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Balagny P, D'Ortho MP, Berard L, Rousseau A, Gourmelen J, Ravaud P, Durand-Zaleski I, Simon T, Steg PG. AMI-Sleep: protocol for a prospective study of sleep-disordered breathing/sleep apnoea syndrome and incident cardiovascular events after acute myocardial infarction. BMJ Open 2025; 15:e090093. [PMID: 39965954 PMCID: PMC11836868 DOI: 10.1136/bmjopen-2024-090093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 01/14/2025] [Indexed: 02/20/2025] Open
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) and the related clinical syndrome, sleep apnoea syndrome (SAS), are highly prevalent in patients with ischaemic heart disease and often remain undiagnosed. The AMI-Sleep study will describe its prevalence in patients with acute myocardial infarction (AMI) and assess the independent contribution of the type and severity of SDB/SAS to subsequent incident cardiovascular events and mortality. METHODS AND ANALYSIS This prospective study will include patients hospitalised for AMI enrolled in the multicentre nationwide prospective French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry. A nightly simplified polygraphy is performed before discharge from the index AMI admission, and participants complete two self-administered sleep questionnaires. Baseline data are obtained from the FRENCHIE registry. Each participant will be subsequently followed based on data from the National Health Data System (SNDS). Over a period of 4 years, the AMI-Sleep study is expected to recruit approximately 2000 participants. Assuming at least a 10% rate of incident cardiovascular events over 1 year, there would be an estimated 200 events during the first year of follow-up that would be sufficient in multivariable analysis. The primary objective is to describe the prevalence and severity of SDB in AMI and to analyse the association between the type and severity of SDB (based on the apnoea-hypopnoea index) and the occurrence of cardiovascular events (incident acute coronary syndrome, transient ischaemic attack, stroke) or all-cause death after AMI. Secondary objectives include determining the association between the presence of SAS and coronary artery disease severity, in-hospital mortality, morbidity events, healthcare consumption and related costs. ETHICS AND DISSEMINATION Eligible individuals are provided with information about the AMI-Sleep study and provided written informed consent. The protocol was approved by the regional Ethics Committee (CPP Ouest II - Angers, RCB N°2018-A00719-46) on 17 February 2019, is registered on ClinicalTrials.gov (NCT04064593) and started in January 2019 with the expected publication of primary outcome results in 2025. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04064593.
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Affiliation(s)
- Pauline Balagny
- Department of Physiology and Functional Exploration - Bichat Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
- UMS 011, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France
| | - Marie-Pia D'Ortho
- Department of Physiology and Functional Exploration - Bichat Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
- Inserm, NeuroDiderot, Université Paris Cité, Paris, Île-de-France, France
| | - Laurence Berard
- Department of Clinical Pharmacology-Clinical Research Platform - Saint Antoine Hospital, French Alliance for Cardiovascular Trials, Sorbonne Université, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform - Saint Antoine Hospital, French Alliance for Cardiovascular Trials, Sorbonne Université, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
| | - Julie Gourmelen
- UMS 011, Population-based Cohorts Unit, INSERM, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France
| | - Philippe Ravaud
- METHODS Team, CRESS, INSERM, INRAE, Université Paris Cité, Paris, Île-de-France, France
- Centre d'Épidémiologie Clinique - Hotel Dieu Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
| | - Isabelle Durand-Zaleski
- Research Centre of Research Epidemiology and Statistics (CRESS-UMR1153), Inserm, University of Paris, Paris, France
- DRCI-URC Eco Ile-de-France, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform - Saint Antoine Hospital, French Alliance for Cardiovascular Trials, Sorbonne Université, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
| | - Philippe Gabriel Steg
- Department of cardiology - Bichat Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
- INSERM U1148, Laboratory for Vascular Translational Science, Université Paris Cité, Paris, Île-de-France, France
- Institut Universitaire de France, Paris, Île-de-France, France
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Uzair A, Waseem M, Bin Shahid A, Bhatti NI, Arshad M, Ishaq A, Sajawal M, Toor Z, Ahmad O. Correlation Between Body Mass Index and Apnea-Hypopnea Index or Nadir Oxygen Saturation Levels in Patients With Obstructive Sleep Apnea. Cureus 2024; 16:e59066. [PMID: 38800192 PMCID: PMC11128192 DOI: 10.7759/cureus.59066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Apnea-hypopnea index (AHI) and nadir oxygen saturation (SpO2) are the indexes used to measure the severity of obstructive sleep apnea (OSA). Obesity, measured by body mass index (BMI), is one of the main contributing factors to the onset and severity of OSA in patients. This study was conducted to find the association between BMI and OSA severity indexes, mainly AHI and nadir SpO2 levels. METHODS Polysomnography reports of patients with diagnosed OSA in a teaching hospital were retrospectively reviewed. BMI, AHI, and nadir SpO2 levels were recorded from the sleep study reports of the patients. Spearman's Rho test was applied to find the correlation between BMI and AHI/nadir Spo2 levels. RESULTS A total of 167 patients were included in the study, comprising 83 males and 84 females. The Mann-Whitney U test was utilized to investigate the association between BMI and gender and age groups. The analysis revealed a significant difference in BMI between males and females, with females having a higher BMI. However, there was no significant difference in BMI among individuals in the early middle and late middle age groups. Spearman's Rho test was employed to explore the correlation between BMI and AHI/nadir SpO2 levels. The results indicated no significant correlation between BMI and AHI (p = .122) or nadir SpO2 levels (p = .239). CONCLUSION Contrary to common belief, BMI was not linked to the severity of OSA. It implies that several other factors, independent of BMI, play a role in the disease progression and severity.
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Affiliation(s)
- Ahmed Uzair
- Pulmonary Medicine, Sahiwal Medical College & Allied Teaching Hospital, Sahiwal, PAK
| | - Muhammad Waseem
- Pulmonary Medicine, Sahiwal Medical College & Allied Teaching Hospital, Sahiwal, PAK
| | - Aun Bin Shahid
- Pulmonary Medicine, Sahiwal Medical College & Allied Teaching Hospital, Sahiwal, PAK
| | - Nauman I Bhatti
- Internal Medicine, Sahiwal Medical College & Allied Teaching Hospital, Sahiwal, PAK
| | - Muhammad Arshad
- Internal Medicine, King Edward Medical University & Allied Hospital, Lahore, PAK
| | - Asher Ishaq
- Emergency Department, Pak Red Crescent Medical College & Allied Teaching Hospital, Lahore, PAK
| | - Muhammad Sajawal
- Pulmonary Medicine, Sahiwal Medical College & Allied Teaching Hospital, Sahiwal, PAK
| | - Zoha Toor
- Medical Intensive Care Unit, Mukhtar A. Shiekh Hospital, Multan, PAK
| | - Osama Ahmad
- Internal Medicine, Abwa Medical College Faisalabad, Pakistan, Faisalabad, PAK
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Fong PY, Tay ZY, Soh RY, Fook SMC, Li HH, Phua CQ. Should mild obstructive sleep apnoea be treated? A systematic review from the standpoint of disease progression. J Laryngol Otol 2023; 137:828-839. [PMID: 36380495 DOI: 10.1017/s0022215122002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was a systematic review to investigate the progression of untreated obstructive sleep apnoea in order to evaluate whether mild obstructive sleep apnoea should be treated from the standpoint of disease progression. METHOD The database search study outcomes that were collected included Apnea Hypopnea Index and Respiratory Disturbance Index. A meta-analysis of obstructive sleep apnoea severity over time intervals was performed. RESULTS A total of 17 longitudinal studies and 1 randomised, controlled trial were included for review. For patients with mild obstructive sleep apnoea, mean pre-study and post-study Apnea Hypopnea Index was 5.21 and 8.03, respectively, over a median interval of 53.1 months. In patients with moderate to severe obstructive sleep apnoea, mean pre-study and post-study Apnea Hypopnea Index was 28.9 and 30.3, respectively, over a median interval of 57.8 months. Predictors for disease progression in mild obstructive sleep apnoea are patients aged less than 60 years and those with a baseline body mass index less than 25. CONCLUSION Mild obstructive sleep apnoea progression is observed, but it does not appear to reach any clinically significant progression to moderate or severe obstructive sleep apnoea.
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Affiliation(s)
- P Y Fong
- Department of Otolaryngology, Sengkang General Hospital, Singapore
| | - Z Y Tay
- Department of Otolaryngology, Sengkang General Hospital, Singapore
| | - R Y Soh
- Sleep Medicine Unit, Sengkang General Hospital, Singapore
| | - S M C Fook
- Health Science Research Unit, Singapore General Hospital, Singapore
| | - H H Li
- Health Science Research Unit, Singapore General Hospital, Singapore
| | - C Q Phua
- Department of Otolaryngology, Sengkang General Hospital, Singapore
- Sleep Medicine Unit, Sengkang General Hospital, Singapore
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Ciavarella D, Campobasso A, Conte E, Burlon G, Guida L, Montaruli G, Cassano M, Laurenziello M, Illuzzi G, Tepedino M. Correlation between dental arch form and OSA severity in adult patients: an observational study. Prog Orthod 2023; 24:19. [PMID: 37246168 DOI: 10.1186/s40510-023-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/27/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The role of interdental widths and palatal morphology on the development of obstructive sleep apnea (OSA) has not been well investigated in adult patients yet. The aim of this paper was to assess the morphology of maxilla and mandibular dental arches on three-dimensional (3D) casts and to correlate these measurements with the severity of OSA. METHODS Sixty-four patients (8 women and 56 men, mean age 52.4) with a diagnosis of mild-to-moderate OSA were retrospectively enrolled. On each patient, home sleep apnea test and 3D dental models were collected. Apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were recorded, as well as the dental measurements including inter-molar distance, anterior and posterior widths of maxillary and mandibular arches, upper and lower arch lengths, palatal height, and palatal surface area. The respiratory and dental variables were then correlated. RESULT A statistically inverse correlation was found between ODI and anterior width of lower arch, maxillary arch length, palatal height, and palatal area. AHI showed a significant inverse correlation with anterior width of mandibular arch and maxillary length. CONCLUSION A significant inverse correlation between maxillary and mandibular morphology and respiratory parameters was shown in the present paper.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Elisa Conte
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy.
| | - Giuseppe Burlon
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Laura Guida
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Michele Cassano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Gaetano Illuzzi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Transoral awake state neuromuscular electrical stimulation therapy for mild obstructive sleep apnea. Sleep Breath 2022; 27:527-534. [DOI: 10.1007/s11325-022-02644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is a common disorder with major neurocognitive and cardiovascular sequelae. The treatment of symptomatic patients with mild OSA remains controversial given that adherence to positive airway pressure (PAP) has historically been suboptimal. With this notion in mind, we assessed a daily transoral neuromuscular electrical stimulation (NMES) device for individuals with mild OSA.
Methods
The sample represents a subset of participants with a baseline AHI 5–14.9 events/hour, drawn from a parent study which also included participants with primary snoring. Outcome measures for the current study included changes in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and snoring levels before and after use of the NMES.
Results
Among 65 participants (68% men) with median age of 49 years (range 24 to 79) and median BMI of 27.7 kg/m2 (range 20 to 34), the NMES device was used daily for 6 weeks. We observed a significant improvement in the AHI from 10.2 to 6.8 events/hour among all participants and from 10.4 to 5.0 events/h among responders. Statistically significant improvements in the ESS, PSQI, objectively measured snoring, and bed partner-reported snoring were observed. Adherence among all participants was 85%.
Discussion
This NMES device has the benefit of being a treatment modality of daytime therapy which confers a high level of tolerability and patient acceptance. It alleviates the need for an in situ device during sleep and leads to improvements in OSA severity, snoring, and subjective sleep metrics, potentially crucial in mild OSA. Further studies are needed to define which individuals may benefit most from the device across the wider spectrum of OSA severity and assess long-term therapeutic outcomes.
Trial registration
ClinicalTrials.gov Identifier: NCT03829956.
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Wang L, Pan M, Ou Q. The effects of long-term continuous positive airway pressure on apnea-hypopnea index change following short-term that withdrawal in patients with obstructive sleep apnea. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:352-360. [PMID: 35466516 PMCID: PMC9366582 DOI: 10.1111/crj.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022]
Abstract
The effect of long‐term continuous positive airway pressure (CPAP) treatment on apnea–hypopnea index (AHI) after CPAP withdrawal remains unclear, especially in obstructive sleep apnea (OSA) patients screened from the population. To examine that, 1241 civil servants who participated in the annual physical examination were screened for OSA between September and December 2017. Screened OSA firstly underwent 1‐week CPAP adherence assessment. Then, patients with good CPAP adherence would be freely provided CPAP to continued treatment. All OSA patients were followed for 2 years. At study end, all OSA patients underwent home sleep testing (HST) again within 1 week of CPAP withdrawal. The effect of 2‐year CPAP treatment on OSA severity was investigated by using linear regression and multinominal logistic regression. In total, 103 OSA patients were screened, including 41 cases (39.8%) in CPAP treatment group and 62 cases (60.2%) in non‐CPAP treatment group. At 2‐year follow‐up, compared with baseline, in CPAP treatment group, following CPAP withdrawal, a significant decrease in AHI was observed in patients with severe OSA (P = 0.014); in non‐CPAP treatment group, a significant increase in AHI was observed in patients with moderate OSA (P = 0.028). After adjustment for confounding factors, multivariate linear regression showed that △AHI was negatively associated with CPAP treatment (β = −4.930, 95% confidence interval [CI] [−9.361, −0.500], P = 0.030). Multinominal logistic regression showed that the AHI of patients not treated with CPAP tended to be unchanged or worsened with the AHI improvement group as a reference (OR [odds ration] [95% CI], 4.555 [1.307, 15.875], P = 0.017; 6.536 [1.171, 36.478], P = 0.032). In conclusion, active OSA screening and long‐term CPAP intervention may improve the severity of severe OSA patients following short‐term CPAP withdrawal in the general population.
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Affiliation(s)
- Longlong Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Minxia Pan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Qiong Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Guangdong Provincial Geriatrics Institute, Guangzhou, China
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Mei-Hsiang L, Ning-Hung C, Hsiao PR, Hsiu-Chin H. Factors Associated With Undiagnosed Obstructive Sleep Apnea in Overweight and Obese High-Tech Employees: A Multisite Cross-Sectional Study. Biol Res Nurs 2022; 24:400-409. [DOI: 10.1177/10998004221094109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Being overweight or obese is regarded as crucial risk factors for obstructive sleep apnea (OSA). Objectives: This study aimed to determine the influencing factors of overweight and obese employees with OSA in high-tech workplaces. Methods: A cross-sectional study design was employed. A total of 491 overweight and obese participants were recruited from a large-scale electronics industry. The Chinese version of Pittsburgh Sleep Quality Index, the Epworth Sleep Scale, and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting overweight and obese employees with OSA. This study was conducted from August 2019 to July 2020. Results: 60.5% of the overweight and obese participants were found to have OSA, of which 58.9% had mild and 18.5% had severe OSA, respectively. The results showed that age, neck circumference, snoring, and habitual drinking were the crucial factors affecting OSA. Remarkably, age and snoring times showed a significant correlation in predicting OSA of different severities. Neck circumference was an independent risk factor for moderate and severe OSA. Conclusion: More than 60% of the overweight and obese high-tech workplace employees were found to have OSA. We found that the older the age, the larger the neck circumference, a higher number of snoring instances, and drinking were important risk factors for predicting OSA in overweight high-tech employees. The healthcare providers should actively educate OSA-related information for employees in the workplace, and promote high-risk OSA groups to adopt screening based on at-home sleep apparatus.
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Affiliation(s)
- Lin Mei-Hsiang
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Ping-Ru Hsiao
- Department of Nursing, Chang Gung University of Science and Technology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsu Hsiu-Chin
- Department of Graduate Institute of Health Care, Chang Gung University of Science and Technology, Toa-Yuan, Taiwan
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Chang WH, Wu HC, Lan CC, Wu YK, Yang MC. The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System. Respiration 2021; 100:1060-1069. [PMID: 34350901 DOI: 10.1159/000517031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. OBJECTIVES The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). METHODS This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. RESULTS In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, p = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, p = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, p = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, p = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust R2 = 0.056, p = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. CONCLUSIONS In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.
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Affiliation(s)
- Wei-Hsiu Chang
- Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Hsien-Chang Wu
- Department of Traditional Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Sugiyama A, Shiota S, Yanagihara M, Nakayama H, Tsuiki S, Hayashida K, Inoue Y, Takahashi K. The role of long-term continuous positive airway pressure in the progression of obstructive sleep apnoea: A longitudinal cohort study. J Sleep Res 2021; 30:e13374. [PMID: 34137104 DOI: 10.1111/jsr.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
Recent evidence suggests that short-term obstructive sleep apnea (OSA) treatment could affect OSA pathogenesis such as ventilatory control. The aim of our present study was to identify the impact of long-term treatment on the change in pathogenesis and natural progression of OSA. In a longitudinal analysis of a non-obese cohort study, patients with OSA treated with either continuous positive airway pressure (CPAP) or an oral appliance (OA), interrupted their treatment for 1 week and underwent a polysomnography (PSG) off treatment that was compared with their initial PSG taken 5 years before treatment initiation. In all, 154 consecutive patients with OSA who were treated by CPAP using an auto-titrating continuous positive airway pressure device (CPAP-APAP) (n = 112), or by OA (n = 27) or were untreated (n = 15), PSG was performed twice with a median (range) follow-up of 93 (60-176) months. Multivariate logistic regression showed that reduction of body mass index (BMI) and good treatment adherence to be significant predictors of favourable OSA progression, as represented by an improved or unchanged apnea-hypopnea index (AHI) (odds ratios were 5.14 and 2.89, respectively). Amongst the patients with an unchanged BMI and good CPAP-APAP adherence (n = 55), the improvement in AHI was significantly associated with the decrease in supine non-rapid eye movement-AHI and mixed apnoea index/apnoea index, which are generally recognised to be determinants of ventilator instability. These findings suggest that not only weight but also treatment adherence are determinants in the natural progression of OSA severity.
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Affiliation(s)
- Ai Sugiyama
- Department of Respiratory Medicine, Faculty of Medicine and Graduate, School of Medicine, Juntendo University, Tokyo, Japan.,Yoyogi Sleep Disorder Center, Tokyo, Japan
| | - Satomi Shiota
- Department of Respiratory Medicine, Faculty of Medicine and Graduate, School of Medicine, Juntendo University, Tokyo, Japan
| | | | | | | | | | | | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate, School of Medicine, Juntendo University, Tokyo, Japan
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Karhu T, Myllymaa S, Nikkonen S, Mazzotti DR, Töyräs J, Leppänen T. Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study. Front Neurosci 2021; 15:657126. [PMID: 33994931 PMCID: PMC8113677 DOI: 10.3389/fnins.2021.657126] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Obesity, older age, and male sex are recognized risk factors for sleep apnea. However, it is unclear whether the severity of hypoxic burden, an essential feature of sleep apnea, is associated with the risk of sleep apnea worsening. Thus, we investigated our hypothesis that the worsening of sleep apnea is expedited in individuals with more severe desaturations. Methods The blood oxygen saturation (SpO2) signals of 805 Sleep Heart Health Study participants with mild sleep apnea [5 ≤ oxygen desaturation index (ODI) < 15] were analyzed at baseline and after a mean follow-up time of 5.2 years. Linear regression analysis, adjusted for relevant covariates, was utilized to study the association between baseline SpO2-derived parameters and change in sleep apnea severity, determined by a change in ODI. SpO2-derived parameters, consisting of ODI, desaturation severity (DesSev), desaturation duration (DesDur), average desaturation area (avg. DesArea), and average desaturation duration (avg. DesDur), were standardized to enable comparisons between the parameters. Results In the group consisting of both men and women, avg. DesDur (β = 1.594, p = 0.001), avg. DesArea (β = 1.316, p = 0.004), DesDur (β = 0.998, p = 0.028), and DesSev (β = 0.928, p = 0.040) were significantly associated with sleep apnea worsening, whereas ODI was not (β = -0.029, p = 0.950). In sex-stratified analysis, avg. DesDur (β = 1.987, p = 0.003), avg. DesArea (β = 1.502, p = 0.024), and DesDur (β = 1.374, p = 0.033) were significantly associated with sleep apnea worsening in men. Conclusion Longer and deeper desaturations are more likely to expose a patient to the worsening of sleep apnea. This information could be useful in the planning of follow-up monitoring or lifestyle counseling in the early stage of the disease.
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Affiliation(s)
- Tuomas Karhu
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, OLD, Australia
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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11
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Natural History of Sleep-disordered Breathing during Rapid Eye Movement Sleep. Relevance for Incident Cardiovascular Disease. Ann Am Thorac Soc 2021; 17:614-620. [PMID: 32011165 DOI: 10.1513/annalsats.201907-524oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) occurring primarily during rapid eye movement (REM) sleep is a common clinical problem. The natural history of REM-related SDB and the associated cardiovascular sequelae of disease progression remain to be determined.Objectives: The objective of the current study was to describe the natural history of REM-related SDB, ascertain predictors of progression, and determine whether the evolution of REM-related SDB into non-REM (NREM) sleep is associated with incident cardiovascular events.Methods: Participants from the Sleep Heart Health Study with a baseline NREM apnea-hypopnea index (NREM-AHI) of <5 events/h and data from a follow-up sleep study along with information on incident cardiovascular disease were included in the study. Bivariate logistic regression was used to jointly model the predictors of disease progression based on the presence or absence of SDB during NREM and REM sleep using a cut-point of 5 events/h. Explanatory variables such as age, race, body mass index (BMI), change in BMI, and baseline REM-AHI were considered. Proportional hazards regression was then used to establish whether the development of SDB during NREM sleep was associated with incident cardiovascular disease.Results: The majority of the 1,908 participants included in the study did not develop SDB during NREM sleep. The likelihood of progression of SDB into NREM sleep did increase with higher baseline REM-AHI. BMI and an increase in BMI predicted progression of SDB in both NREM and REM sleep in men but not in women. There was a strong interdependence between developing a NREM-AHI of ≥5 events/h and worsening REM-AHI at follow-up with odds ratios of 6.01 and 4.47, in women and men, respectively. Moreover, the relative risk for incident cardiovascular events among those who developed a NREM-AHI of ≥5 events/h at the follow-up visit was elevated only in women with REM-related SDB at baseline.Conclusions: SDB during REM sleep is a relatively stable condition and does not progress in the majority of individuals. Progression of SDB into NREM sleep is associated with sex, weight, and age. SDB during REM and NREM sleep tends to develop concurrently. Finally, the development of SDB during NREM sleep is associated with incident cardiovascular events, but only in women with REM-related SDB at baseline.
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Berger M, Hirotsu C, Haba-Rubio J, Betta M, Bernardi G, Siclari F, Waeber G, Vollenweider P, Marques-Vidal P, Heinzer R. Risk factors of excessive daytime sleepiness in a prospective population-based cohort. J Sleep Res 2020; 30:e13069. [PMID: 32412149 DOI: 10.1111/jsr.13069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/01/2023]
Abstract
Although excessive daytime sleepiness is commonly evaluated in clinical and research settings using the Epworth Sleepiness Scale, few studies have assessed the factors associated with its incidence in the general population. We prospectively investigated the predictors of incident and persistent excessive daytime sleepiness in 2,751 subjects (46.1% men, mean age 56.0 ± 9.8 years) from the CoLaus-PsyCoLaus population-based cohort (Lausanne, Switzerland) over 5 years. Participants completed the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, and underwent a full clinical evaluation at baseline and 5 years afterwards. Ambulatory polysomnography was performed at baseline in a sub-sample of 1,404 subjects. Among the 2,438 subjects without excessive daytime sleepiness (Epworth Sleepiness Scale ≤ 10) at baseline, the 5-year incidence of excessive daytime sleepiness was 5.1% (n = 124). Multivariate logistic regression revealed that male sex, depressive symptoms, reported poor sleep quality and moderate to severe obstructive sleep apnea were independent predictors of incident excessive daytime sleepiness, while older age, moderate coffee consumption, periodic leg movement during sleep and hypertension were independent protective factors. Stratified analysis according to sex and age showed some distinctive associations. Among the 313 patients with excessive daytime sleepiness at baseline, 137 (43.8%) had persistent excessive daytime sleepiness 5 years later. Our findings provide new insights into the predictors of incident excessive daytime sleepiness, but interventional studies are needed to understand the impact of treating these risk factors on the incidence of excessive daytime sleepiness.
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Affiliation(s)
- Mathieu Berger
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Gerard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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13
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Svanborg E, Ulander M, Broström A, Sunnergren O. Palatal Sensory Function Worsens in Untreated Snorers but not in CPAP-Treated Patients With Sleep Apnea, Indicating Vibration-Induced Nervous Lesions. Chest 2020; 157:1296-1303. [PMID: 32059960 DOI: 10.1016/j.chest.2020.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Signs of both motor and sensory nervous lesions have previously been shown in the upper airway of patients with OSA and habitual snorers. Snoring per se may damage all upper airway neurons over time, thereby causing progression to manifest sleep apnea. To test this hypothesis, nonsnoring subjects, untreated snorers, and CPAP-treated patients underwent repeated sensory testing of the soft palate in a prospective long-term study. METHODS Cold detection threshold (CDT) testing at the soft palate and lip with a thermode and nocturnal respiratory recordings were performed in 2008 to 2009 with retesting 6 to 7 years later. RESULTS In 25 untreated snorers, palatal CDT worsened from a median (25th-75th percentile range) 4.2°C (3.2-5.9) to 11.0°C (7.0-17.4) (P < .001). The apnea-hypopnea index increased from a median 7.0 to 14.0 events/h (P < .05). There was no significant correlation between changes in CDT and the apnea-hypopnea index. In 21 nonsnoring control subjects, palatal CDT increased from a median 3.2°C to 5.6°C (P < .005). In 19 CPAP-treated patients, palatal CDT did not significantly change; eight patients had improved values. CDTs worsened significantly more in the snorers group than in the control subjects (P < .05) and the CPAP-treated patients (P < .001). There was no significant difference between control subjects and CPAP-treated patients. CONCLUSIONS CDT worsened considerably over time in untreated snorers, significantly more than in nonsnoring control subjects and CPAP-treated patients. Untreated snorers therefore risk developing poor sensitivity in the upper airway. In contrast, efficient treatment of OSA seems to protect the sensory innervation, as the CPAP-treated group maintained their sensitivity to cold and, in some cases, the sensitivity even improved.
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Affiliation(s)
- Eva Svanborg
- Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Martin Ulander
- Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden
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Correlation between body mass index and obstructive sleep apnea severity indexes - A retrospective study. Am J Otolaryngol 2018; 39:388-391. [PMID: 29625769 DOI: 10.1016/j.amjoto.2018.03.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA). MATERIALS AND METHODS Seventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p < 0.025. RESULTS No correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r2 = 0.424; p < 0.001) was found between the BMI index and the Nadir SaO2. CONCLUSIONS Higher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA.
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15
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Knappe SW, Sonnesen L. Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives. Nat Sci Sleep 2018; 10:65-72. [PMID: 29440942 PMCID: PMC5800493 DOI: 10.2147/nss.s135760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The purpose of this article is to review 1) mandibular advancement device (MAD) - indication, treatment success, and side effects; 2) maxillomandibular advancement (MMA) surgery of the jaws - indication, treatment success, and side effects; and 3) current perspectives. Both MAD and MMA are administered to increase the upper airway volume and reduce the collapsibility of the upper airway. MAD is noninvasive and is indicated as a first-stage treatment in adult patients with mild-to-moderate obstructive sleep apnea (OSA) and in patients with severe OSA unable to adhere to continuous positive airway pressure (CPAP). MAD remains inferior to CPAP in reducing the apnea-hypopnea index (AHI) with a treatment success ranging between 24% and 72%. However, patient compliance to MAD is greater, and with regard to subjective sleepiness and health outcomes, MAD and CPAP have been found to be similarly effective. Short-term side effects of MAD are minor and often transient. Long-term side effects primarily appear as changes in the dental occlusion related to decreases in overjet and overbite. MMA is efficacious but highly invasive and indicated as a second-stage treatment in patients with moderate-to-severe OSA, with prior failure to other treatment modalities or with craniofacial abnormalities. The surgical success and cure rates are found to be 86.0% and 43.2%, respectively. Side effects may appear as postsurgical complications such as temporary facial paresthesia and compromised facial esthetics. However, most patients report satisfaction with their postsurgical appearance. Both treatment modalities require experienced clinicians and multidisciplinary approaches in order to efficaciously treat OSA patients. Some researchers do propose possible predictors of treatment success, but clear patient selection criteria and clinical predictive values for treatment success are still needed in both treatment modalities.
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Affiliation(s)
- Sofie Wilkens Knappe
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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17
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Jeon HJ, Bang YR, Jeon S, Lee TY, Park HY, Yoon IY. Modest Improvement of Untreated Severe Sleep-Disordered Breathing in the Middle-Aged and Elderly. Psychiatry Investig 2017; 14:662-668. [PMID: 29042892 PMCID: PMC5639135 DOI: 10.4306/pi.2017.14.5.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/18/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity. METHODS Baseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed. RESULTS At the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037). CONCLUSION Untreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.
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Affiliation(s)
- Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Rong Bang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
| | - Soyeon Jeon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
| | - Tae Young Lee
- Medical Research Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
- Department of Psychiatry, School of Medicine, Seoul National University, Seoul, Republic of Korea
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18
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Physiopathologie du syndrome d’apnées-hypopnées obstructives du sommeil et de ses conséquences cardio-métaboliques. Presse Med 2017; 46:395-403. [DOI: 10.1016/j.lpm.2016.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 01/03/2023] Open
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19
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Marcussen L, Stokbro K, Aagaard E, Torkov P, Thygesen T. Changes in Upper Airway Volume Following Orthognathic Surgery. J Craniofac Surg 2016; 28:66-70. [PMID: 27893557 DOI: 10.1097/scs.0000000000003206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Reduced volume of the internal skeletal dimensions of the face is 1 of the main causes of obstructive sleep apnea, and attention to patients' airways is necessary when planning orthognathic treatment. This study aims to describe changes in upper airway volume following virtually planned orthognathic surgery.A retrospective pilot study was designed with 30 randomly selected patients (10 men and 20 women, aged 23.1 ± 6.8 years, molar-relations: 15 neutral, 8 distal, and 7 mesial). Cone-beam computed tomography scans were performed before surgery and 1 week following surgery. The authors did total upper airway volume measurements and obtained 1-mm slices at vertical levels in the velo-, oro-, and hypopharynx and at the smallest visible cross-section.Measurements before and after surgery were compared using Student t test.After orthognathic surgery, the minimum cross-sectional area at the vertical level increased from 83 mm ± 33 before surgery to 102 mm ± 36 after surgery (P = 0.019). In patients with neutral and distal occlusions, the minimum cross-sectional slice volume increased in 87% but in only 57% with mesial occlusion.The present findings suggest that orthognathic surgery increases upper airway volume parameters, but a few patients have continued impairment of the airways following orthognathic surgery. Further studies are needed to confirm an individual surgical planning approach that potentially could bring the minimum cross sectional area out of the risk zone.
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Affiliation(s)
- Lillian Marcussen
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
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20
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Alamin FAERM, Ayad CE. Characterization of Upper Air Way Tract in Snoring and Non-Snoring Patients: A CT Based Study. OPEN JOURNAL OF RADIOLOGY 2016; 06:181-190. [DOI: 10.4236/ojrad.2016.63025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Hayashida K, Kobayashi M, Namba K, Ueki Y, Nakayama H, Ito E, Higami S, Inoue Y. Progression of obstructive sleep apnoea syndrome in Japanese patients. Sleep Breath 2015; 20:711-8. [PMID: 26589953 DOI: 10.1007/s11325-015-1286-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 07/10/2014] [Accepted: 09/12/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The aggravation of obstructive sleep apnoea syndrome (OSAS) is reportedly associated with weight gain. The present study investigated the factors associated with worsening of respiratory functional parameters in Japanese OSAS patients who showed no body weight change during the follow-up period. METHODS A follow-up polysomnography (PSG) was performed in 82 patients with a mean of 7.5 years after the diagnostic PSG, and the apnoea-hypopnoea index (AHI), respiratory event duration, minimum percutaneous oxygen saturation (SpO2), baseline SpO2, and 3 % oxygen desaturation index (ODI) during sleep were compared between the two PSGs. Furthermore, factors associated with worsened AHI, respiratory event duration, and minimum SpO2 were investigated using logistic regression analysis. RESULTS No significant differences were observed in AHI, baseline SpO2, and 3 % ODI between the two PSGs. However, there was a significantly increased respiratory event duration and decreased minimum SpO2 observed. In addition, 17 patients had a ≥25 % AHI increase, and the age of 40-60 years and initial OSAS severity (mild and moderate) were the significantly associated factors. Age of ≥60 years and a baseline body mass index (BMI) of ≥25 kg/m(2) were significantly associated with prolonged respiratory event duration. The age of 40-60 years was significantly associated with decreased minimum SpO2. CONCLUSIONS Untreated middle-aged patients may be at a high risk for worsened AHI and SpO2 even without weight gain.
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Affiliation(s)
- Kenichi Hayashida
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.,Sleep and Stress Clinic, Tokyo, Japan
| | - Mina Kobayashi
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.,Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Kazuyoshi Namba
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoichiro Ueki
- Sleep and Stress Clinic, Tokyo, Japan.,Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Nakayama
- Department of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Eiki Ito
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.,Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Shigeru Higami
- Higami Ear-Nose-Throat, Snore and Sleep Clinic, Tottori, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan. .,Department of Somnology, Tokyo Medical University, Tokyo, Japan. .,Department of Psychiatry, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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Baril AA, Gagnon K, Arbour C, Soucy JP, Montplaisir J, Gagnon JF, Gosselin N. Regional Cerebral Blood Flow during Wakeful Rest in Older Subjects with Mild to Severe Obstructive Sleep Apnea. Sleep 2015; 38:1439-49. [PMID: 25761981 DOI: 10.5665/sleep.4986] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/31/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate changes in regional cerebral blood flow (rCBF) during wakeful rest in older subjects with mild to severe obstructive sleep apnea (OSA) and healthy controls, and to identify markers of OSA severity that predict altered rCBF. DESIGN High-resolution (99m)Tc-HMPAO SPECT imaging during wakeful rest. SETTING Research sleep laboratory affiliated with a University hospital. PARTICIPANTS Fifty untreated OSA patients aged between 55 and 85 years, divided into mild, moderate, and severe OSA, and 20 age-matched healthy controls. INTERVENTIONS N/A. MEASUREMENTS Using statistical parametric mapping, rCBF was compared between groups and correlated with clinical, respiratory, and sleep variables. RESULTS Whereas no rCBF change was observed in mild and moderate groups, participants with severe OSA had reduced rCBF compared to controls in the left parietal lobules, left precentral gyrus, bilateral postcentral gyri, and right precuneus. Reduced rCBF in these regions and in areas of the bilateral frontal and left temporal cortex was associated with more hypopneas, snoring, hypoxemia, and sleepiness. Higher apnea, microarousal, and body mass indexes were correlated to increased rCBF in the basal ganglia, insula, and limbic system. CONCLUSIONS While older individuals with severe obstructive sleep apnea (OSA) had hypoperfusion in the sensorimotor and parietal areas, respiratory variables and subjective sleepiness were correlated with extended regions of hypoperfusion in the lateral cortex. Interestingly, OSA severity, sleep fragmentation, and obesity correlated with increased perfusion in subcortical and medial cortical regions. Anomalies with such a distribution could result in cognitive deficits and reflect impaired vascular regulation, altered neuronal integrity, and/or undergoing neurodegenerative processes.
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Affiliation(s)
- Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychiatry, Montreal, Quebec, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université du Québec à Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Caroline Arbour
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- McGill University, McConnell Brain Imaging Centre, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychiatry, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université du Québec à Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychology, Montreal, Quebec, Canada
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Toraldo DM, De Benedetto M, Scoditti E, De Nuccio F. Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure. Sleep Breath 2015; 20:457-65. [PMID: 26169715 DOI: 10.1007/s11325-015-1227-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/22/2015] [Accepted: 06/29/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder associated with severe cardiovascular events, morbidity and mortality. Recent evidence has highlighted OSAS as an independent risk factor for an excessive platelet activation and arterial thrombosis, but the underlying mechanisms have not yet been determined. Studies in cell culture and animal models have significantly increased our understanding of the mechanisms of inflammation in OSAS. Hypoxia is a critical pathophysiological element that leads to an intense sympathetic activity, in association with systemic inflammation, oxidative stress and procoagulant activity. While platelet dysfunction and/or hypercoagulability play an important role in the pathogenesis of vascular disease, there are limited studies on the potential role of blood viscosity in the development of vascular disease in OSAS. CONCLUSION Further studies are required to determine the precise role of hypercoagulability in the cardiovascular pathogenesis of OSAS, particularly its interaction with oxidative stress, thrombotic tendency and endothelial dysfunction. Nasal continuous positive airway pressure (nCPAP), the gold standard treatment for OSAS, not only significantly reduced apnea-hypopnoea indices but also markers of hypercoagulability, thus representing a potential mechanisms by which CPAP reduces the rate of cardiovascular morbidity and mortality in OSAS patients.
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Affiliation(s)
| | | | - Egeria Scoditti
- National Research Council (CNR), Institute of Clinical Physiology, Lecce, Italy
| | - Francesco De Nuccio
- Laboratory of Human Anatomy and Neuroscience, Department of Biological and Environmental Sciences and Technologies, University of Salento, Via Prov. le Lecce-Monteroni (Centro Ecotekne), 73100, Lecce, Italy.
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Lin CY, Shih TS, Liou SH, Lin MH, Chang CP, Chou TC. Predictors for Progression of Sleep Disordered Breathing among Public Transport Drivers: A 3-Year Follow-Up Study. J Clin Sleep Med 2015; 11:419-25. [PMID: 25766707 DOI: 10.5664/jcsm.4596] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/02/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is associated with an increased risk of motor vehicle crashes. This study aimed to understand SDB progression and related factors among professional drivers. METHODS A total of 524 professional male drivers from a transportation company were included in this study. These drivers completed overnight in-home pulse oximetry studies both in 2006 and in 2009. Participants with abnormal results (oxygen desaturation index [ODI] ≥ 10 events/h) comprised the SDB group. Data included questionnaire information on demographics, medical history, SDB symptoms, and anthropometric measurements. RESULTS A total of 318 male workers were recruited for further analysis. Fifty of these workers belonged to the SDB group. Workers with untreated SDB significantly progressed to a more severe state after three years. Baseline body mass index (BMI), baseline ODI, and change in BMI were all significant positive predictors of SDB progression (β = 0.823, 0.242, and 1.626; p = 0.047, 0.013, and 0.004, respectively). Compared with non-SDB drivers, SDB subjects showed a greater proportion of newly diagnosed cardiovascular disease (38.0%) at follow-up. CONCLUSIONS Untreated SDB was a gradually progressive disorder in professional drivers over a three-year period. Subjects with high BMI and moderate to severe SDB should be closely monitored to allow for early detection of worsening SDB. Weight control should be highlighted in the management of SDB. COMMENTARY A commentary on this article appears in this issue on page 409.
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Affiliation(s)
- Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Environmental and Occupational Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Otolaryngology, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Tung-Sheng Shih
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan.,Institute of Labor, Occupational Safety and Health, Ministry of Labor, Executive Yuan, New Taipei, Taiwan
| | - Saou-Hsing Liou
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Hsiu Lin
- Institute of Labor, Occupational Safety and Health, Ministry of Labor, Executive Yuan, New Taipei, Taiwan
| | - Cheng-Ping Chang
- Department of Occupational Safety and Health, Chang Jung Christian University, Tainan, Taiwan
| | - Tzu-Chieh Chou
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
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25
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Blomster H, Laitinen TP, Hartikainen JE, Laitinen TM, Vanninen E, Gylling H, Sahlman J, Kokkarinen J, Randell J, Seppä J, Tuomilehto H. Mild obstructive sleep apnea does not modulate baroreflex sensitivity in adult patients. Nat Sci Sleep 2015. [PMID: 26203292 PMCID: PMC4487157 DOI: 10.2147/nss.s82443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic and progressive disease. OSA is associated with increased cardiovascular morbidity and mortality, the risk being more frequently encountered with severe degrees of OSA. Increased sympathetic activation and impaired cardiac autonomic control as reflected by depressed baroreceptor reflex sensitivity (BRS) are possible mechanisms involved in the cardiovascular complications of OSA. However, it is not known at what stage of OSA that changes in BRS appear. The aim of this study was to evaluate BRS in patients with mild OSA. METHODS The study population consisted of 81 overweight patients with mild OSA and 46 body weight-matched non-OSA subjects. BRS, apnea-hypopnea index, body mass index, and metabolic parameters were assessed. The phenylephrine test was used to measure BRS. RESULTS Patients in the OSA group were slightly but significantly older than the non-OSA population (50.3±9.3 years vs 45.7±11.1 years, P=0.02). Body mass index, percentage body fat, blood pressure, fasting glucose, insulin, and lipid levels did not differ between the OSA patients and non-OSA subjects. Absolute BRS values in patients with mild OSA and non-OSA subjects (9.97±6.70 ms/mmHg vs 10.51±7.16 ms/mmHg, P=0.67) and BRS values proportional to age-related and sex-related reference values (91.4%±22.7% vs 92.2%±21.8%, P=0.84) did not differ from each other. BRS <50% of the sex-specific reference value was found in 6% of patients with mild OSA and in 2% of non-OSA subjects (P=0.29). CONCLUSION Patients with mild OSA did not show evidence of disturbed BRS in comparison with weight-matched non-OSA controls.
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Affiliation(s)
- Henry Blomster
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Ek Hartikainen
- Department of Internal Medicine, University of Eastern Finland, Kuopio, Finland ; Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Esko Vanninen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Helena Gylling
- Department of Clinical Nutrition, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Department of Medicine, Division of Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Sahlman
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jouko Kokkarinen
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Randell
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Juha Seppä
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Henri Tuomilehto
- Department of Clinical Nutrition, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Oivauni Sleep Clinic, Kuopio, Finland
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Chen X, Pensuksan WC, Lohsoonthorn V, Lertmaharit S, Gelaye B, Williams MA. Obstructive Sleep Apnea and Multiple Anthropometric Indices of General Obesity and Abdominal Obesity among Young Adults. ACTA ACUST UNITED AC 2014; 2:89-99. [PMID: 25530977 DOI: 10.11114/ijsss.v2i3.439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to examine the association between obstructive sleep apnea (OSA) and obesity among young adults. A total of 2911 college students in Thailand participated in the study. Anthropometric measurements and blood pressure were taken by trained research staff. Overall, 6.3% of college students had OSA determined by the Berlin Questionnaire, 9.6% were overweight (BMI: 25-29 kg/m2), 4.5% were obese (BMI≥30 kg/m2); 12.4% had abdominal obesity (men: waist circumference≥90 cm; women: waist circumference≥80 cm). There were significant associations between OSA and overweight (odds ratio (OR)=1.72; 95% confidence interval (CI)=1.04-1.85) and obesity (OR=24.23; 95% CI=15.20-38.61), independent of demographic and lifestyle factors, blood pressure, and psychological distress. Students with OSA were more likely to have abdominal obesity than those without OSA (OR=2.09; 95% CI=1.19-3.67). OSA was significantly related to joint effects of general and abdominal obesity. The OSA-obesity associations were robust and evident for both genders, individuals with normal and elevated blood pressure, and those with and without psychological distress. This study shows independent associations of OSA with general and abdominal obesity among young adults. OSA could be a risk factor for obesity and consequent cardiovascular morbidities. OSA screening and treatment might be important for young adults.
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Affiliation(s)
- Xiaoli Chen
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | | | - Vitool Lohsoonthorn
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Somrat Lertmaharit
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand ; College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
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Abstract
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.
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Affiliation(s)
- David P White
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA.
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28
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Si X, Xi J, Kim J. Effect of Laryngopharyngeal Anatomy on Expiratory Airflow and Submicrometer Particle Deposition in Human Extrathoracic Airways. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojfd.2013.34036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ivanoff CS, Hottel TL, Pancratz F. Is There a Place for Teaching Obstructive Sleep Apnea and Snoring in the Predoctoral Dental Curriculum? J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.12.tb05427.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chris S. Ivanoff
- Department of Prosthodontics; College of Dentistry; University of Tennessee Health Science Center
| | - Timothy L. Hottel
- Department of Prosthodontics; University of Tennessee Health Science Center
| | - Frank Pancratz
- College of Dentistry; University of Tennessee Health Science Center
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30
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Jafari B, Roux F. Non-positive airway pressure therapy for obstructive sleep apnea. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0016-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Laporta R, Anandam A, El-Solh AA. Screening for obstructive sleep apnea in veterans with ischemic heart disease using a computer-based clinical decision-support system. Clin Res Cardiol 2012; 101:737-44. [PMID: 22476823 DOI: 10.1007/s00392-012-0453-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/22/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the validity of a handheld clinical decision-support system (CDSS) in detecting obstructive sleep apnea (OSA) in veterans with ischemic heart disease against polysomnography (PSG) and to compare the diagnostic accuracy of the CDSS versus the Berlin questionnaire. METHODS We enrolled prospectively 143 patients with underlying ischemic heart disease. Veterans with history of neurologic disease, systolic congestive heart failure, or receiving opiates were excluded from participation. Participants were asked to complete the Berlin Questionnaire and to answer all eight questions of CDSS-software. At the end of the interview, veterans were scheduled for an in-laboratory polysomnogram. RESULTS Ninety one patients completed the study. The prevalence of OSA (AHI ≥5/h) was 74.7 % with a median AHI of 11.5/h (range 0-90). When compared to PSG, the CDSS and the Berlin questionnaire achieved a sensitivity of 98.5 % [95 % confidence interval (CI) 92.1-100] and 80.9 % (95 % CI 69.5-89.4) and a specificity of 86.9 % (95 % CI 66.4-97.2) and 39.1 % (95 % CI 19.7-61.5) at a threshold value of AHI ≥5 with a corresponding area under the curve of 0.93 (95 % CI 0.85-0.97) and 0.60 (95 % CI 0.49-0.70); respectively. CONCLUSIONS CDSS is a superior screening tool for identifying cardiac veterans with undiagnosed OSA than the BQ.
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Affiliation(s)
- Rachel Laporta
- Medical Research, VA Western New York Healthcare System, Buffalo, NY, 14215-1199, USA
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Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders. Sleep Med 2012; 13:616-20. [PMID: 22459090 DOI: 10.1016/j.sleep.2011.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 12/26/2011] [Accepted: 12/29/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To correlate sleep apnea with craniofacial characteristics and facial patterns according to gender. METHODS In this prospective survey we studied 77 male and female children (3-12 years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch (MA), and vertical growth coefficient (VERT) index. RESULTS The prevalence of sleep apnea was 46.75% with no statistical difference between genders. Among children with obstructive sleep apnea (Apneia Hypopnea Index - AHI ≥ 1) boys had higher AHI values than girls. A predominance of the dolichofacial pattern (81.9%) was observed. The following skeletal craniofacial measurements correlated with AHI in boys: FD (r(s)=-0.336/p=0.020), MP (r(s)=0.486/p=0.00), and VERT index (r(s)=-0.337/p=0.019). No correlations between craniofacial measurements and AHI were identified in girls. CONCLUSIONS Craniofacial morphology may influence the severity of sleep apnea in boys but not in girls.
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Association of duration of sleep and cardiovascular and metabolic comorbidities in sleep apnea syndrome. SLEEP DISORDERS 2011; 2012:316232. [PMID: 23471129 PMCID: PMC3581129 DOI: 10.1155/2012/316232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 11/17/2022]
Abstract
Background/Aim. Previous population-based studies found association between duration of sleep and cardiovascular and metabolic comorbidities. Our aim was to investigate the association between the duration of sleep and cardiovascular and metabolic comorbidities in OSAS. Patients and Methods. The study enrolled 312 patients, who had polysomnography (PSG) during 2006-2007 and responded to a telephone-administered questionnaire providing information on characteristics of sleep on average 12 months after PSG. Results. Of the patients, 90 were female (28.8%), 173 (58.5) received the diagnosis of OSAS, 150 (45%) had no comorbidities, 122 had hypertension (HT), 44 had diabetes mellitus (DM), and 38 had coronary heart disease (CHD). Mean ± SD of age in years was 47.2 ± 10.6, 56.5 ± 9.3, 53.2 ± 8.9, and 59.9 ± 9.0 for the no comorbidity, HT, DM, and CHD groups, respectively. Reported duration of sleep was not associated with any of the comorbidities in the overall group. In the analysis restricted to OSAS patients, sleep duration ≤6 hours was significantly associated with CHD after the adjustment for age, gender, and other associated factors (OR: 5.8, 95% CI: 1.0–32.6). Conclusions. Confirmation of the association between shorter duration of sleep and CHD will provide prognostic information and help for the management of OSAS.
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Pillar G, Lavie P. Obstructive sleep apnea: diagnosis, risk factors, and pathophysiology. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:383-99. [PMID: 21056200 DOI: 10.1016/b978-0-444-52006-7.00025-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Giora Pillar
- Sleep Medicine Center, Ramham Hospital and Lloyd Rigler Sleep Apnea Research Laboratory, Haifa, Israel.
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Ciftci TU, Kokturk O, Demirtas S, Gülbahar Ö, Bukan N. Consequences of hypoxia-reoxygenation phenomena in patients with obstructive sleep apnea syndrome. Ann Saudi Med 2011; 31:14-8. [PMID: 21245593 PMCID: PMC3101718 DOI: 10.4103/0256-4947.75772] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by numerous episodes of absence of respiratory flow during sleep, which can be followed by a decrease in SaO2, which is rapidly normalized when ventilation resumes. We hypothesize that this hypoxia-reoxygenation phenomena may affect the generation of vascular endothelial growth factor (VEGF), erythropoietin (EPO), endothelin-1 (ENDO-1), and inducible nitric oxide synthase (iNOS). DESIGN AND SETTING Prospective, patients referred to sleep disorders center. PATIENTS AND METHODS The presence and severity of OSAS were determined using the standard overnight polysomnography. Diagnosis of OSAS was made when the apnea-hypopnea index (AHI) was ≥15, independent of the appearance of symptoms. Serum levels of VEGF, EPO, ENDO-1, and nitrite-nitrate were measured after overnight fasting in 69 patients with OSAS and in 17 healthy control subjects. Serum levels of VEGF and nitrite-nitrate were measured again after 12 weeks of treatment with continuous positive airway pressure (CPAP) in OSAS patients. RESULTS Serum VEGF levels were found to be significantly higher and nitrite-nitrate levels were found to be significantly lower in OSAS patients than in controls (P=.003, .008, respectively), but no differences in EPO and ENDO-1 levels were found between the groups. We demonstrated that in OSAS patients, the serum VEGF levels were decreased and nitrate levels were increased after 12 weeks of CPAP treatment (P=.001, .002, respectively). CONCLUSION According to our data, it is likely that hypoxia-reoxygenation phenomena affect the VEGF and nitrite-nitrate levels, which may be pathogenic factors in generating cardiovascular complications in OSAS.
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Affiliation(s)
- Tansu Ulukavak Ciftci
- From the Sleep Disorders Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Oguz Kokturk
- From the Sleep Disorders Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Senay Demirtas
- From the Sleep Disorders Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özlem Gülbahar
- From the Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Neslihan Bukan
- From the Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
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Lieberman JA. Obstructive sleep apnea (OSA) and excessive sleepiness associated with OSA: recognition in the primary care setting. Postgrad Med 2009; 121:33-41. [PMID: 19641266 DOI: 10.3810/pgm.2009.07.2027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Obstructive sleep apnea (OSA) is a common and debilitating condition characterized by recurrent episodes of upper airway obstruction, resulting in intermittent occurrence of apnea-hypopnea. Clinical features include snoring or disturbed sleep, reduced concentration and memory, mood disorders, and excessive sleepiness (ES). Left undiagnosed and untreated, OSA may have detrimental consequences, including cardiovascular (CV) morbidity and mortality, decreased health-related quality of life, and increased incidence of motor vehicle accidents. As most individuals affected by OSA will initially present in the primary care setting, primary care physicians have the opportunity to recognize the condition and refer patients for treatment when necessary. Management of the condition should include lifestyle changes and continuous positive airway pressure (CPAP) treatment if required. Wakefulness-promoting agents may be considered if ES persists despite CPAP. Effective intervention for OSA not only provides symptomatic benefits, but also improves hypertension and reduces the risk for fatal and nonfatal CV events associated with the condition.
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Donzel-Raynaud C, Redolfi S, Arnulf I, Similowski T, Straus C. Abnormal respiratory-related evoked potentials in untreated awake patients with severe obstructive sleep apnoea syndrome. Clin Physiol Funct Imaging 2008; 29:10-7. [PMID: 18803640 DOI: 10.1111/j.1475-097x.2008.00830.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Obstructive sleep apnoeas generate an intense afferent traffic leading to arousal and apnoea termination. Yet a decrease in the sensitivity of the afferents has been described in patients with obstructive sleep apnoea, and could be a determinant of disease severity. How mechanical changes within the respiratory system are processed in the brain can be studied through the analysis of airway occlusion-related respiratory-related evoked potentials. Respiratory-related evoked potentials have been found altered during sleep in mild and moderate obstructive sleep apnoea syndrome, with contradictory results during wake. We hypothesized that respiratory-related evoked potentials' alterations during wake, if indeed a feature of the obstructive sleep apnoea syndrome, should be present in untreated severe patients. METHODS Ten untreated patients with severe obstructive sleep apnoea syndrome and eight matched controls were studied. Respiratory-related evoked potentials were recorded in Cz-C3 and Cz-C4, and described in terms of the amplitudes and latencies of their components P1, N1, P2 and N2. RESULTS Components amplitudes were similar in both groups. There was no significant difference in P1 latencies. This was also the case for N1 in Cz-C3. In contrast, N1 latencies in Cz-C4 were significantly longer in patients with obstructive sleep apnoea syndrome [median 98 ms (interquartile range 16.00) versus 79.5 ms (5.98), P = 0.015]. P2 and N2 were also significantly delayed, on both sides. CONCLUSIONS The cortical processing of airway occlusion-related afferents seems abnormal in untreated patients with severe obstructive sleep apnoea syndrome. This could be either a severity marker and/or an aggravating factor.
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Affiliation(s)
- Christine Donzel-Raynaud
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Laboratoire de Physiopathologie Respiratoire, Paris, France.
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Jauhar S, Lyons MF, Banham SW, Cameron DA, Orchardson R. Ten-year follow-up of mandibular advancement devices for the management of snoring and sleep apnea. J Prosthet Dent 2008; 99:314-21. [PMID: 18395542 DOI: 10.1016/s0022-3913(08)60067-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
STATEMENT OF PROBLEM Intraoral mandibular advancement devices have become widely used in recent years for the management of snoring and sleep apnea, and short-term effectiveness has been demonstrated. However, there is a shortage of data regarding long-term compliance. PURPOSE The purpose of this study was to investigate the long-term compliance of patients who were provided with a mandibular advancement device. MATERIAL AND METHODS Records of 180 patients who were provided with a mandibular advancement device in 1996 were available for review. A questionnaire was sent to all of these patients inquiring about continued device usage, comfort, and effectiveness. Questions were also asked about smoking, alcohol consumption, height, and weight. Data were analyzed with chi-square tests for any association between these factors and success of the device (alpha=.05). RESULTS The response rate was 40%, with 72 replies. Of this number, 34 patients were currently wearing the device every night, with a further 13 wearing the device for up to 6 nights per week. Thirty-one of the respondents who were wearing the device felt more refreshed on waking. The median body mass index (BMI) was 30, 8 were smokers, and 12 subjects drank more than 20 units of alcohol per week. Few adverse effects of the device were reported. CONCLUSIONS The mandibular advancement device appears to be an effective long-term solution for a significant number of patients with problem snoring and also those with mild to moderate obstructive sleep apnea.
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Affiliation(s)
- Sachin Jauhar
- Department of Restorative Dentistry, Glasgow Dental Hospital, Glasgow, UK
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Moraes W, Poyares D, Sukys-Claudino L, Guilleminault C, Tufik S. Donepezil improves obstructive sleep apnea in Alzheimer disease: a double-blind, placebo-controlled study. Chest 2008; 133:677-83. [PMID: 18198262 DOI: 10.1378/chest.07-1446] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is an association between Alzheimer disease and sleep-disordered breathing. Donepezil is the drug most frequently used to treat cognitive symptoms in Alzheimer disease. This study evaluates the effects of donepezil on obstructive sleep apnea in patients with Alzheimer disease. METHODS Randomized, double-blind, placebo-controlled design. Twenty-three patients with mild-to-moderate Alzheimer disease and apnea-hypopnea index (AHI) > 5/h were allocated to two groups: donepezil treated (n = 11) and placebo treated (n = 12). Polysomnography and cognitive evaluation using Alzheimer disease assessment scale-cognitive (ADAS-cog) subscale were performed at baseline and after 3 months. Cognitive and sleep data were analyzed using analysis of variance. RESULTS AHI and oxygen saturation improved significantly after donepezil treatment compared to baseline and placebo (p < 0.05). Rapid eye movement (REM) sleep duration increased after donepezil treatment (p < 0.05). ADAS-cog scores improved after donepezil treatment, although they did not correlate with REM sleep increase and sleep apnea improvement (p < 0.01). CONCLUSIONS Donepezil treatment improved AHI and oxygen saturation in patients with Alzheimer disease. Treatment also increased REM sleep duration and reduced ADAS-cog scores. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00480870.
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Affiliation(s)
- Walter Moraes
- Psychobiology Department, Universidade Federal de São Paulo, São Paulo, Brazil.
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Sadikot S. An overview: Obstructive Sleep Apnea and the Metabolic Syndrome: Should “X” be changed to “Zzz…Zzzz….Zzzzzzzzz….Zzz”? Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2007. [DOI: 10.1016/j.dsx.2007.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Parati G, Lombardi C, Narkiewicz K. Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk. Am J Physiol Regul Integr Comp Physiol 2007; 293:R1671-83. [PMID: 17652356 DOI: 10.1152/ajpregu.00400.2007] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several studies have shown the occurrence of an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease, including arterial hypertension, ischemic heart disease, and stroke. The pathogenesis of the cardiovascular complications of OSAS is still poorly understood, however. Several mechanisms are likely to be involved, including sympathetic overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormality in the process of coagulation, and metabolic dysregulation. The latter may involve insulin resistance and disorders of lipid metabolism. The aim of this review, which reports the data presented at a workshop jointly endorsed by the European Society of Hypertension and by the European Union COST action on OSAS (COST B26), is to critically summarize the evidence available to support an independent association between OSAS and cardiovascular disease.
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Affiliation(s)
- Gianfranco Parati
- Dept. of Clinical Medicine and Prevention, Univ. of Milano-Bicocca and Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, via Spagnoletto 3, 20149, Milano, Italy.
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Sahlman J, Pukkila M, Seppä J, Tuomilehto H. Evolution of mild obstructive sleep apnea after different treatments. Laryngoscope 2007; 117:1107-11. [PMID: 17464235 DOI: 10.1097/mlg.0b013e3180514d08] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES To evaluate the prognosis of mild obstructive sleep apnea in relation to different treatment modalities. STUDY DESIGN An open, retrospective, longitudinal follow-up study. METHODS Fifty adult patients diagnosed and treated for mild obstructive sleep apnea at the Department of Otorhinolaryngology at Kuopio University Hospital between 1998 and 2004 had a control polysomnography in 2005. The changes in apnea-hypopnea index (AHI) were observed in untreated (n = 28), operative (n = 11), and continuous positive airway pressure (n = 11) treatment groups at a long-term follow-up visit. RESULTS The mean follow-up period was 4 (range, 1.3-9.0; SD, 1.9) years. The untreated patients had a statistically significant increase in AHI (13.3, SD 18.3) at the follow-up. Half of these patients developed a moderate or severe degree of sleep apnea, and only 11% were cured. In patients who were treated with continuous positive airway pressure, the degree of obstructive sleep apnea became worse in 64% of cases, and in 27% of patients, the AHI returned to normal (<5). The degree of obstructive sleep apnea in operated patients deteriorated only in 18%, and in 27% of the patients, the AHI returned to normal (<5). CONCLUSIONS Mild obstructive sleep apnea has a natural tendency to worsen with time. Active treatment of mild obstructive sleep apnea appears, therefore, to be advisable.
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Affiliation(s)
- Johanna Sahlman
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland.
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Abstract
Sleep apnea is highly prevalent in subjects after age 60, and affects older men and women similarly. Central apneas are often observed in addition to obstructive and mixed events. Pathogenesis of obstructive and central events during sleep in the elderly can be attributed to an amplification of well-established causes of sleep-disordered breathing (SDB) in younger adults. As in middle-aged adults, sleep-related complaints, cardiovascular diseases, depression and traffic accidents should prompt an evaluation by a sleep specialist. However, secondary enuresis and nocturia, cognitive impairment, ophthalmic conditions and repeated falls may be the main complaint in elderly subjects. Sleep studies in the elderly should systematically include reliable means to detect central apneas and periodic leg movements. Untreated SDB in the elderly appears to have a lesser impact on mortality than in middle-aged adults. However, the typical morbidity associated with the disorder in younger adults is observed in the elderly. Elderly symptomatic SDB patients tolerate CPAP no differently than younger patients and should be effectively treated. In conclusion, whether sleep apnea in the elderly represents a specific entity or the same disease as in younger subjects, with some distinctive features, is still unclear. Further research, in particular focusing on the impact of age on SDB outcomes, is needed.
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Affiliation(s)
- Sandrine H Launois
- HP2 Laboratory INSERM ERI EA 3745, Université Joseph Fourier, and Sleep Laboratory, Centre Hospitalo-Universitaire, Grenoble, France.
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Stuck BA. A critical evaluation of surgery for sleep disordered breathing. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2006; 5:Doc04. [PMID: 22073073 PMCID: PMC3199803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Surgical strategies for the treatment of sleep disordered breathing, although widespread and frequently used, continue to be a controversial issue. Colleagues who primarily focus on conservative treatment options point to the limitations in the available data and remind us of serious methodological concerns surrounding the current literature for surgical treatment alternatives. In accordance with the principles of evidence based medicine the best available evidence should be used to assess the efficacy of surgical treatment. While placebo-controlled trials are feasible only in selected cases, recent examples of controlled clinical trials demonstrate that well designed prospective studies are indeed possible in the field of surgical treatment. Aim of the presented review is to critically evaluate current knowledge and evidence in this field and to give examples for how to overcome methodological issues in the future. Furthermore it will be demonstrated that even the "gold standard" of conservative treatment still leaves numerous questions open in regard to primary acceptance, long term compliance and surveillance. The assessment of treatment strategies is still based primarily on the effects seen in respiratory surrogate parameters under laboratory conditions. In the future, a broad spectrum of subjective and long-term objective parameters such as cardiovascular mortality needs to be kept in mind when critically evaluating beneficial effects of any kind of treatment for sleep disordered breathing. The presented review intends to initiate an open and critical discussion on the available treatment options.
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Affiliation(s)
- Boris A. Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
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Randerath W, Bauer M, Blau A, Fietze I, Galetke W, Hein H, Maurer JT, Orth M, Rasche K, Ruhle KH, Sanner B, Stuck BA, Verse T. Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. Relevance of Non-CPAP Treatment Options in the Therapy of the Obstructive Sleep Apnoea Syndrome. SOMNOLOGIE 2006. [DOI: 10.1111/j.1439-054x.2006.00082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. SOMNOLOGIE 2006. [DOI: 10.1007/j.1439-054x.2006.00082.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hawkins C, Gatenby P, Tuck R, Danta G, Andrews C. Cerebrovascular disease associated with antiphospholipid antibodies: more questions than answers. JOURNAL OF AUTOIMMUNE DISEASES 2006; 3:3. [PMID: 16573816 PMCID: PMC1448177 DOI: 10.1186/1740-2557-3-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 03/30/2006] [Indexed: 11/13/2022]
Abstract
Neurological syndromes occur in a significant number of patients with antiphospholipid antibodies. The optimal management for these patients however remains uncertain. Our study is a descriptive analysis looking retrospectively at 45 patients who presented to the principal tertiary referral centre in the Australian Capital Territory, with either cerebral arterial or venous thrombosis for which there was no obvious cause for their presentation when initially reviewed. The diagnosis was based on the clinical findings made by one of three neurologists attached to our centre. Radiological findings and the presence of either IgM or IgG anticardiolipin antibodies, IgG anti-beta-2 glycoprotein 1 antibodies or a lupus anticoagulant were then documented. In this group of patients three subgroups were identified: 1. Individuals that fulfilled the Sapporo Classification Criteria 2. Individuals with transiently positive antiphospholipid antibodies and 3. Individuals with persistently low positive antiphospholipid antibodies. The most interesting of these three groups are those individuals with transiently positive antiphospholipid antibodies. A potential cause for presentation was identified in only one patient of this group with documented infective endocarditis and bacteraemia. Comparison with the other two groups suggested that there was little in terms of clinical presentation, radiological findings or intercurrent risk factors for thrombotic disease to distinguish between them. With disappearance of antiphospholipid antibodies, the individuals within this group have not had further thrombotic events. Our observations emphasise the problems that continue to exist in relation to the occurrence of cerebrovascular disease in the context of antiphospholipid antibodies and the optimal management of these stratified groups. Our findings also raise an as yet unanswered question as to the signficance of these transiently positive antiphospholipid antibodies. In the absence of significant intercurrent risk factors our findings would suggest that in the group we describe that they are likely to be of clinical significance.
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Affiliation(s)
- Carolyn Hawkins
- Department of Clinical Immunology, The Canberra Hospital, Garran, Australia
- Australian National University Medical School (ANUMS), Australian National University, Acton, Australia
| | - Paul Gatenby
- Department of Clinical Immunology, The Canberra Hospital, Garran, Australia
- Australian National University Medical School (ANUMS), Australian National University, Acton, Australia
| | - Roger Tuck
- Department of Neurology, The Canberra Hospital, Garran, Australia
| | - Gytis Danta
- Department of Neurology, The Canberra Hospital, Garran, Australia
| | - Colin Andrews
- Department of Neurology, The Canberra Hospital, Garran, Australia
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Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathing: clinical and polysomnographic features. Chest 2005; 128:3350-7. [PMID: 16304283 DOI: 10.1378/chest.128.5.3350] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The existence of a rapid eye movement (REM)-specific sleep-disordered breathing (SDB) has been suggested based on the finding of an association between sleepiness and respiratory disturbances confined primarily to REM sleep. The aim of the study was to define the frequency and the clinical and polysomnographic features of REM SDB in a large clinical population. METHODS Anthropometric, clinical, and polysomnographic characteristics of 415 patients undergoing polysomnography for SDB were examined. For all patients the apnea-hypopnea index (AHI) during total sleep time, the AHI during REM (AHI-REM), and the AHI during non-REM sleep (AHI-NREM) were calculated. REM SDB was defined as an AHI-REM/AHI-NREM ratio >2. Patients were stratified according to the severity of disease in mild, moderate, and severe cases. Daytime sleepiness was assessed subjectively by the Epworth sleepiness scale (ESS), and objectively, in a subgroup of 228 patients, by the maintenance wakefulness test (MWT). RESULTS Of the initial sample, 36.4% of cases (n = 151) fulfilled the REM SDB criteria. No significant differences in subjective complaints, medical history, and drug intake were present between REM and non-REM SDB patients, and no significant differences were found in ESS scores and mean sleep latency of the MWT between groups. A high occurrence of REM SDB was found in mild (73.1%) and moderate cases (47.2%). While in the entire group and in non-REM SDB patients a strong male prevalence was found, the incidence of REM SDB was similar in men and women. CONCLUSION Our results show that neither clinical history nor daytime sleepiness differentiate patients with REM SDB from non-REM SDB patients. The disorder is more common in mild and moderate cases; there is an equal incidence in women and men. These findings may suggest that REM-related SDB is a part of the spectrum of SDB.
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Affiliation(s)
- José Haba-Rubio
- Sleep Laboratory, Department of Psychiatry, University Hospital, Geneva, Switzerland
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Bizieux-Thaminy A, Gagnadoux F, Binquet C, Meslier N, Person C, Racineux JL. Acceptation à long terme du traitement par pression positive continue. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85726-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med 2005; 172:1590-5. [PMID: 16192452 PMCID: PMC2718458 DOI: 10.1164/rccm.200504-637oc] [Citation(s) in RCA: 517] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Cross-sectional association has been reported between sleep-disordered breathing (SDB) and insulin resistance, but no prospective studies have been performed to determine whether SDB is causal in the development of diabetes. OBJECTIVES The purpose of our study was to investigate the prevalence and incidence of type II diabetes in subjects with SDB and whether an independent relationship exists between them. METHODS A cross-sectional and longitudinal analysis was performed in 1,387 participants of the Wisconsin Sleep Cohort. Full polysomnography was used to characterize SDB. Diabetes was defined in two ways: (1) physician-diagnosis alone or (2) for those with glucose measurements, either fasting glucose > or = 126 mg/dl or physician diagnosis. MEASUREMENTS AND MAIN RESULTS There was a greater prevalence of diabetes in subjects with increasing levels of SDB. A total of 14.7% of subjects with an apnea-hypopnea index (AHI) of 15 or more had a diagnosis of diabetes compared with 2.8% of subjects with an AHI of less than 5. The odds ratio for having a physician diagnoses of diabetes mellitus with an AHI of 15 or greater versus an AHI of less than 5 was 2.30 (95% confidence interval, 1.28-4.11; p = 0.005) after adjustment for age, sex, and body habitus. The odds ratio for developing diabetes mellitus within 4 yr with an AHI of 15 or more compared with an AHI of less than 5 was 1.62 (95% confidence interval, 0.67-3.65; p = 0.24) when adjusting for age, sex, and body habitus. CONCLUSIONS Diabetes is more prevalent in SDB and this relationship is independent of other risk factors. However, it is not clear that SDB is causal in the development of diabetes.
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Affiliation(s)
- Kevin J Reichmuth
- Department of Medicine, University of Wisconsin Medical School, Madison, WI, USA.
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