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Apnea, sleep, obstructive [keywords]
- Abdominal and General Adiposity and Level of Asthma Control in Adults with Uncontrolled Asthma. [JOURNAL ARTICLE]
- Ann Am Thorac Soc 2014 Oct; 11(8):1218-1224.
Rationale: Abdominal adiposity may be an important risk factor for uncontrolled asthma in adults, controlling for general obesity. Whether the relationship, if present, is explained by other factors (e.g., asthma onset age, sex, and/or coexisting conditions) is unclear. Objectives: To examine whether clinically applicable anthropometric measures of abdominal adiposity-waist circumference and waist-to-height ratio (WHtR)-are related to poorer asthma control in adults with uncontrolled asthma controlling for body mass index (BMI), and whether the relationship (if present) is explained by gastroesophageal reflux disorder (GERD), sleep quality, or obstructive sleep apnea (OSA) or differs by age of asthma onset or sex. Methods: Patients aged 18 to 70 years with uncontrolled asthma (n = 90) participated in a 6-month randomized clinical trial. Measurements and Main Results: Baseline measures included sociodemographics, standardized anthropometrics, Asthma Control Test (ACT), GERD Symptom Assessment Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire for Sleep Apnea. Participants (mean [SD] age, 52  yr) were racially and ethnically diverse, 67% women, and 69% overweight or obese, and 71% reported their age of asthma onset was 12 years or older. Participants had uncontrolled asthma (mean [SD] ACT score, 14.9 [3.7]) and low GERD symptoms score (0.6 [0.4]); 67% reported poor sleep quality, and 42% had a high OSA risk. General linear regression results showed that worse ACT scores were significantly associated with every SD increase in waist circumference (β= -1.03; 95% confidence interval [CI], -1.96 to -0.16; P = 0.02) and waist-to-height ratio (β= -1.16; 95% CI, -2.00 to -0.33; P = 0.008), controlling for sociodemographics. Waist-to-height ratio remained correlated with ACT (β= -2.30; 95% CI, -4.16 to -0.45; P = 0.02) after further adjusting for BMI. The BMI-controlled relationship between WHtR and ACT did not differ by age of asthma onset or sex (P > 0.05 for interactions) and persisted after additional adjustment for GERD, sleep quality, or OSA scores. Poor sleep quality was associated with worse ACT scores (β= -0.87; 95% CI, -1.71 to -0.03; P = 0.045) controlling for waist-to-height ratio, BMI, and sociodemographics. Conclusions: Abdominal adiposity by waist-to-height ratio and poor sleep quality correlated with poorer asthma control in adults with uncontrolled asthma, after controlling for BMI and sociodemographics. These results warrant replication in larger studies of diverse populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01725945).
- Prevalence of Sleep Disorders and their Effects on Sleep Quality in Epileptic Patients. [Journal Article]
- Basic Clin Neurosci 2013; 4(1):36-41.
Epilepsy is a complex pervasive neurobehavioral and social condition accompanied by a wide range of comorbid conditions that can adversely affect the quality of life of patients. Sleep complaints are common among patients with epilepsy. The aim of this study was to assess the prevalence of subjective sleep disturbances and its effects on sleep quality in epileptic patients.In this cross-sectional study, 152 consecutive epileptic patients and 152 controls were interviewed. We used Epworth Sleepiness Scale, Insomnia Severity Index, Berlin Questionnaire and Pittsburg Sleep Quality Index to measure excessive daytime sleepiness, insomnia, obstructive sleep apnea and sleep quality. R estless leg syndrome was diagnosed using three questions.The age, gender and average total sleep time was similar in patients and control group. The frequency of excessive sleepiness scale and subjective complaint of sleep maintenance was higher in epileptic patients than control group (P<0.05). The symptoms of restless leg syndrome were reported by 32.3% of patients and 11.8% of controls (P<0.05).Daytime sleepiness, difficulty in sleep maintenance, poor sleep quality and RLS appear to be common in patients with epilepsy. Further confirmatory studies are needed using objective sleep studies to detect underlying mechanisms of sleep disorders in these patients.
- The prevalence of obstructive sleep apnea-hypopnea syndrome-related symptoms and their relation to airflow limitation in an elderly population receiving home care. [Journal Article]
- Int J Chron Obstruct Pulmon Dis 2014.:1111-7.
Both airflow limitation and obstructive sleep apnea-hypopnea syndrome (OSAHS)-related symptoms are most prevalent in the elderly population. Previous studies revealed significant associations between OSAHS-related symptoms and obstructive airway diseases in the general population. However, other studies showed that the frequency of OSAHS-related symptoms in patients with obstructive airway diseases decreases after the age of 60 and older.To investigate the prevalence of OSAHS-related symptoms (snoring, breathing pauses, and excessive daytime sleepiness [EDS]) and their relations to airflow limitation, for people over 65 years old.A full screening spirometry program was performed in a total of 490 aging participants (mean age 77.5 years - range 65-98) who were attending 16 home care settings in central Greece. Airflow limitation was assessed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric criteria (FEV1/FVC <70%). The Berlin Questionnaire and the Epworth Sleepiness Scale were used to screen individuals for OSAHS-related symptoms. Bivariate associations were described using odds ratio (OR) with 95% confidence intervals (CI).Airflow limitation prevalence was 17.1% (male 24.2% and female 9.9%) and was strongly related to male gender and smoking status. The prevalence rates of frequent snoring, breathing pauses, and EDS were 28.1%, 12.9%, and 11.6%, respectively. However, participants with airflow limitation were less likely to report breathing pauses, frequent snoring, EDS, and obesity. Finally, frequent snoring was significantly more common in males than females.This study revealed decreased frequency of OSAHS-related symptoms in participants with airflow limitation suggesting that OSAHS-related symptoms and airflow limitation are not related in our elderly population.
- Impact of sleep-disordered breathing and efficacy of positive airway pressure on mortality in patients with chronic heart failure and sleep-disordered breathing: a meta-analysis. [JOURNAL ARTICLE]
- Clin Res Cardiol 2014 Oct 22.
To conduct a meta-analysis to investigate whether sleep-disordered breathing (SDB) is an independent risk factor for mortality and whether positive airway pressure (PAP) decreases mortality in patients with chronic heart failure (HF). The impact of SDB and the effects of PAP on mortality in patients with chronic HF remain unclear.We searched the MEDLINE, EMBASE, and Cochrane databases. Clinical trials that addressed mortality and the effect of PAP on mortality in chronic HF patients with SDB were included in this meta-analysis.Eleven studies (1,944 participants in total) that addressed mortality in chronic HF patients with SDB were included in this study. Patients with SDB showed a significantly increased mortality risk compared to those without SDB [risk ratio (RR) 1.66 (1.19-2.31)]. In sub-analyses, a significant increase in risk of mortality was observed for central sleep apnea versus no-SDB [RR 1.48 (1.15-1.91)], whereas no significant increase in risk was observed for obstructive sleep apnea versus no-SDB. Five randomized controlled studies (395 participants) that assessed the effect of PAP in chronic HF patients with SDB were analyzed. Adaptive servo-ventilation (ASV) significantly reduced all-cause mortality in chronic HF patients with SDB [RR 0.13 (0.02-0.95)], whereas continuous PAP did not significantly reduce all-cause mortality [RR 0.71 (0.32-1.57)].The prevalence of SDB in patients with chronic HF is associated with worse survival, and ASV reduces all-cause mortality in patients with chronic HF concomitant with SDB.
- A promising concept of combination therapy for positional obstructive sleep apnea. [JOURNAL ARTICLE]
- Sleep Breath 2014 Oct 22.
The objective of this randomized controlled trial was to assess the additional effect of a chest-worn sleep position trainer (SPT) in patients with residual supine-dependent obstructive sleep apnea (sdOSA) under mandibular advancement device (MAD) therapy.Baseline and follow-up polysomnography with MAD were performed. Twenty patients with sdOSA under MAD therapy underwent two consecutive randomized polysomnographies: one with SPT and one with combination of SPT + MAD. Data are presented as median (quartile 1, quartile 3).The SPT reduced the time spent in supine sleeping position compared to baseline and MAD therapy. Both MAD and SPT were individually effective in reducing the overall apnea/hypopnea index (AHI) significantly when compared to baseline from 20.8 (15.1; 33.6)/h at baseline to 11.0 (6.7; 13.8)/h and to 11.1 (3.5; 17.7)/h with MAD or SPT, respectively. The combination of SPT + MAD further reduced the overall AHI to 5.7 (3.6; 7.4), which was significantly lower than with MAD alone (p < 0.001) and SPT alone (p < 0.008), respectively.The results of this study indicate that combination of SPT + MAD leads to a higher therapeutic efficacy in patients with sdOSA under MAD therapy when compared to one of the treatment modalities alone.
- Obstructive Sleep Apnea: Role of Intermittent Hypoxia and Inflammation. [JOURNAL ARTICLE]
- Semin Respir Crit Care Med 2014 Oct; 35(5):531-544.
Obstructive sleep apnea results in intermittent hypoxia via repetitive upper airway obstruction leading to partial or complete upper airway closure, apneas and hypopneas, respectively. Intermittent hypoxia leads to sympathetic nervous system activation and oxidative stress with a resultant systemic inflammatory cascade. The putative mechanism by which obstructive sleep apnea has been linked to numerous pathologic conditions including stoke, cardiovascular disease, hypertension, and metabolic derangements is through these systemic effects. Treatment of obstructive sleep apnea appears to reduce systemic markers of inflammation and ameliorates the adverse sequelae of this disease.
- [Effects of allitridi capsules on endothelial function and clinical prognosis in coronary artery disease patients with obstructive sleep apnea hypopnea syndrome]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2014 Jul 22; 94(28):2184-7.
To explore the effects of allitridi capsules on endothelial function and clinical prognosis in coronary artery disease (CAD) patients with obstructive sleep apnea hypopnea syndrome (OSAHS).A total of 80 CAD patients with OSAHS were randomly assigned to receive conventional treatment (control, n = 40) and additional allitridi treatment (120 mg/day, n = 40) for 6 months. Another 40 CAD patients without OSAHS and 30 healthy individuals were chosen as controls. Endothelial function was assessed by endothelium dependent flow-mediated dilation (FMD) with high-definition color Doppler ultrasound. Serum nitric oxide (NO) and plasma endothelin-1 (ET-1) levels were determined by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay. The duration of follow-up was 1 year.The baseline clinical characteristics were not different between control and allitridi groups (P > 0.05). Compared with CAD patients without OSAHS, FMD and serum NO level were significantly lower ((7.9 ± 1.5)% vs (11.2 ± 2.9)%, P = 0.011 and (71.11 ± 10.62) vs (86.28 ± 11.03) µmol/L, P = 0.007), plasma ET-1 level was markedly higher ((112.34 ± 17.22) vs (89.87 ± 11.56) ng/L, P = 0.025) in CAD patients with OSAHS. At Month 6 post-treatment, FMD and serum NO level were significantly higher ((12.1 ± 3.1)% vs (9.1 ± 1.6)%, P = 0.020 and (105.24 ± 17.01) vs (82.39 ± 11.12) µmol/L, P = 0.001) and plasma ET-1 level in the allitridi group was lower ((77.12 ± 9.65) vs (97.77 ± 11.04) ng/L, P = 0.001) than that in the control group. At Month 12 post-treatment, the incidence of MACE was lower in the allitridi group than that in the control group (8.3% vs 15.8%, P = 0.016).Allitridi capsules significantly improved endothelial function in CAD patients with OSAHS.
- Soft palatal webbing flap palatopharyngoplasty for both soft palatal and oropharyngeal lateral wall collapse in the treatment of snoring and obstructive sleep apnea: a new innovative technique without tonsillectomy. [JOURNAL ARTICLE]
- Sleep Breath 2014 Oct 21.
The soft palate and the lateral pharyngeal walls have been known to contribute to the collapse of the upper airway in many patients with snoring and obstructive sleep apnea (OSA). To our knowledge, there are few surgeries that specifically reshape the soft palate and create enough tension in the lateral pharyngeal wall in the same operation. In this study, we assessed the efficacy of a new technique in the treatment of snoring and OSA.Twenty eight adults with a body mass index of less than 30 kg/m(2) with Friedman type 2 upper airway with significant soft palatal webbing and lateral pharyngeal wall collapse were selected for the study with a minimum follow-up period of 6 months.The preoperative to postoperative apnea-hypopnea index (AHI) and lowest O2 saturation were statistically improved in all patients. Postoperative endoscopic findings showed significant improvement in soft palatal and lateral pharyngeal wall collapse.Soft palatal webbing flap palatopharyngoplasty provided objective clinical improvement of OSA in adults with soft palatal and lateral pharyngeal wall collapse and has the potential to serve as an effective alternative for these cases.
- Reoperation on patients with obstructive sleep apnea-hypopnea syndrome after failed uvulopalatopharyngoplasty. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Oct 21.
The goals of this study were to explore the reasons after failed uvulopalatopharyngoplasty (UPPP) in some patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to observe the efficacy of the second surgery. Twenty-three OSAHS patients with failed UPPP were included in the study. Routine physical exams, electronic endoscopy, computed tomography scan and polysomnography after nasopharyngeal tube insertion were performed to assess the site of upper airway obstruction, and corresponding appropriate surgical treatment was carried out based on the diagnosis. Comprehensive evaluation of the 23 patients revealed that the sites of obstruction after failed UPPP were as follows: 7 cases predominantly in the oropharyngeal area, 2 cases in the nasal, nasopharyngeal and oropharyngeal area, 5 cases predominantly in the glossopharyngeal area and 9 cases in the oropharyngeal and glossopharyngeal areas. Correspondingly, 7 cases underwent improved UPPP alone, 2 cases underwent adenoidectomy or nasal expansion and improved UPPP, 5 cases underwent glossopharyngeal surgery alone and 9 cases underwent improved UPPP and glossopharyngeal surgery. Follow-up for more than 12 months showed that there were four cured cases, 12 cases with marked improvement, and 7 cases with treatment failure. The success rate was 69.6 %. After undergoing UPPP, OSAHS patients may still have oropharyngeal airway obstruction. By performing a detailed preoperative assessment on the patient's airway condition and clarifying the site of obstruction, performing the second surgical treatment can still achieve a relatively satisfactory treatment outcome.
- Nocturnal Stem Cell Mobilization in Patients with Obstructive Sleep Apnea: A Pilot Study. [JOURNAL ARTICLE]
- Eur J Clin Invest 2014 Oct 21.
Patients with obstructive sleep apnea (OSA) experience repetitive cessation of breathing during sleep, leading to intermittent hypoxemia, excessive oxidative stress and systemic inflammation. These insults may damage the vasculature and provoke the corresponding repair response, such as stem cell mobilization to peripheral blood. This study aimed to investigate nocturnal mobilization of stem cells in OSA.Thirty-five OSA patients and thirteen healthy controls were enrolled. Polysomnography was performed, and severity of OSA was defined by apnea-hyponea index (AHI). Peripheral venous blood was drawn after and before sleep for measurement of CD34+ cell and SDF-1α level. Stem cell mobilization was gauged by ratios of the CD34+ level in the morning to that at night or their difference. Correlation analysis was done to identify factors related to stem cell mobilization RESULTS: Compared to controls, the nocturnal ratios and difference of CD34+ cell level were larger in OSA patients (ratios: 1.141 vs. 0.896, p=0.036; difference: 340 vs. -166 /cc blood, p=0.036), suggestive of stem cell mobilization. The mobilization ratios were related to AHI、body mass index (BMI)、SpO2 nadir、oxygen desaturation index and time sustaining hypoxemia. After adjusting age, gender and BMI, AHI (r=0.357, p=0.016) and hypoxemia-related parameter remained significant. Paired nocturnal differences in CD34+ cell count (p=0.009) and SDF-1α (p=0.001) were also significant in OSA patients, but not in controls. After CPAP therapy for 6 months, the elevated mobilization ratios in OSA patients tended to decline (p=0.059).CD34+ stem cell mobilization during sleep was observed in OSA. This article is protected by copyright. All rights reserved.