Apnea, sleep, obstructive [keywords]
- Successful use of cyclosporine as treatment for eosinophilic cystitis: a case report. [Journal Article]
- World Allergy Organ J 2016.:22.
Eosinophilic cystitis is a rare inflammatory disorder characterized by eosinophilic infiltration of all layers of the urinary bladder wall. Due to lack of consensus and potential for side effect from various therapeutic options, treatment of the disease is often challenging.A 64-year old woman with hypertensive nephropathy resulting in stage III chronic kidney disease, obstructive sleep apnea, and obstructive lung disease presented with a 4 month history of dysuria, urgency, frequency, and persistent hematuria. Based on eosinophilic infiltration on bladder wall biopsy in the absence of any evidence of infection, malignancy, or immune disorder, she was diagnosed with eosinophilic cystitis. Despite multiple medication regimens, her symptoms persisted, requiring high-dose prednisone with steroid-related side effects. After four months, she was started on cyclosporine, which led to symptomatic improvement and reduction in prednisone dosage. At that time, repeat urine cytology and cystoscopy did not reveal friable tissues or eosinophiluria.This case illustrates the utility of using cyclosporine to treat eosinophilic cystitis in adult patient with multiple comorbid conditions.
- Interrelationships with Metabolic Syndrome, Obesity and Cardiovascular. [JOURNAL ARTICLE]
- Curr Vasc Pharmacol 2016 Jul 22.
Cardiovascular (CV) disease is the most common cause of morbidity and mortality worldwide, particularly in the presence of the metabolic syndrome (MetS). Classifications and treatment of the MetS have recently been redefined. While the majority of the cardiac components such as hypertension, diabetes mellitus (DM) and dyslipidemia are objectively measurable elements, a few disparities among the definitions have to be considered that can variably modify diagnosis, treatment and prevention. Noncardiac factors such as liver disease (including, but not limited to, alcoholic and non-alcoholic steatosis/hepatitis), renal disease, severe obesity, polycystic ovarian syndrome and obstructive sleep apnea, may have independent or synergistic relationship with complementary cardiac MetS elements, and these additional risk factors may have an incremental adverse impact on CV outcome. The combination of all these factors potentiates the adverse significance on CV events. MetS not only increases morbidity and mortality but also has economic ramifications for the healthcare system. Prevention of CV disease includes primary and secondary aspects. Besides overall advances to provide optimal care for hypertension, diabetes, and dyslipidemia, early-targeted inventions to diagnose, treat and prevent obstructive sleep apnea, and severe obesity, are needed.
- Ophthalmic Diseases in Patients With Obstructive Sleep Apnea. [Journal Article]
- J Am Osteopath Assoc 2016 Aug 1; 116(8):522-9.
Symptomatic obstructive sleep apnea (OSA) affects 2% of women and 4% of men, but the prevalence of asymptomatic OSA is significantly higher. Several ophthalmic conditions are associated with OSA, including floppy eyelid syndrome, glaucoma, nonarteritic anterior ischemic optic neuropathy, papilledema, keratoconus, and central serous chorioretinopathy. The purpose of this review is to provide primary care physicians with a general knowledge of the signs, symptoms, and management of the ophthalmic diseases associated with OSA.
- A Brief Report on the Development of The Usability of Sleep Apnea Equipment-Oral Appliance (USE-OA) Questionnaire: A Pilot Study. [JOURNAL ARTICLE]
- J Dent Sleep Med 2015 Jul 10; 2(3):67-70.
To develop a questionnaire for measuring human factors (usability) associated with oral appliance use and to assess the feasibility of administering the questionnaire to patients with obstructive sleep apnea in a clinic setting.We developed the 11-item Usability of Sleep Apnea Equipment-Oral Appliance (USE-OA) Questionnaire by adapting items from a published questionnaire that had been developed to assess human factors associated with positive airway pressure device use. Then we distributed the USE-OA to patients at a university dental clinic between January and July 2014. We evaluated our survey methods qualitatively, calculated the response rate, and assessed completeness and response patterns of the USE-OA.Our formative evaluation revealed that the questionnaire was easy to distribute and administer in a clinic setting. Our response rate was 23%. A majority of respondents gave favorable usability ratings, and a small number of respondents gave unfavorable usability ratings.The USE-OA questionnaire can be easily administered in a dental clinic setting. Additional studies conducted in high-volume sleep oral appliance clinics are needed to assess the psychometric properties of the USE-OA and to compare the results of the USE-OA to direct observation of patients getting their oral appliance ready for use and cleaning their oral appliance.
- Obstructive Sleep Apnea is a Risk Factor for Recurrent Venous Thromboembolism. [JOURNAL ARTICLE]
- Chest 2016 Jul 21.
Obstructive sleep apnea (OSA) is a risk factor for a first episode of pulmonary embolism (PE), although its impact on the risk of thromboembolism recurrence is uncertain. Our objective was to explore the prognostic value of OSA after discontinuing oral anticoagulation (OAC) in patients with a first episode of PE.In 120 consecutive patients who had stopped OAC for a first episode of PE, we performed a home respiratory polygraphy and recorded sleep characteristics, classical risk factors for PE, blood pressure, spirometric parameters, physical activity and levels of D-dimer and prothrombin fragment 1+2. Patients were followed for 5 to 8 years, and the main end-point was PE recurrence. Restarting OAC for any thromboembolic event was evaluated as a secondary end-point.During the follow-up period, 19 patients had a PE recurrence, and 16 of them had an apnea-hypopnea index (AHI) ≥10 h(-1). In a multivariate Cox regression model, an AHI ≥10 (hazard ratio [HR], 20.73; 95%CI, 1.71-251.28), mean nocturnal oxygen saturation (SaO2) (HR, 0.39; 95%CI, 0.20-0.78), time with SaO2<90% (HR, 0.90; 95%CI, 0.82-0.98) and D-dimer level (HR 1.001; 95%CI, 1.00-1.002) were identified as independent risk factors for recurrent PE. 24 patients resumed OAC, and AHI ≥10 (HR, 20.66; 95%CI, 2.27-188.35), mean nocturnal SaO2 (HR, 0.54; 95%CI, 0.32-0.94) and Epworth sleepiness score (HR, 0.73; 95%CI, 0.56-0.97) were retained as independent risk factors to resume OAC.After a first episode of PE, OSA is an independent risk factor for PE recurrence or restarting OAC for a new thromboembolic event.
- Effect of CPAP-withdrawal on blood pressure in OSA: data from three randomized-controlled trials. [JOURNAL ARTICLE]
- Chest 2016 Jul 21.
Based on meta-analyses, the blood pressure (BP) lowering effect of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) is reported to be approximately 2-3mmHg. This figure is derived from heterogeneous trials, often limited by poor CPAP-adherence, and thus possibly underestimating the treatment effect. We analyzed morning BP data from three randomized controlled CPAP withdrawal trials which included only patients with optimal CPAP-compliance.Within the three trials, 149 OSA patients on CPAP were randomized to continue therapeutic CPAP (n=65) or to withdraw CPAP (n=84) for two weeks. Morning BP was measured at home before, and after sleep studies in hospital.CPAP-withdrawal was associated with a return of OSA (apnea-hypopnea index (AHI) at baseline 2.8/h, at follow-up 33.2/h). Systolic office BP increased in the CPAP-withdrawal group, compared to CPAP-continuation, by +5.4mmHg (95%CI 1.8-8.9mmHg, p=0.003), and systolic home BP by +9.0mmHg (95%-CI 5.7-12.3mmHg, p<0.001). Diastolic office BP increased by +5.0mmHg (95%CI 2.7-7.3mmHg, p<0.001), and diastolic home BP by +7.8mmHg (95%CI 5.6-10.4mmHg, p<0.001). AHI, baseline home systolic BP, statin usage, gender, and number of antihypertensive drugs were all independently associated with systolic BP change in multivariate analysis, controlling for age, BMI, smoking, diabetes, and sleepiness.CPAP-withdrawal results in a clinically relevant increase in BP, which is considerably higher than in conventional CPAP trials, and is also underestimated when office BP is used. Greater OSA severity is associated with a higher BP rise in response to CPAP-withdrawal.
- The efficiency of continuous positive airway pressure therapy in reducing cardiovascular dysfunction in a patient with arterial hypertension and obstructive sleep apnea. [Journal Article, Research Support, Non-U.S. Gov't]
- Pneumologia 2015 Oct-Dec; 64(4):41-4.
Obstructive sleep apnea (OSA) has been included by European and American hypertension therapy guidelines as a common cause of high blood pressure. Recent studies have demonstrated a strong link between OSA and HBP and the treatment thereof should consist of combination therapy, especially in patients with refractory AHT and a non-dipping profile. We present the case of a patient with high grade hypertension, with secondary organ damage and severe OSA. The ultimate method for controlling blood pressure and reversing subclinical cardiac and cerebrovascular dysfunction of this patient was the specific therapy with continuous positive airway pressure (cPAP).
- Predictors of daytime sleepiness in patients with obstructive sleep apnea. [Journal Article]
- Pneumologia 2015 Oct-Dec; 64(4):21-5.
The main symptomatic criterion to diagnose obstructive sleep apnea (OSA) is the level of daytime sleepiness. The Epworth Sleepiness Scale is a simple, self-administered questionnaire which provides a measurement of the subject's general level of daytime sleepiness. The aim of this study was to investigate the factors that can predict daytime sleepiness in patients with sleep apnea.50 consecutive patients with obstructive sleep apnea were enrolled into the study. Age, gender, anthropometric and polygraphic data were thoroughly analyzed. In all subjects daily sleepiness was assessed by Epworth Sleepiness Scale.The mean age of the subjects was 54.7 ± 12.8 years, 82% males. The mean BMI was 31.9 ± 6 kg/m2. Pearson correlation coefficient analysis demonstrates a significant positive correlation between the Epworth Sleepiness Scale and the desaturation index (r = 0.31, p < 0.01) and arterial hypertension (r = 0.32, p < 0.01). The forward stepwise regression analysis shows that the apnea hypopnea index and desaturation index are important predictors of daytime sleepiness in patients with obstructive sleep apnea which explains 40% of the Epworth Sleepiness Scale score.The desaturation index showed the strongest correlation with the Epworth scale. According to the results of the backward stepwise multiple regression and logistic regression, the predictors for the level of daytime sleepiness are oAHI and index of desaturation. According to the analysis of the ROC curve, desaturation index is a predictor of a high specificity.
- Sex-Specific Association of Obstructive Sleep Apnea With Retinal Microvascular Signs: The Multi-Ethnic Study of Atherosclerosis. [Journal Article]
- J Am Heart Assoc 2016; 5(7)
Obstructive sleep apnea (OSA) is a common condition affecting more men than women. The relationship of OSA with microvascular disease is unclear, complicated by possible sex difference. Assessment of the relationship of OSA with retinal microvascular signs in men and women may provide insights into such a relationship.We examined the sex-specific cross-sectional association of OSA severity with retinal vascular calibers in 1808 participants, and with specific retinopathy signs in 1831 participants from a sample of 2060 participants aged 54 to 93 years who underwent successful polysomnography in the Multi-Ethnic Study of Atherosclerosis, 2010-2012. OSA severity was defined by the apnea-hypopnea index (events/h) as none (<5), mild (5-14.9), moderate (15-29.9), and severe (≥30). As compared to no OSA, moderate/severe OSA in men was associated with retinal arteriolar narrowing (odds ratio [OR] and 95% CI for the narrowest quartile: 1.65 [1.00-2.71]) and retinal venular widening (1.80 [1.07-3.04] for the widest quartile), but not in women (odds ratio: 1.10 [0.67-1.81] and 0.91 [0.58-1.43], respectively) after adjusting for age, race/ethnicity, body mass index, pack-years of cigarette smoking, alcohol intake, hypertension duration, diabetes mellitus duration, HbA1c levels, lipid profile, micro-/macroalbuminuria, estimated glomerular filtration rate, β-blockers use, antihypertensive therapy, and lipid-lowering therapy. In contrast, severe OSA was associated with retinal microaneurysms in women, but not in men (odds ratio: 3.22 [1.16-8.97] and 0.59 [0.27-1.30], respectively).The associations of OSA severity with retinal microvascular signs may differ by sex. Whether these findings were related to sex differences in OSA exposure needs further investigation.