Obstructive Sleep Apnea-Hypopnea Syndrome

Obstructive sleep apnea hypopnea syndrome: Protocol for the development of a core outcome set

BACKGROUND

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common, chronic sleep disease. As the incidence of OSAHS increases, it has seriously threatened people's health. There have been an increasing number of clinical trials of OSAHS in recent years. However, the clinical trials of OSAHS have heterogeneous outcomes, surrogate outcomes, subjective outcomes, and composite outcomes, as well as the lack of endpoints or patient perspectives. The best method is to develop a core outcomes sets (COSs) for OSAHS's clinical trials.

METHODS

The development of COSs of OSAHS will include 5 stages: RESULTS:: The results of our study will be published in a peer-reviewed journal.

DISCUSSION

The development of the COSs of OSAHS will improve the design and operation of OSAHS clinical trials to conform to international standards and ensure the credibility of the outcomes. In addition, this study will involve different stakeholder groups to help ensure that the developed COSs will be suitable and well accepted.

TRIAL REGISTRATION NUMBER

1544.

Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions

PURPOSE

The aim of this study was to compare olfactory functions pre- and post-CPAP treatment in patients with moderate to severe OSA, and to evaluate the factors that cause changes in olfactory functions.

METHODS

Twenty-two patients who had completed regular usage of CPAP treatment for 2 months were included in this prospective study. Olfactory tests using Sniffin' Sticks were performed pre- and post-treatment.

RESULTS

The mean age of the subjects was 47.6 ± 9.5 years. We did not find a significant change in olfactory functions after 2 months of CPAP treatment in our study group. When the patients were divided into two groups-those whose olfactory functions showed improvement and those whose functions did not-it was found that the mean age of the patients whose olfactory functions did not improve was significantly higher statistically. A significant adverse correlation was found between age and post-treatment olfactory functions, specifically in odour threshold and odour identification scores.

CONCLUSIONS

Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

The association of hemocyte profile and obstructive sleep apnea

BACKGROUND

The hemocyte profile is one of the most frequently requested clinical laboratory tests. However, the analysis of blood cell indexes of obstructive sleep apnea (OSA) patients in previous studies was not comprehensive. And, this study aimed to fully analyze the blood routine in OSA patients.

METHODS

A retrospective study was conducted on 1087 male patients, who were admitted to the sleep center of Nanfang Hospital from May 2013 to February 2018. According to the apnea hypopnea index (AHI), patients were divided into four groups: control group (AHI < 5, n = 135), mild OSA (5 ≦ AHI < 15, n = 185), moderate OSA (15 ≦ AHI < 30, n = 171), and severe OSA (AHI ≧ 30, n = 596). Data collected included sleep parameters, complete blood routine, body mass index (BMI), age, and comorbidities.

RESULTS

In our study, leukocytes, neutrophils, lymphocytes, monocytes, eosinophils, basophils, erythrocytes, hemoglobin, hematocrit, platelets, MPV, and PDW-SD were statistically significant among the four groups based on AHI (P < 0.05), but no significant differences were found in MCV, RDW-SD, N/L, and P/L ratio (P > 0.05). Neutrophils, lymphocytes, monocytes, eosinophils, basophils, hemoglobin, hematocrit, platelets, and MPV were significantly correlated with AHI. Moreover, multiple linear regression analysis demonstrated that hematocrit (β = 73.254, P = 0.001), neutrophils (β = 1.414, P = 0.012), and lymphocytes (β = 4.228, P < 0.001) were independently associated with AHI.

CONCLUSION

Neutrophils, lymphocytes, and hematocrit were independently associated with OSA severity. And combining these three blood cell indicators could contribute to the diagnosis of OSA.

Obstructive sleep apnea is associated with an increased risk of colorectal neoplasia

BACKGROUND AND AIMS

A recent meta-analysis showed that obstructive sleep apnea (OSA) is associated with a higher prevalence of cancer and cancer-related mortality; however, little information is available on the association between OSA and colorectal neoplasia.

METHODS

We identified consecutive patients who underwent overnight polysomnography (PSG) and subsequent colonoscopy. We compared the prevalence of colorectal neoplasia between patients with or without OSA according to the results of PSG. For each patient with OSA, 1 or 2 controls matched for age (±5 years), sex, body mass index (BMI), and smoking who had undergone first-time screening colonoscopy were selected.

RESULTS

Of the 163 patients, 111 patients were diagnosed with OSA and 52 patients were within the normal range of the Apnea-Hypopnea Index. Of the 111 patients with OSA, 18 patients (16.2%) had advanced colorectal neoplasia, including 4 (3.6%) colorectal cancers. In the multivariate analyses, OSA was associated with an increased risk of advanced colorectal neoplasia after adjusting for factors including age and sex (mild: odds ratio [OR], 14.09; 95% confidence interval [CI], 1.55-127.83; P = .019; moderate or severe: OR, 14.12; 95% CI, 1.52-131.25; P = .020). Our case-control study revealed that the odds of detecting advanced colorectal neoplasia among patients with OSA were approximately 3.03 times greater than in the controls matched for age, sex, BMI, and smoking (OR, 3.03; 95% CI, 1.44-6.34; P = .002).

CONCLUSION

Physicians should be aware of the association between OSA and the development of colorectal neoplasia and explain the need for colonoscopy to patients with OSA.

Evaluation of Ocular Surface Health in Patients with Obstructive Sleep Apnea Syndrome

Objectives:

To evaluate ocular surface health in obstructive sleep apnea syndrome (OSAS) and to investigate the tendency of these patients toward dry eyes.

Materials and Methods:

Fifty patients who underwent polysomnography and were diagnosed with OSAS and 50 normal control subjects were compared with respect to ocular surface disease index (OSDI), Schirmer I test and tear film break-up time (TBUT) values.

Results:

Patients were grouped as mild (n=15, 30%), moderate (n=15, 30%) and severe (n=20, 40%) according to apnea-hypopnea index values. The right eyes of patients were included in both groups. OSDI values were as follows: control group, 18.7±8.5; mild OSAS group, 40.2±2.8; moderate OSAS group, 48.5±2.2 and severe OSAS group, 62.7±2.3 (p<0.001). TBUT values were as follows: control group, 12.3±4.9; mild OSAS group, 8.2±4.7; moderate OSAS group, 5.8±2.1 and severe OSAS group, 4.2±3.7 (p<0.001). Schirmer values were as follows: control group, 18±6.1 mm; mild OSAS group, 12.9±6.7 mm; moderate OSAS group, 8.5±5.2 mm and severe OSAS group, 7.9±4.7 mm (p<0.001).

Conclusion:

Patients with OSAS seem to have a tendency toward dry eyes. Clinicians should be aware of dry eye development in these patients.

Sleep, Cognition and Dementia

The older patient population is growing rapidly around the world and in the USA. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation all of which may be misinterpreted as dementia. The key sleep disorders impacting patients with dementia include insomnia, hypersomnolence, circadian rhythm misalignment, sleep disordered breathing, motor disturbances of sleep such as periodic leg movement disorder of sleep and restless leg syndrome, and parasomnias, mostly in the form of rapid eye movement (REM) sleep behavior disorder (RBD). RBD is a pre-clinical marker for a class of neurodegenerative diseases, the "synucleinopathies", and requires formal polysomnographic evaluation. Untreated sleep disorders may exacerbate cognitive and behavioral symptoms in patients with dementia and are a source of considerable stress for bed partners and family members. When left untreated, sleep disturbances may also increase the risk of injury at night, compromise health-related quality of life, and precipitate and accelerate social and economic burdens for caregivers.

The effect of duration of nasal obstruction on mean platelet volume in patients with marked nasal septal deviation

Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. This study aimed to investigate the effect of age on mean platelet volume in patients with marked nasal septal deviation. We made a retrospective study of patients with marked nasal septal deviation between January 2012 and May 2014. The patients were divided into four groups according to duration of nasal obstruction (less than 10, 10-20, 20-30 and more than 30 years). The groups were compared with each other in terms of mean platelet volume, platelet distribution width, platelet count in preoperative hemogram. This study was performed on 356 male and 139 female patients. Mean age was 33.9 ± 12.3 years. It was determined that the platelet count, mean platelet volume did not constitute statistically significant difference between groups (p > 0.05). Nevertheless, it was determined that as the duration of nasal obstruction elongated the mean platelet volume value increased and platelet count values decreased. Mean values of platelet distribution width constituted statistically significant difference between all groups (p = 0.026). Patients with marked nasal septum deviation should be subjected to surgery as soon as possible because of the increase in mean platelet volume and platelet distribution width values which are related to increase in the risk of cardiopulmonary complications of nasal obstruction.

Relation of mean platelet volume with obstructive adenoid hypertrophy in children

OBJECTIVE

Adenoid hypertrophy (AH) is a common etiology of chronic upper airway obstruction. Upper respiratory tract obstruction may cause chronic alveolar hypoventilation and pulmonary vasoconstriction. In one previous study in patients with obstructive sleep apnea (OSA), it has been claimed that mean platelet volume (MPV), an indicator of platelet activation is increased and that MPV has an important role in the pathophysiology of cardiovascular diseases. We investigated in our study if MPV can be used as an indicator of obstruction due to adenoid hypertrophy.

METHODS

Our study includes 61 children that underwent adenoidectomy with a mean age of 7.12 (± 2.373). White blood cell, platelet count, MPV, platelet crit and platelet distribution width levels were measured before and 3 months after adenoidectomy. Children's symptoms for upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were questioned in the preoperative and postoperative period by a standardized questionnaire.

RESULTS

There was no significant difference between preoperative and postoperative mean values of MPV, hemoglobin, platelet count (p > 0.05). White blood cell levels were significantly higher in the preoperative period values compared with postoperative period values (p < 0.05). Preoperative UAO scores were significantly higher than the postoperative UAO scores. After stratification of the degree of obstruction (as mild, moderate and severe) there was no significant difference in between groups in terms of MPV values.

CONCLUSION

There was no significant relation between MPV levels and obstructive adenoid hypertrophy.

Impact of septoplasty on mean platelet volume levels in patients with marked nasal septal deviation

Nasal septal deviation (NSD) is a very common cause of recurrent and chronic nasal obstruction. Chronic nasal obstruction leads to increased upper respiratory tract resistance, and also upper respiratory tract resistance leads to chronic hypoxia and hypercarbic because of alveolar hypoventilation. Chronic hypoxia and hypercarbia show tendency for hypercoagulopathy.Mean platelet volume (MPV), the most commonly used measure of platelet size, is a potential marker of platelet reactivity. Large platelets that contain more dense granules are enzymatically and metabolically more active and have greater prothrombotic potential. In previous studies, increased MPV was demonstrated in hypertension, unstable angina pectoris, myocardial infarction, stroke, and obstructive sleep apnea.We aimed to determine whether MPV levels are elevated in patients with marked NSD (MNSD) compared with healthy controls. In addition, we tried to find out the effect of nasal septoplasty on MPV levels. We found that the MPV levels were significantly higher in the MNSD group than in the control healthy group, and also we found that MPV levels were significantly decreased in the MNSD group after septoplasty operation.In conclusion, in our knowledge, this is the first study investigating MPV levels in patients with MNSD. Increased platelet activation may be related to increase the cardiovascular risk in patients with MNSD. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with MNSD, and the increase in MPV levels of the cases with MNSD could be treated by septoplasty.

Analysis of obstructive sleep apnea patients with "sawtooth sign" on the flow-volume curve

PURPOSE

The aims of the present study are to determine whether there is an obstructive sleep apnea (OSA) subgroup presenting with sawtooth sign on the spirometric flow-volume curve, and to identify the clinical importance of the sawtooth sign in these patients.

METHODS

The study subjects consisted of 134 OSA patients (≥18 years) whose spirometric tests were made on the same day with the polysomnography. Patients without sawtooth sign were taken as the control group. Patients with sawtooth sign and control subjects were retrospectively analyzed in terms of distinctive demographic, anthropometric, polysomnographic, and spirometric characteristics.

RESULTS

OSA patients with sawtooth sign (n = 36) had greater neck circumference and body weight, and were taller than control subjects (n = 98). Patients with sawtooth sign were mainly males (p < 0.01). Female/male ratios were similar in control subjects. The presence of coronary artery disease was higher (p = 0.024), and current smokers were more (p = 0.014) among the patients with sawtooth sign than control subjects. In logistic regression analysis, the presence of sawtooth sign and age were the only statistically significant parameters (p = 0.028 and p = 0.002, respectively) that affect the likelihood of coronary artery diseases. There were no differences among the groups with regard to age, BMI, wrist circumference, and other comorbid conditions. The duration time of oxygen desaturation (<90%), avarage, and longest duration of total apnea were longer (p = 0.050, p = 0.034 and p = 0.014, respectively) and the obstructive apnea index was more (p = 0.035) in OSA patients with sawtooth sign when compared to control subjects. There were no differences with regard to other polysomnographic parameters, sleep architecture, Epworth sleepiness score, and spirometric parameters.

CONCLUSIONS

As an OSA subgroup, the OSA patients with sawtooth sign may have more frequent and longer duration of obstructive apneas, longer duration time of oxygen desaturation, and greater risk for the coronary artery disease.

Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea

Obstructive sleep apnoea (OSA) has been implicated as a risk factor for the development of hypertension, stroke and myocardial infarction. The main cause of cardiovascular and cerebrovascular disease in OSA is thought to be exposure to intermittent hypoxia, which can lead to oxidative stress, inflammation, atherosclerosis, endothelial dysfunction and hypertension. These proposed mechanisms have been drawn from basic research in animal and human models of intermittent hypoxia in addition to clinical investigation of patients with OSA. This review outlines the association between OSA and vascular disease, describes basic mechanisms that may be responsible for this association and compares the results from studies of OSA subjects with those in experimental models of intermittent hypoxia.

Rapid screening test for sleep apnea using a nonlinear and nonstationary signal processing technique

It is hypothesized that obstructive sleep apnea (OSA) can be detected from a short-time, daytime recording of the nasal airway pressure, resulting in a screening tool to identify adult patients at risk for OSA. A nonlinear and nonstationary signal analysis technique based on the Hilbert-Huang transform was used to extract signals intrinsic to OSA, using the first two intrinsic mode functions from the empirical mode decomposition. The Hilbert spectrum was centered around 1.5Hz for normal subjects and shifted upward in frequency scale with increased likelihood of OSA. The histogram of the 1.5Hz signal from the Hilbert spectrum was used to compute the apnea percentage for assessing OSA. The proposed method was tested with two data sets. Data set 1 consisted of 18 human subjects with 3 OSA cases from retrospective diagnosis. Data set 2 consisted of 16 subjects who went through a prospective study of the all-night polysomnographic test and the 5-min nasal airway pressure test. The proposed OSA detection method achieved 100% sensitivity and 100% specificity for data set 1, 85.7% sensitivity and 100% specificity for data set 2. While further tests will be needed to insure robustness and standardize the instrumentation, the study has demonstrated the feasibility of a rapid screening test for obstructive sleep apnea.

A correlation between the shape of the epiglottis and obstructive sleep apnea

The incidence of Obstructive Sleep Apnea (OSA) is increasing with the rise in the prevalence of obesity in the population. Upon performing esophagogastroduodenoscopy (EGD) on more than 50 patients with BMI ranging from 21 to 63, we noticed an increase in the concavity of the posterior surface of the epiglottis in correlation with the increase in BMI. Since OSA is caused by collapse of the airways, this same pressure seems to be responsible for the deformity of the epiglottis, which normally has a minimally concave posterior surface. Therefore the shape of the epiglottis reflects the degree of airway collapse and thus the severity of OSA. We recommend that patients with increased concavity of the posterior epiglottal surface seen endoscopically should be tested for OSA.