1
|
Morris JL, Orbell S, Scott PW, Imes CC, Jeon B, Baniak LM, Burke LE, Chasens ER. Risk stratification by sex and menopausal status in the multivariable apnea prediction index. Sleep Breath 2023; 27:1695-1702. [PMID: 36571709 DOI: 10.1007/s11325-022-02766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVES To determine the sensitivity of the Multivariable Apnea Prediction (MAP) index for obstructive sleep apnea (OSA) in pre- and post-menopausal women with the goal of developing a tailored scoring classification approach. METHODS Data from two studies (N = 386); the diabetes sleep treatment trial (N = 236) and EMPOWER (N = 150) were used to assess the sensitivity and specificity of the MAP index by comparing men (n = 129) to women (n = 257), and premenopausal (n = 100) to post-menopausal women (n = 136). We evaluated participants at two cut points, apnea-hypopnea index (AHI) values of ≥ 5 and ≥ 10, using 0.5 as a predicted probability cut point to establish baseline sensitivity and specificity. Contingency tables and receiver operating characteristic (ROC) analysis were conducted to evaluate the accuracy of the MAP index in predicting OSA in men versus women, and in pre-versus post-menopausal women. To select optimal predicted probabilities for classification by sex and menopausal status, Youden's J statistic was generated from ROC coordinates. RESULTS The MAP index was more sensitive to women in the AHI ≥ 5 group (76%) compared to AHI ≥ 10 group (30%). Among post-menopausal women with AHI ≥ 5, sensitivity was similar to men (98%), but less than men when AHI ≥ 10 (32%). Suggested probability cut points for women with an AHI ≥ 10 are 0.24 overall; 0.15 for premenopausal, and 0.38 for postmenopausal women. CONCLUSIONS Because women's risk for OSA (AHI ≥ 10) was underestimated by the MAP index, we suggest the use of tailored cut points based on sex and menopausal status or assessing for OSA risk with an AHI of ≥ 5.
Collapse
Affiliation(s)
- Jonna L Morris
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA.
| | - Staci Orbell
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA
| | - Paul W Scott
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA
| | - Christopher C Imes
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA
| | - Bomin Jeon
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA
| | - Lynn M Baniak
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA
- VA Healthcare system, PA, Pittsburgh, USA
| | | | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA
| |
Collapse
|
2
|
Lee YH. Implications of Obstructive Sleep-related Breathing Disorder in Dentistry: Focus on Snoring and Obstructive Sleep Apnea. DENTAL RESEARCH AND ORAL HEALTH 2022; 5:74-82. [PMID: 36310852 PMCID: PMC9608377 DOI: 10.26502/droh.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obstructive sleep-related breathing disorder (SRBD) is an umbrella term that encompasses various types of upper airway dysfunctions during sleep characterized by increased respiratory effort secondary to snoring and/or increased upper airway resistance and pharyngeal collapse. Obstructive sleep apnea (OSA) is a representative SRBD that involves a significant decrease in or cessation of airflow despite the presence of respiratory effort. While snoring is considered a normal condition, it can cause serious noise disturbance to sleep partners and is considered a predictor of OSA. Snoring and OSA are highly correlated with obesity. SRBDs can lead to cardiovascular disease, hypertension, decreased quality of life, decreased work efficiency, daytime sleepiness, decreased neurocognitive activity, and psychological impairments. In dentistry, research on sleep problems has focused on temporomandibular disorder (TMD)/orofacial pain. The relationship between OSA and TMD/orofacial pain has been reported, but it is not clear whether it is a simple correlation or a causal relationship. Therefore, we aimed to review the causes of SRBDs including snoring and OSA and to review and infer the relationship between these SRBDs and TMD/orofacial pain. The effects of snoring and OSA extend beyond sleep disturbances and are worthy of future research, especially with regard to TMD.
Collapse
Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Kyung Hee Medical center, Kyung Hee University, Seoul, Korea
| |
Collapse
|
3
|
Smardz J, Wieckiewicz M, Gac P, Poreba R, Wojakowska A, Mazur G, Martynowicz H. Influence of age and gender on sleep bruxism and snoring in non-apneic snoring patients: A polysomnographic study. J Sleep Res 2020; 30:e13178. [PMID: 32871629 DOI: 10.1111/jsr.13178] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
The present study aimed to assess the influence of gender and age on snoring and sleep bruxism in non-apneic snoring patients. Adult participants with clinical suspicion of snoring and with no other significant medical history were recruited. Single-night video polysomnography was performed to detect snoring and sleep bruxism. Finally, 137 snoring non-apneic participants were included. Statistical analysis of gender groups showed that the total snore index and snore train were significantly higher in men than in women. Men also presented severe bruxism, with significantly more frequent episodes and higher bruxism episodes index scores. The correlation analysis showed the presence of significant linear relationships in the supine sleep position between age and snore index, snore index in non-rapid eye movement 2 (N2) sleep stage, and snore train. The analysis of groups separated according to the criterion of third age quartile showed that the average, maximum and minimum audio volume in the non-supine sleep position was significantly higher in the older group. The analysis of groups separated according to the criterion of median age showed that the bruxism episode index and bruxism phasic episodes were significantly higher in the younger group. Thus, it can be concluded that both age and gender influence snoring and sleep bruxism. Snoring and sleep bruxism seem to be more intensive in men. Older patients seem to snore more in N2 sleep and the supine sleep position and present lower bruxism episodes, especially the phasic type. The results of the present study indicate the need for further research on this topic to establish the possible relationship between snoring and sleep bruxism.
Collapse
Affiliation(s)
- Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Pawel Gac
- Department of Hygiene, Wroclaw Medical University, Wroclaw, Poland
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
4
|
Sekizuka H, Miyake H. Relationship between Snoring and Lifestyle-related Diseases among a Japanese Occupational Population. Intern Med 2020; 59:2221-2228. [PMID: 32938849 PMCID: PMC7578604 DOI: 10.2169/internalmedicine.4723-20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Snoring is a common physical condition in active workers. However, the link between snoring and health problems is poorly understood. Therefore, the prevalence of snoring in Japanese workers and the relationships between snoring and lifestyle-related diseases were investigated. Methods This was a retrospective, single-center, cross-sectional study. The results of a single year's medical examinations were investigated for 25,141 Japanese active office workers 20 to 59 years old. The presence and duration of snoring were investigated using a personal computer at a medical interview before the medical checkup. The snoring frequency was investigated for each gender. In addition, the relationships between snoring and hypertension, diabetes, and dyslipidemia were also analyzed. Results Men (21,774) were a mean 46±6 years old with a snoring prevalence of 43%. Women (3,367) were a mean 46±6 years old with a snoring prevalence of 20%. In men, snoring was an independent comorbid factor of hypertension and dyslipidemia. In particular, a long snoring vintage (multiple years) was an independent comorbid factor for hypertension [odds ratio (OR), 1.14; 95% confidence interval (CI), 1.05-1.24; p=0.002; and OR, 1.20; 95% CI, 1.07-1.34; p=0.001]. In women, snoring was not an independent comorbid factor for lifestyle-related diseases when adjusted for the age and body mass index. Conclusion Snoring was shown to be a frequent pathophysiology in active workers. It was a health indicator for active workers, and especially in men, intervention for snoring may reduce the risk of developing lifestyle-related diseases.
Collapse
Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, FUJITSU Clinic, Japan
- Health Promotion Unit, FUJITSU LIMITED, Japan
| | | |
Collapse
|
5
|
Al-Dekhel K, Banabilh SM. Impact of Habitual Snoring on Subjective Dental Esthetics in University Population. J Int Soc Prev Community Dent 2019; 9:27-32. [PMID: 30923690 PMCID: PMC6402254 DOI: 10.4103/jispcd.jispcd_336_18] [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: 09/24/2018] [Accepted: 11/05/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aims of this study were to assess the prevalence of snoring in the University population and to test the null hypothesis that there is no impact of habitual snoring on the self-perceived of dental esthetics. MATERIALS AND METHODS Berlin Questionnaire and esthetic component of the index of orthodontic treatment need was given to 700 students and employees aged 17-59 years (22 ± 4.5). Both snorers and nonsnorers were assessed for orthodontic treatment need. Chi-square and Student t-test were used to compare the difference between both groups using SPSS Statistics for Windows, Version 23.0. (IBM Corp, Armonk, NY). RESULTS The prevalence of snoring was 19.2% (male 11.8% and female 7.4%). Nodded off or fall asleep during driving a car or while waiting at least twice a month were reported in 46%. The prevalence of tiredness and fatigue after sleep from 3 to 4 times a week was 36.9% and during the working time was 33.6%. Based on the Berlin Questionnaire stratification for risk of obstructive sleep apnea (OSA), 8.2% were considered as a high-risk patient for OSA, (males: 3.8% and females: 4.4%). About 38.3% of the participants with habitual snoring have gone through orthodontic treatment, while only 28.5% of nonsnoring participant have done that. About 12.3% of snoring participant consider themselves in need of orthodontic treatment compared to 6.6% of a nonsnoring participant (P < 0.04). CONCLUSION The null hypothesis is rejected; snoring has an impact on the self-perceived of dental esthetics. Snoring participant seeks orthodontic treatment more than the nonsnoring participant in our University population.
Collapse
Affiliation(s)
- Khaled Al-Dekhel
- Interns Affairs Unit, College of Dentistry, Qassim University, Saudi Arabia
| | - Saeed M. Banabilh
- Department of Orthodontic and Pedodontic, College of Dentistry, Qassim University, Saudi Arabia,Address for correspondence: Dr. Saeed M. Banabilh, Associate Professor, Department of Orthodontic and Pedodontic, College of Dentistry, Qassim University, Buraidah 51412, P. O. Box 6700, Saudi Arabia. E-mail:
| |
Collapse
|
6
|
Cohen-Levy J, Quintal MC, Abela A, Rompré P, Almeida FR, Huynh N. Persistent sleep disordered breathing after adenoidectomy and/or tonsillectomy: a long-term survey in a tertiary pediatric hospital. Sleep Breath 2018; 22:1197-1205. [PMID: 30324546 DOI: 10.1007/s11325-018-1734-3] [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] [Received: 06/04/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the long-term prevalence of persistent sleep disordered breathing (SDB) in children, after adenoidectomy, tonsillectomy or adenotonsillectomy, and to assess the relationship between baseline characteristics and persistent nocturnal symptoms. METHODS The clinical charts of children operated for adenoidectomy and/or tonsillectomy in a tertiary hospital, between January 2000 and March 2016, were retrospectively reviewed. All patients who had signs of SDB prior to surgery received a six-question validated pediatric questionnaire, the Hierarchic Severity Clinical Scale (HSCS). RESULTS A total of 4000 children showing SDB prior to surgery were selected out of 5809 (68.9%); 1176 parents returned the questionnaire (29.4%), with a mean age at surgery of 4.3 ± 2.2 and age at survey of 9.6 ± 3.6. Complete resolution of SDB was subjectively reported in 798 patients (67.9%), and mild SDB was suspected in 301 children (25.6%, HSCS > 0 with chronic snoring), while 77 (6.5%) had a HSCS > 2.72, suggesting persistent obstructive sleep apnea. In non-syndromic children, male sex, history of sole adenoidectomy, or sole tonsillectomy, and early age of surgery (< 2 years-old) were associated with higher HSCS scores (p < 0.05). Moreover, symptoms had a tendency to decrease from 1 to 6 years, re-occur at age 7-8, and also after 13, with boys reporting more severe symptoms, at a younger age. CONCLUSIONS Surgical excision of lymphoid tissue to treat SDB in childhood seems to be effective in the long term in two-thirds of subjects, while partial surgeries, specific age groups and early surgery are more likely to have persistent or recurrent symptoms.
Collapse
Affiliation(s)
- Julia Cohen-Levy
- Clinique d'orthodontie majeure, Faculté de médecine dentaire, Université de Montréal, Montréal, Canada.
| | | | - Anthony Abela
- Service d'Oto-Rhino-Laryngologie, CHU Sainte-Justine, Montréal, Canada
| | - Pierre Rompré
- Clinique d'orthodontie majeure, Faculté de médecine dentaire, Université de Montréal, Montréal, Canada
| | - Fernanda R Almeida
- Dentistry University of British Columbia, Vancouver, Canada.,Centre de recherche, CHU Sainte-Justine, Montréal, Canada
| | - Nelly Huynh
- Centre de recherche, CHU Sainte-Justine, Montréal, Canada
| |
Collapse
|
7
|
Doyle-McClam M, Shahid MH, Sethi JM, Koo P. Nocturia in Women With Obstructive Sleep Apnea. Am J Lifestyle Med 2018; 15:260-268. [PMID: 34025318 DOI: 10.1177/1559827618782657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is underdiagnosed in women compared with men. Women have a tendency to underreport or present with atypical symptoms such as behavior changes, insomnia, fatigue, and depression. Nocturia, waking up from sleep 2 times or more to void, has been shown to be associated with OSA, but it is not an included symptom in commonly used screening questionnaires in primary provider offices. About 50% of patients with OSA have nocturia, and treatment of OSA improves it. Recognition of nocturia as a relevant symptom of OSA is important for primary providers to provide timely referral for the diagnosis of OSA.
Collapse
Affiliation(s)
- Megan Doyle-McClam
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Muhammad H Shahid
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Jigme M Sethi
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Patrick Koo
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| |
Collapse
|