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Punjabi N, Vacaru A, Inman JC. 3D Genial Tubercle Anatomic Considerations in Genioglossus Advancement Surgery. Otolaryngol Head Neck Surg 2024. [PMID: 39031714 DOI: 10.1002/ohn.870] [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: 03/11/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To qualitatively describe variation in morphology of the genial tubercle and quantify the spatial relationship between the tubercle and genioglossus muscle. STUDY DESIGN Case series. SETTING Cadaver dissection. METHODS Segmental sections of the mandible, with muscular attachments intact, were harvested from 18 fresh cadaver heads. Three-dimensional laser scans, with a resolution of 0.025 mm, were taken of each specimen with muscle attached and repeated after muscle removal. The genioglossus muscular attachment was measured relation to bony landmarks. RESULTS The morphology of the genial tubercle varied, with anywhere from 1 large spine to 4 individual spines. However, all specimens had a distinguishable superior portion of the tubercle, where the genioglossus attached, and an inferior portion, where the geniohyoid attached. The height of the superior tubercle (ST) was 6.1 mm (95% confidence inerval [CI]: 5.7-6.5). The height of the genioglossus muscle above the peak amplitude of the ST was 4.3 mm (3.8-4.9), but only 2.5 mm (2.0-3.0) below. On average, 64.4% (58.6-70.2) of the height of the genioglossus muscle attachment was above the peak. Overall, 19.5% (14.1-25.0) of the muscle surface area extended beyond the boundaries of the tubercle. CONCLUSION The genioglossus muscle attachment originates from the superior genial tubercle, which has a variable topography and amplitude. However, the muscle is not centered on the spines-more of the muscular fibers attach above the spine as compared to below. This new data may explain the genioglossus advancement "miss rate"-failure to advance muscle on initial osteotomy-of 39-78% reported in the literature.
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Affiliation(s)
- Nihal Punjabi
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexandra Vacaru
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jared C Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
- Loma Linda University School of Medicine, Loma Linda, California, USA
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Terawatpothong A, Sessirisombat C, Banhiran W, Hotokezaka H, Yoshida N, Sirisoontorn I. Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea. J Clin Med 2024; 13:3540. [PMID: 38930069 PMCID: PMC11204907 DOI: 10.3390/jcm13123540] [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: 05/16/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity remains controversial. To study OSA's etiology, cephalometry, fiberoptic pharyngoscopy, polysomnography, and sleep endoscopy have been used; however, airway obstructions cannot be located. Recent research suggested ultrasonography for OSA screening and upper airway obstruction localization. Thus, this study aims to investigate the relationship between specific craniofacial cephalometric and ultrasonic airway parameters in adults at high risk of OSA. Methods: To assess craniofacial structure, lateral cephalograms were taken from thirty-three adults over 18 with a STOP-Bang questionnaire score of three or higher and a waist-to-height ratio (WHtR) of 0.5 or higher. Airway parameters were assessed through submental ultrasound. Results: NSBA correlated with tongue base airspace width, while MP-H correlated with oropharynx, tongue base, and epiglottis airspace width. SNA, SNB, and NSBA correlated with tongue width at the oropharynx. At tongue base, ANB and MP-H correlated with tongue width. SNB and NSBA were associated with deep tissue thickness at the oropharynx, while MP-H correlated with superficial tissue thickness at velum and oropharynx. Conclusions: Cephalometric parameters (SNA, SNB, ANB, NSBA, and MP-H) were correlated with ultrasonic parameters in the velum, oropharynx, tongue base, and epiglottis.
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Affiliation(s)
- Anutta Terawatpothong
- Department of Clinical Dentistry, Walailak University International College of Dentistry (WUICD), 87 Ranong 2 Road, Dusit, Bangkok 10300, Thailand
| | - Chidchanok Sessirisombat
- Department of Clinical Dentistry, Walailak University International College of Dentistry (WUICD), 87 Ranong 2 Road, Dusit, Bangkok 10300, Thailand
| | - Wish Banhiran
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Hitoshi Hotokezaka
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Irin Sirisoontorn
- Department of Clinical Dentistry, Walailak University International College of Dentistry (WUICD), 87 Ranong 2 Road, Dusit, Bangkok 10300, Thailand
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Santamarina AB, de Freitas JA, Franco LAM, Nehmi-Filho V, Fonseca JV, Martins RC, Turri JA, da Silva BFRB, Fugi BEI, da Fonseca SS, Gusmão AF, Olivieri EHR, de Souza E, Costa S, Sabino EC, Otoch JP, Pessoa AFM. Nutraceutical blends predict enhanced health via microbiota reshaping improving cytokines and life quality: a Brazilian double-blind randomized trial. Sci Rep 2024; 14:11127. [PMID: 38750102 PMCID: PMC11096337 DOI: 10.1038/s41598-024-61909-3] [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: 12/31/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Nutraceutical interventions supporting microbiota and eliciting clinical improvements in metabolic diseases have grown significantly. Chronic stress, gut dysbiosis, and metainflammation have emerged as key factors intertwined with sleep disorders, consequently exacerbating the decline in quality of life. This study aimed to assess the effects of two nutraceutical formulations containing prebiotics (fructooligosaccharides (FOS), galactooligosaccharides (GOS), yeast β-glucans), minerals (Mg, Se, Zn), and the herbal medicine Silybum marianum L. Gaertn., Asteraceae (Milk thistle or Silymarin). These formulations, namely NSupple (without silymarin) and NSupple_Silybum (with silymarin) were tested over 180 days in overweight/obese volunteers from Brazil's southeastern region. We accessed fecal gut microbiota by partial 16S rRNA sequences; cytokines expression by CBA; anthropometrics, quality of life and sleep, as well as metabolic and hormonal parameters, at baseline (T0) and 180 days (T180) post-supplementation. Results demonstrated gut microbiota reshaping at phyla, genera, and species level post-supplementation. The Bacteroidetes phylum, Bacteroides, and Prevotella genera were positively modulated especially in the NSupple_Silybum group. Gut microbiota modulation was associated with improved sleep patterns, quality-of-life perception, cytokines expression, and anthropometric parameters post-supplementation. Our findings suggest that the nutraceutical blends positively enhance cardiometabolic and inflammatory markers. Particularly, NSupple_Silybum modulated microbiota composition, underscoring its potential significance in ameliorating metabolic dysregulation. Clinical trial registry number: NCT04810572. 23/03/2021.
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Affiliation(s)
- Aline Boveto Santamarina
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Pesquisa e Desenvolvimento Efeom Nutrição S/A, São Paulo, SP, 03317000, Brazil
| | - Jéssica Alves de Freitas
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Pesquisa e Desenvolvimento Efeom Nutrição S/A, São Paulo, SP, 03317000, Brazil
| | - Lucas Augusto Moyses Franco
- Laboratório de Parasitologia Médica (LIM-46), Departamento de Doenças Infecciosas e Parasitárias, Universidade de São Paulo Instituto de Medicina Tropical de São Paulo, São Paulo, SP, 05403-000, Brazil
| | - Victor Nehmi-Filho
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Pesquisa e Desenvolvimento Efeom Nutrição S/A, São Paulo, SP, 03317000, Brazil
| | - Joyce Vanessa Fonseca
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana (LIM-49)Departamento de Doenças Infecciosas e Parasitárias, Universidade de São Paulo Instituto de Medicina Tropical de São Paulo, São Paulo, SP, 05403-000, Brazil
| | - Roberta Cristina Martins
- Laboratório de Parasitologia Médica (LIM-46), Departamento de Doenças Infecciosas e Parasitárias, Universidade de São Paulo Instituto de Medicina Tropical de São Paulo, São Paulo, SP, 05403-000, Brazil
| | - José Antônio Turri
- Grupo de Pesquisa em Economia da Saúde, Departamento de Ginecologia e Obstetrícia, Universidade de São Paulo Faculdade de Medicina, São Paulo, SP, 01246903, Brazil
| | - Bruna Fernanda Rio Branco da Silva
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Laboratório Interdisciplinar em Fisiologia e Exercício, Universidade Federal de São Paulo (UNIFESP), Santos, SP, 11015-020, Brazil
| | - Beatriz Emi Itikawa Fugi
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Graduação em Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, 01246904, Brazil
| | - Sumaia Sobral da Fonseca
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Graduação em Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, 01246904, Brazil
| | - Arianne Fagotti Gusmão
- International Research Center, A.C. Camargo Cancer Center, São Paulo, SP, 01508-010, Brazil
| | | | - Erica de Souza
- Ambulatório Monte Azul, São Paulo, SP, 05801-110, Brazil
| | - Silvia Costa
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana (LIM-49)Departamento de Doenças Infecciosas e Parasitárias, Universidade de São Paulo Instituto de Medicina Tropical de São Paulo, São Paulo, SP, 05403-000, Brazil
| | - Ester Cerdeira Sabino
- Laboratório de Parasitologia Médica (LIM-46), Departamento de Doenças Infecciosas e Parasitárias, Universidade de São Paulo Instituto de Medicina Tropical de São Paulo, São Paulo, SP, 05403-000, Brazil
| | - José Pinhata Otoch
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil
- Pesquisa e Desenvolvimento Efeom Nutrição S/A, São Paulo, SP, 03317000, Brazil
- Faculdade de Medicina da, Universidade de São Paulo, Hospital Universitário da Universidade de São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Ana Flávia Marçal Pessoa
- Laboratório de Produtos e Derivados Naturais, Laboratório de Investigação Médica-26 (LIM-26), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, 01246903, Brazil.
- Pesquisa e Desenvolvimento Efeom Nutrição S/A, São Paulo, SP, 03317000, Brazil.
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Ren Y, Cui X, Zhu X, Guo H, Zhou Q, Yuan P, Cheng H, Wu W. Effect of Weight Loss on the Apnea Hypopnea Index is Related to Waist Circumference in Chinese Adults with Overweight and Obesity. Diabetes Metab Syndr Obes 2024; 17:453-463. [PMID: 38299196 PMCID: PMC10829506 DOI: 10.2147/dmso.s442738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose The present study aimed to evaluate the efficiency of traditional anthropometric and body composition parameters in predicting apnea hypopnea index (AHI) change after weight loss. Patients and Methods Chinese adults with overweight and obesity were included into this study containing two parts. A cross-sectional study was conducted in 137 individuals using the baseline data from two weight loss intervention trials. The second part was the weight-loss intervention study conducted in 60 overweight and obese patients with obstructive sleep apnea (OSA). All participants underwent physical examination, bioelectrical impedance analysis and overnight polysomnography. Multivariate linear regression models were used to identify the most accurate parameters to predict AHI and the mediation analysis to evaluate the mediators between weight loss and AHI reduction. Results Waist circumference (WC), body mass index and fat mass were positively associated with AHI after adjusting multiple collinearities in the cross-sectional study. After weight-loss intervention, body weight decreased from 94.6 ± 15.3 to 88.0 ± 13.9 kg, and AHI decreased from 41.9 (13.0,66.9) to 20.7 (8.7,51.2) events/h. Among these parameters, only percentage changes in WC and AHI across the intervention were positively intercorrelated after controlling for covariates (adjusted r = 0.271, P = 0.041). The mediation analysis supported WC as a mediator between weight loss and AHI reduction (standardized indirect effect [95% CI] = 4.272[0.936,7.999]). Conclusion Both general and abdominal obesity are of high prognostic value for OSA. WC as an easily accessible parameter mediates the effects of weight loss in decreasing OSA severity.
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Affiliation(s)
- Ye Ren
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Xiaochuan Cui
- Department of Sleep Center, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Xiaowen Zhu
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Hua Guo
- Department of Sleep Center, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Qunyan Zhou
- Department of Nutrition Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Peng Yuan
- Department of Rehabilitation, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Haiyan Cheng
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Wenjun Wu
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
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Senaratna CV, Lowe A, Walters EH, Abramson MJ, Bui D, Lodge C, Erbas B, Burgess J, Perret JL, Hamilton GS, Dharmage SC. Associations of early life and childhood risk factors with obstructive sleep apnoea in middle-age. Respirology 2024; 29:63-70. [PMID: 37733623 PMCID: PMC10952926 DOI: 10.1111/resp.14592] [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: 03/05/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Early-life risk factors for obstructive sleep apnoea (OSA) are poorly described, yet this knowledge may be critical to inform preventive strategies. We conducted the first study to investigate the association between early-life risk factors and OSA in middle-aged adults. METHODS Data were from population-based Tasmanian Longitudinal Health Study cohort (n = 3550) followed from 1st to 6th decades of life. Potentially relevant childhood exposures were available from a parent-completed survey at age 7-years, along with previously characterized risk factor profiles. Information on the primary outcome, probable OSA (based on a STOP-Bang questionnaire cut-off ≥5), were collected when participants were 53 years old. Associations were examined using logistic regression adjusting for potential confounders. Analyses were repeated using the Berlin questionnaire. RESULTS Maternal asthma (OR = 1.5; 95% CI 1.1-2.0), maternal smoking (OR = 1.2; 1.05, 1.5), childhood pleurisy/pneumonia (OR = 1.3; 1.04, 1.7) and frequent bronchitis (OR = 1.2; 1.01, 1.5) were associated with probable OSA. The risk-factor profiles of 'parental smoking' and 'frequent asthma and bronchitis' were also associated with probable OSA (OR = 1.3; 1.01, 1.6 and OR = 1.3; 1.01-1.9, respectively). Similar associations were found for Berlin questionnaire-defined OSA. CONCLUSIONS We found novel temporal associations of maternal asthma, parental smoking and frequent lower respiratory tract infections before the age of 7 years with adult OSA. While determination of their pathophysiological and any causal pathways require further research, these may be useful to flag the risk of OSA within clinical practice and create awareness and vigilance among at-risk groups.
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Affiliation(s)
- Chamara V. Senaratna
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- Non‐Communicable Diseases Research CentreUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Adrian Lowe
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - E. Haydn Walters
- School of Medicine and Menzies InstituteThe University of TasmaniaHobartTasmaniaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Dinh Bui
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
| | - Caroline Lodge
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Bircan Erbas
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
- Violet Vines Marshman Centre for Rural Health ResearchLa Trobe UniversityBendigoVictoriaAustralia
| | - John Burgess
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
| | - Jennifer L. Perret
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Institute for Breathing and Sleep (IBAS)HeidelbergVictoriaAustralia
| | - Garun S. Hamilton
- Department of Lung, Sleep, Allergy and ImmunologyMonash HealthClaytonVictoriaAustralia
- School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
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Saleh AM, Ahmed MA, El Said EA, Awadalla NJ, Attia AA. BASET scoring: A novel simple biometric score for screening and grading obstructive sleep apnea. Sleep Med X 2023; 6:100083. [PMID: 37635707 PMCID: PMC10457551 DOI: 10.1016/j.sleepx.2023.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background Polysomnography (PSG) is the gold-standard diagnostic tool for Obstructive Sleep Apnea (OSA). However, the availability of PSG is limited, and OSA is widely underdiagnosed; more than 80% of most developed nations undiagnosed. There is no diagnostic validated simple tool with clear cutoff point for predicting and roll out patient with OSA in primary care clinics significantly alters clinical outcomes. Objectives Our study aimed to assess the validity of BASET scoring as a new potential tool for screening and grading the severity of OSA patients. Methods After institution review board approval and formal patient consent, 144 subjects for suspected OSA and their relatives were enrolled. All subjects were subjected to a full night PSG study after history taking, sleep questionnaires, and physical examination, including BASET score components: B= Body Mass Index (BMI), A= Abdominal circumference (AC), S = Snoring, E= Epworth Sleepiness Scale, and T= Tongue teeth imprint. ROC analysis that used to assess the optimal cutoff point of the BASET score and to compare its accuracy for predicting OSA with Berlin and STOP-Bang scores. Results This study included 63 OSAS patients, 33 (52.38%) males and 30 (47.62%) females, and 81 controls; 22 (27.16%) males and 50 (72.84%) females. The Cronbach's alpha for the 5 BASET score components was 0.846, indicating the internal consistency reliability of the scale. Moreover, BASET score has a moderately strong positive significant correlation (r = 0.778, p<0.001) with AHI. By ROC analysis, the accuracy of the three measures was generally high, with BASET score predicting OSA most accurately (AUC=0.984, 95%CI: 0.956-0.999), followed by STOP-Bang (AUC=0.939, 95%CI: (0.887-0.972) and Berlin (AUC=0.901, 95%CI: 0.841-0.945). The AUC of BASET score was significantly higher compared to the Berlin score (difference= 0.0825, 95%CI: 0.039-0.125) and STOP-Bang score (difference= 0.0447, 95%CI: 0.011-0.078). On the other hand, there was no difference between the AUC of Berlin and STOP-Bang scores (difference=0.0378, 95%CI: 0.006 - 0.081 4). BASET score was significantly (p<0.001) associated with OSA grades. Conclusion BASET score is a convenient, reliable, and valid tool for diagnosing OSA. BASET score is more accurate for predicting OSA than Berlin and STOP-Bang scores, while there is no difference between Berlin and STOP-Bang scores. BASET score indicates OSA grades. Registration of clinical trials by number NCT05511974. Name of the registry ClinicalTrials.gov URL: https://clinicaltrials.gov/.
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Affiliation(s)
- Abdelbaset M. Saleh
- Department of Chest Medicine, Sleep Disordered Breathing Unit, Faculty of Medicine, Mansoura University, Egypt
| | - Magda A. Ahmed
- Department of Chest Medicine, Sleep Disordered Breathing Unit, Faculty of Medicine, Mansoura University, Egypt
| | - Eman A. El Said
- Department of Chest Medicine, Sleep Disordered Breathing Unit, Faculty of Medicine, Mansoura University, Egypt
| | - Nabil J. Awadalla
- Department of Public Health and Community Medicine, Faculty of Medicine Mansoura University, Egypt
| | - Amira A.M.M. Attia
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
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Sistla SK, Kanodia A. STOP-BANG Questionnaire: Inadequacies in Indian/Asian Context. Indian J Otolaryngol Head Neck Surg 2023; 75:2637. [PMID: 37636675 PMCID: PMC10447825 DOI: 10.1007/s12070-023-03791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
| | - Anupam Kanodia
- Asian Institute of Gastroenterology, Gachibowli, Hyderabad, Telangana 500032 India
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Hu LK, Liu YH, Yang K, Chen N, Ma LL, Yan YX. Association between hypertriglyceridemic-waist phenotype and circadian syndrome risk: a longitudinal cohort study. Hormones (Athens) 2023; 22:457-466. [PMID: 37423976 DOI: 10.1007/s42000-023-00462-6] [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: 12/29/2022] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Recently, circadian syndrome (CircS) has been proposed as a new predictor of cardiometabolic risk. We aimed to investigate the relationship between the hypertriglyceridemic-waist phenotype and its dynamic status with CircS in China. We conducted a two-stage study based on the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. Multivariate logistic regression models in cross-sectional analysis and Cox proportional hazards regression models in longitudinal analysis were used to estimate the associations of hypertriglyceridemic-waist phenotypes with CircS and its components. We then applied multiple logistic regression analysis to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) for CircS risk by transformation into the hypertriglyceridemic-waist phenotype. A total of 9863 participants were included in the cross-sectional analysis and 3884 participants in the longitudinal analysis. Compared with normal waist circumference (WC) and normal triglyceride (TG) level (NWNT), CircS risk was increased with enlarged WC and high TG level (EWHT) (hazard ratio (HR) 3.87 [95% CI: 2.38, 5.39]). Similar results were observed in subgroup analyses by sex, age, smoking status, and drinking status. During follow-up, CircS risk was increased in group K (stable EWNT during follow-up) (OR 9.97 [95% CI: 6.41, 15.49]) compared with group A (stable NWNT during follow-up), while group L (baseline enlarged WC and normal TG level transformed to follow-up EWHT) had the highest risk of CircS (OR 116.07 [95% CI: 72.77, 185.14]). In conclusion, the hypertriglyceridemic-waist phenotype and its dynamic status were associated with the risk of developing CircS in Chinese adults.
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Affiliation(s)
- Li-Kun Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Yu-Hong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Kun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Ning Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Lin-Lin Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Yu-Xiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China.
- Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
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Ronchi P, Saccomanno S, Disconzi B, Saran S, Carganico A, Bocchieri S, Mastrapasqua RF, Fiorillo L, Sambataro S, Cicciù M, Levrini L. Upper Airway Changes and OSAS Risk in Patients after Mandibular Setback Surgery to Treat III Class Skeletal Malocclusion. J Pers Med 2023; 13:1105. [PMID: 37511718 PMCID: PMC10382036 DOI: 10.3390/jpm13071105] [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: 05/19/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Mandibular setback surgery (MSS) is one of the treatment options to resolve mandibular prognathism in patients suffering from skeletal class III malocclusion, which cannot be treated with simple orthodontic treatment. The mandibular setback surgical operation can involve changes in the pharyngeal morphology, resulting in a narrowing of the posterior airway space (PAS). This aspect is associated with an increase in airflow resistance, which increases the risk of developing snoring or obstructive sleep apnea syndrome (OSAS). The aim of this study is to evaluate the medium- and long-term effects of mandibular setback surgery on the upper airways and its possible association with OSAS in patients suffering from class III skeletal malocclusion. MATERIAL AND METHODS A total of 12 patients (5 males and 7 females) were enrolled in this study. The statistical tests highlighted a significant change in the PAS and BMI values in relation to T0, before surgery (PAS: 12.7 SD: 1.2; BMI: 21.7 SD: 1.2), and T1, after surgery (PAS: 10.3 SD: 0.6, p < 0.01; BMI: 23.8 SD: 1.2, p < 0.05). Sample size was calculated to detect an effect size of 0.9, with statistical power set at 0.8 and the significance level set at 0.05. RESULTS No statistically significant correlation was found between the extent of mandibular setback, PAS and BMI change. CONCLUSION This study confirms the effects of mandibular setback surgery on the upper airways, reporting a statistically significant PAS reduction in the medium- and long-term follow-up. On the other hand, no direct correlation was identified with OSAS risk, at least for the small mandibular setback (<8 mm), despite the statistically significant increase in BMI.
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Affiliation(s)
- Paolo Ronchi
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy
| | - Sabina Saccomanno
- Orthodontic Residency, Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Barbara Disconzi
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy
| | - Stefano Saran
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy
| | - Andrea Carganico
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy
| | - Salvatore Bocchieri
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy
| | | | - Luca Fiorillo
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, India
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121 Naples, Italy
| | - Sergio Sambataro
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical Sciences, University of Catania, 95124 Catania, Italy
| | - Luca Levrini
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy
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10
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Kawasaki Y, Kitamura E, Kasai T. Impact of Body Composition on Sleep and Its Relationship with Sleep Disorders: Current Insights. Nat Sci Sleep 2023; 15:375-388. [PMID: 37220427 PMCID: PMC10200107 DOI: 10.2147/nss.s340946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Sleep is involved in many physiological processes and is essential for both physical and mental health. Obesity and sleep deprivation due to sleep disorders are major public health issues. Their incidence is increasing, and they have a wide range of adverse health-related consequences, including life-threatening cardiovascular disease. The impact of sleep on obesity and body composition is well-known, and many studies have shown an association between insufficient or excessive sleep duration and obesity, body fat percentage, and weight gain. However, there is growing evidence of the effects of body composition on sleep and sleep disorders (particularly sleep disordered breathing) through anatomical and physiological mechanisms (nocturnal fluid shift, core body temperature, or diet). Although some research has been conducted on the bidirectional effects of sleep-disordered breathing and body composition, the specific effects of obesity and body composition on sleep and the underlying mechanisms that explain these effects remain unclear. Therefore, this review summarizes the findings on the effects of body composition on sleep and draws conclusions and proposals for future research in this field.
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Affiliation(s)
- Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eri Kitamura
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- 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 Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan
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11
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Aini N, Chu H, Banda KJ, Chen R, Lee TY, Pien LC, Liu D, Lai YJ, Kang XL, Chou KR. Prevalence of sleep-related breathing disorders and associated risk factors among people with dementia: A meta-analysis. Sleep Med 2023; 103:51-61. [PMID: 36758347 DOI: 10.1016/j.sleep.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Sleep-related breathing disorders (SRBD) have shown to cause worsened cognitive impairment among people with dementia. Therefore, we conducted the first meta-analysis to estimate the prevalence of SRBD among people with dementia. METHODS Comprehensive searches were conducted in Embase, Ovid-MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, and CINAHL. The generalized linear mixed model (GLMM) was used for the pooled prevalence analysis and heterogeneity using I2 test and Cochran's Q-statistic in R-software. Study quality was assessed by Hoy's risk of bias assessment tool. Overall, 20 studies from 1282 studies were included with 1461 participants. RESULTS The pooled prevalence of SRBD among dementia was 59% (95%CI: 44%-73%) with 55% (95%CI: 34%-74%) for obstructive sleep apnea (OSA), 49% (95%CI: 25%-73%) for unspecified SRBD, and 11% (95%CI: 5%-21%) for central sleep apnea (CSA). Regarding dementia subtypes, the prevalence of SRBD was 89% (95%CI: 61%-97%) for Alzheimer's dementia, 56% (95%CI: 48%-63%) for Parkinson's and Idiopathic Parkinson's dementia, and 16% (95%CI: 8%-30%) for Huntington's dementia. Significant moderator variables were male, body mass index, larger waist and hip circumference, waist-hip ratio, and comorbidities including hypertension, dyslipidemia, renal disease, diabetes, heart disease, and stroke. CONCLUSIONS There is considerable high prevalence of SRBD among dementia people, with OSA and unspecified SRBD being fivefold higher than CSA. Regarding dementia subtypes, Parkinson's and Idiopathic Parkinson's, and Alzheimer's dementia had four to sixfold increased risk of presenting with SRBD than Huntington's dementia. Therefore, assessment and management of SRBD in Alzheimer's, and Parkinson's and Idiopathic Parkinson's dementia deserves more attention in future research.
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Affiliation(s)
- Nur Aini
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Nursing Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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12
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Jeong HG, Kim T, Hong JE, Kim HJ, Yun SY, Kim S, Yoo J, Lee SH, Thomas RJ, Yun CH. Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea. J Clin Sleep Med 2023; 19:327-337. [PMID: 36271597 PMCID: PMC9892734 DOI: 10.5664/jcsm.10258] [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: 02/16/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVES Information on obstructive sleep apnea (OSA) is often latently detected in diagnostic tests conducted for other purposes, providing opportunities for maximizing value. This study aimed to develop a convolutional neural network (CNN) to identify the risk of OSA using lateral cephalograms. METHODS The lateral cephalograms of 5,648 individuals (mean age, 49.0 ± 15.8 years; men, 62.3%) with or without OSA were collected and divided into training, validation, and internal test datasets in a 5:2:3 ratio. A separate external test dataset (n = 378) was used. A densely connected CNN was trained to diagnose OSA using a cephalogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Gradient-weighted class activation mapping (Grad-CAM) was used to evaluate the region of focus, and the relationships between the model outputs, anthropometric characteristics, and OSA severity were evaluated. RESULTS The AUROC of the model for the presence of OSA was 0.82 (95% confidence interval, 0.80-0.84) and 0.73 (95% confidence interval, 0.65-0.81) in the internal and external test datasets, respectively. Grad-CAM demonstrated that the model focused on the area of the tongue base and oropharynx in the cephalogram. Sigmoid output values were positively correlated with OSA severity, body mass index, and neck and waist circumference. CONCLUSIONS Deep learning may help develop a model that classifies OSA using a cephalogram, which may be clinically useful in the appropriate context. The definition of ground truth was the main limitation of this study. CITATION Jeong H-G, Kim T, Hong JE, et al. Automated deep neural network analysis of lateral cephalogram data can aid in detecting obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):327-337.
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Affiliation(s)
- Han-Gil Jeong
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Eun Hong
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Ji Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - So-Yeon Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sejoong Kim
- Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jun Yoo
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Robert Joseph Thomas
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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13
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Su X, Li K, Yang L, Yang Y, Gao Y, Gao Y, Guo J, Lin J, Chen K, Han J, Liu L. Associations between abdominal obesity and the risk of stroke in Chinese older patients with obstructive sleep apnea: Is there an obesity paradox? Front Aging Neurosci 2022; 14:957396. [PMID: 36172486 PMCID: PMC9510899 DOI: 10.3389/fnagi.2022.957396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeAbdominal obesity (AO) is a well-known independent risk factor for stroke in the general population although it remains unclear in the case of the elderly, especially in Chinese older patients with obstructive sleep apnea (OSA), considering the obesity paradox. This study aimed to investigate the association between AO and stroke among Chinese older patients with OSA.MethodsData were collected from January 2015 to October 2017, and 1,290 older patients (age 60–96 years) with OSA (apnea–hypopnea index ≥ 5 events/h on polysomnography) were consecutively enrolled from sleep centers at six hospitals, evaluated for AO defined as waist circumference (WC) using the standardized criteria for the Chinese population, and followed up prospectively for a median period of 42 months. Logistic regression and Cox regression analyses were used to determine the cross-sectional and longitudinal associations between AO and stroke risk in these participants and different groups of the severity of OSA.ResultsParticipants with AO had a higher prevalence of stroke at baseline. A higher incidence of stroke during a median follow-up period of 42 months in participants with AO than in participants without AO (12.4% vs. 6.8% and 8.3% vs. 2.4%, respectively; both P < 0.05) was predicted. Cross-sectional analysis revealed an association between AO and stroke (odds ratio [OR]1.96, 95% confidence interval [CI] 1.31–2.91), which was stronger among participants with moderate OSA only (OR 2.16, 95%CI 1.05–4.43). Cox regression analysis showed that, compared to participants without AO, participants with AO had a higher cumulative incidence of stroke (hazard ratio [HR] 2.16, 95% CI 1.12–4.04) during a median follow-up of 42 months, and this association was observed in patients with severe OSA only (HR 3.67, 95% CI 1.41–9.87) but not for individuals with mild OSA (HR = 1.84, 95% CI 0.43–6.23) and moderate OSA (HR = 1.98, 95% CI 0.73–6.45).ConclusionThe risk of stroke is associated with AO among Chinese older patients who have OSA, both at baseline and during follow-up, and the strength of the association varied by OSA severity. Active surveillance for early detection of AO could facilitate the implementation of stroke-preventive interventions in the Chinese older OSA population.
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Affiliation(s)
- Xiaofeng Su
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Sichuan College of Traditional Chinese Medicine, Mianyang, China
- Medical College, Yan’an University, Yan’an, China
| | - Kailiang Li
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ling Yang
- Medical College, Yan’an University, Yan’an, China
| | - Yang Yang
- Medical College, Yan’an University, Yan’an, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Yan Gao
- Department of General Practice, 960th Hospital of PLA, Jinan, China
| | - JingJing Guo
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
| | - Junling Lin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kaibing Chen
- Sleep Center, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
- *Correspondence: Lin Liu,
| | - Jiming Han
- Medical College, Yan’an University, Yan’an, China
- Jiming Han,
| | - Lin Liu
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Kaibing Chen,
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14
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Wu J, Lu Y, Cai X, Chen Y, Shen Z, Lyv Q. Gut microbiota dysbiosis in 4- to 6-year-old children with obstructive sleep apnea-hypopnea syndrome. Pediatr Pulmonol 2022; 57:2012-2022. [PMID: 35580999 DOI: 10.1002/ppul.25967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/16/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Several experiments on animals have reported the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and gut microbiota. We investigated the gut microbiota composition of children aged 4-6 years with OSAHS to complement the pathogenesis and clinical screening methods of OSAHS. METHODS We collected feces from 43 children with OSAHS and 45 controls aged 4-6 years. We extracted total bacterial DNA from feces and analyzed the composition of gut microbiota through 16S ribosomal RNA sequencing. RESULTS There were significant differences in bacteria producing short-chain fatty acids (SCFAs) between OSAHS children and controls, including Faecalibacterium, Roseburia, and a member of Ruminococcaceae. A gut microbiota model for pediatric OSAHS screening showed that the receiver operating characteristic-area under the curve (ROC-AUC) was 0.794 with 79.1% and 80.0% sensitivity and specificity, respectively. Functional analysis of the gut microbiota revealed several alterations in metabolism. CONCLUSION The composition of gut microbiota in OSAHS children is partially changed. The altered intestinal flora may provide a new screening method for the diagnosis of children with OSAHS. The prediction of gut microbiota function suggests that intestinal metabolic function may be altered in OSAHS children.
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Affiliation(s)
- Junhua Wu
- Medical School of Ningbo University, Ningbo, Zhejiang, China.,Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Yanbo Lu
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Xiaohong Cai
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Yuanyuan Chen
- Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Zhisen Shen
- Department of Otorhinolaryngology, Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qin Lyv
- Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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15
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Shnaimer JA, Dahlan HM, Hanbashi FM, Bahammam AS, Gosadi IM. Assessment of the risk of obstructive sleep apnoea among patients with type 2 diabetes and its associated factors using the STOP-BANG questionnaire: A cross-sectional study. J Taibah Univ Med Sci 2022; 17:606-613. [PMID: 35983435 PMCID: PMC9356349 DOI: 10.1016/j.jtumed.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the risk of obstructive sleep apnoea (OSA) and its associated risk factors among patients with type 2 diabetes in southern KSA. Methods This was a cross-sectional study conducted at the Armed Forces Hospital in Jazan. The prevalence of OSA was assessed using a validated Arabic translation of the STOP-BANG screening questionnaire. The odds of a higher OSA risk were calculated via regression analysis, according to the measured clinical and demographic variables. Results The total number of participants was 306, of which 213 (69.6%) were over the age of 50, 247 (80.7%) were married, and 161 (52.6%) were female. The overall median score of the OSA risk level assessed by the STOP-BANG items was three on a scale of 0–8, of which 193 (63.1%) of the participants in the sample were classified as being at high risk of developing OSA. Several statistically significant associations were identified, where odds ratios (ORs) with a higher OSA risk level were detected according to age, sex, marital status, waist and neck circumference, haemoglobin A1c (HbA1c) and body mass index levels, duration of diabetes, and comorbidity with hypertension (p < 0.05). Conclusion The higher risk of OSA identified in our sample of diabetic patients can be related to a high prevalence of obesity, larger neck circumferences, hypertension, and other factors linked to the duration and treatment of diabetes. Additionally, the association between waist circumference, HbA1c, and duration since the diagnosis of diabetes suggests an interaction effect that requires further investigation.
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Affiliation(s)
| | - Hesham M. Dahlan
- Department of Family Medicine, Jazan Armed Forces Hospital, Abu Arish, KSA
| | - Fatima M. Hanbashi
- Department of Family Medicine, Jazan Armed Forces Hospital, Abu Arish, KSA
| | - Ahmed S. Bahammam
- Department of Medicine, University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, KSA
| | - Ibrahim M. Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, KSA
- Corresponding address: Department of Family and Community Medicine, Faculty of Medicine, Jazan University, P.O. Box: 2349, Jazan, 82621, KSA.
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Tsai CY, Liu WT, Lin YT, Lin SY, Houghton R, Hsu WH, Wu D, Lee HC, Wu CJ, Li LYJ, Hsu SM, Lo CC, Lo K, Chen YR, Lin FC, Majumdar A. Machine learning approaches for screening the risk of obstructive sleep apnea in the Taiwan population based on body profile. Inform Health Soc Care 2021; 47:373-388. [PMID: 34886766 DOI: 10.1080/17538157.2021.2007930] [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: 02/08/2023]
Abstract
(a) Objective: Obstructive sleep apnea syndrome (OSAS) is typically diagnosed through polysomnography (PSG). However, PSG incurs high medical costs. This study developed new models for screening the risk of moderate-to-severe OSAS (apnea-hypopnea index, AHI ≥15) and severe OSAS (AHI ≥30) in various age groups and sexes by using anthropometric features in the Taiwan population.(b) Participants: Data were derived from 10,391 northern Taiwan patients who underwent PSG.(c) Methods: Patients' characteristics - namely age, sex, body mass index (BMI), neck circumference, and waist circumference - was obtained. To develop an age- and sex-independent model, various approaches - namely logistic regression, k-nearest neighbor, naive Bayes, random forest (RF), and support vector machine - were trained for four groups based on sex and age (men or women; aged <50 or ≥50 years). Dataset was separated independently (training:70%; validation: 10%; testing: 20%) and Cross-validated grid search was applied for model optimization. Models demonstrating the highest overall accuracy in validation outcomes for the four groups were used to predict the testing dataset.(d) Results: The RF models showed the highest overall accuracy. BMI was the most influential parameter in both types of OSAS severity screening models.(e) Conclusion: The established models can be applied to screen OSAS risk in the Taiwan population and those with similar craniofacial features.
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Affiliation(s)
- Cheng-Yu Tsai
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Wen-Te Liu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Tzu Lin
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shang-Yang Lin
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Robert Houghton
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Dizziness and Balance Disorder Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Biomedical Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Lok Yee Joyce Li
- Department of Medicine, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shin-Mei Hsu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chen-Chen Lo
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kang Lo
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - You-Rong Chen
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Feng-Ching Lin
- Division of Integrated Diagnostic and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Taipei, Taiwan
| | - Arnab Majumdar
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London, UK
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Kapoor P, Chowdhry A, Sengar P, Mehta A. Development, testing, and feasibility of a customized mobile application for obstructive sleep apnea (OSA) risk assessment: A hospital-based pilot study. J Oral Biol Craniofac Res 2021; 12:109-115. [PMID: 34840941 DOI: 10.1016/j.jobcr.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstructive Sleep Apnea (OSA), the most prevalent form of sleep-related breathing disorder has practical and financial limitations in diagnosis by polysomnography, hence OSA risk-assessment can identify OSA-related symptoms early. Objectives To develop a mobile application for OSA-risk assessment and tests its validity, feasibility, and application in a hospital-based pilot sample. Study design and methods The study comprised of two parts. Part i Development of a mobile application "OSA-Risk Assessment Tool" using automated questionnaires. Part ii A pilot study to screen OSA-risk in 200 patients (100 adults,100 children) from the orthodontic OPD of a Govt. Dental Hospital, using the mobile application. Internal validation by manual and mobile-based methods was done on 30 random patients. Non-parametric tests assessed the statistical differences between OSA-risk and nonOSA-risk variables. Results The prevalence of OSA-risk was 21.4% in adults and 8% in children. In adults, OSA-risk showed significantly greater neck circumference (p = 0.0001), waist circumference(p = 0.001), body mass index(p = 0.008), daytime sleepiness, headache, and mouth breathing(p = 0.0001). In children, OSA-risk is associated with a dry mouth on awakening, daytime sleepiness, and mouth breathing, and nocturnal enuresis. The low OSA-risk patients were suggested standardized preventive management counseling and orthodontic interventions while medium to high-risk underwent sleep-specialist referrals. Conclusions This study supports the feasibility and usability of the mobile application "OSA-risk assessment tool" in a hospital setup. This cost-effective tool can be advocated for self-evaluation, early detection, and awareness in pandemic times. The future upgraded versions may include preventive modules and real-time coordination with the nearest sleep clinics and specialists.
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Affiliation(s)
- Priyanka Kapoor
- Orthodontics & Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Aman Chowdhry
- Oral Pathology & Microbiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Poonam Sengar
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Abhishek Mehta
- Public Health Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
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Obstructive Sleep Apnea in a Clinical Population: Prevalence, Predictive Factors, and Clinical Characteristics of Patients Referred to a Sleep Center in Mongolia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212032. [PMID: 34831784 PMCID: PMC8624414 DOI: 10.3390/ijerph182212032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022]
Abstract
Obstructive sleep apnea (OSA) disrupts sleep. This study examined factors related to OSA severity. A cross-sectional, prospective, hospital-based study was conducted with 205 patients who underwent polysomnography (PSG). Demographic, anthropometric, clinical, PSG, and sleep quality assessment data were analyzed. Participants (N = 205) were classified into four groups based on apnea–hypopnea index (AHI); no OSA (AHI < 5/h; N = 14), mild (mOSA, 5 < AHI < 15/h; N = 50), moderate (modOSA, 15 < AHI < 30/h; N = 41), severe (sOSA, 30 < AHI < 60/h; N = 50), and very severe (vsOSA, AHI ≥ 60; N = 50). Men had more severe OSA than women (p < 0.001). Anthropometric characteristics differed with OSA severity (p < 0.001). OSA patients had decreased sleep quality and increased excessive daytime sleepiness (EDS). Body mass index (BMI), neck/waist circumference, and blood pressure (BP) differed between groups (p < 0.001). Patients with vsOSA had the highest Mallampati grades (p < 0.001). Multiple linear regression indicated that OSA severity was related to gender and sleep quality. PSG parameters (oxygen saturation, systolic BP, and arousal/respiratory arousal) were strongly related to OSA severity. In conclusion, about half of study-referred patients had severe/very severe OSA; these groups were predominantly obese men with high BP. OSA severity associated with high BP, BMI, waist circumference, and neck circumference.
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Pei C, Gui S. Effect of arterial blood bicarbonate (HCO 3-) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea. BMC Pulm Med 2021; 21:366. [PMID: 34774046 PMCID: PMC8590281 DOI: 10.1186/s12890-021-01720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01720-2.
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Affiliation(s)
- Chong Pei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 81 of Mei Shan Road, Hefei, 230001, Anhui, People's Republic of China.,Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), No. 390 of Huai He Road, Hefei, 230001, Anhui, People's Republic of China
| | - Shuyu Gui
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 81 of Mei Shan Road, Hefei, 230001, Anhui, People's Republic of China.
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20
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TUĞAN YILDIZ B, TUNCEL D, SÖKMEN G. Obstruktif uyku apne sendromu olan hastalarda ambulatuvar kan basıncının önemi ve vücut kitle indeksinin nondipping patern üzerine etkisi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.951570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Qin H, Chen C, Steenbergen N, Cheng Y, Penzel T. Time-dependence and comparison of regional and overall anthropometric features between Asian and Caucasian populations with obstructive sleep apnea: a cumulative meta-analysis. J Thorac Dis 2021; 13:1746-1759. [PMID: 33841965 PMCID: PMC8024799 DOI: 10.21037/jtd-20-1799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Anthropometric measurements are simple and reachable tools for self-evaluating and screening patients with a high risk of obstructive sleep apnea (OSA). However, the accumulated relationship of obesity on the anthropometric characteristics of OSA is not well understood. The aim of the study was to show the time-dependent trend of OSA patients and compare overall and regional anthropometric between two ethnicities. Methods A cumulative meta-analysis was performed to assess obesity metrics in patients with and without OSA between Asians and Caucasians. We searched PubMed, Web of Science, Embase, and Scopus up to Jun 2020. Included studies used body mass index (BMI), neck circumference (NC), waist circumference (WC) and waist-to-hip ratio (WHR) as measures of anthropometric features in the adult OSA population and controls, utilized in-lab polysomnography or home sleep testing with apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) classification, reported ethnicity/race, and were published in English. Any studies lacking one of these criteria or sufficient data were excluded. Results Forty studies with a total of 19,142 subjects were investigated. Comparison of changes between patients with and without OSA showed that OSA patients had a higher BMI [mean difference (MD) 3.12, 95% confidence interval (CI): 2.51–3.73], NC (MD 3.10, 95% CI: 2.70–3.51), WC (MD 9.84, 95% CI: 8.42–11.26) and waist-hip ratio (MD 0.04, 95% CI: 0.03–0.05) than the control subjects. The accumulated time-dependent increase in population with OSA was significantly apparent with all anthropometric features. BMI increased from 2000 (MD 0.50) to 2012 (MD 3.08–3.48) and remained stable afterwards (MD 2.70–3.17), NC increased from 2000 (MD 0.40) to 2013 (MD 3.09) and remained stable afterwards too (MD 3.06–3.21). WC increased from 2000 (MD 2.00) to 2012 (MD 9.37–10.03) and also remained stable afterwards (MD 8.99–9.84). WHR was stable from 2000 to 2004 with an MD of 0.01 and then stable from 2007 onwards with an increased MD of 0.03–0.04. Compared with Caucasian patients, Asian patients had lower obesity relevant variates. Conclusions BMI, NC, WC and WHR are associated with OSA in both ethnic groups. Anthropometry for overall and regional obesity could facilitate differentiation of patients with OSA from individuals without OSA by ethnicity.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Chongxiang Chen
- Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | | | - Yang Cheng
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, the Fourth Medical College of Peking University, Beijing, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany.,Saratov State University, Saratov, Saratov Oblast, Russia
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22
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Ribeiro OR, do Carmo I, Paiva T, Figueira ML. Body mass index and neuropsychological and emotional variables: joint contribution for the screening of sleep apnoea syndrome in obese. SLEEP SCIENCE (SAO PAULO, BRAZIL) 2021; 14:19-26. [PMID: 34104333 PMCID: PMC8157784 DOI: 10.5935/1984-0063.20200030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea (OSA) is the most common sleep disorder and its prevalence has increased with the obesity pandemic. We aimed to explore the presence of OSA in severe obesity and to evaluate the association of body mass index (BMI) with sleep architecture, cognition, emotional distress and comorbidities in OSA versus non-OSA patients. METHODS A sample of 61 patients performed a neuropsychological battery that included tasks of attention, memory, perceptual/visuospatial ability, vocabulary, inhibition, cognitive flexibility and distress symptomatology, before overnight polysomnography. RESULTS More than half of the sample had OSA. Excessive daytime sleepiness was not a prominent complaint. Sleep architecture was worse in the OSA than in the non-OSA group, and hypertension was increased with OSA, especially in the severe OSA group. A higher BMI was associated with cognitive distress and sleep variables and with type 2 diabetes. The apnoea-hypopnoea index (AHI) was correlated with gender and cognitive measurements. Cognitive complaints were associated with enhanced distress in both OSA and non-OSA patients. DISCUSSION OSA is considerably present in severely obese patients. The BMI was strongly associated with other important anthropometric measurements along with worsening sleep architecture and lower executive functioning, both of which may contribute to weight gain. The AHI was significantly higher in men and affected memory and maintaining sets on the Wisconsin Card Sorting Test which may represent a barrier to treatment adherence for this disorder. The substantial presence of cognitive complaints in OSA and non-OSA patients suggests the need for psychological intervention focused on adaptive coping strategies, mostly for depressive symptoms. Given the current obesity epidemic, these results support the need for routine sleep investigation in obese people, particularly in primary care settings. BMI, neuropsychological and emotional screening can provide crucial information about asymptomatic and high-risk patients who require prompt sleep intervention and obesity treatment.
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Affiliation(s)
- Olga Rodrigues Ribeiro
- Hospital Egas Moniz, Neuroscience - Lisbon - Portugal.,ISAMB - Instituto de Saúde Ambiental - Lisbon - Portugal
| | - Isabel do Carmo
- Hospital de Santa Maria, Endocrinology, Diabetes and Metabolism - Lisbon - Portugal
| | - Teresa Paiva
- Sleep Medicine Centre, Sleep Medicine - Lisbon - Portugal
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Del Brutto OH, Mera RM, Recalde BY, Castillo PR. Assessment of Neck Grasp as a Screening Tool for Identifying Obstructive Sleep Apnea in Community-Dwelling Older Adults. J Prim Care Community Health 2020; 11:2150132720984421. [PMID: 33356814 PMCID: PMC7768834 DOI: 10.1177/2150132720984421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Inability to encircle the neck by hands (neck grasp) has been proposed as an indicator of obstructive sleep apnea (OSA) that would be useful for recognition of candidates for polysomnography (PSG). We assessed the value of neck grasp for predicting OSA in community-dwelling older adults of Amerindian ancestry. Methods Neck grasp was evaluated in individuals aged ≥60 years undergoing PSG. The association between neck grasp and OSA was assessed by logistic regression models adjusted for relevant covariates. Mediation analysis was used to establish the proportion of the effect of the association between neck grasp and OSA, which is mediated by the neck circumference (a well-known OSA biomarker). Receiver operator characteristics curve analysis was used to estimate diagnostic accuracy of neck grasp for predicting OSA. Results Of 201 individuals undergoing PSG, 167 (83%) had the neck grasp test. The remaining 34 could not perform the test because of different factors. Neck grasp was positive in 127 (76%) cases, and 114 (68%) individuals had OSA (apnea-hypopnea index ≥5). Multivariate logistic regression models disclosed a significant association between neck grasp and OSA. The neck circumference was the single covariate remaining independently significant in these models. Neck grasp was not efficient at predicting OSA (sensitivity: 83.3%, specificity: 39.6%, positive predictive value: 0.75 and negative predictive value: 0.53). The area under the curve disclosed only a moderate predictive capability (61.5%) of neck grasp. Conclusion Results do not support the use of neck grasp as an independent predictor of OSA in the study population.
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Affiliation(s)
- Oscar H. Del Brutto
- Universidad Espíritu Santo—Ecuador, Samborondón, Ecuador
- Oscar H. Del Brutto, School of Medicine, Universidad Espíritu Santo—Ecuador, Air Center 3542, PO Box 522970, Miami, Fl 33152-2970, USA.
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24
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Dong L, Lin M, Wang W, Ma D, Chen Y, Su W, Chen Z, Wang S, Li X, Li Z, Liu C. Lipid accumulation product (LAP) was independently associatedwith obstructive sleep apnea in patients with type 2 diabetes mellitus. BMC Endocr Disord 2020; 20:179. [PMID: 33298050 PMCID: PMC7727244 DOI: 10.1186/s12902-020-00661-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lipid accumulation product (LAP) is a new index based on a combination of waist circumference (WC) and serum triglycerides (TG) reflecting lipid accumulation. In this cross-sectional study, we aimed to explore whether LAP was independently associated with obstructive sleep apnea (OSA) in Type 2 diabetes mellitus (T2DM) patients. METHODS A cross-sectional study of 317 T2DM patients who underwent overnight polysomnography (PSG) tests was conducted. The clinical data between non-OSA group and OSA group were compared. Multivariable linear regression and multivariable logistic regression analyses were performed to determine associations of LAP, with apnea-hypopnea index (AHI) and OSA. RESULTS Among 317 patients, 219 (69.1%) were men, and the mean ages (±SD) were 51.4 (±13.5) years for men and 54.6 (±15.1) years for women (p = 0.067). The prevalence rates of OSA were 63.0% for men and 68.4% for women (p = 0.357). LAP (log-transformed) was significantly correlated with AHI (log-transformed), with the Pearson's correlation coefficient of 0.170 (p = 0.002). With adjustment for potential confounding factors, multivariate linear regression analyses showed the association of LAP with AHI was not statistically significant, with the adjusted linear regression coefficients (95% CI) of per SD increase of LAP for AHI (log-transformed) was 0.092 (- 0.011-0.194, p = 0.080). Multivariate logistic regression analyses showed LAP was significantly associated with increased risk of OSA, with the adjusted OR (95%CI) of per SD increase of LAP of 1.639 (1.032-2.604, p = 0.036). However, as constituents of LAP, neither TG nor WC was significantly associated with AHI and OSA. CONCLUSION LAP was independently associated with OSA and might be used as a potential OSA risk marker in T2DM patients, beyond the general index of obesity.
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Affiliation(s)
- Lianqin Dong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Wengui Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
| | - Danyan Ma
- School of Medicine, Xiamen University, Xiamen, China
| | - Yun Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Weijuan Su
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Zheng Chen
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Shunhua Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Zhibin Li
- Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China.
| | - Changqin Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China.
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China.
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China.
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Wang X, Li W, Zhou J, Wei Z, Li X, Xu J, Zhang F, Wang W. Smoking and sleep apnea duration mediated the sex difference in daytime sleepiness in OSA patients. Sleep Breath 2020; 25:289-297. [PMID: 32529520 DOI: 10.1007/s11325-020-02109-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Daytime sleepiness is a common symptom of obstructive sleep apnea (OSA) and is more common in men, but the underlying mechanism remains unclear. The aim of this study was to assess whether or not sex differences in daytime sleepiness persisted after controlling for age and OSA severity and to explore the factors contributing to daytime sleepiness in patients with OSA. METHODS A total of 104 pairs of patients with OSA, matched by age and apnea-hypopnea index (AHI), were enrolled in this retrospective study. Demographic data were collected; daytime sleepiness was measured by the Epworth Sleepiness Scale (ESS); and polysomnography (PSG) was performed on each participant. These measurements were compared between sexes, and the factors affecting daytime sleepiness were explored with correlation and multivariate linear regression analyses. RESULTS Men had significantly higher ESS scores (p = 0.021) than women. Regarding demographics, BMI, neck/height ratio, and proportion of habitual smoking and alcohol intake were significantly higher in men. Regarding PSG findings, men had more rapid eye movement sleep, a longer mean apnea-hypopnea duration, and a longer mean apnea duration (MAD). Regression analysis showed that two sex-associated variables, habitual smoking (β = 0.189, p = 0.006) and MAD (β = 0.154, p = 0.024), had the strongest association with ESS scores. Further analysis revealed that MAD was significantly influenced by apnea index (β = 0.306, p < 0.001) and sex (β = - 0.193, p = 0.003). CONCLUSION The sex difference in daytime sleepiness persists in patients with OSA, even after matching AHI and age. The difference is mediated by sex-specific smoking habits and sex differences in apnea duration.
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Affiliation(s)
- Xingjian Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenyang Li
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiawei Zhou
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhijing Wei
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaomeng Li
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiahuan Xu
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Fang Zhang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China.
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Orbea CAP, Lloyd RM, Faubion SS, Miller VM, Mara KC, Kapoor E. Predictive ability and reliability of the STOP-BANG questionnaire in screening for obstructive sleep apnea in midlife women. Maturitas 2020; 135:1-5. [PMID: 32252960 PMCID: PMC7644815 DOI: 10.1016/j.maturitas.2020.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The STOP-BANG questionnaire (snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender) was originally validated to screen for obstructive sleep apnea (OSA) in the surgical population. It has been validated in mixed populations of men and women. We aimed to evaluate its reliability for OSA screening of midlife women. STUDY DESIGN We retrospectively evaluated midlife women seen at the Women's Health Clinic at Mayo Clinic in Rochester, Minnesota, who completed the STOP-BANG questionnaire and subsequently underwent diagnostic polysomnography (PSG) or home sleep apnea testing (HSAT). MAIN OUTCOME MEASURES The questionnaire's predictive ability was assessed with the apnea hypopnea index (AHI) measured at PSG and HSAT. RESULTS Because participants were female, the gender question response was consistently 0, making the mean (SD) STOP-BANG score low at 3 (1.2). The most sensitive item to detect any OSA and moderate to severe OSA through STOP-BANG was observed apneas; the most specific item to detect OSA and moderate to severe OSA was neck circumference exceeding 40 cm. A score of 3 or more had a sensitivity of 77 % and a specificity of 45 % to detect moderate to severe OSA. The area under the curve with the STOP-BANG score to predict moderate to severe OSA was 0.67 (95 % CI, 0.51-0.84). CONCLUSIONS Interpretation of the STOP-BANG questionnaire is nuanced for midlife women. Given the nature of its questions, a lower score may be predictive of more severe OSA in women, necessitating use of a lower threshold to trigger further testing.
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Affiliation(s)
| | - Robin M Lloyd
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Virginia M Miller
- Division of Surgery Research, Mayo Clinic, Rochester, MN, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Ekta Kapoor
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, United States.
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Kuo CFJ, Lin CS, Chuang CH, Lin CS, Chiu FS, Liu SC. Quantitative Morphometric Measurements of the Oropharynx in Obstructive Sleep Apnea Syndrome Using a Laser Depth Measurement Module. Nat Sci Sleep 2020; 12:1181-1190. [PMID: 33363424 PMCID: PMC7754258 DOI: 10.2147/nss.s284836] [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: 10/01/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Current diagnostic routines in obstructive sleep apnea syndrome (OSAS), including drug-induced sleep endoscopy (DISE), provide qualitative data. Quantitative morphometric measurements of oropharyngeal structures remain challenging. This study aims to introduce a special linear laser projection device that can facilitate computer-assisted digitalized analysis and provide important quantitative information for OSAS prediction. MATERIALS AND METHODS We used a single-wavelength green three-linear laser to provide the scaling reference, with one at an angle of 8.5 degrees with the other two which were parallel. The oropharyngeal images were divided into two groups: the non-OSAS and OSAS group, after polysomnography. A minimum of three evaluations were carried out to determine the maximum cross-sectional area of the oropharyngeal inlet (CSAOI) and the retropalatal depth. RESULTS A total of 132 subjects were enrolled in this study, with 76 subjects in the non-OSAS group and 56 cases in the OSAS group. In the non-OSAS group, the CSAOI was significantly larger in males than in females. There was a trend toward deeper retropalatal region in men than in women (14.25 vs 11.76 mm). Correlation analysis revealed that retropalatal depth is significantly related to body height and the CSAOI. The body weight and BMI of patients with OSAS were significantly higher than those of participants without OSAS. The retropalatal depth and CSAOI were significantly decreased in OSAS patients as compared to those without OSAS. Our new parameter, the oropharyngeal index, showed the most outstanding discrimination by ROC analysis to predict OSAS. CONCLUSION Our innovative module can provide reference parameters, which make it possible to directly estimate the objective absolute values of relevant oropharyngeal structures. Our non-invasive approach can be used for outpatient screening, since it allows the identification of potential OSAS patients who should be referred for polysomnography, as many patients do not require DISE early in their evaluation.
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Affiliation(s)
- Chung-Feng Jeffrey Kuo
- Department of Material Science & Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Cheng-Hsien Chuang
- Department of Material Science & Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Chung-Shen Lin
- Department of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Feng-Shiang Chiu
- Department of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Unal Y, Aslan Ozturk D, Tosun K, Kutlu G. Response to: Obstructive sleep apnea syndrome and obesity: screening ability. Sleep Breath 2019; 24:1671-1672. [PMID: 31792909 DOI: 10.1007/s11325-019-01974-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/02/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yasemin Unal
- Department of Neurology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
| | - Dilek Aslan Ozturk
- Department of Neurology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | | | - Gülnihal Kutlu
- Department of Neurology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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Obstructive sleep apnea syndrome and obesity: screening ability. Sleep Breath 2019; 24:743. [PMID: 31776898 DOI: 10.1007/s11325-019-01973-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/23/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
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