pharynx. There are several types of devices available for use. Many patients intolerant to continuous positive airway pressure (CPAP) are using oral appliances for OSA. Oral appliances have been shown to improve polysomnography, quality of life and health measures associated with OSA. There is current work to better identify patients who are ideal candidates. Development of titratable devices and monitoring are optimizing usage. They have been compared with CPAP, with both showing improvement in OSA; however, CPAP remains superior overall. Oral appliances are becoming first-line therapy for mild and moderate OSA. They provide a meaningful alternative in severe OSA for patients unable to use CPAP. Device titration and usage monitoring are beginning to hone oral appliances as a therapeutic option.

  10. Metabolic aspects of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    M. R. Bonsignore

    2009-06-01

    Full Text Available Insulin resistance is often associated with obstructive sleep apnoea syndrome (OSAS and could contribute to cardiovascular risk in OSAS. Sleep loss and intermittent hypoxia could contribute to the pathogenesis of the metabolic alterations associated with obesity, a common feature of OSAS. The biology of the adipocyte is being increasingly studied, and it has been found that hypoxia negatively affects adipocyte function. In November 2007, the European Respiratory Society and two EU COST Actions (Cardiovascular risk in OSAS (B26 and Adipose tissue and the metabolic syndrome (BM0602, held a Research Seminar in Düsseldorf, Germany, to discuss the following: 1 the effects of hypoxia on glucose metabolism and adipocyte function; 2 the role of inflammatory activation in OSAS and obesity; 3 the alarming rates of obesity and OSAS in children; 4 the harmful effects of the metabolic syndrome in OSAS; 5 the effects of OSAS treatment on metabolic variables; and 6 the relationship between daytime sleepiness and hormonal and inflammatory responses. Insulin resistance in skeletal muscle, the role of the endocannabinoid system and novel pharmacological approaches to treat insulin resistance were also discussed. As obesity and hypoxia could be the basic links between OSAS and adipocyte dysfunction, further research is needed to translate these new data into clinical practice.

  11. The obstructive sleep apnoea syndrome in adolescents.

    Science.gov (United States)

    Marcus, Carole L; Keenan, Brendan T; Huang, Jingtao; Yuan, Haibo; Pinto, Swaroop; Bradford, Ruth M; Kim, Christopher; Bagchi, Sheila; Comyn, Francois-Louis; Wang, Stephen; Tapia, Ignacio E; Maislin, Greg; Cielo, Christopher M; Traylor, Joel; Torigian, Drew A; Schwab, Richard J

    2017-08-01

    The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromotor factors; however, the relative contributions of these factors have not been studied during the important developmental phase of adolescence. We hypothesised that adenotonsillar volume (ATV), nasopharyngeal airway volume (NPAV), upper airway critical closing pressure (Pcrit) in the hypotonic and activated neuromotor states, upper airway electromyographic response to subatmospheric pressure and the ventilatory response to CO 2 during sleep would be major predictors of OSAS risk. 42 obese adolescents with OSAS and 37 weight-matched controls underwent upper airway MRI, measurements of Pcrit, genioglossal electromyography and ventilatory response to CO 2 during wakefulness and sleep. ATV, NPAV, activated and hypotonic Pcrit, genioglossal electromyography and ventilatory response to CO 2 during sleep were all associated with OSAS risk. Multivariate models adjusted for age, gender, body mass index and race indicated that ATV, NPAV and activated Pcrit each independently affected apnoea risk in adolescents; genioglossal electromyography was independently associated in a reduced sample. There was significant interaction between NPAV and activated Pcrit (p=0.021), with activated Pcrit more strongly associated with OSAS in adolescents with larger NPAVs and NPAV more strongly associated with OSAS in adolescents with more negative activated closing pressure. OSAS in adolescents is mediated by a combination of anatomic (ATV, NPAV) and neuromotor factors (activated Pcrit). This may have important implications for the management of OSAS in adolescents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. The genetics of obstructive sleep apnoea.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-02-01

    PURPOSE OF REVIEW: Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder associated with reduced quality of life and adverse cardiovascular and metabolic sequelae. Recent years have seen an intensification of the research effort to establish the genetic contribution to the development of OSAS and its sequelae. This review explores emerging evidence in this field. RECENT FINDINGS: A genetic basis for sleep-disordered breathing has been demonstrated for discrete disorders such as Treacher-Collins and Down syndromes, but the picture is less clear in so-called idiopathic OSAS. A degree of heritability appears likely in some of the intermediate phenotypes that lead to OSAS, particularly craniofacial morphology. However, only sparse and often contradictory evidence exists regarding the role of specific polymorphisms in causing OSAS in the general population. Similarly, investigations of the cardiovascular sequelae of OSAS have in general failed to consistently find single causative genetic mutations. Nonetheless, evidence suggests a role for tumour necrosis factor-alpha polymorphisms in particular, and large-scale family studies have suggested shared pathogenetic pathways for the development of obesity and OSAS. SUMMARY: As with other common disorders, OSAS is likely to result from multiple gene-gene interactions occurring in a suitable environment. The application of modern genetic investigative techniques, such as genome-wide association studies, may facilitate new discoveries in this field.

  13. Expiratory timing in obstructive sleep apnoeas.

    Science.gov (United States)

    Cibella, F; Marrone, O; Sanci, S; Bellia, V; Bonsignore, G

    1990-03-01

    Diaphragmatic electromyogram was recorded during NREM sleep in 4 patients affected by obstructive sleep apnoea (OSA) syndrome in order to evaluate the behaviour of expiratory time (TE) in the course of the obstructive apnoea-ventilation cycle. The two components of TE, i.e. time of post-inspiratory inspiratory activity (TPIIA) and time of expiratory phase 2 (TE2) were separately analysed. TPIIA showed a short duration, with only minor variations, within the apnoea, while its duration was more variable and longer in the interapnoeic periods: the longest TPIIA values were associated with the highest inspiratory volumes in the same breaths. This behaviour seemed regulated according to the need of a more or less effective expiratory flow braking, probably as a result of pulmonary stretch receptors discharge. Conversely TE2 showed a continuous gradual modulation, progressively increasing in the pre-apnoeic period, decreasing during the apnoea and increasing in the post-apnoeic period: these TE2 variations seemed related to oscillations in chemical drive. These data show that TE in the obstructive apnoea-ventilation cycle results from a different modulation in its two components and suggest that both mechanical and chemical influences play a role in its overall duration.

  14. Obstructive sleep apnoea among older patients attending the ...

    African Journals Online (AJOL)

    Aim: To determine the risk of obstructive sleep apnoea and sleep difficulties among older patients attending the geriatric clinic at the University College Hospital (UCH), Ibadan, Nigeria. Methods: The Berlin questionnaires was used to assess the risk of OSA in 843 older patients aged 60 years and above at geriatric clinic, ...

  15. Sexual function in male patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petersen, Marian; Kristensen, Ellids; Berg, Søren

    2010-01-01

    OBJECTIVE: Our objective was to investigate general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA) and compare the results with normative data. MATERIALS AND METHODS: We investigated 308 male patients (age 30-69) admitted to a sleep...... of sexuality were worse in patients with (untreated) OSA when compared with normative data. Both aspects were dependent on age, obesity, social factors and concomitant medication but not on the severity of OSA as reflected by the apnoea-hypopnoea index or subjective sleepiness. CONCLUSION: We conclude...... that although sexual dysfunction is more prevalent in OSA patients than in the general population, it is a complex problem relating more to age, obesity, social factors and comorbidity than to the severity of OSA....

  16. Risk of obstructive sleep apnoea syndrome among in-patients at a ...

    African Journals Online (AJOL)

    We screened for risk of OSA among in-patients with severe mental illness to determine its prevalence ... Keywords: obstructive sleep apnoea; severe mental illness; Nigeria, in-patients .... a physical co-morbidity which was hypertension, none.

  17. Reduced Inspiratory Muscle Strength in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnoea

    DEFF Research Database (Denmark)

    Rehling, Thomas; Banghoj, Anne Margareta; Kristiansen, Marie Hvelplund

    2017-01-01

    Background: Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. Methods: Patients with T2DM with OSA (n = 33...

  18. Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP

    NARCIS (Netherlands)

    Peker, Yuksel; Thunstrom, Erik; Glantz, Helena; Wegscheider, Karl; Eulenburg, Christine

    2017-01-01

    Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA) have increased risk for major adverse cardiovascular and cerebrovascular events (MACCEs) compared with CAD patients without OSA. We aimed to address if the risk is similar in both groups when OSA patients are treated. This

  19. Screening for Sleep Apnoea in Mild Cognitive Impairment: The Utility of the Multivariable Apnoea Prediction Index

    Directory of Open Access Journals (Sweden)

    Georgina Wilson

    2014-01-01

    Full Text Available Purpose. Mild cognitive impairment (MCI is considered an “at risk” state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI, a patient self-report survey, to assess OSA in MCI. Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG. Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI. Receiver-operating characteristics (ROC curve analyses were performed using various cut-off scores for apnoea severity. Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI: r=0.47, P=0.017. However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC in the MCI sample compared to the controls across all AHI severity cut-off scores. Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI.

  20. Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study.

    Science.gov (United States)

    Elhennawi, D M; Ahmed, M R; Abou-Halawa, A S

    2016-12-01

    To study the correlation of obstructive sleep apnoea (OSA) and laryngopharyngeal reflux (LPR). A descriptive study. Suez Canal University Hospital, Ismailia, Egypt. 62 patients with polysomnography confirmed OSA. Patients were evaluated with ambulatory 24-h double channel pH monitoring. Mean reflux symptom index in the study group was 9 ± 5.5, and it was > 13 in all patients with severe OSA. Signs of LPR reflux were present in 34 (55%) patients. Abnormal reflux was detected in the distal oesophagus in 41 patients (66%) and in the proximal oesophagus in 21 patients (34%). Patients with severe OSA had significantly higher nocturnal LPR reflux episodes compared to patients with mild disease (P .05). LPR is common in patients with OSA. Patients with severe OSA have significantly higher nocturnal LPR. This should be considered when treating this group of patients. © 2016 John Wiley & Sons Ltd.

  1. Obstructive sleep apnoea syndrome in children

    Directory of Open Access Journals (Sweden)

    Anna Włodarska

    2016-09-01

    Full Text Available Sleep-related breathing disorders in children are a clinical problem which is more and more often diagnosed by doctors nowadays. They can be the basis for diagnosing obstructive sleep apnoea syndrome that causes a number of complications: lowering the quality of life, behavioural problems, complications involving cardiovascular system. The incidence of obstructive sleep apnoea syndrome in the paediatric population is estimated to be at the level of 2%. The symptoms of obstructive sleep apnoea syndrome can be divided into daytime and night ones. Night symptoms in children include: snoring, apnoea, breathing with open mouth (both during the day and at night, dry tongue and mouth during sleep, agitated sleep in unnatural positions. Among daytime symptoms of obstructive sleep apnoea syndrome there are: irritability, aggressiveness, hyperactivity, attention deficit disorder, delayed development and growth pattern (mainly failure to thrive, learning problems, morning headaches. Parents often do not connect the night and daytime symptoms with the possible development of obstructive sleep apnoea syndrome in their children. The main predisposing factor of obstructive sleep apnoea syndrome in children is adenotonsillar hypertrophy. Effective and in most cases preferred treatment for the management of obstructive sleep apnoea syndrome in children is adenotonsillectomy. Polysomnography and polygraphy are diagnostic tools helpful in the study of sleep-related disorders. The objective of this study was to systematise the knowledge on the epidemiology, aetiology, clinical image and prevention of obstructive sleep apnoea syndrome in children.

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

    Directory of Open Access Journals (Sweden)

    Walter T. McNicholas

    2015-12-01

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

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

    Science.gov (United States)

    McNicholas, Walter T; Rodenstein, Daniel

    2015-12-01

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

  4. Obstructive Sleep Apnoea

    African Journals Online (AJOL)

    listed below; any history of excessive snoring, restless sleep, headaches ... 2014; 56(5):29-32. Open Access article distributed under the terms of the ..... contains 11 different forms of carotenes and 5 different forms of vitamin e. It contains no ...

  5. Intermittent hypoxia, cardiovascular disease and obstructive sleep apnoea.

    Science.gov (United States)

    Turnbull, Chris D

    2018-01-01

    Obstructive sleep apnoea (OSA) is a common disorder and is associated with cardiovascular disease. Continuous positive airway pressure (CPAP), whilst reducing blood pressure, has not been shown to reduce cardiovascular events when used as a treatment solely for this purpose in patients with previous cardiovascular disease. Developing a better understanding of the mechanisms underlying cardiovascular disease in OSA is important to develop new treatments. Potential causative mechanisms for cardiovascular disease in OSA include arousal induced sympathetic activation, large intrathoracic pressure swings leading to shear stress on the heart and great vessels, and intermittent hypoxia (IH). This review discusses the role of IH, as a major physiological consequence of OSA, in the development of cardiovascular disease.

  6. Lifestyle modification for obstructive sleep apnoea.

    Science.gov (United States)

    Shneerson, J; Wright, J

    2001-01-01

    Obstructive sleep apnoeas are due to transient closure of the upper airway during sleep and merge into hypopnoeas in which the airway narrows, but some airflow continues. They are due to the forces compressing the airway overcoming those which stabilise its patency. The commonest association is obesity in which fatty tissue is deposited around the airway. Exercise has been recommended as a method of losing weight, but other techniques which achieve this are also thought to improve symptoms due to sleep apnoeas. Sleep hygiene may alter the sleep structure and the control of the upper airway during sleep and thus promote its patency. The objectives of this review are to determine whether weight loss, sleep hygiene and exercise are effective in the treatment of obstructive sleep apnoeas. The Cochrane Airways Group Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of review articles have been searched. Randomised, single or double blind placebo controlled, either parallel group or crossover design studies of any of these interventions were to have been included. No completed trials have been identified. No randomised trial data were available for analysis. There is a need for randomised controlled trials of these commonly used treatments in obstructive sleep apnoeas. These should identify which sub groups of patients with sleep apnoeas benefit most from each type of treatment and they should have clear and standardised outcome measures.

  7. Neurocognitive function in obstructive sleep apnoea: a meta-review.

    Science.gov (United States)

    Bucks, Romola S; Olaithe, Michelle; Eastwood, Peter

    2013-01-01

    Adult obstructive sleep apnoea (OSA) is associated with cognitive dysfunction. While many review articles have attempted to summarize the evidence for this association, it remains difficult to determine which domains of cognition are affected by OSA. This is because of marked differences in the nature of these reviews (e.g. many are unsystematic) and the many different tasks and domains assessed. This paper addresses this issue by comparing the results of only systematic reviews or meta-analyses assessing the effects of OSA on cognition, the relationship between OSA severity and cognition, and/or the effects of treatment on cognition in OSA. Electronic databases and hand-searching were undertaken to select reviews that reported on these areas. We found 33 reviews; five reviews met predetermined, stringent selection criteria. The majority of reviews supported deficits in attention/vigilance, delayed long-term visual and verbal memory, visuospatial/constructional abilities, and executive function in individuals with OSA. There is also general agreement that language ability and psychomotor function are unaffected by OSA. Data are equivocal for the effects of OSA on working memory, short-term memory and global cognitive functioning. Attention/vigilance dysfunction appears to be associated with sleep fragmentation and global cognitive function with hypoxaemia. Continuous positive airway pressure treatment of OSA appears to improve executive dysfunction, delayed long-term verbal and visual memory, attention/vigilance and global cognitive functioning. In order to improve our understanding of cognitive dysfunction in OSA, future research should pay particular attention to participant characteristics, measures of disease severity and choice of neuropsychological tests. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

  8. Obstructive sleep apnoea syndrome in children and anaesthesia

    Directory of Open Access Journals (Sweden)

    A Rudra

    2010-01-01

    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a common medical disorder among adults, which is increasingly being recognized in children too. It is a breathing disorder characterized by upper airway obstruction with or without intermittent complete obstruction that disrupts normal breathing during sleep. Anatomical and neuromuscular disorders are mainly responsible for this disorder. This disorder leads to a state of chronic hypoxemia, which has significant cardiac, pulmonary and central nervous system implications. Diagnosis of OSAS is based on thorough history and clinical examination along with appropriate sleep studies including polysomnography. The mainstay of treatment of paediatric OSAS is adenotonsillectomy. Good anaesthetic practice in Paediatric patients with OSAS revolves around good and ideal airway management. Early detection of airway obstruction, intense monitoring to warn of impending airway problems and appropriate and early intervention of airway compromise are good anaesthetic practices. Coexisting medical problems should be adequately addressed and safe analgesic techniques in the perioperative period go towards improving outcomes in patients with paediatric OSAS.

  9. Sleep apnoea and driving: how can this be dealt with?

    Directory of Open Access Journals (Sweden)

    J. Krieger

    2007-12-01

    Full Text Available Excessive daytime sleepiness has long been known to be associated with an increased risk of often particularly severe traffic accidents. Obstructive sleep apnoea (OSA is among the most prevalent conditions leading to excessive daytime sleepiness, in addition to impaired cognitive function, both of which are likely to impair driving ability. An increased risk of traffic accidents has been demonstrated repeatedly, in association with OSA, as well its normalisation with effective treatment. However, it seems that not all patients are at equal risk, but it is not clear how to identify when and how at-risk patients can be identified. Nevertheless, some European countries have made specific regulations concerning OSA and/or excessive daytime sleepiness and the capacity to obtain or to keep a driving license. Most countries have the general rule that "a driving license should not be given or renewed to any candidate or license holder suffering from a disorder ... likely to compromise safety on the road", without a specific mention of sleepiness and/or sleep apnoea. However, the way in which such a statement is applied and the measures taken to identify unfit drivers vary greatly from country to country. In addition, in those countries that have made specific regulations, no evaluation of their efficacy in reducing sleepiness-related accidents is available. In practice, it is the physician's responsibility to inform the untreated obstructive sleep apnoea patient about the risk associated with their condition, and about the regulations that prevail in their country, if relevant; only in a few countries, is the physician allowed (or compelled to report the unfit patient to the licensing authorities. Although it is generally accepted that the treated patient may be allowed to drive, the specific treatment conditions that eliminate the risk are not clearly established.

  10. Sleep apnoea in patients with quadriplegia.

    Science.gov (United States)

    McEvoy, R. D.; Mykytyn, I.; Sajkov, D.; Flavell, H.; Marshall, R.; Antic, R.; Thornton, A. T.

    1995-01-01

    BACKGROUND--This study was undertaken to establish the prevalence of, and the factors contributing towards, sleep disordered breathing in patients with quadriplegia. METHODS--Forty representative quadriplegic patients (time since injury > 6 months, injury level C8 and above, Frankel category A, B, or C; mean (SE) age 35.0 (1.7) years) had home sleep studies in which EEG, EOG, submental EMG, body movement, nasal airflow, respiratory effort, and pulse oximetry (SpO2) were measured. Patients reporting post traumatic amnesia of > 24 hours, drug or alcohol abuse or other major medical illness were excluded from the study. A questionnaire on medications and sleep was administered and supine blood pressure, awake SpO2, spirometric values, height, and neck circumference were measured. RESULTS--A pattern of sustained hypoventilation was not observed in any of the patients. Sleep apnoeas and hypopnoeas were, however, common. Eleven patients (27.5%) had a respiratory disturbance index (RDI, apnoeas plus hypopnoeas per hour of sleep) of > or = 15, with nadir SpO2 ranging from 49% to 95%. Twelve of the 40 (30%) had an apnoea index (AI) of > or = 5 and, of these, nine (75%) had predominantly obstructive apnoeas-that is, > 80% of apnoeas were obstructive or mixed. This represents a prevalence of sleep disordered breathing more than twice that observed in normal populations. For the study population RDI correlated with systolic and diastolic blood pressure and neck circumference. RDI was higher in patients who slept supine compared with those in other postures. Daytime sleepiness was a common complaint in the study population and sleep architecture was considerably disturbed with decreased REM sleep and increased stage 1 non-REM sleep. CONCLUSIONS--Sleep disordered breathing is common in quadriplegic patients and sleep disturbance is significant. The predominant type of apnoea is obstructive. As with non-quadriplegic patients with sleep apnoea, sleep disordered breathing in

  11. Obstructive Sleep Apnoea Syndrome and Weight Loss: Review

    Directory of Open Access Journals (Sweden)

    Douglas C. Cowan

    2012-01-01

    Full Text Available Obstructive sleep apnoea (OSA syndrome is common, and obesity is a major risk factor. Increased peripharyngeal and central adiposity result in increased pharyngeal collapsibility, through increased mechanical loading around the upper airway, reduced tracheal traction on the pharynx, and reduced neuromuscular activity, particularly during sleep. Significant and sustained weight loss, if achieved, is likely to be a useful therapeutic option in the management of OSA and may be attempted by behavioural, pharmacological, and surgical approaches. Behavioural therapy programs that focus on aspects such as dietary intervention, exercise prescription patients and general lifestyle counselling have been tested. Bariatric surgery is an option in the severely obese when nonsurgical measures have failed, and laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass are the most commonly employed techniques in the United Kingdom. Most evidence for efficacy of surgery comes from cohort studies. The role of sibutramine in OSA in the obese patients has been investigated, however, there are concerns regarding associated cardiovascular risk. In this paper the links between obesity and OSA are discussed, and the recent studies evaluating the behavioural, pharmacological and surgical approaches to weight loss in OSA are reviewed.

  12. Management of the obstructive sleep apnoea syndrome: More knowledge required for an optimal choice of treatment modality

    NARCIS (Netherlands)

    Hoekema, A

    2006-01-01

    In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to

  13. Quantifying the ventilatory control contribution to sleep apnoea using polysomnography.

    Science.gov (United States)

    Terrill, Philip I; Edwards, Bradley A; Nemati, Shamim; Butler, James P; Owens, Robert L; Eckert, Danny J; White, David P; Malhotra, Atul; Wellman, Andrew; Sands, Scott A

    2015-02-01

    Elevated loop gain, consequent to hypersensitive ventilatory control, is a primary nonanatomical cause of obstructive sleep apnoea (OSA) but it is not possible to quantify this in the clinic. Here we provide a novel method to estimate loop gain in OSA patients using routine clinical polysomnography alone. We use the concept that spontaneous ventilatory fluctuations due to apnoeas/hypopnoeas (disturbance) result in opposing changes in ventilatory drive (response) as determined by loop gain (response/disturbance). Fitting a simple ventilatory control model (including chemical and arousal contributions to ventilatory drive) to the ventilatory pattern of OSA reveals the underlying loop gain. Following mathematical-model validation, we critically tested our method in patients with OSA by comparison with a standard (continuous positive airway pressure (CPAP) drop method), and by assessing its ability to detect the known reduction in loop gain with oxygen and acetazolamide. Our method quantified loop gain from baseline polysomnography (correlation versus CPAP-estimated loop gain: n=28; r=0.63, p<0.001), detected the known reduction in loop gain with oxygen (n=11; mean±sem change in loop gain (ΔLG) -0.23±0.08, p=0.02) and acetazolamide (n=11; ΔLG -0.20±0.06, p=0.005), and predicted the OSA response to loop gain-lowering therapy. We validated a means to quantify the ventilatory control contribution to OSA pathogenesis using clinical polysomnography, enabling identification of likely responders to therapies targeting ventilatory control. Copyright ©ERS 2015.

  14. Body Fat Distribution, Serum Leptin, And Insulin Resistance In Obese Subjects With Obstructive Sleep Apnoea

    OpenAIRE

    Hassan ZA*,Attia MF**, Ahmed AH**;Hassan HA***,

    2006-01-01

    Obstructive sleep apnoea (OS A) is strongly associated with obesity and is characterized by endocrine and metabolic changes. The aim of the present study is to clarify whether there is interrelationship between body fat, serum leptin, glucose-insulin metabolism and OSA. Subjects and measurements: we studied 23 obese subjects with OSA (13 males,& 10 females; age mean 36 ± 4.4 years; BMI: 31.7 ± 3.6 kg/m2; WHR: 1.2 ± .25 in males and 0.81+.5 in females ;Apnoea Index "AI"( 9.2 ±6.1) event/hour o...

  15. Effect of CPAP on arterial stiffness in severely obese patients with obstructive sleep apnoea.

    Science.gov (United States)

    Seetho, Ian W; Asher, Rebecca; Parker, Robert J; Craig, Sonya; Duffy, Nick; Hardy, Kevin J; Wilding, John P H

    2015-12-01

    Obstructive sleep apnoea (OSA) may independently increase cardiovascular risk in obesity. Although there is evidence that arterial stiffness is altered in OSA, knowledge of these effects with continuous positive airway pressure (CPAP) in severe obesity (body mass index (BMI) ≥ 35 kg/m(2)) is limited. This study aimed to explore how arterial stiffness, as measured by the augmentation index (Aix), changed in severely obese patients with OSA who were treated with CPAP and in patients without OSA. Forty-two patients with severe obesity-22 with OSA, 20 without OSA-were recruited at baseline and followed-up after a median of 13.5 months. Pulse wave analysis (PWA) was performed using applanation tonometry at the radial artery to measure augmentation index (Aix), augmentation pressure (AP) and subendocardial viability ratio (SEVR). Cardiovascular parameters and body composition were also measured. There were significant improvements in Aix, AP (both P CPAP compared with subjects without OSA. Epworth scores (P CPAP. Regression showed that CPAP was significantly associated with change in arterial stiffness from baseline. However, patients with OSA on CPAP continued to have increased arterial stiffness (Aix) (P CPAP in severe obesity, CPAP alone is not sufficient to modify PWA measures to levels comparable with non-OSA patients. This supports a need for a multifaceted approach when managing cardiovascular risk in patients with severe obesity and obstructive sleep apnoea receiving CPAP therapy.

  16. Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement.

    Science.gov (United States)

    de Ruiter, M H T; Apperloo, R C; Milstein, D M J; de Lange, J

    2017-11-01

    Maxillomandibular advancement (MMA) is an alternative therapeutic option that is highly effective for treating obstructive sleep apnoea (OSA). MMA provides a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure or mandibular advancement devices. The goal of this study was to investigate the different characteristics that determine OSA treatment success/failure after MMA. The apnoea-hypopnoea index (AHI) was used to determine the success or failure of OSA treatment after MMA. Sixty-two patients underwent MMA for moderate and severe OSA. A 71% success rate was observed with a mean AHI reduction of 69%. A statistically significant larger neck circumference was measured in patients with failed OSA treatments following MMA (P=0.008), and older patients had failed OSA treatments with MMA: 58 vs. 53 years respectively (P=0.037). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients. The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%). The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Sleep apnoea syndrome and 10-year cardiovascular risk in females with type 2 diabetes: relationship with insulin secretion and insulin resistance.

    Science.gov (United States)

    Hermans, Michel P; Ahn, Sylvie A; Mahadeb, Yovan P; Rousseau, Michel F

    2013-03-01

    Obstructive sleep apnoea syndrome (OSAS) is a risk factor for type 2 diabetes mellitus (T2DM) and promotes cardiovascular events, especially in men. The prevalence of sleep apnoea and its association with microvascular and macrovascular diseases and glycaemic control are poorly documented in T2DM women. A total of 305 T2DM women were sleep apnoea diagnosed through (hetero)anamnesis, Epworth's score, oximetry and polysomnography. Sleep apnoea[+] (n = 25) were compared with sleep apnoea[-] (n = 280) regarding cardiovascular risk factors, glucose homeostasis, micro/macrovascular complications and the United Kingdom Prospective Diabetes Study (UKPDS) 10-year risk. Mean (1 SD) age was 66 (12) years, diabetes duration 15 (9) years, sleep apnoea prevalence 8.2% and metabolic syndrome 86%. There were no differences in age, diabetes duration, education, smoking and blood pressure between groups. Sleep apnoea[+] had significantly higher values of body mass index, waist, relative/absolute fat, conicity, visceral fat (all p Women with sleep apnoea had higher UKPDS risk of CAD: 18 (11)% versus 12 (10)% (p = 0.0136). Prevalent micro/macrovascular complications were not different between groups. Sleep apnoea, a frequent comorbidity of T2DM women, is associated with central fat, atherogenic dyslipidaemia, inflammation, worsening β-cell function, poorer glycaemic control and coronary artery disease risk. Sleep apnoea may increase residual vascular risk for microvascular and macrovascular events in T2DM women. Copyright © 2013 John Wiley & Sons, Ltd.

  18. Prevalence of metabolic syndrome in a north Indian hospital-based population with obstructive sleep apnoea

    Science.gov (United States)

    Agrawal, Swastik; Sharma, Surendra K.; Sreenivas, Vishnubhatla; Lakshmy, Ramakrishnan

    2011-01-01

    Background & objectives: Obstructive sleep apnoea (OSA) is known to be associated with cardiovascular risk factors and metabolic syndrome (MS). The burden of MS in patients with OSA in India is unknown. We investigated the prevalence of MS and its components in a cross-sectional study in patients with and without OSA in a hospital-based population of a tertiary health care centre in New Delhi, India. Methods: Consecutive patients undergoing overnight polysomnography in the Sleep Laboratory of the Department of Internal Medicine of All India Institute of Medical Sciences (AIIMS) hospital, New Delhi, were studied. Anthropometry and body composition analysis, blood pressure (BP), fasting blood glucose, insulin resistance by homeostasis model assessment (HOMA-IR) and fasting blood lipid profile were measured. MS was defined using the National Cholesterol Education Program Adult treatment panel III criteria, with Asian cut-off values for abdominal obesity. Results: Of the 272 subjects recruited, 187 (82%) had OSA [apnoea-hypopnoea index (AHI)>5 events/h] while 40 (18%) had a normal sleep study. Prevalence of MS in OSA patients was 79 per cent compared to 48 per cent in non-OSA individuals [OR 4.15, (2.05-8.56), P<0.001]. Prevalence of OSA in mild, moderate and severe OSA was 66, 72 and 86 per cent, respectively (P<0.001). Patients with OSA were more likely to have higher BP [OR: 1.06 (1.02-1.11)], fasting insulin [OR: 1.18 (1.05-1.32)], HOMA-IR [OR: 1.61 (1.11-2.33)] and waist circumference [OR: 1.20 (1.13-1.27)]. Interpretation & conclusions: Our findings suggest that OSA is associated with a 4-fold higher occurrence of MS than patients without OSA. The prevalence of MS increases with increasing severity of OSA, therefore, early detection will be beneficial. PMID:22199102

  19. Inflammatory cardiovascular risk markers in obstructive sleep apnoea syndrome.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    Obstructive sleep apnoea syndrome (OSAS) represents a highly prevalent disease and is recognized as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood, but given the complexity of the disorder, a multifactorial etiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of atherosclerosis in general and they mediate many of the stages of atheroma formation. Circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These markers include cell adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and selectins, cytokines such as tumour necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), chemokines such as IL-8, and C-reactive protein (CRP). There is increasing evidence that inflammatory processes also play a central role in the cardiovascular pathophysiology of OSAS. This is supported by cell culture and animal studies identifying a preferential activation of inflammatory pathways by intermittent hypoxia (IH), the hallmark of OSAS. A number of studies have selectively examined the expression of inflammatory factors in OSAS patients with different conclusions. These different findings may have been contributed to by a number of methodological factors such as small subject numbers, inadequately matched study populations, particularly in terms of body mass index (BMI), and inclusion of patients with pre-existing cardiovascular or metabolic diseases. This review will focus on the potential role of various inflammatory markers in OSAS with a critical analysis of the current literature.

  20. Mild obstructive sleep apnoea: clinical relevance and approaches to management.

    Science.gov (United States)

    McNicholas, Walter T; Bonsignore, Maria R; Lévy, Patrick; Ryan, Silke

    2016-10-01

    Obstructive sleep apnoea is highly prevalent in the general population worldwide, especially in its mild form. Clinical manifestations correlate poorly with disease severity measured by the apnoea-hypopnoea index (AHI), which complicates diagnosis. Full polysomnography might be more appropriate to assess suspected mild cases because limited ambulatory diagnostic systems are least accurate in mild disease. Treatment options in mild obstructive sleep apnoea include continuous positive airway pressure (CPAP) and oral appliance therapy, in addition to positional therapy and weight reduction when appropriate. The superior efficacy of CPAP in reducing AHI is offset by greater tolerance of oral appliances, especially in mild disease. Although severe obstructive sleep apnoea is associated with adverse health consequences, including cardiometabolic comorbidities, the association with mild disease is unclear, and reports differ regarding the clinical relevance of mild obstructive sleep apnoea. Improved diagnostic techniques and evidence-based approaches to management in mild obstructive sleep apnoea require further research. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-10-01

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

  2. Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students

    OpenAIRE

    Sharma, Sushma; Srijithesh, P. R.

    2013-01-01

    Background: Obstructive sleep apnoea (OSA) syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. Objective: To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Methods: Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. Results: 180 participant...

  3. Relationship between obstructive sleep apnoea syndrome and sleep bruxism: a systematic review.

    Science.gov (United States)

    Jokubauskas, L; Baltrušaitytė, A

    2017-02-01

    Obstructive sleep apnoea syndrome (OSAS) is a clinical risk factor for sleep bruxism (SB). Both OSAS and SB are reported to be associated with sleep-related arousal reactions, although no clear causative link has been established. An electronic literature search was conducted of the MEDLINE, ScienceDirect, Wiley Online Library, SAGE Journals and EBSCOhost databases covering the period January 2006 and September 2016. Sequential screenings at the title, abstract and full-text levels were performed. The review included observational studies in the English language with a clearly established aim to assess the relationship between OSAS and SB using full-night PSG. The seven-item quality-assessment tool for experimental bruxism studies was used to assess the methodology across the studies. After a comprehensive screening of titles, abstracts and full texts, only three studies that met the pre-defined criteria were finally included in this systematic review. Two studies gave evidence that OSAS is associated with the occurrence of SB events: (i) SB events frequently occur during micro-arousal events consequent on apnoea-hypopnoea (AH) events and (ii) most SB events occur in temporal conjunction with AH events termination. However, one study did not report a strong association between AH and SB events. It can be concluded that there are not enough scientific data to define a clear causative link between OSAS and SB. However, they appear to share common clinical features. Further studies should focus on the intermediate mechanisms between respiratory and SB events. © 2016 John Wiley & Sons Ltd.

  4. Circulating cell-derived microparticles in patients with minimally symptomatic obstructive sleep apnoea.

    Science.gov (United States)

    Ayers, L; Ferry, B; Craig, S; Nicoll, D; Stradling, J R; Kohler, M

    2009-03-01

    Moderate-severe obstructive sleep apnoea (OSA) has been associated with several pro-atherogenic mechanisms and increased cardiovascular risk, but it is not known if minimally symptomatic OSA has similar effects. Circulating cell-derived microparticles have been shown to have pro-inflammatory, pro-coagulant and endothelial function-impairing effects, as well as to predict subclinical atherosclerosis and cardiovascular risk. In 57 patients with minimally symptomatic OSA, and 15 closely matched control subjects without OSA, AnnexinV-positive, platelet-, leukocyte- and endothelial cell-derived microparticles were measured by flow cytometry. In patients with OSA, median (interquartile range) levels of AnnexinV-positive microparticles were significantly elevated compared with control subjects: 2,586 (1,566-3,964) microL(-1) versus 1,206 (474-2,501) microL(-1), respectively. Levels of platelet-derived and leukocyte-derived microparticles were also significantly higher in patients with OSA (2,267 (1,102-3,592) microL(-1) and 20 (14-31) microL(-1), respectively) compared with control subjects (925 (328-2,068) microL(-1) and 15 (5-23) microL(-1), respectively). Endothelial cell-derived microparticle levels were similar in patients with OSA compared with control subjects (13 (8-25) microL(-1) versus 11 (6-17) microL(-1)). In patients with minimally symptomatic obstructive sleep apnoea, levels of AnnexinV-positive, platelet- and leukocyte-derived microparticles are elevated when compared with closely matched control subjects without obstructive sleep apnoea. These findings suggest that these patients may be at increased cardiovascular risk, despite being minimally symptomatic.

  5. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnoea syndrome: a randomised, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems

    NARCIS (Netherlands)

    Nikolopoulou, M.; Byraki, A.; Ahlberg, J.; Heymans, M. W.; Hamburger, H. L.; de Lange, J.; Lobbezoo, F.; Aarab, G.

    2017-01-01

    Obstructive sleep apnoea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported

  6. Identifying patients at high risk for obstructive sleep apnoea ...

    African Journals Online (AJOL)

    Background: Obstructive sleep apnoea is associated with significant health consequences. A significant proportion of hospitalized patients at risk for obstructive sleep apnoea were never identified and referred for polysomnography for diagnosis. The objective of this study was to determine the factors associated with high ...

  7. Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

    Directory of Open Access Journals (Sweden)

    Jaroslava Hybášková

    2016-01-01

    Full Text Available The present study evaluated whether drug-induced sleep endoscopy (DISE helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA. A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%. The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%, followed by palatal and oropharyngeal collapse (n=12, 23.5%. Pathology of the larynx (epiglottis was observed in 16 patients (31.4%. The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3% patients. After DISE, the surgical plan was changed in 31 patients (60.8%. The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

  8. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design

    DEFF Research Database (Denmark)

    Petri, N.; Svanholt, P.; Solow, B.

    2008-01-01

    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non......). Eighty-one patients (87%) completed the trial. The MAA group achieved mean AHI and Epworth scores significantly lower (P group and the no-intervention group. No significant differences were found between the MNA group and the no-intervention group. The MAA group had...

  9. Are We overestimating the prevalence of depression in chronic illness using questionnaires? Meta-analytic evidence in obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Nanthakumar, Shenooka; Bucks, Romola S.; Skinner, Timothy C.

    2016-01-01

    Depression is common in chronic illness, albeit prevalence can be highly variable. This variability may be a function of symptom overlap between depression and chronic illness. Using Obstructive Sleep Apnoea (OSA) as an exemplar, this meta-analysis explored whether the proportion of overlapping s...

  10. Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea : An inter-ethnic comparison

    NARCIS (Netherlands)

    Wong, M.L.; Sandham, John; Ang, PK; Wong, DC; Tan, WC; Huggare, J

    The aim of this study was to measure craniofacial morphology and nasal respiratory resistance (NRR) in Malay, Indian and Chinese subjects with obstructive sleep apnoea (OSA). The sample consisted of 34 male subjects, 27-52 years of age (Malay n = 11, which included five mild and six moderate-severe

  11. Obstructive sleep apnoea and atopy among middle aged chronic obstructive pulmonary disease and bronchial asthma patients.

    Science.gov (United States)

    Kumar, Raj; Nagar, Devender; Mallick, Adeeb; Kumar, Manoj; Tarke, Chandrakant R; Goel, Nitin

    2013-09-01

    Obstructive sleep apnoea syndrome is associated with significant morbidity. A high prevalence of obstructive sleep apnoea (OSA) symptoms has been reported in patients with asthma and chronic obstructive pulmonary disease (COPD). There are limited studies regarding relationship between atopy and OSA. To study the risk of obstructive sleep apnoea among middle aged chronic obstructive pulmonary disease and asthma patients by a home based sleep study and its association with atopy. Patients with asthma and COPD were evaluated for OSA symptoms by Epworth sleepiness scale (ESS) and Berlin questionnaire (BQ). ESS score > or = 9 was considered as high risk for OSA. Patients having high risk for OSA by ESS and BQ were further evaluated for OSA by home based sleep study. Skin prick test against common allergens was done to diagnose atopy in these patients. Among 400 patients (229, 57.25% male and 171, 42.75% female) 328 were asthmatics and 72 were COPD patients. ESS and BQ was positive in 11.25% (45/400) and 18.25% (73/400) patients respectively. ESS was positive in 10.67% (35/328) of asthma and 13.88% (10/72) of COPD patients. BQ was positive in 18.29% (60/328) of asthmatic and 18.05% (13/72) of COPD patients. Skin prick test was positive in 74.16% patients. The maximum positivity was found in asthmatics (139/155, 89.68%) compared to COPD patients (16/155, 10.32%). Skin prick test was done for 40 patients out of 73 of Asthma and COPD patients who were found positive by ESS and BQ. 72.5% patients were found to be atopic. Out of 19 patients in whom home polysomnography was done, 13 patients consented for skin prick test with common aeroallergens and 9 (69.23%) patients were found to be atopic. There is an increased risk of obstructive sleep apnoea among middle aged chronic obstructive pulmonary disease and asthma patients. Atopy could be associated with OSA. The association needs to be proved in a larger study.

  12. Sleep fragmentation: comparison of two definitions of short arousals during sleep in OSAS patients.

    Science.gov (United States)

    Smurra, M V; Dury, M; Aubert, G; Rodenstein, D O; Liistro, G

    2001-04-01

    The measurement of arousals during sleep is useful to quantify sleep fragmentation. The criteria for electroencephalography (EEG) arousals defined by the American Sleep Disorders Association (ASDA) have recently been criticized because of lack of interobserver agreement. The authors have adopted a scoring method that associates the increase in chin electromyography (EMG) with the occurrence of an alpha-rhythm in all sleep stages (Université Catholique de Louvain (UCL) definition of arousals). The aim of the present study was to compare the two scoring definitions in terms of agreement and repeatability and the time taken for scoring in patients with obstructive sleep apnoea syndrome (OSAS) of varying severity. Two readers using both ASDA and UCL definitions scored twenty polysomnographies (PSGs) each on two occasions. The PSGs were chosen retrospectively to represent a wide range of arousal index (from 6-82) in OSAS patients. There was no difference in the arousal indices between readers and between scoring methods. The mean+/-SD difference between the two definitions (the bias) was 1.1+/-3.76 (95% confidence interval: -0.66-2.86). There was a strong linear relationship between the arousal index scored with the two definitions (r=0.981, pASDA definitions (18.5+/-5.4 versus 25.3+/-6.6 min, p<0.001). In conclusion, it has been found that in obstructive sleep apnoea syndrome patients, the American Sleep Disorders Association and Université Catholique de Louvain definitions were comparable in terms of agreement and repeatability.

  13. The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls

    Science.gov (United States)

    Fogel, Robert B; Trinder, John; White, David P; Malhotra, Atul; Raneri, Jill; Schory, Karen; Kleverlaan, Darci; Pierce, Robert J

    2005-01-01

    Pharyngeal dilator muscles are important in the pathophysiology of obstructive sleep apnoea syndrome (OSA). We have previously shown that during wakefulness, the activity of both the genioglossus (GGEMG) and tensor palatini (TPEMG) is greater in patients with OSA compared with controls. Further, EMG activity decreases at sleep onset, and the decrement is greater in apnoea patients than in healthy controls. In addition, it is known that the prevalence of OSA is greater in middle-aged compared with younger men. Thus, we had two goals in this study. First we compared upper airway muscle activity between young and middle-aged healthy men compared with men with OSA. We also explored the mechanisms responsible for the decrement in muscle activity at sleep onset in these groups. We investigated muscle activity, ventilation , and upper airway resistance (UAR) during wakefulness and sleep onset (transition from α to θ EEG activity) in all three groups. Measurements were obtained during basal breathing (BB) and nasal continuous positive airway pressure (CPAP) was applied to reduce negative pressure-mediated muscle activation). We found that during wakefulness there was a gradation of GGEMG and UAR (younger < older < OSA) and that muscle activity was reduced by the application of nasal CPAP (to a greater degree in the OSA patients). Although CPAP eliminated differences in UAR during wakefulness and sleep, GGEMG remained greater in the OSA patients. During sleep onset, a greater initial fall in GGEMG was seen in the OSA patients followed by subsequent muscle recruitment in the third to fifth breaths following the α to θ transition. On the CPAP night, and GGEMG still fell further in the OSA patients compared with control subjects. CPAP prevented the rise in UAR at sleep onset along with the associated recruitment in GGEMG. Differences in TPEMG among the groups were not significant. These data suggest that the middle-aged men had upper airway function midway between that of

  14. Developing a successful treatment for co-morbid insomnia and sleep apnoea.

    Science.gov (United States)

    Sweetman, Alexander M; Lack, Leon C; Catcheside, Peter G; Antic, Nick A; Chai-Coetzer, Ching Li; Smith, Simon S; Douglas, James A; McEvoy, R Doug

    2017-06-01

    Insomnia and sleep apnoea are the two most common sleep disorders, found in 6% and 23-50% of the general population respectively. These disorders also frequently co-occur, with 39-58% of sleep apnoea patients reporting symptoms indicative of co-morbid insomnia. When these disorders co-occur, clinicians are faced with difficult treatment decisions, patients experience the additive detrimental impacts of both disorders, and the effectiveness of discrete treatments for each disorder may be impaired. A common finding is that co-morbid insomnia and sleep apnoea (COMISA) is more difficult to treat than either disorder presenting alone. Co-morbid insomnia reduces the initial acceptance of, and later adherence to, continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea. This has resulted in recent recommendations that treatment approaches should initially target COMISA patients' insomnia to remove this barrier to CPAP treatment, and improve patient outcomes. However, no randomised controlled trial outcomes investigating this treatment approach currently exist. The current article aims to review and integrate recent research examining the prevalence, characteristics, and theoretical mechanistic relationships between co-occurring insomnia and OSA, and discuss previous treatment attempts. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Arterial alterations in severely obese children with obstructive sleep apnoea.

    Science.gov (United States)

    Dubern, Beatrice; Aggoun, Yacine; Boulé, Michèle; Fauroux, Brigitte; Bonnet, Damien; Tounian, Patrick

    2010-05-03

    Obstructive sleep apnoea (OSA) in obese adults is associated with cardiovascular disease independently of obesity. Vascular alterations exist in children with obesity and may constitute the first stage in the development of adulthood cardiovascular disease. To investigate the relationship between OSA and early arterial alterations in obese children. Cross-sectional study of a prospective cohort. A total of 51 children with severe obesity managed at a teaching hospital outpatient clinic. Polysomnography was performed. We measured the intima-media thickness and incremental elastic modulus (Einc) to assess the mechanical characteristics of the common carotid artery. Arterial endothelial function was evaluated by measuring flow-mediated dilation and glyceryl trinitrate-mediated dilation (GTNMD) of the brachial artery. A total of 24 (47%) children had a desaturation index (DI) >10/h and 7 (14%) had a respiratory event index >10/h. DI >10/h was associated with significantly higher values of Einc (4.0 + or - 0.5 vs. 2.4 + or - 0.4 mm Hg(-1) x 10(3), p=0.003) and GTNMD (18.0 + or - 1.1 vs. 14.1 + or - 1.0 %, p=0.02) after adjustment for age, sex, body mass index, fasting insulin, and leptin. In the univariate analysis, GTNMD correlated positively with DI (r=0.14, p=0.02) after adjustment for age, sex, fasting insulin and leptin. By multivariate analysis with BMI as an additional independent variable, both GTNMD and Einc correlated significantly with DI (beta=0.4, p=0.02 and beta=0.27, p=0.04, respectively). OSA in children is associated with arterial alterations independently from obesity. The increased vasodilation in response to glyceryl trinitrate reflects pre-existing vasoconstriction probably induced by intermittent hypoxia. OSA should be detected early in children with severe obesity.

  16. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk.

    Science.gov (United States)

    Dobrosielski, Devon A; Papandreou, Christopher; Patil, Susheel P; Salas-Salvadó, Jordi

    2017-06-30

    Obstructive sleep apnoea (OSA) is associated with increased cardiovascular disease (CVD) morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved ( e.g. altered dietary quality) or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients. Copyright ©ERS 2017.

  17. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk

    Directory of Open Access Journals (Sweden)

    Devon A. Dobrosielski

    2017-06-01

    Full Text Available Obstructive sleep apnoea (OSA is associated with increased cardiovascular disease (CVD morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved (e.g. altered dietary quality or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients.

  18. Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea.

    Science.gov (United States)

    Tan, Evan; Healey, Dione; Schaughency, Elizabeth; Dawes, Patrick; Galland, Barbara

    2014-01-01

    The relationship between obstructive sleep apnoea (OSA) and poorer neurobehavioural outcomes in school-age children is well established, but the relationship in obese children and adolescents, in whom OSA is more common, is not so well established. We aimed to investigate this relationship in 10-18-year-olds. Thirty-one participants with a mean body mass index (BMI) of 32.3 ± 4.9 enrolled. BMI-for-age cut-offs were used to define obesity. Participants underwent polysomnography and were classified into OSA (apnoea-hypopnoea index (AHI) > 2 per hour) and non-OSA (AHI ≤ 2) groups. Intelligence, memory and learning, academic achievement, behaviour and executive functioning were assessed using the Wechsler Abbreviated Scale of Intelligence, Wide Range Assessment of Memory and Learning 2, Wechsler Individual Achievement Test II (WIAT-II), Behavioural Assessment System for Children 2 and Behaviour Rating Inventory of Executive Function, respectively. Forty-eight per cent (15/31) were classified as having OSA, and 52% (16/31) as non-OSA. The obese cohort performed below the average of normative data on several neurobehavioural measures. WIAT-II maths scores were significantly lower (P = 0.034) in the OSA group than in the non-OSA group (means 84.5 vs. 94.6, respectively), losing significance after adjustment for IQ, age and gender. Self-reported school problems were significantly worse in the OSA group before and after multivariate adjustment (P = 0.010, Cohen's d = 1.02). No other significant differences were found. Results suggest that OSA may increase risk for some poorer educational and behavioural outcomes. The findings are reasonably consistent with and add to the evidence base of the few studies that have explored this relationship. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  19. The role of nasal CPAP in obstructive sleep apnoea syndrome due to mandibular hypoplasia.

    LENUS (Irish Health Repository)

    Miller, Stanley D W

    2012-02-01

    Melnick Needles syndrome (MNS), Treacher Collins syndrome (TCS) and Pierre Robin syndrome (PRS) are congenital abnormalities with characteristic facial appearances that include micrognathia. A 20-year-old girl with MNS, a 16-year-old boy with TCS and a 12-year-old girl with PRS attended the sleep apnoea clinic at our institution at different times. Diagnostic sleep studies were initially performed on all three patients to confirm the diagnosis of obstructive sleep apnoea syndrome (OSAS). They subsequently commenced nasal CPAP (nCPAP) treatment and their progress was followed. A limited sleep study on the patient with MNS demonstrated moderate\\/severe OSAS with an AHI of 33 events\\/h. Commencement of nCPAP resulted in symptomatic improvement. Overnight oximetry in the patient with TCS showed repeated desaturation to SpO2<90%. Subsequent treatment by nCPAP almost completely abolished the desaturation events. Overnight polysomnography in the patient with PRS demonstrated severe OSAS with an AHI of 49 events\\/h. After 3 years of nCPAP therapy, this patient requested discontinuation of treatment. Subsequent polysomnography without nCPAP revealed an AHI of <5 events\\/h. The use of nCPAP in the patients with MNS and TCS resulted in effective control of their sleep abnormalities. Mandibular growth and enlargement of the posterior airway space led to resolution of OSAS in the patient with PRS. There is a definite role for nCPAP therapy in patients with congenital micrognathia and OSAS. The use of nCPAP may obviate the need for more invasive corrective surgery for OSAS and is not necessarily a life-long requirement.

  20. Obstructive sleep apnoea is frequent in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Banghoej, Anne Margareta; Nerild, Henriette Holst; Kristensen, Peter Lommer

    2017-01-01

    mild OSA (60 patients (69%)). OSA was present in 32% of the patients with normal BMI, in 60% of overweight patients, and in 61% of obese patients. Patients with type 1 diabetes and OSA were largely asymptomatic and did not report more sleepiness than patients without OSA. At multivariate analysis, age......AIM: Obstructive Sleep Apnoea (OSA) is frequent in patients with type 2 diabetes. The aim of this study is to evaluate prevalence of OSA in patients with type 1 diabetes. METHODS: In a cross-sectional design, all patients with type 1 diabetes attending the outpatient clinic were offered screening...... of 200 of 518 eligible patients with type 1 diabetes (39%) participated (68% men; age 52±15years (mean±SD), diabetes duration 24±14years and BMI 25.3±3.3kg/m(2)). OSA was diagnosed in 92 patients (46% (95% CI: 40-53)). Five patients had known OSA, and OSA was newly diagnosed in 87 patients, predominantly...

  1. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation.

    LENUS (Irish Health Repository)

    Garvey, J F

    2012-02-01

    There is increasing evidence that intermittent hypoxia plays a role in the development of cardiovascular risk in obstructive sleep apnoea syndrome (OSAS) through the activation of inflammatory pathways. The development of translational models of intermittent hypoxia has allowed investigation of its role in the activation of inflammatory mechanisms and promotion of cardiovascular disease in OSAS. There are noticeable differences in the response to intermittent hypoxia between body tissues but the hypoxia-sensitive transcription factors hypoxia-inducible factor-1 and nuclear factor-kappaB appear to play a key role in mediating the inflammatory and cardiovascular consequences of OSAS. Expanding our understanding of these pathways, the cross-talk between them and the activation of inflammatory mechanisms by intermittent hypoxia in OSAS will provide new avenues of therapeutic opportunity for the disease.

  2. Polymorphism of the ACE gene and the risk of obstructive sleep apnoea.

    Science.gov (United States)

    Chmielewska, Izabela; Mlak, Radosław; Krawczyk, Paweł; Czukiewska, Ewa; Milanowski, Janusz

    2013-01-01

    Obstructive sleep apnoea/hypopnea syndrome (OSA) is characterized by obstruction of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen desaturation and arousal from sleep. Among the candidate genes affecting the risk of OSA, genes whose polymorphisms influence the development of diseases with similar pathogenesis such as OSA could be listed: APOE, genes for leptin and leptin receptor, TNFA1, ADRB2 and ACE (gene for angiotensin-converting enzyme). Until now there has been a confirmed relationship between ACE gene polymorphism and cardiovascular diseases, but its effect on the incidence of OSA is debatable. The aim of this study was to investigate the effect of ACE gene insertion/deletion (I/D) polymorphism on the risk of OSA. Fifty-five patients with confirmed diagnose of OSA and qualified to CPAP therapy entered the study. The control group included 50 subjects who did not complain of any sleep related symptoms. Diagnose of OSA was set on the basis of full overnight polysomnography together with Epworth Sleepiness Scale according to American Academy of Sleep Medicine guidelines. DNA was isolated from peripheral blood leukocytes with Qiagen DNA mini Kit. ACE gene polymorphism was determined in genomic DNA using allele specific polymerase chain reaction. Different sizes of PCR products were observed on agarose gel electrophoresis. There were non-significant differences in the frequency of ACE genotypes. However, allele D had significantly lower prevalence in the study group than in the control group. (χ(2) = 4.25 p = 0.04). Moreover, I allele carriers had a threefold greater risk of developing OSA (HR = 2.748, 95% CI = 1.029-7.340, p gene polymorphism might be useful to determine the risk of developing OSA in clinically predisposed patients.

  3. How to assess, diagnose, refer and treat adult obstructive sleep apnoea: a commentary on the choices.

    Science.gov (United States)

    Mansfield, Darren R; Antic, Nicholas A; McEvoy, R Doug

    2013-10-21

    Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular disease independent of daytime sleepiness. A major challenge is to correctly identify, from the large community pool of disease, people with symptoms and those at risk of long-term complications. For treatment plans to achieve quality patient outcomes, clinicians must have a clear understanding of patients' symptoms and their motivations for presentation, and be knowledgeable about the evidence surrounding the health risks of OSA and the relative merits of the various diagnostic and treatment options available. The diagnosis of OSA represents a teachable moment to target adverse lifestyle factors such as excessive weight, excessive alcohol consumption and smoking, which may be contributing to OSA and long-term cardiometabolic risk. OSA assessment and management has traditionally involved specialist referral and in-laboratory polysomnography. However, these services may not always be easy to access. Controlled studies have shown that patients with a high pretest probability of symptomatic, moderate to severe OSA can be managed well in primary care, or by skilled nurses with appropriate medical backup, using simplified ambulatory models of care. The future of sleep apnoea assessment and management will likely include models of care that involve early referral to specialists of patients with complex or atypical presentations, and an upskilled and supported primary care workforce to manage symptomatic, uncomplicated, high pretest probability disease.

  4. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state

    Directory of Open Access Journals (Sweden)

    Sithole J

    2006-11-01

    Full Text Available Abstract Obstructive sleep apnoea (OSA is a cardio-metabolic disorder. Whether metabolic syndrome (MS, insulin resistance (IR and albuminuria are independently associated with OSA is unclear, but defining the interactions between OSA and various cardiovascular (CV risk factors independent of obesity facilitates the development of therapeutic strategies to mitigate their increased CV risks. We prospectively recruited 38 subjects with OSA and 41 controls. Anthropometric measurements, glucose, lipids, insulin and blood pressure (BP were measured after an overnight fast. IR state was defined as homeostasis model assessment (HOMA value >3.99 and MS diagnosed according to the International Diabetes Federation (IDF criteria. Subjects with OSA were more obese, more insulin resistant, more hyperglycaemic, had higher Epworth score (measure of day time somnolence and systolic blood pressure levels. The prevalence of MS was higher in OSA compared with non-OSA subjects (74% vs 24%, p 103 cm would predict MS in patients with OSA at 75–78% sensitivity and 61–64% specificity. The agreement between MS and IR state in this cohort is poor. Thus, OSA is associated with MS independent of obesity predominantly due to increased triglyceride, glucose and Epworth score values but not IR or microalbuminuria status. This observation suggests an alternative pathogenic factor mediating the increased cardiovascular risk in patients with OSA and MS, other than that due to IR. The independent link between Epworth score and MS in patients with OSA implicates the role of daytime sleepiness and chronic hypoxia as a potential mediator. Given the discordant between MS and IR state, measurement of waist is useful for predicting mainly MS but not insulin resistance status in patients with OSA. Appropriate pharmacological intervention targeting these independent factors is important in reducing the increased CV risks among patients with OSA.

  5. Sleep bruxism associated with obstructive sleep apnoea syndrome - A pilot study using a new portable device.

    Science.gov (United States)

    Winck, M; Drummond, M; Viana, P; Pinho, J C; Winck, J C

    Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways. We aimed to study the presence and relationship of SB in a OSAS population. Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles. From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3±11.3 years, and apnea hypopnea index of 11.1±5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index>2/h). Mean SB index was 5.12±3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7±9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R=0.755, p=0.019 and R=0.737, p=0.023 respectively, Pearson correlation). Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R=-0.632 and R=-0.611, p>0.05, Pearson correlation). This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  6. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    Jaime Corral-Peñafiel

    2013-09-01

    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

  7. The Management of Co-Morbidities in Patients with Heart Failure – Obstructive Sleep Apnoea

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    Andrew J Stewart Coats

    2017-01-01

    Full Text Available Heart failure (HF patients are older and frequently present with multiple co-morbidities. Co- morbidities worsen patient symptoms and may contribute to the progression of heart failure, increase mortality or limit the therapeutic response to treatment. Obstructive sleep apnoea (OSA affects 2–4% of the adult population world-wide and is associated with similar risk factors to HF, meaning it is a frequent finding in HF patients, including HFrEF, HFmrEF and HFpEF. OSA has consistently been shown to be associated with hypertension, coronary artery disease, arrhythmias, heart failure, and stroke. A thorough understanding of the diagnosis and treatment options of OSA is of paramount importance to the practising HF clinician. Patients may present to the HF specialist having been diagnosed by a formal sleep study or may be suspected of OSA because of symptoms of snoring, reports of obstructed breathing by the sleep partner or day-time sleepiness. The mainstay of treatment for OSA is a positive airway pressure mask which can be used in mild moderate and severe OSA. The need for therapy should be discussed with the patient and if the AHI is above 15/ hr then treatment is indicated to reduce this to below 15. This is a consensus recommendation and no adequately powered clinical trials have shown this improves either mortality or the risk of disease progression. Other options are discussed

  8. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates.

    Science.gov (United States)

    Vizzardi, Enrico; Sciatti, Edoardo; Bonadei, Ivano; D'Aloia, Antonio; Curnis, Antonio; Metra, Marco

    2017-07-01

    Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately. We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews. Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH. Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.

  9. Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students.

    Science.gov (United States)

    Sharma, Sushma; Srijithesh, P R

    2013-04-01

    Obstructive sleep apnoea (OSA) syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. 180 participants completed the survey questionnaire. Only 24 (13.3%) identified OSA as a reversible risk factor for ischemic stroke. 11 (6%) participants only could answer OSA as an identified risk factor for hypertension as per Seventh Joint National Committee report. This study reveals dismal level of awareness, among health professionals and medical students, about OSA being an established and modifiable risk factor for hypertension and ischemic stroke.

  10. Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students

    Directory of Open Access Journals (Sweden)

    Sushma Sharma

    2013-01-01

    Full Text Available Background: Obstructive sleep apnoea (OSA syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. Objective: To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Methods: Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. Results: 180 participants completed the survey questionnaire. Only 24 (13.3% identified OSA as a reversible risk factor for ischemic stroke. 11 (6% participants only could answer OSA as an identified risk factor for hypertension as per Seventh Joint National Committee report. Poor awareness extended over all categories of participants (medical students, trained doctors and nursing staff . Conclusion: This study reveals dismal level of awareness, among health professionals and medical students, about OSA being an established and modifiable risk factor for hypertension and ischemic stroke.

  11. Comparison of Standard and Novel Signal Analysis Approaches to Obstructive Sleep Apnoea Classification

    Directory of Open Access Journals (Sweden)

    Aoife eRoebuck

    2015-08-01

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

  12. Surgery for adult patients with obstructive sleep apnoea: A review for general practitioners.

    Science.gov (United States)

    Phan, Nga T; Wallwork, Benjamin; Panizza, Benedict

    2016-08-01

    Obstructive sleep apnoea (OSA) is a complex disease process that involves collapse of the upper airway during sleep and subsequent reduction or cessation of airflow. Continuous positive airway pressure (CPAP) is the primary treatment for OSA and is the recommended first-line treatment for patients with moderate-to-severe forms of the disease. However, some patients are unable to tolerate CPAP or are unwilling to accept it as a form of permanent management. In these cases, surgical management aimed at addressing anatomical obstruction may be useful and warranted. This article presents an overview of the surgical options available for OSA. The review also describes a useful approach for selecting appropriate patients for surgery. On the basis of an OSA model that accounts for observed increased risk of stroke, cardiovascular disease and motor vehicle accidents, there is evidence to support that surgery is beneficial and cost-effective for patients with severe OSA who are intolerant of CPAP. There are many surgical options available for OSA.

  13. Three-dimensional photography for the evaluation of facial profiles in obstructive sleep apnoea.

    Science.gov (United States)

    Lin, Shih-Wei; Sutherland, Kate; Liao, Yu-Fang; Cistulli, Peter A; Chuang, Li-Pang; Chou, Yu-Ting; Chang, Chih-Hao; Lee, Chung-Shu; Li, Li-Fu; Chen, Ning-Hung

    2018-06-01

    Craniofacial structure is an important determinant of obstructive sleep apnoea (OSA) syndrome risk. Three-dimensional stereo-photogrammetry (3dMD) is a novel technique which allows quantification of the craniofacial profile. This study compares the facial images of OSA patients captured by 3dMD to three-dimensional computed tomography (3-D CT) and two-dimensional (2-D) digital photogrammetry. Measurements were correlated with indices of OSA severity. Thirty-eight patients diagnosed with OSA were included, and digital photogrammetry, 3dMD and 3-D CT were performed. Distances, areas, angles and volumes from the images captured by three methods were analysed. Almost all measurements captured by 3dMD showed strong agreement with 3-D CT measurements. Results from 2-D digital photogrammetry showed poor agreement with 3-D CT. Mandibular width, neck perimeter size and maxillary volume measurements correlated well with the severity of OSA using all three imaging methods. Mandibular length, facial width, binocular width, neck width, cranial base triangle area, cranial base area 1 and middle cranial fossa volume correlated well with OSA severity using 3dMD and 3-D CT, but not with 2-D digital photogrammetry. 3dMD provided accurate craniofacial measurements of OSA patients, which were highly concordant with those obtained by CT, while avoiding the radiation associated with CT. © 2018 Asian Pacific Society of Respirology.

  14. Obstructive sleep apnoea syndrome as a cause of road traffic accidents.

    Science.gov (United States)

    Aguiar, M; Valença, J; Felizardo, M; Caeiro, F; Moreira, S; Staats, R; Bugalho de Almeida, A A

    2009-01-01

    Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. We studied 163 patients with OSAS (apnoea- hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 TDAH) (T test). Group I (no road traffic accidents) No=89 patients; group II (road traffic accidents) No=74 patients. Age (years) was 57.6+/-11.8 vs. 54.7+/-10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3+/-5.4 vs. 17.6+/-4.3 (pTDAH (minutes), 98.5+/-63.7 vs. 133.3+/-83.2 (p=0,005). In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.

  15. Cholesterol Metabolism and Weight Reduction in Subjects with Mild Obstructive Sleep Apnoea: A Randomised, Controlled Study

    Directory of Open Access Journals (Sweden)

    Maarit Hallikainen

    2013-01-01

    Full Text Available To evaluate whether parameters of obstructive sleep apnoea (OSA associate with cholesterol metabolism before and after weight reduction, 42 middle-aged overweight subjects with mild OSA were randomised to intensive lifestyle intervention (N=23 or to control group (N=18 with routine lifestyle counselling only. Cholesterol metabolism was evaluated with serum noncholesterol sterol ratios to cholesterol, surrogate markers of cholesterol absorption (cholestanol and plant sterols and synthesis (cholestenol, desmosterol, and lathosterol at baseline and after 1-year intervention. At baseline, arterial oxygen saturation (SaO2 was associated with serum campesterol (P<0.05 and inversely with desmosterol ratios (P<0.001 independently of gender, BMI, and homeostasis model assessment index of insulin resistance (HOMA-IR. Apnoea-hypopnoea index (AHI was not associated with cholesterol metabolism. Weight reduction significantly increased SaO2and serum cholestanol and decreased AHI and serum cholestenol ratios. In the groups combined, the changes in AHI were inversely associated with changes of cholestanol and positively with cholestenol ratios independent of gender and the changes of BMI and HOMA-IR (P<0.05. In conclusion, mild OSA seemed to be associated with cholesterol metabolism independent of BMI and HOMA-IR. Weight reduction increased the markers of cholesterol absorption and decreased those of cholesterol synthesis in the overweight subjects with mild OSA.

  16. Arterial stiffness in people with Type 2 diabetes and obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Hvelplund Kristiansen, M; Banghøj, A M; Laugesen, E

    2018-01-01

    AIMS: To examine whether people with Type 2 diabetes with concurrent obstructive sleep apnoea have increased arterial stiffness as compared with people with Type 2 diabetes without obstructive sleep apnoea. METHODS: In a study with a case-control design, 40 people with Type 2 diabetes and treatment......-naïve moderate to severe obstructive sleep apnoea (Apnoea-Hypopnoea Index ≥15) and a control group of 31 people with Type 2 diabetes without obstructive sleep apnoea (Apnoea-Hypopnoea Index ... was not significantly different between participants with Type 2 diabetes with obstructive sleep apnoea and those without obstructive sleep apnoea (10.7±2.2 m/s vs 10.3±2.1 m/s; P=0.513), whereas oscillometric pulse wave velocity was significantly higher in participants with Type 2 diabetes with obstructive sleep...

  17. Positional therapy in sleep apnoea - one fits all? What determines success in positional therapy in sleep apnoea syndrome.

    Directory of Open Access Journals (Sweden)

    Natascha Troester

    Full Text Available Positional therapy is a simple means of therapy in sleep apnoea syndrome, but due to controversial or lacking evidence, it is not widely accepted as appropriate treatment. In this study, we analysed data to positional therapy with regard to successful reduction of AHI and predictors of success.All consecutive patients undergoing polysomnography between 2007 and 2011 were analysed. We used a strict definition of positional sleep apnoea syndrome (supine-exclusive sleep apnoea syndrome and of therapy used. Patients underwent polysomnography initially and during follow-up.1275 patients were evaluated, 112 of which had supine-exclusive sleep apnoea syndrome (AHI 5-66/h, median 13/h, 105 received positional therapy. With this treatment alone 75% (70/105 reached an AHI <5/h, in the follow-up 1 year later 37% (37/105 of these still had AHI<5/h, 46% (43/105 yielded an AHI between 5 and 10/h. Nine patient switched to APAP due to deterioration, 3 wanted to try APAP due to comfort reasons. At the last follow-up, 32% patients (34/105 were still on positional therapy with AHI <5/h. BMI was a predictor for successful reduction of AHI, but success was independent of sex, the presence of obstructive versus central sleep apnoea, severity of sleep apnoea syndrome or co-morbidities.Positional therapy may be a promising therapy option for patients with positional sleep apnoea. With appropriate adherence it yields a reasonable success rate in the clinical routine.

  18. Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study.

    Science.gov (United States)

    Wu, Xu; Liu, Zilong; Chang, Su Chi; Fu, Cuiping; Li, Wenjing; Jiang, Hong; Jiang, Liyan; Li, Shanqun

    2016-02-16

    Nocturnal heart block often occurs in patients with obstructive sleep apnoea (OSA). It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep disorder. Berlin Questionnaire (BQ) is a highly reliable way to discover the risk factors of OSA, whereas the validity in sleep-related heart block patients is uncertain. We performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure (CPAP). Patients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan hospital. These recruited participants completed Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring. A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA, as well as to assess the diagnostic accuracy of the BQ. Subsequently, subjects diagnosed with OSA (apnoea-hypopnoea index > 5) underwent 3 consecutive days of CPAP therapy. On the third day, patients repeated 24-hour Holter monitoring within the institution of CPAP. The symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block (r = 0.306, 0.226, respectively, p = 0.015, 0.019) than syncope (r = 0.134, p = 0.282) and palpitations (r = 0.106, p = 0.119), which were prominent trait of our study population. The sensitivity, specificity, positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0 %, 44.4 %, 91.07 % and 25 %. Nocturnal heart block does not appear to occur exclusively in severe sleep apnoea. The frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between them. CPAP therapy resulted in significant decrease in the average number of

  19. Physiological consequences of CPAP therapy withdrawal in patients with obstructive sleep apnoea-an opportunity for an efficient experimental model.

    Science.gov (United States)

    Schwarz, Esther I; Stradling, John R; Kohler, Malcolm

    2018-01-01

    Randomised controlled trials (RCTs) of continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA) are time consuming, and their findings often inconclusive or limited due to suboptimal CPAP adherence in CPAP-naïve patients with OSA. Short-term CPAP withdrawal in patients with prior optimal CPAP adherence results in recurrence of OSA and its consequences. Thus, this experimental model serves as an efficient tool to investigate both the consequences of untreated OSA, and potential treatment alternatives to CPAP. The CPAP withdrawal protocol has been thoroughly validated, and applied in several RCTs focusing on cardiovascular and metabolic consequences of untreated OSA, as well as the assessment of treatment alternatives to CPAP.

  20. Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea.

    Science.gov (United States)

    Juhász, J; Becker, H; Cassel, W; Rostig, S; Peter, J H

    2001-03-01

    Proportional positive airway pressure (PPAP) was designed to optimize airway pressure for the therapy of obstructive sleep apnoea (OSA). In a randomized crossover prospective study, the clinical feasibility of PPAP and its immediate effects on the breathing disorder and sleep in comparison with continuous positive airway pressure (CPAP) was evaluated. Twelve patients requiring CPAP therapy underwent CPAP and PPAP titration in a random order. Obstructive and mixed respiratory events could be completely abolished with both forms of treatment. This efficacy could be achieved at a significantly lower mean mask pressure during PPAP titration (8.45+/-2.42 cmH2O) compared to CPAP (9.96+/-2.7 cmH2O) (p=0.002). The mean minimal arterial oxygen saturation (Sa,O2) (82.8+/-6.5%) on the diagnostic night increased significantly (pPPAP titration. Total sleep time, slow wave sleep and rapid eye movement (REM) sleep increased significantly by the same amount during both CPAP and PPAP titration (pPPAP titration night, four patients did not have a preference, and two patients preferred CPAP. The present data show that proportional positive airway pressure is as effective as continuous positive airway pressure in eliminating obstructive events and has the same immediate effect on sleep. The lower average mask pressure during proportional positive airway pressure implies potential advantages compared to continuous positive airway pressure. Proportional positive airway pressure presents a new effective therapeutic approach to obstructive sleep apnoea.

  1. Examining uptake of online education on obstructive sleep apnoea in general practitioners: a randomised trial.

    Science.gov (United States)

    Paul, Christine; Rose, Shiho; Hensley, Michael; Pretto, Jeffrey; Hardy, Margaret; Henskens, Frans; Clinton-McHarg, Tara; Carey, Mariko

    2016-07-19

    Obstructive sleep apnoea (OSA) affects up to 28 % of the adult population in Western countries. The detection and management of OSA by general practitioners (GPs) can be poor. The study aimed to examine what influence enhanced invitations had on uptake of on-line learning modules for OSA by GPs, and whether recent referrals of patients to sleep specialists influenced uptake. Practicing GPs in regional Australia were identified and randomised to receive either an enhanced or standard invitation letter to a new on-line education module for OSA. The enhanced letter included indication that the module was eligible for professional accreditation and described the prevalence and burden of sleep disorders. Some included extra emphasis if the GP had recently referred a patient for diagnostic investigation of OSA. Two reminder letters were sent. Of 796 eligible GPs who received the letters, sixteen (2 %) accessed the website and four completed the modules over the four-month study period. GPs who received an enhanced invitation letter were not significantly more likely to access the website compared to GPs who received the standard invitation letter. Recent referral of a patient for diagnostic investigation was also not a significant factor in influencing use of the module. GP interest in on-line education about OSA appears low, and emphasis of relevant recent past patient(s) and the opportunity for professional education points was not successful in increasing engagement. There is a need to identify effective approaches to improving the detection and management of OSA in general practice.

  2. Continuous positive airway pressure improves gait control in severe obstructive sleep apnoea: A prospective study.

    Directory of Open Access Journals (Sweden)

    Sébastien Baillieul

    Full Text Available Severe obstructive sleep apnoea (OSA can lead to neurocognitive alterations, including gait impairments. The beneficial effects of continuous positive airway pressure (CPAP on improving excessive daytime sleepiness and daily functioning have been documented. However, a demonstration of CPAP treatment efficacy on gait control is still lacking. This study aims to test the hypothesis that CPAP improves gait control in severe OSA patients.In this prospective controlled study, twelve severe OSA patients (age = 57.2±8.9 years, body mass index = 27.4±3.1 kg·m-2, apnoea-hypopnoea index = 46.3±11.7 events·h-1 and 10 healthy matched subjects were included. Overground gait parameters were recorded at spontaneous speed and stride time variability, a clinical marker of gait control, was calculated. To assess the role of executive functions in gait and postural control, a dual-task paradigm was applied using a Stroop test as secondary cognitive task. All assessments were performed before and after 8 weeks of CPAP treatment.Before CPAP treatment, OSA patients had significantly larger stride time variability (3.1±1.1% vs 2.1±0.5% and lower cognitive performances under dual task compared to controls. After CPAP treatment, stride time variability was significantly improved and no longer different compared to controls. Cognitive performance under dual task also improved after CPAP treatment.Eight weeks of CPAP treatment improves gait control of severe OSA patients, suggesting morphological and functional cerebral improvements. Our data provide a rationale for further mechanistic studies and the use of gait as a biomarker of OSA brain consequences.

  3. Obstructive sleep apnoea syndrome in a patient with retrosternal goiter: a case report

    International Nuclear Information System (INIS)

    Sevketbeyoglu, H.; Kara, K.; Ince, M.; Karaagac, H.

    2012-01-01

    Full text: Introduction: Obstructive sleep apnoea syndrome (OSAS) is associated with a large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia etc.). In addition to these factors goiter and hypothyroidism have been reported to be associated with OSAS. Objectives and tasks: In our case with retrosternal goiter, values of OSAS before and after thyroidectomy were shown. Materials and methods: Seventy-two years old, BMI: 26,8 kg/m 2 , female patient was admitted our hospital because of complaints to stop breathing during sleep, snoring, morning headache and daytime drowsiness. Results: Thorax CT and ultrasonography of thyroid shown retrosternal goiter and left tracheal deviation. Severe OSAS was diagnosed by polysomnography (PSG). Thyroid function tests were normal. Apneahypopnea index (AHI) was 63,1/h. Patients was performed 7 cm H 2 O nasal continuous positive airway pressure (gvrnCPAP). AHI was 11,4/h under nCPAP. One month after OSAS diagnosis the patient underwent thyroidectomy operation. Pathological examination was reported as multinodular GOITER. In postoperative period CPAP treatment couldn't continue, because patient was not compliant. In postoperative 8-th weeks, PSG was performed; AHI was 34,8/h. The patient's weight and BMI didn't change. Conclusion: In our case, despite absence of continued CPAP treatment after thyroidectomy, symptoms and PSG values improved partially. As a result of these findings, especially, compression of upper airway and deterioration of venous circulation of patients with large goiter may lead to an increase in OSAS symptoms. During patients with OSAS are treated with CPAP, goiter needs to be investigated

  4. The development of a screening questionnaire for obstructive sleep apnoea in children with Down syndrome

    Directory of Open Access Journals (Sweden)

    Emma eSanders

    2015-10-01

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

  5. Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment

    DEFF Research Database (Denmark)

    Petersen, Marian Christin; Kristensen, Ellids; Berg, Søren

    2012-01-01

    OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1...... year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26-77) received a survey with questions drawn from two self-administered questionnaires on sexuality - Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used...... of CPAP treatment. ESS score decreased significantly after 1 year of CPAP treatment. CONCLUSION: One year of CPAP treatment improves all aspects of sexual function in male patients with OSA. Our data indirectly suggest that organic factors are the most likely explanation to these improvements....

  6. Computed tomographic cephalometric analysis of chinese patients with obstructive sleep apnoea

    International Nuclear Information System (INIS)

    Peh, W.C.G.; Chu, F.S.K.; Ip, M.S.M.; Chung, K.-F.

    2000-01-01

    Variations of craniofacial and upper airway structures are recognized to contribute to the phenomenon of obstructive sleep apnoea (OSA). Most previous cephalometric studies were performed using erect lateral radiographs in Caucasian patients. The present project aims to determine cephalometric measurements, utilizing CT, in normal Chinese subjects and in Chinese patients with OSA. Computed tomography of 25 patients with OSA (proven using overnight polysomnography), and of 25 age-, sex-, height-, bodyweight- and body mass index (BMI)-matched control subjects were prospectively performed. Thirteen standard bony and soft-tissue measurements were obtained from the CT lateral scout view of the head and neck, taken with each subject in the neutral supine position. The cross-sectional area was calculated at two axial levels (velopharynx and hypopharynx). The measurements in the two groups, OSA and control subjects, were compared. The measurements for hyoid position (P=0.00), nasal cavity length (P=0.01), mandibular prognathism (P = 0.05), tongue size (P = 0.02), oropharyngeal airway space (P = 0.02), posterior tongue airway space (P = 0.04) and cross-sectional areas at the level of the velopharynx (P = 0.00) and hypopharynx (P = 0.01) differed significantly between the two groups. In conclusion, CT cephalometric measurements show that certain anatomical variations in the head and neck are likely to contribute to the pathogenesis of OSA in Chinese patients. Copyright (1999) Blackwell Science Pty Ltd

  7. Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Martinez-Beneyto, Paz; Soria Checa, Cristina E; Botella-Rocamora, Paloma; Rincon-Piedrahita, Inés; Garcia Callejo, Francisco J; Algarra, Jaime Marco

    Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (Pde Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  8. A resource of potential drug targets and strategic decision-making for obstructive sleep apnoea pharmacotherapy.

    Science.gov (United States)

    Horner, Richard L; Grace, Kevin P; Wellman, Andrew

    2017-07-01

    There is currently no pharmacotherapy for obstructive sleep apnoea (OSA) but there is no principled a priori reason why there should not be one. This review identifies a rational decision-making strategy with the necessary logical underpinnings that any reasonable approach would be expected to navigate to develop a viable pharmacotherapy for OSA. The process first involves phenotyping an individual to quantify and characterize the critical predisposing factor(s) to their OSA pathogenesis and identify, a priori, if the patient is likely to benefit from a pharmacotherapy that targets those factors. We then identify rational strategies to manipulate those critical predisposing factor(s), and the barriers that have to be overcome for success of any OSA pharmacotherapy. A new analysis then identifies candidate drug targets to manipulate the upper airway motor circuitry for OSA pharmacotherapy. The first conclusion is that there are two general pharmacological approaches for OSA treatment that are of the most potential benefit and are practically realistic, one being fairly intuitive but the second perhaps less so. The second conclusion is that after identifying the critical physiological obstacles to OSA pharmacotherapy, there are current therapeutic targets of high interest for future development. The final analysis provides a tabulated resource of 'druggable' targets that are relatively restricted to the circuitry controlling the upper airway musculature, with these candidate targets being of high priority for screening and further study. We also emphasize that a pharmacotherapy may not cure OSA per se, but may still be a useful adjunct to improve the effectiveness of, and adherence to, other treatment mainstays. © 2017 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

  9. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.

    Science.gov (United States)

    Carvalho, F R; Lentini-Oliveira, D; Machado, M A C; Prado, G F; Prado, L B F; Saconato, H

    2007-04-18

    Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adenotonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they change the mandible posture forwards and potentially enlarge the upper airway and increase the upper airspace, improving the respiratory function. To assess the effectiveness of oral appliances or functional orthopaedic appliances for OSAS in children. A sensitive search was developed for the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); PubMed (January 1966 to September 2005); EMBASE (1980 to September 2005); Lilacs (1982 to September 2005); BBO-Bibliografia Brasileira de Odontologia (1986 to September 2005); and SciELO (1997 to September 2005). There was no restriction of language or source of information. All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. reduction of apnoea to less than one episode per hour. dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiologic function, behavioural problems, drop outs and withdrawals, quality of life, side effects (tolerability), economic evaluation. Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes. The initial search identified 384 trials

  10. Obstructive Sleep Apnoea | Gardner | South African Family Practice

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 56, No 2 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Obstructive Sleep Apnoea. BM Gardner. Abstract.

  11. Follow-up of conservatively treated sleep apnoea patients

    African Journals Online (AJOL)

    Health of School Children: Treatment of /ntestinal. Helminths and Schistosomiasis (WHO/GDS/IPI/GTD 92.1). Geneva: WHO, 1992. Accepted 17 June 1994. Follow-up of conservatively treated sleep apnoea patients. P. R. Bartel, J. Verster, P. J. Becker. Polysomnograms have been recorded at our laboratory since 1985 for ...

  12. High-intensity interval training improves obstructive sleep apnoea.

    Science.gov (United States)

    Karlsen, Trine; Nes, Bjarne Martens; Tjønna, Arnt Erik; Engstrøm, Morten; Støylen, Asbjørn; Steinshamn, Sigurd

    2016-01-01

    Three hours per week of vigorous physical activity is found to be associated with reduced odds of sleep-disordered breathing. To investigate whether 12 weeks of high-intensity interval training (HIIT) reduced the apnoea-hypopnea index (AHI) in obese subjects with moderate-to-severe obstructive sleep apnoea. In a prospective randomised controlled exercise study, 30 (body mass index 37±6 kg/m 2 , age 51±9 years) patients with sleep apnoea (AHI 41.5±25.3 events/hour) were randomised 1:1 to control or 12 weeks of supervised HIIT (4×4 min of treadmill running or walking at 90%-95% of maximal heart rate two times per week). In the HIIT group, the AHI was reduced by 7.5±11.6 events/hour (within-group pHIIT improved the AHI and self-reported daytime sleepiness in subjects with obese sleep apnoea without any change in the desaturation index and body weight.

  13. The diagnosis of obstructive sleep apnoea (Pickwickian syndrome)

    International Nuclear Information System (INIS)

    Stark, P.; Aguilar, E.A. Jr.; Robbins, K.T.

    1984-01-01

    Two patients with obstructive sleep apnoea are described and the value of computer tomography in the diagnosis and follow-up is stressed. Narrowing of the oro-pharynx is a major feature in the diagnosis of this condition and is best demonstrated by CT. (orig.) [de

  14. Obstructive Sleep Apnoea | Gardner | South African Family Practice

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 56, No 5 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Obstructive Sleep Apnoea. BM Gardner. Abstract.

  15. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome?

    LENUS (Irish Health Repository)

    Ryan, S

    2012-02-01

    Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disease and is recognised as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood but a multifactorial aetiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of atherosclerosis at all stages of atheroma formation. Increased levels of various circulating markers of inflammation including tumour necrosis factor alpha (TNFalpha), interleukin 6 (IL6), IL-8 and C-reactive protein (CRP) have been reported as associated with future cardiovascular risk. There is increasing evidence of elevated inflammatory markers in OSAS with a significant fall after effective treatment with continuous positive airway pressure. This evidence is particularly strong for TNFalpha, whereas studies on IL6 and CRP have yielded conflicting results possibly due to the confounding effects of obesity. Cell culture and animal studies have significantly contributed to our understanding of the underlying mechanisms of the association between OSAS and inflammation. Intermittent hypoxia, the hallmark of OSAS, results in activation of pro-inflammatory transcription factors such as nuclear factor kappa B (NF-kappaB) and activator protein (AP)-1. These promote activation of various inflammatory cells, particularly lymphocytes and monocytes, with the downstream consequence of expression of pro-inflammatory mediators that may lead to endothelial dysfunction. This review provides a critical analysis of the current evidence for an association between OSAS, inflammation and cardiovascular disease, discusses basic mechanisms that may be responsible for this association and proposes future research possibilities.

  16. Flextube reflectometry for level diagnosis in patients with obstructive sleep apnoea and snoring

    DEFF Research Database (Denmark)

    Faber, C E; Hilberg, O; Grymer, L

    2002-01-01

    The aim of this study was to use sound reflections in a flexible tube (flextube reflectometry) for identifying the predominant obstructive level of the upper airway in a series of patients referred to a sleep clinic. We also wished to study the relationship between the number of flextube narrowings...... per hour recording and the RDI (respiratory disturbance index = apnoeas and hypopneas per hour recording) by ResMed AutoSet (AS), which is a device based on nasal pressure variations. We performed sleep studies on 54 patients referred for snoring or OSA; 1) at home with AS; 2) in hospital using...... flextube reflectometry and AS simultaneously. The predominant obstructive level of the upper airway was retropalatal in 15 of the patients and retrolingual in 25 of the patients determined by flextube reflectometry. In 14 there was no predominant level of narrowing. We found a statistically significant...

  17. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.

    Science.gov (United States)

    Carvalho, Fernando R; Lentini-Oliveira, Débora A; Prado, Lucila Bf; Prado, Gilmar F; Carvalho, Luciane Bc

    2016-10-05

    Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adeno-tonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function. To assess the effects of oral appliances or functional orthopaedic appliances for obstructive sleep apnoea in children. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 7 April 2016); Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3) in the Cochrane Library (searched 7 April 2016); MEDLINE Ovid (1946 to 7 April 2016); Embase Ovid (1980 to 7 April 2016); LILACS BIREME (from 1982 to 7 April 2016); BBO BIREME (from 1986 to 7 April 2016) and SciELO Web of Science (from 1997 to 7 April 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials on 7 April 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. reduction of apnoea to less than one episode per hour. dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiological function, behavioural problems, quality of life, side effects

  18. Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men.

    Science.gov (United States)

    Cole, Alexander P; Hanske, Julian; Jiang, Wei; Kwon, Nicollette K; Lipsitz, Stuart R; Kathrins, Martin; Learn, Peter A; Sun, Maxine; Haider, Adil H; Basaria, Shehzad; Trinh, Quoc-Dien

    2018-05-01

    To assess the association of testosterone replacement therapy (TRT) with thromboembolism, cardiovascular disease (stroke, coronary artery disease and heart failure) and obstructive sleep apnoea (OSA). A cohort of 3 422 male US military service members, retirees and their dependents, aged 40-64 years, was identified, who were prescribed TRT between 2006 and 2010 for low testosterone levels. The men in this cohort were matched on a 1:1 basis for age and comorbidities to men without a prescription for TRT. Event-free survival and rates of thromboembolism, cardiovascular events and OSA were compared between men using TRT and the control group, with a median follow-up of 17 months. There was no difference in event-free survival with regard to thromboembolism (P = 0.239). Relative to controls, men using TRT had improved cardiovascular event-free survival (P = 0.004), mainly as a result of lower incidence of coronary artery disease (P = 0.008). The risk of OSA was higher in TRT users (2-year risk 16.5% [95% confidence interval 15.1-18.1] in the TRT group vs 12.7% [11.4-14.1] in the control group. This study adds to growing evidence that the cardiovascular risk associated with TRT may be lower than once feared. The elevated risk of OSA in men using TRT is noteworthy. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  19. Sex, stress and sleep apnoea: Decreased susceptibility to upper airway muscle dysfunction following intermittent hypoxia in females.

    Science.gov (United States)

    O'Halloran, Ken D; Lewis, Philip; McDonald, Fiona

    2017-11-01

    Obstructive sleep apnoea syndrome (OSAS) is a devastating respiratory control disorder more common in men than women. The reasons for the sex difference in prevalence are multifactorial, but are partly attributable to protective effects of oestrogen. Indeed, OSAS prevalence increases in post-menopausal women. OSAS is characterized by repeated occlusions of the pharyngeal airway during sleep. Dysfunction of the upper airway muscles controlling airway calibre and collapsibility is implicated in the pathophysiology of OSAS, and sex differences in the neuro-mechanical control of upper airway patency are described. It is widely recognized that chronic intermittent hypoxia (CIH), a cardinal feature of OSAS due to recurrent apnoea, drives many of the morbid consequences characteristic of the disorder. In rodents, exposure to CIH-related redox stress causes upper airway muscle weakness and fatigue, associated with mitochondrial dysfunction. Of interest, in adults, there is female resilience to CIH-induced muscle dysfunction. Conversely, exposure to CIH in early life, results in upper airway muscle weakness equivalent between the two sexes at 3 and 6 weeks of age. Ovariectomy exacerbates the deleterious effects of exposure to CIH in adult female upper airway muscle, an effect partially restored by oestrogen replacement therapy. Intriguingly, female advantage intrinsic to upper airway muscle exists with evidence of substantially greater loss of performance in male muscle during acute exposure to severe hypoxic stress. Sex differences in upper airway muscle physiology may have relevance to human OSAS. The oestrogen-oestrogen receptor α axis represents a potential therapeutic target in OSAS, particularly in post-menopausal women. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Dynamic loop gain increases upon adopting the supine body position during sleep in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Joosten, Simon A; Landry, Shane A; Sands, Scott A; Terrill, Philip I; Mann, Dwayne; Andara, Christopher; Skuza, Elizabeth; Turton, Anthony; Berger, Philip; Hamilton, Garun S; Edwards, Bradley A

    2017-11-01

    Obstructive sleep apnoea (OSA) is typically worse in the supine versus lateral sleeping position. One potential factor driving this observation is a decrease in lung volume in the supine position which is expected by theory to increase a key OSA pathogenic factor: dynamic ventilatory control instability (i.e. loop gain). We aimed to quantify dynamic loop gain in OSA patients in the lateral and supine positions, and to explore the relationship between change in dynamic loop gain and change in lung volume with position. Data from 20 patients enrolled in previous studies on the effect of body position on OSA pathogenesis were retrospectively analysed. Dynamic loop gain was calculated from routinely collected polysomnographic signals using a previously validated mathematical model. Lung volumes were measured in the awake state with a nitrogen washout technique. Dynamic loop gain was significantly higher in the supine than in the lateral position (0.77 ± 0.15 vs 0.68 ± 0.14, P = 0.012). Supine functional residual capacity (FRC) was significantly lower than lateral FRC (81.0 ± 15.4% vs 87.3 ± 18.4% of the seated FRC, P = 0.021). The reduced FRC we observed on moving to the supine position was predicted by theory to increase loop gain by 10.2 (0.6, 17.1)%, a value similar to the observed increase of 8.4 (-1.5, 31.0)%. Dynamic loop gain increased by a small but statistically significant amount when moving from the lateral to supine position and this may, in part, contribute to the worsening of OSA in the supine sleeping position. © 2017 Asian Pacific Society of Respirology.

  1. Novel method for detection of Sleep Apnoea using respiration signals

    DEFF Research Database (Denmark)

    Nielsen, Kristine Carmes; Kempfner, Lykke; Sørensen, Helge Bjarup Dissing

    2014-01-01

    desaturations > 3%, extracted from the thorax and abdomen respiration effort belts, and the oxyhemoglobin saturation (SaO2), fed to an Elastic Net classifier and validated according to American Academy of Sleep Medicine (AASM) using the patients' AHI value. The method was applied to 109 patient recordings......Polysomnography (PSG) studies are considered the “gold standard” for the diagnosis of Sleep Apnoea (SA). Identifying cessations of breathing from long-lasting PSG recordings manually is a labour-intensive and time-consuming task for sleep specialist, associated with inter-scorer variability...

  2. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnoea syndrome: a randomised, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems.

    Science.gov (United States)

    Nikolopoulou, M; Byraki, A; Ahlberg, J; Heymans, M W; Hamburger, H L; De Lange, J; Lobbezoo, F; Aarab, G

    2017-06-01

    Obstructive sleep apnoea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomised placebo-controlled trial, sixty-four OSAS patients (52·0 ± 9·6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design. All participants filled out the validated Dutch Sleep Disorders Questionnaire (SDQ) twice: one before treatment and one after six months of treatment. With 88 questions, thirteen scales were constructed, representing common sleep disorders and sleep-related problems. Linear mixed model analyses were performed to study differences between the groups for the different SDQ scales over time. The MAD group showed significant improvements over time in symptoms corresponding with 'insomnia', 'excessive daytime sleepiness', 'psychiatric sleep disorder', 'periodic limb movements', 'sleep apnoea', 'sleep paralysis', 'daytime dysfunction', 'hypnagogic hallucinations/dreaming', 'restless sleep', 'negative conditioning' and 'automatic behaviour' (range of P values: 0·000-0·014). These improvements in symptoms were, however, not significantly different from the improvements in symptoms observed in the nCPAP and placebo groups (range of P values: 0·090-0·897). It can be concluded that there is no significant difference between MAD and nCPAP in their positive effects on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. These beneficial effects may be a result of placebo effects. © 2017 John Wiley & Sons Ltd.

  3. EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA - OVERLAP SYNDROME

    Directory of Open Access Journals (Sweden)

    Vaddadi Sailendra

    2016-09-01

    Full Text Available BACKGROUND The drop in oxygen saturation during sleep is more than during exercise and patients of COPD who spend more time in sleeping. Significant sleep desaturation and the sleep disturbances are greater in overlap syndrome than in OSA alone. The present study is conducted in Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, to find the prevalence of obstructive sleep apnoea in the patients with COPD. AIMS The present study was a cross-sectional study prospectively carried out with an aim to evaluate the breathing disorders during sleep in patients with COPD and to correlate these disorders with the stage of the disease. SETTINGS AND DESIGN The study Cohort was constituted by patients of COPD registered into Chest OPD or admitted in Indoor units of Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, from July 2014 to May 2016. A total of thirty six consecutive COPD patients who consented to be enrolled into the study were classified into Mild, Moderate and Severe stages based on the Indian Guidelines for the management of COPD. METHODS AND MATERIAL Spirometric evaluation and bronchial reversibility testing was conducted in all the patients. Arterial Blood Gas Analysis was done using ABL3 arterial blood gas analyser (Radiometer, Copenhagen. POLYSOMNOGRAPHY Patients were hooked to Compumedics ProFusion Polysomnographic Machine (Compumedics Private Limited 2001, USA, by standard gold cups/electrodes. Thereafter, the patients were subjected to a full night sleep study (Overnight polysomnography. The electrode and sensor connection system utilises E-series EEG/PSG system in order to record the PSG study. The impedance of electrodes was checked and set to <10. A total of 20 leads were utilised for the study. The various parameters monitored included Electroencephalogram (EEG, Electro-oculogram (EOG, Electrocardiogram (ECG, chin and leg Electromyogram (EMG

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

    Science.gov (United States)

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

    2008-08-01

    In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

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

    International Nuclear Information System (INIS)

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

    2008-01-01

    In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

  6. Interaction of obstructive sleep apnoea and cognitive impairment with slow gait speed in middle-aged and older adults.

    Science.gov (United States)

    Lee, Sunghee; Shin, Chol

    2017-07-01

    to investigate whether slow gait speed is associated with cognitive impairment and further whether the association is modified by obstructive sleep apnoea (OSA). in total, 2,222 adults aged 49-80 years, free from dementia, stroke and head injury were asked to walk a 4-m course at fast and usual gait speeds. The time taken to walk was measured. All participants completed the Korean Mini-Mental State Examination, which was validated in the Korean language, to assess cognitive function. Additionally, the participants completed a polysomnography test to ascertain OSA (defined as an apnoea-hypopnoea index ≥15). Multivariable linear regression models were utilised to test the associations. time taken to walk 4 m showed significant inverse associations with cognitive scores (P value = 0.001 at fast gait speed and P = 0.002 at usual gait speed). Furthermore, a significant interaction according to OSA on the association between time to walk and cognitive impairment was found (P value for interaction = 0.003 at fast gait speed and P value for interaction = 0.007 at usual gait speed). we found that the inverse association between the time taken to walk 4 m and a cognitive score became significantly stronger, if an individual had OSA. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  7. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform.

    Science.gov (United States)

    Mazza, S; Pépin, J-L; Naëgelé, B; Rauch, E; Deschaux, C; Ficheux, P; Lévy, P

    2006-11-01

    Sleepiness is considered to be the major cause of increased traffic accidents in patients with obstructive sleep apnoea syndrome (OSAS). Until now, OSAS patients' driving ability has been assessed using driving simulators, but no assessment in a more natural driving environment has been carried out to date. The aim of the present study was to evaluate driving parameters in OSAS and in controls on a road safety platform, and to compare them with attentional in-laboratory measures before and after continuous positive airway pressure treatment. The parameters measured were: reaction time; distance to stop and number of collisions on the platform; maintenance of wakefulness; and sustained, selective and divided attention in laboratory. Patients exhibited much longer reaction times than controls, leading to a lengthening of the vehicle's stopping distance of 8.8 m at 40 km.h(-1) and to twice the number of collisions. Patients did not demonstrate objective sleepiness or selective and sustained attention deficits. Divided attention deficits were found. However, they did not allow the prediction of real driving impairment. After CPAP treatment, there was no longer any difference between patients and controls regarding driving and attention performances. Driving abilities are significantly impaired in obstructive sleep apnoea syndrome. After continuous positive airway pressure treatment, deficits were normalised. This stresses the importance of evaluating attentional parameters in apnoeic patients and of offering continuous positive airway pressure treatment even to non-sleepy subjects.

  8. Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device

    DEFF Research Database (Denmark)

    Knappe, S W; Bakke, M; Svanholt, P

    2017-01-01

    Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to inv......Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim...... was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic...... changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups....

  9. Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification.

    Science.gov (United States)

    Koutsourelakis, I; Vagiakis, E; Perraki, E; Karatza, M; Magkou, C; Kopaka, M; Roussos, C; Zakynthinos, S

    2011-03-01

    Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms, such as congestion to obstructive sleep apnoea (OSA) patients, whose symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known. 20 patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomised to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-α and nasal mucosa histopathology were assessed at baseline and after each treatment arm. Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa. In conclusion, nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin and the addition of heated humidification decreases nasal resistance and mucosal inflammation.

  10. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy

    DEFF Research Database (Denmark)

    Lamberts, Morten; Nielsen, O W; Lip, G Y H

    2014-01-01

    BACKGROUND: The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS: Using nationwide databases, the entire Danish population was followed from 2000 until 2011. First......-time sleep apnoea diagnoses and use of CPAP therapy were determined. Incidence rate ratios (IRRs) of ischaemic stroke and myocardial infarction (MI) were analysed using Poisson regression models. RESULTS: Amongst 4.5 million individuals included in the study, 33 274 developed sleep apnoea (mean age 53, 79......% men) of whom 44% received persistent CPAP therapy. Median time to initiation of CPAP therapy was 88 days (interquartile range 34-346). Patients with sleep apnoea had more comorbidities compared to the general population. Crude rates of MI and ischaemic stroke were increased for sleep apnoea patients...

  11. Maximal exercise capacity in patients with obstructive sleep apnoea syndrome: A systematic review and meta-analysis.

    Science.gov (United States)

    Mendelson, Monique; Marillier, Mathieu; Bailly, Sébastien; Flore, Patrice; Borel, Jean-Christian; Vivodtzev, Isabelle; Doutreleau, Stéphane; Tamisier, Renaud; Pépin, Jean-Louis; Verges, Samuel

    2018-04-26

    Maximal aerobic capacity is a strong health predictor and peak oxygen consumption (VO 2peak ) is considered a reflection of total body health. No systematic reviews or meta-analysis' to date have synthesised the existing data regarding VO 2peak in patients with obstructive sleep apnoea (OSA).A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing VO 2peak of OSA patients in mL·kg -1 ·min -1 compared with controls or in % predicted. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.Mean VO 2peak expressed in mL·kg -1 ·min -1 was significantly lower in patients with OSA when compared with controls (mean difference=-2.7 mL·kg -1 ·min -1 ; p<0.001; n=850). This reduction in VO 2peak was found to be larger in non-obese patients (BMI<30 kg·m -2 ). Mean VO 2peak in % predicted was 90.7±21.0% in OSA patients (n=643).OSA patients present reduced maximal aerobic capacity, which can be associated with increased cardiovascular risks and reduced survival in certain patient subgroups. Maximal exercise testing can be useful to characterise functional limitation and to evaluate health status in OSA patients. Registration # CRD42017057319. Copyright ©ERS 2018.

  12. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

    Directory of Open Access Journals (Sweden)

    Del Ben Maria

    2012-07-01

    Full Text Available Abstract Background Several studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS. We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP on oxidative stress and arterial dysfunction. Methods We studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp. Serum levels of nitrite/nitrate (NOx were also determined. Flow-mediated brachial artery dilation (FMD was measured to asses endothelial function. Results Patients with severe OSAS had higher urinary 8-iso-PGF2α (p Conclusions The results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

  13. Sleep apnoea syndromes and the cardiovascular system.

    Science.gov (United States)

    Pepperell, Justin C

    2011-06-01

    Management of SAS and cardiovascular disease risk should be closely linked. It is important to screen for cardiovascular disease risk in patients with SAS and vice versa. CSA/CSR may be improved by ventilation strategies in heart failure, but benefit remains to be proven. For OSA, although CPAP may reduce cardiovascular disease risk, its main benefit is symptom control. In the longer-term, CPAP should be used alongside standard cardiovascular risk reduction strategies including robust weight management programmes, with referral for bariatric surgery in appropriate cases. CPAP and NIV should be considered for acute admissions with decompensated cardiac failure.

  14. Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

    International Nuclear Information System (INIS)

    Oezdemir, Hueseyin; Mahmutyaziciglu, Kamran; Davsancimath, Halit; Guendogdu, Sadi; Altin, Remzi; Kart, Levent; Soeguet, Ayhan; Tomac, Nazan; Cinar, Fikret; Uzun, Lokman

    2004-01-01

    Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS). To evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity. The study population consisted of 39 children, aged 4-12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded. Cranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P 0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=-0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH. (orig.)

  15. Pink Masks: Obstructive Sleep Apnoea and the Sociology of Diagnosis

    Directory of Open Access Journals (Sweden)

    SHARON HANCOCK

    2013-01-01

    Full Text Available The sociology of diagnosis takes a new look at diagnostic categories, the means by which they are delivered, and the social consequences of diagnosis for patient and professional alike. Considering the social elements which contribute to the recognition of disease categories and their consequences highlights important phenomena which can enrich the thinking of nurses regardless of whether or not they diagnose as part of their practice. However, the principles of the sociology of diagnosis, while widely debated in academe, have yet to penetrate nursing literature. In this discussion article, we use obstructive sleep apnoea in women as an exemplar to illustrate how a clearly material, pathophysiological disorder has, nonetheless, significant social “content.” We demonstrate the social structures and interests which shape obstructive sleep apnoea as a male disease, and the risks, paradoxically, of both under- and over-diagnosis that arise from this social construction. We use this example to exhort nurses to consider how the social and the biological intermesh and shape how we perceive disease and its impact. This should open the door for more responsive and responsible health care.

  16. Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea?

    Directory of Open Access Journals (Sweden)

    Liam Mercieca

    Full Text Available Introduction: Continuous positive airway pressure (CPAP is the standard treatment for obstructive sleep apnoea (OSA, with limited data about the prevalence of respiratory infections and microbial colonization in these patients. Objectives: The aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients. Method: A retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers. Results: 66 (48.2% patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%. No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively. Conclusions: This study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.

  17. Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study.

    Science.gov (United States)

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

    2015-09-01

    The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up. Copyright ©ERS 2015.

  18. A simple procedure for measuring pharyngeal sensitivity: a contribution to the diagnosis of sleep apnoea

    OpenAIRE

    Dematteis, M; Levy, P; Pepin, J

    2005-01-01

    Background: Patients with severe apnoea may have an impaired pharyngeal dilating reflex related to decreased pharyngeal sensitivity. The accuracy of a simple new procedure to measure pharyngeal sensitivity and to diagnose sleep disordered breathing (SDB) was investigated.

  19. Effect of continuous positive airway pressure treatment for obstructive sleep apnoea on visual processing of degraded words.

    Science.gov (United States)

    Proudlove, Katie; Manuel, Ari; Hall, Rachel; Rieu, Romelie; Villarroel, Mauricio; Stradling, John

    2014-01-01

    In a previous uncontrolled study, continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) improved vision in patients with diabetic macular oedema. We investigated whether the above improvement in vision (or visual processing) might have been due to reduced sleepiness, rather than a true improvement in retinal function. Twelve normal control subjects and 20 patients with OSA were tested for their ability to recognise degraded words, by means of a computer programme displaying 5-letter words every 4 s for 10 min, with variable amounts of the bottom half of the word missing; the percentage of the word necessary to achieve correct identification on average half the time was 'hunted' (the test score). All subjects were tested twice, 2-3 weeks apart; the OSA group after the commencement of CPAP. The Epworth Sleepiness Score (ESS) in patients was measured at the same visit. The test score at visit 1 was 26.7% for normal subjects and 31.6% for patients with OSA. At visit 2, the test score was 25.0% for normal subjects and 29.9% for patients with OSA. The groups showed a small and identical improvement over the trial period in the test score, of 1.7% (p = 0.01 and p = 0.03 for the normal and OSA groups, respectively). The group with OSA experienced a drop in ESS of 7.5 (SD 5.5) points following treatment. The small and identical improvement in both groups suggests only a similar learning effect rather than any improvement due to reduced sleepiness.

  20. Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men.

    Science.gov (United States)

    Adams, Robert J; Appleton, Sarah L; Vakulin, Andrew; Lang, Carol; Martin, Sean A; Taylor, Anne W; McEvoy, R Doug; Antic, Nick A; Catcheside, Peter G; Wittert, Gary A

    2016-10-01

    To determine correlates of excessive daytime sleepiness (EDS) identified with the Epworth Sleepiness Scale (ESS) and a more broad definition, while accounting for obstructive sleep apnoea (OSA) in community dwelling men. Participants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) Study (n = 837, ≥ 40 years) without a prior OSA diagnosis, underwent in-home full unattended polysomnography (PSG, Embletta X100), completed the ESS, STOP questionnaire and Pittsburgh Sleep Quality Index in 2010-2011. In 2007-2010, questionnaires and biomedical assessment (in South Australian public hospital-based clinics) identified medical conditions. An alternate EDS definition (EDSAlt ) consisted of ≥ 2 of 3 problems (feeling sleepy sitting quietly; feeling tired/fatigued/sleepy; trouble staying awake). EDSAlt (30.4%, n = 253), but not ESS ≥ 11 (EDSESS , 12.6%, n = 104), increased significantly across OSA severity and body mass index categories. In adjusted analyses, EDSESS was significantly associated with depression: odds ratio (OR), 95%CI: 2.2 (1.3-3.8) and nocturia: 2.0 (1.3-3.2). EDSAlt was associated with depression, financial stress, relationship, work-life balance problems and associations with nocturia and diabetes were borderline. After excluding men with EDSESS , EDSAlt was associated with oxygen desaturation index (3%) ≥ 16 and the highest arousal index quartile but not with comorbidities. Sleepiness not necessarily leading to dozing, but not ESS ≥ 11, was related to sleep disordered breathing. Clinicians should be alert to (1) differing perspectives of sleepiness for investigation and treatment of OSA, and (2) the presence of depression and nocturia in men presenting with significant Epworth sleepiness regardless of the presence of OSA. © 2016 Asian Pacific Society of Respirology.

  1. Qualitative assessment of awake nasopharyngoscopy for prediction of oral appliance treatment response in obstructive sleep apnoea.

    Science.gov (United States)

    Sutherland, Kate; Chan, Andrew S L; Ngiam, Joachim; Darendeliler, M Ali; Cistulli, Peter A

    2018-01-23

    Clinical methods to identify responders to oral appliance (OA) therapy for obstructive sleep apnoea (OSA) are needed. Awake nasopharyngoscopy during mandibular advancement, with image capture and subsequent processing and analysis, may predict treatment response. A qualitative assessment of awake nasopharyngoscopy would be simpler for clinical practice. We aimed to determine if a qualitative classification system of nasopharyngoscopic observations reflects treatment response. OSA patients were recruited for treatment with a customised two-piece OA. A custom scoring sheet was used to record observations of the pharyngeal airway (velopharynx, oropharynx, hypopharynx) during supine nasopharyngoscopy in response to mandibular advancement and performance of the Müller manoeuvre. Qualitative scores for degree ( 75%), collapse pattern (concentric, anteroposterior, lateral) and diameter change (uniform, anteroposterior, lateral) were recorded. Treatment outcome was confirmed by polysomnography after a titration period of 14.6 ± 9.8 weeks. Treatment response was defined as (1) Treatment AHI  50% AHI reduction and (3) > 50% AHI reduction. Eighty OSA patients (53.8% male) underwent nasopharyngoscopy. The most common naspharyngoscopic observation with mandibular advancement was a small ( 75% velopharyngeal collapse on performance of the Müller manoeuvre. Mandibular advancement reduced the observed level of pharyngeal collapse at all three pharyngeal regions (p < 0.001). None of the nasopharyngoscopic qualitative scores differed between responder and non-responder groups. Qualitative assessment of awake nasopharyngoscopy appears useful for assessing the effect of mandibular advancement on upper airway collapsibility. However, it is not sensitive enough to predict oral appliance treatment outcome.

  2. Pharyngeal shape and dimensions in healthy subjects, snorers, and patients with obstructive sleep apnoea.

    OpenAIRE

    Rodenstein, D O; Dooms, G; Thomas, Y; Liistro, G; Stanescu, D C; Culée, C; Aubert-Tulkens, G

    1990-01-01

    To characterise the relation between pharyngeal anatomy and sleep related disordered breathing, 17 men with complaints of snoring were studied by all night polysomnography. Ten of them had obstructive sleep apnoea (mean (SD) apnoea-hypopnoea index 56.3 (41.7), age 52 (10) years, body mass index 31.4 (5.3) kg/m2); whereas seven were simple snorers (apnoea-hypopnoea index 6.7 (4.6), age 40 (17) years, body mass index 25.9 (4.3) kg/m2). The pharynx was studied by magnetic resonance imaging in al...

  3. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome.

    OpenAIRE

    Engleman, H. M.; Martin, S. E.; Douglas, N. J.

    1994-01-01

    BACKGROUND--Continuous positive airway pressure (CPAP) therapy is the treatment of choice for the sleep apnoea/hypopnoea syndrome. Compliance with this relatively obtrusive therapy has not been well studied. METHODS--Usage of CPAP was investigated in 54 patients with sleep apnoea/hypopnoea syndrome (median 36 (range 7-129) apnoeas + hypopnoeas/hour slept) over the first 1-3 months after starting CPAP therapy. In all cases CPAP usage was monitored by hidden time clocks that indicated for how l...

  4. Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?

    Science.gov (United States)

    Rubio-Bueno, P; Landete, P; Ardanza, B; Vázquez, L; Soriano, J B; Wix, R; Capote, A; Zamora, E; Ancochea, J; Naval-Gías, L

    2017-11-01

    Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P<0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8±1.4 (P<0.001). 3D changes revealed a volume increase of 106.3±38.8%. The mandible was advanced 10.4±3.9mm and maxilla 4.9±3.2mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Titration effectiveness of two autoadjustable continuous positive airway pressure devices driven by different algorithms in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Damiani, Mario Francesco; Quaranta, Vitaliano Nicola; Tedeschi, Ersilia; Drigo, Riccardo; Ranieri, Teresa; Carratù, Pierluigi; Resta, Onofrio

    2013-08-01

    Nocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A-CPAP). The aim of the present study was to compare the titration effectiveness of two A-CPAP devices using different flow-based algorithms in patients with OSA. This is a randomized study; 79 subjects underwent two consecutive unattended home A-CPAP titration nights with two different devices (Autoset Resmed; Remstar Auto Respironics); during the third and the fourth night, patients underwent portable monitoring in the sleep laboratory during fixed CPAP at the A-CPAP recommended pressure. Bland Altman plots showed good agreement between the recommended median and maximal pressure levels obtained with the two devices. A significant improvement was observed in all the sleep parameters by both A-CPAP machines to a similar degree. It was observed that the two A-CPAP devices using different algorithms are equally effective in initial titration of CPAP. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  6. Obstructive sleep apnoea syndrome, endothelial function and markers of endothelialization. Changes after CPAP.

    Science.gov (United States)

    Muñoz-Hernandez, Rocio; Vallejo-Vaz, Antonio J; Sanchez Armengol, Angeles; Moreno-Luna, Rafael; Caballero-Eraso, Candela; Macher, Hada C; Villar, Jose; Merino, Ana M; Castell, Javier; Capote, Francisco; Stiefel, Pablo

    2015-01-01

    This study tries to assess the endothelial function in vivo using flow-mediated dilatation (FMD) and several biomarkers of endothelium formation/restoration and damage in patients with obstructive sleep apnoea (OSA) syndrome at baseline and after three months with CPAP therapy. Observational study, before and after CPAP therapy. We studied 30 patients with apnoea/hypopnoea index (AHI) >15/h that were compared with themselves after three months of CPAP therapy. FMD was assessed non-invasively in vivo using the Laser-Doppler flowmetry. Circulating cell-free DNA (cf-DNA) and microparticles (MPs) were measured as markers of endothelial damage and the vascular endothelial growth factor (VEGF) was determined as a marker of endothelial restoration process. After three month with CPAP, FMD significantly increased (1072.26 ± 483.21 vs. 1604.38 ± 915.69 PU, pDNA and MPs significantly decreased (187.93 ± 115.81 vs. 121.28 ± 78.98 pg/ml, p<0.01, and 69.60 ± 62.60 vs. 39.82 ± 22.14 U/μL, p<0.05, respectively) and VEGF levels increased (585.02 ± 246.06 vs. 641.11 ± 212.69 pg/ml, p<0.05). These changes were higher in patients with more severe disease. There was a relationship between markers of damage (r = -0.53, p<0.005) but not between markers of damage and restoration, thus suggesting that both types of markers should be measured together. CPAP therapy improves FMD. This improvement may be related to an increase of endothelial restoration process and a decrease of endothelial damage.

  7. Obstructive sleep apnoea syndrome, endothelial function and markers of endothelialization. Changes after CPAP.

    Directory of Open Access Journals (Sweden)

    Rocio Muñoz-Hernandez

    Full Text Available This study tries to assess the endothelial function in vivo using flow-mediated dilatation (FMD and several biomarkers of endothelium formation/restoration and damage in patients with obstructive sleep apnoea (OSA syndrome at baseline and after three months with CPAP therapy.Observational study, before and after CPAP therapy.We studied 30 patients with apnoea/hypopnoea index (AHI >15/h that were compared with themselves after three months of CPAP therapy. FMD was assessed non-invasively in vivo using the Laser-Doppler flowmetry. Circulating cell-free DNA (cf-DNA and microparticles (MPs were measured as markers of endothelial damage and the vascular endothelial growth factor (VEGF was determined as a marker of endothelial restoration process.After three month with CPAP, FMD significantly increased (1072.26 ± 483.21 vs. 1604.38 ± 915.69 PU, p< 0.005 cf-DNA and MPs significantly decreased (187.93 ± 115.81 vs. 121.28 ± 78.98 pg/ml, p<0.01, and 69.60 ± 62.60 vs. 39.82 ± 22.14 U/μL, p<0.05, respectively and VEGF levels increased (585.02 ± 246.06 vs. 641.11 ± 212.69 pg/ml, p<0.05. These changes were higher in patients with more severe disease. There was a relationship between markers of damage (r = -0.53, p<0.005 but not between markers of damage and restoration, thus suggesting that both types of markers should be measured together.CPAP therapy improves FMD. This improvement may be related to an increase of endothelial restoration process and a decrease of endothelial damage.

  8. Sleep apnoea during upper respiratory infection and metabolic alkalosis in infancy.

    Science.gov (United States)

    Abreu e Silva, F A; MacFadyen, U M; Williams, A; Simpson, H

    1986-01-01

    Three to four hour polygraphic sleep studies were carried out in 10 infants, five with upper respiratory infection and five with metabolic alkalosis secondary to vomiting during and after recovery from illness. During upper respiratory infection, the main abnormality detected was brief (greater than 3 less than 6 seconds) or prolonged (greater than 6 seconds) attacks of obstructive apnoea. Other indices of apnoea were similar to recovery data. Gross body movements were also increased. In infants with metabolic alkalosis indices of central apnoea were significantly increased when compared with recovery or case control data. Prolonged (greater than 15 seconds) attacks of central apnoea and obstructive apnoea (greater than 6 seconds) were only observed during illness. Gross body movements and periodic breathing were also increased. These findings suggest that the functional consequences of apparently 'mild' illnesses in young infants may be greater than is generally suspected and perhaps relevant to mechanism(s) of death in sudden infant death syndrome. PMID:3789786

  9. Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012.

    Science.gov (United States)

    Laitinen, L A; Anttalainen, U; Pietinalho, A; Hämäläinen, P; Koskela, K

    2003-04-01

    (1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients

  10. [The Overlap Syndrome: association of COPD and Obstructive Sleep Apnoea].

    Science.gov (United States)

    Weitzenblum, E; Chaouat, A; Kessler, R; Canuet, M; Hirschi, S

    2010-04-01

    Chronic obstructive pulmonary disease (COPD) and the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) are both common diseases affecting respectively 10 and 5% of the adult population over 40 years of age. Their coexistence, which is denominated "Overlap Syndrome", can be expected to occur in about 0.5% of this population. Two recent epidemiologic studies have shown that the prevalence of OSAHS is not higher in COPD than in the general population, and that the coexistence of the two conditions is due to chance and not through a pathophysiological linkage. Patients with "overlap" have a higher risk of sleep-related O(2) desaturation than do patients with COPD alone and the same degree of bronchial obstruction. They have an increased risk of developing hypercapnic respiratory failure and pulmonary hypertension when compared with patients with OSAHS alone and with patients with "usual" COPD. In patients with overlap, hypoxaemia, hypercapnia, and pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction, which is different from "usual" COPD. Treatment of the overlap syndrome consists of nasal continuous positive airway pressure or nocturnal non-invasive ventilation (NIV), with or without nocturnal O(2). Patients who are markedly hypoxaemic during the daytime (PaO(2)<55-60 mmHg) should be given conventional long-term O(2) therapy in addition to nocturnal ventilation. Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  11. Sleep. 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome.

    Science.gov (United States)

    George, C F P

    2004-09-01

    Driving is a complex task involving distinct cognitive, perceptual, motor, and decision making skills. After placing the vehicle on the road, the driver must constantly survey the ever changing roadway environment to keep the vehicle in the lane and moving at an appropriate safe speed. This surveillance involves two distinct visual tasks: estimating and responding to the oncoming curvature and controlling lane position. Driving is therefore a divided attention task involving speed and lane control as well as monitoring. To do this in a safe manner requires careful attention and alertness which can be problematic for patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or other sleep disorders.

  12. Severe obstructive sleep apnoea syndrome in an adult patient with Laron syndrome.

    Science.gov (United States)

    Dagan, Y; Abadi, J; Lifschitz, A; Laron, Z

    2001-08-01

    A 68 year old patient with Laron syndrome (primary growth hormone (GH) resistance-insensitivity due to a molecular defect of the GH receptor) and severe obstructive sleep apnoea syndrome is described. Treatment with continuous positive air pressure therapy resulted in improved nocturnal sleep, daytime alertness and cognitive functions. Copyright 2001 Harcourt Publishers Ltd.

  13. Lack of effect of sleep apnea on oxidative stress in obstructive sleep apnea syndrome (OSAS patients.

    Directory of Open Access Journals (Sweden)

    M Simiakakis

    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.

  14. Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

    DEFF Research Database (Denmark)

    Alonderis, A.; Barbee, F.; Bonsignore, M.

    2008-01-01

    Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulati......Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license...... sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries...... it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea...

  15. A single qualitative study can show same findings as years of quantitative research: Obstructive sleep apnoea as an example

    Directory of Open Access Journals (Sweden)

    Howard Tandeter

    2016-06-01

    Full Text Available Background Many years of quantitative research led to our present knowledge of the symptoms and associated features (S&AF of the obstructive sleep apnoea (OSA syndrome. Aims 1. To prove that a qualitative research approach may identify symptoms and associated features of OSA in less time/effort than that used in a quantitative approach; 2. To describe the experience of patients with OSA and the effects of the syndrome on their quality of life and that of their spouses and families (issues that quantitative methods fail to recognize. Methods We used a narrative inquiry methodology (qualitative research. The sample was selected using the “snowball sampling technique". The sample included 10 patients with moderate to severe OSA who had good adherence to CPAP and significant clinical improvement after treatment, and 3 of the patient’s spouses. Results The following issues were identified: A long pre-diagnosis phase of OSA (20 years in one of the patients; Characteristic S&AF of the syndrome as experienced by patients and their spouses; The need for increased awareness of both the public and the medical establishment in regards to this disorder; Premature ejaculation (not reported previously and nightmares (non-conclusive in the literature were identified and improved with CPAP therapy. Conclusion With the use of quantitative research methods it took decades to discover things that we found in one simple qualitative study. We therefore urge scientists to use more often these qualitative methods when looking for S&AF of diseases and syndromes.

  16. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis.

    Science.gov (United States)

    Simou, Evangelia; Britton, John; Leonardi-Bee, Jo

    2018-02-01

    A systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults. We searched Medline, EMBASE and Web of Science databases from 1985 to 2015 for comparative epidemiological studies assessing the relation between alcohol consumption and sleep apnoea. Two authors independently screened and extracted data. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was quantified using I 2 and explored using subgroup analyses based on study exposure and outcome measures, quality, design, adjustment for confounders and geographical location. Publication bias was assessed using a funnel plot and Egger's test. We identified 21 studies from which estimates of relative risk could be obtained. Meta-analysis of these estimates demonstrated that higher levels of alcohol consumption increased the risk of sleep apnoea by 25% (RR 1.25, 95%CI 1.13-1.38, I 2  = 82%, p Country locations. We detected evidence of publication bias (p = 0.001). A further eight included studies reported average alcohol consumption in people with and without sleep apnoea. Meta-analysis revealed that mean alcohol intake was two units/week higher in those with sleep apnoea, but this difference was not statistically significant (p = 0.41). These findings suggest that alcohol consumption is associated with a higher risk of sleep apnoea, further supporting evidence that reducing alcohol intake is of potential therapeutic and preventive value in this condition. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  17. Quality of sleep and risk for obstructive sleep apnoea in ambulant individuals with type 2 diabetes mellitus at a tertiary referral hospital in Kenya: a cross-sectional, comparative study.

    Science.gov (United States)

    Sokwalla, Sairabanu Mohammed Rashid; Joshi, Mark David; Amayo, Erastus Olonde; Acharya, Kirtida; Mecha, Jared Ongechi; Mutai, Kenneth Kipyegon

    2017-02-06

    Sleep disorders are common and associated with multiple metabolic and psychological derangements. Obstructive sleep apnoea (OSA) is among the most common sleep disorders and an inter-relationship between OSA, insulin resistance, obesity, type 2 diabetes (T2DM) and cardiovascular diseases has been established. Prevalence of sleep disorders in Kenyans, particularly in individuals with T2DM is unknown. We thus aimed to determine prevalence of poor quality of sleep (QOS) and high risk for OSA, among persons with T2DM and determine their associations with socio-demographic and anthropometric variables. Utilising a Cross- Sectional Descriptive design, QOS and risk for OSA were determined in a randomly selected sample of patients with T2DM (cases) and an age and sex matched comparison group. The validated Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire (BQ) were used to measure QOS and risk for OSA respectively. Associations between poor QOS, high risk for OSA, and socio-demographic and anthropometric variables in cases were evaluated. From 245 randomly selected persons with T2DM attending outpatient clinics, aged over 18 years, 22 were excluded due to ineligibility thus 223 were included in the analysis; 53.8% were females, mean age was 56.8 (SD 12.2) years and mean BMI was 28.8 kg/m 2 (SD 4.4). Among them, 119 (53%, CI 95% 46.5-60.2) had poor QOS and 99 (44% CI 95% 37.8-50.9) were at high risk for OSA. Among 112 individuals in comparison group, 33 (29.5%, CI 95% 20.9-38.3) had poor QOS and 9 (8%, CI 95% 3.3-13.4) had high risk for OSA. Cases had a significantly higher probability for poor QOS [OR 2.76 (95% CI 1.7-4.4))] and high risk for OSA [OR 9.1 (95% CI 4.4-19.0)]. Higher waist circumference was independently associated with a high risk for OSA in cases. We demonstrate a high burden of sleep disturbances in patients with T2DM. Our findings may have implications for clinicians to screen for sleep disorders when assessing patients with T2DM and

  18. Flextube reflectometry and pressure recordings for level diagnosis in obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Faber, C E; Grymer, L; Hilberg, O

    2002-01-01

    The objective of this study was to compare sound reflections in a flexible tube (flextube reflectometry) with pressure-catheter recordings (ApneaGraph) for identifying the predominant obstructive level of the upper airway during sleep. Seventeen males with suspected obstructive sleep apnoea...... results were found in flextube reflectometry studies and pressure-recordings performed on different nights regarding the level distribution of obstructions during sleep. Possible explanations of this discrepancy are discussed....

  19. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study.

    Science.gov (United States)

    Jennum, Poul; Ibsen, Rikke; Kjellberg, Jakob

    2013-10-01

    Little is known about the diagnostic patterns of obstructive sleep apnoea (OSA) in children. A study was undertaken to evaluate morbidity and mortality in childhood OSA. 2998 patients aged 0-19 years with a diagnosis of OSA were identified from the Danish National Patient Registry. For each patient we randomly selected four citizens matched for age, sex and socioeconomic status, thus providing 11 974 controls. Patients with OSA had greater morbidity at least 3 years before their diagnosis. The most common contacts with the health system arose from infections (OR 1.19, 95% CI 1.01 to 1.40); endocrine, nutritional and metabolic diseases (OR 1.30, 95% CI 0.94 to 1.80); nervous conditions (OR 2.12, 95% CI 1.65 to 2.73); eye conditions (OR 1.43, 95% CI 1.07 to 1.90); ear, nose and throat (ENT) diseases (OR 1.61, 95% CI 1.33 to 1.94); respiratory system diseases (OR 1.78, 95% CI 1.60 to 1.98); gastrointestinal diseases (OR 1.34, 95% CI 1.09 to 1.66); skin conditions (OR 1.32, 95% CI 1.02 to 1.71); congenital malformations (OR 1.56, 95% CI 1.31 to 1.85); abnormal clinical or laboratory findings (OR 1.21, 95% CI 1.06 to 1.39); and other factors influencing health status (OR 1.29, 95% CI 1.16 to 1.43). After diagnosis, OSA was associated with incidences of endocrine, nutritional and metabolic diseases (OR 1.78, 95% CI 1.29 to 2.45), nervous conditions (OR 3.16, 95% CI 2.58 to 3.89), ENT diseases (OR 1.45, 95% CI 1.14 to 1.84), respiratory system diseases (OR 1.94, 95% CI 1.70 to 2.22), skin conditions (OR 1.42, 95% CI 1.06 to 1.89), musculoskeletal diseases (OR 1.29, 95% CI 1.01 to 1.64), congenital malformations (OR 1.83, 95% CI 1.51 to 2.22), abnormal clinical or laboratory findings (OR 1.16, 95% CI 1.06 to 1.27) and other factors influencing health status (OR 1.35, 95% CI 1.20 to 1.51). The 5-year death rate was 70 per 10 000 for patients and 11 per 10 000 for controls. The HR for cases compared with controls was 6.58 (95% CI 3.39 to 12.79; p<0.001). Children with OSA

  20. Insufficient evidence to confirm effectiveness of oral appliances in treatment of obstructive sleep apnoea syndrome in children.

    Science.gov (United States)

    Fox, Nigel A

    2007-01-01

    Searches were made using the Cochrane Central Register of Controlled Trials, Medline, Embase, Latin American and Caribbean Health Sciences Literature, Bibliografia Brasileira de Odontologia and SciELO (the Scientific Electronic Library Online). Studies chosen were randomised controlled trials (RCT) or quasi-RCT comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children of 15 years old or younger. Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes. A total of 384 trials were identified, of which only one, reporting results from a total of 23 patients, was suitable for inclusion in the review. Data provided in the published report did not answer all the questions from this review, but did answer some: the results presented favour treatment. At present there is not sufficient evidence to state that oral appliances or functional orthopaedic appliances are effective in the treatment of obstructive sleep apnoea (OSA) syndrome in children. Oral appliances or functional orthopaedic appliances may be helpful in the treatment of children with craniofacial anomalies which are risk factors for apnoea.

  1. Blood pressure response to CPAP treatment in subjects with obstructive sleep apnoea: the predictive value of 24-h ambulatory blood pressure monitoring.

    Science.gov (United States)

    Castro-Grattoni, Anabel L; Torres, Gerard; Martínez-Alonso, Montserrat; Barbé, Ferran; Turino, Cecilia; Sánchez-de-la-Torre, Alicia; Cortijo, Anunciacion; Duran-Cantolla, Joaquin; Egea, Carlos; Cao, Gonzalo; Sánchez-de-la-Torre, Manuel

    2017-10-01

    The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea-hypopnoea index 42 events·h -1 ) were included; 28.4% had hypertension. 62 patients finished the study, and 60 were analysed. The daytime diastolic BP (-2 mmHg) and norepinephrine (-109.5 nmol·day -1 ) were reduced after CPAP, but no changes in the 24-h BP, night-time BP, dopamine, epinephrine, CRP, leptin or adiponectin were detected. The nocturnal normotension was associated with an increased night-time-BP (+4 mmHg) after CPAP, whereas nocturnal hypertension was associated with a reduction of 24-h BP (-3 mmHg). A multivariate linear regression model showed differential night-time BP changes after CPAP. Specifically, low night-time heart rate (CPAP and support the usefulness of 24-h ABPM for OSA patients before treatment initiation. These results need to be confirmed in further studies. Copyright ©ERS 2017.

  2. Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea.

    Science.gov (United States)

    Kauppi, Paula; Bachour, Patrick; Maasilta, Paula; Bachour, Adel

    2016-12-01

    Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms. A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test™ (ACT) and a visual analogue scale (0 = no symptoms, 100 = severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution. We sent 2577 questionnaires and received 1586 answers (61 %). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13 %. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p CPAP (P CPAP in patients with both asthma and obstructive sleep apnoea.

  3. Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    Side-effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. Twenty-one patients (19 male, 49+\\/-10years) with the established diagnosis of OSAS [apnoea\\/hypopnoea index (AHI): 52+\\/-22] and who had a successful CPAP titration were commenced on CPAP therapy (10+\\/-2cmH2O), and randomized to 4weeks of a nasal pillow (P) and a standard nasal mask (M) in a crossover design. Outcome measures were objective compliance, AHI, quality of life, Epworth Sleepiness Score (ESS) and CPAP side-effects. There was no difference in compliance (M versus P: 5.1+\\/-1.9h versus 5.0+\\/-1.7h; P=0.701) and AHI (2.6+\\/-2.7 versus 3.0+\\/-2.9; P=0.509). Quality of life and ESS improved with CPAP, but there was no difference in the extent of improvement between both devices. Usage of nasal pillows resulted in less reported pressure on the face and more subjects found the nasal pillow the more comfortable device. However, there was no clear overall preference for either device at the end of the study (mask=57%, pillow=43%; P=0.513). The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and >\\/=10cm H(2) O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.

  4. Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial.

    Science.gov (United States)

    Isacsson, Göran; Nohlert, Eva; Fransson, Anette M C; Bornefalk-Hermansson, Anna; Wiman Eriksson, Eva; Ortlieb, Eva; Trepp, Livia; Avdelius, Anna; Sturebrand, Magnus; Fodor, Clara; List, Thomas; Schumann, Mohamad; Tegelberg, Åke

    2018-05-16

    The clinical benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that the two types of appliances are equally effective in treating OSA. To compare the efficacy of monobloc versus bibloc appliances in a short-term perspective. In this multicentre, randomized, blinded, controlled, parallel-group equivalence trial, patients with OSA were randomly assigned to use either a bibloc or a monobloc appliance. One-night respiratory polygraphy without respiratory support was performed at baseline, and participants were re-examined with the appliance in place at short-term follow-up. The primary outcome was the change in the apnoea-hypopnea index (AHI). An independent person prepared a randomization list and sealed envelopes. Evaluating dentist and the biomedical analysts who evaluated the polygraphy were blinded to the choice of therapy. Of 302 patients, 146 were randomly assigned to use the bibloc and 156 the monobloc device; 123 and 139 patients, respectively, were analysed as per protocol. The mean changes in AHI were -13.8 (95% confidence interval -16.1 to -11.5) in the bibloc group and -12.5 (-14.8 to -10.3) in the monobloc group. The difference of -1.3 (-4.5 to 1.9) was significant within the equivalence interval (P = 0.011; the greater of the two P values) and was confirmed by the intention-to-treat analysis (P = 0.001). The adverse events were of mild character and were experienced by similar percentages of patients in both groups (39 and 40 per cent for the bibloc and monobloc group, respectively). The study shows short-term results with a median time from commencing treatment to the evaluation visit of 56 days and long-term data on efficacy and harm are needed to be fully conclusive. In a short-term perspective, both appliances were equivalent in terms of their positive effects for treating OSA and caused adverse events of similar magnitude. Registered with Clinical

  5. Pattern recognition of obstructive sleep apnoea and Cheyne–Stokes respiration

    International Nuclear Information System (INIS)

    Weinreich, Gerhard; Teschler, Helmut; Armitstead, Jeff

    2008-01-01

    The aim of this study was to assess the validity of an artificial neural network based on flow-related spectral entropy as a diagnostic test for obstructive sleep apnoea and Cheyne–Stokes respiration. A data set of 37 subjects was used for spectral analysis of the airflow by performing a fast Fourier transform. The examined intervals were divided into epochs of 3 min. Spectral entropy S was applied as a measure for the spread of the related power spectrum. The spectrum was divided into several frequency areas with various subsets of spectral entropy. We studied 11 subjects with obstructive apnoeas (n = 267 epochs), 10 subjects with obstructive hypopnoeas (n = 80 epochs), 11 subjects with Cheyne–Stokes respiration (n = 253 epochs) and 5 subjects with normal breathing in non-REM sleep (n = 174 epochs). Based on spectral entropy an artificial neural network was built, and we obtained a sensitivity of 90.2% and a specificity of 90.9% for distinguishing between obstructive apnoeas and Cheyne–Stokes respiration, and a sensitivity of 91.3% and a specificity of 94.6% for discriminating between obstructive hypopnoeas and normal breathing in non-REM sleep. This resulted in an accuracy of 91.5% for identifying flow patterns of obstructive sleep apnoea, Cheyne–Stokes respiration and normal breathing in non-REM sleep. It is concluded that the use of an artificial neural network relying on spectral analysis of the airflow could be a useful method as a diagnostic test for obstructive sleep apnoea and Cheyne–Stokes respiration

  6. Paradoxical reaction of blood pressure on sleep apnoea patients treated with Positive Airway Pressure

    Directory of Open Access Journals (Sweden)

    C. Chaves Loureiro

    2011-03-01

    Full Text Available Introduction: Obstructive Sleep Apnoea Syndrome (OSAS patients may develop hypertension and Positive Airway Pressure (PAP is an effective treatment in blood pressure (BP control. Objectives: Analyse a hypertensive OSAS population with unexpected BP rise after PAP usage and verify correlations between BP rise, either with OSAS severity index or nocturnal ventilatory support compliance. Methods: Descriptive, retrospective analysis of 30 patients with PAP treated OSA, for one year, on average, and with previous controlled hypertension, who developed a rise in BP, defined as augmentation of > 5 mmHg in systolic (SBP and/or diastolic BP (DBP, after PAP usage. Co-relational analysis of BP increase, with OSAS severity indexes and therapy compliance, using Pearson coefficient. Results: Of 508 consecutive patients followed in our Department, treated with nocturnal ventilatory support, 30 evolved with BP rise after initiating treatment (age 58 ± 10.8 years; Apnoea-Hypopnoea Index [AHI], 46.1 ± 18.68. After PAP usage, mean blood pressure (MBP, Systolic BP (SBP and Diastolic BP (DBP variation was 16 ± 15 mmHg, 20 ± 25 mmHg and 6 ± 19.4 mmHg, respectively. No patient showed significant BMI increase. Epworth Sleepiness Scale (ESS value decreased 8.9 ± 5.48 points. MBP, SBP and DBP variations were not correlated with P90/P95, residual AHI, leaks or PAP compliance. Conclusions: No specific characteristics were identified in the group who developed a rise in BP with PAP usage. No correlations were found between rises in BP and OSAS severity indexes or PAP compliance. Neither BMI nor variation in wakefulness status explained the rise in BP. Studies relate polymorphisms of b1-adrenoreceptors with different BP responses to ventilatory support. More studies are needed to clarify the cause of this paradoxical response. Resumo: Introdução: Doentes com síndrome de Apneia Obstrutiva do Sono (SAOS podem desenvolver hipertensão arterial (HTA sendo a

  7. Reversal of functional changes in the brain associated with obstructive sleep apnoea following 6 months of CPAP

    Directory of Open Access Journals (Sweden)

    Rania H. Fatouleh

    2015-01-01

    Full Text Available Obstructive sleep apnoea (OSA is associated with an increase in the number of bursts of muscle sympathetic nerve activity (MSNA, leading to neurogenic hypertension. Continuous positive airway pressure (CPAP is the most effective and widely used treatment for preventing collapse of the upper airway in OSA. In addition to improving sleep, CPAP decreases daytime MSNA towards control levels. It remains unknown how this restoration of MSNA occurs, in particular whether CPAP treatment results in a simple readjustment in activity of those brain regions responsible for the initial increase in MSNA or whether other brain regions are recruited to over-ride aberrant brain activity. By recording MSNA concurrently with functional Magnetic Resonance Imaging (fMRI, we aimed to assess brain activity associated with each individual subject's patterns of MSNA prior to and following 6 months of CPAP treatment. Spontaneous fluctuations in MSNA were recorded via tungsten microelectrodes inserted into the common peroneal nerve in 13 newly diagnosed patients with OSA before and after 6 months of treatment with CPAP and in 15 healthy control subjects while lying in a 3 T MRI scanner. Blood Oxygen Level Dependent (BOLD contrast gradient echo, echo-planar images were continuously collected in a 4 s ON, 4 s OFF (200 volumes sampling protocol. MSNA was significantly elevated in newly diagnosed OSA patients compared to control subjects (55 ± 4 vs 26 ± 2 bursts/min. Fluctuations in BOLD signal intensity in multiple regions covaried with the intensity of the concurrently recorded bursts of MSNA. There was a significant fall in MSNA after 6 months of CPAP (39 ± 2 bursts/min. The reduction in resting MSNA was coupled with significant falls in signal intensity in precuneus bilaterally, the left and right insula, right medial prefrontal cortex, right anterior cingulate cortex, right parahippocampus and the left and right retrosplenial cortices. These data support

  8. Reversal of functional changes in the brain associated with obstructive sleep apnoea following 6 months of CPAP.

    Science.gov (United States)

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

    2015-01-01

    Obstructive sleep apnoea (OSA) is associated with an increase in the number of bursts of muscle sympathetic nerve activity (MSNA), leading to neurogenic hypertension. Continuous positive airway pressure (CPAP) is the most effective and widely used treatment for preventing collapse of the upper airway in OSA. In addition to improving sleep, CPAP decreases daytime MSNA towards control levels. It remains unknown how this restoration of MSNA occurs, in particular whether CPAP treatment results in a simple readjustment in activity of those brain regions responsible for the initial increase in MSNA or whether other brain regions are recruited to over-ride aberrant brain activity. By recording MSNA concurrently with functional Magnetic Resonance Imaging (fMRI), we aimed to assess brain activity associated with each individual subject's patterns of MSNA prior to and following 6 months of CPAP treatment. Spontaneous fluctuations in MSNA were recorded via tungsten microelectrodes inserted into the common peroneal nerve in 13 newly diagnosed patients with OSA before and after 6 months of treatment with CPAP and in 15 healthy control subjects while lying in a 3 T MRI scanner. Blood Oxygen Level Dependent (BOLD) contrast gradient echo, echo-planar images were continuously collected in a 4 s ON, 4 s OFF (200 volumes) sampling protocol. MSNA was significantly elevated in newly diagnosed OSA patients compared to control subjects (55 ± 4 vs 26 ± 2 bursts/min). Fluctuations in BOLD signal intensity in multiple regions covaried with the intensity of the concurrently recorded bursts of MSNA. There was a significant fall in MSNA after 6 months of CPAP (39 ± 2 bursts/min). The reduction in resting MSNA was coupled with significant falls in signal intensity in precuneus bilaterally, the left and right insula, right medial prefrontal cortex, right anterior cingulate cortex, right parahippocampus and the left and right retrosplenial cortices. These data support our contention that

  9. Radiofrequency vs laser in the management of mild to moderate obstructive sleep apnoea: does the number of treatment sessions matter?

    Science.gov (United States)

    Atef, Ahmed; Mosleh, Mohammed; Hesham, Mohammed; Fathi, Ahmed; Hassan, Mohammed; Fawzy, Mahmoud

    2005-11-01

    Obstructive sleep apnea (OSA) is a relatively common and serious problem with many medical and social consequences. Laser and radiofrequency are two recent techniques used to treat OSA and they can be carried out under local anaesthesia, but they need multiple sessions to achieve satisfactory outcome and are associated with better short-term than long-term outcomes. In this work we compare the two modalities as regards the optimal number of treatment sessions needed to achieve a favourable outcome in the short and long term. A total of 150 patients with apnoea hypopnoea index (AHI) between 5 and 30 events per hour, no morbid obesity and retropalatal site of obstruction were included in this prospective study. Patients were randomly and equally divided into two groups, each comprising 75 patients. The first group was treated with bipolar radiofrequency volumetric tissue reduction of the palate (BRVTR) and the second group was treated with laser-assisted uvulopalatoplasty (LAUP). Each group was further subdivided into five subgroups each consisting of 15 patients. The first group received one treatment session, the second received two sessions, the third received three sessions, the fourth received four sessions and the fifth group received five treatment sessions. Evaluation of efficiency of both techniques in treating OSA was assessed objectively by polysomnography. In those treated with BRVTR; at least three sessions were needed to achieve a favourable outcome in OSA in the short and long term. In those treated with LAUP, a single treatment session was enough to achieve a favourable outcome on OSA in the short term, while two sessions were needed to achieve the same long-term outcome. In OSA, fewer treatment sessions are needed with LAUP (one session) than with BRVTR (three sessions) to achieve a favourable outcome. In LAUP more treatment sessions (two) are needed to maintain a longer-term favourable outcome than those needed to achieve short-term favourable

  10. The relationship between driving simulation performance and obstructive sleep apnoea risk, daytime sleepiness, obesity and road traffic accident history of commercial drivers in Turkey.

    Science.gov (United States)

    Demirdöğen Çetinoğlu, Ezgi; Görek Dilektaşlı, Aslı; Demir, Nefise Ateş; Özkaya, Güven; Acet, Nilüfer Aylin; Durmuş, Eda; Ursavaş, Ahmet; Karadağ, Mehmet; Ege, Ercüment

    2015-09-01

    Driving performance is known to be very sensitive to cognitive-psychomotor impairment. The aim of the study was to determine the relationship between obesity, risk of obstructive sleep apnoea (OSA), daytime sleepiness, history of road traffic accident (RTA) and performance on a driving simulator, among commercial drivers. We examined commercial vehicle drivers admitted to Psycho-Technical Assessment System (PTAS), which is a computer-aided system that includes a driving simulator test and tests assessing psychomotor-cognitive skills required for driving. Risk of OSA and daytime sleepiness were assessed by the Berlin Questionnaire and the Epworth Sleepiness Scale (ESS), respectively. A total of 282 commercial vehicle drivers were consecutively enrolled. The age range was 29-76 years. Thirty drivers were at high risk of OSA. Median ESS of the group was 2 (0-20). Forty-seven percent of the subjects at high risk of OSA failed in early reaction time test, while 28% of the drivers with low risk of OSA failed (p = 0.03). The obese drivers failed the peripheral vision test when compared with non-obese drivers (p = 0.02). ESS was higher for drivers with a history of RTA when compared to those without RTA (p = 0.02). Cognitive-psychomotor functions can be impaired in obese and high risk of OSA patients. In our opinion, requiring obese and/or high risk of OSA drivers to take PTAS tests that assess driving skills and psychomotor-cognitive functions crucial to those skills would significantly improve road traffic safety, which is of considerable importance to public health.

  11. At least one in three people with Type 2 diabetes mellitus referred to a diabetes centre has symptomatic obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Storgaard, H; Mortensen, B; Almdal, T

    2014-01-01

    , diabetic complications or medication use. In multiple regression analyses, age, BMI and HDL cholesterol levels were all significant, independent predictors of obstructive sleep apnoea. CONCLUSIONS: At least one third of people with Type 2 diabetes referred to a diabetes clinic in Denmark has symptomatic......AIMS: To investigate the prevalence of symptomatic obstructive sleep apnoea in unselected patients with Type 2 diabetes referred to a tertiary diabetes clinic. METHODS: In a cross-sectional design, all newly referred patients were offered a stepwise screening for obstructive sleep apnoea with: (1...... obstructive sleep apnoea. Our data suggest higher age, a compromised plasma lipid profile and a more obese phenotype in patients with Type 2 diabetes who have obstructive sleep apnoea, highlighting the need to focus on screening and treatment of obstructive sleep apnoea in these patients....

  12. Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea.

    Science.gov (United States)

    de Chazal, Philip; Heneghan, Conor; Sheridan, Elaine; Reilly, Richard; Nolan, Philip; O'Malley, Mark

    2003-06-01

    A method for the automatic processing of the electrocardiogram (ECG) for the detection of obstructive apnoea is presented. The method screens nighttime single-lead ECG recordings for the presence of major sleep apnoea and provides a minute-by-minute analysis of disordered breathing. A large independently validated database of 70 ECG recordings acquired from normal subjects and subjects with obstructive and mixed sleep apnoea, each of approximately eight hours in duration, was used throughout the study. Thirty-five of these recordings were used for training and 35 retained for independent testing. A wide variety of features based on heartbeat intervals and an ECG-derived respiratory signal were considered. Classifiers based on linear and quadratic discriminants were compared. Feature selection and regularization of classifier parameters were used to optimize classifier performance. Results show that the normal recordings could be separated from the apnoea recordings with a 100% success rate and a minute-by-minute classification accuracy of over 90% is achievable.

  13. Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

    Science.gov (United States)

    Guralnick, Amy S; Balachandran, Jay S; Szutenbach, Shane; Adley, Kevin; Emami, Leila; Mohammadi, Meelad; Farnan, Jeanne M; Arora, Vineet M; Mokhlesi, Babak

    2017-12-01

    Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. ClinicalTrials.gov Identifier: NCT02553694. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep

    Directory of Open Access Journals (Sweden)

    D. Pevernagie

    2007-12-01

    Full Text Available The concept of central sleep apnoea or hypoventilation encompasses hypercapnic central hypoventilation, such as obesity hypoventilation syndrome and eucapnic or hypocapnic central sleep apnoea. Among subjects with eucapnic or hypocapnic central sleep apnoea, several therapeutic options are available for those with Cheyne–Stokes respiration (CSR. CSR is frequent in patients with New York Heart Association stage III and IV chronic heart failure, and in various neurological disorders. In these patients, treatment modalities include optimising cardiac condition and drugs, such as theophylline, acetazolamide and/or oxygen. Ventilatory support, such as nasal continuous positive airway pressure (CPAP, bi-level pressure support, or adaptive servo-ventilation (ASV, has been shown to improve CSR in patients with cardiac failure; however, convincing evidence that nasal CPAP improves life expectancy in these patients is lacking. Nevertheless, the treatment of associated obstructive sleep-disordered breathing is indicated per se, as it may improve cardiac function. There is currently no proof that bi-level ventilation is superior to nasal CPAP. The few available studies that have focused on ASV have shown satisfactory control of CSR in cardiac failure patients. While ASV is not a first-line treatment choice, it appears to be superior to oxygen, CPAP and bi-level pressure ventilation in controlling the apnoea/hypopnea index and probably sleep fragmentation. As yet there are no data on mortality and, as such, firm conclusions cannot be drawn as to the role of ASV in the management of cardiac failure patients suffering from CSR. Obesity-related hypoventilation has increased dramatically over recent decades due to the epidemic increase in obesity in the developed countries. Obesity hypoventilation syndrome predisposes to the development of pulmonary hypertension and cor pulmonale. Noninvasive home ventilation is increasingly applied in obese patients with

  15. Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea.

    Science.gov (United States)

    Rudkowski, J C; Verschelden, P; Kimoff, R J

    2001-09-01

    The aim of this study was to evaluate manual nasal continuous positive airway pressure (nCPAP) titration during daytime polysomnography compared with conventional overnight titration for patients with severe obstructive sleep apnoea. Thirty-two patients who underwent daytime titration were retrospectively matched (for age, sex, body mass index and apnoea/hypopnoea index (AHI)) to a group titrated overnight during the same period. Successful titration was defined as the identification of the nCPAP level (effective nCPAP (Peff)) required to eliminate respiratory events during all sleep stages. After 3 months of therapy on nCPAP at Peff, nCPAP utilization history was obtained and a group of patients underwent a repeat polysomnogram (PSG) and completed a follow-up Epworth Sleepiness Scale (ESS) score. Initial titration was successful in 91% of daytime patients and 91% of overnight patients. The success of daytime titration was not related to diagnostic AHI or ESS score. Subjective nCPAP utilization was statistically similar in both groups. On the follow-up PSG, there were no significant differences between daytime (n=11) and overnight (n=11) patients in measures of sleep quality or respiratory disturbance. Both groups demonstrated similar and significant improvements in ESS score. These findings suggest that the effective nasal continuous positive airway pressure can be accurately established during daytime titration in a substantial proportion of severe, symptomatic obstructive sleep apnoea patients.

  16. Asthma Control and Its Relationship with Obstructive Sleep Apnea (OSA in Older Adults

    Directory of Open Access Journals (Sweden)

    Mihaela Teodorescu

    2013-01-01

    Full Text Available Background/Objectives. Asthma in older individuals is poorly understood. We aimed to characterize the older asthma phenotype and test its association with obstructive sleep apnea (OSA. Design. Cross-sectional. Setting. Pulmonary and Asthma/Allergy clinics. Participants. 659 asthma subjects aged 18–59 years (younger and 154 aged 60–75 (older. Measurements. Sleep Apnea scale of Sleep Disorders Questionnaire (SA-SDQ, asthma severity step (1–4, severe if step 3 or 4, established OSA diagnosis, continuous positive airway pressure (CPAP use, and comorbidities. Results. Older versus younger had worse control, as assessed by asthma step, lung function, and inhaled corticosteroid use. Among older subjects, after controlling for known asthma aggravators, OSA diagnosis was the only factor robustly associated with severe asthma: on average, OSA was associated with nearly 7 times greater likelihood of severe asthma in an older individual (OR=6.67. This relationship was of greater magnitude than in younger subjects (OR=2.16. CPAP use attenuated the likelihood of severe asthma in older subjects by 91% (P=0.005, much more than in the younger asthmatics. Conclusion. Diagnosed OSA increases the risk for worse asthma control in older patients, while CPAP therapy may have greater impact on asthma outcomes. Unrecognized OSA may be a reason for poor asthma control, particularly among older patients.

  17. Assessment of the Depression, Anxiety, and Stress Scale (DASS-21) in untreated obstructive sleep apnea (OSA).

    Science.gov (United States)

    Nanthakumar, Shenooka; Bucks, Romola S; Skinner, Timothy C; Starkstein, Sergio; Hillman, David; James, Alan; Hunter, Michael

    2017-10-01

    The assessment of depression in obstructive sleep apnea (OSA) is confounded by symptom overlap. The Depression, Anxiety, and Stress Scale-short form (DASS-21) is a commonly used measure of negative affect, but it not known whether the DASS-21 is suitable for use in an OSA sample. This study compared the fit of Lovibond and Lovibond's (1995) correlated 3-factor structure of the DASS-21 and measurement invariance between a non-OSA and an OSA sample using confirmatory factor analysis. As measurement invariance was not found, to determine the source of non-invariance differential item functioning (DIF) was examined using dMACS. The correlated 3-factor structure (with correlated errors) of the DASS-21 was a better fit in the non-OSA sample. dMACS indicated that there was a degree of DIF for each of the subscales, especially for the Anxiety subscale, in which 2 symptoms (that are also physiological symptoms of OSA) produced lower severity scores in the OSA sample compared with the non-OSA sample. However, the degree of DIF for each of the subscales is not sufficient to cause concern when using the DASS-21; therefore, the total DASS-21 is suitable for use in an OSA sample. Interestingly, the impact of symptom overlap in anxiety symptoms may be reducing anxiety scores because of DIF, which contrasts with the proposed effect of symptom overlap in depression, where it leads to the inflation of depression scores in OSA. This deserves greater consideration in relation to OSA and other clinical disorders or chronic illness conditions with different patterns of overlapping symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

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

    Science.gov (United States)

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

    2015-02-01

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

  19. Obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome

    OpenAIRE

    Hill, Elizabeth A.

    2016-01-01

    Key points Adults with Down syndrome are predisposed to obstructive sleep apnoea/hypopnoea syndrome (OSAHS) due to overlap between the Down syndrome phenotype and OSAHS risk factors. The prevalence of OSAHS in adults with Down syndrome is estimated at 35?42%. This is up to ten-times higher than in the general adult population. Symptoms of OSAHS, including behavioural and emotional disturbances as well as standard symptoms such as sleepiness, should be monitored as part of regular health surve...

  20. Obstructive sleep apnoea in pregnancy and its association with pre ...

    African Journals Online (AJOL)

    Results: The median gestational age in this sample was 28 weeks; 80.3% (CI ... The association between the hypertensive disorders and OSA must be ... and mortality for mother and baby.1–3 Continuous positive airway ... During pregnancy weight gain can be attributed to oedema, ..... Maternal and neonatal morbidities.

  1. Adherence to CPAP therapy: comparing the effect of three educational approaches in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Delanote, Isabelle; Borzée, Pascal; Belge, Catharina; Buyse, Bertien; Testelmans, Dries

    2018-01-01

    Continuous positive airway pressure (CPAP)-therapy is the first-line treatment for moderate to severe obstructive sleep apnoea (OSA). A significant limitation of CPAP treatment is the poor therapy adherence, compromising the beneficial effects. This study evaluates three different educational approaches and their effect on therapy adherence. This single-center, retrospective study compared three groups of 100 consecutive, CPAP-naive patients with moderate to severe OSA who were started on CPAP therapy. Group 1 and 2 received the same individual structured education on two consecutive days with an extra phone call 7 to 10 days after CPAP start in group 2. Group 3 received individual structured education on the first day and participated in a group education using a slide presentation open for discussion on the second day. Re-evaluation was performed after 24 weeks. Baseline characteristics did not differ significantly between groups. During the 24 weeks follow-up there was a drop-out rate of 16% (group 1), 12% (group 2) and 5% (group 3). In the patients still on CPAP after 24 weeks, the mean nightly CPAP usage was, respectively, 4.7 ± 1.8, 5.2 ± 2.3 and 5.7 ± 2.1 h/night. In group 3 both the drop-out rate and mean CPAP usage were significantly different (P values, respectively, P CPAP adherence is an ongoing challenge. This study shows that a multi-modality approach, using a combination of individual and group education using a slide presentation open for discussion resulted in improved therapy adherence. © 2016 John Wiley & Sons Ltd.

  2. Sibutramine versus continuous positive airway pressure in obese obstructive sleep apnoea patients.

    Science.gov (United States)

    Ferland, A; Poirier, P; Sériès, F

    2009-09-01

    The aim of the present study was to compare the efficacy of 1 yr of sibutramine-induced weight loss versus continuous positive airway pressure (CPAP) treatment on sleep-disordered breathing, cardiac autonomic function and systemic blood pressure in obese patients with obstructive sleep apnoea. Subjects with a body mass index of > or =30 kg.m(-2) without previous treatment for obstructive sleep apnoea underwent either sibutramine (n = 22) or CPAP (n = 18) treatment for 1 yr. Sibutramine induced a 5.4+/-1.4 kg decrease in body weight compared to the CPAP group, in which no changes in anthropometric variables were observed. The CPAP treatment improved all sleep and respiratory variables, whereas sibutramine-induced weight loss improved only nocturnal arterial oxygen saturation profile. Only CPAP treatment improved night-time systolic and diastolic blood pressure and 24-h and daytime ambulatory diastolic blood pressure. Sibutramine-induced weight loss had no impact on indices of heart rate variability, whereas CPAP treatment increased daytime time domain indices. CPAP treatment for 1 yr had beneficial impacts on nocturnal breathing disturbances, and improved nocturnal oxygenation, night-time systolic and diastolic blood pressure, and daytime cardiac parasympathetic modulation. Sibutramine did not improve sleep-disordered breathing, systemic blood pressure or heart rate variability. There were no adverse effects, such as increment in blood pressure or arrhythmias, associated with this treatment regimen.

  3. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.

    Science.gov (United States)

    Isetta, Valentina; Negrín, Miguel A; Monasterio, Carmen; Masa, Juan F; Feu, Nuria; Álvarez, Ainhoa; Campos-Rodriguez, Francisco; Ruiz, Concepción; Abad, Jorge; Vázquez-Polo, Francisco J; Farré, Ramon; Galdeano, Marina; Lloberes, Patricia; Embid, Cristina; de la Peña, Mónica; Puertas, Javier; Dalmases, Mireia; Salord, Neus; Corral, Jaime; Jurado, Bernabé; León, Carmen; Egea, Carlos; Muñoz, Aida; Parra, Olga; Cambrodi, Roser; Martel-Escobar, María; Arqué, Meritxell; Montserrat, Josep M

    2015-11-01

    Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). NCT01716676. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  4. Apnoeic-hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis.

    Science.gov (United States)

    Mishra, Poonam; Nugent, Clarke; Afendy, Arian; Bai, Chunhong; Bhatia, Priya; Afendy, Mariam; Fang, Yun; Elariny, Hazem; Goodman, Zachary; Younossi, Zobair M

    2008-09-01

    Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnoea are associated with metabolic syndrome and atherosclerotic heart disease. This study evaluates the potential association between the NAFLD subtypes and a number of polysomnographical (PSG) parameters. This study included patients undergoing bariatric surgery with extensive clinical and histological data for whom complete PSG data before surgery were also available. Excess alcohol intake and other causes of liver disease were excluded. Apnoea, hypopnoea and apnoea-hypopnoea index (AHI) were calculated as described previously. In this study, a total of 101 patients [77 nonalcoholic steatohepatitis (NASH) and 22 non-NASH controls] with PSG data were included (age 42.9 +/- 11.4 years, body mass index 51.6 +/- 9.5 kg/m(2), fasting serum glucose 117.4 +/- 53.4 mg/dl, fasting serum triglycerides 171.3 +/- 82.9 mg/dl, 58% hypertension and 33% diabetes mellitus). Subjects with histological NASH had significantly lower lowest desaturation (77 vs. 85%, P=0.006), lower mean nocturnal oxygen saturation (91 vs. 93%, P=0.05), higher AHI (35 vs. 22, P=0.03), higher respiratory disturbance index (46 vs. 21, P=0.02) and higher alanine aminotransferase/aspartate aminotransferase ratio (1.4 vs. 1.3, P=0.05) compared with non-NASH controls. In multivariate analysis, the lowest desaturation (P=0.04) was independently associated with histological NASH. Lowest desaturation and mean nocturnal oxygen saturation were significantly lower in subjects with fibrosis (76 vs. 85%, P=0.004 and 90.4 vs. 93.0%, P=0.02). Our results suggest that the frequent nocturnal hypoxic episodes in NAFLD patients may be a risk factor for developing NASH. Additional studies are needed to study the effect of optimizing sleep apnoea management on the outcomes of patients with NAFLD.

  5. Obstructive Sleep Apnea

    Medline Plus

    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 ...

  6. Obstructive Sleep Apnea

    Science.gov (United States)

    ... 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 ...

  7. Obstructive sleep apnea (OSA): a complication of acute infectious mononucleosis infection in a child.

    Science.gov (United States)

    Cheng, Jeffrey

    2014-03-01

    Independently, obstructive sleep apnea (OSA) and infectious mononucleosis are not uncommon in the pediatric population, but acute onset of OSA, as a respiratory complication in the setting of acute EBV infection is extremely uncommon. Previous reports of this clinical entity are sparse and from nearly two decades ago. Urgent adenotonsillectomy was commonly advocated. This complication may be managed medically with systemic corticosteroids and non-invasive continuous positive airway pressure (CPAP), and a case is presented to highlight an updated management approach to this rarely encountered clinical problem in children. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Quality of Life in Youth With Obstructive Sleep Apnea Syndrome (OSAS) Treated With Continuous Positive Airway Pressure (CPAP) Therapy.

    Science.gov (United States)

    Lynch, Mary K; Elliott, Lindsey C; Avis, Kristin T; Schwebel, David C; Goodin, Burel R

    2017-05-30

    Improvement is sought for youth with obstructive sleep apnea syndrome (OSAS) who have poor quality of life (QoL), which resolves somewhat following treatment. One mitigating factor in improved QoL following treatment may be adherence to the CPAP protocol, which presents a barrier to most youth. This study explored relations between CPAP adherence and QoL in youth with OSAS. We recruited 42 youth-caregiver dyads in which youth between the ages of 8 and 16 years were diagnosed with OSAS and required CPAP use as part of their treatment plan. Following diagnosis of OSAS requiring treatment with CPAP therapy, caregivers completed baseline measures of OSAS-specific QoL. The OSAS-specific QoL domains assessed included sleep disturbance, physical symptoms, emotional distress, daytime function, and caregiver concern. Families received routine CPAP care for three months, after which caregivers again completed measures of OSAS-specific QoL. Adherence data were collected from smartcards within the CPAP machine after three months of treatment. Fifteen youth were adherent to CPAP therapy and 10 were not adherent. CPAP-adherent youth demonstrated significant changes in two domains of OSAS-specific QoL when compared to nonadherent youth: decreased sleep disturbance and decreased caregiver concern. CPAP adherence appears to be associated with positive changes in OSAS-specific QoL domains. It will be important for future research and clinical work to examine strategies for improving CPAP adherence in youth with OSAS.

  9. Temporal associations between arousal and body/limb movement in children with suspected obstructed sleep apnoea.

    Science.gov (United States)

    Lamprecht, Marnie L; Bradley, Andrew P; Williams, Gordon; Terrill, Philip I

    2016-01-01

    The inter-relationship between arousal events and body and/or limb movements during sleep may significantly impact the performance and clinical interpretation of actigraphy. As such, the objective of this study was to quantify the temporal association between arousals and body/limb movement. From this, we aim to determine whether actigraphy can predict arousal events in children, and identify the impact of arousal-related movements on estimates of sleep/wake periods. Thirty otherwise healthy children (5-16 years, median 9 years, 21 male) with suspected sleep apnoea were studied using full polysomnography and customised raw tri-axial accelerometry measured at the left fingertip, left wrist, upper thorax, left ankle and left great toe. Raw data were synchronised to within 0.1 s of the polysomnogram. Movements were then identified using a custom algorithm. On average 67.5% of arousals were associated with wrist movement. Arousals associated with movement were longer than those without movement (mean duration: 12.2 s versus 7.9 s respectively, p  <  0.01); movements during wake and arousal were longer than other sleep movements (wrist duration: 6.26 s and 9.89 s versus 2.35 s respectively, p  <  0.01); and the movement index (movements/h) did not predict apnoea-hypopnoea index (ρ  =  -0.11). Movements associated with arousals are likely to unavoidably contribute to actigraphy's poor sensitivity for wake. However, as sleep-related movements tend to be shorter than those during wake or arousal, incorporating movement duration into the actigraphy scoring algorithm may improve sleep staging performance. Although actigraphy-based measurements cannot reliably predict all arousal events, actigraphy can likely identify longer events that may have the greatest impact on sleep quality.

  10. Genetic aspects of hypertension and metabolic disease in the obstructive sleep apnoea-hypopnoea syndrome

    DEFF Research Database (Denmark)

    Riha, R.L.; Diefenbach, K.; Jennum, P.

    2008-01-01

    Though it has long been recognised that there is a hereditary component to the obstructive steep apnoea/hypopnoea syndrome (OSAHS), identifying its genetic basis remains elusive. Hypertension and metabolic syndrome, Like OSAHS, are polygenic disorders, physiologically complex and the product...... phenotyping, which has hampered genetic dissection of these diseases; in addition, sleep-disordered breathing has not been factored into most studies dealing with essential hypertension or metabolic syndrome. Genome-wide scans have yielded inconsistent results in all three disorders under discussion...... for the expression of cardiovascular disease and metabolic syndrome in the context of OSAHS. (C) 2007 Elsevier Ltd. All rights reserved Udgivelsesdato: 2008/2...

  11. Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge

    Directory of Open Access Journals (Sweden)

    Shruti Redhu

    2016-01-01

    Full Text Available Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.

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

    Science.gov (United States)

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

    2016-11-01

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

  13. Management of obstructive sleep apnea in Europe

    DEFF Research Database (Denmark)

    Fietze, I; Penzel, T; Alonderis, A

    2011-01-01

    In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA...

  14. Simulated driving in obstructive sleep apnoea-hypopnoea : effects of oral appliances and continuous positive airway pressure

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stegenga, Boudewijn; Bakker, Marije; Brouwer, Wiebo H.; de Bont, Lambert G. M.; Wijkstra, Peter J.; van der Hoeven, Johannes H.

    Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. Although continuous positive airway pressure (CPAP) generally improves simulated driving performance, the effects of oral-appliance (OA) therapy are unknown. The aims of this

  15. Adaptive servo ventilation for central sleep apnoea in heart failure : SERVE-HF on-treatment analysis

    NARCIS (Netherlands)

    Woehrle, Holger; Cowie, Martin R.; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K.; Somers, Virend K.; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

    2017-01-01

    This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the

  16. Behavioural hyperventilation as a novel clinical condition associated with central sleep apnoea: A report of three cases

    NARCIS (Netherlands)

    Pevernagie, D.; Mariman, A.; Vandenbussche, N.; Tobback, E.; Overeem, S.; Delesie, L.; Janssen, H.; Vogelaers, D.

    2012-01-01

    Central sleep apnoea (CSA) is a disorder characterised by repetitive episodes of decreased ventilation due to complete or partial reduction in the central neural outflow to the respiratory muscles. Hyperventilation plays a prime role in the pathogenesis of CSA. Chronic heart failure and dwelling at

  17. Sleeping Well Trial: Increasing the effectiveness of treatment with continuous positive airway pressure using a weight management program in overweight adults with obstructive sleep apnoea-A stepped wedge randomised trial protocol.

    Science.gov (United States)

    Truby, Helen; Edwards, Bradley A; O'Driscoll, Denise M; Young, Alan; Ghazi, Ladan; Bristow, Claire; Roem, Kerryn; Bonham, Maxine P; Murgia, Chiara; Day, Kaitlin; Haines, Terry P; Hamilton, Garun S

    2018-05-24

    The majority of adults diagnosed with obstructive sleep apnoea (OSA) are overweight or obese. Continuous positive airway pressure (CPAP) is the most common effective therapy for OSA. However, adherence declines over time with only 50% of patients prescribed CPAP continuing to use it long term. Furthermore, a recent prospective analysis indicated that those more adherent with CPAP therapy have enhanced weight gain trajectories which in turn may negatively impact their OSA. The Sleeping Well Trial aims to establish whether the timing of starting a lifestyle weight loss intervention impacts on weight trajectory in those with moderate-severe OSA treated at home with CPAP, while testing the potential for smart phone technology to improve adherence with lifestyle interventions. A stepped wedge design with randomisation of individuals from 1 to 6 months post-enrolment, with 5 months of additional prospective follow up after completion of the stepped wedge. This design will investigate the effect of the 6-month lifestyle intervention on people undergoing CPAP on body weight, body composition and health-related quality of life. This trial tests whether the timing of supporting the patient through a weight loss intervention is important in obtaining the maximum benefit of a lifestyle change and CPAP usage, and identify how best to support patients through this critical period. The protocol (v1) is registered prospectively with the International Clinical Trials Registry (CTR) ACTRN12616000203459 (public access). Any amendments to protocol will be documented via the CTR. Recruitment commenced in March 2016 with data collection scheduled to finish by May 2018. © 2018 Dietitians Association of Australia.

  18. Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health

    Directory of Open Access Journals (Sweden)

    Chamara Visanka Senaratna

    2016-10-01

    Full Text Available Abstract Background Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors. Methods We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18–55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI. Results Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18–25 years to 7.8 % in the age 45–55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all. Sleep apnoea was significantly associated with older age (p < 0.001, unemployment (p < 0.001, asthma (p = 0.011, chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002, diabetes (p < 0.001, hypercholesterolemia (p < 0.001, hypertension (p < 0.001, heart attack (p < 0.001, heart failure (p < 0.001, angina (p < 0.001, depression (p < 0.001, post-traumatic stress disorder (p

  19. The neuropharmacology of upper airway motor control in the awake and asleep states: implications for obstructive sleep apnoea

    Directory of Open Access Journals (Sweden)

    Horner Richard L

    2001-08-01

    Full Text Available Abstract Obstructive sleep apnoea is a common and serious breathing problem that is caused by effects of sleep on pharyngeal muscle tone in individuals with narrow upper airways. There has been increasing focus on delineating the brain mechanisms that modulate pharyngeal muscle activity in the awake and asleep states in order to understand the pathogenesis of obstructive apnoeas and to develop novel neurochemical treatments. Although initial clinical studies have met with only limited success, it is proposed that more rational and realistic approaches may be devised for neurochemical modulation of pharyngeal muscle tone as the relevant neurotransmitters and receptors that are involved in sleep-dependent modulation are identified following basic experiments.

  20. Effects of CPAP therapy on visceral fat thickness, carotid intima-media thickness and adipokines in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Ng, Susanna S S; Liu, Eric K H; Ma, Ronald C W; Chan, Tat-On; To, Kin-Wang; Chan, Ken K P; Ngai, Jenny; Yip, Wing-Ho; Ko, Fanny W S; Wong, Chun-Kwok; Hui, David S C

    2017-05-01

    Obstructive sleep apnoea (OSA) is associated with an increased prevalence of metabolic syndrome. This study explores the effects of continuous positive airway pressure (CPAP) for patients with OSA on visceral and mesenteric fat thickness, carotid intima-media thickness (IMT) and adipokines. A randomized controlled study was conducted at a teaching hospital on 90 patients newly diagnosed with OSA to receive either therapeutic CPAP or subtherapeutic CPAP for 3 months. Visceral fat thickness and carotid IMT were measured with B-mode ultrasound; adipokine levels were assessed at baseline and 3 months. Altogether, 45 patients received therapeutic CPAP and 45 received subtherapeutic CPAP without significant differences in age 50.3 (10.1) versus 48.7 (9.0) years, BMI 28.2 (3.9) versus 28.2 (4.5) kg/m 2 , Epworth Sleepiness Scale (ESS) 12.4 (5.9) versus 11.3 (4.7), apnoea-hypopnoea index (AHI) 30.6 (21.4) versus 35.2 (25.5) /h, minimum SaO 2 79.6 (10.8) versus 76.7 (12.4) % and existing co-morbidities. CPAP usage was therapeutic 4.2 (2.1) versus subtherapeutic 4.1 (2.0) h/night over 3 months. Adiponectin and irisin levels changed significantly following therapeutic CPAP for 3 months versus subtherapeutic CPAP (-1.6 vs 7.3, P = 0.042; 0.1 vs -0.1, P = 0.028 respectively) while only serum level of monocyte chemotactic protein 1 (MCP-1) at baseline was positively correlated with AHI (r = 0.278). No significant changes were observed in other adipokines, visceral fat thickness and IMT. Short-term therapeutic CPAP versus subtherapeutic CPAP does not significantly reduce visceral fat thickness and IMT, although it reduces adiponectin and increases irisin. © 2016 Asian Pacific Society of Respirology.

  1. Accuracy and reliability of the sensory test performed using the laryngopharyngeal endoscopic esthesiometer and rangefinder in patients with suspected obstructive sleep apnoea hypopnoea: protocol for a prospective double-blinded, randomised, exploratory study.

    Science.gov (United States)

    Giraldo-Cadavid, Luis Fernando; Bastidas, Alirio Rodrigo; Padilla-Ortiz, Diana Marcela; Concha-Galan, Diana Carolina; Bazurto, María Angelica; Vargas, Leslie

    2017-08-21

    Patients with obstructive sleep apnoea hypopnoea syndrome (OSA) might have varying degrees of laryngopharyngeal mechanical hyposensitivity that might impair the brain's capacity to prevent airway collapse during sleep. However, this knowledge about sensory compromises in OSA comes from studies performed using methods with little evidence of their validity. Hence, the purpose of this study is to assess the reliability and accuracy of the measurement of laryngopharyngeal mechanosensitivity in patients with OSA using a recently developed laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER). The study will be prospective and double blinded, with a randomised crossover assignment of raters performing the sensory tests. Subjects will be recruited from patients with suspected OSA referred for baseline polysomnography to a university hospital sleep laboratory. Intra-rater and inter-rater reliability will be evaluated using the Bland-Altman's limits of agreement plot, the intraclass correlation coefficient, and the Pearson or Spearman correlation coefficient, depending on the distribution of the variables. Diagnostic accuracy will be evaluated plotting ROC curves using standard baseline polysomnography as a reference. The sensory threshold values ​​for patients with mild, moderate and severe OSA will be determined and compared using ANOVA or the Kruskal-Wallis test, depending on the distribution of the variables. The LPEER could be a new tool for evaluating and monitoring laryngopharyngeal sensory impairment in patients with OSA. If it is shown to be valid, it could help to increase our understanding of the pathophysiological mechanisms of this condition and potentially help in finding new therapeutic interventions for OSA. The protocol has been approved by the Institutional Review Board of Fundacion Neumologica Colombiana. The results will be disseminated through conference presentations and peer-reviewed publication. This trial was registered at Clinical

  2. Is there a difference between the STOP-BANG and the Berlin Obstructive Sleep Apnoea Syndrome questionnaires for determining respiratory complications during the perioperative period?

    Science.gov (United States)

    Gokay, Pervin; Tastan, Sevinc; Orhan, Mehmet Emin

    2016-05-01

    This study aimed to compare the efficiency of the STOP-BANG and Berlin Obstructive Sleep Apnoea Syndrome questionnaires for evaluating potential respiratory complications during the perioperative period. Questionnaires that are used to determine obstructive sleep apnoea risk are not widely used for surgical patients. Among the questionnaires that are commonly used for obstructive sleep apnoea screening, it remains unclear whether the STOP-BANG or Berlin Obstructive Sleep Apnoea Syndrome questionnaire is more effective in terms of ease of use, usage period and diagnosis of surgical patients with obstructive sleep apnoea risk. This study was designed as a descriptive and prospective study. The study included 126 patients over 18 years of age who were American Society of Anesthesiologists classification class I-II and underwent laparoscopic cholecystectomy. To determine the potential obstructive sleep apnoea syndrome risk, the STOP-BANG and Berlin questionnaires were administered. Respiratory complications were then observed during the perioperative period. During intubation and extubation, we observed statistically significant differences in difficult intubation, difficult facemask ventilation and desaturation frequency between the high- and low-risk groups for obstructive sleep apnoea syndrome, as determined by the STOP-BANG questionnaire. During extubation, statistically significant differences in coughing, breath-holding and desaturation frequency were observed between the high-risk and low-risk groups, according to the Berlin questionnaire. In the post-anaesthesia care unit, both questionnaires found statistically significant differences between the low- and high-risk groups. Obstructive sleep apnoea syndrome screening questionnaires administered during the preoperative period are useful for predicting perioperative respiratory complications. It may be most useful to administer the STOP-BANG questionnaire as the initial evaluation. Questionnaires may be used to

  3. Physiological consequences of CPAP therapy withdrawal in patients with obstructive sleep apnoea—an opportunity for an efficient experimental model

    OpenAIRE

    Schwarz, Esther I.; Stradling, John R.; Kohler, Malcolm

    2018-01-01

    Randomised controlled trials (RCTs) of continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA) are time consuming, and their findings often inconclusive or limited due to suboptimal CPAP adherence in CPAP-naïve patients with OSA. Short-term CPAP withdrawal in patients with prior optimal CPAP adherence results in recurrence of OSA and its consequences. Thus, this experimental model serves as an efficient tool to investigate both the consequences of untreated OSA, and poten...

  4. Obstructive Sleep Apnea Syndrome (OSAS, metabolic syndrome and mental health in small enterprise workers. feasibility of an Action for Health.

    Directory of Open Access Journals (Sweden)

    Sergio Garbarino

    Full Text Available OBJECTIVE: To determine the frequency of obstructive sleep apnea syndrome (OSAS, metabolic syndrome and common mental disorders in the working population of 11 small enterprises and the feasibility of a program of action for health. METHOD: The clinical risk of OSAS, the prevalence of metabolic syndrome, and the level of psychological disorders were assessed during routine medical examination at the workplace in 2012. The response to medical advice was assessed in 2013. RESULTS: 12.3% of the workers were suspected of being affected by OSAS. One or more components of metabolic syndrome were present in 24.5% of cases. OSAS in "healthy" workers was significantly associated with the presence of one or more components of metabolic syndrome (OR = 3.83; 95%CI 1.45-10.13 and with a psychological disorders score in the highest quartile (OR = 4.67; 95%CI = 1.72-12.64. Workers with suspected OSAS were reluctant to follow advice about undergoing further tests under the NHS. However, in some cases, confirmation of the OSAS diagnosis and subsequent treatment led to an improvement in metabolic condition. CONCLUSION: Although participation in treatment was limited, anecdotal cases support the idea that prevention of obstructive sleep apnea in the workplace might be useful for workers' health.

  5. Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial.

    Science.gov (United States)

    Pépin, J L; Tamisier, R; Baguet, J P; Lepaulle, B; Arbib, F; Arnol, N; Timsit, J F; Lévy, P

    2016-08-01

    Millions of individuals with obstructive sleep apnoea (OSA) are treated by CPAP aimed at reducing blood pressure (BP) and thus cardiovascular risk. However, evidence is scarce concerning the impact of different CPAP modalities on BP evolution. This double-blind, randomised clinical trial of parallel groups of patients with OSA indicated for CPAP treatment compared the efficacy of fixed-pressure CPAP (FP-CPAP) with auto-adjusting CPAP (AutoCPAP) in reducing BP. The primary endpoint was the change in office systolic BP after 4 months. Secondary endpoints included 24 h BP measurements. Patients (322) were randomised to FP-CPAP (n=161) or AutoCPAP (n=161). The mean apnoea+hypopnoea index (AHI) was 43/h (SD, 21); mean age was 57 (SD, 11), with 70% of males; mean body mass index was 31.3 kg/m(2) (SD, 6.6) and median device use was 5.1 h/night. In the intention-to-treat analysis, office systolic blood pressure decreased by 2.2 mm Hg (95% CI -5.8 to 1.4) and 0.4 mm Hg (-4.3 to 3.4) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.3 mm Hg (95% CI -4.1 to 1.5); p=0.37, adjusted for baseline BP values). 24 h diastolic BP (DBP) decreased by 1.7 mm Hg (95% CI -3.9 to 0.5) and 0.5 mm Hg (95% CI -2.3 to 1.3) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.4 mm Hg (95% CI -2.7 to -0.01); p=0.048, adjusted for baseline BP values). The result was negative regarding the primary outcome of office BP, while FP-CPAP was more effective in reducing 24 h DBP (a secondary outcome). NCT01090297. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Response to a combination of oxygen and a hypnotic as treatment for obstructive sleep apnoea is predicted by a patient's therapeutic CPAP requirement.

    Science.gov (United States)

    Landry, Shane A; Joosten, Simon A; Sands, Scott A; White, David P; Malhotra, Atul; Wellman, Andrew; Hamilton, Garun S; Edwards, Bradley A

    2017-08-01

    Upper airway collapsibility predicts the response to several non-continuous positive airway pressure (CPAP) interventions for obstructive sleep apnoea (OSA). Measures of upper airway collapsibility cannot be easily performed in a clinical context; however, a patient's therapeutic CPAP requirement may serve as a surrogate measure of collapsibility. The present work aimed to compare the predictive use of CPAP level with detailed physiological measures of collapsibility. Therapeutic CPAP levels and gold-standard pharyngeal collapsibility measures (passive pharyngeal critical closing pressure (P crit ) and ventilation at CPAP level of 0 cmH 2 O (V passive )) were retrospectively analysed from a randomized controlled trial (n = 20) comparing the combination of oxygen and eszopiclone (treatment) versus placebo/air control. Responders (9/20) to treatment were defined as those who exhibited a 50% reduction in apnoea/hypopnoea index (AHI) plus an AHICPAP requirement compared with non-responders (6.6 (5.4-8.1)  cmH 2 O vs 8.9 (8.4-10.4) cmH 2 O, P = 0.007), consistent with their reduced collapsibility (lower P crit , P = 0.017, higher V passive P = 0.025). Therapeutic CPAP level provided the highest predictive accuracy for differentiating responders from non-responders (area under the curve (AUC) = 0.86 ± 0.9, 95% CI: 0.68-1.00, P = 0.007). However, both P crit (AUC = 0.83 ± 0.11, 95% CI: 0.62-1.00, P = 0.017) and V passive (AUC = 0.77 ± 0.12, 95% CI: 0.53-1.00, P = 0.44) performed well, and the difference in AUC for these three metrics was not statistically different. A therapeutic CPAP level ≤8 cmH 2 O provided 78% sensitivity and 82% specificity (positive predictive value = 78%, negative predictive value = 82%) for predicting a response to these therapies. Therapeutic CPAP requirement, as a surrogate measure of pharyngeal collapsibility, predicts the response to non-anatomical therapy (oxygen and

  7. The rheological properties of blood and the risk of cardiovascular disease in patients with obstructive sleep apnea syndrome (OSAS

    Directory of Open Access Journals (Sweden)

    Władysław Pierzchała

    2011-07-01

    Full Text Available Obstructive sleep apnea (OSA is an important public health concern, which affects around 2–4% of the population. Left untreated, it causes a decrease not only in quality of life, but also of life expectancy. Despite the fact that knowledge about the mechanisms of development of cardiovascular disease in patients with OSA is still incomplete, observations confirm a relationship between sleep disordered breathing and the rheological properties of blood. One possible consequence of an increased incidence of cardiovascular disease may be a rise in mortality in OSA patients. Continuously improved research methods are allowing for an increasingly more accurate understanding of the significance of observed changes. (Folia Histochemica et Cytobiologica 2011, Vol. 49, No. 2, 206–210

  8. Functional MRI of the pharynx in obstructive sleep apnea (OSA) with rapid 2-D flash sequences

    International Nuclear Information System (INIS)

    Jaeger, L.; Guenther, E.; Gauger, J.; Nitz, W.; Kastenbauer, E.; Reiser, M.

    1996-01-01

    Functional imaging of the pharynx used to be the domain of cineradiography, CT and ultrafast CT. The development of modern MRI techniques led to new access to functional disorders of the pharynx. The aim of this study was to implement a new MRI technique to examine oropharyngeal obstructive mechanisms in patients with obstructive sleep apnea (OSA). Sixteen patients suffering from OSA and 6 healthy volunteers were examined on a 1.5 T whole-body imager ('Vision', Siemens, Erlangen Medical Engineering, Germany) using a circular polarized head coil. Imaging was performed with 2D flash sequences in midsagittal and axial planes. Patients and volunteers were asked to breathe normally through the nose and to simulate snoring and the Mueller maneuver during magnetic resonance imaging (MRI). Prior to MRI, all patients underwent an ear, nose and throat (ENT) examination, functional fiberoptic nasopharyngoscopy and polysomnography. A temporal resolution of 6 images/s and an in-plane resolution of 2.67x1.8 mm were achieved. The mobility of the tongue, soft palate and pharyngeal surface could be clearly delineated. The MRI findings correlated well with the clinical examinations. We propose ultrafast MRI as a reliable and non-invasive method of evaluating pharyngeal obstruction and their levels. (orig.) [de

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

    Science.gov (United States)

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

    2005-01-01

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

  10. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing

    DEFF Research Database (Denmark)

    Jennum, P; Riha, R L

    2009-01-01

    Epidemiological studies have revealed a high prevalence of sleep-disordered breathing in the community (up to 20%). A subset of these patients has concurrent symptoms of excessive daytime sleepiness attributable to their nocturnal breathing disorder and is classified as having obstructive sleep a...

  11. Comparability of pulse oximeters used in sleep medicine for the screening of OSA

    International Nuclear Information System (INIS)

    Böhning, N; Schultheiß, B; Eilers, S; Schmittendorf, E; Penzel, T; Böhning, W

    2010-01-01

    Obstructive sleep apnea syndrome (OSA) is a frequent clinical picture. It is characterized by repetitive respiratory arrest with a consecutive decrease in arterial oxygen saturation (SaO 2 ). In clinical practice, the number of desaturations per hour, oxygen desaturation index (ODI), is used as an important diagnostic criterion. Medical literature, however, mentions different threshold values that are defined as pathological. By means of systematic comparative measurements, the study presented here will examine to what extent the diagnosis and the quantification of OSA severity are affected by the device-specific measurement technique, thus impacting the predictive value of nighttime pulse oximetry in outpatient OSA screening. Different pulse oximeters commonly used in clinical practice were analyzed comparatively regarding technical parameters, temporal dynamics and the reproducibility of measuring results. The measurements were executed simultaneously and time synchronized in a reference group of five test subjects (four males, one female, average age 33.0 ± 9.4 years), in a group of five patients (all males, average age 51.8 ± 18.4 years) and using a simulator (pulse oximeter simulator index 2). All devices underestimate the simulator's predetermined oxygen desaturation of 10%. The dispersion of values is high. The device-specific characteristics have a significant influence on the collected data. The fundamental weakness of the systems lies in the reproducibility of measuring results (this only seems adequate at a signal resolution in steps of 0.1%) as well as the differing temporal dynamics. In the synchronous use of different systems on patients for the purpose of a direct comparison of devices, the dispersion of values is serious, reaching a fluctuation range of up to factor 1.42. In measuring dynamic events (apneas), different pulse oximeters do not record identical values. This is due to the different internal signal processing of the devices

  12. Behavioural hyperventilation as a novel clinical condition associated with central sleep apnoea: a report of three cases.

    Science.gov (United States)

    Pevernagie, Dirk; Mariman, An; Vandenbussche, Nele; Tobback, Els; Overeem, Sebastiaan; Delesie, Liesbeth; Janssen, Hennie; Vogelaers, Dirk

    2012-12-01

    Central sleep apnoea (CSA) is a disorder characterised by repetitive episodes of decreased ventilation due to complete or partial reduction in the central neural outflow to the respiratory muscles. Hyperventilation plays a prime role in the pathogenesis of CSA. Chronic heart failure and dwelling at high altitude are classical conditions in which CSA is induced by hyperventilation. Hyperventilation syndrome (HVS) is a prevalent behavioural condition in which minute ventilation exceeds metabolic demands, resulting in haemodynamic and chemical changes that produce characteristic dysphoric symptoms. HVS is frequently caused by anxiety disorders and panic attacks. Until now, medical literature has focussed primarily on daytime symptoms of behavioural hyperventilation. It is currently unknown how this condition may affect sleep. Three cases are reported in which behavioural hyperventilation was associated with occurrence of significant central sleep apnoea, which was not present during normal tidal breathing in steady sleep. Therefore, behavioural hyperventilation should be added to the list of known clinical conditions associated with CSA. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Xavier Soler

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

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

    Science.gov (United States)

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

    2017-01-01

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

  15. The predictive value of drug-induced sleep endoscopy for CPAP titration in OSA patients.

    Science.gov (United States)

    Lan, Ming-Chin; Hsu, Yen-Bin; Lan, Ming-Ying; Huang, Yun-Chen; Kao, Ming-Chang; Huang, Tung-Tsun; Chiu, Tsan-Jen; Yang, Mei-Chen

    2017-12-15

    The aim of this study was to identify possible upper airway obstructions causing a higher continuous positive airway pressure (CPAP) titration level, utilizing drug-induced sleep endoscopy (DISE). A total of 76 patients with obstructive sleep apnea (OSA) underwent CPAP titration and DISE. DISE findings were recorded using the VOTE classification system. Polysomnographic (PSG) data, anthropometric variables, and patterns of airway collapse during DISE were analyzed with CPAP titration levels. A significant association was found between the CPAP titration level and BMI, oxygen desaturation index (ODI), apnea-hypopnea index (AHI), and neck circumference (NC) (P CPAP titration level (P CPAP titration level and any other collapse at the tongue base or epiglottis. By analyzing PSG data, anthropometric variables, and DISE results with CPAP titration levels, we can better understand possible mechanisms resulting in a higher CPAP titration level. We believe that the role of DISE can be expanded as a tool to identify the possible anatomical structures that may be corrected by oral appliance therapy or surgical intervention to improve CPAP compliance.

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

    Science.gov (United States)

    2008-01-01

    32–44. 66] A.K. Al-Shukaili, A.A. Al-Jabri, Rheumatoid arthritis , cytokines and hypoxia. What is the link? Saudi Med. J. 27 (2006) 1642–1649. 67...OSA. OSA appears to increase secretion of and/or lter responsiveness to the adipocyte hormone leptin and the rexigenic hormone ghrelin , and these...diabetes, dementia, arthritis , nd OSA itself [65–69]. Sequelae of obesity and OSA cross all organ systems. or example, chronic excessive

  17. Evaluation of the upper airway measurements by multi-slice CT before and after operations in obstructive sleep apnoea syndrome patients

    International Nuclear Information System (INIS)

    Tao Ping; Dang Yuqing; Chang Bei; Wang Xiao; Jin Zhengyu; Li Wuyi; Huo Hong

    2009-01-01

    Objective: To evaluate the changes of the upper airway of the patients with obstructive sleep apnoea syndrome (OSAS) before and after operations and to know the effects of operations by MSCT. Methods: The upper airway dimensions of 26 patients with OSAS were measured on multiplanar reformatted (MPR), curved-planar reformatted (CPR), volume rendering (VR) images of 16-slice spiral CT. The measurements include the anteroposterior calibres and the areas on the reformatted axial images on the pharyngeal cavity levels, the calibres and the minimum areas in retropalatal and retroglossal regions, the areas of the soft palate and uvula on the reformatted sagittal view with maximum thickness, the maximum wall thickness of the right and left the upper airway on the coronary images, the volume of the upper airway before and after the operations. The measurements were correlated with the polysomnography (PSG) records. The data were analyzed paired-samples t-test and Pearson correlations. Results: By comparison, the anteroposterior calibres and the cross-sectional areas on the reformatted axial view of the lower retropalatal region (slice 4) of the upper airway increased significantly after operations. The anteroposterior diameter increased from 5.9 mm before operations to 12.8 mm after operations, where t=-5.506, P 2 before operations to 275.0 mm 2 after operations, where t=-5.011, P 2 before operations to 128.0 mm 2 after operations, where t=3.087, P 2 before operation to 10.9 mm, 76.0 mm 2 after operation, where t=-3.413, -2.216, respectively and P 2 before operations to 76.0 mm 2 after operations, were t=-4.932, P<0.05. The anteroposterior calibres increased from 4.6 mm before operations to 6.6 mm after operations, where t=-7.308, P<0.05. The L-R calibres increased from 8.3 mm before operations to 13.6 mm after operations, where t=-4.320, P<0.05. Conclusions: MPR, CPR, VR of MSCT can evaluate the not only the morphology but the function changes of the upper airways on the

  18. Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA).

    Science.gov (United States)

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

    2014-05-15

    Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .

  19. Driving simulator and neuropsychological [corrected] testing in OSAS before and under CPAP therapy.

    Science.gov (United States)

    Orth, M; Duchna, H-W; Leidag, M; Widdig, W; Rasche, K; Bauer, T T; Walther, J W; de Zeeuw, J; Malin, J-P; Schultze-Werninghaus, G; Kotterba, S

    2005-11-01

    Patients with obstructive sleep apnoea syndrome (OSAS) have an increased car accident rate. Investigations on accident frequency are based on case history, insurance reports and driving simulator studies. The present study combines neuropsychological testing of different attention aspects engaged in driving a car and driving simulation to evaluate a suitable instrument for assessing therapeutic effects of continuous positive airway pressure (CPAP). Driving simulator investigation and neuropsychological testing of alertness, vigilance and divided attention were performed in 31 patients with polysomnographically confirmed OSAS (apnoea-hypopnoea index 24.8+/-21.5.h(-1)) before, and 2 and 42 days after initiation of CPAP. Divided attention and alertness improved significantly during CPAP, whereas vigilance remained unchanged. However, accident frequency (OSAS before therapy: 2.7+/-2.0; 2 days after CPAP: 1.5+/-1.4; 42 days after CPAP: 0.9+/-1.3) and frequency of concentration faults (OSAS before therapy: 12.4+/-5.1; 2 days after CPAP: 6.5+/-3.9; 42 days after CPAP: 4.9+/-3.3) decreased in the simulated driving situation after 2 and 42 days of therapy. There was no relation between accident frequency, concentration faults and daytime sleepiness, as measured by the Epworth Sleepiness Scale, and polysomnographic or neuropsychological findings, respectively. In conclusion, the present results suggest that driving simulation is a possible benchmark parameter of driving performance in obstructive sleep apnoea syndrome patients.

  20. Long-term screening for sleep apnoea in paced patients: preliminary assessment of a novel patient management flowchart by using automatic pacemaker indexes and sleep lab polygraphy.

    Science.gov (United States)

    Aimé, Ezio; Rovida, Marina; Contardi, Danilo; Ricci, Cristian; Gaeta, Maddalena; Innocenti, Ester; Cabral Tantchou-Tchoumi, Jacques

    2014-10-01

    The primary aim of this pilot study was to prospectively assess a flowchart to screen and diagnose paced patients (pts) affected by sleep apnoeas, by crosschecking indexes derived from pacemakers (minute ventilation sensor on-board) with Sleep-Lab Polygraphy (PG) outcomes. Secondarily, "smoothed" long-term pacemaker indexes (all the information between two consecutive follow-up visits) have been retrospectively compared vs. standard short-term pacemaker indexes (last 24h) at each follow-up (FU) visit, to test their correlation and diagnostic concordance. Data from long-term FU of 61 paced pts were collected. At each visit, the standard short-term apnoea+hypopnoea (PM_AHI) index was retrieved from the pacemaker memory. Patients showing PM_AHI ≥ 30 at least once during FU were proposed to undergo a PG for diagnostic confirmation. Smoothed pacemaker (PM_SAHI) indexes were calculated by averaging the overall number of apnoeas/hypopnoeas over the period between two FU visits, and retrospectively compared with standard PM_AHI. Data were available from 609 consecutive visits (overall 4.64 ± 1.78 years FU). PM_AHI indexes were positive during FU in 40/61 pts (65.6%); 26/40 pts (65%) accepted to undergo a PG recording; Sleep-Lab confirmed positivity in 22/26 pts (84.6% positive predictive value for PM_AHI). A strong correlation (r=0.73) and a high level of concordance were found between smoothed and standard indexes (multivariate analysis, Cohen's-k and Z-score tests). Pacemaker-derived indexes may help in screening paced pts potentially affected by sleep apnoeas. Long-term "smoothed" apnoea indexes could improve the accuracy of pacemaker screening capability, even though this hypothesis must be prospectively confirmed by larger studies. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  1. Comparison of manual versus automatic continuous positive airway pressure titration and the development of a predictive equation for therapeutic continuous positive airway pressure in Chinese patients with obstructive sleep apnoea.

    Science.gov (United States)

    Luo, Jiaying; Xiao, Sichang; Qiu, Zhihui; Song, Ning; Luo, Yuanming

    2013-04-01

    Whether the therapeutic nasal continuous positive airway pressure (CPAP) derived from manual titration is the same as derived from automatic titration is controversial. The purpose of this study was to compare the therapeutic pressure derived from manual titration with automatic titration. Fifty-one patients with obstructive sleep apnoea (OSA) (mean apnoea/hypopnoea index (AHI) = 50.6 ± 18.6 events/h) who were newly diagnosed after an overnight full polysomnography and who were willing to accept CPAP as a long-term treatment were recruited for the study. Manual titration during full polysomnography monitoring and unattended automatic titration with an automatic CPAP device (REMstar Auto) were performed. A separate cohort study of one hundred patients with OSA (AHI = 54.3 ± 18.9 events/h) was also performed by observing the efficacy of CPAP derived from manual titration. The treatment pressure derived from automatic titration (9.8 ± 2.2 cmH(2)O) was significantly higher than that derived from manual titration (7.3 ± 1.5 cmH(2)O; P titration (54.3 ± 18.9 events/h before treatment and 3.3 ± 1.7 events/h after treatment; P titration pressure derived from REMstar Auto is usually higher than the pressure derived from manual titration. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  2. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children

    NARCIS (Netherlands)

    Venekamp, Roderick P; Hearne, Benjamin J; Chandrasekharan, Deepak; Blackshaw, Helen; Lim, Jerome; Schilder, Anne G M

    2015-01-01

    BACKGROUND: Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children,

  3. Auto-titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute quadriplegia (COSAQ): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Berlowitz, David J; Ayas, Najib; Barnes, Maree; Brown, Douglas J; Cistulli, Peter A; Geraghty, Tim; Graham, Alison; Lee, Bonsan Bonne; Morris, Meg; O'Donoghue, Fergal; Rochford, Peter D; Ross, Jack; Singhal, Balraj; Spong, Jo; Wadsworth, Brooke; Pierce, Robert J

    2013-06-19

    Quadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute quadriplegia. Specialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial three-night trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009. The results of

  4. Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis.

    Science.gov (United States)

    Woehrle, Holger; Cowie, Martin R; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K; Somers, Virend K; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

    2017-08-01

    This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the control group in the SERVE-HF trial.Time-dependent on-treatment analyses were conducted (unadjusted and adjusted for predictive covariates). A comprehensive, time-dependent model was developed to correct for asymmetric selection effects (to minimise bias).The comprehensive model showed increased cardiovascular death hazard ratios during adaptive servo ventilation usage periods, slightly lower than those in the SERVE-HF intention-to-treat analysis. Self-selection bias was evident. Patients randomised to adaptive servo ventilation who crossed over to the control group were at higher risk of cardiovascular death than controls, while control patients with crossover to adaptive servo ventilation showed a trend towards lower risk of cardiovascular death than patients randomised to adaptive servo ventilation. Cardiovascular risk did not increase as nightly adaptive servo ventilation usage increased.On-treatment analysis showed similar results to the SERVE-HF intention-to-treat analysis, with an increased risk of cardiovascular death in heart failure with reduced ejection fraction patients with predominant central sleep apnoea treated with adaptive servo ventilation. Bias is inevitable and needs to be taken into account in any kind of on-treatment analysis in positive airway pressure studies. Copyright ©ERS 2017.

  5. Plasma natriuretic peptides in children and adolescents with obstructive sleep apnoea and their changes following intervention

    Directory of Open Access Journals (Sweden)

    Albert Martin Li

    2014-03-01

    Full Text Available Objective: This study aimed to evaluate circulating natriuretic peptides (NP concentration in obese and non-obese children and adolescents with and without OSA, and their levels following OSA treatment.Methods: Subjects with habitual snoring and symptoms suggestive of OSA were recruited. They underwent physical examination and overnight polysomnography (PSG. OSA was diagnosed if obstructive apnea hypopnea index (OAHI ≥1/h. Fasting serum atrial natriuretic peptide (ANP and brain natriuretic peptide (BNP were taken after overnight PSG. The subjects were divided into obese, non-obese, with and without OSA groups for comparisons.Results: 114 children (77 were boys with a median (IQR age of 10.8 (8.3-12.7 years (range: 2.4-11.8 years were recruited. Sixty-eight subjects were found to have OSA. Natriuretic peptide levels did not differ between subjects with and without OSA in both obese and non-obese groups. . Stepwise multiple linear regressions revealed that body mass index (BMI z-score was the only independent factor associated with NP concentrations. Fifteen children with moderate-to-severe OSA (OAHI >5/h underwent treatment and there were no significant changes in both ANP and BNP levels after intervention.Conclusion: BMI rather than OSA was the main determinant of natriuretic peptide levels in school-aged children and adolescents.

  6. The role of nocturnal oximetry in obstructive sleep apnoea-hypopnoea syndrome screening

    Directory of Open Access Journals (Sweden)

    Celestina Ventura

    2007-07-01

    Full Text Available Aim: The aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry (NO as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome (OSAHS, compared with polysomnography (PSG as the gold standard. Methodology: 63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease underwent PSG and NO. We then determined NO sensitivity, specificity, positive (PPV and negative predictive values (NPV. Results: OSAHS was diagnosed in 47 patients with a mean age of 54 years. In the evaluation of the percentage of Total Sleep Time (TST with oxygen desaturation below 90%, we found significant differences between patients with OSAHS (25.4 ± 29.7% and without OSAHS (1 ± 1.5%, p<0,001. We used two cutoff points to evaluate sensitivity, specificity, positive (PPV and negative predictive values (NPV, based on the severity of O2 desaturation (StO2<90%. Using the first cutoff point we diagnosed with NO as positive all the patients with TST desaturation values ≥1% of the TST. Under these circumstances we found a sensitivity of 76.6%, a specificity of 75%, a PPV of 90% and an NPV value of 52.2% for our screening test (NO. Using the second cutoff point, we diagnosed with NO as positive all the patients with TST desaturation values ≥5% of the TST. With this method we found a sensitivity of 65.9%, a specificity of 100%, a PPV of 100% and an NPV of 50%. Conclusion: NO is a useful screening test for the diagnosis of OSAHS in patients without respiratory disease. Resumo: Objectivo: Foi objectivo deste estudo determinar a sensibilidade e a especificidade da oximetria nocturna (ON como método de screening diagnóstico para a síndroma de apneia-hipopneia obstrutiva do sono (SAHOS, utilizando como método de referência a polissonografia (PSG. Metodologia: Foram incluídos 63 doentes com suspeita clínica de SAHOS e exclusão de doença respiratória, sendo

  7. Rhythm disturbances in childhood obstructive sleep apnea during apnea-hypopnea episodes

    International Nuclear Information System (INIS)

    Khositseth, Anant; Chokechuleekorn, Jittamas; Kuptanon, Teeradej; Leejakpai, Anchalee

    2013-01-01

    Obstructive sleep apnoea (OSA) can result in cardiovascular complications. Nocturnal arrhythmias are reported up to 50% of adult OSA patients. Arrhythmias and heart rate variability in children with OSA have not been well studied. We sought to study rhythm disturbances in childhood OSA and also to analyze the relationship of heart rate variability to the severity of OSA in children. In a retrospective cross sectional study, records of children aged < 15 years with history of snoring and suspected OSA, who had undergone polysomnography (PSG) for first time were analyzed. The cardiac rhythm and heart rate variability were studied during PSG. A total of 124 patients diagnosed with OSA were grouped into mild (n = 52), moderate (n = 30), and severe (n = 42) OSA. During PSG, all had sinus arrhythmias and only three patients had premature atrial contractions (PACs). The standard deviation of heart rate (SD-HR) during rapid eye movement (REM) sleep in severe OSA (9.1 ± 2.4) was significantly higher than SD-HR in mild OSA (7.5 ± 1.3, P < 0.0001). The maximum heart rate (max-HR) during REM-sleep in severe OSA (132.1 ± 22.1) was significantly higher than the max-HR in mild OSA (121.3 ± 12.6 bpm, P = 0.016). There was no significant arrhythmia in children with OSA during their sleep. Heart rate variability correlated with the severity of OSA

  8. Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly

    Czech Academy of Sciences Publication Activity Database

    Dostálová, S.; Šonka, K.; Šmahel, Zbyněk; Weiss, V.; Marek, J.; Hořínek, D.

    2001-01-01

    Roč. 144, - (2001), s. 491-497 ISSN 0804-4643 R&D Projects: GA MZd IZ3575 Institutional research plan: CEZ:AV0Z5039906 Keywords : apnoea syndrome Subject RIV: AC - Archeology, Anthropology, Ethnology Impact factor: 2.133, year: 2001

  9. Assessment of the Depression, Anxiety, and Stress Scale (DASS-21) in untreated obstructive sleep apnea (OSA)

    DEFF Research Database (Denmark)

    Nanthakumar, Shenooka; Bucks, Romola S.; Skinner, Timothy C.

    2017-01-01

    compared the fit of Lovibond and Lovibond's (1995) correlated 3-factor structure of the DASS-21 and measurement invariance between a non-OSA and an OSA sample using confirmatory factor analysis. As measurement invariance was not found, to determine the source of non-invariance differential item functioning...... (DIF) was examined using dMACS. The correlated 3-factor structure (with correlated errors) of the DASS-21 was a better fit in the non-OSA sample. dMACS indicated that there was a degree of DIF for each of the subscales, especially for the Anxiety subscale, in which 2 symptoms (that are also...

  10. A multicentre randomised controlled trial and economic evaluation of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome in older people: PREDICT.

    Science.gov (United States)

    McMillan, Alison; Bratton, Daniel J; Faria, Rita; Laskawiec-Szkonter, Magda; Griffin, Susan; Davies, Robert J; Nunn, Andrew J; Stradling, John R; Riha, Renata L; Morrell, Mary J

    2015-06-01

    The therapeutic and economic benefits of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnoea syndrome (OSAS) have been established in middle-aged people. In older people there is a lack of evidence. To determine the clinical efficacy of CPAP in older people with OSAS and to establish its cost-effectiveness. A randomised, parallel, investigator-blinded multicentre trial with within-trial and model-based cost-effectiveness analysis. Two hundred and seventy-eight patients, aged ≥ 65 years with newly diagnosed OSAS [defined as oxygen desaturation index at ≥ 4% desaturation threshold level for > 7.5 events/hour and Epworth Sleepiness Scale (ESS) score of ≥ 9] recruited from 14 hospital-based sleep services across the UK. CPAP with best supportive care (BSC) or BSC alone. Autotitrating CPAP was initiated using standard clinical practice. BSC was structured advice on minimising sleepiness. Subjective sleepiness at 3 months, as measured by the ESS (ESS mean score: months 3 and 4) and cost-effectiveness over 12 months, as measured in quality-adjusted life-years (QALYs) calculated using the European Quality of Life-5 Dimensions (EQ-5D) and health-care resource use, information on which was collected monthly from patient diaries. Subjective sleepiness at 12 months (ESS mean score: months 10, 11 and 12) and objective sleepiness, disease-specific and generic quality of life, mood, functionality, nocturia, mobility, accidents, cognitive function, cardiovascular risk factors and events at 3 and 12 months. Two hundred and seventy-eight patients were randomised to CPAP (n = 140) or BSC (n = 138) over 27 months and 231 (83%) patients completed the trial. Baseline ESS score was similar in both groups [mean (standard deviation; SD) CPAP 11.5 (3.3), BSC 11.4 (4.2)]; groups were well balanced for other characteristics. The mean (SD) in ESS score at 3 months was -3.8 (0.4) in the CPAP group and -1.6 (0.3) in the BSC group. The

  11. Influence of craniofacial and upper spine morphology on mandibular advancement device treatment outcome in patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Svanholt, Palle; Petri, Niels; Wildschiødtz, Gordon

    2015-01-01

    Summary BACKGROUND/OBJECTIVES: The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea...... patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test......, t-test, and multiple regression analysis. RESULTS: Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P

  12. Sleep Apnoea Detection in Single Channel ECGs by Analyzing Heart Rate Dynamics

    National Research Council Canada - National Science Library

    Zywietz, C

    2001-01-01

    .... Sleep disorders are typically investigated by means of polysomnographic recordings. We have analyzed 70 eight-hour single-channel ECG recordings to find out to which extent sleep apneas may be detected from the ECG alone...

  13. Study into the use of continuous positive airway pressure in obstructive sleep apnoea-hypopnoea syndrome patients with daytime drowsiness

    Directory of Open Access Journals (Sweden)

    Clélia Maria Ribeiro Franco

    2009-03-01

    Full Text Available Background: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. Aims: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. Method: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. Results: There was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017; patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162. 100% of CPAP users reported benefits and 50% of these reported related discomforts. Conclusions: Patients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it. Resumo: Introdução: A síndroma da apneia-hipopneia obstrutiva do sono (SAHOS é um distúrbio respiratório de elevada morbimortalidade. A terapia com pressão positiva contínua das vias aéreas (CPAP representa o tratamento conservador mais prescrito para a SAHOS e tem o intuito de restabelecer a patência das vias aéreas, normalizando o índice de eventos respiratórios obstrutivos, corrigindo os sintomas. Objectivo: Avaliar o impacto do uso do CPAP nasal sobre a hipersonia diurna em portadores de SAHOS. Método: Amostra de vinte doentes portadores de SAHOS diagnosticados por estudo de polissonografia de noite inteira, usuários ou não de CPAP nasal, todos avaliados quanto à hipersonia diurna através da escala de sonolência de Epworth. Resultados: O decréscimo do nível de sonolência diurna dos usuários de CPAP nasal foi significante (p=0,017, enquanto para não usuários de CPAP nasal a m

  14. Depression and obstructive sleep apnea.

    Science.gov (United States)

    Hobzova, Milada; Prasko, Jan; Vanek, Jakub; Ociskova, Marie; Genzor, Samuel; Holubova, Michaela; Grambal, Ales; Latalova, Klara

    2017-10-01

    Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses. The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life". After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms. It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.

  15. Dynamic cycling in atrial size and flow during obstructive apnoea.

    Science.gov (United States)

    Pressman, Gregg S; Cepeda-Valery, Beatriz; Codolosa, Nicolas; Orban, Marek; Samuel, Solomon P; Somers, Virend K

    2016-01-01

    Obstructive sleep apnoea (OSA) is strongly associated with cardiovascular disease. However, acute cardiovascular effects of repetitive airway obstruction are poorly understood. While past research used a sustained Mueller manoeuver to simulate OSA we employed a series of gasping efforts to better simulate true obstructive apnoeas. This report describes acute changes in cardiac anatomy and flow related to sudden changes in intrathoracic pressure. 26 healthy, normal weight participants performed 5-6 gasping efforts (target intrathoracic pressure -40 mm Hg) while undergoing Doppler echocardiography. 14 participants had sufficient echocardiographic images to allow comparison of atrial areas during the manoeuver with baseline measurements. Mitral and tricuspid E-wave and A-wave velocities postmanoeuver were compared with baseline in all participants. Average atrial areas changed little during the manoeuver, but variance in both atrial areas was significantly greater than baseline. Further, an inverse relationship was noted with left atrial collapse and right atrial enlargement at onset of inspiratory effort. Significant inverse changes were noted in Doppler flow when comparing the first beat postmanoeuver (pMM1) with baseline. Mitral E-wave velocity increased 9.1 cm/s while tricuspid E-wave velocity decreased 7.0 cm/s; by the eighth beat postmanoeuver (pMM8) values were not different from baseline. Mitral and tricuspid A-wave velocities were not different from baseline at pMM1, but both were significantly higher by pMM8. Repetitive obstructive apnoeas produce dynamic, inverse changes in atrial size and Doppler flow across the atrioventricular valves. These observations have important implications for understanding the pathophysiology of OSA.

  16. Transvenous stimulation of the phrenic nerve for the treatment of central sleep apnoea: 12 months' experience with the remedē® System.

    Science.gov (United States)

    Jagielski, Dariusz; Ponikowski, Piotr; Augostini, Ralph; Kolodziej, Adam; Khayat, Rami; Abraham, William T

    2016-11-01

    Patients with central sleep apnoea (CSA) often have poor quality of life and are at increased risk of morbidity and mortality. This study sought to evaluate the 12-month clinical outcomes of patients with CSA treated with unilateral transvenous phrenic nerve stimulation in the prospective, multicentre, non-randomized remedē ® System pilot study. Forty-seven patients with CSA were treated with the remedē ® System (Respicardia Inc., Minnetonka, MN, USA) for a minimum of 3 months. Sleep-disordered breathing parameters were evaluated by polysomnography (PSG) at 3, 6, and 12-month follow-up. Sleep symptoms and quality of life were also evaluated. Forty-one patients completed all follow-up PSGs and were included in the analysis. At 12 months, there was sustained improvement compared with baseline in the apnoea-hypopnoea index (49.9 ± 15.1 vs. 27.5 ± 18.3 events/h, P phrenic nerve stimulation is associated with sustained improvement in key sleep parameters, sleep symptoms, and quality of life over 12 months of follow-up. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  17. Síndroma de apneia obstrutiva do sono como causa de acidentes de viação Obstructive sleep apnoea syndrome as a cause of road traffic accidents

    Directory of Open Access Journals (Sweden)

    M Aguiar

    2009-05-01

    Full Text Available Vários estudos demonstram que os doentes com síndroma de apneia obstrutiva do sono (SAOS têm um risco aumentado de acidentes de viação. O objectivo do presente trabalho consistiu em analisar, nestes doentes, se há diferenças nos que referem acidentes e/ /ou quase acidentes e aqueles que o não fazem. Material e métodos: Estudaram-se prospectivamente 163 doentes com SAOS (índice apneia/hipopneia (IAH>10/h diagnosticados por polissonografia nocturna (PSG, todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II = 74 ou não (Grupo I = 89. Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC, escala de sonolência de Epworth (ESE, PaO2 e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito Functional Outcomes of Sleep Questionnaire (FOSQ teste e dados da polissonografia - tempo total de sono (TTS, eficiência do sono, estádios do sono, índice de microdespertares (IMD, índice de apneia/hipopneia (IAH, SaO2 mínima e média, % tempo SaO2Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. Methods: We studied 163 patients with OSAS (apnoea-hypopnoea index (AHI>10/h diagnosed using nocturnal polysomnography (NPSG, all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age

  18. Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Steinke, E; Palm Johansen, P; Fridlund, B

    2016-01-01

    -analysis. RESULTS: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 ... literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool...

  19. Translation of Berlin Questionnaire to Portuguese language and its application in OSA identification in a sleep disordered breathing clinic

    Directory of Open Access Journals (Sweden)

    A.P. Vaz

    2011-03-01

    Full Text Available Background: Berlin Questionnaire (BQ, an English language screening tool for obstructive sleep apnea (OSA in primary care, has been applied in tertiary settings, with variable results. Aims: Development of BQ Portuguese version and evaluation of its utility in a sleep disordered breathing clinic (SDBC. Material and methods: BQ was translated using back translation methodology and prospectively applied, previously to cardiorespiratory sleep study, to 95 consecutive subjects, referred to a SDBC, with OSA suspicion. OSA risk assessment was based on responses in 10 items, organized in 3 categories: snoring and witnessed apneas (category 1, daytime sleepiness (category 2, high blood pressure (HBP/obesity (category 3. Results: In the studied sample, 67.4% were males, with a mean age of 51 ± 13 years. Categories 1, 2 and 3 were positive in 91.6, 24.2 and 66.3%, respectively. BQ identified 68.4% of the patients as being in the high risk group for OSA and the remaining 31.6% in the low risk. BQ sensitivity and specificity were 72.1 and 50%, respectively, for an apnea-hipopnea index (AHI > 5, 82.6 and 44.8% for AHI > 15, 88.4 and 39.1% for AHI > 30. Being in the high risk group for OSA did not infl uence significantly the probability of having the disease (positive likelihood ratio [LR] between 1.44-1.49. Only the items related to snoring loudness, witnessed apneas and HBP/obesity presented a statistically positive association with AHI, with the model constituted by their association presenting a greater discrimination capability, especially for an AHI > 5 (sensitivity 65.2%, specificity 80%, positive LR 3.26. Conclusions: The BQ is not an appropriate screening tool for OSA in a SDBC, although snoring loudness, witnessed apneas, HBP/obesity have demonstrated being significant questionnaire elements in this population. Resumo: Introdução: O Questionário de Berlim (QB, originalmente desenvolvido em língua inglesa como um instrumento de

  20. Afternoon serum-melatonin in sleep disordered breathing.

    Science.gov (United States)

    Ulfberg, J; Micic, S; Strøm, J

    1998-08-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

  3. Recommendations for the management of patients with obstructive sleep apnoea and hypertension

    DEFF Research Database (Denmark)

    Parati, Gianfranco; Lombardi, Carolina; Hedner, Jan

    2013-01-01

    Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts...

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

    Science.gov (United States)

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

    2017-01-01

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

  5. Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea

    Energy Technology Data Exchange (ETDEWEB)

    Hou, T.-N., E-mail: dr-htn@hotmail.co [Department of Otolaryngology Head and Neck Surgery, Affiliated SIR RUN RUN SHAW Hospital, Zhejiang University, Hangzhou 310016 (China); Zhou, L.-N.; Hu, H.-J. [Department of Otolaryngology Head and Neck Surgery, Affiliated SIR RUN RUN SHAW Hospital, Zhejiang University, Hangzhou 310016 (China)

    2011-06-15

    Aim: To determine the relationship between the lingual artery and lingual markers for preoperative evaluation of the lingual artery in patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Methods: A 16-section computed tomographic angiography (CTA) of the lingual artery was performed in 87 inpatient cases with OSAHS, from December 2007 to May 2009. The course of the lingual artery and the anatomic relationship between the lingual artery and the lingual markers were analyzed using CTA imaging. Results: The course of the lingual artery with the tongue in a resting position was similar to that of the Big Dipper constellation (Plough) in the sagittal view of CTA imaging. The first segment of the lingual artery declined approximately 19.27 {+-} 5.24 mm, the middle segment of the lingual artery was forward approximately 19.30 {+-} 6.79 mm, and the ascending segment of the lingual artery rose approximately 52.49 {+-} 10.98 mm. The entry point where the lingual artery entered into the tongue was adjacent to the tip of the greater horn of the hyoid bone. The relationship between the second segment of the lingual artery and the greater horn of the hyoid bone was relatively steady with the tongue in whatever position. The interval between the bilateral greater horn of the hyoid bone equalled that between the bilateral lingual arteries. Conclusions: Recognizing some lingual markers in the patients with OSAHS, such as the greater horn of the hyoid bone, foramen cecum, circumvallate papilla, lingual vein and tongue midline, may facilitate the surgeon's ability to define the course of the lingual artery accurately in the treatment of OSAHS.

  6. CPAP increases bronchial reactivity in OSAS patients

    Directory of Open Access Journals (Sweden)

    P. Korczyski

    2008-06-01

    Full Text Available Continuous positive airways pressure (CPAP is a well known and safe method of treatment patients with obstructive sleep apnoea syndrome (OSAS. The effects of CPAP administration on the upper respiratory tract are known. However its effects on the lower respiratory tract still needs to be determined. Studies on bronchial hyperreactivity in patients treated by CPAP are contradictory. The aim of the study was to assess the influence of a 3-week CPAP treatment in patients with OSAS and to evaluate associations between changes in bronchial reactivity and clinical features of OSAS and lung function tests (LFT. Patients with newly diagnosed OSAS and lack of infection or chronic illness of the respiratory tract or other conditions which could influence bronchial hyperreactivity (BHR were included. Investigations were performed in 101 patients. There were 88 males and 13 females, mean age 51.5±11.2 years and BMI 32.6±5.4 kg·m–2. Qualified patients were randomly divided into 2 groups: 76 patients to CPAP treatment group, 25 control group. Both groups did not differ in anthropometrics features, severity of OSAS and LFT. Metacholine challenge test (MchCT was performed at baseline and repeated after 3 weeks. Analysis of the individual results showed that in 11 patients the MchCT was positive (6 in the CPAP and 5 in the control groups. After 3 weeks in the group of CPAP treated patients an increase of BHR was noted. Log PC20M decreased from 1.38±0.3 to 1.26±0.5 (p<0.05. The number of patients with a positive result in the MchCT increased from 6 to 16 patients. There was no significant change in BHR in the control group. It was found that CPAP treated patients with BHR were older, had less severe OSAS and lower FEV1 (p<0.05. In none of the patients positive result of BHR did no affect compliance to CPAP treatment. Conclusions: CPAP therapy increases bronchial reactivity, but does not affect compliance to treatment.

  7. Obstructive Sleep Apnea

    Medline Plus

    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 ...

  8. Economic implications of sleep disorders.

    Science.gov (United States)

    Skaer, Tracy L; Sclar, David A

    2010-01-01

    Sleep disorders such as insomnia, obstructive sleep apnoea (OSA), excessive daytime sleepiness (EDS) and fatigue, sleep deprivation and restless legs syndrome (RLS) are increasingly seen in clinical practice. Sleep is considered vital for preserving daytime cognitive function and physiological well-being. Sleep insufficiency may have deleterious effects on work-life balance, overall health and safety. The consequential economic burden at both the individual and societal levels is significant. Moreover, sleep disorders are commonly associated with other major medical problems such as chronic pain, cardiovascular disease, mental illness, dementias, gastrointestinal disorders and diabetes mellitus. Thus, in order to properly care for patients presenting with sleep-related morbidity, and to reduce the consequential economic burden, accurate screening efforts and efficacious/cost-effective treatments need to be developed and employed.

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

    Science.gov (United States)

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

    2014-03-01

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

  10. The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

    Science.gov (United States)

    Bosi, Marcello; De Vito, Andrea; Gobbi, Riccardo; Poletti, Venerino; Vicini, Claudio

    2017-03-01

    The objective of this study is to highlight the importance of anatomical and not-anatomical factors' identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.

  11. Changes of plasma IL-6 and TNF-α levels after CPAP treatment in patients with obstructive sleep apnea syndrome (OSAS)

    International Nuclear Information System (INIS)

    Cao Zhuo; Wang Liangxing

    2009-01-01

    Objective: To investigate the changes of plasma IL-6 and TNF-α levels after continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea syndrome (OSAS). Methods: Plasma IL-6 and TNF-α levels were measured with RIA in 60 patients with OSAS both before and after CPAS therapy as well as in 30 controls. Results: Before CPAP therapy, the plasma IL-6 and TNF-α levels in patients with OSAS were significantly higher than those in controls (25.92 ± 4.48pg/ ml and 11.27 ± 2.60pg/ml vs 13.21 ± 1.97pg/ml and 5.83±0.99pg/mi, P 2 level (r=-0.495, 0.483, P<0.05). After treatment with CPAP for three months, the plasma IL-6 and TNF-α levels were significantly decreased (15.37±1.78pg/ml and 6.79±0.87pg/ml, vs pre-treatment levels, P<0.05, P<0.01). Conclusion: CPAP therapy could effectively decrease the plasma IL-6 and TNF-α levels in patients with OSAS. (authors)

  12. Severe obstructive sleep disorders in Prader-Willi syndrome patients in southern Italy.

    Science.gov (United States)

    Canora, Angelo; Franzese, Adriana; Mozzillo, Enza; Fattorusso, Valentina; Bocchino, Marialuisa; Sanduzzi, Alessandro

    2018-01-09

    Sleep-related disordered breathing (SDB) is very common in paediatric patients affected by Prader-Willi Syndrome (PWS). However, data addressing SBD patterns and their management are lacking. The aim of the present study was to analyse SDB features in 14 PWS patients (age range, 8 months-17 years). Polygraphic registration (PG) during a 12-h nocturnal sleep was performed in all patients. Obstructive and central apnoea indices and oxygen saturation (SpO 2 ) were recorded along with demographic and clinical data. Obstructive sleep apnoea (OSA) was diagnosed in 13/14 patients (92.9%); the mean obstructive apnoea-hypopnea index (OAHI) was 7.6 ± 4.2 events/h with a mean central apnoea index (CAI) of 0.7 ± 1.04 events/h. Time spent with SpO 2 Prader-Willi syndrome. What is New: • Severe obstructive sleep apnoea is the most frequent sleep-related disorder in our case series.

  13. Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity.

    Science.gov (United States)

    Broström, Anders; Sunnergren, Ola; Nilsen, Per; Fridlund, Bengt; Ulander, Martin; Svanborg, Eva

    2013-04-01

    Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (pobesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

  14. Impact of sacubitril-valsartan combination in patients with chronic heart failure and sleep apnoea syndrome: the ENTRESTO-SAS study design.

    Science.gov (United States)

    Jaffuel, Dany; Molinari, Nicolas; Berdague, Philippe; Pathak, Atul; Galinier, Michel; Dupuis, Marion; Ricci, Jean-Etienne; Mallet, Jean-Pierre; Bourdin, Arnaud; Roubille, François

    2018-06-01

    Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

  15. Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS.

    Science.gov (United States)

    Broström, Anders; Strömberg, Anna; Mårtensson, Jan; Ulander, Martin; Harder, Lena; Svanborg, Eva

    2007-12-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires; the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment.

  16. Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study.

    Science.gov (United States)

    Emilsson, Össur I; Bengtsson, Anna; Franklin, Karl A; Torén, Kjell; Benediktsdóttir, Bryndís; Farkhooy, Amir; Weyler, Joost; Dom, Sandra; De Backer, Wilfried; Gislason, Thorarinn; Janson, Christer

    2013-06-01

    Nocturnal gastro-oesophageal reflux (nGOR) is associated with asthma and obstructive sleep apnoea (OSA). Our aim was to investigate whether nGOR is a risk factor for onset of asthma and onset of respiratory and OSA symptoms in a prospective population-based study. We invited 2640 subjects from Iceland, Sweden and Belgium for two evaluations over a 9-year interval. They participated in structured interviews, answered questionnaires, and underwent spirometries and methacholine challenge testing. nGOR was defined by reported symptoms. Subjects with persistent nGOR (n=123) had an independent increased risk of new asthma at follow-up (OR 2.3, 95% CI 1.1-4.9). Persistent nGOR was independently related to onset of respiratory symptoms (OR 3.0, 95% CI 1.6-5.6). The risk of developing symptoms of OSA was increased in subjects with new and persistent nGOR (OR 2.2, 95% CI 1.3-1.6, and OR 2.0, 95% CI 1.0-3.7, respectively). No significant association was found between nGOR and lung function or bronchial responsiveness. Persistent symptoms of nGOR contribute to the development of asthma and respiratory symptoms. New onset of OSA symptoms is higher among subjects with symptoms of nGOR. These findings provide evidence that nGOR may play a role in the genesis of respiratory symptoms and diseases.

  17. Physiological consequences of CPAP therapy withdrawal in patients with obstructive sleep apnoea—an opportunity for an efficient experimental model

    Science.gov (United States)

    Stradling, John R.; Kohler, Malcolm

    2018-01-01

    Randomised controlled trials (RCTs) of continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA) are time consuming, and their findings often inconclusive or limited due to suboptimal CPAP adherence in CPAP-naïve patients with OSA. Short-term CPAP withdrawal in patients with prior optimal CPAP adherence results in recurrence of OSA and its consequences. Thus, this experimental model serves as an efficient tool to investigate both the consequences of untreated OSA, and potential treatment alternatives to CPAP. The CPAP withdrawal protocol has been thoroughly validated, and applied in several RCTs focusing on cardiovascular and metabolic consequences of untreated OSA, as well as the assessment of treatment alternatives to CPAP. PMID:29445525

  18. Diagnostic approaches to respiratory sleep disorders

    OpenAIRE

    Riha, Renata L.

    2015-01-01

    Sleep disordered breathing (SDB) comprises a number of breathing disturbances occurring during sleep including snoring, the obstructive sleep apnoea/hypopnea syndrome (OSAHS), central sleep apnoea (CSA) and hypoventilation syndromes. This review focuses on sleep disordered breathing and diagnostic approaches in adults, in particular clinical assessment and overnight assessment during sleep. Although diagnostic approaches to respiratory sleep disorders are reasonably straightforward, they do r...

  19. [The NHG guideline 'Sleep problems and sleeping pills'].

    Science.gov (United States)

    Damen-van Beek, Zamire; Lucassen, Peter L B J; Gorgels, Wim; Smelt, Antonette F H; Knuistingh Neven, Arie; Bouma, Margriet

    2015-01-01

    The Dutch College of General Practitioners' (NHG) guideline 'Sleep problems and sleeping pills' provides recommendations for the diagnosis and treatment of the most prevalent sleep problems and for the management of chronic users of sleeping pills. The preferred approach for sleeplessness is not to prescribe medication but to give information and behavioural advice. Practice assistants of the Dutch Association of Mental Health and Addiction Care are also expected to be able to undertake this management. The GP may consider prescribing sleeping pills for a short period only in cases of severe insomnia with considerable distress. Chronic users of sleeping pills should be advised by the GP to stop using them or to reduce the dose gradually (controlled dose reduction). The GP may refer patients with suspected obstructive sleep apnoea (OSA) to a pulmonary or ear, nose and throat specialist or neurologist for further diagnosis depending on the regional arrangements. The GP may then consider the cardiovascular risk factors commonly present with OSA. In patients with restless legs syndrome (RLS) who continue to experience major distress despite being given advice without the prescription of medication, the GP may consider prescribing a dopamine agonist.

  20. Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy

    Directory of Open Access Journals (Sweden)

    Catherine A.P. Crofts

    2018-03-01

    Full Text Available Background: The global pandemic of metabolic disease is worsening. The metabolic theory of obesity proposes that hormonal changes, especially hyperinsulinaemia, precede metabolic disease development. Although quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia.   Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP, a novel non-pharmacological OSA treatment strategy.   Methods: A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3 comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP in OSA patients.   Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease.   Conclusion: Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease. Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.

  1. A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications.

    Science.gov (United States)

    Collu, Maria Antonietta; Esteller, Eduard; Lipari, Fiorella; Haspert, Raul; Mulas, Demetrio; Diaz, Miguel Angel; Dwivedi, Raghav C

    2018-05-01

    To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. A case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan. Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. 150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population. Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6-26.4). DISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent

  2. Frequency of obstructive sleep apnea (OSA in patients with gastroesophageal reflux disease (GERD and the effect of nasal continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Amany Shaker

    2016-10-01

    Conclusion: (1 A high risk for OSA development is more frequent in GERD patients especially NERD ones and who experience nighttime symptoms, (2 there is a mutual relationship between OSA and GERD reinforcing each other, and (3 CPAP therapy has a good role in the treatment of both OSA and GERD symptoms.

  3. Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night

    Directory of Open Access Journals (Sweden)

    Sophia Schiza

    2015-06-01

    Full Text Available The prevalence of obstructive sleep apnoea (OSA is continuously increasing in patients with idiopathic pulmonary fibrosis (IPF and, for the first time, the recent IPF guidelines recognise OSA as an important associated comorbidity that can affect patient's survival. Thus, it becomes conceivable that clinicians should refer patients with newly diagnosed IPF to sleep centres for the diagnosis and treatment of OSA as well as for addressing issues regarding the reduced compliance of patients with continuous positive airway pressure therapy. The discovery of biomarkers common to both disorders may help early diagnosis, institution of the most appropriate treatment and follow-up of patients. Better understanding of epigenetic changes may provide useful information about pathogenesis and, possibly, development of new drugs for a dismal disease like IPF.

  4. Adaptive servo-ventilation for central sleep apnoea in systolic heart failure: results of the major substudy of SERVE-HF.

    Science.gov (United States)

    Cowie, Martin R; Woehrle, Holger; Wegscheider, Karl; Vettorazzi, Eik; Lezius, Susanne; Koenig, Wolfgang; Weidemann, Frank; Smith, Gillian; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K; Somers, Virend K; Zannad, Faiez; Teschler, Helmut

    2018-03-01

    The SERVE-HF trial investigated the impact of treating central sleep apnoea (CSA) with adaptive servo-ventilation (ASV) in patients with systolic heart failure. A preplanned substudy was conducted to provide insight into mechanistic changes underlying the observed effects of ASV, including assessment of changes in left ventricular function, ventricular remodelling, and cardiac, renal and inflammatory biomarkers. In a subset of the 1325 randomised patients, echocardiography, cardiac magnetic resonance imaging (cMRI) and biomarker analysis were performed at baseline, and 3 and 12 months. In secondary analyses, data for patients with baseline and 12-month values were evaluated; 312 patients participated in the substudy. The primary endpoint, change in echocardiographically determined left ventricular ejection fraction from baseline to 12 months, did not differ significantly between the ASV and the control groups. There were also no significant between-group differences for changes in left ventricular dimensions, wall thickness, diastolic function or right ventricular dimensions and ejection fraction (echocardiography), and on cMRI (in small patient numbers). Plasma N-terminal pro B-type natriuretic peptide concentration decreased in both groups, and values were similar at 12 months. There were no significant between-group differences in changes in cardiac, renal and systemic inflammation biomarkers. In patients with systolic heart failure and CSA, addition of ASV to guideline-based medical management had no statistically significant effect on cardiac structure and function, or on cardiac biomarkers, renal function and systemic inflammation over 12 months. The increased cardiovascular mortality reported in SERVE-HF may not be related to adverse remodelling or worsening heart failure. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

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

    Science.gov (United States)

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

    2017-01-01

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

  6. Role of spousal involvement in continuous positive airway pressure (CPAP adherence in patients with obstructive sleep apnea (OSA

    Directory of Open Access Journals (Sweden)

    Batool-Anwar S

    2017-05-01

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

  7. Hippocampal hypertrophy and sleep apnea: a role for the ischemic preconditioning?

    Directory of Open Access Journals (Sweden)

    Ivana Rosenzweig

    Full Text Available The full impact of multisystem disease such as obstructive sleep apnoea (OSA on regions of the central nervous system is debated, as the subsequent neurocognitive sequelae are unclear. Several preclinical studies suggest that its purported major culprits, intermittent hypoxia and sleep fragmentation, can differentially affect adult hippocampal neurogenesis. Although the prospective biphasic nature of chronic intermittent hypoxia in animal models of OSA has been acknowledged, so far the evidence for increased 'compensatory' neurogenesis in humans is uncertain. In a cross-sectional study of 32 patients with mixed severity OSA and 32 non-apnoeic matched controls inferential analysis showed bilateral enlargement of hippocampi in the OSA group. Conversely, a trend for smaller thalami in the OSA group was noted. Furthermore, aberrant connectivity between the hippocampus and the cerebellum in the OSA group was also suggested by the correlation analysis. The role for the ischemia/hypoxia preconditioning in the neuropathology of OSA is herein indicated, with possible further reaching clinical implications.

  8. [Obstructive sleep apnea syndrome. Analytical study of 63 cases].

    Science.gov (United States)

    Battikh, Mohamed H; Joobeur, Sameh; Ben Sayeh, Mohamed M; Rouetbi, Naceur; Maatallah, Anis; Daami, Monia; el Kamel, Ali

    2004-02-01

    Obstructive sleep apnoea (OSA) is a relatively common disorder, in developed country with prevalence estimated to lie between 2 and 4% in adult population. The diagnosis of this syndrome is made on the basis of characteristic clinical features and the results of nocturnal polysomnography. There is no data concerning the OSA in developing country. It is therefore of interest to determine the clinic and polysomnographic profile of this disease and to landmark factors correlated with severity in our country. This was achieved by studying a set of 63 OSA. The mean of age was 53 + 13 years with sex ratio 1. The means of Epworth sleepiness scale score, BMI and Apnoea/Hypopnoea index (AHI) were respectively 16 + 4, 38.8 + 7 kg/m2 and 51.7 + 28.6. 44% of patients have OSA severe with IAH > 50/h. Arousal index and desaturation index were respectively 36.4 + 21.7 and 49 + 26. Trial of continuous positive airway pressure (CPAP) therapy was proposed first to 40 patients, 17 were able to use CPAP.

  9. 5-years APAP adherence in OSA patients--do first impressions matter?

    Science.gov (United States)

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

    2013-12-01

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

  10. Sleep quality in children: questionnaires available in Brazil

    Directory of Open Access Journals (Sweden)

    Maria Gabriela Cavalheiro

    Full Text Available Introduction: The purpose of this paper was to evaluate and compare the questionnaires regarding sleep quality among children aged up to 12 years old, used in the Portuguese language in Brazil. Material and methods: A search at the literature databases of Lilacs, Scielo and Pubmed was performed using keywords “sleep quality” and “children”. Selected Articles were analysed for age of the studied population, the number of questions and the issues addressed thereby, who realized the application, the analysis of the results, and content. Results: Out of 9377 titles, 11 studies were included, performing 7 different questionnaires: Questionnaire to measure quality of life among children with enlarged palatine and pharyngeal tonsils (translation of OSD-6 (1; Inventory of Sleep Habits for Preschool Children (2; the Questionnaire on Obstructive Sleep Apnoea-18 (OSA-18 (3, Sleep Questionnaire by Reimão and Lefévre - QRL (4; the Questionnaire on Sleep Behaviour Patterns (5 and the translation of the Sleep Disturbance Scale for Children (6; Brief Infant Sleep Questionnaire - BISQ (7 . Six of the questionnaires have covered the following issues: snoring and daytime sleepiness. Conclusions: A total of 7 protocols were found to be available in Brazil, the most commonly mentioned being OSA-18 and OSD-6. The use of protocols as a guided interview helps to define diagnosis and treatment among the paediatric population, but its large variability makes it difficult to compare a standardised monitoring process.

  11. Sleep disorders in Charcot-Marie-Tooth disease type 1.

    Science.gov (United States)

    Boentert, Matthias; Knop, Katharina; Schuhmacher, Christine; Gess, Burkhard; Okegwo, Angelika; Young, Peter

    2014-03-01

    Obstructive sleep apnoea (OSA) and restless legs syndrome (RLS) have been reported in Charcot-Marie-Tooth disease (CMT) type 1A and axonal subtypes of CMT, respectively. The aim of this case-control study was to investigate both prevalence and severity of OSA, RLS and periodic limb movements in sleep (PLMS) in adult patients with genetically proven CMT1. 61 patients with CMT1 and 61 insomnic control subjects were matched for age, sex, and Body Mass Index. Neurological disability in patients with CMT was assessed using the Functional Disability Scale (FDS). RLS diagnosis was based on a screening questionnaire and structured clinical interviews. All participants underwent overnight polysomnography. OSA was present in 37.7% of patients with CMT1 and 4.9% of controls (psleep quality. In addition to known risk factors, CMT may predispose to OSA. RLS is highly prevalent not only in axonal subtypes of CMT but also in primarily demyelinating subforms of CMT. PLMS are common in CMT1, but do not significantly impair sleep quality.

  12. The importance of neck circumference to thyromental distance ratio (NC/TM as a predictor of difficult intubation in obstructive sleep apnea (OSA patients

    Directory of Open Access Journals (Sweden)

    Hala Ezzat Abdel Naim

    2014-07-01

    Conclusion: Difficult intubation in OSA obese patients was independently associated with a Mallampati score of III or IV, and NC/TM ⩾5.15. Moreover, NC/TM yielded a high sensitivity, specificity and a negative predictive value.

  13. Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure.

    Science.gov (United States)

    Cowie, Martin R; Woehrle, Holger; Wegscheider, Karl; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita; Somers, Virend K; Zannad, Faiez; Teschler, Helmut

    2013-08-01

    Central sleep apnoea/Cheyne-Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF. SERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave, AutoSet CS; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients. The SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR. ISRCTN19572887.

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

    Science.gov (United States)

    Toth, Marton; Faludi, Bela; Kondakor, Istvan

    2012-10-01

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

  15. Obstructive sleep apnoea and obesity

    African Journals Online (AJOL)

    aDepartment of Internal Medicine, Steve Biko Academic Hospital, Faculty of Health Sciences .... a significant number have an alternative predisposing factor, such ... to atherosclerosis, ischaemic heart disease, strokes, and peripheral vascular disease. ... tumour necrosis factor-alpha (TNF-a) and interleukin-1 (IL-1), the so.

  16. Endocrine and Metabolic Aspects of OSA

    Directory of Open Access Journals (Sweden)

    Ravinder Goswami

    2014-03-01

    Full Text Available Obstructive sleep apnea (OSA is characterized by repeated spells of apnea.Collapsibility of hypopharynx due to multiple factors involving pharyngeal dilatormuscles and deposition of fat or fluid in the surrounding soft tissues are importantcontributing factors in its pathogenesis. OSA commonly affects obese individuals.Males are more commonly affected than the females probably due to the disturbingeffect of testosterone on sleep.The impact of OSA on human health include disturbances in endocrine and metabolicsystem affecting hypothalamic-pituitary-gonadal axis, adrenocorticotrophic-cortisolaxis, growth hormone, antidiuretic hormones and insulin resistance. There is atendency for predisposition of the metabolic syndrome or its components includingglycemic dysregulation, hypertension, hyperlipidemia and physical parameters relatedto adiposity. On the other hand, several endocrine disorders such as hypothyroidism,growth hormone excess, polycystic ovarian disease and testosterone replacement areassociated with increased prevalence of OSA.There is limited information on the effect of treatment of OSA by continuous positiveairway pressure (CPAP on the endocrine and metabolic disturbances. There is a needto conduct randomized controlled trials using CPAP therapy in patients with OSA andto study its cause and effect relationship with endocrine and metabolic disturbances.

  17. Cervical vertebral column morphology in patients with obstructive sleep apnoea assessed using lateral cephalograms and cone beam CT. A comparative study

    DEFF Research Database (Denmark)

    Sonnesen, L; Jensen, K E; Petersson, A R

    2013-01-01

    beam CT (CBCT) in adult patients with OSA and to compare 2D lateral cephalograms with three-dimensional (3D) CBCT images. METHODS: For all 57 OSA patients, the cervical vertebral column morphology was evaluated on lateral cephalograms and CBCT images and compared according to fusion anomalies...... and posterior arch deficiency. RESULTS: The CBCT assessment showed that 21.1% had fusion anomalies of the cervical column, i.e. fusion between two cervical vertebrae (10.5%), block fusions (8.8%) or occipitalization (1.8%). Posterior arch deficiency occurred in 14% as partial cleft of C1 and in 3...

  18. Health, social and economical consequences of sleep-disordered breathing

    DEFF Research Database (Denmark)

    Jennum, Poul; Kjellberg, Jakob

    2011-01-01

    The objective direct and indirect costs of sleep-disordered breathing (snoring, sleep apnoea (SA) and obesity hypoventilation syndrome (OHS)) and the treatment are incompletely described.......The objective direct and indirect costs of sleep-disordered breathing (snoring, sleep apnoea (SA) and obesity hypoventilation syndrome (OHS)) and the treatment are incompletely described....

  19. The importance of neck circumference to thyromental distance ratio (NC/TM) as a predictor of difficult intubation in obstructive sleep apnea (OSA) patients

    OpenAIRE

    Hala Ezzat Abdel Naim; Sabah Abdel Raouf Mohamed; Sherif Mohamed Soaida; Haitham Hassan Awad Eltrabily

    2014-01-01

    Background: The trial to find a bedside examination that is helpful for foreseeing difficult intubation is quite inspiring. It was reported that thyromental distance (TM), body mass index (BMI), neck circumference (NC) and a Mallampati score >3 were the only helpful bedside test predictors. By using magnetic resonance imaging, it was established that more fat was present in areas around the collapsible parts of the pharynx in OSA patients. So distribution of fat may provide a better suggestio...

  20. The effect of CPAP treatment on EEG of OSAS patients.

    Science.gov (United States)

    Zhang, Cheng; Lv, Jun; Zhou, Junhong; Su, Li; Feng, Liping; Ma, Jing; Wang, Guangfa; Zhang, Jue

    2015-12-01

    Continuous positive airway pressure (CPAP) is currently the most effective treatment method for obstructive sleep apnea syndrome (OSAS). The purpose of this study was to compare the sleep electroencephalogram (EEG) changes before and after the application of CPAP to OSAS patients. A retrospective study was conducted and 45 sequential patients who received both polysomnography (PSG) and CPAP titration were included. The raw data of sleep EEG were extracted and analyzed by engineers using two main factors: fractal dimension (FD) and the zero-crossing rate of detrended FD (zDFD). FD was an effective indicator reflecting the EEG complexity and zDFD was useful to reflect the variability of the EEG complexity. The FD and zDFD indexes of sleep EEG of 45 OSAS patients before and after CPAP titration were analyzed. The age of 45 OSAS patients was 52.7 ± 5.6 years old and the patients include 12 females and 33 males. After CPAP treatment, FD of EEG in non-rapid eye movement (NREM) sleep decreased significantly (P CPAP therapy (P CPAP therapy had a significant influence on sleep EEG in patients with OSAHS, which lead to a more stable EEG pattern. This may be one of the mechanisms that CPAP could improve sleep quality and brain function of OSAS patients.

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

    Science.gov (United States)

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

    2016-11-01

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

  2. Obstructive Sleep Apnea

    Medline Plus

    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 ...

  3. Sleep disordered breathing and autonomic function in overweight and obese children and adolescents

    Directory of Open Access Journals (Sweden)

    Annelies Van Eyck

    2016-12-01

    Full Text Available Obstructive sleep apnoea (OSA, common in children with obesity, is associated with cardiovascular morbidity. Autonomic dysfunction has been suggested to be a key player in the development of these complications. We investigated the relationship between obesity, OSA and sympathetic activity in children. 191 children with obesity were included and distributed into two groups: 131 controls and 60 with OSA. Beat-to-beat RR interval data were extracted from polysomnography for heart rate variability analysis. Urinary free cortisol levels were determined. Urinary free cortisol did not differ between groups and was not associated with OSA, independent of the level of obesity. Differences in heart rate variability measures were found: mean RR interval decreased with OSA, while low/high-frequency band ratio and mean heart rate increased with OSA. Heart rate variability measures correlated with OSA, independent of obesity parameters and age: oxygen desaturation index correlated with mean heart rate (r=0.19, p=0.009 and mean RR interval (r= −0.18, p=0.02, while high-frequency bands and low/high-frequency band ratio correlated with arterial oxygen saturation measured by pulse oximetry (SpO2 (r= −0.20, p=0.008 and r= −0.16, p=0.04 and SpO2 nadir (r=0.23, p=0.003 and r= −0.19, p=0.02. These results suggest that sympathetic heart activity is increased in children with obesity and OSA. Measures of hypoxia were related to increased sympathetic tone, suggesting that intermittent hypoxia is involved in autonomic dysfunction.

  4. How do we recognize the child with OSAS?

    Science.gov (United States)

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

    2017-02-01

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

  5. A prospective observational study to evaluate the effect of social and personality factors on continuous positive airway pressure (CPAP) compliance in obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Gulati, Atul; Ali, Masood; Davies, Mike; Quinnell, Tim; Smith, Ian

    2017-03-22

    Compliance with CPAP treatment for OSAS is not reliably predicted by the severity of symptoms or physiological variables. We examined a range of factors which could be measured before CPAP initiation to look for predictors of compliance. This was a prospective cohort-study of CPAP treatment for OSAS, recording; socio-economic status, education, type D personality and clinician's prediction of compliance. We recruited 265 subjects, of whom 221 were still using CPAP at 6 months; median age 53 years, M: F, 3.4:1, ESS 15 and pre-treatment ODI 21/h. Median compliance at 6 months was 5.6 (3.4- 7.1) hours/night with 73.3% of subjects using CPAP ≥4 h/night. No association was found between compliance and different socio-economic classes for people in work, type D personality, education level, sex, age, baseline ESS or ODI. The clinician's initial impression could separate groups of good and poor compliers but had little predictive value for individual patients. Compared to subjects who were working, those who were long term unemployed had a lower CPAP usage and were more likely to use CPAP < 4 h a night (OR 4.6; p value 0.011). A high Beck Depression Index and self-reported anxiety also predicted poor compliance. In our practice there is no significant association between CPAP compliance with socio-economic status, education or personality type. Long term unemployed or depressed individuals may need more intensive support to gain the optimal benefit from CPAP.

  6. Ocorrência da síndrome da apneia obstrutiva do sono (SAOS em crianças respiradoras orais Obstructive sleep apnea syndrome (OSAS in mouth breathing children

    Directory of Open Access Journals (Sweden)

    Suemy Cioffi Izu

    2010-10-01

    Full Text Available É bem estabelecido que a respiração oral em crianças está relacionada à hipertrofia adenoamigdaliana, que é a principal causa de apneia do sono nesta população. Apesar da importância deste tema, há poucos estudos que comprovam a relação entre SAOS e respiração oral. OBJETIVO: Determinar a prevalência de distúrbios respiratórios do sono em crianças respiradoras orais e sua correlação com achados otorrinolaringológicos. MATERIAL E MÉTODO: Foram avaliados retrospectivamente 248 prontuários de crianças respiradoras orais do serviço de Otorrinolaringologia Pediátrica de uma grande instituição entre 2000 e 2006, analisando os achados otorrinolaringológicos, polissonografia, nasofibroscopia e/ou radiografia em perfil do Cavum. O principal dado polissonográfico utilizado foi o índice de apneia (IA. Classificou-se como ronco primário aqueles com IA1. Desenho Científico: Coorte retrospectivo. RESULTADOS: Dos 248 pacientes incluídos, 144 (58% apresentavam ronco primário e 104 (42% apresentavam SAOS. Os achados otorrinolaringológicos mais frequentes foram Hipertrofia adenoamigdaliana (n=152; 61,2%, Hipertrofia de tonsila palatina (n=17; 6,8% Hipertrofia da tonsila faríngea (n=37; 14,9%, Rinite Alérgica (n=155; 62,5% e Otite Secretora (36; 14,5%. CONCLUSÕES: Ronco Primário e SAOS são frequentes em crianças respiradoras orais. A afecção otorrinolaringológica mais encontrada em crianças com SAOS é a hipertrofia adenoamigdaliana acompanhada ou não de rinite alérgica.It is well known that mouth breathing is associated with adenotonsillar hypertrophy - which is the main cause of obstructive sleep apnea among children. Despite the importance of this matter, there are only a handful of studies showing the relationship between OSAS and mouth breathing. AIM: to determine the prevalence of obstructive sleep disorders in mouth breathing children and study its correlation with otorhinolaryngological findings. STUDY

  7. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure.

    Science.gov (United States)

    Sharples, Linda; Glover, Matthew; Clutterbuck-James, Abigail; Bennett, Maxine; Jordan, Jake; Chadwick, Rebecca; Pittman, Marcus; East, Clare; Cameron, Malcolm; Davies, Mike; Oscroft, Nick; Smith, Ian; Morrell, Mary; Fox-Rushby, Julia; Quinnell, Timothy

    2014-01-01

    BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1

  8. Initiation of CPAP therapy for OSA: does prophylactic humidification during CPAP pressure titration improve initial patient acceptance and comfort?

    Science.gov (United States)

    Wiest, G H; Harsch, I A; Fuchs, F S; Kitzbichler, S; Bogner, K; Brueckl, W M; Hahn, E G; Ficker, J H

    2002-01-01

    Heated humidifiers (HH) enable effective treatment of upper airway dryness during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA), but the role of prophylactic use of HH during the initiation of nCPAP treatment has not been studied so far. The aim of the present study was to investigate whether prophylactic HH during the initiation of CPAP would result in improved initial patient comfort and acceptance. In 44 consecutive, previously untreated OSA patients with no history of upper airway dryness, CPAP titration with and without HH was performed on two consecutive nights in a randomised order. The patients were interviewed after each treatment night in order to establish the comfort of the treatment, and, after the second treatment, they were asked which of the two nights they considered more pleasant, and which treatment they would prefer for long-term use. Following CPAP titration with HH, 32 patients (73%) claimed to have had a better night's sleep than usual (i.e. without CPAP treatment) compared with 33 patients (75%) saying the same following CPAP treatment without HH. For 21 patients (47.7%) treatment with HH was more pleasant, 23 (52.3%) saw no difference or said that treatment without HH was more pleasant. Nineteen patients (43.2%) gave preference to treatment with HH for long-term use, while 25 patients (56.8%) had no preference or said they would prefer treatment without HH. The use of HH during the initiation phase of CPAP treatment was associated neither with an initial improvement in comfort nor with greater initial treatment acceptance. Copyright 2002 S. Karger AG, Basel

  9. Brain metabolic impairment of OSAS: evidence from MRS

    International Nuclear Information System (INIS)

    Shen Jie; Long Miaomiao; Shen Wen; Qi Ji

    2011-01-01

    Objective: To evaluate the impact of obstructive sleep apnea syndrome (OSAS) on human cerebral metabolism by using magnetic resonance spectroscopy (MRS). Materials and methods: Twenty-one severe OSAS patients, 14 mild-moderate OSAS patients, and 15 healthy control subjects were included. All subjects underwent MRS using the point-resolved echo spin spectroscopy (PRESS). Proton volumes of interest were placed in the bilateral frontal lobes and left temporal -parietal-occipital cortex, and left hippocampus. Results: 1. Compared to the controls, the NAA/Cr ratio was significantly decreased in the left frontal lobe in the severe OSAS group (P=0.004), and in the right frontal lobe in the severe (P=0.002) and mild-moderate (P=0.007) OSAS patients. The NAA/Cr ratio trended to be decreased in the left hippocampus in the OSAS patients compared to controls. 2. A significant increase in the ml/Cr ratio was detected in the right frontal regions in the severe (P=0.008) and mild-moderate (P<0.001) OSAS groups. 3. Clx/Cr ratio values were significantly smaller than controls in the left (P=0.006) and right (P=0.027) frontal regions. Conclusion: Bilateral frontal lobes are the vulnerable location in patients with OSAS. MRS can be used to screen the brain metabolic impairment. (authors)

  10. Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial - protocol for an observational cohort study.

    Science.gov (United States)

    Szymański, Filip M; Gałązka, Zbigniew; Płatek, Anna E; Górko, Dariusz; Ostrowski, Tomasz; Adamkiewicz, Karolina; Łęgosz, Paweł; Ryś, Anna; Semczuk-Kaczmarek, Karolina; Celejewski, Krzysztof; Filipiak, Krzysztof J

    2017-01-01

    Peripheral arterial disease (PAD) is in fact a group of disease entities with different symptoms and course but a common underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be aggravated by several cardiovascular risk factors, including obstructive sleep apnoea (OSA). Following paper is a protocol for the Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial, which aims to describe the prevalence of OSA in PAD patients scheduled for revascularisation, and to determine the effect of OSA on the procedure outcomes. The PARADISE study is an observational cohort trial. It plans to include 200 consecutive patients hospitalised for revascularisation due to PAD. In every patient an overnight sleep study will be performed to diagnose sleep disorders. Accord¬ing to the results of the test, patients will be divided into two groups: group A - patients with OSA, and group B - patients without OSA (control group). All patients will also be screened for classical and non-classical cardiovascular risk factors. In some of the patients, during surgery, a fragment of atherosclerotic plaque will be collected for further testing. Patients will be followed for one year for adverse events and end-points. Primary end-point of the study will be the failure of revascularisa¬tion defined as recurrence or new onset of the symptoms of ischaemia from the treated region, a need for re-operation or procedure revision, or recurrence of ischaemia signs on the imaging tests. The data obtained will help determine the incidence of OSA in the population of patients with PAD. The au¬thors expect to show that, as with other cardiovascular diseases associated with atherosclerosis, also in patients with PAD the incidence of undiagnosed OSA is high and its presence is associated with elevated cholesterol, inflammatory markers, and higher prevalence of arterial hypertension and poor control of other cardiovascular risk factors. In addition, due to

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

    Science.gov (United States)

    Turnbull, Christopher D; Bratton, Daniel J; Craig, Sonya E; Kohler, Malcolm; Stradling, John R

    2016-02-01

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

  12. Autonomic and metabolic effects of OSA in childhood obesity.

    Science.gov (United States)

    Oliveira, F M; Tran, W H; Lesser, D; Bhatia, R; Ortega, R; Mittelman, S D; Keens, T G; Davidson Ward, S L; Khoo, M C

    2010-01-01

    This study investigates the effects of exposure to intermittent hypoxia on cardiovascular autonomic control and metabolic function in obese children with obstructive sleep apnea (OSA). Each subject underwent: (1) a polysomnography; (2) morning fasting blood samples and a subsequent FSIVGTT; (3) noninvasive measurement of respiration, arterial blood pressure, and heart rate during supine and standing postures. Assessment of adiposity was performed using a DEXA scan. From these measurements, we deduced the pertinent sleep parameters, Bergman minimal model parameters and the parameters characterizing a minimal model of cardiovascular variability. Results suggest that intermittent hypoxia in OSA contributes independently to insulin resistance and autonomic dysfunction in overweight children.

  13. The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease.

    Science.gov (United States)

    Johansson, Peter; Svensson, Erland; Alehagen, Urban; Jaarsma, Tiny; Broström, Anders

    2015-06-01

    This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality. A total of 331 community-dwelling elderly aged 71-87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years. In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (pinsomnia (pinsomnia. Hypoxia of more than 1.5% of sleep time with SaO2causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002). In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis. © The European Society of Cardiology 2014.

  14. Overlap syndrome of COPD and OSA in Koreans.

    Science.gov (United States)

    Choi, Kyung-Mee; Thomas, Robert J; Kim, Jinkwan; Lee, Seung Ku; Yoon, Dae Wui; Shin, Chol

    2017-07-01

    Overlap syndrome of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) leads to increased morbidity and mortality. There have been no reports available on the overlap syndrome for Koreans. Our primary aim was to identify prevalence and predictors of the overlap syndrome in Koreans.This is a cross-sectional study with a community-based sample of 1298 participants (mean age, 59.7 ± 6.7) from the cohort of Korean Genomic and Epidemiologic Study during 2013 to 2014. OSA and COPD were assessed by apnea-hypopnea index (AHI) and the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC syndrome. The prevalence of COPD remained the same as 10.8% regardless of the presence of OSA. The mean ratio of FEV1/FVC for those with COPD was 0.77, regardless of OSA. The OR increased for age (OR, 1.1; 95% CI, 1.0-1.1) and smokers (OR, 3.6; 95% CI, 2.0-6.4), but decreased for body mass index (BMI) (OR, 0.84; 95% CI, 0.8-0.9) and overweight state (OR, 0.4; 95% CI, 0.2-0.7). Risk factors of the overlap syndrome differed by OSA severity, that is, BMI in those with moderate-to-severe OSA, whereas sex (OR, 4.7; 95% CI, 2.1-10.6) and age (OR, 1.1; 95% CI, 1.0-1.1) in those with mild OSA.In a population study from Korea, 10.8% of OSA patients had an overlap syndrome with COPD. Although BMI is a well-known risk factor of OSA, it is likely that being overweight may be protective for moderate-to-severe OSA patients from the risk of COPD (i.e., overlap syndrome).

  15. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... OSA causes daytime drowsiness that can result in accidents, lost productivity and relationship problems. The National Sleep ... 30 apneas during a seven-hour sleep. In severe cases, periods of not breathing may last for ...

  16. Obstructive Sleep Apnea

    Medline Plus

    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 ...

  17. Obstructive Sleep Apnea

    Medline Plus

    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 ...

  18. Effects of 12 months continuous positive airway pressure on sympathetic activity related brainstem function and structure in obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Luke Anthony Henderson

    2016-03-01

    Full Text Available Muscle sympathetic nerve activity (MSNA is greatly elevated in patients with obstructive sleep apnoea (OSA during normoxic daytime wakefulness. Increased MSNA is a precursor to hypertension and elevated cardiovascular morbidity and mortality. However, the mechanisms underlying the high MSNA in OSA are not well understood. In this study we used concurrent microneurography and magnetic resonance imaging to explore MSNA-related brainstem activity changes and anatomical changes in 15 control and 15 subjects with OSA prior to and following 6 and 12 months of continuous positive airway pressure (CPAP treatment. We found that 6 and 12 months of CPAP treatment significantly reduced the elevated resting MSNA in individuals with OSA. Furthermore, this MSNA reduction was associated with restoration of MSNA-related activity and structural changes in the medullary raphe, rostral ventrolateral medulla, dorsolateral pons and ventral midbrain. This restoration occurred after 6 months of CPAP treatment and was maintained following 12 months CPAP. These findings show that continual CPAP treatment is an effective long-term treatment for elevated MNSA likely due to its effects on restoring brainstem structure and function.

  19. [Intraabdominal fat redistribution in long-term continuous positive airway pressure treatment in obstructive sleep apnea patients].

    Science.gov (United States)

    Català, Raquel; Ferré, Raimón; Sangenís, Sandra; Cabré, Anna; Hernández-Flix, Salvador; Masana, Lluís

    2016-06-03

    Obesity is the main risk factor for obstructive sleep apnoea (OSA). The aim was to evaluate the long-term effect of continuous positive airway pressure (CPAP) on intraabdominal fat distribution in OSA patients. Fifty OSA patients with and 35 without CPAP treatment criteria were followed-up for 2 years. Visceral and subcutaneous adipose tissue (VAT and SAT) and preaortic intraabdominal fat (PIF) were assessed by sonography. In the non CPAP treated group, SAT and VAT mean values didn't change, while a significantly PIF growth was observed (55.19 [23.44] vs. 63.45 [23.94] mm, P=.021). In the CPAP treated group, VAT and PIF mean were not changed, while SAT decreased significantly (11.29 [5.69] vs. 10.47 [5.71] mm, P=.012). Long-term CPAP treatment produces intraabdominal fat redistribution and is associated with an anthropometric profile of lower cardiovascular risk in OSA patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  20. Diagnosis and treatment of sleep related breathing disorders in children: 2007 to 2011.

    LENUS (Irish Health Repository)

    Walsh, A

    2015-03-01

    Sleep related breathing disorders (SRBD) have historically been under-recognised and under-treated. Obstructive sleep apnoea (OSA) affects approximately 3% of children. In line with the increased recognition of SRBD there has been an increase in demand for diagnostic services. We determined the awareness of SRBD amongst Irish paediatricians, examined the provision of sleep services to children throughout the country between 2007 and 2011 and audited diagnostic sleep services in a tertiary centre in 2011. Amongst respondents there was an awareness of SRBD but a poor understanding of diagnostic evaluation with 31\\/46 (67) referring to inappropriate services. There has been a sharp increase in both diagnostic sleep tests (433-1793 [414]) and in the use of non-invasive ventilation (NIV) (31-186 [627]) for treatment of SRBD between 2007 and 2011. Paediatric sleep services are organized in an ad-hoc manner nationally with significant service variation. The use of domiciliary overnight oximetry reduced the requirement for more formal polysomnography by 70%.

  1. Sleep in trigeminal autonomic cephalagias

    DEFF Research Database (Denmark)

    Barløse, Mads; Lund, Nunu; Jensen, Rigmor Højland

    2014-01-01

    and eventually to more effective therapeutic regimens. This review aims to evaluate the existing literature on the subject of TACs and sleep. An association between episodic CH and distinct macrostructural sleep phases, especially the relation to rapid eye movement (REM) sleep, has been described in some older...... studies but could not be confirmed in other, more recent studies. Investigations into the microstructure of sleep in these patients are lacking. Only a few case reports exist on the relation between sleep and other TACs. SUMMARY: Recent studies do not find an association between CH and REM sleep. One...... older study suggests chronic paroxysmal hemicranias may be locked to REM sleep but otherwise the relation is unknown. Reports indicate that CH and obstructive sleep apnoea are associated in some individuals but results are diverging. Single cases show improvement of CH upon treatment of sleep apnoea...

  2. Low morning serum cortisol levels in children with tonsillar hypertrophy and moderate-to-severe OSA.

    Science.gov (United States)

    Malakasioti, Georgia; Alexopoulos, Emmanouel I; Varlami, Vasiliki; Chaidas, Konstantinos; Liakos, Nikolaos; Gourgoulianis, Konstantinos; Kaditis, Athanasios G

    2013-09-01

    Hypertrophic tonsillar tissue in children with obstructive sleep apnea (OSA) has enhanced expression of glucocorticoid receptors, which may reflect low endogenous cortisol levels. We have evaluated the effect of the interaction between tonsillar hypertrophy and OSA severity on morning serum cortisol levels. Children with and without snoring underwent polysomnography, tonsillar size grading, and measurement of morning serum cortisol. Seventy children (2-13 years old) were recruited: 30 with moderate-to-severe OSA (apnea-hypopnea index [AHI] > 5 episodes/h), 26 with mild OSA (AHI > 1 and ≤ 5), and 14 controls (no snoring; AHI ≤ 1). Tonsillar hypertrophy was present in 56.7%, 53.8%, and 42.9% of participants in each group, respectively. Application of a general linear model demonstrated a significant effect of the interaction between severity of OSA and tonsillar hypertrophy on cortisol levels (P = 0.04), after adjustment for obesity, gender, and age. Among children with tonsillar hypertrophy, subjects with moderate-to-severe OSA (n = 17; AHI 14.7 ± 10.6), mild OSA (n = 14; AHI 2.3 ± 1.2), and control participants (n = 6; AHI 0.7 ± 0.2) were significantly different regarding cortisol levels (P = 0.02). Subjects with moderate-to-severe OSA had lower cortisol (16.9 ± 8.7 mcg/dL) than those with mild OSA (23.3 ± 4.2; P = 0.01) and those without OSA (controls) (23.6 ± 5.3 mcg/dL; P = 0.04). In contrast, children with normal-size tonsils and moderate-to-severe OSA, mild OSA, and controls did not differ in cortisol levels. Children with moderate-to-severe obstructive sleep apnea and the phenotype of hypertrophic tonsils have reduced morning serum cortisol levels and potentially decreased glucocorticoid inhibitory effects on tonsillar growth.

  3. Correlation of Lateral Cephalogram and Flexible Laryngoscopy with Sleep Study in Obstructive Sleep Apnea

    OpenAIRE

    Narayanan, Anila; Faizal, Bini

    2015-01-01

    Objective. To study the correlation between lateral cephalogram, flexible laryngoscopy, and sleep study in patients diagnosed with obstructive sleep apnea (OSA). Background. Screening tools should be devised for predicting OSA which could be performed on an outpatient basis. With this aim we studied the skeletal and soft tissue characteristics of proven OSA patients. Methods. A prospective study was performed in patients diagnosed with obstructive sleep apnea by sleep study. They were evaluat...

  4. Sleep

    Science.gov (United States)

    ... Institute (NHLBI). 1 Mood. Sleep affects your mood. Insufficient sleep can cause irritability that can lead to trouble with relationships, ... basics/understanding_sleep.htm#dynamic_activity Centers for Disease ... insufficient rest or sleep among adults—United States, 2008. MMWR, 58 (42), ...

  5. Improvement in Obstructive Sleep Apnea With Weight Loss is Dependent on Body Position During Sleep.

    Science.gov (United States)

    Joosten, Simon A; Khoo, Jun K; Edwards, Bradley A; Landry, Shane A; Naughton, Matthew T; Dixon, John B; Hamilton, Garun S

    2017-05-01

    Weight loss fails to resolve obstructive sleep apnea (OSA) in most patients; however, it is unknown as to whether weight loss differentially affects OSA in the supine compared with nonsupine sleeping positions. We aimed to determine if weight loss in obese patients with OSA results in a greater reduction in the nonsupine apnea/hypopnea index (AHI) compared with the supine AHI, thus converting participants into supine-predominant OSA. Post hoc analysis of data from a randomized controlled trial assessing the effect of weight loss (bariatric surgery vs. medical weight loss) on OSA in 60 participants with obesity (body mass index: >35 and sleep study at 2 years. Eight of 37 (22%) patients demonstrated a normal nonsupine AHI (sleep avoidance may cure their OSA. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  6. Obstructive Sleep Apnea

    Medline Plus

    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 ...

  7. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... also affects 2% to 3% of children. Yet, people who have OSA may not be aware they ... initiates impulses from the brain to wake the person just enough to restart the breathing process. Sleep ...

  8. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and relationship problems. The National Sleep Foundation ...

  9. Effect of obstructive sleep apnea on the sleep architecture in cirrhosis.

    Science.gov (United States)

    Kappus, Matthew R; Leszczyszyn, David J; Moses, Leonard; Raman, Shekar; Heuman, Douglas M; Bajaj, Jasmohan S

    2013-03-15

    Sleep disturbances in cirrhosis are assumed to be due to hepatic encephalopathy (HE). The interaction between cirrhosis, prior HE, and obstructive sleep apnea (OSA) has not been evaluated. We aimed to evaluate the additional effect of cirrhosis with and without prior HE on the sleep architecture and perceived sleep disturbances of OSA patients. A case-control review of OSA patients who underwent polysomnography (PSG) in a liver-transplant center was performed. OSA patients with cirrhosis (with/without prior HE) were age-matched 1:1 with OSA patients without cirrhosis. Sleep quality, daytime sleepiness, sleep quality, and sleep architecture was compared between groups. Forty-nine OSA cirrhotic patients (age 57.4 ± 8.3 years, model for end-stage liver disease (MELD) 8.3 ± 5.4, 51% HCV, 20% prior HE) were age-matched 1:1 to OSA patients without cirrhosis. Apnea-hypopnea index, arousal index, sleep efficiency, daytime sleepiness, and effect of sleepiness on daily activities were similar between OSA patients with/ without cirrhosis. Sleep architecture, including %slow wave sleep (SWS), was also not different between the groups. MELD was positively correlated with time in early (N1) stage (r = 0.4, p = 0.03). All prior HE patients (n = 10) had a shift of the architecture towards early, non-restorative sleep (higher % [N2] stage [66 vs 52%, p = 0.005], lower % SWS [0 vs 29%, p = 0.02], lower REM latency [95 vs 151 minutes, p = 0.04]) compared to the rest. Alcoholic etiology was associated with higher latency to N1/N2 sleep, but no other effect on sleep architecture was seen. OSA can contribute to sleep disturbance in cirrhosis and should be considered in the differential of sleep disturbances in cirrhosis. Prior HE may synergize with OSA in worsening the sleep architecture.

  10. The effect of allergic rhinitis on the degree of stress, fatigue and quality of life in OSA patients.

    Science.gov (United States)

    Park, Cheol Eon; Shin, Seung Youp; Lee, Kun Hee; Cho, Joong Saeng; Kim, Sung Wan

    2012-09-01

    Both allergic rhinitis (AR) and obstructive sleep apnea (OSA) are known to increase stress and fatigue, but the result of their coexistence has not been studied. The objective of this study was to evaluate the amount of stress and fatigue when AR is combined with OSA. One hundred and twelve patients diagnosed with OSA by polysomnography were enrolled. Among them, 37 patients were diagnosed with AR by a skin prick test and symptoms (OSA-AR group) and 75 patients were classified into the OSA group since they tested negative for allergies. We evaluated the Epworth sleepiness scale (ESS), stress score, fatigue score, ability to cope with stress, and rhinosinusitis quality of life questionnaire (RQLQ) with questionnaires and statistically compared the scores of both groups. There were no significant differences in BMI and sleep parameters such as LSAT, AHI, and RERA between the two groups. However, the OSA-AR group showed a significantly higher ESS score compared to the OSA group (13.7 ± 4.7 vs. 9.3 ± 4.8). Fatigue scores were also significantly higher in the OSA-AR group than in the OSA group (39.8 ± 11.0 vs. 30.6 ± 5.4). The OSA-AR group had a significantly higher stress score (60.4 ± 18.6 vs. 51.2 ± 10.4). The ability to cope with stress was higher in the OSA group, although this difference was not statistically significant. RQLQ scores were higher in the OSA-AR group (60.2 ± 16.7 compared to 25.1 ± 13.9). In conclusion, management of allergic rhinitis is very important in treating OSA patients in order to eliminate stress and fatigue and to minimize daytime sleepiness and quality of life.

  11. Analysis of OSAS incidence and influential factors in middle-aged and elderly patients with hypertension.

    Science.gov (United States)

    Wang, Shuang; Niu, Xinqing; Zhang, Peipei; Su, Dexing; Zhang, Jing; Liu, Wei

    2018-04-24

    To investigate the detection rate and influencing factors of obstructive sleep apnea syndrome (OSAS) in middle-aged and elderly patients with hypertension. A total of 440 patients with hypertension were selected as the research objects, all of them participated in the Berlin questionnaire survey, and the polysomnography (PSG) was performed on the patients with a high risk of OSAS. The detection rate of OSAS was analyzed, the clinical data between non-OSAS group and OSAS group were compared and stepwise linear regression and Logistic regression were used to analyze the related influencing factors to apnea hyponea index (AHI) and OSAS in hypertensive patients. A total of 235 patients completed PSG and 196 patients were diagnosed as OSAS with the detection rate of 83.40%. The detection rate of OSAS in male patients was higher than that in females (89.04% vs.74.16%, x²=8.025, P=0.006). The detection rates of OSAS in normal BMI group, overweight group and obesity group were 56.52%, 92.37% and 100%, respectively (x²=36.438, P<0.001). The detection rates of OSAS in normal waistline group and central obesity group were 74.42% and 88.59% (x²=7.539, P=0.016). The detection rates of OSAS in grade1, grade 2 and grade 3 hypertension groups were 57.47%, 98.23% and 100%, respectively (x²=44.623, P<0.001). BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), low density lipoprotein (LDL) and waist circumference of OSAS group were all higher than those in non-OSAS group (P<0.05). BMI, SBP and DBP were positively correlated with AHI (p<0.05), which were independent risk factors of OSAS [OR value (95%CI) = 2.548 (1.449-4.327), 1.342 (1.214-1.965) and 1.169 (1.025-1.622), respectively, P<0.05]. The incidence of OSAS in middle-aged and elderly patients with hypertension is high. High BMI, SBP, and DBP are independent risk factors of OSAS.

  12. Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea.

    Science.gov (United States)

    Rowland, Sharn; Aiyappan, Vinod; Hennessy, Cathy; Catcheside, Peter; Chai-Coezter, Ching Li; McEvoy, R Doug; Antic, Nick A

    2018-01-15

    To determine if the type of continuous positive airway pressure (CPAP) mask interface influences CPAP treatment efficacy, adherence, side effects, comfort and sleep quality in patients with moderate-severe obstructive sleep apnea (OSA). This took place in a hospital-based tertiary sleep disorders unit. It is a prospective, randomized, crossover trial comparing three CPAP interfaces: nasal mask (NM), nasal mask plus chinstrap (NM-CS) and oronasal mask (ONM) each tried in random order, for 4 weeks. After each 4-week period, patient outcomes were assessed. Participants had a new diagnosis of obstructive sleep apneas. Forty-eight patients with moderate-severe OSA (32 males, mean ± standard deviation apnea-hypopnea index (AHI) 55.6 ± 21.1 events/h, age 54.9 ± 13.1 years, body mass index 35.8 ± 7.2 kg/m 2 ) were randomized. Thirty-five participants completed the full study, with complete data available for 34 patients. There was no statistically significant difference in CPAP adherence; however, residual AHI was higher with ONM than NM and NM-CS (residual AHI 7.1 ± 7.7, 4.0 ± 3.1, 4.2 ± 3.7 events/h respectively, main effect P = .001). Patient satisfaction and quality of sleep were higher with the NM and NM-CS than the ONM. Fewer leak and mask fit problems were reported with NM (all chi-square P CPAP adherence did not differ between the three different mask interfaces but the residual AHI was lower with NM than ONM and patients reported greater mask comfort, better sleep, and overall preference for a NM. A nasal mask with or without chinstrap should be the first choice for patients with OSA referred for CPAP treatment. Registry: Australian and New Zealand Clinical Trials Registry, URL: https://www.anzctr.org.au, title: A comparison of continuous positive airway pressure (CPAP) interface in the control of leak, patient compliance and patient preference: nasal CPAP mask and chinstrap versus full face mask in patients with obstructive sleep apnoea (OSA), identifier

  13. Beyond factor analysis: Multidimensionality and the Parkinson's Disease Sleep Scale-Revised.

    Directory of Open Access Journals (Sweden)

    Maria E Pushpanathan

    Full Text Available Many studies have sought to describe the relationship between sleep disturbance and cognition in Parkinson's disease (PD. The Parkinson's Disease Sleep Scale (PDSS and its variants (the Parkinson's disease Sleep Scale-Revised; PDSS-R, and the Parkinson's Disease Sleep Scale-2; PDSS-2 quantify a range of symptoms impacting sleep in only 15 items. However, data from these scales may be problematic as included items have considerable conceptual breadth, and there may be overlap in the constructs assessed. Multidimensional measurement models, accounting for the tendency for items to measure multiple constructs, may be useful more accurately to model variance than traditional confirmatory factor analysis. In the present study, we tested the hypothesis that a multidimensional model (a bifactor model is more appropriate than traditional factor analysis for data generated by these types of scales, using data collected using the PDSS-R as an exemplar. 166 participants diagnosed with idiopathic PD participated in this study. Using PDSS-R data, we compared three models: a unidimensional model; a 3-factor model consisting of sub-factors measuring insomnia, motor symptoms and obstructive sleep apnoea (OSA and REM sleep behaviour disorder (RBD symptoms; and, a confirmatory bifactor model with both a general factor and the same three sub-factors. Only the confirmatory bifactor model achieved satisfactory model fit, suggesting that PDSS-R data are multidimensional. There were differential associations between factor scores and patient characteristics, suggesting that some PDSS-R items, but not others, are influenced by mood and personality in addition to sleep symptoms. Multidimensional measurement models may also be a helpful tool in the PDSS and the PDSS-2 scales and may improve the sensitivity of these instruments.

  14. Evaluation of degree of lacunar infarction and carotid atherosclerosis in patients with different severity of OSAS

    Directory of Open Access Journals (Sweden)

    Ming Du

    2016-07-01

    Full Text Available Objective: To assess the degree of lacunar infarction and carotid atherosclerosis in patients with different severity of obstructive sleep apnea syndrome (OSAS. Methods: A total of 198 patients with OSAS were retrospectively studied from case information and test results, and were divided into mild group 84 cases, medium group 70 cases and severe group 44 cases according to apnea-hypopnea index (AHI, and 176 cases of non-OSAS people who received physical examination in our hospital during the same period were selected as healthy control group. Differences in the values of serum lacunar infarction-related indexes, blood viscosity and hemocyte-related indexes, carotid structure and function parameters, serum arteriosclerosis-related indexes and so on were compared among groups. Results: t-PA value of healthy control group was higher than those of OSAS group while vWF, PAI-1 and Fg values were lower than those of OSAS group (P<0.05, and with the increase of OSAS severity, t-PA value decreased while vWF, PAI-1 and Fg values increased (P<0.05; blood viscosity, Hct, PDW, RDW and EFR values of healthy control group were lower than those of OSAS group (P<0.05, and with the increase of OSAS severity, blood viscosity, Hct, PDW, RDW and EFR values increased (P<0.05; FMD, NID and DC values of healthy control group were higher than those of OSAS group while Dis, CC and PWV values were lower than those of OSAS group (P<0.05, and with the increase of OSAS severity, FMD, NID and DC values decreased while Dis, CC and PWV values increased (P<0.05; blood uric acid and EF-1 values of healthy control group were lower than those of OSAS group while CGRP and fetuin A levels were higher than those of OSAS group (P<0.05, and with the aggravation of OSAS, blood uric acid and EF-1 levels increased while CGRP and fetuin A levels decreased, and differences among groups were significant (P<0.05. Conclusions: With the aggravation of OSAS, patients’ microcirculation

  15. Prosthodontic Approach to Treat Obstructive Sleep Apnea ...

    African Journals Online (AJOL)

    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.

  16. Obstructive sleep apnea: Awakening the hidden truth

    African Journals Online (AJOL)

    2014-01-16

    Jan 16, 2014 ... The repetitive nocturnal hypoxemia experienced by patients with OSA is ... etiopathogenesis, epidemiology, associated systemic diseases such as cardiovascular diseases, diabetes, and dental .... Obstructive sleep apnea and cardiovascular diseases ... showing that successful treatment of sleep apnea.

  17. Sleep Misperception in Chronic Insomnia Patients with Obstructive Sleep Apnea Syndrome: Implications for Clinical Assessment.

    Science.gov (United States)

    Choi, Su Jung; Suh, Sooyeon; Ong, Jason; Joo, Eun Yeon

    2016-11-15

    To investigate whether sleep perception (SP), defined by the ratio of subjective and objective total sleep time, and habitual sleep time in various sleep disorders may be based on comorbid insomnia status. We enrolled 420 patients (age 20-79 y) who underwent polysomnography (PSG). They were divided into three groups based on chief complaints: chronic insomnia (CI, n = 69), patients with both obstructive sleep apnea and insomnia (OSA-I, n = 49) or OSA only (OSA, n = 149). Healthy volunteers were also recruited (normal controls [NC], n = 80). We compared differences in PSG parameters and habitual sleep duration and investigated the discrepancy between objective and subjective total sleep time (TST) and sleep latency among four groups. Subjective TST was defined as sleep time perceived by participants the next morning of PSG. SP for TST was highest in the OSA group (median 92.9%), and lowest in the CI group (80.3%). SP of the NC group (91.4%) was higher than the CI, but there was no difference between OSA-I and OSA groups. OSA-I had higher depressive mood compared to the OSA group (p insomnia and arousal index of PSG. Insomnia patients with (OSA-I) or without OSA (CI) reported the smallest discrepancy between habitual sleep duration and objective TST. Patients with OSA with or without insomnia have different PSG profiles, which suggests that objective measures of sleep are an important consideration for differentiating subtypes of insomnia and tailoring proper treatment. A commentary on this articles appears in this issue on page 1437. © 2016 American Academy of Sleep Medicine

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

    Directory of Open Access Journals (Sweden)

    Stefan Mihaicuta

    2017-05-01

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

  19. Portable Prescreening System for Sleep Apnea

    DEFF Research Database (Denmark)

    Guul, Martin Kjær; Jennum, Poul; Sørensen, Helge Bjarup Dissing

    2016-01-01

    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......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...... of suffering from OSA would be beneficial. The system must be able to identify individuals with a high pre-test reliability regarding OSA with the aim of referral and further investigation. We aimed to develop a portable, smartphone, and homebased monitoring system to classify whether a patient screened...

  20. THE SUFFERING OF PATIENTS WITH RESPIRATORY DISORDERS DURING SLEEP

    Directory of Open Access Journals (Sweden)

    Jacek Lech

    2013-11-01

    Full Text Available Assumption : Respiratory disorders during sleep involving the occurrence of sleep apnoea leading to a reduction in arterial oxygen saturation are classified as: obstructive sleep apnoea, central sleep apnoea and sleep-related hypoventilation with hypoxaemia. A close correlation has been proved between the occurrence of apnoea and obesity. This problem concerns 2–4% of the population, and is more likely to affect men. Aim : Presentation of the problem of respiratory disorders during sleep as a chronic disease causing much suffering. Its symptoms may lead to sleep fragmentation and somatic consequences (such as dysfunction of the cardiovascular system as well as mental consequences (personality changes. Method : An analysis of literature concerning the subject-matter from the perspective of a doctor conducting ventilation therapy of patients with respiratory sleep disorders. Summary : The problem of sleep apnoea is most often diagnosed and treated too late due to the number of symptoms with a simultaneous absence of pathognomonic symptoms. Despite its commonness, recognition of this disease is still insufficient.

  1. Health promotion in obstructive sleep apnea syndrome.

    Science.gov (United States)

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

    2015-04-01

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

  2. Obstructive Sleep Apnea and Aldosterone

    Science.gov (United States)

    Svatikova, Anna; Olson, Lyle J.; Wolk, Robert; Phillips, Bradley G.; Adachi, Taro; Schwartz, Gary L.; Somers, Virend K.

    2009-01-01

    Background: Obstructive sleep apnea (OSA) is a major risk factor for hypertension and has been associated with increased risk for cardiovascular morbidity. A dysregulated renin-angiotensin-aldosterone system may contribute to excess sodium retention and hypertension and may be activated in OSA. We tested the hypothesis that serum levels of aldosterone and plasma renin activity (PRA) are increased by apneic sleep in subjects without cardiovascular disease, compared to healthy control subjects. Methods and Results: Plasma aldosterone level was measured in 21 subjects with moderate to severe OSA and was compared to 19 closely matched healthy subjects. Plasma renin activity (PRA) was measured in 19 OSA patients and in 20 healthy controls. Aldosterone and PRA were measured before sleep (9pm), after 5 hrs of untreated OSA (2am) and in the morning after awakening (6am). There were no baseline (9pm) differences in serum aldosterone levels and PRA between the healthy controls and OSA patients (aldosterone: 55.2 ± 9 vs 56.0 ± 9 pg/mL; PRA: 0.99 ± 0.15 vs 1.15 ± 0.15 ng/mL/hr). Neither several hours of untreated severe OSA nor CPAP treatment affected aldosterone levels and PRA in OSA patients. Diurnal variation of both aldosterone and PRA was observed in both groups, in that morning renin and aldosterone levels were higher than those measured at night before sleep. Conclusions: Our study shows that patients with moderate to severe OSA without co-existing cardiovascular disease have plasma aldosterone and renin levels similar to healthy subjects. Neither untreated OSA nor CPAP treatment acutely affect plasma aldosterone or renin levels. Citation: Svatikova A; Olson LJ; Wolk R; Phillips BG; Adachi T; Schwartz GL; Somers VK. Obstructive sleep apnea and aldosterone. SLEEP 2009;32(12):1589-1592. PMID:20041594

  3. Obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Steven D. Brass

    2011-11-01

    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.

  4. Obstructive sleep apnea.

    Science.gov (United States)

    Ho, Matthew L; Brass, Steven D

    2011-11-29

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

  5. Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans

    Science.gov (United States)

    Orr, Jeremy E.; Smales, Carolina; Alexander, Thomas H.; Stepnowsky, Carl; Pillar, Giora; Malhotra, Atul; Sarmiento, Kathleen F.

    2017-01-01

    Study Objectives: Posttraumatic stress disorder (PTSD) is common among veterans of the military, with sleep disturbance as a hallmark manifestation. A growing body of research has suggested a link between obstructive sleep apnea and PTSD, potentially due to obstructive sleep apnea (OSA) related sleep disruption, or via other mechanisms. We examined the hypothesis that treatment of OSA with positive airway pressure would reduce PTSD symptoms over 6 months. Methods: A prospective study of Veterans with confirmed PTSD and new diagnosis of OSA not yet using PAP therapy were recruited from a Veteran's Affairs sleep medicine clinic. All subjects were instructed to use PAP each night. Assessments were performed at 3 and 6 months. The primary outcome was a reduction in PTSD symptoms at 6 months. Results: Fifty-nine subjects were enrolled; 32 remained in the study at 6 months. A significant reduction in PTSD symptoms, measured by PCL-S score was observed over the course of the study (60.6 ± 2.7 versus 52.3 ± 3.2 points; p J Clin Sleep Med. 2017;13(1):57–63. PMID:27707436

  6. Sleep apnea syndrome and cognition

    Directory of Open Access Journals (Sweden)

    Emilia eSforza

    2012-05-01

    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.

  7. Obstructive Sleep Apnea and Age: A Double Insult to Brain Function?

    OpenAIRE

    Ayalon, Liat; Ancoli-Israel, Sonia; Drummond, Sean P. A.

    2010-01-01

    Rationale: Healthy aging is associated with cognitive deficits similar to those found in obstructive sleep apnea (OSA). As in OSA, older adults show compensatory cerebral activation during cognitive demands in the face of neurocognitive decline.

  8. Endothelial Dysfunction in the Microcirculation of Patients with Obstructive Sleep Apnea

    OpenAIRE

    Patt, Brian T.; Jarjoura, David; Haddad, Diane N.; Sen, Chandan K.; Roy, Sashwati; Flavahan, Nicholas A.; Khayat, Rami N.

    2010-01-01

    Rationale: Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease. We hypothesized that patients with OSA and no cardiovascular disease have oxidant-related microcirculatory endothelial dysfunction.

  9. Security Analysis of Parlay/OSA Framework

    NARCIS (Netherlands)

    Corin, R.J.; Di Caprio, G.; Etalle, Sandro; Gnesi, S.; Lenzini, Gabriele; Moiso, C.; Villain, B.

    2004-01-01

    This paper analyzes the security of the Trust and Security Management (TSM) protocol, an authentication protocol which is part of the Parlay/OSA Application Program Interfaces (APIs). Architectures based on Parlay/OSA APIs allow third party service providers to develop new services that can access,

  10. Security Analysis of Parlay/OSA Framework

    NARCIS (Netherlands)

    Corin, R.J.; Di Caprio, G.; Etalle, Sandro; Gnesi, S.; Lenzini, Gabriele; Moiso, C.

    This paper analyzes the security of the Trust and Security Management (TSM) protocol, an authentication protocol which is part of the Parlay/OSA Application Program Interfaces (APIs). Architectures based on Parlay/OSA APIs allow third party service providers to develop new services that can access,

  11. Hypertension and obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Phillips CL

    2013-05-01

    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

  12. Control of upper airway muscle activity in younger versus older men during sleep onset

    Science.gov (United States)

    Fogel, Robert B; White, David P; Pierce, Robert J; Malhotra, Atul; Edwards, Jill K; Dunai, Judy; Kleverlaan, Darci; Trinder, John

    2003-01-01

    Pharyngeal dilator muscles are clearly important in the pathophysiology of obstructive sleep apnoea syndrome (OSA). We have previously shown that the activity of both the genioglossus (GGEMG) and tensor palatini (TPEMG) are decreased at sleep onset, and that this decrement in muscle activity is greater in the apnoea patient than in healthy controls. We have also previously shown this decrement to be greater in older men when compared with younger ones. In order to explore the mechanisms responsible for this decrement in muscle activity nasal continuous positive airway pressure (CPAP) was applied to reduce negative pressure mediated muscle activation. We then investigated the effect of sleep onset (transition from predominantly α to predominantly θ EEG activity) on ventilation, upper airway muscle activation and upper airway resistance (UAR) in middle-aged and younger healthy men. We found that both GGEMG and TPEMG were reduced by the application of nasal CPAP during wakefulness, but that CPAP did not alter the decrement in activity in either muscle seen in the first two breaths following an α to θ transition. However, CPAP prevented both the rise in UAR at sleep onset that occurred on the control night, and the recruitment in GGEMG seen in the third to fifth breaths following the α to θ transition. Further, GGEMG was higher in the middle-aged men than in the younger men during wakefulness and was decreased more in the middle-aged men with the application of nasal CPAP. No differences were seen in TPEMG between the two age groups. These data suggest that the initial sleep onset reduction in upper airway muscle activity is due to loss of a ‘wakefulness’ stimulus, rather than to loss of responsiveness to negative pressure. In addition, it suggests that in older men, higher wakeful muscle activity is due to an anatomically more collapsible upper airway with more negative pressure driven muscle activation. Sleep onset per se does not appear to have a greater

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Obstructive sleep apnea alters sleep stage transition dynamics.

    Directory of Open Access Journals (Sweden)

    Matt T Bianchi

    2010-06-01

    Full Text Available Enhanced characterization of sleep architecture, compared with routine polysomnographic metrics such as stage percentages and sleep efficiency, may improve the predictive phenotyping of fragmented sleep. One approach involves using stage transition analysis to characterize sleep continuity.We analyzed hypnograms from Sleep Heart Health Study (SHHS participants using the following stage designations: wake after sleep onset (WASO, non-rapid eye movement (NREM sleep, and REM sleep. We show that individual patient hypnograms contain insufficient number of bouts to adequately describe the transition kinetics, necessitating pooling of data. We compared a control group of individuals free of medications, obstructive sleep apnea (OSA, medical co-morbidities, or sleepiness (n = 374 with mild (n = 496 or severe OSA (n = 338. WASO, REM sleep, and NREM sleep bout durations exhibited multi-exponential temporal dynamics. The presence of OSA accelerated the "decay" rate of NREM and REM sleep bouts, resulting in instability manifesting as shorter bouts and increased number of stage transitions. For WASO bouts, previously attributed to a power law process, a multi-exponential decay described the data well. Simulations demonstrated that a multi-exponential process can mimic a power law distribution.OSA alters sleep architecture dynamics by decreasing the temporal stability of NREM and REM sleep bouts. Multi-exponential fitting is superior to routine mono-exponential fitting, and may thus provide improved predictive metrics of sleep continuity. However, because a single night of sleep contains insufficient transitions to characterize these dynamics, extended monitoring of sleep, probably at home, would be necessary for individualized clinical application.

  15. Sleep disorders of Whipple's disease of the brain.

    Science.gov (United States)

    Panegyres, P K; Goh, J

    2015-02-01

    To understand the effects of Whipple's disease (WD) of the brain on sleep function. Clinical and polysomnographic studies of two patients with severe disruption of sleep due to WD: a 48-year-old female with primary WD of the brain and a 41-year-old male with secondary WD of the brain. The patient with primary WD had hypersomnolence with severe obstructive sleep apnoea, reduced sleep efficiency, frequent waking and sleep fragmentation. The patient with secondary WD was also hypersomnolent with oculomastictory myorhythmia. He was shown to have severe sleep initiation insomnia with poor sleep efficiency, severe obstructive sleep apnoea/hypopnoea and oculomasticatory myorhythmia at sleep-wake transitions. WD of the brain may affect sleep biology in its primary and secondary forms leading to hypersomnolence from obstructive sleep apnoea, sleep fragmentation, reduced sleep efficiency, sleep initiation insomnia and intrusive oculomasticatory myorhythmia. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    DEFF Research Database (Denmark)

    Olaithe, Michelle; Skinner, Timothy C.; Hillman, David

    2015-01-01

    and a tertiary hospital sleep clinic. All underwent comprehensive, laboratory-based polysomnography (PSG) and completed assessments of cognition including attention, short- and long-term memory and executive function. Structural equation modelling (SEM) was used to construct a theoretically-driven model......© 2014, Springer-Verlag Berlin Heidelberg. Introduction: Obstructive sleep apnea (OSA) is a common disorder that is associated with impaired attention, memory and executive function. However, the mechanisms underlying such dysfunction are unclear. To determine the influence of sleep fragmentation...... these significant relationships. No significant predictors of memory function were found. Conclusions: The mechanisms underlying the effects of OSA on cognition remain to be defined. Implications are discussed in light of these findings....

  17. Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll.

    Science.gov (United States)

    Swanson, Leslie M; Arnedt, J Todd; Rosekind, Mark R; Belenky, Gregory; Balkin, Thomas J; Drake, Christopher

    2011-09-01

    Chronic sleep deprivation is common among workers, and has been associated with negative work outcomes, including absenteeism and occupational accidents. The objective of the present study is to characterize reciprocal relationships between sleep and work. Specifically, we examined how sleep impacts work performance and how work affects sleep in individuals not at-risk for a sleep disorder; assessed work performance outcomes for individuals at-risk for sleep disorders, including insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS); and characterized work performance impairments in shift workers (SW) at-risk for shift work sleep disorders relative to SW and day workers. One-thousand Americans who work 30 h per week or more were asked questions about employment, work performance and sleep in the National Sleep Foundation's 2008 Sleep in America telephone poll. Long work hours were associated with shorter sleep times, and shorter sleep times were associated with more work impairments. Thirty-seven percent of respondents were classified as at-risk for any sleep disorder. These individuals had more negative work outcomes as compared with those not at-risk for a sleep disorder. Presenteeism was a significant problem for individuals with insomnia symptoms, OSA and RLS as compared with respondents not at-risk. These results suggest that long work hours may contribute to chronic sleep loss, which may in turn result in work impairment. Risk for sleep disorders substantially increases the likelihood of negative work outcomes, including occupational accidents, absenteeism and presenteeism. © 2010 European Sleep Research Society.

  18. Obstructive sleep apnea and severe mental illness: evolution and consequences.

    Science.gov (United States)

    Lin, Wei-Chen; Winkelman, John W

    2012-10-01

    Sleep complaints are commonly encountered in psychiatric clinics. Underlying medical disorders or sleep disorders need to be identified and treated to optimize treatment of the mental illness. Excessive daytime sleepiness, which is the main symptom of obstructive sleep apnea (OSA), overlaps with those of many severe mental illnesses. Medication side effects or the disorder itself maybe account for daytime sleepiness but comorbid OSA is a possibility that should not be overlooked. The diagnosis of OSA is straightforward but treatment compliance is problematic in psychiatric patients. This article summarizes studies concerning comorbid OSA in patients with severe mental illness and includes suggestions for future investigations.

  19. Cognitive MAC designs for OSA networks

    CERN Document Server

    Derakhshani, Mahsa

    2014-01-01

    This SpringerBrief presents recent advances in the cognitive MAC designs for opportunistic spectrum access (OSA) networks. It covers the basic MAC functionalities and MAC enhancements of IEEE 802.11. Later chapters discuss the existing MAC protocols for OSA and classify them based on characteristic features. The authors provide new research in adaptive carrier sensing-based MAC designs tailored for OSA, which optimize spectrum utilization and ensure a peaceful coexistence of licensed and unlicensed systems. Analytically devised via optimization and game-theoretic approaches, these adaptive M

  20. Obstructive sleep apnea.

    Science.gov (United States)

    White, David P; Younes, Magdy K

    2012-10-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive collapse of the pharyngeal airway during sleep. Control of pharyngeal patency is a complex process relating primarily to basic anatomy and the activity of many pharyngeal dilator muscles. The control of these muscles is regulated by a number of processes including respiratory drive, negative pressure reflexes, and state (sleep) effects. In general, patients with OSA have an anatomically small airway the patency of which is maintained during wakefulness by reflex-driven augmented dilator muscle activation. At sleep onset, muscle activity falls, thereby compromising the upper airway. However, recent data suggest that the mechanism of OSA differs substantially among patients, with variable contributions from several physiologic characteristics including, among others: level of upper airway dilator muscle activation required to open the airway, increase in chemical drive required to recruit the pharyngeal muscles, chemical control loop gain, and arousal threshold. Thus, the cause of sleep apnea likely varies substantially between patients. Other physiologic mechanisms likely contributing to OSA pathogenesis include falling lung volume during sleep, shifts in blood volume from peripheral tissues to the neck, and airway edema. Apnea severity may progress over time, likely due to weight gain, muscle/nerve injury, aging effects on airway anatomy/collapsibility, and changes in ventilatory control stability. © 2012 American Physiological Society

  1. Electrocardiographic changes in obstructive sleep apnea syndrome.

    Science.gov (United States)

    Prakasa, Kalpana; Ahmed, Jehanara; Hasan, Syed; Yousef, Mahmoud; Shridharani, Sachin

    2005-01-01

    The acute electrocardiographic changes during apneic episodes in patients with sleep apnea are well known. Long-term electro-cardiographic changes in these patients are not well studied. We conducted a retrospective case-control study to assess the electrocardiographic changes in African-American patients with established obstructive sleep apnea syndrome (OSA). A significant percentage of patients with OSA had abnormal EKGs as compared to the control group. The effect of sleep apnea on the cardiovascular system is more complex in African-Americans due to higher prevalence of co-morbid conditions. Seventy-three percent of our patients with OSA had metabolic syndrome.

  2. Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers

    Science.gov (United States)

    2015-01-01

    Punjabi , 2008). Prevalence data on OSA are somewhat inconsistent, depending on how the condition is measured (e.g., with gold-standard, in...indicate a 67.8-percent rate of OSA among those referred for diagnostic sleep testing in sleep center settings ( Punjabi , Welch, and Strohl, 2000). In...February 2012, pp. e99–e103. Aurora, R. Nisha, Ciprian Crainiceanu, Brian Caffo, and Naresh M. Punjabi , “Sleep-Disordered Breathing and Caffeine

  3. PALLIATIVE CARE ELDERLY PATIENTS WITH SLEEPING DISORDERS ARE POORLY TREATED

    OpenAIRE

    Bellido-Estevez, Inmaculada

    2015-01-01

    Background: Sleep disorders are frequent in patients with advanced cancer receiving palliative-care, especially in elderly patients (1). Sleep disorders during palliative-care may be related with anxiety, opioids related central-sleep apnoea or corticoids therapy between others (2). Our aim was to quantify the effectiveness of hypnotic medication in the sleep quality in advanced cancer receiving palliative-care elderly patients. Material and methods: A descriptive cross-sectional study was...

  4. Sitting and television viewing: novel risk factors for sleep disturbance and apnea risk? results from the 2013 National Sleep Foundation Sleep in America Poll.

    Science.gov (United States)

    Buman, Matthew P; Kline, Christopher E; Youngstedt, Shawn D; Phillips, Barbara; Tulio de Mello, Marco; Hirshkowitz, Max

    2015-03-01

    Excess sitting is emerging as a novel risk factor for cardiovascular disease, diabetes, mental illness, and all-cause mortality. Physical activity, distinct from sitting, is associated with better sleep and lower risk for OSA, yet relationships among sitting behaviors and sleep/OSA remain unknown. We examined whether total sitting time and sitting while viewing television were associated with sleep duration and quality, OSA risk, and sleepiness. The 2013 National Sleep Foundation Sleep in America Poll was a cross-sectional study of 1,000 adults aged 23 to 60 years. Total sitting time, time watching television while sitting, sleep duration and quality, OSA risk, and daytime sleepiness were assessed. After adjusting for confounding factors (including BMI and physical activity), each additional hour per day of total sitting was associated with greater odds of poor sleep quality (OR [95% CI] = 1.06 [1.01, 1.11]) but not with other sleep metrics (including sleep duration), OSA risk, or daytime sleepiness. For television viewing while sitting, each additional hour per day was associated with greater odds of long sleep onset latency (≥ 30 min) (OR = 1.15 [1.04, 1.27]), waking up too early in the morning (OR = 1.12 [1.03, 1.23]), poor sleep quality (OR = 1.12 [1.02, 1.24]), and "high risk" for OSA (OR = 1.15 [1.04, 1.28]). Based upon an interaction analysis, regular physical activity was protective against OSA risk associated with television viewing (P = .04). Excess sitting was associated with relatively poor sleep quality. Sitting while watching television was associated with relatively poor sleep quality and OSA risk and may be an important risk factor for sleep disturbance and apnea risk.

  5. What is the most important factor affecting the cognitive function of obstructive sleep apnea syndrome patients: a single center study

    OpenAIRE

    LI Xiang; LI Yan-peng; WU Hui-juan; ZHANG Lin; ZHAO Zheng-qing; PENG Hua; ZHAO Zhong-xin

    2013-01-01

    Objective Patients with obstructive sleep apnea syndrome (OSAS) usually complain of daytime hypersomnia and decrease in cognitive function, which affects the quality of their work and life. The reason why the cognitive function of OSAS patients decreased remains controversial. The aim of this study is to evaluate the impairment and the main influencing factors of cognitive function in OSAS. Methods There were totally 50 OSAS patients (OSAS group) and 25 volunteers (control group) included i...

  6. The comparison of nasal surgery and CPAP on daytime sleepiness in patients with OSAS.

    Science.gov (United States)

    Tagaya, M; Otake, H; Suzuki, K; Yasuma, F; Yamamoto, H; Noda, A; Nishimura, Y; Sone, M; Nakashima, T; Nakata, S

    2017-09-01

    Residual sleepiness after continuous positive airway pressure (CPAP) is a critical problem in some patients with obstructive sleep apnea syndrome (OSAS). However, nasal surgery is likely to reduce daytime sleepiness and feelings of unrefreshed sleep. The aim of this study is to clarify the effects of nasal surgery and CPAP on daytime sleepiness. This is a retrospective and matched-case control study. The participants were consecutive 40 patients with OSAS who underwent nasal surgery (Surgery group) and 40 matched patients who were treated with CPAP (CPAP group). In the Surgery group, although the nasal surgery did not decrease either apnea or hypopnea, it improved oxygenation, the quality of sleep. In the CPAP Group, the CPAP treatment reduced apnea and hypopnea, and improved oxygenation, quality of sleep. The degree of relief from daytime sleepiness was different between the two groups. The improvement of Epworth Sleepiness Scale was more significant in the Surgery Group than those in the CPAP Group (Surgery from 11.0 to 5.1, CPAP from 10.0 to 6.2). These findings suggest that the results of the nasal surgery is more satisfactory for some patients with OSAS than CPAP on daytime sleepiness.

  7. Obstructive sleep apnea and cortical thickness in females and males.

    Science.gov (United States)

    Macey, Paul M; Haris, Natasha; Kumar, Rajesh; Thomas, M Albert; Woo, Mary A; Harper, Ronald M

    2018-01-01

    Obstructive sleep apnea (OSA) affects approximately 10% of adults, and alters brain gray and white matter. Psychological and physiological symptoms of the disorder are sex-specific, perhaps related to greater injury occurs in female than male patients in white matter. Our objective was to identify influences of OSA separated by sex on cortical gray matter. We assessed cortical thickness in 48 mild-severe OSA patients (mean age±std[range] = 46.5±9.0[30.8-62.7] years; apnea-hypopnea index = 32.6±21.1[6-102] events/hour; 12 female, 36 male; OSA severity: 5 mild, 18 moderate, 25 severe) and 62 controls (mean age = 47.7±8.9[30.9-65.8] years; 22 female, 40 male). All OSA patients were recently-diagnosed via polysomnography, and control subjects screened and a subset assessed with sleep studies. We used high-resolution magnetic resonance imaging to identify OSA-related cortical thinning, based on a model with condition and sex as independent variables. OSA and OSA-by-sex interaction effects were assessed (Pfrontal lobe in female OSA vs. all other groups. Significant thinning within the pre- and post-central gyri and the superior temporal gyrus, extending into the insula, appeared between the general OSA populations vs. control subjects. No areas showed increased thickness in OSA vs. controls or positive female OSA interaction effects. Reduced cortical thickness likely represents tissue atrophy from long term injury, including death of neurons and supporting glia from repeated intermittent hypoxic exposure in OSA, although disease comordities may also contribute to thinning. Lack of polysomnography in all control subjects means results may be confounded by undiagnosed OSA. The greater cortical injury in cognitive areas of female OSA patients may underlie enhanced symptoms in that group. The thinning associated with OSA in male and females OSA patients may contribute to autonomic dysregulation and impaired upper airway sensori-motor function.

  8. Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

    Science.gov (United States)

    Andrade, Rafaela G S; Viana, Fernanda M; Nascimento, Juliana A; Drager, Luciano F; Moffa, Adriano; Brunoni, André R; Genta, Pedro R; Lorenzi-Filho, Geraldo

    2018-03-01

    Nasal CPAP is the "gold standard" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA. The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" and "CPAP" or "sleep apnea" and "oronasal mask" or "OSA" and "oronasal CPAP" or "oronasal mask" and "adherence." Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article; (2) randomized or nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence. We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P CPAP level, higher residual AHI, and poorer adherence than nasal masks. PROSPERO database; No.: CRD42017064584; URL: https://www.crd.york.ac.uk/prospero/. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  9. Determinants of Unintentional Leaks During CPAP Treatment in OSA.

    Science.gov (United States)

    Lebret, Marius; Arnol, Nathalie; Martinot, Jean-Benoît; Lambert, Loïc; Tamisier, Renaud; Pepin, Jean-Louis; Borel, Jean-Christian

    2018-04-01

    Unintentional leakage from the mouth or around the mask may lead to cessation of CPAP treatment; however, the causes of unintentional leaks are poorly understood. The objectives of this study were (1) to identify determining factors of unintentional leakage and (2) to determine the effect of the type of mask (nasal/oronasal) used on unintentional leakage. Seventy-four polysomnograms from patients with OSA syndrome treated with auto-CPAP were analyzed (23 women; 56 ± 13 years; BMI, 32.9 kg/m 2 (range, 29.0-38.0 kg/m 2 ). Polysomnographic recordings were obtained under auto-CPAP, and mandibular behavior was measured with a magnetic sensor. After sleep and respiratory scoring, polysomnographic signals were computed as mean values over nonoverlapping 10-s intervals. The presence/absence of unintentional leakage was dichotomized for each 10-s interval (yes/no). Univariate and multivariate conditional regression models estimated the risk of unintentional leaks during an interval "T" based on the explanatory variables from the previous interval "T-1." A sensitivity analysis for the type of mask was then conducted. The univariate analysis showed that mandibular lowering (mouth opening), a high level of CPAP, body position (other than supine), and rapid eye movement (REM) sleep increased the risk of unintentional leaks and microarousal decreased it. In the multivariate analysis, the same variables remained independently associated with an increased risk of unintentional leakage. The sensitivity analysis showed that oronasal masks reduced the risk of unintentional leaks in cases of mouth opening and REM sleep. Mouth opening, CPAP level, sleep position, and REM sleep independently contribute to unintentional leakage. These results provide a strong rationale for the definition of phenotypes and the individual management of leaks during CPAP treatment. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  10. AASM standards of practice compliant validation of actigraphic sleep analysis from SOMNOwatch(TM) versus polysomnographic sleep diagnostics shows high conformity also among subjects with sleep disordered breathing

    International Nuclear Information System (INIS)

    Dick, R; Schulz, J; Penzel, T; Fietze, I; Partinen, M; Hein, H

    2010-01-01

    In recent AASM practice, parameter actimetry is cited to measure total sleep time in obstructive sleep apnoea patients, when polysomnography is not available. An actigraph was therefore compared to polysomnographic data in 28 subjects with known sleep disordered breathing. Total sleep time (TST), sleep period time (SPT), sleep efficiency (SE), sustained sleep efficiency (SSE), sleep onset latency (SL) and sleep/wake pattern were compared to gold standard polysomnography. The results of an epoch-by-epoch comparison of sleep/wake from actigraphy to sleep stages from polysomnography gave a sensitivity of 90.2%, a specificity of 95.2% and an overall accuracy of 85.9%. Correlations were moderately strong for SE (0.71, p < 0.001) and SSE (0.65, p < 0.001) and high for TST (0.89, p < 0.001), SPT (0.91, p < 0.001) and SL (0.89, p < 0.001). It was concluded that actigraphy is not identical with PSG recording but gives good results in sleep/wake patterns and predicting TST, SPT, SSE, SE and SL also in sleep apnoea patients not suffering from other sleep disorders. The difficult detection of correct sleep onset causes SSE and SL to be less predictable. Therefore a 15-epoch criterion was introduced and resulted in high correlation of 0.89 for sleep latency, but has to be tested on a bigger population

  11. Effect of Daytime Exercise on Sleep Eeg and Subjective Sleep

    Science.gov (United States)

    Sasazawa, Y.; Kawada, T.; Kiryu, Y.

    1997-08-01

    This study was designed to assess the effects of daytime physical exercise on the quality of objective and subjective sleep by examining all-night sleep EEGs. The subjects were five male students, aged 19 to 20 years, who were in the habit of performing regular daytime exercise. The sleep polygraphic parameters in this study were sleep stage time as a percentage of total sleep time (%S1, %S2, %S(3+4), %SREM, %MT), time in bed (TIB), sleep time (ST), total sleep time (TST), sleep onset latency (SOL), waking from sleep, sleep efficiency, number of awakenings, number of stage shifts, number of spindles, and percentages of α and δ waves, all of which were determined by an automatic computer analysis system. The OSA questionnaire was used to investigate subjective sleep. The five scales of the OSA used were sleepiness, sleep maintenance, worry, integrated sleep feeling, and sleep initiation. Each sleep parameter was compared in the exercise and the non-exercise groups. Two-way analysis of variance was applied using subject factor and exercise factor. The main effect of the subject was significant in all parameters and the main effect of exercise in %S(3+4), SOL and sleep efficiency, among the objective sleep parameters. The main effects of the subject, except sleepiness, were significant, as was the main effect of exercise on sleep initiation, among the subjective sleep parameters. These findings suggest that daytime exercise shortened sleep latency and prolonged slow-wave sleep, and that the subjects fell asleep more easily on exercise days. There were also significant individual differences in both the objective and subjective sleep parameters.

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

    Science.gov (United States)

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

    2016-03-01

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

  13. Real Time Apnoea Monitoring of Children Using the Microsoft Kinect Sensor: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ali Al-Naji

    2017-02-01

    Full Text Available The objective of this study was to design a non-invasive system for the observation of respiratory rates and detection of apnoea using analysis of real time image sequences captured in any given sleep position and under any light conditions (even in dark environments. A Microsoft Kinect sensor was used to visualize the variations in the thorax and abdomen from the respiratory rhythm. These variations were magnified, analyzed and detected at a distance of 2.5 m from the subject. A modified motion magnification system and frame subtraction technique were used to identify breathing movements by detecting rapid motion areas in the magnified frame sequences. The experimental results on a set of video data from five subjects (3 h for each subject showed that our monitoring system can accurately measure respiratory rate and therefore detect apnoea in infants and young children. The proposed system is feasible, accurate, safe and low computational complexity, making it an efficient alternative for non-contact home sleep monitoring systems and advancing health care applications.

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

    Science.gov (United States)

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

    2015-08-15

    To determine whether obstructive sleep apnea syndrome (OSAS) patients with mixed sleep apnea (MSA) have different clinical, polysomnographic, and continuous positive airway pressure (CPAP) titration findings compared to OSAS patients without MSA. We retrospectively reviewed the records of OSAS patients who had undergone CPAP titration and categorized them into pure-OSA and mixed-OSA groups. Demographic features, daytime sleepiness, and apnea severity were compared between the two groups using univariate and multivariate analyses. CPAP titration findings were also compared between the two groups. One hundred and ninety-five subjects (n=126 pure-OSA; n=69 mixed-OSA) were included in the analysis. Compared to the pure-OSA group, the mixed-OSA group had a higher percentage of males (p=0.003) and a higher body mass index (p=0.044), Epworth Sleepiness Scale score (p=0.028), and apnea-hypopnea index (AHI) (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.

  15. Hipersonolência diurna e variáveis polissonográficas em doentes com síndroma de apneia do sono Daytime sleepiness and polysomnographic variables in sleep apnoea patients

    Directory of Open Access Journals (Sweden)

    O Mediano

    2007-12-01

    indivíduos sofria de doença crónica, nomeadamente DPOC, cirrose hepática, disfunção tiroideia, artrite reumatóide, insuficiência renal crónica ou fazia qualquer tipo de medicação. O diagnóstico de SAOS foi estabelecido por polissonografia nocturna com registo de múltiplas variáveis, como sejam electroencefalograma (EEG, electromiograma (EMG mentoniano, electrooculograma, fluxo oronasal, movimentos toracoabdominais e oximetria de fluxo. Apneia foi definida como a interrupção de fluxo oronasal >10s e hipopneia como uma redução >50% do fluxo por um período >10s associado a uma descida >4% da SaO2 ou despertar. O índice de apneia/hipopneia (IAH consiste no somatório do número de apneias e hipopneias por hora de sono. Os estádios do sono foram classificados de acordo com os critérios de Rechtschoffen e Kales. A latência do sono foi definida como o período compreendido entre o acto de deitar e os primeiros 30s do estádio I e a eficiência do sono como a duração do sono nocturno expressa como percentagem do tempo total de permanência no leito. De acordo com os critérios da American Sleep Disorders Association Task Force, os despertares foram definidos como despertares de origem respiratória quando ocorriam 3s após uma apneia, hipopneia ou ressonar, sabendo que existem outros tipos de despertares (espontâneos, relacionados com os movimentos periódicos dos membros e técnicos. O total de despertares foi determinado pela soma de cada tipo dos mesmos. A hipersonolência subjectiva foi avaliada utilizando a ESE constituída por 8 itens a que são atribuídos um score de 0 a 3. A avaliação objectiva é obtida através do teste de latência múltipla de acordo com as guidelines internacionais. Um score 10 min a sua ausência. Foram estudados, no total, 23 indivíduos do sexo masculino com hipersonolência diurna (ESE: 17±3; teste latência múltipla: 4±1 min e 17 sem sonolência excessiva (ESE: 5±2 e teste latência: 16±3 min. Ambos os grupos

  16. Obstructive sleep apnea

    DEFF Research Database (Denmark)

    Jennum, Poul; Tønnesen, Philip; Ibsen, Rikke

    2017-01-01

    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...

  17. Obstructive Sleep Apnea during REM Sleep and Cardiovascular Disease.

    Science.gov (United States)

    Aurora, R Nisha; Crainiceanu, Ciprian; Gottlieb, Daniel J; Kim, Ji Soo; Punjabi, Naresh M

    2018-03-01

    Obstructive sleep apnea (OSA) during REM sleep is a common disorder. Data on whether OSA that occurs predominantly during REM sleep is associated with health outcomes are limited. The present study examined the association between OSA during REM sleep and a composite cardiovascular endpoint in a community sample with and without prevalent cardiovascular disease. Full-montage home polysomnography was conducted as part of the Sleep Heart Health Study. The study cohort was followed for an average of 9.5 years, during which time cardiovascular events were assessed. Only participants with a non-REM apnea-hypopnea index (AHI) of less than 5 events/h were included. A composite cardiovascular endpoint was determined as the occurrence of nonfatal or fatal events, including myocardial infarction, coronary artery revascularization, congestive heart failure, and stroke. Proportional hazards regression was used to derive the adjusted hazards ratios for the composite cardiovascular endpoint. The sample consisted of 3,265 subjects with a non-REM AHI of less than 5.0 events/h. Using a REM AHI of less than 5.0 events/h as the reference group (n = 1,758), the adjusted hazards ratios for the composite cardiovascular endpoint in those with severe REM OSA (≥30 events/h; n = 180) was 1.35 (95% confidence interval, 0.98-1.85). Stratified analyses demonstrated that the association was most notable in those with prevalent cardiovascular disease and severe OSA during REM sleep with an adjusted hazards ratio of 2.56 (95% confidence interval, 1.46-4.47). Severe OSA that occurs primarily during REM sleep is associated with higher incidence of a composite cardiovascular endpoint, but in only those with prevalent cardiovascular disease.

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

    Science.gov (United States)

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

    2017-03-01

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

  19. Influencing factors on CPAP adherence and anatomic characteristics of upper airway in OSA subjects.

    Science.gov (United States)

    Park, Pona; Kim, Jinil; Song, Yoon Jae; Lim, Jae Hyun; Cho, Sung Woo; Won, Tae-Bin; Han, Doo Hee; Kim, Dong-Young; Rhee, Chae Seo; Kim, Hyun Jik

    2017-12-01

    Although continuous positive airway pressure (CPAP) is the most effective treatment modality, poor adherence still remains a problem for obstructive sleep apnea (OSA) treatment and there is little evidence regarding how this might be improved. This study aims to analyze the anatomic and clinical factors of OSA subjects who failed to comply with CPAP therapy.The medical records of 47 OSA subjects who received CPAP therapy as a first-line treatment modality were retrospectively reviewed. The medical records were reviewed for demographic and polysomnographic data and anatomic findings of the nasal cavity and oropharynx.24 patients who adhered to CPAP therapy and 23 patients who were nonadherent were enrolled in the study. There were no statistically significant differences in sleep parameters between CPAP-adherent patients and CPAP nonadherent subjects. Mean body mass index of CPAP nonadherent group was significantly higher than CPAP adherent group. Higher grades of septal deviation and hypertrophic change of the inferior turbinate were observed more in the CPAP nonadherent group. In addition, CPAP nonadherent subjects showed considerably bigger tonsils and higher grade palatal position comparing with the CPAP adherent subjects. Subjective discomfort including inconvenience, mouth dryness, and chest discomfort were the main problems for OSA subjects who did not comply with CPAP therapy.Excessive upper airway blockage in the nasal cavity and oropharynx was predominant in CPAP nonadherent subjects, which might cause the reported subjective discomfort that reduces CPAP compliance. Therefore, resolution of these issues is needed to enhance CPAP compliance for control of OSA. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  20. Childhood Obesity and Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Indra Narang

    2012-01-01

    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.

  1. online-osa festivalil / Tiia Johannson

    Index Scriptorium Estoniae

    Johannson, Tiia, 1965-2002

    1998-01-01

    Prantsusmaa, Balti ja Põhjamaade video ja uue meedia festival "offline@online" Eesti Kunstiakadeemias. Ka eesti netikunstist, festivali korralduslikust küljest, tulevikuplaanidest. Erilist äramärkimist leidis sloveenia kunstniku Vuk Cosici töö "ascii history of moving images", online-presentatsioonide osas Lev Manovichi teoreetiline loeng "Uue meedia keel". Aadress festivali netikunsti vaatamiseks

  2. [Obesity and obstructive sleep apnea in children].

    Science.gov (United States)

    Amaddeo, A; de Sanctis, L; Olmo Arroyo, J; Giordanella, J-P; Monteyrol, P-J; Fauroux, B

    2017-02-01

    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.

  3. Increased MCP-1 gene expression in monocytes of severe OSA patients and under intermittent hypoxia.

    Science.gov (United States)

    Chuang, Li-Pang; Chen, Ning-Hung; Lin, Yuling; Ko, Wen-Shan; Pang, Jong-Hwei S

    2016-03-01

    Obstructive sleep apnea (OSA) is known to be a risk factor of coronary artery disease. Monocyte chemoattractant protein-1 (MCP-1), as a critical factor for monocyte infiltration, is known to play a role in the development of atherosclerosis. This study aimed to investigate the effect of intermittent hypoxia, the hallmark of OSA, on the MCP-1 expression of monocytes. Peripheral blood was sampled from 61 adults enrolled for suspected OSA. RNA was prepared from the isolated monocytes for the analysis of MCP-1. The effect of in vitro intermittent hypoxia on the regulation and function of MCP-1 was investigated on THP-1 monocytic cells and human monocytes. The mRNA and secreted protein levels were investigated by RT/real-time PCR and enzyme-linked immunosorbent assay, respectively. Monocytic MCP-1 gene expression was found to be increased significantly in severe OSA patients. In vitro intermittent hypoxia was demonstrated to increase the mRNA and protein expression levels of MCP-1 dose- and time-dependently in THP-1 monocytic cells. The MCP-1 mRNA expression in monocytes isolated from OSA patient was induced to a much higher level compared to that from normal control. Pre-treatment with inhibitor for p42/44 MAPK or p38 MAPK suppressed the activation of MCP-1 expression by intermittent hypoxia. This is the first study to demonstrate the increase of MCP-1 gene expression in monocytes of severe OSA patients. In addition, monocytic MCP-1 gene expression can be induced under intermittent hypoxia.

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

    Science.gov (United States)

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

    2014-10-01

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

  5. Prevalence of obstructive sleep apnea in patients with chronic wounds.

    Science.gov (United States)

    Patt, Brian T; Jarjoura, David; Lambert, Lynn; Roy, Sashwati; Gordillo, Gayle; Schlanger, Richard; Sen, Chandan K; Khayat, Rami N

    2010-12-15

    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. 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. 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. 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.

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

    Directory of Open Access Journals (Sweden)

    Luciana Balester Mello de Godoy

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

  7. OSA – a risk factor for stroke

    Directory of Open Access Journals (Sweden)

    Ryan CM

    2011-12-01

    Full Text Available Clodagh M RyanCentre for Sleep Health and Research, University of Toronto/Toronto General Hospital, Toronto, CanadaAbstract: Obstructive sleep apnea is a sleep breathing disorder characterized by recurrent and intermittent hypoxia with continued respiratory effort against a closed glottis. The result of this is a cascade of acute and chronic systemic pathophysiological responses that cause endothelial dysfunction, atherosclerosis and lead to cardiovascular and cerebrovascular disease. This article focuses on the clinical evidence linking obstructive sleep apnea and stroke and on the specific mechanisms perpetuating stroke risk in this population.Keywords: stroke, obstructive sleep apnea, brain injury, atherosclerosis, continuous positive airway pressure, outcomes

  8. Treatment of Obstructive Sleep Apnea Using Temporary Mandible Advancement Device: A Case Report

    Directory of Open Access Journals (Sweden)

    Young-Chan Choi

    2015-06-01

    Full Text Available Obstructive sleep apnea (OSA is the most prevalent type of sleep apnea, and oral appliance may be one of the options for treatment of OSA. But, the problems with the oral appliance are high cost, possible low compliance, and complications such as temporomandibular disorder. In this article, we described a severe OSA case that was successfully improved by using temporary mandible advancement device, which was designed for therapeutic effect of mandible advancement with low cost and simplified fabrication procedure.

  9. Sleep-dependent memory consolidation in patients with sleep disorders.

    Science.gov (United States)

    Cipolli, Carlo; Mazzetti, Michela; Plazzi, Giuseppe

    2013-04-01

    Sleep can improve the off-line memory consolidation of new items of declarative and non-declarative information in healthy subjects, whereas acute sleep loss, as well as sleep restriction and fragmentation, impair consolidation. This suggests that, by modifying the amount and/or architecture of sleep, chronic sleep disorders may also lead to a lower gain in off-line consolidation, which in turn may be responsible for the varying levels of impaired performance at memory tasks usually observed in sleep-disordered patients. The experimental studies conducted to date have shown specific impairments of sleep-dependent consolidation overall for verbal and visual declarative information in patients with primary insomnia, for verbal declarative information in patients with obstructive sleep apnoeas, and for visual procedural skills in patients with narcolepsy-cataplexy. These findings corroborate the hypothesis that impaired consolidation is a consequence of the chronically altered organization of sleep. Moreover, they raise several novel questions as to: a) the reversibility of consolidation impairment in the case of effective treatment, b) the possible negative influence of altered prior sleep also on the encoding of new information, and c) the relationships between altered sleep and memory impairment in patients with other (medical, psychiatric or neurological) diseases associated with quantitative and/or qualitative changes of sleep architecture. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Detecting obstructive sleep apnea in children by self-affine visualization of oximetry

    NARCIS (Netherlands)

    Garde, Ainara; Dekhordi, Parastoo; Petersen, Christian L.; Ansermino, John Mark; Dumont, Guy A.

    2017-01-01

    Obstructive sleep apnea (OSA), characterized by cessations of breathing during sleep due to upper airway collapse, can affect the healthy growth and development of children. The gold standard for OSA diagnosis, polysomnography (PSG), is expensive and resource intensive, resulting in long waiting

  11. Review of and Updates on Hypertension in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Masood Ahmad

    2017-01-01

    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.

  12. [Mandibular advancement devices in the treatment of obstructive sleep apnea].

    Science.gov (United States)

    Korczyński, Piotr; Górska, Katarzyna; Wilk, Krzysztof; Bielicki, Piotr; Byśkiniewicz, Krzysztof; Baczkowski, Tadeusz

    2004-12-01

    Obstructive sleep apnea (OSA) affects approximately 450,000 people in Poland. Use of nasal continuous positive airway pressure (nCPAP) devices and laryngeal surgery are widely accepted OSA treatment methods. In 1995 ASDA approved oral devices for treatment of OSA patients. The aim of the study was to determine efficiency of mandibular advancement devices (MAD) in OSA therapy. The study group included 20 patients with OSA, all of whom did not tolerate nCPAP and did not have indications or did not agree for surgical treatment. Control polysomnography was carried out in 11 patients using MAD. In 64% of patients AHI was lower then 10. No correlation between MAD use and AHI values was found. 45% of patients declared improvement of sleep quality and life comfort. Use of mandibular advancement devices is an important alternative therapy of OSA.

  13. Specific insomnia symptoms and self-efficacy explain CPAP compliance in a sample of OSAS patients.

    Science.gov (United States)

    Philip, Pierre; Bioulac, Stéphanie; Altena, Elemarije; Morin, Charles M; Ghorayeb, Imad; Coste, Olivier; Monteyrol, Pierre-Jean; Micoulaud-Franchi, Jean-Arthur

    2018-01-01

    This study explores the association between specific insomnia symptoms (sleep onset, sleep maintenance and early morning awakenings symptoms) and self-efficacy (perceived self-confidence in the ability to use CPAP) with CPAP compliance in French patients with obstructive sleep apnea syndrome (OSAS). We performed a retrospective, cross-sectional analysis of CPAP compliance in a cohort of 404 patients diagnosed with OSAS. Patients completed mailed questionnaires on sleepiness (ESS), insomnia (ISI) and self-efficacy in sleep apnea (SEMSA). Linear regression modeling analyses were performed to explore the impact of measured variables on the number of hours of CPAP use. Of the initial pool of 404 patients, 288 returned the questionnaires (71% response rate). Their mean age was 63.16±12.73 yrs, 31% were females, mean BMI was 30.39±6.31 kg/m2, mean daily CPAP use was 6.19±2.03 h, mean number of years of use was 6.58±6.03 yrs, and mean initial AHI before CPAP use was 34.61±20.71 /h. Age (pCPAP use. We found that specific insomnia symptoms and self-efficacy were associated with CPAP compliance. Our findings underline the need to demonstrate that interventions that reduce insomnia symptoms and improve self-efficacy will increase CPAP compliance.

  14. High versus standard dose caffeine for apnoea: a systematic review

    NARCIS (Netherlands)

    Vliegenthart, Roos; Miedema, Martijn; Hutten, Gerard J.; van Kaam, Anton H.; Onland, Wes

    2018-01-01

    Placebo-controlled trials have shown that caffeine is highly effective in treating apnoea of prematurity and reduces the risk of bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI). To identify, appraise and summarise studies investigating the modulating effect of different

  15. Continuous Positive Airway Pressure Prevents Hypoxia in Dental Patient with Obstructive Sleep Apnea Syndrome under Intravenous Sedation.

    Science.gov (United States)

    Kasatkin, Anton A; Reshetnikov, Aleksei P; Urakov, Aleksandr L; Baimurzin, Dmitrii Y

    2017-01-01

    Use of sedation in patients with obstructive sleep apnea (OSA) in dentistry is limited. Hypoxia may develop during medication sleep in dental patients with OSA because of repetitive partial or complete obstruction of the upper airway. In this regard, anesthesiologists prefer not to give any sedative to surgical patients with OSA or support the use of general anesthesia due to good airway control. We report a case where we could successfully sedate a dental patient with OSA using intraoperative continuous positive airway pressure (CPAP) without hypoxia. Use of sedation and intraoperative CPAP in patients with OSA may be considered only if the effectiveness at home CPAP therapy is proven.

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

    Science.gov (United States)

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

    2016-01-01

    To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS), mild Obstructive Sleep Apnea (OSA) and normal individuals. UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale-ESS-≥ 10) and/or fatigue (Modified Fatigue Impact Scale-MFIS-≥ 38) associated to Apnea/hypopnea index (AHI) ≤ 5 and Respiratory Disturbance Index (RDI) > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10) and/or fatigue (MFIS ≥ 38) associated to AHI ≥ 5 and ≤ 15 events/hour. "Control group" criteria were AHI sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in "control group"), adjusted for age, gender, body mass index (BMI) and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT) was performed five times (each two hours) from 8 a.m. to 4 p.m. UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire-FOSQ-and Pittsburgh Sleep Quality Index-PSQI: p sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.

  17. Obstructive Sleep Apnea Screening Using a Piezo-Electric Sensor.

    Science.gov (United States)

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

    2017-06-01

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

  18. [Quality of life in patients with obstructive sleep apnea].

    Science.gov (United States)

    Kasibowska-Kuźniar, Kamilla; Jankowska, Renata; Kuźniar, Tomasz

    2004-11-01

    Obstructive sleep apnea syndrome (OSA) is a condition affecting up to 5% of the population, in which episodes of upper airway obstruction lead to temporary cessation of airflow, disturbed sleep architecture and daily somnolence. The health consequences of OSA also include psychological and cognitive deficits, an increased risk of systemic and pulmonary hypertension, coronary disease, bradyarrhythmias and motor vehicle accidents. Symptoms and complications of OSA lead to a significant decrease of health-related quality of life (HRQOL) of affected patients. We review the current literature on HRQOL effects of OSA and its treatment. There is good evidence of beneficial effect of the continuous positive airway pressure (CPAP) therapy on the quality of life of patients with OSA. Improvements in HRQOL are most appreciable in patients with moderate to severe OSA, although they also seem to be present in selected patients with mild OSA. The effects of dental devices and surgical procedures on HRQOL of patients with OSA have not been studied in randomized, placebo-controlled trials. Health-related quality of life has become one of the major outcome measures in patients with sleep apnea. Assessment of HRQOL has become a crucial part of any clinical study involving patients with OSA.

  19. Obstructive sleep apnea: management considerations in psychiatric patients

    Directory of Open Access Journals (Sweden)

    Heck T

    2015-10-01

    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

  20. Pulmonary hypertension and echocardiogram parameters in obstructive sleep apnea.

    Science.gov (United States)

    Wong, H T; Chee, K H; Chong, A W

    2017-06-01

    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.

  1. Obstructive Sleep Apnea in MPS

    Directory of Open Access Journals (Sweden)

    Abhijit Ricky Pal MBBChir, MA, MD, FRCS(ORL-HNS

    2015-11-01

    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.

  2. Impact of obstructive sleep apnea and snoring on left ventricular ...

    African Journals Online (AJOL)

    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 ...

  3. Prospective assessment of the risk of obstructive sleep apnea in ...

    African Journals Online (AJOL)

    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 ...

  4. Obstructive sleep apnea syndrome and erectile dysfunction: does ...

    African Journals Online (AJOL)

    Objectives: The aim of this age-matched, controlled, prospective clinical study was to investigate frequency and degree of erectile dysfunction (ED) in patients with obstructive sleep apnea syndrome (OSAS) and to evaluate the results of only continuous positive airway pressure (CPAP) therapy on ED in patients with OSAS.

  5. Associations between sleep duration, sleep quality and diabetic retinopathy.

    Directory of Open Access Journals (Sweden)

    Nicholas Y Q Tan

    Full Text Available Abnormal durations of sleep have been associated with risk of diabetes. However, it is not clear if sleep duration is associated with diabetic retinopathy (DR.In a cross-sectional study, we included 1,231 (Malay, n = 395; Indian, n = 836 adults (mean age 64.4 ± 9.0 years, 50.4% female with diabetes from the second visit of two independent population-based cohort studies (2011-15 in Singapore. Self-reported habitual sleep duration was categorized as short (<6 h, normal (6≤ h <8, and long (≥8 h. Questionnaires were administered to detect risk of obstructive sleep apnea (OSA, excessive daytime sleepiness, and insomnia, all of which may indicate poor quality of sleep. The associations between sleep-related characteristics with moderate DR and vision-threatening DR (VTDR were analysed using logistic regression models adjusted for potential confounders.Prevalence of moderate DR and VTDR in the study population were 10.5% and 6.3% respectively. The mean duration of sleep was 6.4 ± 1.5 h. Compared to normal sleep duration, both short and long sleep durations were associated with moderate DR with multivariable odds ratio (95% confidence interval of 1.73 (1.03-2.89 and 2.17 (1.28-3.66 respectively. Long sleep duration (2.37 [1.16-4.89], high risk of OSA (2.24 [1.09-4.75], and excessive daytime sleepiness (3.27 [1.02-10.30] were separately associated with VTDR.Sleep duration had a U-shaped association with moderate DR; long sleep duration, excessive daytime sleepiness and high risk of OSA were positively associated with VTDR.

  6. Continuous positive airway pressure for the treatment of obstructive sleep apnea.

    Science.gov (United States)

    Nurwidya, Fariz; Susanto, Agus Dwi; Juzar, Dafsah A; Kobayashi, Isao; Yunus, Faisal

    2016-01-01

    Obstructive sleep apnea (OSA) is a recurrent episode of partial or complete upper airway obstruction during sleep despite ongoing respiratory efforts and is implicated as the risk factor of cardiovascular disease. The OSA syndrome is typified by recurring partial or total occlusion of the pharynx, sleep fragmentation, episodes of gasping, and, eventually, daytime sleepiness. If it is left untreated, OSA syndrome can cause hypertension, coronary artery disease congestive heart disease, insulin resistance and death. In this review, we describe the pathogenesis and diagnosis of OSA. We also focused on the continuous positive airway pressure (CPAP) as the main therapy for OSA. CPAP has been shown to provide benefit for not only respiratory system, but also for cardiovascular system and metabolic system. Finally, we discussed briefly about the issue of adherence of using CPAP that could contribute to lower compliant in patient with OSA.

  7. Management of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2014-03-01

    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

  8. Self-Reported Sleep Bruxism and Nocturnal Gastroesophageal Reflux Disease in Patients with Obstructive Sleep Apnea: Relationship to Gender and Ethnicity§

    OpenAIRE

    Hesselbacher, Sean; Subramanian, Shyam; Rao, Shweta; Casturi, Lata; Surani, Salim

    2014-01-01

    Study Objectives : Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethn...

  9. Upper airway sensory function in children with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Tapia, Ignacio E; Bandla, Preetam; Traylor, Joel; Karamessinis, Laurie; Huang, Jingtao; Marcus, Carole L

    2010-07-01

    Children with the obstructive sleep apnea syndrome (OSAS) have impaired responses to hypercapnia, subatmospheric pressure, and inspiratory resistive loading during sleep. This may be due, in part, to an impairment in the afferent limb of the upper airway sensory pathway. Therefore, we hypothesized that children with OSAS had diminished upper airway sensation compared to controls. Case-control. Academic hospital. Subjects with OSAS aged 6-16 years, and age- and BMI-matched controls. Two-point discrimination (TPD) was measured during wakefulness with modified calipers in the anterior tongue, right interior cheek, and hard palate. Thirteen children with OSAS and 9 controls were tested. The age (mean +/- SD) for OSAS and controls was 11 +/- 4 vs. 13 +/- 2 years (NS); OSAS BMI Z score 2.4 +/- 0.5, controls 2.2 +/- 0.5 (NS); OSAS apnea hypopnea index 31 +/- 48, controls 0.4 +/- 0.5 events/hour (P Children with OSAS had impaired TPD in the anterior tongue (median [range]) = 9 [3-14] mm, controls 3 [1-7], P = 0.002) and hard palate (OSAS 6 [3-9] mm, controls 3 [1-4], P children with OSAS during wakefulness. We speculate that this impairment might be due to a primary sensory function abnormality or secondary to nerve damage and/or hypoxemia caused by OSAS. Further studies after treatment of OSAS are needed.

  10. The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation.

    Science.gov (United States)

    Desteghe, Lien; Hendriks, Jeroen M L; McEvoy, R Doug; Chai-Coetzer, Ching Li; Dendale, Paul; Sanders, Prashanthan; Heidbuchel, Hein; Linz, Dominik

    2018-04-12

    Sleep apnea is associated with increased cardiovascular risk and may be important in atrial fibrillation (AF) management. It is present in up to 62% of the AF population and is highly under-recognized and underdiagnosed. Obstructive sleep apnea (OSA) is strongly associated with AF and non-randomized trials have shown that its treatment can help to reduce AF recurrences and maintain sinus rhythm. The 2016 European Society of Cardiology guidelines for the management of AF recommend that AF patients should be questioned regarding the symptoms of OSA and that OSA-treatment should be optimized to improve AF treatment results. However, strategies on how to implement OSA testing in the standard work-up of AF patients are not provided in the guidelines. Additionally, overnight OSA monitoring rather than interrogation for OSA-related clinical signs alone may be necessary to reliably identify OSA in the majority of AF patients. This review summarizes the available clinical data on OSA in AF patients, and discusses the following key questions: Why and When is testing for OSA needed in AF patients? How and Where should it be performed and coordinated? and Who should test for OSA? To implement OSA testing in a cardiology or electrophysiology clinic, we propose a multidisciplinary integrated care approach based on a chronic care model. We describe the tools, infrastructure and coordination needed to test for OSA in the standard workup of patients with symptomatic AF prior to the initiation of directed invasive or pharmacological rhythm control management.

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

    Science.gov (United States)

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

    2014-11-01

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

  12. Respiratory and sleep disorders in female children with atypical Rett syndrome caused by mutations in the CDKL5 gene.

    Science.gov (United States)

    Hagebeuk, Eveline E O; van den Bossche, Renilde A S; de Weerd, Al W

    2013-05-01

    In female children with drug-resistant seizures and developmental delay from birth, atypical Rett syndrome caused by mutations in the CDKL5 gene should be considered. Several clinical features resemble classic Rett syndrome. Respiratory and sleep abnormalities are frequently present in Rett syndrome, whereas little is known in patients with CDKL5 mutations. In four genetically confirmed female patients with CDKL5 mutations (age range 2-15 y), the presence of breathing and sleep abnormalities was evaluated using the validated Sleep Disturbance Scale for Children and polysomnography (PSG). The Sleep Disturbance Scale for Children indicated disorders of initiating and maintaining sleep, daytime somnolence, and sleep breathing disorders. In one patient, PSG showed central apnoeas during sleep: her total apnoea-hypopnoea index (AHI) was 4.9, of which the central AHI was 3.4/h. When awake, central apnoeas were present in two of the four female children (central AHI 28/h and 41/h respectively), all preceded by hyperventilation. PSG showed low rapid eye movement (REM) sleep (9.7-18.3%), frequent awakenings, and low sleep efficiency (range 59-78%). Episodic hyperventilation followed by central apnoeas was present while awake in two of four patients. This may indicate failure of brainstem respiratory centres. In addition, low REM sleep, frequent arousals (not caused by apnoeas/seizures), and low sleep efficiency were present. Similar to Rett syndrome, in patients with CDKL5 mutations PSG seems warranted to evaluate breathing and sleep disturbances. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

  13. Gastroesophageal reflux disease: recent advances and its association with sleep.

    Science.gov (United States)

    Oh, Jung Hwan

    2016-09-01

    Gastroesophageal reflux disease (GERD) is prevalent in Asia as well as in Western countries. Sleep disturbance and breathing disorders during sleep are becoming increasingly prevalent, and they are commonly associated with GERD. The relationship between GERD and obstructive sleep apnea (OSA) is still questionable, and it has expanded to include Barrett's esophagus. Nocturnal gastroesophageal reflux (nGER) symptoms might be clinically important in the explanation of this association. The therapy for reflux symptoms has resulted in improved subjective sleep parameters and enhanced sleep quality, thus supporting a direct relationship between GERD and sleep disturbance. This review discusses the epidemiology of sleep disturbances in GERD patients; the causative relationship between GERD and OSA, even though it remains an area of controversy; and the possible role of nGER in sleep problems. It also provides an update on the current state of knowledge linking GERD and sleep. © 2016 New York Academy of Sciences.

  14. Development of Home-Based Sleep Monitoring System for Obstructive Sleep Apnea.

    Science.gov (United States)

    Wu, Peirong; Chen, Guan-Ting; Cui, Yanyan; Li, Jin-Wei; Kuo, Terry B J; Chang, Polun

    2017-01-01

    Obstructive Sleep Apnea (OSA) has been proven to increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes. If people would like to know whether they are suffering from this sleep disorder, they need to go to particular hospital with which a sleep center that could perform polysomnography (PSG); however, for most people, this is not convenient. Consequently, the goal of this study is to develop a convenient, lower priced, and easy-to-use home-based sleep monitoring system. The researchers have developed the "Sleep Healthcare Management System" for OSA patients and healthcare providers. It combines smartphone and wearable devices that can perform real-time sleep monitoring. Healthcare providers could apply their professional knowledge to provide customized feedback via a web application. When the patient is diagnosed with an abnormal sleep health condition, healthcare providers may be able to provide appropriate and timely care.

  15. Medical Cannabis and the Treatment of Obstructive Sleep Apnea: An American Academy of Sleep Medicine Position Statement.

    Science.gov (United States)

    Ramar, Kannan; Rosen, Ilene M; Kirsch, Douglas B; Chervin, Ronald D; Carden, Kelly A; Aurora, R Nisha; Kristo, David A; Malhotra, Raman K; Martin, Jennifer L; Olson, Eric J; Rosen, Carol L; Rowley, James A

    2018-03-30

    The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have differential effects, with variable efficacy and side effects in the treatment of OSA. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety. OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs, and patients with OSA should discuss their treatment options with a licensed medical provider at an accredited sleep facility. Further research is needed to understand the functionality of medical cannabis extracts before recommending them as a treatment for OSA. Copyright © 2018 American Academy of Sleep Medicine. All rights reserved.

  16. High risk for obstructive sleep apnea and other sleep disorders among overweight and obese pregnant women.

    Science.gov (United States)

    Rice, Jayne R; Larrabure-Torrealva, Gloria T; Luque Fernandez, Miguel Angel; Grande, Mirtha; Motta, Vicky; Barrios, Yasmin V; Sanchez, Sixto; Gelaye, Bizu; Williams, Michelle A

    2015-09-02

    Obstructive sleep apnea (OSA), a common and serious disorder in which breathing repeatedly stops during sleep, is associated with excess weight and obesity. Little is known about the co-occurrence of OSA among pregnant women from low and middle-income countries. We examined the extent to which maternal pre-pregnancy overweight or obesity status are associated with high risk for OSA, poor sleep quality, and excessive daytime sleepiness in 1032 pregnant women in Lima, Peru. The Berlin questionnaire was used to identify women at high risk for OSA. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to examine sleep quality and excessive daytime sleepiness, respectively. Multinomial logistic regression procedures were employed to estimate odds ratios (aOR) and 95% confidence intervals (CI) adjusted for putative confounding factors. Compared with lean women (overweight women (25-29.9 kg/m(2)) had 3.69-fold higher odds of high risk for OSA (95% CI 1.82-7.50). The corresponding aOR for obese women (≥30 kg/m(2)) was 13.23 (95% CI: 6.25-28.01). Obese women, as compared with their lean counterparts had a 1.61-fold higher odds of poor sleep quality (95% CI: 1.00-2.63). Overweight or obese pregnant women have increased odds of sleep disorders, particularly OSA. OSA screening and risk management may be indicated among pregnant women in low and middle income countries, particularly those undergoing rapid epidemiologic transitions characterized by increased prevalence of excessive adult weight gain.

  17. Airway inflammation in patients affected by obstructive sleep apnea syndrome.

    Science.gov (United States)

    Salerno, F G; Carpagnano, E; Guido, P; Bonsignore, M R; Roberti, A; Aliani, M; Vignola, A M; Spanevello, A

    2004-01-01

    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.

  18. The roles of dentisty in obstructive sleep apnea syndrome

    International Nuclear Information System (INIS)

    Kikuchi, Makoto; Higurashi, Naoki; Miyazaki, Soichiro

    2007-01-01

    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)

  19. Respiratory flow-sound relationship during both wakefulness and sleep and its variation in relation to sleep apnea.

    Science.gov (United States)

    Yadollahi, Azadeh; Montazeri, Aman; Azarbarzin, Ali; Moussavi, Zahra

    2013-03-01

    Tracheal respiratory sound analysis is a simple and non-invasive way to study the pathophysiology of the upper airway and has recently been used for acoustic estimation of respiratory flow and sleep apnea diagnosis. However in none of the previous studies was the respiratory flow-sound relationship studied in people with obstructive sleep apnea (OSA), nor during sleep. In this study, we recorded tracheal sound, respiratory flow, and head position from eight non-OSA and 10 OSA individuals during sleep and wakefulness. We compared the flow-sound relationship and variations in model parameters from wakefulness to sleep within and between the two groups. The results show that during both wakefulness and sleep, flow-sound relationship follows a power law but with different parameters. Furthermore, the variations in model parameters may be representative of the OSA pathology. The other objective of this study was to examine the accuracy of respiratory flow estimation algorithms during sleep: we investigated two approaches for calibrating the model parameters using the known data recorded during either wakefulness or sleep. The results show that the acoustical respiratory flow estimation parameters change from wakefulness to sleep. Therefore, if the model is calibrated using wakefulness data, although the estimated respiratory flow follows the relative variations of the real flow, the quantitative flow estimation error would be high during sleep. On the other hand, when the calibration parameters are extracted from tracheal sound and respiratory flow recordings during sleep, the respiratory flow estimation error is less than 10%.

  20. Health Promotion in Obstructive Sleep Apnea Syndrome

    Directory of Open Access Journals (Sweden)

    Corrêa, Camila de Castro

    2015-01-01

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

  1. Influence of obstructive sleep apnea on fatty liver disease: role of chronic intermittent hypoxia.

    Science.gov (United States)

    Türkay, Cansel; Ozol, Duygu; Kasapoğlu, Benan; Kirbas, Ismail; Yıldırım, Zeki; Yiğitoğlu, Ramazan

    2012-02-01

    Currently the common pathogenetic mechanisms in nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) are gaining increased attention. The aim of this study is to find out the influence of chronic intermittent hypoxemia and OSA related parameters to the severity of NAFLD. We examined the liver functions tests and ultrasonographic data of liver as well as markers of OSA severity (apnea-hypopnea index [AHI], oxygen desaturation index, minimum oxygen saturation, percentage of time spent with S(pO(2)) hypoxia during sleep. The prevalence of NAFLD was higher in patients with severe OSA, suggesting a role for nocturnal hypoxemia in the pathogenesis of fatty liver disease.

  2. Influence of arousal threshold and depth of sleep on respiratory stability in man: analysis using a mathematical model.

    Science.gov (United States)

    Longobardo, G S; Evangelisti, C J; Cherniack, N S

    2009-12-01

    We examined the effect of arousals (shifts from sleep to wakefulness) on breathing during sleep using a mathematical model. The model consisted of a description of the fluid dynamics and mechanical properties of the upper airways and lungs, as well as a controller sensitive to arterial and brain changes in CO(2), changes in arterial oxygen, and a neural input, alertness. The body was divided into multiple gas store compartments connected by the circulation. Cardiac output was constant, and cerebral blood flows were sensitive to changes in O(2) and CO(2) levels. Arousal was considered to occur instantaneously when afferent respiratory chemical and neural stimulation reached a threshold value, while sleep occurred when stimulation fell below that value. In the case of rigid and nearly incompressible upper airways, lowering arousal threshold decreased the stability of breathing and led to the occurrence of repeated apnoeas. In more compressible upper airways, to maintain stability, increasing arousal thresholds and decreasing elasticity were linked approximately linearly, until at low elastances arousal thresholds had no effect on stability. Increased controller gain promoted instability. The architecture of apnoeas during unstable sleep changed with the arousal threshold and decreases in elasticity. With rigid airways, apnoeas were central. With lower elastances, apnoeas were mixed even with higher arousal thresholds. With very low elastances and still higher arousal thresholds, sleep consisted totally of obstructed apnoeas. Cycle lengths shortened as the sleep architecture changed from mixed apnoeas to total obstruction. Deeper sleep also tended to promote instability by increasing plant gain. These instabilities could be countered by arousal threshold increases which were tied to deeper sleep or accumulated aroused time, or by decreased controller gains.

  3. The consolidation of implicit sequence memory in obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Eszter Csabi

    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.

  4. Ventilatory control sensitivity in patients with obstructive sleep apnea is sleep stage dependent.

    Science.gov (United States)

    Landry, Shane A; Andara, Christopher; Terrill, Philip I; Joosten, Simon A; Leong, Paul; Mann, Dwayne L; Sands, Scott A; Hamilton, Garun S; Edwards, Bradley A

    2018-05-01

    The severity of obstructive sleep apnea (OSA) is known to vary according to sleep stage; however, the pathophysiology responsible for this robust observation is incompletely understood. The objective of the present work was to examine how ventilatory control system sensitivity (i.e. loop gain) varies during sleep in patients with OSA. Loop gain was estimated using signals collected from standard diagnostic polysomnographic recordings performed in 44 patients with OSA. Loop gain measurements associated with nonrapid eye movement (NREM) stage 2 (N2), stage 3 (N3), and REM sleep were calculated and compared. The sleep period was also split into three equal duration tertiles to investigate how loop gain changes over the course of sleep. Loop gain was significantly lower (i.e. ventilatory control more stable) in REM (Mean ± SEM: 0.51 ± 0.04) compared with N2 sleep (0.63 ± 0.04; p = 0.001). Differences in loop gain between REM and N3 (p = 0.095), and N2 and N3 (p = 0.247) sleep were not significant. Furthermore, N2 loop gain was significantly lower in the first third (0.57 ± 0.03) of the sleep period compared with later second (0.64 ± 0.03, p = 0.012) and third (0.64 ± 0.03, p = 0.015) tertiles. REM loop gain also tended to increase across the night; however, this trend was not statistically significant [F(2, 12) = 3.49, p = 0.09]. These data suggest that loop gain varies between REM and NREM sleep and modestly increases over the course of sleep. Lower loop gain in REM is unlikely to contribute to the worsened OSA severity typically observed in REM sleep, but may explain the reduced propensity for central sleep apnea in this sleep stage.

  5. Memory and Obstructive Sleep Apnea: A Meta-Analysis

    Science.gov (United States)

    Wallace, Anna; Bucks, Romola S.

    2013-01-01

    Study Objectives: To examine episodic memory performance in individuals with obstructive sleep apnea (OSA). Design Meta-analysis was used to synthesize results from individual studies examining the impact of OSA on episodic memory performance. The performance of individuals with OSA was compared to healthy controls or normative data. Participants Forty-two studies were included, comprising 2,294 adults with untreated OSA and 1,364 healthy controls. Studies that recorded information about participants at baseline prior to treatment interventions were included in the analysis. Measurements Participants were assessed with tasks that included a measure of episodic memory: immediate recall, delayed recall, learning, and/or recognition memory. Results: The results of the meta-analyses provide evidence that individuals with OSA are significantly impaired when compared to healthy controls on verbal episodic memory (immediate recall, delayed recall, learning, and recognition) and visuo-spatial episodic memory (immediate and delayed recall), but not visual immediate recall or visuo-spatial learning. When patients were compared to norms, negative effects of OSA were found only in verbal immediate and delayed recall. Conclusions: This meta-analysis contributes to understanding of the nature of episodic memory deficits in individuals with OSA. Impairments to episodic memory are likely to affect the daily functioning of individuals with OSA. Citation Wallace A; Bucks RS. Memory and obstructive sleep apnea: a meta-analysis. SLEEP 2013;36(2):203-220. PMID:23372268

  6. Brain Structure Network Analysis in Patients with Obstructive Sleep Apnea.

    Directory of Open Access Journals (Sweden)

    Yun-Gang Luo

    Full Text Available Childhood obstructive sleep apnea (OSA is a sleeping disorder commonly affecting school-aged children and is characterized by repeated episodes of blockage of the upper airway during sleep. In this study, we performed a graph theoretical analysis on the brain morphometric correlation network in 25 OSA patients (OSA group; 5 female; mean age, 10.1 ± 1.8 years and investigated the topological alterations in global and regional properties compared with 20 healthy control individuals (CON group; 6 females; mean age, 10.4 ± 1.8 years. A structural correlation network based on regional gray matter volume was constructed respectively for each group. Our results revealed a significantly decreased mean local efficiency in the OSA group over the density range of 0.32-0.44 (p < 0.05. Regionally, the OSAs showed a tendency of decreased betweenness centrality in the left angular gyrus, and a tendency of decreased degree in the right lingual and inferior frontal (orbital part gyrus (p < 0.005, uncorrected. We also found that the network hubs in OSA and controls were distributed differently. To the best of our knowledge, this is the first study that characterizes the brain structure network in OSA patients and invests the alteration of topological properties of gray matter volume structural network. This study may help to provide new evidence for understanding the neuropathophysiology of OSA from a topological perspective.

  7. Sickness absenteeism is associated with sleep problems independent of sleep disorders: results of the 2016 Sleep Health Foundation national survey.

    Science.gov (United States)

    Reynolds, Amy C; Appleton, Sarah L; Gill, Tiffany K; Taylor, Anne W; McEvoy, R Douglas; Ferguson, Sally A; Adams, Robert J

    2017-10-01

    Sleep disorders are associated with sickness absenteeism (SA), at significant economic cost. Correlates of absenteeism are less well described in nonclinical samples. We determined the relationship between markers of inadequate sleep and SA in a sample of 551 working adults aged ≥18 years across Australia. We considered diagnosed obstructive sleep apnea (OSA) and insomnia symptoms, daytime symptoms, and sleepiness with respect to sickness absenteeism (missing ≥1 day of work in the past 28 days because of problems with physical or mental health). Sickness absenteeism was reported by 27.0% of participants and was more frequent in younger participants, university graduates, and those experiencing financial stress. Sickness absenteeism was independently associated with insomnia (odds ratio [OR]=2.5, confidence interval [CI]=1.5-4.0], OSA (OR=9.8, CI=4.7-20.7), sleep aid use (OR=3.0, CI=1.9-4.7), and daytime symptoms (OR=3.0, CI=2.0-4.6) and inversely associated with perception of getting adequate sleep (OR=0.6, CI=0.4-0.9). Associations persisted in the population free of insomnia and/or OSA. In adults without clinical sleep disorders, sleep behaviors are contributing to sickness absenteeism. An increased focus at an organizational level on improvement of sleep hygiene is important to reduce lost work performance. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

  8. Sleep Sleeping Patch

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The Sleep Sleeping Patch is a new kind of external patch based on modern sleep medicine research achievements, which uses the internationally advanced transdermal therapeutic system (TTS). The Sleep Sleeping Patch transmits natural sleep inducers such as peppermint and liquorice extracts and melatonin through the skin to induce sleep. Clinical research proves that the Sleep Sleeping Patch can effectively improve insomnia and the quality of sleep. Highly effective: With the modern TTS therapy,

  9. Radiological findings in patients with obstructive sleep apnea

    Energy Technology Data Exchange (ETDEWEB)

    Mello Junior, Carlos Fernando de; Guimaraes Filho, Helio Antonio; Gomes, Camila Albuquerque de Brito; Paiva, Camila Caroline de Amorim, E-mail: carlosfmello@hotmail.com [Universidade Federal da Paraiba UFPB, Joao Pessoa (Brazil)

    2013-01-15

    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)

  10. Radiological findings in patients with obstructive sleep apnea

    International Nuclear Information System (INIS)

    Mello Junior, Carlos Fernando de; Guimaraes Filho, Helio Antonio; Gomes, Camila Albuquerque de Brito; Paiva, Camila Caroline de Amorim

    2013-01-01

    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)

  11. Impact of gender on snore-based obstructive sleep apnea screening

    International Nuclear Information System (INIS)

    De Silva, S; Abeyratne, U R; Hukins, C

    2012-01-01

    Obstructive sleep apnea syndrome (OSA) is a serious widespread disease in which upper airways (UA) are collapsed during sleep. OSA has marked male predominance in prevalence. Although women are less vulnerable to OSA, under-diagnosed OSA in women may associate with serious consequences. Snoring is commonly associated with OSA and one of the earliest symptoms. Snore sounds (SS) are generated due to vibration of the collapsing soft tissues of the UA. Structural and functional properties of the UA are gender dependent. SS capture these time varying gender attributed UA properties and those could be embedded in the acoustic properties of SS. In this paper, we investigate the gender-specific acoustic property differences of SS and try to exploit these differences to enhance the snore-based OSA detection performance. We developed a snore-based multi-feature vector for OSA screening and one time-measured neck circumference was augmented. Snore features were estimated from SS recorded in a sleep laboratory from 35 females and 51 males and multi-layer neural network-based pattern recognition algorithms were used for OSA/non-OSA classification. The results were K-fold cross-validated. Gender-dependent modeling resulted in an increase of around 7% in sensitivity and 6% in specificity at the decision threshold AHI = 15 against a gender-neutral model. These results established the importance of adopting gender-specific models for the snore-based OSA screening technique. (paper)

  12. Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study.

    Science.gov (United States)

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

    2014-01-01

    Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4-15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

  13. Inflammatory Markers and Obstructive Sleep Apnea in Obese Children: The NANOS Study

    Directory of Open Access Journals (Sweden)

    Alex Gileles-Hillel

    2014-01-01

    Full Text Available Introduction. Obesity and obstructive sleep apnea syndrome (OSA are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI of 3 events/hour total sleep time (TST. BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1 and plasminogen activator inhibitor-1 (PAI-1 levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P<0.01, while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P<0.001. Conclusion. IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

  14. What is the most important factor affecting the cognitive function of obstructive sleep apnea syndrome patients: a single center study

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    LI Xiang

    2013-05-01

    Full Text Available Objective Patients with obstructive sleep apnea syndrome (OSAS usually complain of daytime hypersomnia and decrease in cognitive function, which affects the quality of their work and life. The reason why the cognitive function of OSAS patients decreased remains controversial. The aim of this study is to evaluate the impairment and the main influencing factors of cognitive function in OSAS. Methods There were totally 50 OSAS patients (OSAS group and 25 volunteers (control group included in our study. All of them were monitored by polysomnography (PSG and tested by Continuous Performance Test (CPT, n-back test and Stroop Color?Word Test (CWT to evaluate their sleep condition and cognitive function. Results No significant difference was found between the two groups in total sleep time and sleep efficiency (P > 0.05, for all. Compared with control group, OSAS group had significant increased time of non-rapid eye movement (NREM sleep stage Ⅰ and stage Ⅱ, significant decreased time of stage Ⅲ (P 0.05, for all, while had significant connection with AI and NREM Ⅲ (P < 0.05, for all. The rate of OSAS patients who underwent nasal continuous positive airway pressure (nCPAP treatment was very low, only 8% (4/50. Conclusion The abnormality of OSAS patients' sleep structure is characterized with sleep fragmentation and decrease of NREM Ⅲ, which may be the main factors of cognitive impairment. Exploration of treatment methods targeted on regulating the effected hormones and receptors is meaningful.

  15. Obstructive sleep apnea in epilepsy: a preliminary Egyptian study.

    Science.gov (United States)

    Shaheen, Hala A; Abd El-Kader, Ann A; El Gohary, Amira M; El-Fayoumy, Neveen M; Afifi, Lamia M

    2012-09-01

    The extent and clinical relevance of the association between epilepsy and sleep apnea are not previously studied in Egypt. What we wanted to know was the frequency of sleep apnea in Egyptian children with epilepsy and its influence on seizure frequency, other seizure characteristics, sleep complaint, and architecture. All patients with epilepsy, aged up to 18 years, who underwent polysomnography were studied. Patients with any neurological disease apart from epilepsy, with psychiatric illness, had hypnotics, or sedatives or those with liver or kidney failure were excluded from the study. The patients were divided into two subgroups according to apnea/hypopnea index: group (1) patients without obstructive sleep apnea (OSA) and group (2) patients with OSA. For control group, we choose 12 healthy individuals, with age and sex matched to that of our patients. We studied the clinical characteristics of epilepsy, sleep history, and polysomnographic recording of the patients with epilepsy and the control. EEG digital and video monitoring was done for all patients. Eleven patients (42.3%) were found to have obstructive sleep apnea. Seizure frequency was significantly higher in the patients with OSA. Apart from apnea and hypopnea indices, all other sleep parameters did not differ between patients' subgroups. Hypopnea index in REM positively correlates with number of awaking. Apnea index in REM positively correlates with latency to deep sleep and to periodic leg movement. Sleep apnea is frequent in patients with epilepsy. OSA may contribute to increase seizure frequency. We recommend investigating sleep apnea in all patients with epilepsy.

  16. Legal Aspects of Sleep Medicine in the 21st Century.

    Science.gov (United States)

    Venkateshiah, Saiprakash B; Hoque, Romy; Collop, Nancy A

    2018-05-08

    Multiple manifestations of sleep disorders may interact with the law making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable due to the actions of sleepy employees. Hence awareness of causes of excessive sleepiness such as sleep deprivation and OSA is increasing among trucking, railroad, and other safety sensitive occupations. Interestingly, litigation related to perioperative complications due to Obstructive Sleep Apnea (OSA) is more frequent than non-operative issues such as a failure to diagnose OSA. Parasomnia associated sleep-related violence (SRV) represents a challenge to clinicians, as they may be asked to consider parasomnia as a possible contributing, mitigating, or exculpatory factor in criminal proceedings. Clinicians should also familiarize with the legal and regulatory aspects of running an independent sleep laboratory. Sleep telemedicine practice using 21 st century technology has opened novel and unique challenges to existing laws. In this review, we shall cover the most common interactions between sleep disorders and the law including the challenges of excessive sleepiness and driving; other legal issues involving patients with obstructive sleep apnea (OSA); and the liabilities associated with parasomnia disorder. We shall also cover some practical legal aspects involving independent sleep laboratories and the field of sleep telemedicine. Published by Elsevier Inc.

  17. Investigation of the relationship between mean platelet volume and obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Ersin Şükrü Erden

    2013-12-01

    Full Text Available Objective: Obstructive sleep apnea syndrome (OSAS is characterized by recurrent upper airway obstruction and intermittent hypoxia during sleep. Intermittent hypoxia and increased inflammatory activity plays a role in increased risk of cardiovascular disease in the OSAS. OSAS is an important cause of morbidity and mortality and cardiovascular disorders are the most important complications of OSAS. Mean platelet volume (MPV is a marker of platelet activation and function, and increased platelet volume is associated with increased platelet activity. Different diseases related with inflammation, hypoxia, vascular injury, thrombosis and atherosclerosis were found to be associated with MPV. In this study, we aimed to investigate the relationship between OSAS and MPV. Methods: In this retrospective study, data of sex and age matched 33 patients with moderate OSAS, 34 patients with severe OSAS and 30 healthy subjects were evaluated. Results: The mean MPV was found in control, moderate OSAS and severe OSAS groups as 7.83±1.00, 8.26±1.40 and 8.94±1.20 (fL respectively. The mean MPV value was significantly higher in severe OSAS group than control subjects (p=0.001. In correlation analysis, there were positive correlation between MPV with apnea-hypopnea index and total sleep time, and negative correlation between MPV with platelet count and minimum oxygen saturation (Respectively, p=0.003 / R=0.295, p=0.030 / R=0.221, p=0.011 / R= -0.257, p=0.019 / R= -0.238. Conclusion: In this study, the increased MPV was associated with severe OSAS and the results of this study suggest that the platelet activation is increased in OSAS. Hypoxia caused by OSAS, due to the activated platelets, may play a role in the development of cardiovascular diseases which is an important cause of morbidity and mortality in OSAS. J Clin Exp Invest 2013; 4 (4: 492-496

  18. A method to screen obstructive sleep apnea using multi-variable non-intrusive measurements

    International Nuclear Information System (INIS)

    De Silva, S; Abeyratne, U R; Hukins, C

    2011-01-01

    Obstructive sleep apnea (OSA) is a serious sleep disorder. The current standard OSA diagnosis method is polysomnography (PSG) testing. PSG requires an overnight hospital stay while physically connected to 10–15 channels of measurement. PSG is expensive, inconvenient and requires the extensive involvement of a sleep technologist. As such, it is not suitable for community screening. OSA is a widespread disease and more than 80% of sufferers remain undiagnosed. Simplified, unattended and cheap OSA screening methods are urgently needed. Snoring is commonly associated with OSA but is not fully utilized in clinical diagnosis. Snoring contains pseudo-periodic packets of energy that produce characteristic vibrating sounds familiar to humans. In this paper, we propose a multi-feature vector that represents pitch information, formant information, a measure of periodic structure existence in snore episodes and the neck circumference of the subject to characterize OSA condition. Snore features were estimated from snore signals recorded in a sleep laboratory. The multi-feature vector was applied to a neural network for OSA/non-OSA classification and K-fold cross-validated using a random sub-sampling technique. We also propose a simple method to remove a specific class of background interference. Our method resulted in a sensitivity of 91 ± 6% and a specificity of 89 ± 5% for test data for AHI THRESHOLD = 15 for a database consisting of 51 subjects. This method has the potential as a non-intrusive, unattended technique to screen OSA using snore sound as the primary signal

  19. Obstructive sleep apnea and cancer: effects of intermittent hypoxia?

    Science.gov (United States)

    Kukwa, Wojciech; Migacz, Ewa; Druc, Karolina; Grzesiuk, Elzbieta; Czarnecka, Anna M

    2015-01-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by pauses in regular breathing. Apneic episodes lead to recurrent hypoxemia-reoxygenation cycles with concomitant cellular intermittent hypoxia. Studies suggest that intermittent hypoxia in OSA may influence tumorigenesis. This review presents recent articles on the potential role of OSA in cancer development. Relevant research has focused on: molecular pathways mediating the influence of intermittent hypoxia on tumor physiology, animal and epidemiological human studies linking OSA and cancer. Current data relating OSA to risk of neoplastic disease remain scarce, but recent studies reveal the potential for a strong relation. More work is, therefore, needed on the impact of OSA on many cancer-related aspects. Results may offer enlightenment for improved cancer diagnosis and treatment.

  20. Sleep apnea and cardiovascular risk.

    Science.gov (United States)

    Floras, John S

    2014-01-01

    Sleep apnea is evident in approximately 10% of adults in the general population, but in certain cardiovascular diseases, and in particular those characterized by sodium and water retention, its prevalence can exceed 50%. Although sleep apnea is not as yet integrated into formal cardiovascular risk assessment algorithms, there is increasing awareness of its importance in the causation or promotion of hypertension, coronary artery disease, heart failure, atrial arrhythmias, and stroke, and thus, not surprisingly, as a predictor of premature cardiovascular death. Sleep apnea manifests as two principal phenotypes, both characterized by respiratory instability: obstructive (OSA), which arises when sleep-related withdrawal of respiratory drive to the upper airway dilator muscles is superimposed upon a narrow and highly compliant airway predisposed to collapse, and central (CSA), which occurs when the partial pressure of arterial carbon dioxide falls below the apnea threshold, resulting in withdrawal of central drive to respiratory muscles. The present objectives are to: (1) review the epidemiology and patho-physiology of OSA and CSA, with particular emphasis on the role of renal sodium retention in initiating and promoting these processes, and on population studies that reveal the long-term consequences of untreated OSA and CSA; (2) illustrate mechanical, autonomic, chemical, and inflammatory mechanisms by which OSA and CSA can increase cardiovascular risk and event rates by initiating or promoting hypertension, atherosclerosis, coronary artery disease, heart failure, arrhythmias, and stroke; (3) highlight insights from randomized trials in which treating sleep apnea was the specific target of therapy; (4) emphasize the present lack of evidence that treating sleep apnea reduces cardiovascular risk and the current clinical equipoise concerning treatment of asymptomatic patients with sleep apnea; and (5) consider clinical implications and future directions of clinical

  1. Effect of CPAP Withdrawal on BP in OSA: Data from Three Randomized Controlled Trials.

    Science.gov (United States)

    Schwarz, Esther I; Schlatzer, Christian; Rossi, Valentina A; Stradling, John R; Kohler, Malcolm

    2016-12-01

    Based on meta-analyses, the BP-lowering effect of CPAP therapy in patients with OSA is reported to be approximately 2 to 3 mm Hg. This figure is derived from heterogeneous trials, which are often limited by poor CPAP adherence, and thus the treatment effect may possibly be underestimated. We analyzed morning BP data from three randomized controlled CPAP withdrawal trials, which included only patients with optimal CPAP compliance. Within the three trials, 149 patients with OSA who were receiving CPAP were randomized to continue therapeutic CPAP (n = 65) or to withdraw CPAP (n = 84) for 2 weeks. Morning BP was measured at home before and after sleep studies in the hospital. CPAP withdrawal was associated with a return of OSA (apnea-hypopnea index [AHI] at a baseline of 2.8/h and at follow-up of 33.2/h). Office systolic BP (SBP) increased in the CPAP withdrawal group compared with the CPAP continuation group by +5.4 mm Hg (95% CI, 1.8-8.9 mm Hg; P = .003) and in the home SBP group by +9.0 mm Hg (95% CI, 5.7-12.3 mm Hg; P CPAP withdrawal results in a clinically relevant increase in BP, which is considerably higher than in conventional CPAP trials; it is also underestimated when office BP is used. Greater OSA severity is associated with a higher BP rise in response to CPAP withdrawal. ClinicalTrials.gov; No.: NCT01332175 and NCT01797653) URL: www.clinicaltrials.gov and ISRCTN registry (ISRCTN 93153804) URL: http://www.isrctn.com/. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  2. Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Mirrakhimov Aibek E

    2013-02-01

    Full Text Available Abstract Background Obstructive sleep apnea (OSA is a common disease, affecting approximately 2% of women and 4% of men residing in Western communities. No systematically reviewed data are available about the prevalence of this disease in Asia, the most heavily populated continent. Methods PubMed/Medline, Scopus and Google Scholar were searched for articles published from 1993 to May 2012 that reported the prevalence of OSA diagnosed via sleep monitoring and the prevalence of patients at risk for OSA as assessed by symptomatology and/or sleep questionnaires. We have also searched abstract database of major pulmonary and sleep scientific societies for relevant abstracts presented from 2010 to 2012. The following inclusion criteria were used: articles published in English, age ≥ 18 years, ≥ 100 participants in studies using sleep monitoring for the diagnosis of OSA, ≥ 300 participants in studies using questionnaires to detect patients at high risk for OSA. Exclusion criteria: duplicate publications, studies reporting the prevalence of central sleep apnea only, hospital based studies as well as studies assessing OSA prevalence among patients with resistant arterial hypertension, chronic kidney disease, heart failure and in patients with concomitant neurological disease. Results Twenty four articles were found to meet the inclusion criteria, covering 47,957 subjects (26,042 men and 21,915 women and four relevant abstracts were noted. OSA prevalence ranged from 3.7% to 97.3%. Male gender, older age, a higher BMI and waist to hip ratio, greater neck circumference, arterial hypertension, smoking, snoring and daytime sleepiness were associated with OSA. Sample size, difference between the populations studied and the fact that some works included patients with a high pre-test probability of OSA explain the difference in prevalence rates. Conclusion This systematic review highlights the lack of data regarding the prevalence of OSA in Asians

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

    Science.gov (United States)

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

    2016-01-01

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

  4. Obstructive sleep apnea combined dyslipidemia render additive effect on increasing atherosclerotic cardiovascular diseases prevalence.

    Science.gov (United States)

    Cao, Zhiyong; Zhang, Ping; He, Zhiqing; Yang, Jing; Liang, Chun; Ren, Yusheng; Wu, Zonggui

    2016-05-26

    Current study was designed to investigate the effects of obstructive sleep apnea (OSA) combined dyslipidemia on the prevalence of atherosclerotic cardiovascular diseases (ASCVD). This was a cross-sectional study and subjects with documented dyslipidemia and without previous diagnosis of OSA were enrolled. Polysomnography was applied to evaluate apnea-hypopnea index (AHI). Based on AHI value, subjects were classified into four groups: without OSA, mild, moderate and severe OSA groups. Clinical characteristics and laboratory examination data were recorded. Relationship between AHI event and lipid profiles was analyzed, and logistic regression analysis was used to evaluate the effects of OSA combined dyslipidemia on ASCVD prevalence. Totally 248 subjects with dyslipidemia were enrolled. Compared to the other 3 groups, subjects with severe OSA were older, male predominant and had higher smoking rate. In addition, subjects with severe OSA had higher body mass index, waist-hip ratio, blood pressure, and higher rates of overweight and obesity. Serum levels of fasting plasma glucose, glycated hemoglobin, LDL-C and CRP were all significantly higher. ASCVD prevalence was considerably higher in subjects with severe OSA. AHI event in the severe OSA group was up to 35.4 ± 5.1 events per hour which was significantly higher than the other groups (P dyslipidemia plus no-OSA group (reference group), OSA enhanced ASCVD risk in subjects with dyslipidemia, regardless of OSA severity. After extensively adjusted for confounding variables, the odds of dyslipidemia plus mild-OSA was reduced to insignificance. While the effects of moderate- and severe-OSA on promoting ASCVD risk in subjects with dyslipidemia remained significant, with severe-OSA most prominent (odds ratio: 1.52, 95% confidence interval: 1.13-2.02). OSA combined dyslipidemia conferred additive adverse effects on cardiovascular system, with severe-OSA most prominent.

  5. Brain Structural Changes in Obstructive Sleep Apnea

    Science.gov (United States)

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

    2008-01-01

    Study Objectives: Determine whether obstructive sleep apnea (OSA) subjects show indications of axonal injury. Design: We assessed fiber integrity in OSA and control subjects with diffusion tensor imaging (DTI). We acquired four whole-brain DTI series from each subject. The four series were realigned, and the diffusion tensor calculated at each voxel. Fractional anisotropy (FA), a measure of fiber integrity, was derived from the diffusion tensor, resulting in a whole brain FA “map.” The FA maps were spatially normalized, smoothed, and compared using voxel-based statistics to determine differences between OSA and control groups, with age as a covariate (P Valladares EM; Yan-Go FL; Harper RM. Brain structural changes in obstructive sleep apnea. SLEEP 2008;31(7):967-977. PMID:18652092

  6. Perioperative management of children with obstructive sleep apnea.

    Science.gov (United States)

    Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S

    2009-07-01

    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.

  7. The potential association between obstructive sleep apnea and diabetic retinopathy in severe obesity-the role of hypoxemia.

    Directory of Open Access Journals (Sweden)

    Dev Banerjee

    Full Text Available Obstructive sleep apnea (OSA is common in obese patients with type 2 diabetes mellitus (DM and may contribute to diabetic microvascular complications.To investigate the association between OSA, hypoxemia during sleep, and diabetic retinal complications in severe obesity. This was a prospective observational study of 93 obese patients mean (SD age: 52(10 years; mean (SD body mass index (BMI: 47.3(8.3 kg/m(2 with DM undergoing retinal screening and respiratory monitoring during sleep. OSA was defined as apnea-hypopnea index (AHI of ≥15 events/hour, resulting in two groups (OSA+ vs. OSA-.Forty-six patients were OSA+: median (95% CI AHI = 37(23-74/hour and 47 were OSA-ve (AHI = 7(4-11/hour. Both groups were similar for ethnicity, BMI, cardiovascular co-morbidities, diabetes duration, HbA1c, and insulin treatment (p>0.05. The OSA+ group was significantly more hypoxemic. There was no significant difference between OSA+ and OSA- groups for the presence of retinopathy (39% vs. 38%. More OSA+ subjects had maculopathy (22% vs. 13%, but this did not reach statistical significance. Logistic regression analyses showed that AHI was not significantly associated with the presence of retinopathy or maculopathy (p>0.05. Whilst minimum oxygen saturation was not significantly associated with retinopathy, it was an independent predictor for the presence of maculopathy OR = 0.79 (95% CI: 0.65-0.95; p<0.05, after adjustment.The presence of OSA, as determined by AHI, was not associated with diabetic retinal complications. In contrast, severity of hypoxemia during sleep (minimum oxygen saturations may be an important factor. The importance of hypoxia in the development of retinal complications in patients with OSA remains unclear and further studies assessing the pathogenesis of hypoxemia in patients with OSA and diabetic retinal disease are warranted.

  8. Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block!

    Science.gov (United States)

    Ali, Shozab S; Oni, Ebenezer T; Warraich, Haider J; Blaha, Michael J; Blumenthal, Roger S; Karim, Adil; Shaharyar, Sameer; Jamal, Omar; Fialkow, Jonathan; Cury, Ricardo; Budoff, Matthew J; Agatston, Arthur S; Nasir, Khurram

    2014-10-01

    Patients with obstructive sleep apnea (OSA) have a high burden of cardiovascular disease (CVD) but a causal relationship between OSA and atherosclerotic CVD remains unclear. We systematically reviewed the literature analyzing the relationship. A review of the Medline database for studies noninvasively evaluating subclinical CVD in OSA was conducted. A total of fifty-two studies were included in this review. Across the studies the prevalence of atherosclerosis, as assessed by coronary artery calcification, carotid intima-media thickness, brachial artery flow-mediated dilation and pulse wave velocity was higher in patients with OSA and correlated with increasing severity and duration of OSA. This study shows OSA is an independent predictor of subclinical CVD as CVD is more likely to occur in patients with long standing and severe OSA. Further research is however necessary to identify specific OSA populations that would benefit from aggressive screening. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Utility of home sleep apnea testing in high-risk veterans.

    Science.gov (United States)

    Cairns, Alyssa; Sarmiento, Kathleen; Bogan, Richard

    2017-09-01

    Many Veterans Affairs Medical Centers (VAMCs) have implemented home sleep apnea testing (HSAT) in lieu of traditional in-lab testing to establish a timely and cost-sensitive diagnosis of obstructive sleep apnea (OSA). However, concern remains for the sensitivity and specificity of said technology in this population as many veterans are at increased risk for many of the comorbid conditions that can limit the accuracy of HSAT results. Hence, the purpose of this study is to evaluate rate of incongruent outcomes (e.g., negative HSAT results despite high clinical symptomology) as well as differences in study quality metrics and predictors of OSA between veteran sleep patients and general sleep patients being evaluated by a home sleep test. A random sample of HSAT outcomes from 1500 veterans and 1500 general sleep clinic patients was retrieved from a repository of anonymized HSAT outcomes from 2009 to 2013. General sleep clinic data were from patients referred for home sleep testing from a variety of clinical practices across North America, whereas VAMC patients were tested using a central dissemination process. All patients were tested for OSA using the Apnea Risk and Evaluation System (ARES), an HSAT that simultaneously records airflow, pulse oximetry, snoring, accelerometry, and EEG. Sample differences and rates of comorbidities, HSAT outcomes, predictors of OSA, and pretest OSA risk information were evaluated between groups. The presence of OSA was defined as an apnea-hypopnea index (AHI; using 4% desaturation criterion) of ≥5 and ≥15 events per hour. Sample differences in predictors of OSA were evaluated using logistic multiple regression. Veterans (91.3% male) were more likely to report comorbidities, especially depression, insomnia, hypertension, diabetes, restless legs syndrome (RLS), and use of sleep and pain medications compared to general sleep clinic patients (57.1% male). Despite differences in the rate of medical comorbidities, no differences were

  10. Occupational exposure to organic solvents and sleep-disordered breathing.

    Science.gov (United States)

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

    1997-01-01

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

  11. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia.

    Directory of Open Access Journals (Sweden)

    Eusebi Chiner

    Full Text Available We hypothesized that obstructive sleep apnea (OSA can predispose individuals to lower airway infections and community-acquired pneumonia (CAP due to upper airway microaspiration. This study evaluated the association between OSA and CAP.We performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group. The controls were matched according to age, sex and body mass index (BMI. A respiratory polygraph (RP was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI. The associations between CAP and the Epworth Sleepiness Scale (ESS, OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests.No significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29-6·44, p = 0·01. Patients with severe OSA (AHI≥30 also had a higher risk of CAP (OR = 3·18, 95%CI 1·11-11·56, p = 0·047. In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007. Furthermore, OSA was significantly associated with CAP severity (p = 0·0002, and OSA severity was also associated with CAP severity (p = 0·0006.OSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk should be explored to investigate the

  12. Apnoea of prematurity – discontinuation of methylxanthines in a ...

    African Journals Online (AJOL)

    Background. Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks' corrected gestational age (GA). Objective. To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting, where GA is often uncertain. Methods.

  13. Autoimmune encephalitis and sleep disorders

    Directory of Open Access Journals (Sweden)

    Yan HUANG

    2017-10-01

    Full Text Available Research shows that autoimmune encephalitis is associated with sleep disorders. Paraneoplastic neurological syndrome (PNS with Ma2 antibodies can cause sleep disorders, particularly narcolepsy and rapid eye movement sleep behavior disorder (RBD. Limbic encephalitis (LE and Morvan syndrome, associated with voltage - gated potassium channel (VGKC-complex antibodies, which include leucine-rich glioma-inactivated 1 (LGI1 antibody and contactin-associated protein 2 (Caspr2, can result in profound insomnia and other sleep disorders. Central neurogenic hypoventilation are found in patients with anti-N-methyl-D-aspartate (NMDA receptor encephalitis, whereas obstructive sleep apnea (OSA, stridor and parasomnia are prominent features of encephalopathy associated with IgLON5 antibodies. Sleep disorders are cardinal manifestations in patients with autoimmune encephalitis. Immunotherapy possiblely can improve clinical symptoms and prognosis in a positive way. DOI: 10.3969/j.issn.1672-6731.2017.10.004

  14. Memory and Executive Screening for the Detection of Cognitive Impairment in Obstructive Sleep Apnea.

    Science.gov (United States)

    Mu, Li; Peng, Liping; Zhang, Zhengjiao; Jie, Jing; Jia, Siqi; Yuan, Haibo

    2017-10-01

    Obstructive sleep apnea (OSA) is commonly associated with cognitive dysfunction, which is more apparent in severe OSA and impairs quality of life. However, the clinical screening methods for these impairments in OSA are still limited. In this study, we evaluated the feasibility of using the Memory and Executive Screening (MES) for assessing cognitive performance in OSA. Twenty-four patients with nonsevere OSA and 36 patients with severe OSA participated in this study. All participants underwent comprehensive, laboratory-based polysomnography and completed assessments of cognitive function, which included both the MES and the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ). Both the total MES scores and 5 recall scores of the MES (MES-5R) were significantly lower in the severe OSA group than those in the nonsevere OSA group. The patients with severe OSA performed worse on the memory subtests of the MES-5R, especially on immediate recall. The sensitivity and specificity of the MES for identifying cognitive impairment in patients with OSA were 63.89% and 66.67%, respectively, for a cutoff value of cognitive dysfunction in patients with OSA. The sensitivity and specificity of the MES were similar to those of the MoCA-BJ. The MES-5R and total MES scores can assess the presence and severity of cognitive impairment in patients with severe OSA. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  15. Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension.

    Science.gov (United States)

    Wang, Lei; Li, Nanfang; Yao, Xiaoguang; Chang, Guijuan; Zhang, Delian; Heizhati, Mulalibieke; Wang, Menghui; Luo, Qin; Kong, Jianqiong

    2017-01-01

    Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA) was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA) (5.8%) and PA + OSA (4.9%). Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing's syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients.

  16. Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension

    Directory of Open Access Journals (Sweden)

    Lei Wang

    2017-01-01

    Full Text Available Background. Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. Methods. Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. Results. Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA (5.8% and PA + OSA (4.9%. Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing’s syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. Conclusion. Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients.

  17. Obstructive sleep apnea decreases central nervous system-derived proteins in the cerebrospinal fluid.

    Science.gov (United States)

    Ju, Yo-El S; Finn, Mary Beth; Sutphen, Courtney L; Herries, Elizabeth M; Jerome, Gina M; Ladenson, Jack H; Crimmins, Daniel L; Fagan, Anne M; Holtzman, David M

    2016-07-01

    We hypothesized that one mechanism underlying the association between obstructive sleep apnea (OSA) and Alzheimer's disease is OSA leading to decreased slow wave activity (SWA), increased synaptic activity, decreased glymphatic clearance, and increased amyloid-β. Polysomnography and lumbar puncture were performed in OSA and control groups. SWA negatively correlated with cerebrospinal fluid (CSF) amyloid-β-40 among controls and was decreased in the OSA group. Unexpectedly, amyloid-β-40 was decreased in the OSA group. Other neuronally derived proteins, but not total protein, were also decreased in the OSA group, suggesting that OSA may affect the interaction between interstitial and cerebrospinal fluid. Ann Neurol 2016;80:154-159. © 2016 American Neurological Association.

  18. Antimony and sleep-related disorders: NHANES 2005-2008.

    Science.gov (United States)

    Scinicariello, Franco; Buser, Melanie C; Feroe, Aliya G; Attanasio, Roberta

    2017-07-01

    Antimony is used as a flame-retardant in textiles and plastics, in semiconductors, pewter, and as pigments in paints, lacquers, glass and pottery. Subacute or chronic antimony poisoning has been reported to cause sleeplessness. The prevalence of short sleep duration (sleep apnea (OSA) affects 12-28 million US adults. Insufficient sleep and OSA have been linked to the development of several chronic conditions including diabetes, cardiovascular disease, obesity and depression, conditions that pose serious public health threats. To investigate whether there is an association between antimony exposure and sleep-related disorders in the US adult population using the National Health and Nutrition Examination Survey (NHANES) 2005-2008. We performed multivariate logistic regression to analyze the association of urinary antimony with several sleep disorders, including insufficient sleep and OSA, in adult (ages 20 years and older) participants of NHANES 2005-2008 (n=2654). We found that participants with higher urinary antimony levels had higher odds to experience insufficient sleep (≤6h/night) (OR 1.73; 95%CI; 1.04, 2.91) as well as higher odds to have increased sleep onset latency (>30min/night). Furthermore, we found that higher urinary antimony levels in participants were associated with OSA (OR 1.57; 95%CI; 1.05, 2.34), sleep problems, and day-time sleepiness. In this study, we found that urinary antimony was associated with higher odds to have insufficient sleep and OSA. Because of the public health implications of sleep disorders, further studies, especially a prospective cohort study, are warranted to evaluate the association between antimony exposure and sleep-related disorders. Copyright © 2017. Published by Elsevier Inc.

  19. Sleep overlap syndrome

    Directory of Open Access Journals (Sweden)

    Fariba Rezaeetalab

    2016-12-01

    Full Text Available Overlap syndrome, which is known as the coexistence of chronic obstructive pulmonary disease (COPD and obstructive sleep apnea (OSA, was first defined by Flenley. Although it can refer to concomitant occurrence of any of the pulmonary diseases and OSA, overlap syndrome is commonly considered as the coexistence of OSA and COPD. This disease has unique adverse health consequences distinct from either condition alone. Given the high prevalence of each solitary disease, overlap syndrome is also likely to be common and clinically relevant. Despite the fact that overlap syndrome has been described in the literature for nearly 30 years, paucity of evaluations and studies limited the discussion on diagnosis, prevalence, pathophysiology, treatment, and outcomes of this disease. This review article addresses these issues by reviewing several recent studies conducted in Iran or other countries. This review suggests that overlap syndrome has worse outcomes than either disease alone. Our findings accentuated the urgent need for further studies on overlap syndrome and all overlaps between OSA and chronic pulmonary disease to provide a deeper insight into diagnosis and non-invasive treatments of this disease.

  20. Obstructive sleep apnea and energy balance regulation: A systematic review.

    Science.gov (United States)

    Shechter, Ari

    2017-08-01

    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.

  1. Nonlinear Dynamics Forecasting of Obstructive Sleep Apnea Onsets.

    Directory of Open Access Journals (Sweden)

    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.

  2. Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review.

    Science.gov (United States)

    Amra, Babak; Rahmati, Behzad; Soltaninejad, Forogh; Feizi, Awat

    2018-05-01

    Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is associated with significant morbidity. We sought to present an updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test. Using the main databases (including Medline, Cochrane Database of Systematic Reviews and Scopus) we used a combination of relevant keywords to filter studies published between January 2010 and April 2017. Population-based studies evaluating the accuracy of screening questionnaires for OSA against PSG were included in the review. Thirty-nine studies comprising 18 068 subjects were included. Four screening questionnaires for OSA had been validated in selected studies including the Berlin questionnaire (BQ), STOP-Bang Questionnaire (SBQ), STOP Questionnaire (SQ), and Epworth Sleepiness Scale (ESS). The sensitivity of SBQ in detecting mild (apnea-hypopnea index (AHI) ≥ 5 events/hour) and severe (AHI ≥ 30 events/hour) OSA was higher compared to other screening questionnaires (range from 81.08% to 97.55% and 69.2% to 98.7%, respectively). However, SQ had the highest sensitivity in predicting moderate OSA (AHI ≥ 15 events/hour; range = 41.3% to 100%). SQ and SBQ are reliable tools for screening OSA among sleep clinic patients. Although further validation studies on the screening abilities of these questionnaires on general populations are required.

  3. Brain Structure Network Analysis in Patients with Obstructive Sleep Apnea.

    Science.gov (United States)

    Luo, Yun-Gang; Wang, Defeng; Liu, Kai; Weng, Jian; Guan, Yuefeng; Chan, Kate C C; Chu, Winnie C W; Shi, Lin

    2015-01-01

    Childhood obstructive sleep apnea (OSA) is a sleeping disorder commonly affecting school-aged children and is characterized by repeated episodes of blockage of the upper airway during sleep. In this study, we performed a graph theoretical analysis on the brain morphometric correlation network in 25 OSA patients (OSA group; 5 female; mean age, 10.1 ± 1.8 years) and investigated the topological alterations in global and regional properties compared with 20 healthy control individuals (CON group; 6 females; mean age, 10.4 ± 1.8 years). A structural correlation network based on regional gray matter volume was constructed respectively for each group. Our results revealed a significantly decreased mean local efficiency in the OSA group over the density range of 0.32-0.44 (p gyrus, and a tendency of decreased degree in the right lingual and inferior frontal (orbital part) gyrus (p < 0.005, uncorrected). We also found that the network hubs in OSA and controls were distributed differently. To the best of our knowledge, this is the first study that characterizes the brain structure network in OSA patients and invests the alteration of topological properties of gray matter volume structural network. This study may help to provide new evidence for understanding the neuropathophysiology of OSA from a topological perspective.

  4. Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity.

    Science.gov (United States)

    Rasheid, Sowsan; Banasiak, Magdalena; Gallagher, Scott F; Lipska, Anna; Kaba, Shadi; Ventimiglia, Daniel; Anderson, W McDowell; Murr, Michel M

    2003-02-01

    We have demonstrated that obstructive sleep apnea (OSA) is prevalent in 60% of patients undergoing bariatric surgery. A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA. All 100 consecutive patients with symptoms of OSA were prospectively evaluated by polysomnography before gastric bypass. Preoperative and postoperative scores of Epworth Sleepiness Scale (ESS), Respiratory Disturbance Index (RDI), and other parameters of sleep quality were compared using t-test. Preoperative RDI was 40 +/- 4 (normal 5 events/hour, n = 100). 13 patients had no OSA, 29 had mild OSA, while the remaining 58 patients were treated preoperatively for moderate-severe OSA. At a median of 6 months follow-up, BMI and ESS scores improved (38 +/- 1 vs 54 +/- 1 kg/m2, 6 +/- 1 vs 12 +/- 0.1, P losing weight (BMI 40 +/- 2 vs 62 +/- 3 kg/m2, P sleep efficiency (85 +/- 2% vs 65 +/- 5%), all P < 0.001, postop vs preop; and RDI (56 +/- 13 vs 23 +/- 7, P = 0.041). Regression analysis demonstrated no correlation between preoperative BMI, ESS score and the severity of OSA; and no correlation between % excess body weight loss and postoperative RDI. Weight loss following gastric bypass results in profound improvement in OSA. The severity of apnea cannot be reliably predicted by preoperative BMI and ESS; therefore, patients with symptoms of OSA should undergo polysomnography.

  5. Effects of obstructive sleep apnea on hemodynamic parameters in patients entering cardiac rehabilitation.

    Science.gov (United States)

    Hargens, Trent A; Aron, Adrian; Newsome, Laura J; Austin, Joseph L; Shafer, Brooke M

    2015-01-01

    Obstructive sleep apnea (OSA) is a prevalent form of sleep-disordered breathing. Evidence suggests that OSA may lead to cardiac remodeling, although the literature is equivocal. Previous literature suggests a high percentage of individuals entering a cardiac rehabilitation (CR) program also have OSA. The objective of this study was to determine whether resting hemodynamic variables were altered in OSA subjects entering CR compared with those without OSA, as determined by impedance cardiography. Subjects entering an early outpatient CR program were screened for OSA using an at-home screening device and verified by a sleep physician. Subjects were divided into an OSA group (n = 48) or a control group (n = 25) on the basis of the screening results. Hemodynamic variables were measured during supine rest using impedance cardiography. A 6-minute walk test was performed to assess functional capacity. The proportion of cardiac diagnoses was similar between groups. Overall, 66% of the subjects were positive for OSA. Subject groups did not differ by age, body mass index, heart rate, diastolic blood pressure, or functional capacity. Cardiac output, cardiac index, stroke volume, contractility index, and left cardiac work index were all significantly decreased in the OSA group compared with the control group (P disadvantage in recovering from their cardiac event, and place them at increased risk for secondary complications.

  6. Rhythm disturbances in childhood obstructive sleep apnea during apnea-hypopnea episodes

    Directory of Open Access Journals (Sweden)

    Anant Khositseth

    2013-01-01

    Methods: In a retrospective cross sectional study, records of children aged < 15 years with history of snoring and suspected OSA, who had undergone polysomnography (PSG for first time were analyzed. The cardiac rhythm and heart rate variability were studied during PSG. Results: A total of 124 patients diagnosed with OSA were grouped into mild ( n = 52, moderate ( n = 30, and severe ( n = 42 OSA. During PSG, all had sinus arrhythmias and only three patients had premature atrial contractions (PACs. The standard deviation of heart rate (SD-HR during rapid eye movement (REM sleep in severe OSA (9.1 ± 2.4 was significantly higher than SD-HR in mild OSA (7.5 ± 1.3, P < 0.0001. The maximum heart rate (max-HR during REM-sleep in severe OSA (132.1 ± 22.1 was significantly higher than the max-HR in mild OSA (121.3 ± 12.6 bpm, P = 0.016. Conclusions: There was no significant arrhythmia in children with OSA during their sleep. Heart rate variability correlated with the severity of OSA.

  7. Effects of positive airway pressure therapy on cardiovascular and metabolic markers in males with obstructive sleep apnea.

    Science.gov (United States)

    Feliciano, A; Oliveira, M J; Cysneiros, A; Martinho, C; Reis, R P; Penque, D; Pinto, P; Bárbara, C

    Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular/metabolic complications. Some analytical parameters (homocysteine, glycemic and lipidic profiles) are recognized markers of these consequences. Limited data is available on the association of these markers and OSAS's severity/response to positive airway pressure therapy (PAP). In this prospective study we analyzed polysomnographic and analytical data of male patients admitted to sleep laboratory. The aim was to evaluate metabolic/cardiovascular markers in snorers and OSAS patients, to relate with sleep parameters and PAP response. One-hundred and three patients were included, and 73 (71%) were OSAS patients. OSAS patients were similar to snorers except for higher body mass index (BMI) and dyslipidemia. Severe OSAS patients showed higher glycemia, HbA1c, insulin, and insulin resistance, and lower HDL cholesterol in comparison to mild-moderate (pprofile and triglycerides were slightly correlated with OSAS severity. 46 OSAS patients were submitted to 6 months of PAP, with a statistical decrease in mean values of homocysteine, glycemia, total and LDL cholesterol (pprofiles changed significantly after 6 months of PAP therapy in OSAS, supporting its cardiovascular and metabolic protective effect. Our study has reinforced the importance of analytical cardiovascular/metabolic evaluation as complementary tool of diagnosis/treatment response in OSAS. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  8. Complex sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Wang J

    2013-07-01

    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

  9. CPAP Adherence is Associated With Attentional Improvements in a Group of Primarily Male Patients With Moderate to Severe OSA.

    Science.gov (United States)

    Deering, Sean; Liu, Lin; Zamora, Tania; Hamilton, Joanne; Stepnowsky, Carl

    2017-12-15

    Obstructive sleep apnea (OSA) is a widespread condition that adversely affects physical health and cognitive functioning. The prevailing treatment for OSA is continuous positive airway pressure (CPAP), but therapeutic benefits are dependent on consistent use. Our goal was to investigate the relationship between CPAP adherence and measures of sustained attention in patients with OSA. Our hypothesis was that the Psychomotor Vigilance Task (PVT) would be sensitive to attention-related improvements resulting from CPAP use. This study was a secondary analysis of a larger clinical trial. Treatment adherence was determined from CPAP use data. Validated sleep-related questionnaires and a sustained-attention and alertness test (PVT) were administered to participants at baseline and at the 6-month time point. Over a 6-month time period, the average CPAP adherence was 3.32 h/night (standard deviation [SD] = 2.53), average improvement in PVT minor lapses was -4.77 (SD = 13.2), and average improvement in PVT reaction time was -73.1 milliseconds (standard deviation = 211). Multiple linear regression analysis showed that higher CPAP adherence was significantly associated with a greater reduction in minor lapses in attention after 6 months of continuous treatment with CPAP therapy (β = -0.72, standard error = 0.34, P = .037). The results of this study showed that higher levels of CPAP adherence were associated with significant improvements in vigilance. Because the PVT is a performance-based measure that is not influenced by prior learning and is not subjective, it may be an important supplement to patient self-reported assessments. Name: Effect of Self-Management on Improving Sleep Apnea Outcomes, URL: https://clinicaltrials.gov/ct2/show/NCT00310310, Identifier: NCT00310310. © 2017 American Academy of Sleep Medicine

  10. DNA Methylation in Inflammatory Genes among Children with Obstructive Sleep Apnea

    OpenAIRE

    Kim, Jinkwan; Bhattacharjee, Rakesh; Khalyfa, Abdelnaby; Kheirandish-Gozal, Leila; Capdevila, Oscar Sans; Wang, Yang; Gozal, David

    2012-01-01

    Background: Pediatric obstructive sleep apnea (OSA) leads to multiple end-organ morbidities that are mediated by the cumulative burden of oxidative stress and inflammation. Because not all children with OSA exhibit increased systemic inflammation, genetic and environmental factors may be affecting patterns of DNA methylation in genes subserving inflammatory functions.

  11. Obstructive sleep apnea syndrome as a novel cause for Ménière's disease.

    Science.gov (United States)

    Nakayama, Meiho; Kabaya, Kayoko

    2013-10-01

    Several recent reports have described the relation between sleep disorders and inner ear function. There are also many reports that insomnia is observed in Ménière's patients. However, the possibility that obstructive sleep apnea syndrome (OSAS) might affect Ménière's disease or other neurotological consequences was not noticed, until studies using polysomnography for these patients. OSAS may cause not only vestibular but also auditory dysfunction. Several reports suggest that insufficient supply of blood via the vertebral basilar artery, which supplies the inner ear, may cause hydropic distension of the endolymphatic system and lead to Ménière's disease. However, few people noticed that in OSAS this insufficient supply might be exacerbated in the night while patients are sleeping. Even more, we should note that Ménière's patients may not only suffer from insomnia, but also that the impaired sleep might be caused by OSAS. Physicians routinely prescribe benzodiazepines or other drugs that have hypnotic, muscle relaxing, antianxiety, and anticonvulsant properties for insomnia, but these properties may have the effect of aggravating OSAS symptoms. Continuous positive airway pressure (CPAP) is an effective therapy used worldwide for the treatment of OSAS. CPAP or surgeries for OSAS may also be useful as one aspect of treatment for Ménière's disease patients with OSAS.

  12. Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment

    DEFF Research Database (Denmark)

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

    2016-01-01

    OBJECTIVES: To systematically review and discuss the outcome of treating obstructive sleep apnea (OSA) in obese children and adolescents. METHODS: In February 2016 Pub Med was searched using a predetermined string to retrieve all relevant articles. The search identified 518 publications. In total...... 10 and 38%. Positive airway pressure was effective for treating OSA, but the mean nightly use was needed...

  13. Low-frequency oscillations and vasoreactivity of cortical vessels in obstructive sleep apnea during wakefulness

    DEFF Research Database (Denmark)

    Schytz, Henrik Winther; Jensen, Benedicte Ersted; Jennum, Poul

    2013-01-01

    Effective nasal continuous positive airway pressure (CPAP) therapy reduces the cardiovascular outcomes associated with obstructive sleep apnea (OSA), but the mechanism behind this effect is unclear. We investigated if OSA patients during wakefulness showed signs of increased sympathetic activity...... and decreased vasoreactivity in cerebral cortical vessels as measured with near-infrared spectroscopy (NIRS), and if this may be reversed by CPAP treatment....

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

    OpenAIRE

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

    2012-01-01

    The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe O...

  15. High‑risk of obstructive sleep apnea and excessive daytime ...

    African Journals Online (AJOL)

    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 ...

  16. Effects of edentulism in obstructive sleep apnea syndrome ...

    African Journals Online (AJOL)

    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.

  17. Morbidity prior to a Diagnosis of Sleep-Disordered Breathing

    DEFF Research Database (Denmark)

    Jennum, Poul; Ibsen, Rikke Falkner; Kjellberg, Jakob

    2013-01-01

    Sleep-disordered breathing (SDB) causes burden to the sufferer, the healthcare system, and society. Most studies have focused on cardiovascular diseases (CVDs) after a diagnosis of obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS); however, the overall morbidity prior...

  18. Sleep architecture in school-aged children with primary snoring.

    Science.gov (United States)

    Zhu, Yin; Au, Chun-Ting; Lam, Hugh S; Chan, Ching-Ching K; Ho, Crover; Wing, Yun-Kwok; Li, Albert M

    2014-03-01

    We aimed to examine if sleep architecture was altered in school-aged children with primary snoring (PS). Children ages 6 to 13 years from 13 primary schools were randomly recruited. A validated obstructive sleep apnea (OSA) screening questionnaire was completed by their parents. Children at high risk for OSA and a randomly chosen low-risk group were invited to undergo overnight polysomnography (PSG) and clinical examination. Participants were classified into healthy controls, PS, mild OSA, and moderate to severe OSA (MS OSA) groups for comparison. A total of 619 participants underwent PSG (mean age, 10.0 ± 1.8 years; 396 (64.0%) boys; 524 (84.7%) prepubertal). For the cohort as a whole, there were no significant differences in measures of sleep architecture between PS and nonsnoring healthy controls. In the multiple regression model, percentage of nonrapid eye movement (NREM) stage 1 (N1) sleep had a significantly positive association, whereas percentage of slow-wave sleep (SWS) had a significantly negative association with sleep-disordered breathing (SDB) severity after controlling for age, gender, body mass index (BMI) z score, and pubertal status. In prepubertal children with PS, no significant disruption of sleep architecture was found. However, pubertal adolescent PS participants had significantly higher adjusted percentage of N1 sleep and wake after sleep onset (WASO) compared to healthy controls. PS did not exert significant adverse influences on normal sleep architecture in prepubertal school-aged children. Nevertheless, pubertal adolescents with PS had increased N1 sleep and WASO. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Effect of Acute Intermittent CPAP Depressurization during Sleep in Obese Patients

    Science.gov (United States)

    Jun, Jonathan C.; Unnikrishnan, Dileep; Schneider, Hartmut; Kirkness, Jason; Schwartz, Alan R.; Smith, Philip L.; Polotsky, Vsevolod Y.

    2016-01-01

    Background Obstructive Sleep Apnea (OSA) describes intermittent collapse of the airway during sleep, for which continuous positive airway pressure (CPAP) is often prescribed for treatment. Prior studies suggest that discontinuation of CPAP leads to a gradual, rather than immediate return of baseline severity of OSA. The objective of this study was to determine the extent of OSA recurrence during short intervals of CPAP depressurization during sleep. Methods Nine obese (BMI = 40.4 ± 3.5) subjects with severe OSA (AHI = 88.9 ± 6.8) adherent to CPAP were studied during one night in the sleep laboratory. Nasal CPAP was delivered at therapeutic (11.1 ± 0.6 cm H20) or atmospheric pressure, in alternating fashion for 1-hour periods during the night. We compared sleep architecture and metrics of OSA during CPAP-on and CPAP-off periods. Results 8/9 subjects tolerated CPAP withdrawal. The average AHI during CPAP-on and CPAP-off periods was 3.6 ± 0.6 and 15.8 ± 3.6 respectively (pCPAP-on and CPAP-off was 4.7 ± 2 and 20.4 ± 4.7 respectively (pCPAP depressurization also induced more awake (pCPAP during sleep led to deterioration of sleep architecture but only partial re-emergence of OSA. These observations suggest carryover effects of CPAP. PMID:26731735

  20. Sleep-related laryngospasm.

    Science.gov (United States)

    Thurnheer, R; Henz, S; Knoblauch, A

    1997-09-01

    The term "sleep-related laryngospasm" refers to episodic, abrupt interruption of sleep accompanied by feelings of acute suffocation followed by stridor. The condition is included in the diagnostic and coding manual of the American Sleep Disorders Association (ASDA), but there are few references in the peer-reviewed literature. Our description of the distinct clinical picture associated with this condition is based on an analysis of the histories of a series of 10 patients. The patients and their families gave precise, uniform accounts of the dramatic attacks. Diagnostic work-up included pulmonary and gastroenterological assessment. All patients reported sudden awakening from sleep due to feelings of acute suffocation, accompanied by intense fear. Apnoea lasting 5-45 s was followed by stridor. Breathing returned to normal within minutes. Patients were left exhausted by the attacks. Nine of our 10 patients had evidence of gastro-oesophageal reflux and six responded to antireflux therapy. We conclude that the nocturnal choking attacks (and the occasional daytime attacks experienced by some of the patients) are caused by laryngospasm. The pathogenesis of the apparent underlying laryngeal irritability is unknown. The condition may be related to a gastro-oesophageal reflux.

  1. Kuninglikus õukonnateatris. I-IV osa / Jaanus Rohumaa

    Index Scriptorium Estoniae

    Rohumaa, Jaanus, 1969-

    1999-01-01

    Jaanus Rohumaa Londonis Royal Court Theatre' poolt korraldatud residentuuris, mis on mõeldud tänapäeva näitekirjanikele ja lavastajatele. Muljeid kokkutulnud eri maade näitekirjanikest ja lavastajatest. Jaanus Rohumaa lavastab Londonis Royal Shakespeare Company teatris Jaan Tätte näidendit "Ristumine peateega"(II osa) Inglise näitekirjaniku Sarah Kane'i loomingust, Robert Lepage'i lavastusest "Imede geomeetria" (III osa)

  2. Obstructive sleep apnea and endothelial progenitor cells

    Directory of Open Access Journals (Sweden)

    Wang Q

    2013-10-01

    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

  3. Gastro-Oesophageal Reflux and Apnoea: Is There a Temporal Relationship?

    Science.gov (United States)

    Rossor, Thomas; Andradi, Gwendolyn; Ali, Kamal; Bhat, Ravindra; Greenough, Anne

    2018-01-01

    Gastro-oesophageal reflux (GOR) and apnoea are common in infants; whether there is a causal relationship is controversial. To determine whether there was a temporal relationship between GOR and apnoea, in particular, the frequency of obstructive apnoeas and if the frequency of GOR episodes correlated with apnoea frequency when maturity at testing was taken into account. Polysomnography and pH/multichannel intraluminal impedance (MII) studies were performed. Apnoeas were classified as central, obstructive, or mixed. MII events were classified as acidic (pH reflux event was compared to that in the 5-min period preceding the event and that in a 5-min reflux-free period (control period). Forty infants (median gestational age 29 [range 24-42] weeks) were assessed at a post-conceptional age of 37 (30-54) weeks. Obstructive (n = 580), central (n = 900), and mixed (n = 452) apnoeas were identified; 381 acid reflux events were detected by MII and 153 by the pH probe only. Apnoeas were not more frequent following GOR than during control periods. Both the frequency of apnoeas (p = 0.002) and GOR episodes (p = 0.01) were inversely related to post-conceptional age at testing, but were not significantly correlated with each other when controlled for post-conceptional age. These results suggest that GOR does not cause apnoea. © 2017 S. Karger AG, Basel.

  4. Genioglossus fatigue in obstructive sleep apnea.

    LENUS (Irish Health Repository)

    McSharry, David

    2012-08-15

    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.

  5. Ambulatory positional obstructive sleep apnea syndrome

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    Fernando Di-Tullio

    Full Text Available Objective: To establish the prevalence of positional (PP OSA patients using self-administered home-based respiratory polygraphy (RP. Materials and Methods: 52 month retrospective study based on RP records. Results: 200 PR records: 70.5% men 29.5% women. 76% were diagnosed with OSA and 54.6% with PP OSA. There were no significant differences in Epworth Sleepiness Scale, apnea hypopnea index and oxygen desaturation index. PP OSA patients were younger, had a lower BMI (30.3±0.9 vs. 35.3±1.2 (p<0.0001, and the time they spent with oxygen saturation <90% (T<90 was lower (8.8 vs. 28.7±6.7, p=0.0038. The PP OSA group spent 43% of total recording time in the supine position. Conclusions: The prevalence of PP OSA patients studied with RP is similar to the one described by sleep laboratories. They have lower BMI, present mostly mild OSA with less desaturation, and are less likely to receive CPAP therapy.

  6. Obstructive sleep apnea and oral language disorders.

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    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.

  7. Obstructive sleep apnea and oral language disorders

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    Camila de Castro Corrêa

    Full Text Available Abstract Introduction 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. Objective To verify, based on the literature, whether OSA in children was correlated to oral language disorders. Methods 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. Results 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. Conclusion 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.

  8. Prevalence, sleep characteristics, and comorbidities in a population at high risk for obstructive sleep apnea: A nationwide questionnaire study in South Korea.

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    Jun-Sang Sunwoo

    Full Text Available To determine the prevalence, sleep characteristics, and comorbidities associated with a high risk for obstructive sleep apnea (OSA in the Korean adult population.We analyzed data from 2,740 subjects who responded to a nationwide questionnaire survey of sleep characteristics. Those who qualified under two or more symptom categories of the Berlin questionnaire were defined as "at high risk for OSA". We investigated their socio-demographic information, sleep habits, and medical and psychiatric comorbidities. Logistic regression analyses were performed to identify factors and consequences significantly associated with a high risk for OSA.The prevalence of a high risk for OSA was 15.8% (95% confidence interval [CI] 14.5-17.2%. Multiple logistic regression analysis showed that old age (≥ 70 years, odds ratio [OR] 2.68 and body mass index ≥ 25 kg/m2 (OR 10.75 were significantly related with a high risk for OSA, whereas regular physical activity (OR 0.70 had a protective effect. Subjective sleep characteristics associated with a high risk for OSA were perceived insufficient sleep (OR 1.49, excessive daytime sleepiness (OR 1.88, and insomnia (OR 3.70. In addition, hypertension (OR 5.83, diabetes mellitus (OR 2.54, hyperlipidemia (OR 2.85, and anxiety (OR 1.63 were comorbid conditions independently associated with a high risk for OSA.This is the first study to demonstrate the prevalence of a high risk for OSA in a nationwide representative sample of the Korean adult population. These findings elucidate the epidemiology and clinical characteristics of those at high risk for OSA.

  9. Pharmacological treatment of sleep disorders and its relationship with neuroplasticity.

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    Abad, Vivien C; Guilleminault, Christian

    2015-01-01

    Sleep and wakefulness are regulated by complex brain circuits located in the brain stem, thalamus, subthalamus, hypothalamus, basal forebrain, and cerebral cortex. Wakefulness and NREM and REM sleep are modulated by the interactions between neurotransmitters that promote arousal and neurotransmitters that promote sleep. Various lines of evidence suggest that sleep disorders may negatively affect neuronal plasticity and cognitive function. Pharmacological treatments may alleviate these effects but may also have adverse side effects by themselves. This chapter discusses the relationship between sleep disorders, pharmacological treatments, and brain plasticity, including the treatment of insomnia, hypersomnias such as narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.

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

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

    2017-08-01

    OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA. Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour). The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  11. The effect of the severity of obstructive sleep apnea syndrome on telomere length.

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    Tempaku, Priscila Farias; Mazzotti, Diego Robles; Hirotsu, Camila; Andersen, Monica Levy; Xavier, Gabriela; Maurya, Pawan Kumar; Rizzo, Lucas Bortolotto; Brietzke, Elisa; Belangero, Sintia Iole; Bittencourt, Lia; Tufik, Sergio

    2016-10-25

    Aging is associated with an increase in the prevalence of obstructive sleep apnea syndrome (OSAS) as well as the shortening of telomeres. It is known that OSAS-related factors are stimuli that can contribute to the acceleration of cellular senescence. Thus, the present study aimed to compare the leukocyte telomere length (LTL) between OSAS patients and controls, as well as to verify the correlation between LTL and sleep parameters. We used DNA extracted of 928 individuals from EPISONO to measure the LTL by the quantitative real-time polymerase chain reaction. All individuals were subjected to one full-night polysomnography. LTL was significantly shorter in OSAS patients compared to controls. The results showed negative correlations between LTL and the following variables: apnea-hypopnea index, respiratory disturbance index, desaturation index and wake after sleep onset. LTL was positively correlated with sleep efficiency, total sleep time, basal, minimum and maximum oxygen saturation. Lastly, it was observed that OSAS severity was associated with shorter LTL even after adjusting for sex, age, years of schooling, body mass index, diabetes, stroke and heart attack. In conclusion, our study indicates the presence of an association between LTL and OSAS and a significant impact of severity of OSAS in telomeres shortening.

  12. Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease

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    Misa Valo

    2015-01-01

    Full Text Available Obstructive sleep apnea (OSA is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T and B-type natriuretic peptide (NT-proBNP in patients with OSA and coexisting coronary artery disease (CAD. Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI, oxygen saturation nadir, and time in bed with oxygen saturation of ≤80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively.

  13. Pulse oximetry recorded from the Phone Oximeter for detection of obstructive sleep apnea events with and without oxygen desaturation in children.

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    Garde, Ainara; Dehkordi, Parastoo; Wensley, David; Ansermino, J Mark; Dumont, Guy A

    2015-01-01

    Obstructive sleep apnea (OSA) disrupts normal ventilation during sleep and can lead to serious health problems in children if left untreated. Polysomnography, the gold standard for OSA diagnosis, is resource intensive and requires a specialized laboratory. Thus, we proposed to use the Phone Oximeter™, a portable device integrating pulse oximetry with a smartphone, to detect OSA events. As a proportion of OSA events occur without oxygen desaturation (defined as SpO2 decreases ≥ 3%), we suggest combining SpO2 and pulse rate variability (PRV) analysis to identify all OSA events and provide a more detailed sleep analysis. We recruited 160 children and recorded pulse oximetry consisting of SpO2 and plethysmography (PPG) using the Phone Oximeter™, alongside standard polysomnography. A sleep technician visually scored all OSA events with and without oxygen desaturation from polysomnography. We divided pulse oximetry signals into 1-min signal segments and extracted several features from SpO2 and PPG analysis in the time and frequency domain. Segments with OSA, especially the ones with oxygen desaturation, presented greater SpO2 variability and modulation reflected in the spectral domain than segments without OSA. Segments with OSA also showed higher heart rate and sympathetic activity through the PRV analysis relative to segments without OSA. PRV analysis was more sensitive than SpO2 analysis for identification of OSA events without oxygen desaturation. Combining SpO2 and PRV analysis enhanced OSA event detection through a multiple logistic regression model. The area under the ROC curve increased from 81% to 87%. Thus, the Phone Oximeter™ might be useful to monitor sleep and identify OSA events with and without oxygen desaturation at home.

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

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

    2015-01-01

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

  15. Omega-3 Index and Obstructive Sleep Apnea: A Cross-Sectional Study.

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    Tittus, Janine; Huber, Marie Theres; Storck, Klaus; Köhler, Anton; Köhler, Jan M; von Arnim, Thomas; von Schacky, Clemens

    2017-10-15

    Erythrocyte levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (Omega-3 Index) were previously found to be associated with obstructive sleep apnea (OSA) at very low levels (Omega-3 Index. These comorbidities can be improved by increasing intake of EPA and DHA, and thus the Omega-3 Index, preferably to its target range of 8% to 11%. Symptoms of OSA might improve by increasing the Omega-3 Index, but more research is needed. In our sleep laboratory, 357 participants with OSA were recruited, and data from 315 participants were evaluated. Three categories of OSA (none/ mild, moderate, severe) were defined based on apnea-hypopnea index. Anthropometrics and lifestyle characteristics (smoking, alcohol, fish intake, omega-3 supplementation) were recorded. Erythrocyte fatty acid compositions were assessed with the HS-Omega-3 Index methodology. The mean Omega-3 Index in all 3 categories of OSA was 5.7%, and no association with OSA was found. There were more male participants with severe OSA (79.7%, P = .042) than females, and participants with severe OSA had a significantly higher body mass index (32.11 ± 6.39 kg/m 2 , P = .009) than participants with mild or moderate OSA. Lifestyle characteristics were not significantly different. In contrast to our hypothesis, an Omega-3 Index of 5.7% was not associated with OSA severity. Previously, an Omega-3 Index Omega-3 Index > 5.7% in an intervention trial with EPA and DHA in OSA, comorbidities of OSA suggest a target range of 8% to 11%. © 2017 American Academy of Sleep Medicine

  16. Sympathetic and Catecholaminergic Alterations in Sleep Apnea with Particular Emphasis on Children.

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    Fahed eHakim

    2012-01-01

    Full Text Available Sleep is involved in the regulation of major organ functions in the human body, and disruption of sleep potentially can elicit organ dysfunction. Obstructive sleep apnea (OSA is the most prevalent sleep disorder of breathing in adults and children, and its manifestations reflect the interactions between intermittent hypoxia (IH, intermittent hypercapnia, increased intra-thoracic pressure swings, and sleep fragmentation, as elicited by the episodic changes in upper airway resistance during sleep. The sympathetic nervous system is an important modulator of the cardiovascular, immune, endocrine and metabolic systems, and alterations in autonomic activity may lead to metabolic imbalance and organ dysfunction. Here we review how OSA and its constitutive components can lead to perturbation of the autonomic nervous system in general, and to altered regulation of catecholamines, both of which then playing an important role in some of the mechanisms underlying OSA-induced morbidities.

  17. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury.

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    Ann C Halbower

    2006-08-01

    Full Text Available Childhood obstructive sleep apnea (OSA is associated with neuropsychological deficits of memory, learning, and executive function. There is no evidence of neuronal brain injury in children with OSA. We hypothesized that childhood OSA is associated with neuropsychological performance dysfunction, and with neuronal metabolite alterations in the brain, indicative of neuronal injury in areas corresponding to neuropsychological function.We conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6-16 y group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared. Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency. Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001 and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03.Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.

  18. Self-Reported Sleep Bruxism and Nocturnal Gastroesophageal Reflux Disease in Patients with Obstructive Sleep Apnea: Relationship to Gender and Ethnicity§

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    Hesselbacher, Sean; Subramanian, Shyam; Rao, Shweta; Casturi, Lata; Surani, Salim

    2014-01-01

    Study Objectives : Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity. Methods : A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a