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Apnea, sleep, obstructive [keywords]
- Seeing Sleep: Dynamic imaging of upper airway collapse and collapsibility in children. [JOURNAL ARTICLE]
- IEEE Pulse 2014 Sep-Oct; 5(5):40-44.
Sleep disordered breathing in children ranges from snoring, which has a prevalence of 12%, to obstructive sleep apnea (OSA) syndrome, which has a prevalence of 2?3% in the general population . The underlying causes of pediatric OSA are extremely complex. There are bony structural influences, as seen in craniofacial abnormalities, and soft tissue abnormalities, such as a large tongue, redundant soft tissue, or compliance/collapsibility issues. In some groups, such as those with Down syndrome, a combination of these factors comes into play.
- Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. [Journal Article]
- Am J Orthod Dentofacial Orthop 2014 Oct; 146(4):477-92.
The aims of this study were to use 3-dimensional simulation and modeling programs to evaluate the effects of bimaxillary orthognathic surgical correction of Class III malocclusions on pharyngeal airway space volume, and to compare them with the changes in obstructive sleep apnea measurements from polysomnography.Twenty-five male patients (mean age, 21.6 years) with mandibular prognathism were treated with bilateral sagittal split osteotomy and LeFort I advancement. Polysomnography and computed tomography were performed before surgery and 1.4 ± 0.2 years after surgery. All computed tomography data were transferred to a computer, and the pharyngeal airway space was segmented using SimPlant OMS (Materialise Medical, Leuven, Belgium) programs. The pretreatment and posttreatment pharyngeal airway space determinants in volumetric, linear distance, and cross-sectional measurements, and polysomnography changes were compared with the paired samples t test. Pearson correlation was used to analyze the association between the computed tomography and polysomnography measurements.The results indicated that setback procedures produce anteroposterior narrowing of the pharyngeal airway space at the oropharyngeal and hypopharyngeal levels and the middle and inferior pharyngeal volumes (P <0.05). In contrast, advancement of the maxilla causes widening of the airway in the nasopharyngeal and retropalatal dimensions and increases the superior pharyngeal volume (P <0.05). Distinctively, bimaxillary orthognathic surgery induces significant increases in the total airway volume and the transverse dimensions of all airway areas (P <0.05). Significant correlations were found between the measurements on the computed tomography scans and crucial polysomnography parameters.Bimaxillary orthognathic surgery for correction of Class III malocclusion caused an increase of the total airway volume and improvement of polysomnography parameters. A proposed treatment plan can be modified according to the risk of potential airway compromise or even to improve it with 3-dimensional imaging techniques and polysomnography.
- [Study of the relationship between arousal parameters and daytime sleepiness in patients with obstructive sleep apnea syndrome]. [English Abstract, Journal Article]
- Zhonghua Jie He He Hu Xi Za Zhi 2014 Jul; 37(7):492-6.
To explore the effect of arousal parameters on excessive daytime sleepiness(EDS) in patients with obstructive sleep apnea syndrome(OSAS).A total of 205 patients who underwent polysomnography (PSG) from June 2012 to September 2013 in our hospital were enrolled. They were divided into 3 groups:85 patients in the OSAS sleepiness group (AHI ≥ 5/h, ESS ≥ 9), 86 patients in the OSAS non-sleepiness group (AHI ≥ 5/h, ESS<9), and 34 healthy subjects in the control group (AHI<5 times/h, ESS<9). Patient characteristics and PSG parameters of the 3 groups were analyzed.The difference of age, BMI, ESS, N1+ N2%, N3%, AHI, oxygen desaturation index (ODI), mean oxygen saturation (MSaO2), lowest oxygen saturation(LSaO2), oxygen below 90% of the time (T90%), total arousal index (ARtotI), respiratory arousal index/ARtotI (RAI/ARtotI), spontaneous arousal index/ARtotI (SAI/ARtotI), sleep pressure score (SPS) were statistically different among the 3 groups (P < 0.05). But except for REM% [(15 ± 5)%, (16 ± 6)%, (17 ± 7)%, P > 0.05], the difference of age and BMI between OSAS sleepiness group and OSAS non-sleepiness group were not significant (P > 0.016 7), but the difference of other indices between any 2 groups were significant(P < 0.016 7). ARtotI and SPS were positively correlated with ESS (r = 0.383 and 0.244, P < 0.001). Logistic regression analysis showed that only awakening and SPS were the risk factors for OSAS[OR = 1.070 (95%CI: 1.038-1.102) and 0.158 (95%CI: 0.026-0.984), respectively].Arousal at night is closely associated with EDS in OSAS. ARtotI and SPS can be evaluated as an objective indicator of EDS in OSAS patients.
- Consolidating innovative practice models: The case for obstructive sleep apnea services in Australian pharmacies. [JOURNAL ARTICLE]
- Res Social Adm Pharm 2014 Aug 27.
Pharmacists in Australia have pioneered an innovative role in providing obstructive sleep apnea (OSA) services in community pharmacies. A professional practice framework is yet to be established for this novel service area.To explore the practices and experiences of Australian pharmacy staff providing OSA services.Semi-structured telephone interviews were conducted using an interview guide to explore a priori areas of interest. Interviews were audio recorded, transcribed verbatim and thematically analyzed using a framework approach.Interviews were completed with 22 practitioners from demographically diverse pharmacies. Key themes emerging from the interviews included motivation for providing the service, current practice frameworks, determinants for sustaining the service and future directions for the profession. Participants reflected on the professional satisfaction they derived from providing the service and being able to contribute to an important public health area. However, numerous impediments to service provision were discussed; these were broadly conceptualized as financial, professional, societal and geographical issues. Important practitioner needs were highlighted, including professional training opportunities and support. The need for a regulatory practice framework to ensure quality and uniformity of service provision within the profession was emphasized. Broader uptake of these services in the absence of such a framework was a key area of concern.This study showcases a novel area of pharmacy service provision. Innovative services need to be explored and defined before being consolidated into professionally recognized areas of practice. For OSA services in Australia, the next key step for the profession is to establish a professional practice framework to support current and future implementers of the service and ensure a minimum standard of care.
- Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Sep 28.
The purpose of this study was to investigate the relationship between various polysomnographic variables and the success of modified tongue base suspension combined with uvulopharyngopalatoplasty in patients with severe obstructive sleep apnea (OSA). A total of 90 patients who had apnea hypopnea index (AHI) >30 and had both oropharyngeal and hypopharyngeal obstruction were included in this prospective case series with planned data collection. All patients were assessed preoperatively and at the sixth postoperative month by polysomnography. The surgery was considered to be successful when a ≥50 % reduction in the mean AHI to a final AHI of <20/h was obtained. Multiple logistic regression analyses were performed to determine the impact of variables on the surgical success. A total of 67 patients (74.4 %) met the surgical success criteria. The univariate analysis revealed a relationship between success and AHI (P = 0.001), obstructive apnea duration (P = 0.001), sleep time with oxygen saturation below 90 % (ST90) (P = 0.004), minimum O2 saturation (P = 0.0001), mean O2 saturation (P = 0.011), mean O2 desaturation (P = 0.0001), and oxygen desaturation index (P = 0.001). However, ST90 [OR (95 % CI) = 1.40 (1.04-1.89), P = 0.023] was the only independent parameter predicting the surgical success in multivariate analysis. The ROC analysis revealed that the ST90 value of ≤36 min was the best cutoff value with 96.97 % sensitivity (CI 89.5-99.6), 95.83 % specificity (CI 78.9-99.9), 98.5 % PPV (CI 91.6-100.0), and 92.0 % NPV (CI 74.0-99.0). The stratification of patients with severe OSA according to the ST90 may allow better identification of patients in whom surgical success is probable.
- Obstructive Sleep Apnea and Progression of Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis Study. [JOURNAL ARTICLE]
- J Am Heart Assoc 2014; 3(5)
Obstructive sleep apnea (OSA) is a common condition associated with cardiovascular disease. Its potential effect on progression of subclinical atherosclerosis is not well understood. We tested the hypothesis that self-reported OSA is associated with progression of coronary artery calcium (CAC). We also evaluated whether traditional cardiovascular risk factors accounted for the association.In the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort, we studied 2603 participants who at baseline (2002-2004) completed a sleep questionnaire and underwent coronary computed tomography (CT) and, then 8 years later (2010-2011), a repeat coronary CT. Participants were categorized by symptoms of habitual snoring or reported physician diagnosis of OSA. At baseline, 102 (3.9%) reported diagnosed OSA; 666 (25.6%) reported diagnosed habitual snoring; and 1835 (70.5%) reported neither habitual snoring nor OSA ("normal"). At baseline, CAC prevalence was highest among those with OSA but similar for those with and without habitual snoring. During 8 years of follow-up, greater progression of CAC was observed among those with OSA versus normal (mean increase of 204.2 versus 135.5 Agatston units; P=0.01), after accounting for demographics, behaviors, and body habitus. Modest attenuation was observed after adjustment for cardiovascular risk factors (188.7 versus 138.8; P=0.06). CAC progression among habitual snorers was similar to that observed in the normal group.OSA was associated with CAC score progression after adjustment for demographics, behaviors, and body mass index. However, the association was not significant after accounting for cardiovascular risk factors, which may mediate the association between OSA and CAC.
- Importance of yawning in the evaluation of excessive daytime sleepiness: a prospective clinical study. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Sep 27.
As a dark and not fully understood side of human nature, yawning is believed to be a signs of various physiological or pathological behaviors of human. In this study, we aimed to investigate the importance of yawning in the evaluation of sleepiness. One hundred and twenty-nine snorers who were suspected to have obstructive sleep apnea syndrome underwent polysomnography and were asked to fill the Epworth sleepiness scale. The number of yawnings of patients was counted during the day following polysomnography. Patients were stratified into two groups: those have apnea hypopnea index <5 (n = 43, group 1) and those have apnea hypopnea index >30 (n = 86, group 2). Mean duration of sleep phases, oxygen saturations, sleep efficacies, yawning frequencies and Epworth scores of the groups were compared. Correlations of yawning frequency with Epworth scores, duration of sleep phases and mean oxygen saturations were investigated. Sleep efficacies were similar between the groups (p > 0.05). Yawning frequencies in group 1 and group 2 were 43.48 and 75.76 (mean rank), respectively (p < 0.01). Mean N1, N2, N3 phase durations and oxygen saturations were significantly lower in group 2 (p < 0.01). While there was a negative correlation between yawning frequency and duration of the non-REM phases and mean oxygen saturation (r = -0.53 and r = -0.31, respectively, p < 0.05), yawning frequency was positively correlated with Epworth scores (r = 0.46, p < 0.05). In addition to the shortened phases of sleep, increased Epworth score and decreased oxygen saturation, increased yawning frequency may indicate sleep deprivation.
- Independent association of obstructive sleep apnea with left ventricular geometry and systolic function in resistant hypertension: the RESIST-POL study. [JOURNAL ARTICLE]
- Sleep Med 2014 Aug 19.
We investigated the impact of obstructive sleep apnea (OSA) and night blood pressure (BP) on left ventricular geometry and systolic function in patients with resistant hypertension (RHTN).Data from 155 patients with RHTN were analyzed. All patients underwent biochemical evaluations, ambulatory blood pressure monitoring (ABPM), and polysomnography. Left ventricular mass index (LVMI), relative wall thickness (RWT), left ventricular ejection fraction (LVEF), midwall fractional shortening (mwFS) and global longitudinal strain (GLS) were measured. Patients were divided into four groups based on the presence of metabolic syndrome (MS) and OSA: group 1: OSA(-), MS(-) [n = 42]; group 2: OSA(+), MS(-) [n = 14]; group 3: OSA(-), MS(+) [n = 46]; and group 4: OSA(+), MS(+) [n = 53]. In group 3 and 4 concentric geometry was present in 53.2% and 79.6% respectively (P = 0.004). There were no differences in LVEF between groups. Group 3 and 4 had lower mwFS as compared with group 1 (16.40 ± 1.9 and 15.38 ± 2.2 vs 17.44 ± 1.9; P < 0.049 and P < 0.0001 respectively). Group 4 had significantly lower GLS as compared with group 1 (-12.64 ± 3.3 vs -15.59 ± 4.0; P < 0.001). In the multivariable analysis, factors independently associated with concentric geometry were age, nighttime SBP (OR -1.04; 95%Cl 1.019-1.082; P < 0.0001) and OSA (OR -3.97; 95%Cl 1.835-8.590; P < 0.0001). In the other multivariable analysis, factors independently associated with GLS were OSA (beta = 0.279; P = 0.001), and nighttime DBP (beta = 0.168; P = 0.048) whereas factors independently associated with mwFS were age, gender, nighttime SBP, concentric geometry, and metabolic syndrome.In patients with true RHTN without diabetes concentric geometry and systolic dysfunction are independently associated with moderate and severe OSA and nighttime BP levels.
- Comparison of cardiovascular co-morbidities and CPAP use in patients with positional and non-positional mild obstructive sleep apnea. [JOURNAL ARTICLE]
- BMC Pulm Med 2014 Sep 26; 14(1):153.
This retrospective cohort study aimed to determine if there are differences in cardiovascular co-morbidities, blood pressure (BP) and continuous positive airway pressure (CPAP) use between patients with positional-dependent and nonpositional-dependent obstructive sleep apnea (OSA).Patients who were referred for overnight polysomnography for suspected OSA between 2007 and 2011 were screened. A total of 371 patients with OSA were included for analysis and divided into six groups according to positional-dependency and severity of OSA: positional mild (n = 52), positional moderate (n = 29), positional severe (n = 24), non-positional mild (n = 18), non-positional moderate (n = 70) and non-positional severe group (n = 178). The six groups were compared for anthropometric and polysomnographic variables, presence of cardiovascular co-morbidities, morning and evening BP and the changes between evening and morning BP, and CPAP device usage patterns.Demographic and anthropometric variables showed non-positional severe OSA had poor sleep quality and higher morning blood pressures. Positional mild OSA had the lowest cardiovascular co-morbidities. Overall CPAP acceptance was 45.6%. Mild OSA patients had the lowest CPAP acceptance rate (10%), followed by moderate group (37.37%) and severe group (61.88%, P < 0.001). However, the significant difference in CPAP acceptance across OSA severity disappeared when the data was stratified by positional dependency.This study found that positional mild OSA had less cardiovascular co-morbidities compared with subjects with positional severe OSA. Independent of posture, CPAP acceptance in patients with mild OSA was low, but CPAP compliance was similar in CPAP acceptors regardless of posture dependency of OSA. Since there are increasing evidences of greater cardiovascular risk for untreated mild OSA, improving CPAP acceptance among mild OSA patients may be clinically important regardless of posture dependency.
- [Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome]. [English Abstract, Journal Article]
- Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014 Jul; 49(7):574-81.
To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months.The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ(2) were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was only 43.2% (χ(2) = 36.189, P < 0.05). B2 and B3 subgroups cured after coblation adenotonsillectomy, but no decrease of the adenoid and tonsil size was found in B1 subgroup (P > 0.05). The nasal endoscopic examination scores of B1, B2 and B3 subgroups showed significant decrease after the treatment, but re-increase was found in both B1 and B2 subgroups at the 6 months (F = 1 614.244, P < 0.05), no significant re-increase was found in the B3 subgroup. The PSG monitor of B3 subgroup was 100.0% normal at 3 months after treatment, B2 subgroup 73.4%, and B1 subgroup only 57.4% (χ(2) = 90.846, P < 0.05).The treatment method of children with OSAHS should be selected according to the age, condition of disease, and size of the adenoid and tonsil. Adenoid and tonsil ≤ degree III should select conservative treatment; while for degree IV adenoid and (or) tonsil, surgical treatment should be primary choice. Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.