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Apnea, sleep, obstructive [keywords]
- Efficacy of uvulopalatopharyngoplasty combined with oral appliance in treatment of obstructive sleep apnea-hypopnea syndrome. [JOURNAL ARTICLE]
- Ir J Med Sci 2014 Apr 16.
This study aimed to investigate the efficacy of UPPP combined with an oral appliance (OA) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).Forty patients diagnosed with severe OSAHS were randomly divided into two groups: 20 patients in the pure surgery group treated by uvulopalatopharyngoplasty (UPPP) surgery and the remaining 20 patients in the combined treatment group for the combined application of UPPP and OA. Nocturnal PSG monitoring was performed in postoperative 0.5 and 3.0a. AHI, SaO2, and sleep structure improvement were calculated to compare the treatment efficiency of the two groups.The AHI of the combined treatment group in the postoperative 3 was lower than that of the pure surgery group, whereas the lowest SaO2 value was higher than that of the pure surgery group (P < 0.05). The sleep structure improvement of the combined treatment group in the postoperative 3a was possibly more normal than that of the pure surgery group.The long-term efficacy of the combined UPPP and OA for the treatment of OSAHS was higher than that of pure UPPP treatment.
- Management of obstructive sleep apnea in adults. [Journal Article]
- Ann Intern Med 2014 Mar 4; 160(5)
- Redefining the Timing of Surgery for Obstructive Sleep Apnea in Anatomically Favorable Patients. [JOURNAL ARTICLE]
- Laryngoscope 2014 Apr 16.
Objectives/Hypothesis: Health care remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP that subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first-line treatment in this specific OSA sub-population. Study Design & Methods: This was a prospective cohort study. Patients with moderate-severe OSA who had failed a minimum six-month trial of CPAP were recruited. All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty +/- septoplasty. Outcome measures included Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Quality of Life Index (SAQLI-E), and blood pressure. Patients were followed for one year. Results: By AHI measurement 85.7% of patients in the entire cohort were successfully treated by surgery. ESS while on CPAP was 13.7 ± 2.9, improving to 4.1 ± 2.5 after surgery. SAQLI-E scores on CPAP were 25.7 ± 5.8, improving to 10.2 ± 3.2 after surgery. Blood pressure remained elevated during CPAP but normalized after surgery. All changes were significant at p<0.001. Conclusions: Surgical intervention improved OSA severity as measured by the ESS, SAQLI-E, and blood pressure. These measures had not improved on CPAP. AHI improved as well. Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence, and with only minor surgical risk.
- TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Apr 16.
The polysomnography (PSG) index of the apnea hypopnea index (AHI) is considered the 'gold standard' for stratifying the severity of obstructive sleep apnea (OSA). However, AHI cannot reflect the true characteristic of chronic intermittent hypoxia (CIH), which may trigger systemic inflammation in some OSA patients. High-sensitivity C-reactive protein (hsCRP) is considered a biomarker of systemic inflammation in OSA patients. The aim of the present study was to evaluate the relationship between PSG variables and hsCRP in men with severe OSA. Men with severe OSA (AHI ≥30 events/h) diagnosed by PSG were enrolled. AHI and body mass index were matched between a high hsCRP group (hsCRP ≥3.0 mg/L) and a low hsCRP group. A blood sample was taken for serum hsCRP analysis. Multiple regression analysis was performed to assess independent predictors of high hsCRP. One hundred and fifty-two subjects were enrolled in the study (76 in each group). Mean serum hsCRP was 3.76 ± 2.13 mg/L. The mean percentage of total sleep time spent with SaO2 <90 % (TST) in the high hsCRP group was significantly higher than in the low hsCRP group (20.99 ± 18.52 vs. 5.84 ± 7.30, p < 0.001). Multivariate analysis showed that TST was the strongest predictor, contributing to 27.7 % of hsCRP variability (β = 0.496, p < 0.01). TST may be superior to AHI for evaluating CIH among OSA patients. The severity of OSA should be stratified by a combination of AHI and other hypoxia variables.
- Effect of Obstructive Sleep Apnea Treatment on Mail-In Cognitive Function Screening Instrument. [JOURNAL ARTICLE]
- Am J Med Sci 2014 Apr 14.
Obstructive sleep apnea syndrome (OSAS) may be associated with cognitive impairment (CI). The goal of this study was to evaluate the impact of risk factors and continuous positive airway pressure (CPAP) on a screening tool for cognitive function.The Mail-In Cognitive Function Screening Instrument (MCFSI) is a self-administered test designed to identify CI in the Alzheimer's Disease Cooperative Study. It was administered to 88 consecutive patients with OSAS attending the Medical University of South Carolina Sleep Clinic. An MCFSI score ≥5 was considered abnormal.Data were analyzed on 61 patients after excluding missing and duplicate data. The MCFSI score was abnormal in 15 patients (25%). African Americans were more likely to be CPAP-noncompliant. Female gender and smoking were associated with abnormal MCFSI scores. CPAP-compliant patients were more likely to have normal MCFSI scores, although the difference was not statistically significant (P = 0.06).CPAP-compliant patients showed a trend toward lower MCFSI scores. There may be gender and racial differences in CI related to OSAS, predisposing certain groups to worse morbidity. Appropriate treatment and compliance with CPAP could improve CI in OSAS. Larger studies with multivariate analyses are needed to identify relationships between individual OSAS and CI risk factors.
- Is brain damage really involved in the pathogenesis of obstructive sleep apnea? [JOURNAL ARTICLE]
- Neuroreport 2014 Apr 14.
Obstructive sleep apnea (OSA) syndrome is a surprisingly complex and highly individualized disease, with different factors contributing toward the disease process. Many factors can induce OSA disease, such as hypertrophy uvula, adenoidectomy, tonsil caused by mechanical obstruction of the airway, airway obstruction on obesity cause of decubitus, etc.; in addition, abnormal structure and function of the central nervous system (CNS) is also one of the important factors. This paper examines the relationship of the CNS with the onset of OSA. Evidence has shown that dysfunction of the CNS may be related to the occurrence of OSA. Although modification of the behaviors of the motor neurons may offer a potentially interesting means of controlling the airway, human afferent and motor pathways that regulate eupnea are still poorly understood. Combining some clinical phenomena of patients with cerebral hemorrhage or brain trauma at the temporal lobe, it seems that no close relation with OSA has been observed in clinical work and animal experiments; however, CNS damage at the temporal lobe is involved in the pathogenesis of OSA. This article examines the role of the CNS in the pathogenesis of OSA and its mechanisms. We have summarized previous findings of OSA-related brain damage, which were obtained by brain functional MRI, clinical, and animal experiment data to better understand the roles of the CNS in the pathogenesis of OSA. More specifically, this review summarizes how altered activity of the limbic system and its related structures could be associated with the occurrence of OSA. This conclusion may contribute toward our understanding of nosogenesis and the treatment of OSA.
- Nocturnal snoring decreases daytime baroreceptor sensitivity. [JOURNAL ARTICLE]
- Respir Med 2014 Apr 2.
In patients with obstructive sleep apnea heart rate variability and baroreceptor sensitivity during night and daytime are impaired. Snoring without obstructive sleep apnea may already influence heart rate variability and baroreceptor sensitivity during daytime.Cardiovascular daytime testing was performed in 11 snorers and age, BMI, and gender matched controls. Sleep apnea and snoring were quantified by sleep recordings. Paced breathing was performed during daytime with ECG, non-invasive blood pressure, and respiration recorded. Heart rate variability and blood pressure variability were analyzed in the time and frequency domain. Baroreceptor sensitivity (alpha gain) was calculated.In snorers a significant increase in high frequency systolic blood pressure variability (SBPV-HF) compared to control group (0.37 mm Hg(2) vs. 0.11 mm Hg(2) for 12 breaths and 0.35 mm Hg(2) vs. 0.10 mm Hg(2) for 15 breaths) was demonstrated. Furthermore a lower baroreceptor sensitivity was found in snorers compared to controls (9.2 ms/mm Hg vs. 16.2 ms/mm Hg for 12 breaths and 8.5 ms/mm Hg vs. 17.4 ms/mm Hg for 15 breaths per minute) using the paced breathing protocol. Mean heart rate was elevated in snorers as well.Snorers may have a reduced parasympathetic tone during daytime rather than an increased sympathetic tone.
- Obstructive Sleep Apnea and Risk of Osteoporosis: A Population-Based Cohort Study in Taiwan. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2014 Apr 15.:jc20141718.
Background: Obstructive sleep apnea (OSA) is associated with metabolic, endocrine, and cardiovascular diseases. It is characterized by repetitive episodes of apnea/hypopnea and hypoxia in tissues, which might also impact bone metabolism. This study investigates the possible association between OSA and osteoporosis. Methods: Random samples of 1 million individuals were collected from Taiwan's National Health Insurance database. A total of 1377 patients with newly diagnosed OSA from 2000 to 2008 were recruited and compared with a matched cohort of 20ü655 patients without OSA. All patients were tracked until an osteoporosis diagnosis, death, or the end of 2011. Results: During the 6-year follow-up period, the incidence rates of osteoporosis in the OSA cohort and comparison group were 2.52 and 1.00 per 1000 person-years, respectively. Patients with OSA were found to be at 2.74 times the risk of osteoporosis than patients without OSA (95% confidence interval 1.69-4.44, P < .05), after adjustment for age, gender, diabetes, hypertension, coronary artery disease, obesity, stroke, hyperlipidemia, chronic kidney disease, gout, monthly income, and geographical location. Subgroup analysis showed that older patients and female patients had a higher risk for osteoporosis than their younger and male counterparts. Log-rank analysis revealed that patients with OSA patients had significantly higher cumulative incidence rates of osteoporosis than the comparison group (P < .0001). Conclusion: People diagnosed with OSA are at increased risk for subsequent osteoporosis.
- Inhaled steroids reduce apnea-hypopnea index in overlap syndrome. [Journal Article, Research Support, Non-U.S. Gov't]
- Pneumologia 2013 Oct-Dec; 62(4):212-4.
Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two of the most common chronic respiratory disorders. Co-existence of both conditions, referred as overlap syndrome (OLS), is associated with substantially high rates of mortality and morbidity. The present study aimed to evaluate the effect of inhaled corticosteroids (ICS) on apnea-hypopnea index (AHI), an indicator for diagnosis and identifying the severity of OSA, in overlap syndrome.We conducted a clinical trial on 60 patients diagnosed with overlap syndrome by employing overnight polysomnography before and after receiving ICS. Tstudent test and Mann-Whitney test were applied to analyze the gathered data including age, AHI, nocturnal oxygen desaturation index and SaO2, (saturated arterial oxygen), daytime (pressure of arterial carbon dioxide) PaCO, level, forced expiratory volume in one second (FEV1), body mass index (BMI), and waist and neck circumferences.By 3-month ICS administration, this study demonstrated significant reduction of mean AHI and nocturnal oxygen desaturation index along with remarkable improvement of FEV1, diurnal PaCO2, level and nocturnal SaO2, (P< 0.05). Meanwhile, BMI and waist and neck circumferences measurement showed no noticeable changes.As we have not found any literature demonstrating, this is the first study which has evaluated the effect of ICS on AHI in overlap syndrome. Because of a remarkable improvement in obstructive sleep apneas, this study suggests that ICS might be beneficial in treatment of overlap syndrome.
- Excessive daytime sleepiness works together with other sleep disorders in determining sleepiness-related events in shift workers. [Journal Article]
- G Ital Med Lav Ergon 2013 Jul-Sep; 35(3):151-6.
Shift-workers may experience sleep disturbances more frequently than day-workers. Interactions between obstructive sleep apnea (OSA), shift-work and other factors promoting sleepiness have never been studied. The present study was designed to assess the prevalence of excessive daytime sleepiness (EDS), high risk for OSA (HR) and insomnia in shift-workers and day-workers and to evaluate their mutual effects on the risk of home-to-work commuting car accidents or episodes of falling asleep during work.Workers (153 shift-workers, 85 day-workers) were evaluated for the presence of sleep disorders including HR and EDS. The relationships between sleepiness-related events, shift-work and sleep disorders were investigated by path analysis.Forty-nine subjects had HR. EDS was more frequent in shift-workers than in day-workers (16.3% vs. 5.9%, P = 0.01) and in workers with HR (28.6% vs. 8.4%, P < 0.001) or insomnia (35.7% vs. 9.5%, P < 0.001). Path analysis support the evidence that EDS was directly linked to shift-work, HR and insomnia. Car accidents or falling asleep at work were directly associated with EDS and shift-work, and indirectly (via EDS) with HR and insomnia.Development of EDS in shift-workers is not only due to work schedule, but also to the presence of sleep disorders. OSA and insomnia co-promote falling asleep during work and sleepiness-related car accidents.