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Zhang L, Zhang X, Li YM, Xiang BY, Han T, Wang Y, Wang C. Association of Craniofacial and Upper Airway Morphology with Cardiovascular Risk in Adults with OSA. Nat Sci Sleep 2021; 13:1689-1700. [PMID: 34629918 PMCID: PMC8493274 DOI: 10.2147/nss.s332117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Clinical and population-based studies have demonstrated a strong association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD). Anatomical abnormalities of the craniofacial region and upper airway are important risk factors for OSA. The objective of this study was to investigate the association of craniofacial and upper airway morphology with CVD risk biomarkers. METHODS One hundred and sixty-nine male patients with OSA underwent in-laboratory polysomnography (PSG) and upper airway computed tomography (CT) scanning. Ten-year Framingham CVD risk score (FRS) was calculated and categorized into low- and moderate-to-high-risk groups. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured as a biomarker of increased myocardial wall stress. RESULTS Compared to the low-risk group, total sleep time (TST), the proportion of N3 (N3%) and mean oxygen saturation (SpO2mean) were lower, while the arousal index of non-rapid eye movement (NREM) sleep, apnea index (AI) of NREM sleep, apnea hypopnea index (AHI) of NREM sleep, oxygen desaturation index (ODI) and percentage of total sleep time spent with oxyhemoglobin saturation below 90% (TST90) were higher in the moderate-to-high risk group. The corrected upper airway length (UAL), ANB angle and gonion-gnathion-hyoid angle were larger for subjects in the moderate-to-high risk group than those in the low-risk group. In multiple regression analysis, TST, AINREM and adjusted UAL were independently associated with moderate-to-high CVD risk. Plasma NT-proBNP levels were higher in patients in the moderate- to high-risk group, and among the PSG and CT scan parameters, only SPO2mean was marginally associated with NT-proBNP (r=0.183, P=0.054). CONCLUSION Craniofacial and upper airway features may contain valid cues about CVD risk, and sleep duration, obstructive event type and occurrence phase may be closely related to CVD risk for patients with OSA.
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Affiliation(s)
- Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
| | - Xiaolei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
- Capital Medical University, Beijing, People's Republic of China
- The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Ming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Bo Yun Xiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
- Capital Medical University, Beijing, People's Republic of China
- The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Sata N, Inoshita A, Suda S, Shiota S, Shiroshita N, Kawana F, Suzuki Y, Matsumoto F, Ikeda K, Kasai T. Clinical, polysomnographic, and cephalometric features of obstructive sleep apnea with AHI over 100. Sleep Breath 2021; 25:1379-1387. [PMID: 33201370 DOI: 10.1007/s11325-020-02241-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/22/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is induced by a sleep-related collapse of the upper airway in association with multiple factors. The severity of OSA is determined by the apnea-hypopnea index (AHI). Although obesity and sex differences are common factors in OSA, the level of the AHI varies to the same degree according to the age and sex and degree of obesity. However, only a few studies have evaluated AHI over 100/h, those reports did not describe why they set the AHI cutoff at 100/h. The purpose of this study was to elucidate the pathogenesis of "very" severe OSA, defined as having an AHI > 100/h. METHODS AHI > 100/h was set as very severe OSA (VS-OSA) in this study. As controls, moderate to severe OSA patients, matched with VS-OSA for age, sex, and body mass index (BMI), were enrolled. The findings of polysomnography and cephalography between VS-OSA and controls were compared. RESULTS Eleven patients in the VS-OSA group (mean AHI 110.2/h) and 22 patients in the control group (mean AHI 41.6/h) were compared (mean age 50.2 vs 50.6, male:female 5:6 vs 10:12, mean BMI 35.4 kg/m2 vs 34.5 kg/m2). There were no significant differences in the clinical characteristics. In the polysomnographic parameters, the VS-OSA group showed apnea predominance, the mean percutaneous oxygen saturation (SO2) was significantly lower in all sleep stages, and the minimum SO2 was significantly lower (49.0% vs 77.5%, p = 0.002). A similar apnea duration and rather shorter hypopnea duration were shown. The time of apnea-to-arousal was significantly earlier (- 0.1 s vs 0.9 s, p = 0.003). Lung-to-finger circulation time showed no differences. The cephalometric findings showed no significant differences. CONCLUSIONS VS-OSA patients were more likely to have apnea predominance, desaturation when sleeping despite a similar apnea duration, and rather shorter hypopnea duration, and arousals were evoked significantly earlier.
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Affiliation(s)
- Naoko Sata
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan
| | - Ayako Inoshita
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
- Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan.
| | - Shoko Suda
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Satomi Shiota
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Department of Respiratory Medicine, Juntendo University Hospital, Tokyo, Japan
| | - Nanako Shiroshita
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yo Suzuki
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan
| | - Takatoshi Kasai
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Chen H, Aarab G, Lobbezoo F, De Lange J, Van der Stelt P, Darendeliler MA, Cistulli PA, Sutherland K, Dalci O. Differences in three-dimensional craniofacial anatomy between responders and non-responders to mandibular advancement splint treatment in obstructive sleep apnoea patients. Eur J Orthod 2019; 41:308-315. [DOI: 10.1093/ejo/cjy085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hui Chen
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Department of Orthodontics, School of Stomatology, Shandong University and Key Laboratory of Oral Biomedicine of Shandong, Jinan, China
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Jan De Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Van der Stelt
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, New South Wales, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, and Charles Perkins Centre, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, and Charles Perkins Centre, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Oyku Dalci
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, New South Wales, Australia
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Inoshita A, Kasai T, Matsuoka R, Sata N, Shiroshita N, Kawana F, Kato M, Ikeda K. Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea. J Thorac Dis 2018; 10:6702-6710. [PMID: 30746215 DOI: 10.21037/jtd.2018.11.09] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Childhood obstructive sleep apnea (OSA) has important implications for growth, learning, behavior, cognition and cardiovascular health as well as snoring and OSA in adulthood. In this study, we elucidated the sex differences in polysomnographic (PSG) findings and pharyngeal radiographic data in pediatric OSA patients. Methods Sixty three children (age between 3 and 15 years old) with OSA [defined as apnea-hypopnea index (AHI) ≥1/h by polysomnography] were enrolled. Lateral neck radiographs were obtained from the patients. All subjects were separated by age: pre-adolescent group (3-8 years old) and adolescent group (9-15 years old). Results Overall, 45 patients in the pre-adolescent group (33 boys and 12 girls) and 18 patients in the adolescent group (10 boys and 8 girls) were enrolled, and sex differences were compared in each group. We found sex differences in craniofacial features and severity of OSA in the adolescent group, in which girls with OSA had more upper airway space, in addition to lower AHI, lower 3% oxygen desaturation index (ODI), higher minimum SO2 and better sleep efficiency than the boys. Conclusions The present study found revealed sex differences in pediatric OSA patients in the adolescent group. Girls in the adolescent group had more upper airway space in addition to lower AHI, lower 3% ODI, higher minimum SO2 and better sleep efficiency than boys.
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Affiliation(s)
- Ayako Inoshita
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan.,Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Takatoshi Kasai
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Rina Matsuoka
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Naoko Sata
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan.,Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Nanako Shiroshita
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsue Kato
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan
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da Silva BC, Kasai T, Coelho FM, Zatz R, Elias RM. Fluid Redistribution in Sleep Apnea: Therapeutic Implications in Edematous States. Front Med (Lausanne) 2018; 4:256. [PMID: 29404327 PMCID: PMC5786568 DOI: 10.3389/fmed.2017.00256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 12/14/2022] Open
Abstract
Sleep apnea (SA), a condition associated with increased cardiovascular risk, has been traditionally associated with obesity and aging. However, in patients with fluid-retaining states, such as congestive heart failure and end-stage renal disease, both prevalence and severity of SA are increased. Recently, fluid shift has been recognized to play an important role in the pathophysiology of SA, since the fluid retained in the legs during the day shifts rostrally while recumbent, leading to edema of upper airways. Such simple physics, observed even in healthy individuals, has great impact in patients with fluid overload. Correction of the excess fluid volume has risen as a potential target therapy to improve SA, by attenuation of nocturnal fluid shift. Such strategy has gained special attention, since the standard treatment for SA, the positive airway pressure, has low compliance rates among its users and has failed to reduce cardiovascular outcomes. This review focuses on the pathophysiology of edema and fluid shift, and summarizes the most relevant findings of studies that investigated the impact of treating volume overload on SA. We aim to expand horizons in the treatment of SA by calling attention to a potentially reversible condition, which is commonly underestimated in clinical practice.
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Affiliation(s)
- Bruno Caldin da Silva
- Renal Division, Department of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fernando Morgadinho Coelho
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roberto Zatz
- Renal Division, Department of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Rosilene M Elias
- Renal Division, Department of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Davoudmanesh Z, Bayat M, Abbasi M, Rakhshan V, Shariati M. Cephalometric risk factors associated with myocardial infarction in patients suffering from obstructive sleep apnea: A pilot case-control study. Cranio 2016; 35:15-18. [PMID: 27095068 DOI: 10.1080/08869634.2016.1169615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) and its craniofacial anatomic risk factors might play a role in several cardiovascular diseases, including myocardial infarction (MI). However, there are no data about cephalometric findings among OSA patients with MI. METHODS In this pilot case-control study, about 2000 individuals referred to the sleep center were evaluated according to apnea - hypopnea index (AHI) and other inclusion criteria. Included were 62 OSA male patients (AHI > 10), of whom 6 had an MI history. In both control (n = 56) and MI groups (n = 6), 18 cephalometric parameters were traced. Data were analyzed using independent samples t-test. RESULTS Compared with control OSA patients, OSA patients with MI showed a significantly larger tongue length (p = 0.015). The other cephalometric variables were not significantly different between the two groups. CONCLUSION An elongated tongue might be considered a risk factor for MI in OSA patients. The role of other variables remains inconclusive and open to investigation with larger samples (determined based on pilot studies such as this report) collected in longitudinal fashion.
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Affiliation(s)
- Zeinab Davoudmanesh
- a Craniomaxillofacial Research Center, Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran.,b Craniomaxillofacial Surgery Research Center , Dental Branch, Islamic Azad University , Tehran , Iran
| | - Mohamad Bayat
- a Craniomaxillofacial Research Center, Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran.,c Dental Faculty, Department of Oral and Maxillofacial Surgery , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohsen Abbasi
- a Craniomaxillofacial Research Center, Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran.,c Dental Faculty, Department of Oral and Maxillofacial Surgery , Tehran University of Medical Sciences , Tehran , Iran
| | - Vahid Rakhshan
- d Iranian Tissue Engineering and Graft Research Center , Tehran University of Medical Sciences , Tehran , Iran.,e Department of Dental Anatomy and Morphology , Dental Branch, Islamic Azad University , Tehran , Iran
| | - Mahsa Shariati
- a Craniomaxillofacial Research Center, Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran
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