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Apnea, sleep, obstructive [keywords]
- Association of Serum YKL-40 With the Presence and Severity of Obstructive Sleep Apnea Syndrome. [JOURNAL ARTICLE]
- Lab Med 2014; 45(3):220-225.
This study examined the association of serum YKL-40 concentrations with the presence and severity of obstructive sleep apnea syndrome (OSAS).A total of 156 patients with OSAS and 110 healthy subjects were enrolled in this study.OSAS patients had significantly higher serum YKL-40 levels compared with healthy controls. Multivariable logistic regression analysis indicated that serum YKL-40 levels were an independent determinant of the presence of OSAS. Serum YKL-40 levels were significantly elevated in severe OSAS patients compared with mild and moderate OSAS patients. Spearman correlation analysis revealed that serum YKL-40 levels were correlated with the severity of OSAS. Simple linear regression analysis showed that the serum levels of YKL-40 were correlated with body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), C-reactive protein (CRP), and apnea-hypopnea index (AHI) in patients with OSAS.Elevated serum YKL-40 levels are associated with the presence and severity of OSAS.
- Sleep apnea awakens cancer: A unifying immunological hypothesis. [JOURNAL ARTICLE]
- Oncoimmunology 2014.:e28326.
The presence of obstructive sleep apnea (OSA) in patients with cancer appears to be accompanied by poorer outcomes. However, the mechanisms underlying such association are unknown. We hypothesize that the constitutive characteristics of OSA, namely, intermittent hypoxia and sleep fragmentation, promote changes in the tumor microenvironment that ultimately lead to a disadvantageous immunosurveillance, thereby accelerating tumor proliferation and enhancing its invasiveness.
- Neck circumference and lowest oxygen saturation are independently associated with high coexistence of hypertension in obstructive sleep apnea. [Journal Article]
- Yonsei Med J 2014 Sep 1; 55(5):1310-7.
Obstructive sleep apnea (OSA) is considered an independent risk factor for hypertension. However, it is still not clear which clinical factors are related with the presence of hypertension in OSA patients. We aimed to find different physical features and compare the sleep study results which are associated with the occurrence of hypertension in OSA patients.Medical records were retrospectively reviewed for patients diagnosed with OSA at Severance Cardiovascular Hospital between 2010 and 2013. Males with moderate to severe OSA patients were enrolled in this study. Clinical and polysomnographic features were evaluated to assess clinical variables that are significantly associated with hypertension by statistical analysis.Among men with moderate to severe OSA, age was negatively correlated with hypertension (odds ratio=0.956), while neck circumference was positively correlated with the presence of hypertension (odds ratio=1.363). Among the polysomnographic results, the lowest O₂ saturation during sleep was significantly associated with the presence of hypertension (odds ratio=0.900).Age and neck circumference should be considered as clinically significant features, and the lowest blood O₂ saturation during sleep should be emphasized in predicting the coexistence or development of hypertension in OSA patients.
- Endoscopic assessment of reflux esophagitis concurrent with hiatal hernia in male Japanese patients with obstructive sleep apnea. [JOURNAL ARTICLE]
- Scand J Gastroenterol 2014 Jul 22.:1-9.
Abstract Objective. The pathogenetic relationship underlying the high prevalence of gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnea (OSA) remains unclear. In addition, GERD has not been adequately assessed by endoscopy in patients with OSA. The purpose of this study was to use endoscopy to investigate potential interactions among reflux esophagitis, hiatal hernia (HH) and OSA. Material and methods. A total of 243 consecutive male Japanese participants who underwent both overnight ambulatory polygraphic monitoring and esophagogastroduodenoscopy were retrospectively evaluated in a cross-sectional study. The prevalence and severity of HH and reflux esophagitis were assessed according to the Los Angeles classification and the Makuuchi classification, respectively. Associations among reflux esophagitis, HH and OSA were examined by univariate and multivariate analyses. Results. OSA was diagnosed in 98 individuals (40.3%). Endoscopy-confirmed esophagitis (p = 0.027) and HH (p < 0.001) were significantly more prevalent among patients with OSA. Multivariate regression model analysis adjusted for age, body mass index, visceral obesity represented by waist circumference, presence of OSA, concurrence of OSA and HH, smoking, and alcohol consumption yielded OSA as the only variable significantly associated with HH (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.35-4.99; p = 0.004), while concurrence of OSA and HH was related to reflux esophagitis (OR, 3.59; CI, 1.87-6.92; p < 0.001). Conclusions. OSA was associated with HH and concurrent OSA and HH with reflux esophagitis in male Japanese patients with OSA. Our results support the hypothesis that complicating HH may link reflux esophagitis to OSA.
- Job stress, burnout, and job satisfaction in sleep apnea patients. [JOURNAL ARTICLE]
- Sleep Med 2014 Jun 11.
To assess job stress, burnout, and job satisfaction in patients with obstructive sleep apnea syndrome (OSAS).A total of 182 patients with OSAS and 71 healthy individuals completed the Job Content Questionnaire, the Maslach Burnout Inventory - General Survey, the Index of Job Satisfaction, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index. All participants were assessed with full-night polysomnography.Survey scores of patients diagnosed with OSAS only differed from those of the control group in the emotional exhaustion dimension (P = 0.015). According to a multivariate analysis, the apnea-hypopnea index (AHI) was only correlated with perceived support at work (β coefficient = 0.142; P = 0.048). Associations were found between subjective sleep quality, perceived support from coworkers, and supervisors (β = 0.157; P = 0.025), psychological demands (β = 0.226; P = 0.001), emotional exhaustion (β = 0,405; P = 0.000), and cynicism (β = 0.224; P = 0.002). The study also revealed associations between excessive daytime sleepiness and the burnout dimensions emotional exhaustion (β = 0.232; P = 0.000) and cynicism (β = 0.139; P = 0.048).Objective parameters of OSAS such as the AHI seem to have limited influence on the psychosocial aspects of the occupational life of patients with OSAS. There is evidence of significant associations between the subjective symptoms of the disease, such as daytime sleepiness, subjective sleep quality, job stress, and burnout.
- Implementation of an innovative postoperative monitoring approach for patients with obstructive sleep apnea. [Journal Article, Research Support, Non-U.S. Gov't]
- Healthc Manage Forum 2014; 27(1 Suppl):S6-16.
This article shares how William Osler Health System (Osler) achieved improved quality of care for clinically challenging patients using state-of-the-art technology combined with interprofessional and intermanagerial teamwork in an acute care setting. Obstructive sleep apnea, a respiratory disorder caused by upper airway obstruction, increases the risk of complications after anesthesia. Although an initial postoperative monitoring strategy designed for patients with obstructive sleep apnea at Osler ensured patient safety, it required reorganization to resolve operational challenges. Concerned stakeholders at all levels contributed to the development and implementation of a new program approach focused on remote pulse oximetry monitoring as a component of the standard of care. Osler has developed a case study to share its experience with other hospitals and health systems that are already engaged in or that are considering implementing such a program.
- [Comparison of rhinomanometry results with polysomnography and physical examination findings in patients with obstructive sleep apnea syndrome.] [JOURNAL ARTICLE]
- Kulak Burun Bogaz Ihtis Derg 2014 Jul-Aug; 24(4):190-4.
This study aims to investigate the effects of anterior rhinomanometry-induced nasal resistance on obstructive sleep apnea syndrome (OSAS) patients.Between May 2011 and September 2011, 100 volunteer patients (76 males, 24 females; mean age 47.6±11.6 years; range 20 to 71 years) who were admitted with complaints of snore, breathing pauses told by their partners, oversleep mood in a daytime and fatigue and diagnosed with OSAS by polysomnography with simple snore were included. Anterior rhinomanometry was applied for all patients and nasal resistance was estimated. Mallampati index and body mass index (BMI) of patients was calculated. The mean apnea-hypopnea index (AHI) and minimum oxygen saturation values were measured.There was no significant relationship between nasal resistance and AHI. However, a significant relationship between AHI and Mallampati and BMI values was observed. The AHI values increased, as the Mallampati and BMI values increased.Our study results show that nasal resistance has no significant effect on AHI and minimum oxygen saturation in OSAS patients.
- Validation of a korean version of the insomnia severity index. [Journal Article]
- J Clin Neurol 2014 Jul; 10(3):210-5.
The purposes of this study were to standardize and validate a Korean version of the Insomnia Severity Index (ISI-K), and to evaluate its clinical usefulness.We translated the ISI into Korean and then translated it back into English to check its accuracy. The 614 patients with sleep disorders who were enrolled in this study comprised 169 with primary insomnia, 133 with comorbid insomnia, and 312 with obstructive sleep apnea. All subjects underwent one night of polysomnography (PSG) and completed the Korean versions of both the Pittsburgh Sleep Quality Index (PSQI-K) and the Epworth Sleepiness Scale, as well as the ISI-K. The ISI-K was compared to these sleep scales and various PSG sleep parameters.The internal consistency the ISI-K total score was confirmed by a Cronbach's alpha of 0.92, and the item-to-total-score correlations (item-total correlations) ranged from 0.65 to 0.84, suggesting adequate reliability. The correlation between the ISI-K total score and PSQI-K was 0.84, which suggested adequate convergent validity. Low-to-moderate correlations were obtained between the ISI-K total score and PSG-defined sleep parameters: 0.22 for sleep onset latency, 0.38 for wake after sleep onset, and 0.46 for sleep efficiency. A cutoff score of 15.5 on the ISI-K was optimal for discriminating patients with insomnia. The test-retest scores over a 4-week interval with 34 subjects yielded a correlation coefficient of 0.86, suggesting excellent temporal stability.The findings of this study show that the ISI-K is a reliable and valid instrument for assessing the severity of insomnia in a Korean population.
- Sleep pathology characterization in sickle cell disease: Case-control study. [JOURNAL ARTICLE]
- Pediatr Pulmonol 2014 Jul 10.
Children and adolescents with sickle cell disease (SCD) have a higher incidence of sleep pathology and obstructive sleep apnea syndrome (OSAS). The nocturnal hypoxemia is a risk to vaso-occlusive crisis among other SCD morbidities. Our aim was to compare polysomnography (PSG) results in a sample of children with SCD with a sample of children with suspected OSAS without SCD.A retrospective study compared clinical and PSG parameters. A descriptive analysis and t-test were done considering P < 0.05 as significant.PSG was done in 65 children with SCD and 65 control-children. Control sample was selected to be equal to SCD sample considering gender (53.8% were male), age (mean age was 9.4 years (SD ± 4.6) and AHI (mean 3.57 events/hr). Mean efficiency, latency and percentage of sleep phases in both groups showed no statistically significant differences. Mean SpO2 and minimum SpO2 were lower in SCD group and it was statistically significant (P < 0.01). Enuresis was more frequent in the SCD children group (35.4% vs. 6.2%, P < 0.01).Comparing children with and without SCD, sleep architecture was similar in both groups and minimum SpO2 was significantly lower in SCD children although both groups had a similar AHI. This is an important issue in these children, so it is essential to have a sleep evaluation in order to prevent complications and co-morbidities. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
- Adhesion molecule increases in sleep apnea: beneficial effect of positive airway pressure and moderation by obesity. [JOURNAL ARTICLE]
- Int J Obes (Lond) 2014 Jul 21.
BackgroundElevated levels of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) may contribute to cardiovascular disease and are associated with obstructive sleep apnea (OSA) and obesity. The relationship between OSA and obesity in determining ICAM-1 and VCAM-1 levels, and the effect of treatment, is unclear.ObjectiveOur aim was to study whether positive airway pressure (PAP) usage resulted in changes in ICAM-1 and VCAM-1 after 2 years within 309 OSA patients from the Icelandic Sleep Apnea Cohort, and determine how obesity affected such changes.Subjects/MethodsThe mean body mass index (BMI) was 32.4±5.1 kg/m(2); subjects had moderate-to-severe OSA (apnea-hypopnea index=45.0±20.2) and 79% were male. There were 177 full PAP users (⩾4 hours/night and ⩾20 of last 28 nights), 44 partial (<4 hours/night or <20 nights), and 88 non-users.ResultsICAM-1 (P<0.001) and VCAM-1 (P=0.012) change was significantly different among the PAP groups. The largest ICAM-1 differences were among the most obese subjects (P<0.001). At follow-up, non-users had increased ICAM-1 compared to decreased levels in full users. All groups had increased VCAM-1, but non-users had a significantly larger increase than full users.ConclusionWithin moderate-to-severe OSA patients, PAP usage prevents increases in adhesion molecules observed in non-users after two years. For ICAM-1, the largest effect is in the most obese subjects. As OSA and obesity commonly coexist, the usage of PAP to limit increases in adhesion molecules may decrease the rate of progression of OSA-related cardiovascular disease.International Journal of Obesity accepted article preview online, 21 July 2014; doi:10.1038/ijo.2014.123.