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Kara İ, Ramadan S, Şenkal E, Koçdor P. Pediatric T-cell Lymphoblastic Leukemia/Lymphoma Diagnosed at Routine Adenoidectomy Specimen. Int J Surg Pathol 2022:10668969221142044. [DOI: 10.1177/10668969221142044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Postoperative routine pathologic evaluation of tonsillectomy and adenoidectomy specimens rarely reveals a diagnosis of malignancy. The object of this case report is to highlight this rare clinical occurrence. A 4-year-old boy presented with symptoms of sleep-disordered breathing and had a history of recurrent tonsillitis. Physical examination revealed adenoid hypertrophy and Brodsky Grade 1 bilateral tonsillar hypertrophy. The patient underwent adenoidectomy and tonsillectomy. The adenoids were found to be MAGS Grade 4 (Modified Adenoid Grading System) hypertrophic causing 100% obstruction. After the histologic examination, T-cell lymphoblastic leukemia/lymphoma was diagnosed. Proper treatment allowed full recovery. Currently, no consensus has been made about routine pathological evaluation. To achieve a cost-effective and precautionary approach, we recommend pathological follow-up of cases with unusual intraoperative findings with/without clinical malignancy suspicion.
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Affiliation(s)
- İlke Kara
- Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey
- Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Saime Ramadan
- Department of Pathology, Başkent University, Istanbul, Turkey
| | - Evrim Şenkal
- Department of Pediatrics, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Pelin Koçdor
- Koç University Research Center for Translational Medicine, Istanbul, Turkey
- Department of Otolaryngology-Head and Neck Surgery, Başkent University, Istanbul, Turkey
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2
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Dunietz GL, Hao W, Shedden K, Holzman C, Chervin RD, Lisabeth LD, Treadwell MC, O’Brien LM. Maternal habitual snoring and blood pressure trajectories in pregnancy. J Clin Sleep Med 2022; 18:31-38. [PMID: 34170225 PMCID: PMC8807914 DOI: 10.5664/jcsm.9474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic vs pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined. This study compared patterns of BP across pregnancy in 3 groups of women: those with chronic habitual snoring, those with pregnancy-onset habitual snoring, and nonhabitual snoring "controls." METHODS In a cohort study of 1,305 pregnant women from a large medical center, participants were asked about habitual snoring (≥ 3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic, health, and BP data throughout pregnancy were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories. RESULTS A third of women reported snoring prior to pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Mean maternal age (SD) was 29.5 (5.6), 30 (6), and 30.5 (5.7) years in controls, chronic, and pregnancy-onset snoring, respectively. Overall, women with pregnancy-onset snoring had higher mean systolic BP and diastolic BP compared to those with chronic habitual snoring or nonhabitual snoring. In gestational week-specific comparisons with controls, systolic BP became significantly higher around 18 weeks' gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. These differences became detectable at 1 mm Hg and increased thereafter, reaching 3 mm Hg-BP difference at 40 weeks' gestation in women with pregnancy-onset snoring relative to controls. Pairwise mean differences in diastolic BP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks' gestation. CONCLUSIONS Pregnancy-onset and chronic maternal snoring are associated with higher BPs beginning in the second and third trimester, respectively. Pregnancy BP trajectories could identify critical windows for enhanced BP surveillance; the divergent BP trajectories suggest that the 2 groups of women with habitual snoring in pregnancy may need to be considered separately when gestational time intervals are evaluated for increased BP monitoring. CITATION Dunietz GL, Hao W, Shedden K, et al. Maternal habitual snoring and blood pressure trajectories in pregnancy. J Clin Sleep Med. 2022;18(1):31-38.
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Affiliation(s)
- Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan,Address correspondence to: Galit Levi Dunietz, MPH, PhD, Division of Sleep Medicine, Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5845; Tel: (734) 647-9241; Fax: (734) 647-9065;
| | - Wei Hao
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Ronald D. Chervin
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Marjorie C. Treadwell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Louise M. O’Brien
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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3
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Ioachimescu OC, Allam JS, Samarghandi A, Anand N, Fields BG, Dholakia SA, Venkateshiah SB, Eisenstein R, Ciavatta MM, Collop NA. Performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea in a large sleep clinic cohort. J Clin Sleep Med 2021; 16:1663-1674. [PMID: 32515348 DOI: 10.5664/jcsm.8620] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES Peripheral arterial tonometry (PAT)-based technology represents a validated portable monitoring modality for the diagnosis of OSA. We assessed the diagnostic accuracy of PAT-based technology in a large point-of-care cohort of patients studied with concurrent polysomnography (PSG). METHODS During study enrollment, all participants suspected to have OSA and tested by in-laboratory PSG underwent concurrent PAT device recordings. RESULTS Five hundred concomitant PSG and WatchPat tests were analyzed. Median (interquartile range) PSG AHI was 18 (8-37) events/h and PAT AHI3% was 25 (12-46) events/h. Average bias was + 4 events/h. Diagnostic concordance was found in 42%, 41%, and 83% of mild, moderate, and severe OSA, respectively (accuracy = 53%). Among patients with PAT diagnoses of moderate or severe OSA, 5% did not have OSA and 19% had mild OSA; in those with mild OSA, PSG showed moderate or severe disease in 20% and no OSA in 30% of patients (accuracy = 69%). On average, using a 3% desaturation threshold, WatchPat overestimated disease prevalence and severity (mean + 4 events/h) and the 4% threshold underestimated disease prevalence and severity by -6 events/h. CONCLUSIONS Although there was an overall tendency to overestimate the severity of OSA, a significant percentage of patients had clinically relevant misclassifications. As such, we recommend that patients without OSA or with mild disease assessed by PAT undergo repeat in-laboratory PSG. Optimized clinical pathways are urgently needed to minimize therapeutic decisions instituted in the presence of diagnostic uncertainty.
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Affiliation(s)
- Octavian C Ioachimescu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - J Shirine Allam
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Arash Samarghandi
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Neesha Anand
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Barry G Fields
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Swapan A Dholakia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Saiprakash B Venkateshiah
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Rina Eisenstein
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Mary-Margaret Ciavatta
- Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Nancy A Collop
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
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4
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El Hamid AAA, Askoura AM, Abdel Hamed DM, Taha MS, Allam MF. Surgical versus Non-Surgical Management of Obstructive Sleep-disordered Breathing in Children: A Meta-analysis. Open Respir Med J 2020; 14:47-52. [PMID: 33299493 PMCID: PMC7705953 DOI: 10.2174/1874306402014010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/09/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Obstructive sleep-disordered breathing (OSDB) is a term for several chronic conditions in which partial or complete cessation of breathing occurs many times throughout the night, resulting in fatigue or daytime sleepiness that interferes with a person’s functions and reduces the quality of life. Objective: Comparing the effectiveness of surgical versus non-surgical treatment of OSDB in children in clinical trials through a meta-analysis study. Patients and Methods: A number of available studies and abstracts concerning the surgical versus non-surgical treatment of OSDB in children were identified through a comprehensive search of electronic databases. Data were abstracted from every study in the form of a risk estimate and its 95% confidence interval. Results: The current study revealed that there was a statistically significant improvement in the surgically treated patients rather than non-surgically treated patients regarding the quality of life. Conclusion: The current meta-analysis reports a significant clinical improvement in the surgical (adenotonsillectomy) group as compared to the non-surgical group, in terms of disease specific quality of life, and healthcare utilization in spite of the availability of only one study.
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Affiliation(s)
| | - Anas Mohamed Askoura
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Shehata Taha
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Farouk Allam
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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5
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Obeidat N, AlRyalat SA, Al Oweidat K, Abu-Khalaf M, Btoush A, Al-Essa M, Obeidat Z, Obeidat M, Wahbeh A. Long-term Effects of Gastric Bypass Surgery in Patients with Obstructive Sleep Apnea. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x16666200206151624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Obstructive sleep apnea is a common disorder involving, intermittent
mechanical obstruction of the upper airway during sleep. Obesity is the most powerful risk factor for
obstructive sleep apnea.
Objective:
This study aimed to investigate the long-term effect of Roux-en-Y gastric bypass bariatric
surgery on patients with obstructive sleep apnea.
Methods:
This study included patients were referred for bariatric surgery (Roux-en-Y gastric bypass)
to control symptoms and complications of obesity during a 5-year period. An overnight sleep study
was performed for each patient before and after the bariatric surgery, to study its effect on different
obstructive sleep apnea-related variables.
Results:
This study included 179 patients (mean age 35.9 ± 10.7 years). The mean duration from preoperative
assessment to postoperative assessment was 2.4 ± 2.2 years. The mean change in body
mass index and weight showed a decrease of 16.0 ± 16.0 kg/m2 and48.7 ± 25.9 kg, respectively. The
apnea hypopnea index decreased by a mean of 22.6 ± 26.3 events/hour.
Conclusion:
We concluded that a decrease in the body mass index by 1 kg/m2 could predict a
decrease in the apnea hypopnea index by 0.46 events/hour. Moreover, after mean follow-up duration
of 2.4 years, 84.3% of mild and 83.3% of moderate obstructive sleep apnea patients became normal
postoperatively.
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Affiliation(s)
- Nathir Obeidat
- Department of Respiratory and Sleep Medicine, The University of Jordan, Amman, Jordan
| | | | - Khaled Al Oweidat
- Department of Respiratory and Sleep Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abu-Khalaf
- Department of Bariatric Surgery, The University of Jordan, Amman, Jordan
| | - Asma Btoush
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Al-Essa
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Zaina Obeidat
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed Obeidat
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Ayman Wahbeh
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
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6
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Ioachimescu OC, Dholakia SA, Venkateshiah SB, Fields B, Samarghandi A, Anand N, Eisenstein R, Ciavatta MM, Allam JS, Collop NA. Improving the performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea. J Investig Med 2020; 68:1370-1378. [PMID: 32900784 PMCID: PMC7719910 DOI: 10.1136/jim-2020-001448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/04/2022]
Abstract
Outside sleep laboratory settings, peripheral arterial tonometry (PAT, eg, WatchPat) represents a validated modality for diagnosing obstructive sleep apnea (OSA). We have shown before that the accuracy of home sleep apnea testing by WatchPat 200 devices in diagnosing OSA is suboptimal (50%-70%). In order to improve its diagnostic performance, we built several models that predict the main functional parameter of polysomnography (PSG), Apnea Hypopnea Index (AHI). Participants were recruited in our Sleep Center and underwent concurrent in-laboratory PSG and PAT recordings. Statistical models were then developed to predict AHI by using robust functional parameters from PAT-based testing, in concert with available demographic and anthropometric data, and their performance was confirmed in a random validation subgroup of the cohort. Five hundred synchronous PSG and WatchPat sets were analyzed. Mean diagnostic accuracy of PAT was improved to 67%, 81% and 85% in mild, moderate-severe or no OSA, respectively, by several models that included participants' age, gender, neck circumference, body mass index and the number of 4% desaturations/hour. WatchPat had an overall accuracy of 85.7% and a positive predictive value of 87.3% in diagnosing OSA (by predicted AHI above 5). In this large cohort of patients with high pretest probability of OSA, we built several models based on 4% oxygen desaturations, neck circumference, body mass index and several other variables. These simple models can be used at the point-of-care, in order to improve the diagnostic accuracy of the PAT-based testing, thus ameliorating the high rates of misclassification for OSA presence or disease severity.
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Affiliation(s)
- Octavian C Ioachimescu
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA .,Atlanta VA Healthcare System, Sleep Medicine Center, Decatur, Georgia, USA
| | - Swapan A Dholakia
- Atlanta VA Healthcare System, Sleep Medicine Center, Decatur, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Saiprakash B Venkateshiah
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Healthcare System, Sleep Medicine Center, Decatur, Georgia, USA
| | - Barry Fields
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Healthcare System, Sleep Medicine Center, Decatur, Georgia, USA
| | - Arash Samarghandi
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neesha Anand
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rina Eisenstein
- Atlanta VA Healthcare System, Sleep Medicine Center, Decatur, Georgia, USA.,Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - J Shirine Allam
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Healthcare System, Sleep Medicine Center, Decatur, Georgia, USA
| | - Nancy A Collop
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emory Healthcare, Emory Clinic, Sleep Medicine Center, Atlanta, Georgia, USA
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7
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Gregori-Pla C, Delgado-Mederos R, Cotta G, Giacalone G, Maruccia F, Avtzi S, Prats-Sánchez L, Martínez-Domeño A, Camps-Renom P, Martí-Fàbregas J, Durduran T, Mayos M. Microvascular cerebral blood flow fluctuations in association with apneas and hypopneas in acute ischemic stroke. NEUROPHOTONICS 2019; 6:025004. [PMID: 31037244 PMCID: PMC6477863 DOI: 10.1117/1.nph.6.2.025004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
In a pilot study on acute ischemic stroke (AIS) patients, unexpected periodic fluctuations in microvascular cerebral blood flow (CBF) had been observed. Motivated by the relative lack of information about the impact of the emergence of breathing disorders in association with stroke on cerebral hemodynamics, we hypothesized that these fluctuations are due to apneic and hypopneic events. A total of 28 patients were screened within the first week after stroke with a pulse oximeter. Five (18%) showed fluctuations of arterial blood oxygen saturation ( ≥ 3 % ) and were included in the study. Near-infrared diffuse correlation spectroscopy (DCS) was utilized bilaterally to measure the frontal lobe CBF alongside respiratory polygraphy. Biphasic CBF fluctuations were observed with a bilateral increase of 27.1 % ± 17.7 % and 29.0 % ± 17.4 % for the ipsilesional and contralesional hemispheres, respectively, and a decrease of - 19.3 % ± 9.1 % and - 21.0 % ± 8.9 % for the ipsilesional and contralesional hemispheres, respectively. The polygraph revealed that, in general, the fluctuations were associated with apneic and hypopneic events. This study motivates us to investigate whether the impact of altered respiratory patterns on cerebral hemodynamics can be detrimental in AIS patients.
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Affiliation(s)
- Clara Gregori-Pla
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Raquel Delgado-Mederos
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Gianluca Cotta
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Giacomo Giacalone
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- San Raffaele Scientific Institute, Milan, Italy
| | - Federica Maruccia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Universitat Autònoma de Barcelona, Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron University Research Institute, Barcelona, Spain
| | - Stella Avtzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Luís Prats-Sánchez
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Pol Camps-Renom
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Joan Martí-Fàbregas
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Mercedes Mayos
- Hospital de la Santa Creu i Sant Pau, Sleep Unit, Department of Respiratory Medicine, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CB06/06), Madrid, Spain
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8
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Predictors of Sleep Apnea in the Canadian Population. Can Respir J 2018; 2018:6349790. [PMID: 30228832 PMCID: PMC6136476 DOI: 10.1155/2018/6349790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
Older age, obesity, hypertension, snoring, and excessive daytime sleepiness have been associated with sleep apnea. The objective of this study was to determine the prevalence (crude and adjusted), as well as the risk factors, of sleep apnea in the adult Canadian population. Data from the 2009 Sleep Apnea Rapid Response (SARR) questionnaire were used to identify the risk factors, and all sleep-related questions in the SARR questionnaire were used. The outcome variable of interest was health professional-diagnosed sleep apnea. Covariates of interest were demographic variables, population characteristics, respiratory and cardiovascular diseases, and enabling resources. The multiple logistic regression model adjusted for the clustering effect was used to analyze the data. Sleep apnea was diagnosed in 858,913 adults (3.4% of the population), and more men (65.4%) than women (34.6%) were diagnosed with sleep apnea. Multivariable logistic regression analysis indicated that age (45 and older), loud snoring, sudden awakening with gasping/choking (rare/sometimes and once or more a week), and nodding off/falling asleep in driving in the past 12 months were significantly associated with diagnosed sleep apnea. Predictive probability demonstrated that in overweight and obese persons, ≥15 minutes of daily exercise significantly decreased the risk of diagnosed sleep apnea. The conclusion of this study is that in the Canadian population, sleep apnea is associated with older age, loud snoring, and sleeping problems. The protective effect of exercise warrants further investigation.
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9
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Abstract
Many aspects of sleep and circadian rhythms change as people age. Older adults usually experience decrease in sleep duration and efficiency, increase in sleep latency and fragmentation, high prevalence of sleep disorders, and weakened rest-activity rhythms. Research evidence suggests that women are more likely to report aging-related sleep problems. This review presents epidemiologic and clinical evidence on the relationships between sleep deficiency and physical and mental outcomes in older women, explores potential mechanisms underlying such relationships, points out gaps in the literature that warrant future investigations, and considers implications in clinical and public health settings.
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Affiliation(s)
- Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA 94158, USA.
| | - Qian Xiao
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA
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10
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Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study. Can Respir J 2018; 2018:9270329. [PMID: 30159105 PMCID: PMC6109479 DOI: 10.1155/2018/9270329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/15/2018] [Indexed: 11/23/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p < 0.001 and p < 0.032), respectively, duration of saturation below 90% (p < 0.001 for both), and saturation nadir (p < 0.036 and p < 0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.
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11
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Behr M, Acker J, Cohrs S, Deuschle M, Danker-Hopfe H, Göder R, Norra C, Richter K, Riemann D, Schilling C, Weeß HG, Wetter TC, Wollenburg LM, Pollmächer T. [Prevalence of sleep-related breathing disorders of inpatients with psychiatric disorders]. DER NERVENARZT 2018; 89:807-813. [PMID: 29876601 DOI: 10.1007/s00115-018-0545-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-related breathing disorders seriously impair well-being and increase the risk for relevant somatic and psychiatric disorders. Moreover, risk factors for sleep-related breathing disorders are highly prevalent in psychiatric patients. The aim of this study was for the first time in Germany to study the prevalence of obstructive sleep apnea syndrome (OSAS) as the most common form of sleep-related breathing disorder in patients with psychiatric disorders. METHODS In 10 psychiatric hospitals in Germany and 1 hospital in Switzerland, a total of 249 inpatients underwent an 8‑channel sleep polygraphy to investigate the prevalence of sleep apnea in this group of patients. RESULTS With a conspicuous screening result of 23.7% of the subjects, a high prevalence of sleep-related breathing disorders was found to occur among this group of patients. Male gender, higher age and high body mass index (BMI) were identified as positive risk factors for the detection of OSAS. DISCUSSION The high prevalence indicates that sleep apnea is a common sleep disorder among psychiatric patients. Although OSAS can lead to substantial disorders of the mental state and when untreated is accompanied by serious somatic health problems, screening procedures are not part of the routine work-up in psychiatric hospitals; therefore, sleep apnea is presumably underdiagnosed in psychiatric patients. In view of the results of this and previous studies, this topic complex should be the subject of further research studies.
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Affiliation(s)
- M Behr
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - J Acker
- Klinik für Schlafmedizin, Bad Zurzach, Schweiz
| | - S Cohrs
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Rostock, Rostock, Deutschland
| | - M Deuschle
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - H Danker-Hopfe
- Kompetenzzentrum Schlafmedizin, Klinik für Psychiatrie und Psychotherapie der Charité, Berlin, Deutschland
| | - R Göder
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - C Norra
- LWL-Klinik Paderborn, Paderborn, Deutschland
| | - K Richter
- Klinik für Psychiatrie und Psychotherapie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
| | - D Riemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Schilling
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - H-G Weeß
- Schlafzentrum am Pfalzklinikum Klingenmünster, Klingenmünster, Deutschland
| | - T C Wetter
- Schlafmedizinisches Zentrum, Klinik für Psychiatrie und Psychotherapie, Universität Regensburg am Bezirksklinikum, Regensburg, Deutschland
| | - L M Wollenburg
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - T Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland.
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Abstract
PURPOSE OF REVIEW To summarize recent research investigating the interaction between obstructive sleep apnea (OSA) and anxiety, and contextualize their bidirectional relationship. RECENT FINDINGS Recent investigations corroborate the bidirectional relationship between sleep-disordered breathing (SDB) and anxiety, evaluate the etiological and clinical manifestations through different mechanisms, and provide insight into clinical implications of this interaction. Much of the literature about anxiety as it relates to SDB is from small samples, using different tools of symptom measurement that are often subjectively quantified. The objective severity of OSA does not appear to be associated with subjectively reported sleepiness and fatigue, whereas physiological manifestations of anxiety are associated with the severity of subjective symptoms reported. Recent findings support that women are more likely to have comorbid SDB and anxiety than men. SDB may precipitate and perpetuate anxiety, whereas anxiety in OSA negatively impacts quality-of-life. Treating SDB may improve anxiety symptoms, whereas anxiety symptoms can be an obstacle and deterrent to appropriate treatment. SUMMARY The interaction between anxiety and SDB is still poorly elucidated. Being aware of the clinical associations, risk factors, and treatment implications for SDB as related to anxiety disorders in different populations can help clinicians with the diagnosis and management of both SDB and anxiety.
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13
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Pliska BT, Tam IT, Lowe AA, Madson AM, Almeida FR. Effect of orthodontic treatment on the upper airway volume in adults. Am J Orthod Dentofacial Orthop 2017; 150:937-944. [PMID: 27894542 DOI: 10.1016/j.ajodo.2016.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to examine the effects of orthodontic treatment with and without extractions on the anatomic characteristics of the upper airway in adults. METHODS For this retrospective study, the pretreatment and posttreatment cone-beam computed tomography scans of 74 adult patients meeting defined eligibility criteria were analyzed. Imaging software was used to segment and measure upper airway regions including the nasopharynx, the retropalatal, and retroglossal areas of the oropharynx, as well as the total airway. The Wilcoxon signed rank test was used to compare volumetric and minimal cross-sectional area changes from pretreatment to posttreatment. RESULTS The reliability values were high for all measurements, with intraclass correlation coefficients of 0.82 or greater. The volumetric treatment changes for the extraction and nonextraction groups were as follows: total airway, 1039.6 ± 3674.3 mm3 vs 1719.2 ± 4979.2 mm3; nasopharynx, 136.1 ± 1379.3 mm3 vs -36.5 ± 1139.8 mm3; retropalatal, 412.7 ± 3042.5 mm3 vs 399.3 ± 3294.6 mm3; and retroglossal, 412.5 ± 1503.2 mm3 vs 1109.3 ± 2328.6 mm3. The treatment changes in volume or minimal cross-sectional area for all airway regions examined were not significantly (P >0.05) different between the extraction and nonextraction groups. CONCLUSIONS Orthodontic treatment in adults does not cause clinically significant changes to the volume or the minimally constricted area of the upper airway. These results suggest that dental extractions in conjunction with orthodontic treatment have a negligible effect on the upper airway in adults.
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Affiliation(s)
- Benjamin T Pliska
- Assistant professor, Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Isaac T Tam
- Private practice, Vancouver, British Columbia, Canada
| | - Alan A Lowe
- Professor and chair, Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Fernanda R Almeida
- Associate professor, Division of Orthodontics, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Xiao Q, Gu F, Caporaso N, Matthews CE. Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample. BMC OBESITY 2016; 3:48. [PMID: 27857841 PMCID: PMC5106827 DOI: 10.1186/s40608-016-0128-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/29/2016] [Indexed: 03/29/2023]
Abstract
BACKGROUND Short sleep has been linked to obesity. However, sleep is a multidimensional behavior that cannot be characterized solely by sleep duration. There is limited study that comprehensively examined different sleep characteristics in relation to obesity. METHODS We examined various aspects of sleep in relation to adiposity in 2005-2006 NHANES participants who were 18 or older and free of cardiovascular disease, cancer, emphysema, chronic bronchitis and depression (N = 3995). Sleep characteristics were self-reported, and included duration, overall quality, onset latency, fragmentation, daytime sleepiness, snoring, and sleep disorders. Body measurements included weight, height, waist circumference, and dual-energy X-ray absorptiometry measured fat mass. RESULTS Snoring was associated with higher BMI (adjusted difference in kg/m2 comparing snoring for 5+ nights/week with no snoring (95 % confidence interval), 1.85 (0.88, 2.83)), larger waist circumference (cm, 4.52 (2.29, 6.75)), higher percentage of body fat (%, 1.61 (0.84, 2.38)), and higher android/gynoid ratio (0.03 (0.01, 0.06)). The associations were independent of sleep duration and sleep quality, and cannot be explained by the existence of sleep disorders such as sleep apnea. Poor sleep quality (two or more problematic sleep conditions) and short sleep duration (<6 h) were also associated with higher measures of body size and fat composition, although the effects were attenuated after snoring was adjusted. CONCLUSION In a nationally representative sample of healthy US adults, snoring, short sleep, and poor sleep quality were associated with higher adiposity.
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Affiliation(s)
- Qian Xiao
- Department of Health and Human Physiology, University of Iowa, E118 Field House, Iowa City, Iowa 52242 USA
| | - Fangyi Gu
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland USA
| | - Neil Caporaso
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland USA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland USA
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15
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Nikolakaros G, Virtanen I, Markkula J, Vahlberg T, Saaresranta T. Obstructive sleep apnea in psychiatric outpatients. A clinic-based study. J Psychiatr Res 2015; 69:126-34. [PMID: 26343604 DOI: 10.1016/j.jpsychires.2015.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 12/16/2022]
Abstract
Psychiatric diseases and symptoms are common among patients with obstructive sleep apnea (OSA). However, only a few studies have examined OSA in psychiatric patients. At the outpatient clinic of the Uusikaupunki Psychiatric Hospital, Finland, we used a low referral threshold to a diagnostic sleep study. An ambulatory cardiorespiratory polygraphy was performed in 114 of 221 patients. 95 patients were referred by the psychiatric clinic and 19 were examined in other clinical settings. We reviewed the medical files and retrospectively assessed the prevalence of OSA and the effect of gender, age, obesity, hypertension, type 2 diabetes, alcohol abuse, and symptoms suggesting OSA. 58 of the 221 patients (26.2%), 30 of 85 men (35.3%) and 28 of 136 women (20.6%), had OSA as determined by an apnea-hypopnea index (AHI) of 5/h or more. 20 patients (12 men and 8 women) had moderate or severe OSA (AHI ≥ 15/h). 46 patients (including 11 patients with moderate or severe OSA) were identified in the psychiatric clinic. In univariate analysis, a high body mass index, male gender, hypertension, snoring, and a history of witnessed apneas during sleep were associated with the presence of OSA. In multivariate analysis, a history of witnessed apneas did not remain significant. Age, type 2 diabetes, alcohol abuse, excessive daytime sleepiness (EDS), and fatigue did not associate with the presence of OSA. Our findings suggest that in psychiatric outpatients OSA is common but underdiagnosed. Presentation is often atypical, since many patients with OSA do not report witnessed apneas or EDS.
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Affiliation(s)
- Georgios Nikolakaros
- "Specialists in Psychiatry" Medical Center, Yliopistonkatu 33C28, 20100 Turku, Finland; Department of Psychiatry, Uusikaupunki Psychiatric Hospital, Välskärintie 2, PB 15, 23501 Uusikaupunki, Finland.
| | - Irina Virtanen
- Department of Clinical Neurophysiology, TYKS-SAPA, Hospital District of Southwest Finland, PB 52, 20521 Turku, Finland.
| | - Juha Markkula
- Turku University Hospital, Neuropsychiatric Outpatient Clinic, PB 52, 20521 Turku, Finland.
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Lemminkäisenkatu 1, Turun Yliopisto, FI-20014, Finland.
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PB 52, 20521 Turku, Finland; Sleep Research Centre, Department of Physiology, University of Turku, Lemminkäisenkatu 3B, 20520 Turku, Finland.
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16
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Radzikowska J, Gronkiewicz Z, Kukwa A, Lisik W, Czarnecka AM, Krzeski A, Kukwa W. Nasopharyngeal chordoma in a patient with a severe form of sleep-disordered breathing: A case report. Oncol Lett 2015; 10:1805-1809. [PMID: 26622754 DOI: 10.3892/ol.2015.3393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/22/2015] [Indexed: 12/18/2022] Open
Abstract
Nasopharyngeal chordoma is a rare type of malignant neoplasm that originates in the remnants of the notochord, a primitive tissue of embryonic origin preserved outside the axial skeleton. Approximately one-third of chordomas are located in the base of the skull, in the midline of the body. The slow growth rate of the tumor, which gradually fills the nasopharyngeal cavity, contributes to a delayed oncological diagnosis. Among its isolated and non-specific symptoms, the obstruction of the nasopharynx is dominant, thus, sleep-disordered breathing (SDB) may occur. The current study presents the case of a 32-year-old female patient who was incidentally diagnosed with a nasopharyngeal chordoma during a diagnostic examination for SDB. The diagnostic examination was performed as a part of a research program for pathologically obese patients who qualified for bariatric surgery. Following tumor resection, a significant improvement in various polysomnographic parameters occurred, including a decrease in the apnea hypopnea index from 53.5 to 6.4 and an increase in the mean saturation rate from 92.5 to 95%, confirming that an association exists between tumor obstruction of the nasopharynx and SDB. The incidental diagnosis of this rare type of neoplasm drew attention to diagnostic and therapeutic problems associated with nasopharyngeal chordomas. Furthermore, it indicated the necessity for the accurate laryngological examination of patients with SDB.
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Affiliation(s)
- Joanna Radzikowska
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Zuzanna Gronkiewicz
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Andrzej Kukwa
- Department of Otolaryngology and Head and Neck Disease, University of Varmia and Mazuria School of Medicine, Olsztyn 10-082, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw 04-141, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
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17
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Sleep disorders in COPD. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Shanmugam GV, Abraham G, Mathew M, Ilangovan V, Mohapatra M, Singh T. Obstructive sleep apnea in non-dialysis chronic kidney disease patients. Ren Fail 2014; 37:214-8. [DOI: 10.3109/0886022x.2014.979730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Abstract
Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration.
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Affiliation(s)
- Gilbert Seda
- Department of Pulmonary and Sleep Medicine, Naval Medical Center San Diego, 34730 Bob Wilson Drive, Building 3-3, Suite 301, San Diego, CA 92134, USA.
| | - Sheila Tsai
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Teofilo Lee-Chiong
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, University of Colorado, 1400 Jackson Street, Denver, CO 80206, USA
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20
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Evening and morning exhaled volatile compound patterns are different in obstructive sleep apnoea assessed with electronic nose. Sleep Breath 2014; 19:247-53. [DOI: 10.1007/s11325-014-1003-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/27/2014] [Accepted: 05/02/2014] [Indexed: 01/20/2023]
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21
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Salas RE, Chakravarthy R, Sher A, Gamaldo CE. Management of sleep apnea in the neurology patient: Five new things. Neurol Clin Pract 2014; 4:44-52. [PMID: 29473567 DOI: 10.1212/01.cpj.0000442583.87327.5d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Recognizing and treating sleep-disordered breathing (SDB) is essential in delivering neurologic care due to its association with a growing list of neurologic conditions (e.g., stroke, neurodegenerative disorders). Thus, increased proficiency in the recognition and management of SDB is likely to result in better outcomes, care, and utilization of health care resources. To date, continuous positive airway pressure remains the gold standard for patients with moderate to severe obstructive sleep apnea and has been shown to be effective in treating variations of SDB. Appropriate application of new methods and technology such as home sleep testing can help bridge the gap between the need and supply for sleep health care and delivery. Increased focus on efficacious strategies to further awareness and education for patients, caretakers, and providers is paramount to long-term adherence to treatment.
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Affiliation(s)
- Rachel E Salas
- Neuro-Sleep Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rohini Chakravarthy
- Neuro-Sleep Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alex Sher
- Neuro-Sleep Division, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charlene E Gamaldo
- Neuro-Sleep Division, Johns Hopkins University School of Medicine, Baltimore, MD
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22
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Dewire J, Calkins H. Impact of Obstructive Sleep Apnea on Outcomes of Catheter Ablation of Atrial Fibrillation. J Atr Fibrillation 2013; 5:777. [PMID: 28496814 PMCID: PMC5153109 DOI: 10.4022/jafib.777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/28/2013] [Accepted: 02/02/2013] [Indexed: 01/03/2023]
Abstract
Obstructive sleep apnea (OSA) is a growing epidemic in the United States and significantly contributes to the increasing prevalence of atrial fibrillation (AF) in the U.S. POPULATION Although a strong correlation between OSA and AF has been demonstrated, a causal relationship between these two conditions has not been definitively established. Evidence of OSA is an important consideration of AF management and impacts the success rate of catheter ablation. The presence of OSA tends to predict a lower success rate and higher complication rate for catheter ablation of AF. However, recent studies evaluating OSA as an independent risk predictor of AF recurrence following an ablation procedure have yielded conflicting results. A greater understanding of these conditions would allow for a more specific therapy targeting the type of AF associated with OSA. The following review provides a brief summary of obstructive sleep apnea etiology, focuses on the relationship between OSA and AF, and discusses the impact of OSA on the outcomes of catheter ablation of AF.
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Affiliation(s)
- Jane Dewire
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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23
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Alsufyani NA, Al-Saleh MAQ, Major PW. CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review. Sleep Breath 2013; 17:911-23. [DOI: 10.1007/s11325-012-0799-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/28/2012] [Accepted: 12/24/2012] [Indexed: 11/28/2022]
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