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Wei Z, Shen H, Wang F, Huang W, Li X, Xu H, Zhu H, Guan J. Melatonin mediates intestinal barrier dysfunction and systemic inflammation in moderate-severe OSA patients. Ann Med 2024; 56:2361825. [PMID: 38973375 PMCID: PMC11232642 DOI: 10.1080/07853890.2024.2361825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/21/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Intestinal barrier dysfunction and systemic inflammation are common in obstructive sleep apnoea (OSA). We aimed to investigate the role of melatonin, an anti-inflammatory mediator, in mediating the relationships between OSA, intestinal barrier dysfunction and systemic inflammation. METHODS Two hundred and thirty-five male participants who complained with sleep problems and underwent whole night polysomnography at our sleep centre between 2017 and 2018 were enrolled. Polysomnographic data, anthropometric measurements and biochemical indicators were collected. Serum melatonin, intestinal barrier function biomarker zonula occludens-1 (ZO-1) and inflammatory biomarkers C-reactive protein (CRP) with lipopolysaccharide (LPS) were detected. Spearman's correlation analysis assessed the correlations between sleep parameters, melatonin and biomarkers (ZO-1, LPS and CRP). Mediation analysis explored the effect of OSA on intestinal barrier dysfunction and systemic inflammation in moderate-severe OSA patients. RESULTS As OSA severity increased, serum melatonin decreased, whereas ZO-1, LPS and CRP increased. Spearman's correlation analysis showed that serum melatonin was significantly negatively correlated with ZO-1 (r = -0.19, p < .05) and LPS (r = -0.20, p < .05) in the moderate-OSA group; serum melatonin was significantly negatively correlated with ZO-1 (r = -0.46, p < .01), LPS (r = -0.35, p < .01) and CPR (r = -0.30, p < .05) in the severe-OSA group. Mediation analyses showed melatonin explain 36.12% and 35.38% of the effect of apnoea-hypopnea index (AHI) on ZO-1 and LPS in moderate to severe OSA patients. CONCLUSIONS Our study revealed that melatonin may be involved in mediating intestinal barrier dysfunction and systemic inflammation in moderate-to-severe OSA patients.
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Affiliation(s)
- Zhicheng Wei
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hangdong Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Fan Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Weijun Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huajun Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huaming Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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Ko J, Lim JH, Kim DB, Joo MJ, Jang YS, Park EC, Shin J. Association between alcohol use disorder and risk of obstructive sleep apnea. J Sleep Res 2024; 33:e14128. [PMID: 38112217 DOI: 10.1111/jsr.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder characterised by recurrent upper airway collapse during sleep. Alcohol consumption has been linked to an increased risk of OSA due to its effects on the upper airway and body mass index (BMI). We aimed to investigate the correlation between alcohol use disorders and OSA. We used 11,859 participants data from Korean National Health and Nutrition Examination Surveys. The variable of interest was alcohol use disorder, measured using the Alcohol Use Disorders Identification Test, and the dependent variable was the risk of OSA, measured using the Snoring, Tiredness, Observed apnea, high blood Pressure, BMI, age, neck circumference, and male gender questionnaires. Multiple logistic regression was used to assess the association between alcohol use disorder and OSA risk after adjusted analysis. A significant association was found between alcohol use disorder and OSA (adjusted odds ratio [aOR] 2.14, 95% confidence interval [CI] 1.93-2.37). In the unemployed group, those with alcohol use disorder had the highest odds of being at risk of OSA compared with those who did not have this disorder (aOR 2.45, 95% CI 2.04-2.95). The OSA risk increased as the snoring frequency, amount of alcohol consumed, and frequency of binge drinking increased. This study suggests an association between alcohol use disorders and the risk of OSA. The frequency of alcohol consumption, quantity of alcohol consumed, and snoring frequency were associated with the risk of OSA. Therefore, ceasing alcohol consumption is recommended as an effective approach to enhancing sleep quality.
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Affiliation(s)
- Jisu Ko
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Jae Hyeok Lim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Dan Bi Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Min Jeong Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, New York, USA
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Gauld C, Baillieul S, Martin VP, Richaud A, Lopez R, Pelou M, Abi-Saab P, Coelho J, Philip P, Pépin JL, Micoulaud-Franchi JA. Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms? J Clin Sleep Med 2024; 20:1105-1117. [PMID: 38420966 PMCID: PMC11217627 DOI: 10.5664/jcsm.11086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a heterogeneous condition covering many clinical phenotypes in terms of the diversity of symptoms. Patient-based OSA screening questionnaires used in routine practice contain significantly varying contents that can impact the reliability and validity of the screening. We investigated to what extent common patient-based OSA screening questionnaires differ or overlap in their item content by conducting a rigorous, methodical, and quantified content overlap analysis. METHODS We conducted an item content analysis of 11 OSA screening questionnaires validated in adult populations and characterized their overlap using a 4-step approach: (1) selection of OSA screening questionnaires, (2) item extraction and selection, (3) extraction of symptoms from items, and (4) assessment of content overlap with the Jaccard index (from 0, no overlap, to 1, full overlap). RESULTS We extracted 72 items that provided 25 distinct symptoms from 11 selected OSA questionnaires. The overlap between them was weak (mean Jaccard index: 0.224; ranging from 0.138 to 0.329). All questionnaires contained symptoms of the "OSA symptom" dimension (eg, snoring or witnessed apneas). The STOP-BANG (0.329) and the Berlin (0.280) questionnaires exhibited the highest overlap content. Ten symptoms (40%) were investigated in only 1 questionnaire. CONCLUSIONS The heterogeneity of content and the low overlap across these questionnaires reflect the challenges of screening OSA. The different OSA questionnaires potentially capture varying aspects of the disorder, with the risk of biased results in studies. Suggestions are made for better OSA screening and refinement of clinical OSA phenotypes. CITATION Gauld C, Baillieul S, Martin VP, et al. Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms? J Clin Sleep Med. 2024;20(7):1105-1117.
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Affiliation(s)
- Christophe Gauld
- Service Psychopathologie du Développement de l’Enfant et de l’Adolescent, Hospices Civils de Lyon and Université de Lyon 1, Lyon, France
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS and Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Baillieul
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Vincent P. Martin
- University Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence, France
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | | | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, Montpellier, France
- Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, Montpellier, France
| | - Marie Pelou
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - Poeiti Abi-Saab
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - Julien Coelho
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux, France
| | - Pierre Philip
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux, France
| | - Jean Louis Pépin
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux, France
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Narwade G, Madan M, Kumar R, Ish P, Mahendran AJ, Kaushik R, Gupta N. Clinical characteristics of non-sleepy obstructive sleep apnea patients: a study in a tertiary care sleep clinic in India. Monaldi Arch Chest Dis 2024. [PMID: 38738280 DOI: 10.4081/monaldi.2024.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
Obstructive sleep apnea (OSA) encompasses a diverse population, manifesting with or without symptoms of excessive daytime sleepiness. There is contention surrounding the significance of non-sleepy OSA within clinical contexts and whether routine treatment is warranted. This study aims to evaluate epidemiological and clinical distinctions between sleepy and non-sleepy OSA patients. A retrospective analysis was conducted on consecutive patients undergoing polysomnography for OSA assessment at tertiary care hospitals between 2018 and 2023. For 176 of 250 patients, complete polysomnography records with OSA diagnoses were available. Non-sleepy OSA was defined when a patient had an Epworth sleepiness scale score <10 and polysomnography demonstrated an apnea hypopnea index ≥5/hour. Non-sleepy OSA patients were matched with sleepy OSA patients in terms of age and gender distribution (mean age 51.24±13.25 years versus 50.9±10.87 years, male 70.4% versus 73.3%). The sensitivity of STOP-BANG≥3 for the non-sleepy OSA group was 87.7%, 89.3%, and 95.2% for any OSA severity, moderate to severe OSA, and severe OSA, respectively, while the corresponding sensitivity for the sleepy OSA group was 96.5%, 98.6%, and 100% for any OSA severity, moderate to severe OSA, and severe OSA, respectively. A novel symptom scoring tool, HASSUN (hypertension, nocturnal apneas, snoring, sleep disturbance, unrefreshing sleep, and nocturia), demonstrated a sensitivity of over 90% for all severity categories of OSA in both non-sleepy and sleepy OSA groups. The prevalence of cardiovascular and metabolic comorbidities did not significantly differ between non-sleepy and sleepy OSA patients. The physiological parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, arterial partial pressure of oxygen, and bicarbonate at baseline, were comparable between the two groups. To conclude, non-sleepy OSA patients are less obese, exhibit fewer symptoms, and have less severe OSA in comparison to sleepy OSA. Non-sleepy OSA patients display a similar likelihood of cardiovascular and metabolic comorbidities compared to sleepy OSA patients. Further investigations are warranted to elucidate the mechanisms underlying cardiovascular metabolic comorbidities in non-sleepy OSA patients. The proposed HASSUN scoring tool for non-sleepy OSA screening necessitates validation in future studies.
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Affiliation(s)
- Ganesh Narwade
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Manu Madan
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Rohit Kumar
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Pranav Ish
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - A J Mahendran
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Rajnish Kaushik
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Nitesh Gupta
- Department of Pulmonary Medicine, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
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Gabhale SD, Gupta E, Bagrecha MS, Saifuddin R, Nelson A, Sharma M. Auto-PAP Titration Efficacy in Obstructive Sleep Apnea: A Single-Center Experience. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S302-S304. [PMID: 38595579 PMCID: PMC11001010 DOI: 10.4103/jpbs.jpbs_501_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Obstructive sleep apnea, often known as OSA, is a sleep-related breathing disease that, if not treated, can lead to serious disabilities or even death. Continuous positive airway pressure (CPAP) is the therapy technique that is suggested for treating severe and moderate OSA. An auto/manual CPAP titration study can be used to determine the appropriate pressure that must be maintained to treat this condition. The motive of this research is to appraise the effectiveness among OSA patients for the auto-PAP titrations. Methodology A cross-sectional clinical prospective study was conducted at the tertiary care center. Subjects who underwent auto-PAP titration and had a diagnosis of moderate and sever OSA were included. They were evaluated for the efficacy of auto-PAP titration and other demographic features and their association with the titration efficacy. The values were compared for statistical significance. Results The findings of the study showed that fifty percent of the cohort showed optimal titration, forty percent showed good titration, ten percent showed suitable titration, and none fell into the unacceptable group. Conclusion According to the findings, using auto-PAP was associated with positive results in those with moderate and severe OSA. There is evidence to suggest that unattended auto-PAP titration is a very successful technique that might be regarded as a substitute for attended CPAP titrations. This would result in a reduction in the amount of labor required and the price.
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Affiliation(s)
- Sanjay D. Gabhale
- Department of Respiratory Medicine, Dr D. Y. Patil Medical College, Hospital and Research Centre, Dr D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Ekta Gupta
- Department of Orthodontics and Dentofacial Orthopeadics, Siddhpur Dental College and Hospital, Patan, Gujarat, India
| | - Mahavir Satishchand Bagrecha
- Department of Pulmonary Medicine, Dr D Y Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Rehan Saifuddin
- BDS, Lithuanian University of Health Sciences, Kaunas, Lithuania, Europe
| | - Anish Nelson
- Department of Oral and Maxillofacial Surgery, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed To Be University), Mangalore, India
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Alghamdi MA, Alzahrani R, Ali MA, Alharthi Z, Alyahya AM, Alghamdi AH, Alghamdi BN, Alghamdi W. Knowledge, Awareness, and Attitude Regarding Obstructive Sleep Apnea Among Primary Healthcare Physicians in the Al-Baha Region of Saudi Arabia. Cureus 2024; 16:e51435. [PMID: 38298303 PMCID: PMC10828977 DOI: 10.7759/cureus.51435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a clinically significant disorder that requires attention from healthcare professionals. This study aimed to assess the knowledge, awareness, and attitude of primary healthcare physicians regarding OSA in Saudi Arabia. METHODOLOGY A cross-sectional observational study design was employed from January 18, 2023, to August 18, 2023, focusing on primary healthcare physicians practicing in the Al-Baha region of Saudi Arabia. The survey included questions related to knowledge, awareness, and attitudes toward OSA, using the Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire for OSA, and demographic information. Descriptive statistics and chi-square tests were used to analyze the data. RESULTS A total sample size of 174 primary health care physicians was collected, where the majority of participants were male (101, 58.0%), and the mean age of the participants was 32.73 years (SD = 9.14). The item with the most correct answers was "The majority of patients with obstructive sleep apnea snore" (150, 86.2%). On the other hand, the item with the lowest number of correct answers was "Laser-assisted uvulopalatoplasty is an appropriate treatment for severe obstructive sleep apnea" (17, 9.8%). The majority of participants agreed that it is essential for physicians to know about OSA as a clinical disorder (161, 92.5%). However, when it came to screening all patients for possible OSA, there was a higher proportion of participants who disagreed or strongly disagreed (111, 63.8%). In general, the majority of participants had a low level of knowledge (109, 62.6%). Gender was significantly associated with both knowledge (p = 0.021) and awareness (p = 0.039), as well as nationality (knowledge (p = 0.012) and awareness (p = 0.039)), and specialty training, which was significantly associated with both knowledge (p = 0.000) and awareness (p = 0.002). CONCLUSION Although all participants acknowledged that OSA is a clinical disease, their perspectives on screening and levels of confidence in utilizing screening techniques varied. While the participants exhibited commendable understanding in the majority of domains, there were some facets of OSA in which they lacked expertise.
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Affiliation(s)
- Mohammed A Alghamdi
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Rajab Alzahrani
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Mujtaba A Ali
- Unit of Otolaryngology, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
| | - Ziyad Alharthi
- Department of Medicine, Al-Baha University, Al-Baha, SAU
| | | | | | | | - Wejdan Alghamdi
- Family Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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de Araujo Dantas AB, Gonçalves FM, Martins AA, Alves GÂ, Stechman-Neto J, Corrêa CDC, Santos RS, Nascimento WV, de Araujo CM, Taveira KVM. Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression. Sleep Breath 2023; 27:2083-2109. [PMID: 36971971 DOI: 10.1007/s11325-023-02810-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE This study aimed to identify the prevalence of obstructive sleep apnea (OSA) and associated risk factors globally. METHODS Six databases and registrations and three grey databases were explored for observational field research. Independently and impartially paired reviewers selected research, gathered data, and evaluated the methodological quality. Heterogeneity was investigated using subgroup analysis and meta-regression following the moderating variable in a meta-analysis of proportions with a random-effects model. The critical appraisal instrument developed by the Joanna Briggs Institute was used to evaluate the listed studies' methodology. The certainty of the evidence was evaluated using the GRADE tool. RESULTS A total of 8236 articles were collected during the database search, resulting in 99 articles included for qualitative synthesis, and 98 articles were included for the meta-analysis. The estimated combined prevalence of OSA was 54% [CI 95% = 46-62%; I2 = 100%]. Mean age, percentage of moderate-severe cases, and the sample's body mass index (BMI) did not affect the heterogeneity that was already present when meta-regressed (p > 0.05). Ninety-one studies were deemed to have a low risk of bias, while eight were deemed to have a moderate risk. For OSA prevalence outcomes, the GRADE criteria were considered very low. CONCLUSION Approximately half of the people worldwide have OSA. High BMI, increasing age, and male gender are described as risk factors in the literature, but these covariates do not affect pre-existing heterogeneity.
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Affiliation(s)
- Anna Beatriz de Araujo Dantas
- Department of Morphology - Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), BR 101- Lagoa Nova, Natal, RN - 59072-970, Brazil
| | - Flávio Magno Gonçalves
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Agnes Andrade Martins
- Department of Morphology - Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), BR 101- Lagoa Nova, Natal, RN - 59072-970, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | | | - José Stechman-Neto
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Camila de Castro Corrêa
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
- Planalto University Center of the Federal District (UNIPLAN), Brasília, Brazil
| | - Rosane Sampaio Santos
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Weslania Viviane Nascimento
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
- Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Cristiano Miranda de Araujo
- Tuiuti University of Paraná (UTP), Curitiba, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil
| | - Karinna Veríssimo Meira Taveira
- Department of Morphology - Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), BR 101- Lagoa Nova, Natal, RN - 59072-970, Brazil.
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Curitiba, Brazil.
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Suri TM, Ghosh T, Mittal S, Hadda V, Madan K, Mohan A. Systematic review and meta-analysis of the prevalence of obstructive sleep apnea in Indian adults. Sleep Med Rev 2023; 71:101829. [PMID: 37517357 DOI: 10.1016/j.smrv.2023.101829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder associated with considerable morbidity. However, there is an underrepresentation of data from India and other developing countries in global reviews of OSA prevalence. This systematic review and meta-analysis examined the prevalence of OSA in India. The MEDLINE, Embase, and Scopus databases were searched for articles that reported the prevalence of OSA in the general Indian adult population using sleep studies. Eight studies were included comprising 11,009 subjects with mean age ranging from 35.5 to 47.8 years. On the Joanna Briggs Institute (JBI) checklist for prevalence studies, the study quality ranged from 3/9 to 9/9. Meta-analysis was performed using the random-effects model. The pooled prevalence of OSA (AHI ≥5 events/hour) was 11% overall (95% CI: 7%-15%; I2 = 98.0%, p<0.001), 13% in males (95% CI: 7%-18%; I2 = 96.0%, p<0.001), and 5% in females (95% CI: 3%-7%; I2 = 73.3%, p = 0.01). The pooled prevalence of moderate-to-severe OSA (AHI ≥15 events/hour) was 5% (95% CI: 2%-8%, I2 = 95.3%; p = 0.01). Based on these findings, approximately 104 million Indians of working age suffer from OSA, of whom 47 million have moderate-to-severe OSA. This represents a major public health problem in India with important implications for the global burden of the disease.
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Affiliation(s)
- Tejas Menon Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
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J RG, K D. Apnoea detection using ECG signal based on machine learning classifiers and its performances. J Med Eng Technol 2023; 47:344-354. [PMID: 38625408 DOI: 10.1080/03091902.2024.2336500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
Sleep apnoea is a common disorder affecting sleep quality by obstructing the respiratory airway. This disorder can also be correlated to certain diseases like stroke, depression, neurocognitive disorder, non-communicable disease, etc. We implemented machine learning techniques for detecting sleep apnoea to make the diagnosis easier, feasible, convenient, and cost-effective. Electrocardiography signals are the main input used here to detect sleep apnoea. The considered ECG signal undergoes pre-processing to remove noise and other artefacts. Next to pre-processing, extraction of time and frequency domain features is carried out after finding out the R-R intervals from the pre-processed signal. The power spectral density is calculated by using the Welch method for extracting the frequency-domain features. The extracted features are fed to different machine learning classifiers like Support Vector Machine, Decision Tree, k-nearest Neighbour, and Random Forest, for detecting sleep apnoea and performances are analysed. The result shows that the K-NN classifier obtains the highest accuracy of 92.85% compared to other classifiers based on 10 extracted features. The result shows that the proposed method of signal processing and machine learning techniques can be reliable and a promising method for detecting sleep apnoea with a reduced number of features.
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Affiliation(s)
- Rolant Gini J
- Department of Electronics and Communication Engineering, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, India
| | - Dhanalakshmi K
- Department of Electronics and Communication Engineering, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, India
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10
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Patial K, Mishra HP, Pal G, Suvvari TK, Ghosh T, Mishra SS, Mahapatra C, Amanullah NA, Shukoor SA, Kamal S, Singh I, Israr J, Sharma PS, Gaur SN, Behera RK. Understanding the Association Between Obesity and Obstructive Sleep Apnea Syndrome: A Case-Control Study. Cureus 2023; 15:e45843. [PMID: 37881397 PMCID: PMC10594396 DOI: 10.7759/cureus.45843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) represents a sleep-related impairment linked to upper airway function. The question of whether OSA drives obesity or if shared underlying factors contribute to both conditions remains unresolved. Hence, this present study aims to understand the interplay between obstructive sleep apnea syndrome (OSAS) and obesity through in-depth analysis of anthropometric data within control subjects and OSA patients. Methodology A case-control study was conducted, which included 40 cases and 40 matched healthy controls. Study participants with reported symptoms of snoring, daytime drowsiness, or both were included in the study. All the study participants underwent comprehensive anthropometric assessments such as height, weight, body mass index (BMI), neck circumference, waist circumference, hip circumference, waist-to-hip ratio, skin-fold thickness, and thickness measurements of biceps, triceps, suprailiac, and subscapular muscles. Results Within the OSA group, significant disparities emerged in mean age, waist circumference, waist-to-hip ratio, and diverse fat accumulations encompassing visceral, subcutaneous, trunk, and subcutaneous leg fat. Notably, skin-fold thickness at specific sites - biceps, triceps, subscapula, and suprailiac - demonstrated considerable augmentation relative to the control group. Furthermore, mean values associated with height, weight, BMI, neck circumference, fat percentage, subcutaneous arm fat, entire arm composition, and trunk skeletal muscle either equaled or exceeded those in the control group. However, statistical significance was not attained in these comparisons. Conclusion This investigation underscored a pronounced correlation between numerous endpoints characterizing OSA patients and markers of obesity. Consequently, addressing altered levels of obesity-linked anthropometric variables through pharmacological interventions might hold promise as a pivotal strategy for improving symptoms associated with OSA.
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Affiliation(s)
- Kuldeep Patial
- Sleep Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, IND
| | - Hara Prasad Mishra
- Clinical Trial, All India Institute of Medical Sciences, New Delhi, Delhi, IND
- Pharmacology and Therapeutics, University College of Medical Sciences, University of Delhi, Delhi, IND
| | - Giridhari Pal
- Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, IND
| | - Tarun Kumar Suvvari
- General Medicine, Rangaraya Medical College, Kakinada, IND
- Research, Squad Medicine and Research (SMR), Visakhapatnam, IND
| | - Tamoghna Ghosh
- Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, IND
| | - Smruti Sikta Mishra
- Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, IND
| | | | - Nidhal A Amanullah
- Psychiatry and Behavioral Sciences, Sree Ramakrishna Mission Hospital, Thiruvananthapuram, IND
| | - Sara A Shukoor
- Psychiatry, Government Medical College, Trivandrum, Trivandrum, IND
| | - Sibin Kamal
- Pain and Palliative Medicine, IQRAA International Hospital & Research Centre, Kandhla, IND
| | | | - Juveriya Israr
- Biosciences and Technology, Shri Ramswaroop Memorial University, Lucknow, IND
| | - Prem S Sharma
- Biostatistics & Medical Informatics, University College of Medical Sciences, Delhi, IND
| | - S N Gaur
- Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, IND
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11
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Gupta A, Kaur J, Shukla G, Bhullar KK, Lamo P, Kc B, Agarwal A, Srivastava AK, Sharma G. Effect of yoga-based lifestyle and dietary modification in overweight individuals with sleep apnea: A randomized controlled trial (ELISA). Sleep Med 2023; 107:149-156. [PMID: 37178546 DOI: 10.1016/j.sleep.2023.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Obesity is recognised as an important risk factor for obstructive sleep apnea (OSA), with obese individuals at a four times higher risk of being diagnosed with the syndrome. Treating obesity with lifestyle modification is associated with a reduction in the severity of obstructive sleep apnea. Yoga comprises lifestyle modification that includes asana (postures), pranayama (breathing techniques), dhyana (meditation) and guideline principles for healthy living (Yama and Niyama). There is a scarcity of data to evaluate the effect of yoga on OSA. This study was conducted to evaluate the efficacy of Yoga based lifestyle modification on OSA. METHODS Consenting obese patients (BMI >23) diagnosed with obstructive sleep apnea (OSA) (AHI>5) on Polysomnography (PSG) were enrolled. Eligible patients were randomized into two groups. The control group received counselling for dietary modification (staple Indian) with regular exercise and the active intervention group received Yoga intervention as treatment (OSA module) in addition to similar dietary modification and regular exercise counselling. Polysomnography (PSG) was conducted at baseline and one year follow-up. All patients were evaluated at baseline, six months, and one year for compliance and anthropometric parameters. Additional assessment with Hamilton scales for depression and anxiety, SF-36, and the Pittsburgh sleep quality index was also conducted. RESULTS A total of 37 eligible patients (19 in the control group and 18 in the yoga group) were recruited for the study. The age [45.73 ± 10.71 vs. 46.22 ± 9.39 years, p = 0.88] and gender [15(78.95%) vs. 12(66.67%), p = 0.48 (males)] distribution was similar in both groups. After adjusting for age and gender, the percentage reduction in weight between the two groups did not reach statistical significance at one year. There was no significant difference in mean AHI between the two groups at one year. However, the number of patients with more than 40% AHI reduction [2/19 (10.52%) vs 8/18 (44.44%), p = 0.02] was significantly higher in the yoga group. Additionally, within the groups, the mean AHI at one year was significantly reduced in the yoga group [51.2 ± 28.0 to 36.8 ± 21.0/hour, p = 0.003], while no significant change was found in the control group [47.2 ± 23 to 38.8 ± 19.9/hour, p = 0.08]. CONCLUSIONS Lifestyle alteration using Yoga intervention and modification of staple Indian diet may be effective in reducing OSA severity among obese patients. CTRI NUMBER CTRI/2017/05/008462.
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Affiliation(s)
- Anupama Gupta
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmin Kaur
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Khushpreet Kaur Bhullar
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pasang Lamo
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Biju Kc
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Gautam Sharma
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India; Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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12
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Alshehri AA, Hakami F, Gadi W, Darraj H, Hamdi S, Awaf M, Hakami A, Zogel B. Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia. Cureus 2023; 15:e36135. [PMID: 37065372 PMCID: PMC10101197 DOI: 10.7759/cureus.36135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical college students in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.
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13
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Govindagoudar MB, Lalwani LK, Singh PK, Sen J, Chaudhry D. Dynamic assessment of oropharynx with ultrasonography as a screening tool for obstructive sleep apnea. J Sleep Res 2023; 32:e13712. [PMID: 36054478 DOI: 10.1111/jsr.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 02/03/2023]
Abstract
Ultrasonography is an easily available and portable tool to assess the dynamic changes in the upper airway and surrounding soft tissue. This study aimed to evaluate the utility of oropharynx ultrasonography as a screening tool for obstructive sleep apnea (OSA). The study sequentially enrolled overweight individuals (body mass index >25 kg/m2 ) and subjected them to OSA screening tools (Berlin questionnaire, Epworth Sleepiness Scale and STOP-Bang scores), ultrasonography of the oropharynx followed by overnight polysomnography. A total of 30 healthy individuals were also recruited as controls. Detailed dynamic and static ultrasonography measurements of the oropharynx and surrounding tissue were done. The diagnostic ability of various ultrasonography parameters to detect OSA was determined using receiver operating characteristic curve analysis. A total of 63 subjects were enrolled, with 33 in the OSA group and 30 in non-OSA overweight group. All baseline characteristics were similar in the two groups. Except for the dynamic measurements of oropharynx (Retropalatal% change-inspiration, retropalatal% change-Muller manoeuvre, retroglossal% change-inspiration, and retroglossal% change-Muller manoeuvre) all other parameters were similar in the OSA and non-OSA overweight subjects. The area under the receiver operating characteristic curve was highest for retropalatal% change-inspiration: 0.989, followed by retropalatal% change-Muller manoeuvre: 0.988. Both were also significant predictors of OSA with odds ratios of 0.338 (p = 0.003; 95% confidence interval [CI] 0.164-0.696) and 0.346 (p = 0.018; 95% CI 0.143-0.837), respectively. Ultrasonography provides a near complete picture of the dynamic changes and collapsibility of the oropharynx and can be an effective tool in screening for OSA.
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Affiliation(s)
- Manjunath B Govindagoudar
- Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Lokesh Kumar Lalwani
- Department of Respiratory Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Pawan Kumar Singh
- Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Jyotsna Sen
- Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
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14
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Kour A, Singh T, Singh A, Khader A, Singh A. To evaluate usefulness of stop-bang questionnaire in predicting difficult bag mask ventilation and difficult intubation in adult patients for elective surgery: Important guide for obstructive sleep apnea patients. APOLLO MEDICINE 2023. [DOI: 10.4103/am.am_166_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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15
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Muacevic A, Adler JR, Galav A, Sharma D, Puranik S, Paiwal K. Mandibular Advancement Device (MAD) for Obstructive Sleep Apnea in an Edentulous Patient. Cureus 2022; 14:e32896. [PMID: 36578847 PMCID: PMC9789676 DOI: 10.7759/cureus.32896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/25/2022] Open
Abstract
Mandibular advancement devices have been efficiently used for the treatment of mild to moderate obstructive sleep apnea (OSA) by forward positioning of the tongue-mandible complex with a resultant increase in oropharyngeal volume. However, the literature on the treatment of edentulous patients is limited. This clinical report describes a clinical and laboratory method for the fabrication of a mandibular advancement device in a 75-year-old completely edentulous patient with mild OSA.
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16
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Kim TH, Heo IR, Kim HC. Impact of high-risk of obstructive sleep apnea on chronic cough: data from the Korea National Health and Nutrition Examination Survey. BMC Pulm Med 2022; 22:419. [PMID: 36384528 PMCID: PMC9666978 DOI: 10.1186/s12890-022-02222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic cough is an extremely common clinical symptom of various diseases. However, the relationship between obstructive sleep apnea (OSA) and chronic cough in the general population has not been sufficiently studied. METHODS Using the 2019 Korean National Health and Nutrition Examination Survey data, we identified a group at high-risk of OSA via the STOP-Bang questionnaire and determined the association between OSA and chronic cough by a regression model. RESULTS Of the eligible 4,217 participants, 97.1% and 2.9% were classified into the non-chronic cough and chronic cough groups, respectively. The chronic cough group had higher STOP-Bang scores than those of the group without chronic cough (2.32 ± 1.38 vs. 2.80 ± 1.39; P < 0.001). In the group at high-risk of OSA, 40.4% and 52.0% of participants scored ≥ 3 in STOP-Bang, depending on the absence or presence of chronic cough (P = 0.012), respectively. Chronic cough independently correlated with impaired lung function (forced expiratory volume in one second ≥ 50-<80% predicted value, P = 0.001; <50, P < 0.001), low household income (P = 0.015), and a group at high-risk of OSA (STOP-Bang score 3-4, P = 0.004; 5-8, P < 0.001). Obesity I had a protective role against the occurrence of chronic cough (P = 0.023). CONCLUSION A high-risk for OSA is a significant risk factor for chronic cough. OSA should be considered when evaluating chronic cough patients.
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Affiliation(s)
- Tae Hoon Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjungja-ro, Sungsan-gu, 51472, Changwon, Republic of Korea
| | - I Re Heo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjungja-ro, Sungsan-gu, 51472, Changwon, Republic of Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjungja-ro, Sungsan-gu, 51472, Changwon, Republic of Korea.
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17
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Prevalence and impact of obstructive sleep apnea in type 2 diabetes mellitus: A descriptive cross-sectional study. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Qiu H, Liu WT, Lin SY, Li ZY, He YS, Yim SHL, Wong ELY, Chuang HC, Ho KF. Association of air pollution exposure with low arousal threshold obstructive sleep apnea: A cross-sectional study in Taipei, Taiwan. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119393. [PMID: 35525512 DOI: 10.1016/j.envpol.2022.119393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 06/14/2023]
Abstract
Emerging evidence witnesses the association of air pollution exposure with sleep disorders or the risk of obstructive sleep apnea (OSA); however, the results are not consistent. OSA patients with or without a low arousal threshold (LAT) have different pathology and therapeutic schemes. No study has evaluated the potential diverse effects of air pollution on the phenotypes of OSA. The current study aimed to evaluate the associations of short-term and long-term exposure to air pollution with sleep-disordered measures and OSA phenotypes. This cross-sectional study consisted of 4634 participants from a sleep center in Taipei from January 2015 to April 2019. The personal exposure to ambient PM2.5 and NO2 was assessed by a spatial-temporal model. Overnight polysomnography was used to measure the sleep parameters. According to a developed clinical tool, we defined the low arousal threshold (LAT) and identified the OSA patients with or without LAT. We applied a generalized linear model and multinomial logistic regression model to estimate the change of sleep measures and risk of the OSA phenotypes, respectively, associated with an interquartile range (IQR) increment of personal pollution exposure after adjusting for the essential confounders. In the single-pollutant model, we observed the associations of NO2 with sleep-disordered measures by decreasing the total sleep time, sleep efficiency, extending the time of wake after sleep onset, and the association of NO2 with the increased risk of LAT OSA by around 15%. The two-pollutant model with both long-term and short-term exposures confirmed the most robust associations of long-term NO2 exposure with sleep measures. An IQR increment of NO2 averaged over the past year (6.0 ppb) decreased 3.32 min of total sleep time and 0.85% of sleep efficiency. Mitigating exposure to air pollution may improve sleep quality and reduce the risk of LAT OSA.
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Affiliation(s)
- Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Wen-Te Liu
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shang-Yang Lin
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhi-Yuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
| | - Yan-Su He
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Steve Hung Lam Yim
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China; Department of Geography and Resource Management, The Chinese University of Hong Kong, HKSAR, China; The Asian School of the Environment, Nanyang Technological University, Singapore
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kin-Fai Ho
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China.
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Samitinjay A, Ali Z, Biswas R. Nontubercular mycobacterial cough. BMJ Case Rep 2022; 15:e246285. [PMID: 35256362 PMCID: PMC8905925 DOI: 10.1136/bcr-2021-246285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/04/2022] Open
Abstract
SummaryHabitual cough suppression leading to non-tuberculous mycobacteria infections and bronchiectasis has been reported. We present a case of a 55-year-old woman with a chronic history of cough with mild expectoration and frequent lower respiratory tract infections, remitting with antibiotic therapy and other supportive measures. She also reported habitual cough suppression for several years. She was eventually diagnosed with Mycobacterium avium complex (MAC) positive right middle lobe bronchiectasis-Lady Windermere syndrome and obstructive sleep apnoea (OSA), causing disabling symptoms limiting her daily activities. We aim to highlight two key issues-diagnosing MAC infections in a tuberculosis endemic country, and OSA and its long-term clinical implications.
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Affiliation(s)
- Aditya Samitinjay
- General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
| | - Zulfikar Ali
- Radiology, Sree Venkateswara Diagnostics, Kadapa, Andhra Pradesh, India
| | - Rakesh Biswas
- General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
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20
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Pitta RM, Cerazi BG, Queiroga L, Ritti Dias RM, de Mello MT, Cesena FHY, Rica RL, Baker JS, Sommer M, Cucato GG, Bocalini DS, Kauffman O. Are physical inactivity, sitting time and screen time associated with obstructive sleep apnea in adults? A cross-sectional study. SAO PAULO MED J 2022; 140:171-181. [PMID: 35195233 PMCID: PMC9610257 DOI: 10.1590/1516-3180.2020.0651.r2.08062021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sitting time, screen time and low physical activity (PA) levels have been associated with several diseases and all-cause mortality. PA is related to better sleep quality and absence of daytime sleepiness, along with lower risks of obstructive syndrome apnea (OSA). However, studies on the relationship between sitting time, screen time and OSA are scarce in the literature. OBJECTIVE To analyze associations between PA levels, sitting time, screen time and OSA among adults with suspected sleep disorder. DESIGN AND SETTING Cross-sectional study conducted at Hospital Israelita Albert Einstein. METHODS Data were collected from 369 adults with suspected sleep disorders who visited the hospital's neurophysiology clinic between August 2015 and January 2017. RESULTS Correlations between hypopnea and PA indicators were demonstrated for total sitting time (0.123; P = 0.019) and total screen time (0.108; P = 0.038). There was also a correlation between latency for rapid-eye-movement sleep (REM_LAT) and total sitting time (0.103; P = 0.047) and a negative correlation between mean oxyhemoglobin saturation (SaO_Avg) and total PA time (-0.103; P = 0.048). There were no associations between PA parameters and apnea-hypopnea index. After adjusting for confounding factors (body mass index, age and gender), sitting time and screen time were not associated with OSA. CONCLUSION After adjusting for anthropometric and clinical factors, excessive sitting time or screen time was not associated with OSA in adults suspected of sleep disorders. Age, gender, hypertension, body mass index and waist circumference were associated with OSA.
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Affiliation(s)
- Rafael Mathias Pitta
- MSc. Professor, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Bruno Gion Cerazi
- MSc. Professor, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Luana Queiroga
- MSc. Professor, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | | | - Marco Túlio de Mello
- PhD. Professor, Sports Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Fernando Henpin Yue Cesena
- MD, PhD. Attending Physician, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Roberta Luksevicius Rica
- MSc, PhD. Professor, Department of Physical Education, Estácio de Sá University, Vitória (ES), Brazil.
| | - Julien Steven Baker
- PhD, DSc. Professor, Department of Sport, and Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
| | - Marcio Sommer
- MD, PhD. Attending Physician, Sciences of aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Gabriel Grizzo Cucato
- PhD. Professor, Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom.
| | - Danilo Sales Bocalini
- PhD. Professor, Physical Education and Sports Center, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.
| | - Oskar Kauffman
- MD, PhD. Attending Physician, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
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21
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Pancholi C, Chaudhary SC, Gupta KK, Sawlani KK, Verma SK, Singh A, Verma AK, Usman K, Atam V. Obstructive sleep apnea in hypothyroidism. Ann Afr Med 2022; 21:403-409. [PMID: 36412342 PMCID: PMC9850883 DOI: 10.4103/aam.aam_134_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) and hypothyroidism are closely linked as hypothyroidism has been shown to lead to the development of OSA through multiple mechanisms. With the changing lifestyle patterns worldwide and increased prevalence of obesity, the burden of OSA has substantially increased. The association of OSA with hypothyroidism is essential to establish. If identified early, treatment of OSA and associated hypothyroidism can be done timely to minimize the potential harmful complications of OSA on all aspects of the patient's health. Aims This study was done to find out the prevalence of OSA in hypothyroidism patients. Setting and Designs It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods A total of 100 hypothyroidism patients were enrolled after taking written consent. All patients were subjected to STOP-Bang questionnaire and patient falling in intermediate-high risk (score3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Statistical Analysis Used The Statistical Package for the Social Sciences version 21.0 statistical analysis software. Results Out of 100 patients, who underwent polysomnography, 74 (74%) cases had OSA (AHI ≥5). Out of total 74 OSA cases, 29 (39.2%) cases had mild OSA (AHI 5-14), 15 (20.3%) cases had moderate OSA (AHI 15-30), and 30 (40.5%) cases had severe OSA. The age of the study population ranged between 24 and 78 years and the mean age was 58.28 ± 11.22 years. The mean age of the patients in the OSA group (59.27 ± 11.17 years) was higher than the non-OSA group (55.46 ± 11.09 years). Majority (64%) of our cases were male, and the proportion of males was found to be higher than females in both the groups (OSA/non-OSA). The body mass index (BMI) of the OSA group was found to be statistically higher as compared to that of the non-OSA group (P = 0.040). The BMI was found to be higher in severe OSA, but it was not statistically significant (P = 0.128). The mean value of FT4 was lower and thyroid-stimulating hormone (TSH) was higher in the OSA group as compared with the non-OSA group. However, no significant association was found between FT4 and TSH values in both the groups. Out of 100 cases, 41 patients were treatment naïve with mean TSH value of 13.1 ± 7 and 59 were on treatment with mean TSH of 8.3 ± 4. Treatment-naïve patients had a statistically higher number (85.3%) of OSA cases in comparison to patients on treatment (66.1) (P = 0.030). Conclusions Prevalence of OSA is quite high in hypothyroidism. Patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI. Treatment of hypothyroidism reduces the prevalence of OSA.
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Affiliation(s)
| | - Shyam Chand Chaudhary
- Department of Medicine, K.G.M.U, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Shyam Chand Chaudhary, Department of Medicine, K.G.M.U, Lucknow - 226 016, Uttar Pradesh, India. E-mail:
| | | | | | | | - Abhishek Singh
- Department of Cardiology, K.G.M.U, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Verma
- Department of Respiratory Medicine, K.G.M.U, Lucknow, Uttar Pradesh, India
| | - Kauser Usman
- Department of Respiratory Medicine, K.G.M.U, Lucknow, Uttar Pradesh, India
| | - Virendra Atam
- Department of Respiratory Medicine, K.G.M.U, Lucknow, Uttar Pradesh, India
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Yang L, Chen H, Shu T, Pan M, Huang W. Risk of incident atrial fibrillation with low-to-moderate alcohol consumption is associated with gender, region, alcohol category: a systematic review and meta-analysis. Europace 2021; 24:729-746. [PMID: 34864980 DOI: 10.1093/europace/euab266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The association between low-to-moderate alcohol consumption and atrial fibrillation (AF) has yet to be fully elucidated. The main purpose of this meta-analysis was to estimate the risk of incident AF related to low-to-moderate alcohol consumption. METHODS AND RESULTS A meta-analysis was performed on 13 publications discussing the estimated risk for AF with habitual low-to-moderate alcohol intake in 10 266 315 participants. Graphical augmentations to the funnel plots were used to illustrate the potential impact of additional evidence on the current meta-analysis. Thirteen eligible studies were included in this meta-analysis. We found that moderate alcohol consumption was associated with an increased risk of incident AF in males [hazard ratio (HR) 1.09, 95% confidence interval (CI): 1.07-1.11, P < 0.00001], Europeans (HR 1.32, 95% CI: 1.23-1.42, P < 0.00001), and Asians (HR 1.09, 95% CI: 1.07-1.11, P < 0.00001). Moderate beer consumption was associated with an increased risk of developing AF (HR 1.11, 95% CI: 1.02-1.21, P = 0.01). Low alcohol consumption conferred an increased risk of AF in males (HR 1.14, 95% CI: 1.01-1.28, P = 0.04) and Europeans (HR 1.12, 95% CI: 1.07-1.17, P < 0.00001). CONCLUSIONS This analysis represents the increased risk of incident AF in males, Europeans, and Asians at moderate alcohol consumption levels and in males and Europeans at low alcohol consumption levels. Those who drink any preferred alcohol beverage at moderate levels should be cautious for incident AF. More studies are warranted to find those factors that influence alcohol's effect on predisposing AF.
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Affiliation(s)
- Lingzhi Yang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Huaqiao Chen
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Tingting Shu
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Mingyong Pan
- College of Mathematics and Statistics, Chongqing University, No. 174 Shazhengjie, Shapingba District, Chongqing, 400044, China
| | - Wei Huang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
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Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review. Diseases 2021; 9:diseases9040088. [PMID: 34940026 PMCID: PMC8700568 DOI: 10.3390/diseases9040088] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a serious, potentially life-threatening condition. Epidemiologic studies show that sleep apnea increases cardiovascular diseases risk factors including hypertension, obesity, and diabetes mellitus. OSA is also responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and bronchial asthma. The aim of this systematic review is to evaluate evidence for the association between OSA and cardiovascular disease morbidities and identify risk factors for the conditions. In a review of 34 studies conducted in 28 countries with a sample of 37,599 people, several comorbidities were identified in patients with severe OSA—these were: heart disease, stroke, kidney disease, asthma, COPD, acute heart failure, chronic heart failure, hyperlipidemia, thyroid disease, cerebral infarct or embolism, myocardial infarction, and psychological comorbidities including stress and depression. Important risk factors contributing to OSA included: age > 35 years; BMI ≥ 25 kg/m2; alcoholism; higher Epworth sleepiness scale (ESS); mean apnea duration; oxygen desaturation index (ODI); and nocturnal oxygen desaturation (NOD). Severe OSA (AHI ≥ 30) was significantly associated with excessive daytime sleepiness and oxygen desaturation index. The risk of OSA and associated disease morbidities can be reduced by controlling overweight/obesity, alcoholism, smoking, hypertension, diabetes mellitus, and hyperlipidemia.
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Bhatt SP, Guleria R, Vikram NK. The Effect of the Severity of Obstructive Sleep Apnea on Leukocyte Telomere Length, 25 Hydroxy Vitamin D, and Parathyroid Hormonal Concentrations in Asian Indians. Front Neurol 2021; 12:682739. [PMID: 34764923 PMCID: PMC8577206 DOI: 10.3389/fneur.2021.682739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a common disorder in which breathing repeatedly stops during sleep. Leukocyte telomere length (LTL) and OSA are linked with an increased risk of oxidative stress and inflammation. The possible link between LTL and OSA in Asian Indians has not been evaluated. Thus, the present study aims to compare the link between LTL and OSA in Asian Indians. Methods: In this study, 300 subjects (120 obese with OSA, 110 obese without OSA, and 70 non-obese without OSA) were included after overnight polysomnography and a fasting blood sample. Clinical, anthropometry, metabolic markers, insulin, 25-hydroxyvitamin D [25(OH) D], and parathyroid hormones (PTH) levels were investigated. LTL was investigated by a QPCR. Univariate and stepwise multivariate linear regression analyses adjusting for age, gender, BMI, and % body fat were conducted while treating LTL as a dependent variable in relation to AHI and other covariates. Results: Obese subjects with OSA had significantly decreased 25(OH)D and increased PTH levels. The mean telomere length (T/S) ratio was significantly shorter in patients with OSA. The adjusted correlation analysis showed that shortening of telomere length correlated with increasing age, apnea-hypopnea index (AHI), oxygen desaturation index, and RDI. Univariate analysis showed that LTL revealed a trend toward a negative correlation with a mean age (β + SE, −0.015 + 0.0006; p = 0.01) and positive correlation with AHI [β +slandered error (SE), 0.042 + 0.017; p = 0.008]. In the multiple regression analysis, LTL was positively associated with AHI (β + SE, 0.281 + 0.04; p = 0.001) after adjusting for age, sex, BMI, and % body fat. Even when adjusted for confounding factors, 25(OH)D, and PTH levels, LTL still was related to AHI (β + SE, 0.446 + 0.02; p = 0.05). Conclusion: Our study indicates the presence of an association between LTL and OSA and a significant impact of OSA severity and telomeres shortening in Asian Indians.
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Affiliation(s)
- Surya Prakash Bhatt
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, Metabolic Research Group, All India Institute of Medical Sciences, New Delhi, India
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Singh A, Chaudhary SC, Gupta KK, Sawlani KK, Singh A, Singh AB, Verma AK. Prevalence of obstructive sleep apnea in diabetic patients. Ann Afr Med 2021; 20:206-211. [PMID: 34558450 PMCID: PMC8477286 DOI: 10.4103/aam.aam_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Obstructive sleep apnea (OSA)-related hypoxemia stimulates release of acute-phase proteins and reactive oxygen species that exacerbate insulin resistance and lipolysis and cause an augmented prothrombotic and proinflammatory state which can leads to premature death. Aims This study aims to study the prevalence of OSA in diabetic patients. Setting and Design It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods A total of 149 type 2 diabetic patients were enrolled after taking written consent. All patients were subjected to STOP BANG questionnaire and patients falling in intermediate-high risk (score 3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea hypopnea index ≥ 5). Statistical Analysis Used Statistical Package for Social Sciences (SPSS) Version 21.0 statistical analysis software. Results Fifty-five percent of our diabetic population were having OSA. The age of patients enrolled in the study ranged between 30 and 86 years and prevalence increases with an increase in age groups. Majority (61.7%) of our cases were males. Incremental trend in weight, body mass index (BMI), neck circumference, and waist circumference of OSA cases were found with increasing in severity of OSA. Mean levels of raised blood sugar and HbA1c were higher in severe OSA cases. Conclusions OSA has a high prevalence in patients with type 2 diabetes mellitus. Patients with type 2 diabetes should be screened for OSA, even in the absence of symptoms, especially in individuals with higher waist circumference and BMI.
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Affiliation(s)
- Ankita Singh
- Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | | | | | | | - Abhishek Singh
- Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | | | - Ajay K Verma
- Department of Respiratory Medicine, KGMU, Lucknow, Uttar Pradesh, India
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Dhiman V, Krishnan V, Basu A, Das A, Rohilla J, Rawat VS, Nishchal A, Dave M, Solanki RK, Sahadevan S, Pal A, Garg S, Tikka SK, Dhyani M, Avinash P, Gupta M, Kant R, Gupta R. Development of psychiatry curriculum as a major subject during MBBS in India. Indian J Psychiatry 2021; 63:290-293. [PMID: 34211224 PMCID: PMC8221201 DOI: 10.4103/psychiatry.indianjpsychiatry_466_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/06/2020] [Accepted: 01/26/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vishal Dhiman
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vijay Krishnan
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Aniruddha Basu
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anindya Das
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jitendra Rohilla
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anil Nishchal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Malay Dave
- Consultant Psychiatrist, Mumbai, Maharashtra, India
| | - Ram Kumar Solanki
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - Sreeja Sahadevan
- Department of Psychiatry, MOSC Medical College, Ernakulum, Kerala, India
| | - Arghya Pal
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Shobit Garg
- Department of Psychiatry, Shri Guru Ram Rai Medical College, Dehradun, Uttarakhand, India
| | - Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mohan Dhyani
- Department of Psychiatry, Shri Guru Ram Rai Medical College, Dehradun, Uttarakhand, India
| | - Priyaranjan Avinash
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Manoj Gupta
- Dean Academic, All India Institute of Medical Sciences, Rishikesh, India
| | - Ravi Kant
- Director, All India Institute of Medical Sciences, Rishikesh, India
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Chu CA, Chen YJ, Chang KV, Wu WT, Özçakar L. Reliability of Sonoelastography Measurement of Tongue Muscles and Its Application on Obstructive Sleep Apnea. Front Physiol 2021; 12:654667. [PMID: 33841189 PMCID: PMC8027470 DOI: 10.3389/fphys.2021.654667] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
Few studies have explored the feasibility of shear-wave ultrasound elastography (SWUE) for evaluating the upper airways of patients with obstructive sleep apnea (OSA). This study aimed to establish a reliable SWUE protocol for evaluating tongue muscle elasticity and its feasibility and utility in differentiating patients with OSA. Inter-rater and intra-rater reliability of SWUE measurements were tested using the intraclass correlation coefficients. Submental ultrasound was used to measure tongue thickness and stiffness. Association between the ultrasound measurements and presence of OSA was analyzed using multivariate logistic regression. One-way analysis of variance was used to examine if the values of the ultrasound parameters varied among patients with different severities of OSA. Overall, 37 healthy subjects and 32 patients with OSA were recruited. The intraclass correlation coefficients of intra‐ and inter-rater reliability for SWUE for tongue stiffness ranged from 0.84 to 0.90. After adjusting for age, sex, neck circumference, and body mass index, the risk for OSA was positively associated with tongue thickness [odds ratio 1.16 (95% confidence interval 1.01–1.32)] and negatively associated with coronal imaging of tongue muscle stiffness [odds ratio 0.72 (95% confidence interval 0.54–0.95)]. There were no significant differences in tongue stiffness among OSA patients with varying disease severity. SWUE provided a reliable evaluation of tongue muscle stiffness, which appeared to be softer in patients with OSA. Future longitudinal studies are necessary to investigate the relationship between tongue softening and OSA, as well as response to treatment.
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Affiliation(s)
- Cheng-An Chu
- Department of Dentistry, School of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yunn-Jy Chen
- Department of Dentistry, School of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Ananthakrishnan R, Kakar A, Handa A, Joshi SK, Tyagi R, Mohanty S. Prevalence of cardiac arrhythmias in patients of obstructive sleep apnea syndrome and changes after 6 months of continuous positive airway pressure therapy. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_16_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaur A, Chawla N, Subramanian T. Oropharyngeal muscle strengthening exercises in obstructive sleep apnea. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2021. [DOI: 10.4103/amhs.amhs_318_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pyun SY, Choi SJ, Jo H, Hwang Y, Cho JW, Joo EY. Gender Differences in Korean Patients with Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Ahmad L, Kapoor P, Bhaskar S, Khatter H. Screening of obstructive sleep apnea (OSA) risk in adolescent population and study of association with craniofacial and upper airway morphology. J Oral Biol Craniofac Res 2020; 10:807-813. [PMID: 33224724 DOI: 10.1016/j.jobcr.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing with high prevalence and associated co-morbidities. It still goes largely under-reported due to events occurring in sleep and difficulty in identifying predisposing factors. Aims To perform questionnaire-based screening of OSA-risk in adolescents and study association of OSA-risk with craniofacial and upper airway morphology. Material and methods Modified STOP-BANG questionnaire was used for screening OSA-risk in adolescent orthodontic patients (10-19 years) in a government dental hospital in India. Patients were categorised into two groups: OSA-risk and non-risk, based on the questionnaire scores, and were subsequently evaluated for craniofacial and upper airway morphology, both on examination and on lateral cephalometric radiographs. Results Documented a high prevalence of 14% for OSA-risk in adolescent orthodontic patients. The extra-oral and intra-oral parameters found significantly associated with OSA-risk were convex profile [Odd's ratio (OR) - 3.824], steep mandibular plane angle [MPA] (OR- 79.75), Type 3/4 faucial pillars (OR- 11.227), Class II molar relationship (OR - 4.518), ovoid upper arch form (OR - 13.750). In addition, the cephalometric parameters: ANB (p- 0.025), SN-MP (p- 0.007), BA-SN (p- 0.020), PNS-AD1 (p < 0.001), PNS-AD2 (p - 0.001) also showed highly significant association to OSA-risk. The ROC curves demonstrated high sensitivity and specificity for PNS-AD1 (60%,83.3%), PNS-AD2 (73.3%, 70%) and SN-MP (60%,70%), respectively for OSA-risk. Conclusions The study supported applicability of modified STOP-BANG questionnaire for OSA-risk in Indian adolescents. The parameters [extra-oral, intra-oral, cephalometric and upper airway (PNS-AD1, PNS-AD2, SN-MP)] significantly associated with OSA-risk, were identified.
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Affiliation(s)
- Lubna Ahmad
- Intern, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Priyanka Kapoor
- Professor, Department of Orthodontics & Dentofacial Orthopedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Sejal Bhaskar
- Final Year Student, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Himani Khatter
- Biostatistician, Dept of Neurology, Christian Medical College & Hospital, Ludhiana, 141008, India
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Kareem O, Tanvir M, Bader GN. Prevalence of high risk obstructive sleep apnoea by Berlin questionnaire in patients with hypertension: study from a tertiary care hospital. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-020-00052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstructive Sleep Apnoea (OSA), a condition characterized by a complete or partial cessation of airflow during sleep, can cause various cardiovascular disorders including hypertension. The aim of the study was to determine the prevalence of OSA in patients with hypertension.
Methods
A cross-sectional prospective cohort study of 504 patients with hypertension was undertaken at a tertiary care hospital of India for a period of 6 months. OSA was evaluated using the Berlin questionnaire while the daytime sleepiness was determined using Epworth Sleepiness Scale. Data analysis was done using SPSS v. 20.
Results
High risk of OSA was identified in 120 (23.8%) patients and the prevalence of sleepiness (Epworth Sleepiness score >16) was found to be 32.5% (95% CI, p < 0.001) in these patients. The mean neck circumference, waist circumference and waist-to-hip ratio for high-risk OSA group were 37.41 ± 3.396 cm, 105.90 ± 11.28 cm and 1.01 ± 0.065 respectively while for the low-risk group, these parameters were 35.45 ± 2.652 cm, 98.75 ± 10.87 cm and 0.99 ± 0.080 respectively (95% CI, p<0.001). The mean blood pressure (BP) ≥133.52/84.37 mmHg was recorded in patients with a high risk of OSA (95% CI, P < 0.05), and resistant hypertension (3.3%) was significantly associated with the risk of OSA (95% CI, P < 0.05).
Conclusion
In the tertiary health care setting, the prevalence of high-risk of OSA in patients with hypertension is high. Screening for OSA should be a part of the hypertensive medical investigation and patients may benefit from a proper evaluation of OSA.
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Yassin A, Al-Mistarehi AH, Beni Yonis O, Aleshawi AJ, Momany SM, Khassawneh BY. Prevalence of sleep disorders among medical students and their association with poor academic performance: A cross-sectional study. Ann Med Surg (Lond) 2020; 58:124-129. [PMID: 32983431 PMCID: PMC7494598 DOI: 10.1016/j.amsu.2020.08.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sleep quality is of paramount importance for human health. This multi-site study measures the proportion and types of self-reported sleep disorders in medical students and evaluates their association with academic performance by Grade Point Average (GPA). MATERIALS AND METHODS A cross-sectional survey was conducted on medical students from two medical schools in Jordan during the 2018/2019 academic year. The study utilized the SLEEP-50 questionnaire to estimate the proportion of several sleep disorders and their effects on daily functioning. Below average GPAs were considered poor academic performance. RESULTS 1041 medical students' online surveys were analyzed from two medical schools' campuses, representing a 29.7% response rate. Their mean age was 22 ± 2.1 years (ranging from 18 to 37) and 52.6% were female. The mean body mass index was 24.2 ± 4.4 kg/m2. According to the SLEEP-50 questionnaire, the prevalence of sleep disorders among studied medical students ranged from 0.6% for sleep state misperception (SSM) to 23.1% for hypersomnia. Using binary logistic regression, after adjusting for gender and obesity, poor academic performance was associated with a risk for insomnia [adjusted odds ratio (OR) = 1.96, p < 0.001]; affective disorder [OR = 2.24, P < 0.001]; SSM [OR = 6.40, p = 0.045]; narcolepsy [OR = 9.54, p = 0.045]; and circadian rhythm disorders [OR = 2.03, p < 0.001]. CONCLUSION Sleep disorders are common among medical students. Several sleepdisorders were associated with poor academic performance. Proper diagnosis and treatment of sleep disorders may remedy this issue.
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Affiliation(s)
- Ahmed Yassin
- Division of Neurology, Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Othman Beni Yonis
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdelwahab J. Aleshawi
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Suleiman M. Momany
- Division of Pulmonary, Critical Care & Sleep Disorders, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Y. Khassawneh
- Division of Pulmonary, Critical Care & Sleep Disorders, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Krishnasamy S, Sahid SM, Hashim SA, Singh S, Chung F, Mokhtar RAR, Yin WC. Obstructive sleep apnoea and open heart surgery: a review of its incidence and impact to patients. J Thorac Dis 2020; 11:5453-5462. [PMID: 32030264 DOI: 10.21037/jtd.2019.11.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Obstructive sleep apnea (OSA) is a serious health disorder which contributes to cardiovascular complications, decreased work productivity, automobile accidents, and death. This condition is characterized by a temporary cessation of breathing resulting due to upper airway closure during a person's sleep. Strain to the heart caused by this repetitive hypoxic insult can lead to postoperative complications for patients undergoing heart surgery. Recognizing cardiac surgical patients with OSA is important. Early recognition and intervention such as use of BiPAP device can reduce the postoperative complications due to OSA. Methods The aim of this study is to identify the incidence of unrecognized OSA in cardiac surgical patients. This is a retrospective analysis of a prospective data of the study which was done between July 2012 and July 2013 in University Malaya Medical Center. All patients undergoing elective cardiac surgery were recruited and the demographic data, questionnaire and the portable sleep study results were obtained. Patients were followed up till 30 days to record any complications. Data were entered in SPSS version 17 and analysis was done. Results The incidence of OSA was 61.4% and 43.5% were moderate to severe OSA. There was male predominance of OSA (79%) with a mean age of 60 years. OSA subjects had shorter inter-incisor distance (4.18±0.6 cm) and larger waistline (94.1±12.1 cm). The STOP-Bang questionnaire has a sensitivity of 75.8% in predicting apnoa-hypopnea index (AHI) ≥5/hour. Conclusions OSA can be diagnosed with a simple screening questionnaire and a bedside portable sleep study. Cardiac patients diagnosed with OSA can be pre-emptively given extra attention in managing their postoperative care.
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Affiliation(s)
| | - Saidah Mohd Sahid
- Department of General Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Shahrul Amry Hashim
- Cardiothoracic Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sukcharanjit Singh
- Department of Anaesthesiology, Griffith Base Hospital, Griffith, New South Wales, Australia
| | - Frances Chung
- Department of Anaesthesia, University Health Network-Toronto Western Hospital, Toronto, Canada
| | | | - Wang Chew Yin
- Department of Anaesthesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Park KM, Kim SY, Sung D, Kim H, Kim BN, Park S, Jung KI, Park MH. The relationship between risk of obstructive sleep apnea and other sleep problems, depression, and anxiety in adolescents from a community sample. Psychiatry Res 2019; 280:112504. [PMID: 31401289 DOI: 10.1016/j.psychres.2019.112504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
Obstructive sleep apnea (OSA) is highly related to mental health problems, such as depression and anxiety. However, previous studies on OSA and depression and anxiety have mostly been conducted in the adult population. We aimed to (1) screen for risk of OSA in a sample of adolescents from the general population using self-report questionnaires and (2) examine whether there are differences between the high- and low-risk groups for OSA in depressive and anxiety symptoms, self-esteem, and sleep-related variables. The data of 793 students (age range: 12-17 years old) were analyzed. The participants were assigned to the high-risk (n = 202, 25.5%) or the low-risk group (n = 591, 74.5%) of OSA. The participants in the high-risk group had more severe anxiety symptoms, lower self-esteem, insomnia, excessive daytime sleepiness, and higher BMI compared those in the low-risk group. This study shows that it is possible to efficiently screen for risks of various problems associated with OSA in adolescents using an easy and simple screening tool.
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Affiliation(s)
- Kyu-Myoung Park
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shin-Young Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dajung Sung
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyemin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Subin Park
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - Kyu-In Jung
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Assessment of risk for obstructive sleep apnea by using STOP-BANG questionnaire in type 2 diabetes mellitus. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Magnitude and Determinants of Patients at Risk of Developing Obstructive Sleep Apnea in a Non-Communicable Disease Clinic. ACTA ACUST UNITED AC 2019; 55:medicina55070391. [PMID: 31330779 PMCID: PMC6681367 DOI: 10.3390/medicina55070391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022]
Abstract
Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed—or rather not diagnosed—in primary care settings due to the costly diagnostic techniques involved. This study aimed to assess the number of study participants at risk of developing OSA and to assess and quantify the risk factors associated with this disorder. Materials and Methods: A cross-sectional study was performed in an NCD clinic of a rural health training center, Karikalampakkam, Puducherry of South India from August 2018 to October 2018. A Modified Berlin Questionnaire (MBQ) was used to screen the study participants at risk for OSA. Four-hundred-and-seventy-three people aged 18 years and above were included in the study, using systematic random sampling. Respondents’ socio-demographic and morbidity characteristics, as well as clinical and anthropometric parameters including body weight, height, blood pressure, neck, hip and waist circumference were collected. Data was captured using Epicollect5 and analyzed using SPSS version 20.0. Results: One-fourth (25.8%) of the respondents were at high risk of developing OSA. In terms of gender, 27.9% of the men and 23.8% of the women were at high risk for OSA. In univariate analyses, the risk of developing OSA was significantly associated with a history of diabetes mellitus, hypertension, dyslipidemia and gastro-esophageal reflux disease, weight, body mass index, neck, waist and hip circumference, waist–hip ratio, and systolic and diastolic blood pressure. Multivariate logistic regression analysis showed that a history of dyslipidemia (aOR, 95% CI = 2.34, 1.22–4.48), body mass index (aOR, 95% CI = 1.15, 1.06–1.22) and waist circumference (aOR, 95% CI = 1.10, 1.07–1.14) emerged as significant predictors of risk for OSA. Conclusions: A considerable proportion of NCD patients with easily detectable attributes are at risk of developing OSA, but still remain undiagnosed at a primary health care setting. The results obtained using MBQ in this study were comparable to studies performed using polysomnography. Dyslipidemia, body mass index and waist circumference were independent risk factors for predicting a risk of developing OSA. Prospective studies are needed to confirm whether a reduction in these risk factors could reduce the risk for OSA.
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Kohli M, Sharma SK, Upadhyay V, Varshney S, Sengupta S, Basak T, Sreenivas V. Urinary EPCR and dermcidin as potential novel biomarkers for severe adult OSA patients. Sleep Med 2019; 64:92-100. [PMID: 31677485 DOI: 10.1016/j.sleep.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Due to low predictive values of obstructive sleep apnea (OSA) screening tools, there is a need for biomarker for screening of OSA patients at an early stage. The aim of the study was to evaluate differentially expressed proteins in blood and urine samples of OSA patients. METHODS In this study, we used isobaric tagging for relative and absolute quantification (iTRAQ) based proteomics approach to identify differentially expressed proteins, which were subsequently verified and validated using enzyme-linked immunosorbent assay (ELISA) technique in adult OSA patients. RESULTS Seventeen differentially expressed proteins were selected from iTRAQ data for verification, based on their clinical significance and reproducibility among different iTRAQ experiment sets. Five of these proteins (plasma = 2; urine = 3) were further validated in plasma (non-OSA- = 42; OSA = 198) and urine samples (non-OSA = 46; OSA = 197). ROC curve analysis for all OSA vs. non-OSA subjects ensured optimal diagnostic utility of two urinary proteins: Endothelial protein c receptor (EPCR) (AUC = 73%, cut-off: 35 pg/ml) and dermcidin (AUC = 74%, cut-off: 4.6 pg/ml). For severe OSA, diagnostic accuracy significantly improved with AUC as 88% and 82% for EPCR (cut-off: 46 pg/ml) and dermcidin (cut-off: 5.2 pg/ml) respectively. Sensitivity and specificity of combined performance of both urinary proteins for severe OSA were 94% and 91% respectively. CONCLUSION In this study, urinary EPCR and dermcidin emerged as novel biomarkers for screening severe OSA patients.
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Affiliation(s)
- Mikashmi Kohli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - S K Sharma
- Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, Jamia Hamdard (Deemed-to-be University), New Delhi, India.
| | - Vishwanath Upadhyay
- Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, Jamia Hamdard (Deemed-to-be University), New Delhi, India
| | - Swati Varshney
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Shantanu Sengupta
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Trayambak Basak
- Division of Nephrology and Hypertension, Vanderbilt Medical Center, Nashville, United States
| | - V Sreenivas
- Department of Biostatistics, AIIMS, New Delhi, India
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Geng W, Tang H, Sharma A, Zhao Y, Yan Y, Hong W. An artificial neural network model for prediction of hypoxemia during sedation for gastrointestinal endoscopy. J Int Med Res 2019; 47:2097-2103. [PMID: 30913936 PMCID: PMC6567776 DOI: 10.1177/0300060519834459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study was designed to assess clinical predictors of hypoxemia and develop an artificial neural network (ANN) model for prediction of hypoxemia during sedation for gastrointestinal endoscopy examination. METHODS A total of 220 patients were enrolled in this prospective observational study. Data on demographics, chronic concomitant disease information, neck circumference, thyromental distance and anaesthetic dose were collected and statistically analysed. RESULTS Univariate analysis indicated that body mass index (BMI), habitual snoring and neck circumference were associated with hypoxemia. An ANN model was developed with three variables (BMI, habitual snoring and neck circumference). The area under the receiver operating characteristic curve for the ANN model was 0.80. CONCLUSIONS The ANN model developed here, comprising BMI, habitual snoring and neck circumference, was useful for prediction of hypoxemia during sedation for gastrointestinal endoscopy.
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Affiliation(s)
- Wujun Geng
- 1 Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongli Tang
- 1 Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Apurb Sharma
- 2 Department of Anesthesia, Pain Management and Critical Care, Nepal Mediciti Hospital, Karyabinayak, Nepal
| | - Yizhou Zhao
- 3 Department of Clinical Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ye Yan
- 4 Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wandong Hong
- 4 Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Chung JW, Kim N, Wee JH, Lee J, Lee J, Kwon S, Hwang YJ, Yoon H, Shin CM, Park YS, Lee DH, Kim JW. Clinical features of snoring patients during sedative endoscopy. Korean J Intern Med 2019; 34:305-314. [PMID: 29132198 PMCID: PMC6406094 DOI: 10.3904/kjim.2017.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/02/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Snoring is the sound of turbulence and vibration of the upper respiratory tissues and has been identified as a risk factor of obstructive sleep apnea (OSA) and cardiovascular disease. The aim of this study was to identify associated clinical factors in snoring patients undergoing sedative endoscopy. METHODS A total of 49 patients who snored during standard sedative endoscopy and 127 controls were prospectively enrolled from June 2015 to June 2016. The Korean version of the Berlin Questionnaire was used to identify risk factors of OSA. Clinical information, including comorbidities, was collected from electronic medical records. RESULTS The snoring group showed a higher risk of OSA (42.9% vs. 26.8%, p = 0.039), and a higher prevalence of coronary artery disease (10.2% vs. 0.8%, p = 0.007) and advanced gastric cancer (12.2% vs. 2.4%, p = 0.015) compared with the control group. Multivariate analysis showed that coronary artery disease (odds ratio [OR], 13.93; 95% confidence interval [CI], 1.24 to 155.90; p = 0.033) and advanced gastric cancer (OR, 5.21; 95% CI, 1.01 to 26.98; p = 0.049) were significantly associated with snoring. However, a history of gastrectomy showed only a marginally significant association with snoring (OR, 2.16; 95% CI, 0.91 to 5.11; p = 0.079). CONCLUSION Patients who snore during sedative endoscopy may need to be evaluated for possible coronary artery disease.
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Affiliation(s)
- Jung Wha Chung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Nayoung Kim, M.D. Department of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beongil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7009 Fax: 82-31-787-4051 E-mail:
| | - Jee Hye Wee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaebong Lee
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jongchan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soohoon Kwon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jae Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Nayoung Kim, M.D. Department of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beongil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7009 Fax: 82-31-787-4051 E-mail:
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Ray A, Kanabar K, Upadhyay V, Sharma SK. A four year experience in narcolepsy from a sleep clinic at a tertiary care centre with a short review of contemporary Indian literature. Indian J Med Res 2019; 148:748-751. [PMID: 30778010 PMCID: PMC6396549 DOI: 10.4103/ijmr.ijmr_888_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Narcolepsy is a common sleep disorder in Western countries but rarely reported from India. Here, we report a small case series of four narcolepsy patients seen over a four year period in the sleep clinic of a tertiary care hospital in north India. The diagnosis was established by clinical history and two or more sleep-onset rapid eye movements (SOREMs) on multiple sleep latency tests (MSLTs) following overnight polysomnography (PSG). The mean age of patients was 26.2±6.4 yr; one patient had associated cataplexy and another one had all four cardinal symptoms of narcolepsy. All these patients had a history of excessive daytime sleepiness (EDS). The mean body mass index was 24.2±4.7 kg/m[2]. The mean sleep latency during MSLT was 2.7±1.3 min, and the mean REM latency was 5.7±2.9 min. Narcolepsy, although rarely reported from India, should be suspected in young non-obese patients complaining of EDS and confirmed by performing MSLT following overnight PSG.
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Affiliation(s)
- Animesh Ray
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kewal Kanabar
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwanath Upadhyay
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surendra Kumar Sharma
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
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Geng W, Jia D, Wang Y, Jin S, Ren Y, Liang D, Zheng A, Tang H, Basharat Z, Zimmer V, Stock S, Zippi M, Hong W. A prediction model for hypoxemia during routine sedation for gastrointestinal endoscopy. Clinics (Sao Paulo) 2018; 73:e513. [PMID: 30462756 PMCID: PMC6218956 DOI: 10.6061/clinics/2018/e513] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/04/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The current study was designed to assess the clinical predictors of hypoxemia and to develop a multivariable, predictive model for hypoxemia during routine gastrointestinal endoscopy. METHODS In total, 308 patients were enrolled in the analysis. Demographic data, concurrent chronic disease information, anesthetic dose and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores were collected and analyzed statistically. RESULTS Multivariate logistic regression indicated that age (OR: 1.04; 95%CI 1.01-1.08), body mass index (BMI) (OR: 1.12; 95%CI: 1.02-1.21) and habitual snoring (OR: 3.71; 95%CI: 1.62-8.48) were independently associated with hypoxemia. A logistic regression function (LR model) was developed to predict hypoxemia considering the parameters of -7.73+0.04 age (years), +0.11 BMI, and +1.31 habitual snoring (yes or no). The area under the receiver operating characteristic (ROC) curve for the LR model was 0.76. CONCLUSIONS The LR model, consisting of age, BMI and habitual snoring, was a useful predictor of hypoxemia during routine sedation for gastrointestinal endoscopy.
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Affiliation(s)
- Wujun Geng
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- *Corresponding author. E-mail:
| | - Danyu Jia
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yichuan Wang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Shenhui Jin
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yelong Ren
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Dongdong Liang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Aote Zheng
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Hongli Tang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- *Corresponding author. E-mail:
| | - Zarrin Basharat
- Microbiology & Biotechnology Research Lab, Department of Environmental Sciences, Fatima Jinnah Women University, 46000 Rawalpindi, Pakistan
- *Corresponding author. E-mail:
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
| | - Simon Stock
- Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- *Corresponding author. E-mail:
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Pilakasiri A, Mahakit P. Prospective study of the prevalence and co-morbidities of obstructive sleep apnea in active-duty army personnel in the three southernmost provinces of Thailand using questionnaire screening. Mil Med Res 2018; 5:39. [PMID: 30400956 PMCID: PMC6220474 DOI: 10.1186/s40779-018-0186-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/28/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is crucial for the army to know the prevalence of obstructive sleep apnea (OSA) syndrome in active-duty army personnel. Little information has been reported on the prevalence of OSA and clinical features in active-duty army personnel. This study was aimed to estimate the prevalence of snoring and risk of developing OSA in active-duty army personnel in Thailand and to identify the co-morbidities of OSA. In total, 1107 participants who were aged 20-60 years and were deployed to the three southernmost provinces of Thailand were enrolled. All the participants completed the Phramongkutklao (PMK) Hospital OSA Questionnaire that was modified and validated from the Berlin Questionnaire and underwent physical examination. The participants were 1107 active-duty army personnel in the three southernmost provinces of Thailand, both males and females, aged 20-60 years. METHODS The PMK OSA Questionnaire was used to assess the risk of OSA together with interviewing for snoring, fatigue, falling asleep and day-time sleepiness. Physical examination of the neck, chest and hip circumference, and height was performed. Information concerning physical training, co-morbid diseases, smoking and alcoholic consumption was collected. RESULTS The prevalence of snoring was 58.5, and 4.8% met the PMK OSA Questionnaire criteria, thus indicating a high risk of OSA. The information obtained indicated that laryngopharyngeal reflux (LPR), current smoking and alcoholic consumption were significantly higher in the high-risk OSA group. CONCLUSION Early detection and treatment of OSA in active-duty army personnel are imperative. Physical examination and polysomnography can be used to reveal the high-risk group. High body mess index (BMI), laryngopharyngeal reflux, current smoking and alcoholic consumption are modifiable factors for OSA and are avoidable. A policy to decrease the BMI and risk of LPR, as well as to stop smoking and alcoholic consumption, should be applied.
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Affiliation(s)
- Anisong Pilakasiri
- Department of Otolaryngology, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand.
| | - Prasit Mahakit
- Department of Otolaryngology, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
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Patterson PD, Moore CG, Guyette FX, Doman JM, Weaver MD, Sequeira DJ, Werman HA, Swanson D, Hostler D, Lynch J, Russo L, Hines L, Swecker K, Kroemer AJ, Runyon MS, Buysse DJ. Real-Time Fatigue Mitigation with Air-Medical Personnel: The SleepTrackTXT2 Randomized Trial. PREHOSP EMERG CARE 2018; 23:465-478. [PMID: 30285519 DOI: 10.1080/10903127.2018.1532476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. Methods: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days. Participation was voluntary. All consented participants answered baseline as well as follow-up surveys. All participants answered text message queries, which assessed self-rated fatigue, sleepiness, concentration, recovery, and hours of sleep. Intervention participants received additional text messages with recommendations for behaviors that can mitigate fatigue. Intervention participants received weekly text messages that promoted sleep. Our analysis was guided by the intent-to-treat principle. For the long-term outcome of interest (sleep quality at 120 days), we used a two-sample t-test on the change in sleep quality to determine the intervention effect. Results: Eighty-three individuals were randomized and 2,828 shifts documented (median shifts per participant =37, IQR 23-49). Seventy-one percent of individuals randomized (n = 59) participated up to the 120-day study period and 52% (n = 43) completed the follow-up survey. Of the 69,530 text messages distributed, participants responded to 61,571 (88.6%). Mean sleep quality at 120 days did not differ from baseline for intervention (p > 0.05) or control group participants (p > 0.05), and did not differ between groups (p > 0.05). There was no change from baseline to 120 days in the proportion with poor sleep quality in either group. Intra-shift fatigue increased (worsened) over the course of 12-hour shifts for participants in both study arms. Fatigue at the end of 12-hour shifts was higher among control group participants than participants in the intervention group (p < 0.05). Pre-shift hours of sleep were often less than 7 hours and did not differ between the groups over time. Conclusions: The SleepTrackTXT2 behavioral intervention showed a positive short-term impact on self-rated fatigue during 12-hour shifts, but did not impact longer duration shifts or have a longer-term impact on sleep quality among air-medical EMS clinicians.
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Khurana S, Sharda S, Saha B, Kumar S, Guleria R, Bose S. Canvassing the aetiology, prognosis and molecular signatures of obstructive sleep apnoea. Biomarkers 2018; 24:1-16. [DOI: 10.1080/1354750x.2018.1514655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sartaj Khurana
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - Shivani Sharda
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - Biswajit Saha
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - Sachin Kumar
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi, India
| | - Sudeep Bose
- Amity Institute of Biotechnology, Amity University, Noida, India
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Abstract
PURPOSE OF REVIEW Sleep-disordered breathing encompasses a broad spectrum of sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea, as well as sleep-related hypoventilation and hypoxemia. Diagnostic criteria have been updated in the International Classification of Sleep Disorders, Third Edition and the American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events. Neurologic providers should have basic knowledge and skills to identify at-risk patients, as these disorders are associated with substantial morbidity, the treatment of which is largely reversible. RECENT FINDINGS OSA is the most common form of sleep-disordered breathing and is highly prevalent and grossly underdiagnosed. Recent studies suggest that prevalence rates in patients with neurologic disorders including epilepsy and stroke exceed general population estimates. The physiologic changes that occur in OSA are vast and involve complex mechanisms that play a role in the pathogenesis of cardiovascular and metabolic disorders and, although largely unproven, likely impact brain health and disease progression in neurologic patients. A tailored sleep history and examination as well as validated screening instruments are effective in identifying patients with sleep-disordered breathing, although sleep testing is necessary for diagnostic confirmation. While continuous positive airway pressure therapy and other forms of noninvasive positive pressure ventilation remain gold standard treatments, newer therapies, including mandibular advancement, oral appliance devices, and hypoglossal nerve stimulation, have become available. Emerging evidence of the beneficial effects of treatment of sleep-disordered breathing on neurologic outcomes underscores the importance of sleep education and awareness for neurologic providers. SUMMARY Sleep-disordered breathing is highly prevalent and grossly underrecognized. The adverse medical and psychosocial consequences of OSA and other sleep-related breathing disorders are considerable. The impact of sleep therapies on highly prevalent neurologic disorders associated with substantial morbidity and health care costs is becoming increasingly recognized.
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Kurtis MM, Balestrino R, Rodriguez-Blazquez C, Forjaz MJ, Martinez-Martin P. A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders. Front Neurol 2018; 9:369. [PMID: 29896152 PMCID: PMC5986889 DOI: 10.3389/fneur.2018.00369] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023] Open
Abstract
Patients with movement disorders have a high prevalence of sleep disturbances that can be classified as (1) nocturnal sleep symptoms, such as insomnia, nocturia, restless legs syndrome (RLS), periodic limb movements (PLM), obstructive sleep apnea (OSA), and REM sleep behavior disorder; and (2) diurnal problems that include excessive daytime sleepiness (EDS) and sleep attacks. The objective of this review is to provide a practical overview of the most relevant scales that assess these disturbances to guide the choice of the most useful instrument/s depending on the line of research or clinical focus. For each scale, the reader will find a brief description of practicalities and psychometric properties, use in movement disorder cohorts and analyzed strengths and limitations. To assess insomnia, the Pittsburgh Sleep Quality Index, a generic scale, and three disease-specific scales: the Parkinson Disease Sleep Scale (PDSS), the PDSS-2, and Scales for outcomes in Parkinson's disease (PD)-Sleep-Nocturnal Sleep subscale are discussed. To evaluate nocturia, there are no specific tools, but some extensively validated generic urinary symptom scales (the Overall Bladder Questionnaire and the Overactive Bladder Symptom Score) and some PD-specific scales that include a nocturia item are available. To measure RLS severity, there are currently four domain-specific generic scales: The International Restless Legs Scale, the Johns Hopkins Restless Legs Severity Scale, the Restless Legs Syndrome-6 measure, a Pediatric RLS Severity Scale, and the Augmentation Severity Rating Scale (a scale to evaluate augmentation under treatment) and several instruments that assess impact on quality of sleep and health-related quality of life. To evaluate the presence of PLM, no clinical scales have been developed to date. As far as OSA, commonly used instruments such as the Sleep Apnea Scale of the Sleep Disorders Questionnaire, the STOP-Bang questionnaire, and the Berlin Questionnaire are reviewed. Three scales have been extensively used to assess EDS: the generic Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and the PD-specific Scales for outcomes in PD-Sleep-Daytime sleepiness subscale. To date, only the Inappropriate Sleep Composite Score specifically evaluates propensity to sleep attacks.
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Affiliation(s)
- Mónica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
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Ladera V, Sargento P, Perea V, Faria M, Garcia R. Sensitivity and specificity of Frontal Assessment Battery in newly diagnosed and untreated obstructive sleep apnea patients. Sleep Med 2018; 42:1-6. [PMID: 29458740 DOI: 10.1016/j.sleep.2017.11.1122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/19/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Executive dysfunction (ED) is often observed in subjects diagnosed with obstructive sleep apnea (OSA), but their assessment requires facilities that are not always available. We aim to evaluate the extent to which Frontal Assessment Battery (FAB) discriminates ED in newly diagnosed, untreated, and without-comorbidity OSA patients. METHODS Sixty subjects participated in the study. Of these, 40 (31 males and 9 females) were newly diagnosed for OSA through full-night polysomnography (apnea/hypopnea index; M = 39.01, SD = 27.16), untreated, with a mean age of 54.50 years (SD = 8.90), while the remaining 20 (15 males and 5 females) had no symptoms of OSA (M = 51.60 years, SD = 10.70). The instruments used were the following: Questionnaire for Sleep Apnea Risk, Epworth Sleepiness Scale, Mini-Mental State Examination, and FAB. RESULTS The group with OSA exhibited significantly lower values in the FAB global score (p = 0.003) and in Conceptualization (p = 0.001) and Mental Flexibility (p = 0.009) subtests. ROC analysis showed adequate discriminative capacity for the FAB global score (AUC = 0.74) and for Conceptualization (AUC = 0.75) and Mental Flexibility (AUC = 0.70) scores. CONCLUSIONS The FAB is a short and no-time-consuming tool that can be used to investigate the presence of ED in untreated OSA patients with no comorbidities, providing clinicians with a simple and effective way of detecting the presence of this dysfunction and allowing a more informed decision for the need of a full neuropsychological assessment.
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Affiliation(s)
| | - Paulo Sargento
- Escola Superior de Saúde Ribeiro Sanches, COPElabs, NICiTeS, Portugal.
| | | | - Miguel Faria
- Escola Superior de Saúde Ribeiro Sanches, NICiTeS, Portugal
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Mahajan S, Gupta K, Sinha S, Malhotra A, Mahajan S. Effect of kidney transplantation on sleep-disordered breathing in patients with End Stage Renal Disease: a polysomnographic study. Sleep Med 2018; 45:140-145. [PMID: 29680422 DOI: 10.1016/j.sleep.2017.11.1151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/01/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common in patients with end-stage renal disease (ESRD). SDB is associated with comorbidities such as hypertension, diabetes mellitus, and obesity, interplaying with metabolic derangements in the form of uremia, acidosis, and hypervolemia. Renal transplant has been observed to correct most of these metabolic derangements and to control progression of comorbidities. While SDB is highly prevalent among patients in the pretransplant stage, it remains to be seen whether the beneficial aspects of transplant are extended to improvement in SDB in patients with ESRD. METHODS Eighteen patients undergoing thrice-weekly hemodialysis (HD) for ESRD at the transplant clinic of All India Institute of Medical Sciences (AIIMS), New Delhi, underwent detailed clinical, laboratory, and polysomnographic evaluation. The average number of apneas and hypopneas per hour of sleep, ie, Apnea-Hypopnea Index (AHI), was used to define the severity of sleep apnea. All patients underwent polysomnography (PSG) within 24 h of the last HD and after three months of living-donor transplant. RESULTS Of 18 patients, there were 14 males and four females. The median age was 28 years (range 19-50 years). They had already spent a median period of six months (range 3-31 months) on HD before inclusion. The prevalence of SDB (AHI ≥ 5/h) was 44.4% (8/18) before transplant, which decreased to 5.6% (1/18) after transplant (p = 0.016). The oxygen desaturation index had a median value of 5.8 events/h (range 0.1-35.4) in the pretransplant stage, which decreased to 0 events/h (range 0-6.6) in the post-transplant stage (p = 0.035). CONCLUSION There was a significant improvement in the prevalence and severity of SDB after transplant. Whether improvement in SDB is sustained on a long-term follow-up remains to be seen.
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Affiliation(s)
- Sanjiv Mahajan
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
| | | | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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