Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Apnea, sleep, obstructive [keywords]
- Obstructive sleep apnea syndrome in children with 22q11.2 deletion syndrome after operative intervention for velopharyngeal insufficiency. [Journal Article]
- Front Pediatr 2014.:84.
Surgical treatment of velopharyngeal insufficiency (VPI) in 22q11.2 deletion syndrome is often warranted. In this patient population, VPI is characterized by poor palatal elevation and muscular hypotonia with an intact palate. We hypothesize that 22q11.2 deletion patients are at greater risk of obstructive sleep apnea (OSA) after surgical correction of VPI, due, in part, to their functional hypotonia, large velopharyngeal gap size, and the need to surgically obstruct the velopharynx.We performed a retrospective analysis of patients with 22q11.2 deletion syndrome treated at a tertiary pediatric hospital between the years of 2002 and 2012. The incidence of VPI, need for surgery, post-operative polysomnogram, post-operative VPI assessment, and OSA treatments were evaluated.Forty-three patients (18 males, 25 females, ages 1-14 years) fitting the inclusion criteria were identified. Twenty-eight patients were evaluated by speech pathology due to hypernasality. Twenty-one patients had insufficient velopharyngeal function and required surgery. Fifteen underwent pharyngeal flap surgery, three underwent sphincter pharyngoplasty, two underwent Furlow palatoplasty, and one underwent combined sphincter pharyngoplasty with Furlow palatoplasty. Of these, eight had post-operative snoring. Six of these underwent polysomnography (five underwent pharyngeal flap surgeries and one underwent sphincter pharyngoplasty). Four patients were found to have OSA based on the results of the polysomnography (average apnea/hypopnea index of 4.9 events/h, median = 5.1, SD = 2.1). Two required continuous positive airway pressure (CPAP) due to moderate OSA.Surgery is often necessary to correct VPI in patients with 22q11.2 deletion syndrome. Monitoring for OSA should be considered after surgical correction of VPI due to a high occurrence in this population. Furthermore, families should be counseled of the risk of OSA after surgery and the potential need for treatment with CPAP.
- Cardiovascular autonomic neuropathy contributes to sleep apnea in young and lean type 1 diabetes mellitus patients. [Journal Article]
- Front Endocrinol (Lausanne) 2014.:119.
Knowledge about association between sleep apnea and cardiovascular autonomic neuropathy (CAN) in type 1 diabetes mellitus (T1DM) might give some insight into the pathogenesis of this condition in these patients. In obese patients, excessive central adiposity, including a large neck circumference, can contribute to obstructive sleep apnea (OSA). Its presence in non-obese patients, however, indicates that it could be correlated with autonomic neuropathy. The aim of this study was to compare the prevalence of OSA in young and lean T1DM patients with and without CAN. We studied 20 adult, non-obese, T1DM patients who were divided into two groups according to the results of the cardiovascular autonomic reflex tests (CARTs). These two groups (9 with CAN and 11 without CAN) were compared to a control group of 22 healthy individuals, who were matched by age and BMI. A polysomnography was performed and sleep was analyzed. The CAN+ group had a significantly higher prevalence of sleep apnea compared to the other groups (67% CAN+; 23% CAN-; 4.5% controls: CAN+ vs. Control; p = 0.006 and CAN+ vs. CAN-; p = 0.02). The CAN- group had higher sleep efficiency compared to the CAN+ group, demonstrating impaired sleep architecture in diabetics with this chronic complication. In conclusion, OSA may be related to the presence of CAN in young and lean T1DM patients. It could contribute to worse the prognosis and reducing the quality of life of these patients without specific treatment of these conditions.
- Medication Effects on Sleep and Breathing. [REVIEW]
- Clin Chest Med 2014 Sep; 35(3):557-569.
Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration.
- Sleep-Disordered Breathing in Neurologic Conditions. [REVIEW]
- Clin Chest Med 2014 Sep; 35(3):547-556.
Sleep-related breathing disorder or sleep-disordered breathing (SDB) encompasses central sleep apnea (CSA), obstructive sleep apnea (OSA), and sleep-related hypoventilation or hypoxemic syndromes. SDB is common in neurologic conditions that affect the central and/or peripheral nervous systems. Patients with neurologic conditions are at risk for SDB due to a combination of factors such as muscular weakness, damage to areas of the brain that control respiration, use of sedating medications, and weight gain from limited physical activity. This article discusses recognition and treatment of SDB as important aspects of treating patients with neurologic disease.
- Sleep and Breathing in Congestive Heart Failure. [REVIEW]
- Clin Chest Med 2014 Sep; 35(3):521-534.
Heart failure (HF) is one of the most prevalent and costly diseases in the United States. Sleep apnea is now recognized as a common, yet underdiagnosed, comorbidity of HF. This article discusses the unique qualities that sleep apnea has when it occurs in HF and explains the underlying pathophysiology that illuminates why sleep apnea and HF frequently occur together. The authors provide an overview of the treatment options for sleep apnea in HF and discuss the relative efficacies of these treatments.
- Oxidative stress in obstructive sleep apnea and intermittent hypoxia - Revisited - The bad ugly and good: Implications to the heart and brain. [REVIEW]
- Sleep Med Rev 2014 Jul 24.
Obstructive sleep apnea (OSA), characterized by intermittent hypoxia (IH), is linked with increased reactive oxygen species/reactive nitrogen species (ROS/RNS) and oxidative stress, which adversely affect the associated cardio-/cerebro-vascular disease in OSA. Yet, animal and a small number of human studies support activation of cardio-/cerebro-protective mechanisms as well. ROS/RNS are intricate and multifaceted molecules with multiple functions. At low-moderate concentrations ROS/RNS are considered "good", by regulating vital cellular functions. At higher levels, they are considered "bad" by promoting oxidative stress and damaging vital macromolecules through ischemia and reperfusion (I/R) injury. Subsequently, ROS/RNS can get "ugly" by eliciting sterile inflammation and a multitude of deadly pathologies. What makes ROS/RNS good, bad, or ugly? A dynamic interplay between a large number of factors determines the outcomes. These include the types of ROS/RNS produced, their quantity, duration, frequency, intracellular localization, micro-environmental antioxidants, as well as the genetic make-up and life style related variables. This review presents the currently available data on redox biology in physiological/pathophysiological conditions and in OSA/IH, in order to better understand the apparently contradictory findings on damage vs. repair. These findings are discussed within the context of the prevailing views on I/R associated ROS/RNS, and their potential implications to OSA.
- Changes in site of obstruction in obstructive sleep apnea patients according to sleep position: A DISE study. [JOURNAL ARTICLE]
- Laryngoscope 2014 Aug 22.
This study aimed to evaluate changes in obstruction site in obstructive sleep apnea (OSA) patients according to sleep position.Prospective case series.Eighty-five patients who had undergone level 1 sleep study and drug-induced sleep endoscopy in the supine and lateral positions were included. Obstruction sites were classified as soft palate (SP), tongue base (TB), lateral wall (LW), and larynx (LX). Subgroup analysis was performed according to lateral apnea-hypopnea index (AHI): those with an AHI of ≥ 10 (lateral obstructors, LO) and those with an AHI of < 10 (lateral nonobstructors, LNO).Prevalence in obstruction site of SP, TB, and LX decreased significantly after change from supine to lateral position (P < 0.05). However, the prevalence of LW obstruction was not affected by position change. LW collapse in moderate OSA decreased (from 66.7% to 35.9%) after change to lateral sleep, whereas it persisted in severe OSA patients (81.6%-89.5%). In the lateral position, persistent obstruction at the LW was observed more frequently in the LO group compared to the LNO group (83.3% vs. 33.3%).When sleep posture is changed from supine to lateral, obstruction due to structures such as tongue base and larynx improves dramatically. Obstruction in lateral position is mostly due to obstruction at the oropharyngeal LWs. Therefore, position dependency is mostly determined by LW collapsibility. Evaluating the changes of the upper airway according to sleep position can further characterize the upper airway collapsibility and can be used for tailored treatment planning.Level 4 (case series). Laryngoscope, 2014.
- Correlation between cephalometric data and severity of sleep apnea. [JOURNAL ARTICLE]
- Braz J Otorhinolaryngol 2014 Jun; 80(3):191-195.
Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome.To correlate cephalometric data with the apnea-hypopnea sleep index.We performed a retrospective and cross-sectional study that analyzed the cephalometric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012.Ninety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index.Cephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation with the apnea-hypopnea index.
- [Efficacies of stimulation of genioglossus in mild-to-moderate obstructive sleep apnea syndrome patients after uvulopalatopharyngoplasty]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2014 Jun; 94(22):1726-8.
To evaluate the efficacies of transcutaneous stimulation of genioglossus on remaining mild-to-moderate obstructive sleep apnea syndrome (OSAS) after uvulopalatopharyngoplasty (UPPP).A total of 22 patients diagnosed with mild-to-moderate OSAS by polysomnography (PSG) after UPPP were recruited from Sleep Center of First Affiliated Hospital, Nanjing Medical University from February 2013 to October 2013 and underwent transcutaneous stimulation of genioglossus therapy at night. Prior to and during treatment overnight polysomnography examination was performed. Moreover, the sleepiness of patients was assessed according to the Epworth sleepiness scale (ESS) before and after treatment. Comparison was made to observe the effects of treatment on PSG parameters and daytime ESS.Compared with pre-treatment, nocturnal apnea hypopnea index (AHI) (9.3 ± 4.2 vs 18.3 ± 6.8), microarousal index (MAI) (6.5 ± 3.8 vs 11.2 ± 4.8), radio of duration pulse oxygen saturation (SpO2) < 90% to total sleep time (T90) ((5.1 ± 4.0)% vs (9.5 ± 4.0)%) and score of daytime ESS (8.8 ± 3.3 vs 9.4 ± 3.1) all significantly decreased (all P < 0.01) while mean SpO2 ((95.5 ± 1.0)% vs (94.4 ± 1.1)%) and minimal SpO2 ((88.6 ± 2.9)% vs (84.9 ± 4.6)%) were both significantly elevated (both P < 0.001). None of them experienced obvious discomforts during treatment.Submental transcutaneous electrical stimulation of genioglossus is an effective treatment for remaining mild-to-moderate OSAS after UPPP surgery.
- Effect of ovariectomy on inflammation induced by intermittent hypoxia in a mouse model of sleep apnea. [JOURNAL ARTICLE]
- Respir Physiol Neurobiol 2014 Aug 20.
Patient data report marked gender and pre-vs-postmenopausal differences in obstructive sleep apnea (OSA). However, no experimental data are available on how sexual hormones modulate OSA consequences. Here we report novel results on estrogen-modulated heart and brain inflammation in female mice subjected to intermittent hypoxia, a major injurious challenge in OSA. C57BL/6J (14-week old) intact and ovariectomized mice (n=6 each) were subjected to intermittent hypoxia (20 s at 5% and 40 s at 21%, 60 cycles/h; 6h/day). Identical intact and ovariectomized groups breathing room air were controls. After 30 days, the gene expressions of interleukines 6 and 8 (IL-6, IL-8) in the brain and heart tissues were measured. Whereas, compared with normoxia, intermittent hypoxia considerably increased IL-6 and IL-8 gene expressions in intact females, no change was found in ovariectomized mice when comparing normoxia and intermittent hypoxia. These data suggest that estrogens modulate the inflammatory effects of intermittent hypoxia and point to further studies on the role played by sex hormones in OSA.