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Apnea, sleep, obstructive [keywords]
- Comparison of reliability of lateral cephalogram and computed tomography for assessment of airway space. [JOURNAL ARTICLE]
- Niger J Clin Pract 2014 September-October; 17(5):629-636.
Background and Aims: The oropharyngeal (OP) and nasopharyngeal structures seems to play roles in the development of the dentofacial complex. Soft palate as a part of nasopharyngeal and OP apparatus has an important role in phonation, deglutition and respiration. The aim of this study was to find whether any correlation exists between the three types of malocclusion and airway space using lateral cephalogram and computed tomography (CT) and to compare its reliability. To obtain important information on the morphology of the soft palate on lateral cephalogram and to determine its etiopathogenesis in obstructive sleep apnea (OSA). Materials and Methods: Lateral cephalogram of 45 subjects were used to measure the pharyngeal airway. The subjects were divided into three groups (each group included 15 subjects) according to ANB angle: Class I (ANB angle 2-4°), Class II (ANB angle >4°), Class III (ANB angle ≤2°). Results: The result showed a significant reduction in pharyngeal airway in ANB Class II. Type I soft palate, leaf-shape was found in maximum subjects. The volume of airway size showed higher statistical significance with the greater coefficient of variation on CT in relation to corresponding cephalometric airway area. Conclusion: The sagittal skeletal pattern is a contributory factor in variations in the upper airway dimensions. The measurements acquired from both the modalities are reliable and reproducible, but CT gives the better assessment of cross-sectional dimensions of airway space. Morphology of the soft palate can be used as references for etiological research of OSA.
- Obstructive sleep apnea-hypopnea results in significant variations in cerebral hemodynamics detected by diffuse optical spectroscopies. [JOURNAL ARTICLE]
- Physiol Meas 2014 Sep 22; 35(10):2135-2148.
The objective of this study was to adapt a novel near-infrared diffuse correlation spectroscopy (DCS) flow-oximeter for simultaneous and continuous monitoring of relative changes in cerebral blood flow (rCBF) and cerebral oxygenation (i.e. oxygenated/deoxygenated/total hemoglobin concentration: Δ[HbO2]/Δ[Hb]/ΔTHC) during overnight nocturnal polysomnography (NPSG) diagnostic test for obstructive sleep apnea-hypopnea (OSAH). A fiber-optic probe was fixed on subject's frontal head and connected to the DCS flow-oximeter through a custom-designed fiber-optic connector, which allowed us to easily connect/detach the optical probe from the device when the subject went to bathroom. To minimize the disturbance to the subject, the DCS flow-oximeter was remotely operated by a desktop located in the control room. The results showed that apneic events caused significant variations in rCBF and ΔTHC. Moreover, the degrees of variations in all measured cerebral variables were significantly correlated with the severity of OSAH as determined by the apnea-hypopnea index (AHI), demonstrating the OSAH influence on both CBF and cerebral oxygenation. Large variations in arterial blood oxygen saturation (SaO2) were also found during OSAH. Since frequent variations/disturbances in cerebral hemodynamics may adversely impact brain function, future study will investigate the correlations between these cerebral variations and functional impairments for better understanding of OSAH pathophysiology.
- Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. [JOURNAL ARTICLE]
- J Hypertens 2014 Sep 19.
To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I 76%), respectively, in favor of the CPAP group.The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
- [Treatment of obstructive sleep apnea-hypopnea syndrome for children refractory asthma]. [English Abstract, Journal Article]
- Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014 Jun; 49(6):462-7.
The aim of this study was to understand the effect of different treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) for refractory asthma in children.Fifty two children (32 in surgical group, 20 in conservative group) with refractory asthma and OSAHS were included in the study. All children received asthma condition assessment and polysomnography (PSG) examination before and after treatment, and were followed up for 6 months.All children got improved in PSG values 3 months after treatment, more significant improvement was achieved in surgical group than in conservative group (P < 0.05). While compared of OSAHS treatment, there were 2 cure, 6 notable effective, 9 effective, 3 in vain cases in conservative group, 8 cure, 16 notable effective, 8 effective, 0 in vain cases in surgery group. There was significant difference between the two groups (χ(2) = 8.91, P = 0.031). All children got improved in asthma condition evaluation parameters and decreased the use number of short acting β2 agonists after 6 months treatment. More significant improvement was achieved in surgical group than in conservative group. The differences of all the items had statistical significance (P < 0.05). There was statistical correlation between days mutation rate of peak expiratory flow (PEF) and apnea hypopnea index (r = 0.712, P < 0.01), and between days mutation rate of PEF and lowest oxygen saturation (r = 0.726, P < 0.01).Active treatment of OSAHS can improve asthma symptoms and reduce asthma medication effectively. The curative effect of surgical treatment is superior to conservative treatment.
- [Metabolic profile in obese patients with obstructive sleep apnea. A comparison between patients with insulin resistance and with insulin sensitivity]. [English Abstract, Journal Article]
- Pneumologia 2014 Apr-Jun; 63(2):100-2, 104-6.
Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent hypoxemia and simpathetic activation. It is difficult to demonstrate an independent role of OSAS in the occurrence of metabolic abnormalities, as obesity represents an important risk factor for both OSAS and metabolic abnormalities.to assess the relations between insulin resistance (IR), insulin sensitivity (IS), OSAS severity and nocturnal oxyhaemoglobin levels in obese, nondiabetic patients with daytime sleepiness.We evaluated 99 consecutive, obese, nondiabetic patients (fasting glycemia < 126 mg/dL, no hypoglycemic or hypolipemiant medication) diagnosed with OSAS (AHI > 5/hour and daytime sleepiness) by an ambulatory six channel cardio-respiratory polygraphy. Hight, weight serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) levels were evaluated. Correlations between Apneea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), average and lowest oxyhaemoglobin saturation (SaO), body mass index (BMI) and insulin resistance or sensitivity were assesed. IR was defined as a TG/ HDL-Cratio > 3, and insulin sensitivity (IS) as a TG/HDL-C ratio < 2.64 patients (out of 99) had lR and 18 IS. In the IR group (44 men and 20 women), the mean age was 52 +/- 10.6 years, mean BMI: 38.54 +/- 6.67 Kg/m2 (30-60), TG/HDL-C:5, 27 +/- 2.03 (3.02-11.1), mean AHI: 49.65 +/- 25.55/hour (7-110), mean ODI: 4769 +/- 24.95/hour (4-98), mean average SaO2 89.42 +/- 4.6 and mean lowest SaO2 68.4% +/- 13.8% (32-88%). 48 patients had severe, 7 moderate and 9 mild OSAS. In the IS group (10 men and 8 women), the mean age was 58.4 +/- 8.2years, mean BMI: 35.4 +/- 4.29 Kg/m2 (30-46), TG/ HDL-C: 1.64 +/- 0.29 (1.13-1.95), mean AHI: 45.8 +/- 30.3/hour (9-131), mean ODI: 39.9 +/- 32.2/hour (2-133), mean average SaO2 90.8 +/- 8.2 (81-95) and mean lowest SaO2: 74% +/- 10.8% (52-87%). 12 patients had severe, 3 moderate and 3 mild OSAS. Insulin sensitivity positively correlated with mean average SaO2 (r: 0.49; p: 0.037) and negatively with ODI (r: - 0,56; p: 0.014). Insulin resistance negatively correlated with mean lowest SaO2 (r: -0,25; p: 0.045). Mean lowest SaO2 values were significant lower in patients with IR than in those with IS (p: 0.042). No statistically significant difference was found for BMI, AHI or ODI between IR and IS patients.nocturnal oxyhaemoglobin levels rather than OSAS severity (expressed as AHI or ODI) may be involved in the occurrence of metabolic abnormalities in obese nondiabetic patients. Preserving insulin sensitivity is more likely when oxyhaemoglobin levels are higher and ODI is lower. Mean lowest nocturnal SaO2 levels seems to be independently involved in the development of insulin resistance as no statistically significant differences were found for BMI between the two groups.
- [Evidences related to pulmonary rehabilitation in the respiratory pathology]. [English Abstract, Journal Article]
- Pneumologia 2014 Apr-Jun; 63(2):88-90, 92-5.
Pulmonary rehabilitation represents a modern therapeutic approach of respiratory diseases, with a multidisciplinary character, including: physical training, therapeutic education, psychosocial counseling, and nutritional approach. Pulmonary rehabilitation addresses to any patient suffering from pulmonary pathology whose quality of life is affected by the respiratory symptoms, regardless of the degree of functional impairment. This article is an analysis of evidences from the medical literature on outcomes of rehabilitation programs conducted in various lung diseases. The main indication of pulmonary rehabilitation is the chronic obstructive pulmonary disease - COPD (stable state and exacerbation) in which most studies were carried out. Pulmonary rehabilitation in patients with other respiratory pathology has its reason in the pathophysiological changes that they undergo (impaired lung function and gas exchange, muscle atrophy and deconditioning etc.) leading to symptoms, lower exercise tolerance and decrease daily physical activity, all of which ultimately result in impaired quality of life. The role of rehabilitation is reviewed in the following diseases: post-surgical lung volume reduction for emphysema, asthma, bronchiectasis, interstitial lung disease, cystic fibrosis, lung cancer, neuromuscular disease, intensive care, obstructive sleep apnea, pulmonary hypertension, post-tuberculous sequelae, lung transplantation.
- [Pediatric sleep-disordered breathing and oral medicine]. [English Abstract, Journal Article]
- Hua Xi Kou Qiang Yi Xue Za Zhi 2014 Aug; 32(4):319-22.
Pediatric sleep-disordered breathing, also known as obstructive sleep apnea and hypopnea syndrome (OSAHS) in children, is caused by obstruction of upper airway, characterized by repetitive pauses in breathing during sleep despite the effort to breathe, and usually leads to reduction in oxygen saturation. Due to the importance of sufficient oxygen in growth and development, many children patients suffer from abnormal secretion of growth hormone at night, and also their activity and resting of cerebral cortex during sleep. Therefore, they face great risks in keeping normal physical growth, forming mental behavior, building up learning ability and shaping personalities. It is a very important interdisciplinary subject, yet still much remains unclear about the disease. Oral medicine is one of the subjects that show increasing importance in prevention and treatment of OSAHS in children. On one hand, due to the special means of the field, such as cephalometric, it can diagnose and monitor the development of craniofacial structures, especially the upper airway. On the other hand, it can provide treatments which can both improve breath during sleep and consequent dental facial deformities. Most typical treatments include mandibular sagittal growth stimulation, transverse maxillary palatal expansion and maxillary protraction. Oral medicine provides additional treatment apart from traditional adenectomy and tonsilectomy to improve ventilation. It not only directly helps to improve deformities caused by sleep-disordered breathing in OSAHS children with indications, but also helps to avoid many of physical and mental complications, which will in turn benefit their life quality. Also, it may prospectively provide insights in treatment and prevention of OSAHS in adults.
- Novel use of tissue expander for dilation of oropharyngeal stenosis. [JOURNAL ARTICLE]
- Int J Pediatr Otorhinolaryngol 2014 Sep 8.
Naso/oropharyngeal stenoses are uncommon surgical complications. We present a child having undergone previous adenoidectomy without complication who developed naso/oropharyngeal scarring after subsequent tonsillectomy. She presented with nasal obstruction and frequent gasping at night worrisome for obstructive sleep apnea. Scar was initially excised and the defect allografted. Conventional esophageal dilators were undersized, and ultimately a tissue expander was used intraoperatively as a balloon dilator. The patient's symptoms and sleep apnea resolved. We found use of a tissue expander as a balloon dilator to be at least minimally effective in dilating the oropharynx when all other methods at our disposal proved ineffective.
- Heart rate variability evaluation of Emfit sleep mattress breathing categories in NREM sleep. [JOURNAL ARTICLE]
- Clin Neurophysiol 2014 Sep 6.
Heart rate variability (HRV) analysis of obstructive sleep apnea patients reveals an increase in sympathetic activity. Sleep disordered breathing (SDB) can be also assessed with sleep mattress sensors, as the Emfit sensor, by dividing the signal into different breathing categories. In addition to normal breathing (NB) and periodic apneas/hypopneas (POB), the sleep mattress unveils a breathing category consisting of sustained partial obstruction (increased respiratory resistance, IRR). The aim of our study was to evaluate HRV during these three breathing categories in NREM sleep.53 patients with suspected SDB underwent an overnight polysomnography with an Emfit mattress. The Emfit signal was scored in 3-min epochs according to the established rules. The NB, POB, and IRR epochs were combined to as long NB, POB and IRR periods as possible and HRV was calculated from at least 6-min epochs.The meanHR did not differ between the breathing categories. HRV parameters revealed an increase in sympathetic activity during POB. The mean LF/HF ratio was highest during POB (3.0) and lowest during IRR (1.3). During NB it was 1.7 (all p-values⩽0.001). Interestingly sympathetic activity decreased and parasympathetic activity increased during IRR as compared to NB (the mean HF power was 1113.8ms(2) during IRR and 928.4ms(2) during NB).The HRV findings during POB resembled HRV results of sleep apnea patients but during sustained prolonged partial obstruction a shift towards parasympathetic activity was achieved.The findings encourage the use of sleep mattresses in SDB diagnostics. In addition the findings suggest that sustained partial obstruction represents its own SDB entity.
- Sleep Disordered Breathing as Measured by SRBD-PSQ and Neurocognition in Children With Hypertension. [JOURNAL ARTICLE]
- Am J Hypertens 2014 Sep 20.
Cognitive test performance is decreased in hypertensive adults and children, a finding postulated to represent early target-organ damage to the brain. Hypertensive children are often obese, a comorbidity associated with sleep disordered breathing (SDB), itself associated with cognitive problems; potentially confounding the relation between hypertension (HTN) and neurocognition. Our objective was to determine the association between SDB as measured by a scale and questionnaire score and neurocognition among participants enrolled in an ongoing multicenter study of cognition in children with HTN.Subjects completed laboratory-based neurocognitive tests. Parents and subjects completed rating scales of executive function, mood, and behavior problems. Parents completed the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (SRBD-PSQ).To date, 38 HTN subjects and 34 control subjects have completed neurocognitive testing and the SRBD-PSQ. Median SRBD-PSQ scores were similar between groups but the HTN group had a higher percentage of subjects with SRBD-PSQ scores in the range suggestive of obstructive sleep apnea (26% vs. 6%, P = 0.03). Overall, higher SRBD-PSQ scores were not significantly associated with worse performance on laboratory-based measures of executive function and other cognitive domains but were significantly associated with worse scores on rating scales of executive function as well as mood and behavior problems.A larger proportion of children with HTN had scores suggestive of SDB. The results underscore the importance of using a multi-method approach in the assessment of cognition and adjusting for potential confounding effects of SDB in studies of cognition in hypertensive children.