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Gao L, Li H, Dong X, Li W, Deng H. High-sensitivity QCM humidity sensor based on chitosan/carboxymethylated multiwalled carbon nanotubes composite for non-contact respiratory monitoring. Int J Biol Macromol 2024; 279:135156. [PMID: 39214201 DOI: 10.1016/j.ijbiomac.2024.135156] [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: 04/02/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
Respiratory humidity is an important indicator that can reflect respiratory disorders and is easily accessible in daily life, thus attracting attention in non-contact home respiratory monitoring systems. In this work, a high-sensitivity quartz crystal microbalance (QCM) humidity sensor based on a chitosan/carboxymethylated multiwalled carbon nanotubes composite coating is developed with a response time of 36 s and a recovery time of 38 s. The humidity variations from 11 to 97 % can be detected while the wet hysteresis is 0.95 % RH. The sensor also exhibits good repeatability and stability. The physicochemical characterizations of the materials reveal the mechanism of the rapid humidity response, i.e., compared to the physically blended CS with MWCNT, the crosslinking CS-MWCNT formed the new intercalation by stronger hydrogen and amide bonding, which leads to the homogeneous coverage of CS on MWCNT, exposing more active sites and facilitating the binding rate of water molecules. Combined with respiration monitoring, the sensor is able to accurately monitor human respiration rate and depth in real time, effectively predicting and differentiating between different types of obstructive sleep apnea syndromes, providing a fast and reliable solution for daily health monitoring.
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Affiliation(s)
- Lingfei Gao
- Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Hao Li
- Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Xiangyang Dong
- Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Wei Li
- Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China.
| | - Hongbing Deng
- Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China.
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Huang J, Zhuang J, Zheng H, Yao L, Chen Q, Wang J, Fan C. A Machine Learning Prediction Model of Adult Obstructive Sleep Apnea Based on Systematically Evaluated Common Clinical Biochemical Indicators. Nat Sci Sleep 2024; 16:413-428. [PMID: 38699466 PMCID: PMC11063111 DOI: 10.2147/nss.s453794] [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: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a common and potentially fatal sleep disorder. The purpose of this study was to construct an objective and easy-to-promote model based on common clinical biochemical indicators and demographic data for OSA screening. Methods The study collected the clinical data of patients who were referred to the Sleep Medicine Center of the Second Affiliated Hospital of Fujian Medical University from December 1, 2020, to July 31, 2023, including data for demographics, polysomnography (PSG), and 30 biochemical indicators. Univariate and multivariate analyses were performed to compare the differences between groups, and the Boruta method was used to analyze the importance of the predictors. We selected and compared 10 predictors using 4 machine learning algorithms which were "Gaussian Naive Bayes (GNB)", "Support Vector Machine (SVM)", "K Neighbors Classifier (KNN)", and "Logistic Regression (LR)". Finally, the optimal algorithm was selected to construct the final prediction model. Results Among all the predictors of OSA, body mass index (BMI) showed the best predictive efficacy with an area under the receiver operating characteristic curve (AUC) = 0.699; among the predictors of biochemical indicators, triglyceride-glucose (TyG) index represented the best predictive performance (AUC = 0.656). The LR algorithm outperformed the 4 established machine learning (ML) algorithms, with an AUC (F1 score) of 0.794 (0.841), 0.777 (0.827), and 0.732 (0.788) in the training, validation, and testing cohorts, respectively. Conclusion We have constructed an efficient OSA screening tool. The introduction of biochemical indicators in ML-based prediction models can provide a reference for clinicians in determining whether patients with suspected OSA need PSG.
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Affiliation(s)
- Jiewei Huang
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Jiajing Zhuang
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Huaxian Zheng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Ling Yao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000, People’s Republic of China
- Department of Nephrology, Rheumatology and Immunology, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350014, People’s Republic of China
| | - Qingquan Chen
- The Sleep Disorder Medicine Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Jiaqi Wang
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Chunmei Fan
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
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Lin WC, Wu MC, Wang YH, Lin CH, Wei JCC. The prevalence of obstructive sleep apnea syndrome after COVID-19 infection. J Med Virol 2024; 96:e29392. [PMID: 38235910 DOI: 10.1002/jmv.29392] [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: 07/14/2023] [Revised: 10/06/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
Obstructive sleep apnea is a well-known risk factor regarding the severity of COVID-19 infection. However, to date, relatively little research performed on the prevalence of obstructive sleep apnea in COVID-19 survivors. The purpose of this study was to investigate the risk of obstructive sleep apnea after COVID-19 infection. This study was based on data collected from the US Collaborative Network in TriNetX. From January 1, 2020 to June 30, 2022, participants who underwent the SARS-CoV-2 test were included in the study. Based on their positive or negative results of the COVID-19 test results (the polymerase chain reaction [PCR] test), we divided the study population into two groups. The duration of follow-up began when the PCR test was administered and continued for 12 months. Hazard ratios (HRs) and 95% confidence intervals (CIs) for newly recorded COVID-19 positive subjects for obstructive sleep apnea were calculated using the Cox proportional hazards model and compared to those without COVID-19 infection. Subgroup analyses were performed for the age, sex, and race, groups. The COVID-19 group was associated with an increased risk of obstructive sleep apnea, at both 3 months of follow-up (HR: 1.51, 95% CI: 1.48-1.54), and 1 year of follow-up (HR: 1.57, 95% CI: 1.55-1.60). Kaplan-Meier curves regarding the risk of obstructive sleep apnea revealed a significant difference of probability between the two cohorts in the follow-up periods of 3 months and 1 year (Log-Rank test, p < 0.001). The risks of obstructive sleep apnea among COVID-19 patients were significant in the less than 65 year of age group (HR: 1.50, 95% CI: 1.47-1.52), as well as in the group older than or equal to 65 years (HR:1.69, 95% CI: 1.64-1.73). Furthermore, the risks of obstructive sleep apnea were evident in both the male and female COVID-19 groups. Compared to the control group, the risks of obstructive sleep apnea in the COVID-19 participants increased in the subgroups of White (HR: 1.62, 95% CI: 1.59-1.64), Blacks/African Americans (HR: 1.50, 95% CI: 1.45-1.55), Asian (HR: 1.46, 95% CI: 1.32-1.62) and American Indian/Alaska Native (HR: 1.36, 95% CI: 1.07-1.74). In conclusion, the incidence of new diagnosis obstructive sleep apnea could be substantially higher after COVID-19 infection than non-COVID-19 comparison group. Physicians should evaluate obstructive sleep apnea in patients after COVID-19 infection to help prevent future long-term adverse effects from occurring in the future, including cardiovascular and neurovascular disease.
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Affiliation(s)
- Wen-Chun Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Otolaryngology Head and Neck surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Meng-Che Wu
- Division of Pediatric Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Che-Hsuan Lin
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, TMU Hospital, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
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Jorquera J, Dreyse J, Salas C, Letelier F, Weissglas B, Del-Río J, Henríquez-Beltrán M, Labarca G, Jorquera-Díaz J. Clinical Application of the Multicomponent Grading System for Sleep Apnea Classification and Incident Cardiovascular Mortality. Sleep Sci 2023; 16:e446-e453. [PMID: 38197019 PMCID: PMC10773515 DOI: 10.1055/s-0043-1776770] [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: 07/14/2022] [Accepted: 02/14/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To evaluate the clinical utility of the Baveno classification in predicting incident cardiovascular mortality after five years of follow-up in a clinic-based cohort of patients with obstructive sleep apnea (OSA). Materials and Methods We evaluated the reproducibility of the Baveno classification using data from the Santiago Obstructive Sleep Apnea (SantOSA) study. The groups were labeled Baveno A (minor symptoms and comorbidities), B (severe symptoms and minor comorbidities), C (minor symptoms and severe comorbidities), and D (severe symptoms and comorbidities). Within-group comparisons were performed using analysis of variance (ANOVA) and post hoc tests. The associations between groups and incident cardiovascular mortality were determined through the Mantel-Cox and Cox proportional hazard ratios (HRs) adjusted by covariables. Results A total of 1,300 OSA patients were included (Baveno A: 27.7%; B: 28%; C: 16.8%; and D: 27.5%). The follow-up was of 5.4 years. Compared to Baveno A, the fully-adjusted risk of cardiovascular mortality with Baveno B presented an HR of 1.38 (95% confidence interval [95%CI]: 0.14-13.5; p = 0.78); with Baveno C, it was of 1.71 (95%CI: 0.18-16.2; p = 0.63); and, with Baveno D, of 1.04 (95%CI: 0.12-9.2; p = 0.98). We found no interactions involving Baveno group, sex and OSA severity. Discussion Among OSA patients, the Baveno classification can describe different subgroups. However, its utility in identifying incident cardiovascular mortality is unclear. Long-term follow-up studies and the inclusion of demographic variables in the classification could improve its ability to detect a high-risk phenotype associated with cardiovascular mortality. Conclusion The Baveno classification serves as a valuable method for categorizing varying groups of patients afflicted with OSA. Nevertheless, its precision in identifying occurrence of cardiovascular mortality is still unclear.
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Affiliation(s)
- Jorge Jorquera
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Jorge Dreyse
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Constanza Salas
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Francisca Letelier
- Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
| | - Bunio Weissglas
- Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
| | - Javiera Del-Río
- Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
| | - Mario Henríquez-Beltrán
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Chile
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Chile
| | - Jorge Jorquera-Díaz
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
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Kalkanis A, Testelmans D, Papadopoulos D, Van den Driessche A, Buyse B. Insights into the Use of Point-of-Care Ultrasound for Diagnosing Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:2262. [PMID: 37443656 DOI: 10.3390/diagnostics13132262] [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: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a sleeping disorder caused by complete or partial disturbance of breathing during the night. Existing screening methods include questionnaire-based evaluations which are time-consuming, vary in specificity, and are not globally adopted. Point-of-care ultrasound (PoCUS), on the other hand, is a painless, inexpensive, portable, and useful tool that has already been introduced for the evaluation of upper airways by anesthetists. PoCUS could also serve as a potential screening tool for the diagnosis of OSA by measuring different airway parameters, including retropalatal pharynx transverse diameter, tongue base thickness, distance between lingual arteries, lateral parapharyngeal wall thickness, palatine tonsil volume, and some non-airway parameters like carotid intima-media thickness, mesenteric fat thickness, and diaphragm characteristics. This study reviewed previously reported studies to highlight the importance of PoCUS as a potential screening tool for OSA.
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Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dries Testelmans
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | | | - Bertien Buyse
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
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Aristimunha B, Bayerlein AJ, Cardoso MJ, Pinaya WHL, De Camargo RY. Sleep-Energy: An Energy Optimization Method to Sleep Stage Scoring. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2023; 11:34595-34602. [PMID: 38292346 PMCID: PMC10824396 DOI: 10.1109/access.2023.3263477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/17/2023] [Indexed: 02/01/2024]
Abstract
Sleep is essential for physical and mental health. Polysomnography (PSG) procedures are labour-intensive and time-consuming, making diagnosing sleep disorders difficult. Automatic sleep staging using Machine Learning (ML) - based methods has been studied extensively, but frequently provides noisier predictions incompatible with typical manually annotated hypnograms. We propose an energy optimization method to improve the quality of hypnograms generated by automatic sleep staging procedures. The method evaluates the system's total energy based on conditional probabilities for each epoch's stage and employs an energy minimisation procedure. It can be used as a meta-optimisation layer over the sleep stage sequences generated by any classifier that generates prediction probabilities. The method improved the accuracy of state-of-the-art Deep Learning models in the Sleep EDFx dataset by 4.0% and in the DRM-SUB dataset by 2.8%.
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Affiliation(s)
- Bruno Aristimunha
- Center for Mathematics, Computing and Cognition (CMCC)Federal University of ABC (UFABC)São Paulo09210-580Brazil
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing's College LondonWC2R 2LSLondonU.K
| | - Alexandre Janoni Bayerlein
- Center for Mathematics, Computing and Cognition (CMCC)Federal University of ABC (UFABC)São Paulo09210-580Brazil
| | - M. Jorge Cardoso
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing's College LondonWC2R 2LSLondonU.K
| | - Walter Hugo Lopez Pinaya
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing's College LondonWC2R 2LSLondonU.K
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Du W, Liu G, Zhang W, Zhao N, Shi Y, Peng X. A comparative study of three-dimensional airway changes after fibula flap reconstruction for benign and malignant tumours in the anterior mandible. Int J Oral Maxillofac Surg 2022; 52:633-639. [PMID: 36581476 DOI: 10.1016/j.ijom.2022.12.007] [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] [Received: 08/10/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
Surgical treatment of tumours in the anterior mandible and surrounding tissues may result in defects which can be restored by a fibula free flap. The upper airway may change during this process. The purpose of this retrospective study was to evaluate upper airway changes after fibula free flap reconstruction. A total of 37 patients who underwent anterior mandibulectomy and fibula free flap reconstruction between 2012 and 2020 were recruited. Patients with benign and malignant tumours involving the anterior mandible were included. Spiral computed tomography was performed 1 week preoperatively, 1 week postoperatively, and at> 1 year (range 12-23 months) after surgery. Cross-sectional areas and volumes of the upper airway were measured. Data were analysed by two-way analysis of variance. The upper airway in the malignant tumour group showed an increasing trend, especially at the soft palate and tongue base levels (P < 0.01). In the benign tumour group, the upper airway showed no significant changes. The location of the minimum cross-sectional area moved downwards in both groups, and the area increased in the malignant tumour group during long-term follow-up. Upper airway obstruction is less likely to occur in the long term after surgical resection of anterior mandible malignancies and fibula free flap reconstruction.
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Affiliation(s)
- W Du
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - G Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; Department of Stomatology, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - W Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - N Zhao
- Institute of Quantitative Economics, School of Economics, Nankai University, Tianjin, China
| | - Y Shi
- Department of Stomatology, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Cheng X, Hu F, Yang B, Wang F, Olofsson T. Contactless sleep posture measurements for demand-controlled sleep thermal comfort: A pilot study. INDOOR AIR 2022; 32:e13175. [PMID: 36567523 DOI: 10.1111/ina.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
Thermal comfort during sleep is essential for both sleep quality and human health while sleeping. There are currently few effective contactless methods for detecting the sleep thermal comfort at any time of day or night. In this paper, a vision-based detection approach for human thermal comfort while sleeping was proposed, which is intended to avoid overcooling/overheating supply, meet the thermal comfort needs of human sleep, and improve human sleep quality and health. Based on 438 valid questionnaire surveys, 10 types of thermal comfort sleep postures were summarized. By using a large number of data captured, a fundamental framework of detection algorithm was constructed to detect human sleeping postures, and corresponding weighting model was established. A total of 2.65 million frames of posture data in natural sleep status were collected, and thermal comfort-related sleep postures dataset was created. Finally, the robustness and effectiveness of the proposed algorithm were validated. The validation results show that the sleeping posture and human skeleton keypoints can be used for estimating sleeping thermal comfort, and the the quilt coverage area can be fused to improve the detection accuracy.
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Affiliation(s)
- Xiaogang Cheng
- College of Telecommunications and Information Engineering, Nanjing University of Posts and Telecommunications, Nanjing, China
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Fei Hu
- College of Telecommunications and Information Engineering, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Bin Yang
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
- School of Energy and Safety Engineering, Tianjing Chengjian University, Tianjin, China
| | - Faming Wang
- Department of Biosystems (BIOSYST), KU Leuven, Leuven, Belgium
| | - Thomas Olofsson
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
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Daljeet M, Warunek S, Covell DA, Monegro A, Giangreco T, Al-Jewair T. Association between obstructive sleep apnea syndrome and bone mineral density in adult orthodontic populations. Cranio 2022:1-11. [PMID: 36368042 DOI: 10.1080/08869634.2022.2142724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the association between obstructive sleep apnea syndrome (OSAS) and predicted bone mineral density (BMD) in adults presenting for orthodontic treatment. METHODS This retrospective cross-sectional study included 38 adults divided into OSAS and non-OSAS groups. Using pre-treatment CBCT images, radiographic density (RD) of left and right lateral regions of the 1st cervical vertebrae and dens of the 2nd cervical vertebrae were measured as an indicator for BMD. RESULTS When controlling for age, sex, and BMI, the mean RD was significantly lower in the OSAS group compared to the non-OSAS group (left CV1: 36.69 ± 84.50 vs. 81.67 ± 93.25 Hounsfield Units [HU], respectively, p = 0.031; right CV1: 30.59 ± 81.18 vs. 74.26 ± 91.81 HU, p = 0.045; dens: 159.25 ± 115.96 vs. 223.94 ± 106.09 HU, p = 0.038). CONCLUSION Adults with OSAS have lower values for predicted BMD than those without OSAS.
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Affiliation(s)
| | - Stephen Warunek
- Department of Orthodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - David A Covell
- Department of Orthodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Alberto Monegro
- Pediatric Sleep Center, School of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Thikriat Al-Jewair
- Department of Orthodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
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Romano S, Lo Bue A, Salvaggio A, Oliveira LVF, Ferini-Strambi L, Insalaco G. SANReSP: A new Italian questionnaire to screen patients for obstructive sleep apnea. PLoS One 2022; 17:e0276217. [PMID: 36240186 PMCID: PMC9565397 DOI: 10.1371/journal.pone.0276217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is a common, prevalent, and underdiagnosed disorder. Its lack of diagnosis and treatment is associated with increased morbidity and mortality. Previous screening questionnaires investigated parameters including body mass index, age, neck circumference, and sex, in addition to symptoms. This study aimed to validate a new Italian, self-administered, and easy-to-use six-item questionnaire that evaluates only subjective symptoms. Patients and methods The present study included 2622 patients (male, 2011; female, 611). Patients who were at least 18 years old, spoke Italian, referred to our sleep clinic for possible OSA, and completed the self-administered SANReSP questionnaire were recruited for the study. The predictive performance of the questionnaire was also evaluated. Results Nocturnal study showed 89.9% of OSA patients had apnea-hypopnea index (AHI) ≥ 5/h; 68.7%, AHI ≥ 15/h; and 48.2%, AHI ≥ 30/h. The optimal SANReSP score for AHI ≥ 5/h was >3 with a sensitivity and specificity of 74.76% and 67.92%, respectively, and an area under receiver operating characteristic curve (ROC) of 0.76. For moderate–severe OSA, the optimal SANReSP score was >3 (sensitivity, 78.18%; specificity, 46.53%; ROC, 0.66). For severe OSA, the optimal SANReSP score was >4 (sensitivity, 59.10%; specificity, 64.73%; ROC, 0.65). The probability of OSA increased with higher SANReSP scores (98.7% and 97.9% in men and women, respectively). Conclusion The SANReSP questionnaire is a short, easy-to-use, and self-administered screening tool for OSA. Its performance is similar to that of other widely used questionnaires; furthermore, it is advantageous in that it does not require anthropometric measurements.
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Affiliation(s)
- Salvatore Romano
- National Research Council of Italy, Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Anna Lo Bue
- National Research Council of Italy, Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
- National Research Council of Italy, Institute of Translational Pharmacology (IFT), Palermo, Italy
| | - Adriana Salvaggio
- National Research Council of Italy, Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
- National Research Council of Italy, Institute of Translational Pharmacology (IFT), Palermo, Italy
| | - Luis V. F. Oliveira
- Evangelical University of Goiás (UniEVANGÉLICA), Postgraduate Program in Human Movement and Rehabilitation–PPGMHR, Anapolis, Brazil
| | - Luigi Ferini-Strambi
- Università Vita-Salute San Raffaele, and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
- National Research Council of Italy, Institute of Translational Pharmacology (IFT), Palermo, Italy
- * E-mail:
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Yan X, Wang L, Liang C, Zhang H, Zhao Y, Zhang H, Yu H, Di J. Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea. Front Neurosci 2022; 16:936946. [PMID: 35992917 PMCID: PMC9390335 DOI: 10.3389/fnins.2022.936946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background OSA is an independent risk factor for several systemic diseases. Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. Due to the current limited medical condition, not every patient can be diagnosed and treated in time. To enable timely screening of patients with moderate-to-severe OSA, we selected easily accessible variables to establish a risk prediction model. Method We collected 492 patients who had polysomnography (PSG), and divided them into the disease-free mild OSA group (control group), and the moderate-to-severe OSA group according to the PSG results. Variables entering the model were identified by random forest plots, univariate analysis, multicollinearity test, and binary logistic regression method. Nomogram were created based on the binary logistic results, and the area under the ROC curve was used to evaluate the discriminative properties of the nomogram model. Bootstrap method was used to internally validate the nomogram model, and calibration curves were plotted after 1,000 replicate sampling of the original data, and the accuracy of the model was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Finally, we performed decision curve analysis (DCA) of nomogram model, STOP-Bang questionnaire (SBQ), and NoSAS score to assess clinical utility. Results There are 6 variables entering the final prediction model, namely BMI, Hypertension, Morning dry mouth, Suffocating awake at night, Witnessed apnea, and ESS total score. The AUC of this prediction model was 0.976 (95% CI: 0.962–0.990). Hosmer-Lemeshow goodness-of-fit test χ2 = 3.3222 (P = 0.1899 > 0.05), and the calibration curve was in general agreement with the ideal curve. The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. Conclusion The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. It can be applied to the community population for screening and to the clinic for prioritization of treatment.
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Affiliation(s)
- Xiangru Yan
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Liying Wang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Chunguang Liang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
- *Correspondence: Chunguang Liang,
| | - Huiying Zhang
- Sleep Monitoring Center, The First Hospital of Jinzhou Medical University, Jinzhou, China
| | - Ying Zhao
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hui Zhang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Haitao Yu
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jinna Di
- Respiratory Medicine, The Third Hospital of Jinzhou Medical University, Jinzhou, China
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Ye Min Soe KT, Ishiyama H, Nishiyama A, Shimada M, Maeda S. Effect of Different Maxillary Oral Appliance Designs on Respiratory Variables during Sleep. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6714. [PMID: 35682298 PMCID: PMC9180795 DOI: 10.3390/ijerph19116714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022]
Abstract
This study aimed to analyze the efficacy of maxillary oral appliance (MOA) designs on respiratory variables during sleep. At baseline, 23 participants underwent a sleep test with a portable device for two nights and were categorized as participants with mild obstructive sleep apnea (mild-OSA) (n = 13) and without OSA (w/o-OSA) (n = 10). Three types of MOAs, standard-OA (S-OA), palatal covering-OA (PC-OA), and vertically increasing-OA (VI-OA), were each worn for three nights, and sleep tests with each MOA were performed with a portable device for two nights. Based on the average of the respiratory event index (REI) values for the two nights for each MOA, w/o-OSA participants with an REI ≥ 5.0 were defined as the exacerbation group and those with an REI < 5.0 as the non-exacerbation group. In mild-OSA participants, an REI ≥ 15.0 or REI ≥ baseline REI × 1.5 were defined as the exacerbation group and those with an REI < 15.0 and REI < baseline REI × 1.5 were defined as the non-exacerbation group. The percentage of the exacerbation and non-exacerbation groups with MOA was evaluated in the w/o-OSA and mild-OSA participants. The maxillary and mandibular dental-arch dimension was compared by dentition model analysis. The exacerbation group in w/o-OSA participants (n = 10) comprised 10.0% participants (n = 1) with S-OA, 40.0% (n = 4) with PC-OA, and 30.0% (n = 3) with VI-OA. The exacerbation group in the mild-OSA participants (n = 13) comprised 15.4% subjects (n = 2) with S-OA, 23.1% (n = 3) with PC-OA, and 23.1% (n = 3) in VI-OA. In the model analysis for w/o-OSA, the posterior dental arch width was significantly greater in the exacerbation group than in the non-exacerbation group wearing S-OA (p < 0.05). In addition, the ratio of the maxillary to mandibular dental arch width (anterior dental arch width) was significantly greater in the exacerbation group than in the non-exacerbation group for both PC-OA and VI-OA (p < 0.05). In mild-OSA, the maxillary and mandibular dental arch lengths and the ratio of maxillary to mandibular dental arch width (posterior dental arch width) were significantly smaller in the exacerbation group than in the non-exacerbation group for S-OA (p < 0.05). This study confirmed that wearing an MOA by w/o-OSA and mild-OSA participants may increase the REI during sleep and that PC-OA and VI-OA may increase the REI more than S-OA. The maxillary and mandibular dental-arch dimensions may affect the REI when using an MOA.
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Affiliation(s)
- Kay Thwe Ye Min Soe
- Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hiroyuki Ishiyama
- Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Akira Nishiyama
- Department of General Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Masahiko Shimada
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Shigeru Maeda
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
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Nazar G, Astorquiza C, Cabezón R. El paciente roncador: evaluación y alternativas terapéuticas. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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SNOROSALAB: A Method Facilitating the Diagnosis of Sleep Breathing Disorders Before Polysomnography. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Integrating the precision, sleep, and aerospace medicine fields: a systematic review of the genetic predisposition for obstructive sleep apnea in military aviation. Sleep Breath 2021; 26:505-512. [PMID: 34231084 DOI: 10.1007/s11325-021-02427-8] [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] [Received: 05/03/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is the most common pathologic sleep disorder with an estimated prevalence in the USA of up to 25% of adult males. With military aviation being heavily comprised of adult men, the impact of OSA on flying operations is concerning as OSA is disqualifying for all flying classes in the US Air Force. In order to minimize the impact of OSA on operations, early identification of at-risk patients is critical in disease management. Individuals could be identified for whom regular polysomnography testing may reveal OSA while mild or sub-clinical, at which point treatment may be initiated in order to promote continued medical qualification for duty and career retention. METHODS We performed a keyword search of PubMed, EMBASE, and Google Scholar along with searches in the NHGRI/EBI GWAS Catalogue and the Atlas of GWAS Summary Statistics. We included primary research from candidate gene, GWAS, and meta-analyses. We also included other review articles in our search to confirm interpretations and implications of any genetic associations with OSA. Only studies related to OSA susceptibility or risk were included. RESULTS We identified 134 publications reporting or reviewing genetic associations with OSA risk. These papers reported 301 variants, of which 195 were unique and 33 were replicated in at least two papers. With respect to the strength of association, 43 variants exhibited odds ratios greater than 2. Finally, there were 84 null results reported, 51 of which were in conflict with reported associations. CONCLUSION There is ample evidence in the literature to confirm that genetics provide an important contribution to OSA development. The high number of strongly associated variants suggests that a polygenic risk model could be created with high predictive value for prognostic screening.
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Labarca G, Dreyse J, Salas C, Letelier F, Jorquera J. A Validation Study of Four Different Cluster Analyses of OSA and the Incidence of Cardiovascular Mortality in a Hispanic Population. Chest 2021; 160:2266-2274. [PMID: 34217682 DOI: 10.1016/j.chest.2021.06.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies reported a strong association between sleepiness-related symptoms and comorbidities with poor cardiovascular outcomes among patients with moderate to severe OSA (msOSA). However, the validation of these associations in the Hispanic population from South America and the ability to predict incident cardiovascular disease remain unclear. RESEARCH QUESTION In Hispanic patients with msOSA, are four different cluster analyses reproducible and able to predict incident cardiovascular mortality? STUDY DESIGN AND METHODS Using the SantOSA cohort, we reproduced four cluster analyses (Sleep Heart Health Study [SHHS], Icelandic Sleep Apnea Cohort [ISAC], Sleep Apnea Cardiovascular Endpoints [SAVE], and The Institute de Recherche en Sante Respiratoire des Pays de la Loire [IRSR] cohorts) following a cluster analysis similar to each training dataset. The incidence of cardiovascular mortality was constructed using a Kaplan-Meier (log-rank) model, and Cox proportional hazards models were adjusted by confounders. RESULTS Among 780 patients with msOSA in our cohort, two previous cluster analyses (SHHS and ISAC) were reproducible. The SAVE and IRSR cluster analyses were not reproducible in our sample. We identified the following subtypes for SHHS: "minimally symptomatic," "disturbed sleep," "moderate sleepiness," and "severe sleepiness." For ISAC, three different subtypes ("minimally symptomatic," "disturbed sleep," and "excessive sleepiness") were similar to the original dataset. Compared with "minimally symptomatic," we found a significant association between "excessive sleepiness" and cardiovascular mortality after 5 years of follow-up in SantOSA, hazard ratio (HR), 5.47; 95%CI, 1.74-8.29; P < .01; and HR, 3.23; 95%CI, 1.21-8.63; P = .02, using the SHHS and ISAC cluster analyses, respectively. INTERPRETATION Among patients with msOSA, a symptom-based approach can validate different OSA patient subtypes, and those with excessive sleepiness have an increased risk of incident cardiovascular mortality in the Hispanic population from South America.
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Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Jorge Dreyse
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
| | - Constanza Salas
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
| | - Francisca Letelier
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile
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Elsobki A, Moussa HH, Eldeeb ME, Fayed A, Elzayat S. Efficacy, predictors of success and failure of an updated lateral pharyngoplasty approach as an independent procedure in treating obstructive sleep apnea with CPAP failures. Eur Arch Otorhinolaryngol 2021; 279:945-953. [PMID: 33885973 DOI: 10.1007/s00405-021-06825-2] [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: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess predictors of success and failure of an updated lateral pharyngoplasty as an independent procedure in treating obstructive sleep apnea with CPAP failures. METHODS Forty-six patients with known OSAS who were resistant to CPAP or failures were included. BMI, Stop-Bang score, and sleep study data were recorded before and after the updated Cahali pharyngoplasty procedure. Pre-operative DISE was done for all cases; however, postoperative DISE was done only for non-responders. RESULTS Successful operation outcomes achieved in 69.6% (32 cases) and 30.4% (14 cases) were failure rates. Postoperative snoring index, Stop Bang score, and AHI were significantly decreased compared to pre-operative data (p value < 0.001). There is statistically a significant increase in minimal and baseline SpO2 postoperatively (p value < 0.001). Patients with no laryngeal collapse (L0) predict operation success. However, patients with high pre-operative snoring index, collapse at lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, and low grades tonsils (1, 2) predict the failure of the surgery (p value = 0.006*,0.024*,0.047*, respectively). CONCLUSION Updated Cahali lateral pharyngoplasty could not be used as an independent procedure in all OSA patients. The lack of laryngeal collapse (L0) is a considerable success predictor for the procedure. However, the pre-operative low-grade tonsils (1, 2) and high snoring index predict operation failure.
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Affiliation(s)
- Ahmed Elsobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hany H Moussa
- Chest Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed E Eldeeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
| | - Ashraf Fayed
- Otorhinolaryngology Department, El Galaa Military Hospital, Cairo, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Ishiyama H, Hideshima M, Inukai S, Tamaoka M, Nishiyama A, Miyazaki Y. Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study. J Clin Med 2021; 10:jcm10061255. [PMID: 33803610 PMCID: PMC8002844 DOI: 10.3390/jcm10061255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, p < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA (p < 0.05). There was no significant difference in non-responders (p > 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5–28.0; p = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.
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Affiliation(s)
- Hiroyuki Ishiyama
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (H.I.); (A.N.)
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Masayuki Hideshima
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Correspondence: ; Tel.: +81-3-5803-4551
| | - Shusuke Inukai
- Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Meiyo Tamaoka
- Department of Respiratory Physiology and Sleep Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Akira Nishiyama
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (H.I.); (A.N.)
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
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Akçay BD, Akçay D, Yetkin S. Turkish reliability and validity study of the medical outcomes study (MOS) sleep scale in patients with obstructive sleep apnea. Turk J Med Sci 2021; 51:268-279. [PMID: 33098282 PMCID: PMC7991870 DOI: 10.3906/sag-1909-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background/aim The purpose of the present study was to evaluate the Turkish reliability and validity of the medical outcomes study (MOS) sleep scale in patients who have obstructive sleep apnea. Materials and methods The data of the study were collected from 120 adult patients with obstructive sleep apnea and from 90 healthy individuals between March 04 and May 31, 2019. Results The Cronbach’s α internal consistency reliability coefficient of the MOS sleep scale was found as 0.82. The test-retest reliability was acceptable (r = 0.76-0.94). Six factors were identified by the factor analysis. These were the same as those in the original MOS-Sleep. The correlations between the MOS-Sleep and other instruments administered in this study provided evidence for structural validity. A significant relation was determined between MOS sleep scale and obstructive sleep apnea syndrome (OSAS) severity and the healthy group ( P < 0.05). In addition, the Cronbach α internal consistency reliability coefficient of the healthy group in MOS sleep scale was found as 0.78. The items of the six factors that were obtained with the confirmatory factor analysis for the MOS sleep scale of the healthy group were found to be the same as in the original MOS-Sleep. Conclusion Turkish MOS sleep scale is a measurement tool that consists of 12 items and 6 subdimensions with adequate validity and reliability indicators.
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Affiliation(s)
- Bülent Devrim Akçay
- Department of Mental Health and Diseases, Sleep Research Center, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Duygu Akçay
- Department of Military Health Services, Ministry of National Defense, Ankara, Turkey
| | - Sinan Yetkin
- Department of Mental Health and Diseases, Sleep Research Center, University of Health Sciences, Ankara, Turkey
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Mazidi M, Shekoohi N, Katsiki N, Banach M. Longer sleep duration may negatively affect renal function. Int Urol Nephrol 2021; 53:325-332. [PMID: 32970283 PMCID: PMC7862211 DOI: 10.1007/s11255-020-02624-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Observational studies evaluating the link between sleep duration and kidney function reported controversial results. In the present study, Mendelian randomization analysis was applied to obtain unconfounded estimates of the casual association of genetically determined sleep duration with estimated glomerular filtration rate and the risk of chronic kidney disease. METHODS Data from the largest genome-wide association studies on self-reported and accelerometer-derived sleep duration, estimated glomerular filtration rate and chronic kidney disease were analysed in total, as well as separately in diabetic and non-diabetic individuals. Inverse variance weighted (IVW) method, weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) were applied, as well as the leave-one-out method to rule out the impact of single single-nucleotide polymorphism. RESULTS Individuals with genetically longer self-reported sleep duration had a higher chronic kidney disease risk (IVW: β = 0.358, p = 0.047). Furthermore, in non-diabetics, longer self-reported sleep duration was negatively associated with estimated glomerular filtration rate (IVW: β = - 0.024, p = 0.020). Similarly, accelerometer-derived sleep duration was negatively related to estimated glomerular filtration rate in the total population (IVW: β = - 0.019, p = 0.047) and then on-diabetic individuals. No significant association was found between self-reported sleep duration and estimated glomerular filtration rate in the whole population and type-2 diabetes mellitus patients. None of the estimated associations was subjected to a significant level of heterogeneity. MR-PRESSO analysis did not show any chance of outliers for all estimates. The pleiotropy test also indicated low chance of pleiotropy. The leave-one-out method demonstrated that the links were not driven by single-nucleotide polymorphisms. CONCLUSIONS For the first time, the present study shed a light on the potential harmful effects of longer sleep duration (measured both objectively and subjectively) on kidney function. This finding was observed in the total population and in non-diabetic individuals, but not in those with diabetes. Further research is needed to elucidate the links between sleep duration, estimated glomerular filtration rate and the risk of chronic kidney disease.
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Affiliation(s)
- Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, Lambeth Palace Road, London, SE1 7EH, UK.
| | - Niloofar Shekoohi
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, University of Medical Sciences, Tehran, Iran
| | - Niki Katsiki
- First Department of Internal Medicine, Center for Diabetes, Metabolism and Endocrinology, AHEPA University Hospital, Thessaloniki, Greece
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, WAM University Hospital, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
- Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
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Risk of mortality among patients with moderate to severe obstructive sleep apnea and diabetes mellitus: results from the SantOSA cohort. Sleep Breath 2021; 25:1467-1475. [PMID: 33394326 DOI: 10.1007/s11325-020-02283-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/28/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Patients with obstructive sleep apnea (OSA) and comorbid diabetes mellitus (DM) are reported to have an increased risk of cardiovascular (CV) outcomes; however, data on CV mortality are scant. AIM This study aimed to evaluate if patients with comorbid OSA and DM have an increased risk of CV mortality that is higher than the two diseases in isolation. METHODS In this prospective cohort study, we included patients referred for a sleep study with and without DM at baseline. We developed four study groups as follows: group 1 (reference group), OSA (-) DM (-); group 2, OSA (-) DM (+); group 3, OSA (+) DM (-); group 4, OSA (+) DM (+). Intergroup differences were evaluated using the t test and χ2 test, and multivariate analysis was performed using logistic regression. The incidence rates of CV mortality were calculated using the Kaplan-Meier (log-rank) model, and adjusted HRs were calculated using the Cox regression model. RESULTS A total of 1447 patients were included in the analysis-group 1: 441 participants; group 2: 141 participants; group 3: 736 participants; group 4: 151 participants. The mean follow-up was 5 years. The association between OSA + DM showed an independent risk of incident CV mortality (HR 2.37, CI 1.16-4.82, p = 0.02) and an increased prevalence of coronary heart disease (OR 3.44, CI 1.73-5.59, p < 0.01). In addition, T90% was also associated with CV mortality. CONCLUSION The coexistence of OSA + DM was associated with an independent risk of CV mortality. In addition, T90% was also associated with CV mortality.
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Akbarpour S, Asgari S, Najafi A, Sadeghniiat K, Gholamypour Z. The association between body mass index and risk of obstructive sleep apnea among patients with HIV. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:123. [PMID: 35126586 PMCID: PMC8772514 DOI: 10.4103/jrms.jrms_803_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/23/2020] [Accepted: 07/12/2021] [Indexed: 11/04/2022]
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Laporta ML, Kruthiventi SC, Mantilla CB, Johnson RL, Sprung J, Portner ER, Schroeder DR, Weingarten TN. Three Risk Stratification Tools and Postoperative Pneumonia After Noncardiothoracic Surgery. Am Surg 2020; 87:1207-1213. [PMID: 33342277 DOI: 10.1177/0003134820956299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative in-hospital pneumonia is a serious complication. This study aims to investigate the association between 3 preoperative stratification tools (American Society of Anesthesiologists Physical Status [ASA-PS] score, Charlson Comorbidity Index [CCI], and Rockwood Frailty Deficit Index [FI]) and risk for postoperative pneumonia. METHODS We identified adult patients who developed postoperative pneumonia following noncardiothoracic surgery under general anesthesia, between January 1, 2016 and December 31, 2017. Patients with postoperative pneumonia were 1:1 matched to control subjects based on age, sex, and the exact type of operations. Medical records were reviewed to identify variables that may be associated with risk for developing postoperative pneumonia. Analyses adjusted for clinical characteristics were performed using the conditional logistic regression, taking into account 1:1 matched set case-control study design. RESULTS We identified 211 cases of postoperative pneumonia, and all 3 tested stratification tools were associated with increased risk: ASA-PS (after all adjustments of American Society of Anesthesiologists (ASA) III, odds ratio 4.17 [95% confidence interval 1.74-10.01]; ASA > III 24.03 [6.54-88.32]), CCI (CCI values > 3, 1.29 [1.02-1.63] per unit CCI score), and frail FI score 3.25 (1.45-7.27). Because of incomplete intake documentation, the FI could not be calculated in 57 (13.5%) patients, but these "unknown frailty" patients were also at increased risk for postoperative pneumonia, 3.15 (1.29-7.72). DISCUSSION Three commonly used stratification indices (ASA-PS score, CCI, and FI) were associated with increased risk for postoperative pneumonia. Patients unable to complete intake form to calculate the FI were also at increased risk.
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Affiliation(s)
- Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Erica R Portner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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A clinic-based cluster analysis in patients with moderate-severe obstructive sleep apnea (OSA) in Chile. Sleep Med 2020; 73:16-22. [DOI: 10.1016/j.sleep.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022]
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Elzayat S, El-Sobki A, El-Deeb ME, Moussa HH. Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure. Am J Otolaryngol 2020; 41:102500. [PMID: 32402692 DOI: 10.1016/j.amjoto.2020.102500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is caused by a complete or partial obstruction of the upper airway. A new Cahali lateral pharyngoplasty as a stand-alone procedure for the treatment of OSA patients, whatever the level and pattern of airway obstruction in patients with CPAP failure or non-compliant patients, is it? PATIENTS AND METHODS 40 patients with known OSAS non-compliant with CPAP or CPAP failures included. BMI, Stop-Bang score, and sleep study parameters were reported before and after the new Cahali pharyngoplasty operation. Preoperative DISE was done for all cases. RESULTS There were 28 (70%) cases with successful operation outcomes, and 12 (30%) failed cases. Postoperative Stop Bang score, AHI, snoring index were significantly reduced in comparison to preoperative data (p-value <0.001); however, minimal SpO2 and baseline SpO2 were significantly increased in comparison to preoperative data. There was a significant improvement in AHI postoperative. Patients collapse at the level of lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, all significantly predict failure outcome of the operation (p-value = 0.022). However, the absence of laryngeal collapse (L0) had a successful prediction outcome. The high snoring index significantly predicts operation failure. However, preoperative high baseline SpO2 predicts operation success significantly. CONCLUSION The new Cahali lateral pharyngoplasty can be used as a stand-alone procedure in the absence of lateral wall collapse at the level of the hypopharynx (LH), high tongue base collapse (TH), laryngeal collapse (L1) or tongue palate interaction.
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Zhang J, Hu C, Jiao X, Yang Y, Li J, Yu H, Qin Y, Wei Y. Potential Role of mRNAs and LncRNAs in Chronic Intermittent Hypoxia Exposure-Aggravated Atherosclerosis. Front Genet 2020; 11:290. [PMID: 32328084 PMCID: PMC7160761 DOI: 10.3389/fgene.2020.00290] [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] [Received: 12/09/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
Atherosclerosis is the pathological basis of cardiovascular disease. Obstructive sleep apnea (OSA) aggravates atherosclerosis, and chronic intermittent hypoxia (CIH) as a prominent feature of OSA plays an important role during the process of atherosclerosis. The mechanisms of CIH in the development of atherosclerosis remain unclear. In the current study, we used microarray to investigate differentially expressed mRNAs and long non-coding RNAs (lncRNAs) in aorta from five groups of ApoE–/– mice fed with a high-fat diet and exposed to various conditions: normoxia for 8 weeks, CIH for 8 weeks, normoxia for 12 weeks, CIH for 12 weeks, or CIH for 8 weeks followed by normoxia for 4 weeks. Selected transcripts were validated in aorta tissues and RT-qPCR analysis showed correlation with the microarray data. Gene Ontology analysis and pathway enrichment analysis were performed to explore the mRNA function. Bioinformatic analysis indicated that short-term CIH induced up-regulated mRNAs involved in inflammatory response. Pathway enrichment analysis of lncRNA co-localized mRNAs and lncRNA co-expressed mRNAs were performed to explore lncRNA functions. The up-regulated mRNAs, lncRNA co-localized mRNAs and lncRNA co-expressed mRNAs were significantly associated with protein processing in endoplasmic reticulum pathway in atherosclerotic vascular tissue with long-term CIH exposure, suggesting that differentially expressed mRNAs and lncRNAs play important roles in this pathway. Moreover, a mRNA-lncRNA co-expression network with 380 lncRNAs, 508 mRNAs and 3238 relationships was constructed based on the correlation analysis between the differentially expressed mRNAs and lncRNAs. In summary, our study provided a systematic perspective on the potential function of mRNAs and lncRNAs in CIH-aggravated atherosclerosis, and may provide novel molecular candidates for future investigation on atherosclerosis exposed to CIH.
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Affiliation(s)
- Jing Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Chaowei Hu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xiaolu Jiao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yunyun Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Juan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Huahui Yu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yanwen Qin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yongxiang Wei
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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Byun JI, Kim D, Ahn SJ, Yang KI, Cho YW, Cistulli PA, Shin WC. Efficacy of Oral Appliance Therapy as a First-Line Treatment for Moderate or Severe Obstructive Sleep Apnea: A Korean Prospective Multicenter Observational Study. J Clin Neurol 2020; 16:215-221. [PMID: 32319237 PMCID: PMC7174116 DOI: 10.3988/jcn.2020.16.2.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Responses to oral appliances (OAs) in obstructive sleep apnea (OSA) vary, and have not been fully evaluated in Korean patients. In this study we aimed to determine the efficacy of OAs for the first-line treatment of Korean patients with moderate or severe OSA. METHODS This multicenter prospective observational study included 45 patients with moderate or severe OSA that had been newly diagnosed between March 2017 and May 2018 and who underwent OA treatment for 1 month. Questionnaires were completed and polysomnography (PSG) was performed before and after OA treatment. The primary outcome measures were improvement in the absolute apnea-hypopnea index (AHI) and the percentage reduction in the AHI. The secondary outcomes were improvements in the questionnaire scores related to sleep-associated symptoms and PSG parameters. RESULTS The patients were aged 47.4±12.1 years (mean±SD), only two of them were female, and their AHI at baseline was 29.7±10.9/h. After OA treatment the AHI had reduced by 63.9±25.8%, with the reduction was similar between the patients with moderate OSA and those with severe OSA. Overall 31.1% of the patients achieved a normal AHI (<5/h), and 64.4% had an AHI of ≤10/h after the treatment. The body mass index (BMI) was the most reliable factor for predicting the percentage reduction in the AHI. The OAs also improved the sleep architecture and subjective sleep-related symptoms. CONCLUSIONS The OAs were effective in patients with moderate or severe OSA. The OAs reduced the mean AHI to 63.9% of the baseline value, and this reduction was influenced by the BMI.
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Affiliation(s)
- Jung Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Neurology, School of Medicine, Kyunghee University, Seoul, Korea
| | - Dongha Kim
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Su Jin Ahn
- Department of Biomaterials & Prosthodontics, Kyung Hee University Hospital at Gangdong, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Peter A Cistulli
- Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
- Centre for Sleep, Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Won Chul Shin
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Neurology, School of Medicine, Kyunghee University, Seoul, Korea.
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Kruthiventi SC, Laporta ML, Deljou A, Knopman DS, Petersen RC, Schroeder DR, Sprung J, Weingarten TN. Preoperative cognitive impairment associated with oversedation during recovery from anesthesia. J Anesth 2020; 34:390-396. [PMID: 32222908 DOI: 10.1007/s00540-020-02764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Our objective was to examine the association between preoperative cognitive status and postoperative recovery from anesthesia. METHODS We included patients (70-91 years old) from the Mayo Clinic Study of Aging who received general anesthesia and were admitted to the postanesthesia care unit from January 1, 2010 through April 30, 2018. Procedures were categorized according to patient's preoperative cognitive status: cognitive impaired (CI) and cognitive unimpaired (CU). Perioperative records were reviewed and analyses were performed with generalized estimating equations. RESULTS A total of 896 procedures from 611 patients were included, with 203 (22.7%) procedures in the CI group. Compared to CU procedures, CI procedures had higher rates of moderate-deep sedation during anesthesia recovery (52 [25.6%] vs. 103 [14.9%]; odds ratio [OR], 1.91; 95% CI, 1.30-2.80; P < 0.01), postoperative pulmonary complications (22 [10.8%] vs. 34 [4.9%]; OR, 2.36[1.22-4.54]; P = 0.01), and postoperative delirium (32 [16.2%] vs. 24 [3.5%]; OR, 5.33 [2.88-9.86]; P < 0.01). When moderate-deep sedation during anesthesia recovery was a covariate, both CI (OR, 3.02[1.60-5.70]; P < 0.01) and moderate-deep sedation (OR, 3.94[2.19-7.11]; P < 0.01) were associated with delirium. In multivariable analysis, postoperative pulmonary complications were associated with moderate-deep sedation (OR, 2.14[1.18-3.87]; P = 0 .01) but not with CI (OR, 1.49 [0.76-2.92]; P = 0 .25). CONCLUSIONS Cognitive impairment was associated with higher rates of moderate-deep residual sedation during anesthesia recovery and delirium, while moderate-deep sedation was associated with higher rates of pulmonary complications and delirium. We speculate that tailoring the anesthetic to facilitate faster emergence for CI patients could improve complication rates.
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Affiliation(s)
- S Chandralekha Kruthiventi
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Atousa Deljou
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - David S Knopman
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Darrell R Schroeder
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Hypoxemic features of obstructive sleep apnea and the risk of mortality: a cluster analysis. Sleep Breath 2020; 25:95-103. [DOI: 10.1007/s11325-020-02064-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
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Parolin M, Dassie F, Alessio L, Wennberg A, Rossato M, Vettor R, Maffei P, Pagano C. Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5624994. [PMID: 31722411 DOI: 10.1210/clinem/dgz116] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/11/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. AIM To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. METHODS AND STUDY SELECTION A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. RESULTS OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = -0.16; 95% CI, -0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = -0.03; 95% CI, -0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = -0.36; 95% CI, -0.49 to -0.23; k = 10; P < 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. CONCLUSION Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.
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Affiliation(s)
- Matteo Parolin
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Francesca Dassie
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Luigi Alessio
- Department of Neurosciences, University of Padua, via Giustiniani 2, Padova, Italy
| | - Alexandra Wennberg
- Department of Neurosciences, University of Padua, via Giustiniani 2, Padova, Italy
| | - Marco Rossato
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Pietro Maffei
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
| | - Claudio Pagano
- Department of Medicine, University of Padua, via Giustiniani 2, Padova, Italy
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Kruthiventi SC, Hofer RE, Warner ME, Sprung J, Kellogg TA, Weingarten TN. Postoperative nausea and vomiting after bariatric surgery and dexmedetomidine anesthetic: a propensity-weighted analysis. Surg Obes Relat Dis 2020; 16:545-553. [PMID: 32063491 DOI: 10.1016/j.soard.2020.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 12/27/2019] [Accepted: 01/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients undergoing laparoscopic bariatric surgery have high rates of postoperative nausea and vomiting (PONV). Dexmedetomidine based anesthetic could reduce PONV rates. OBJECTIVES To determine if PONV rates differ in patients undergoing laparoscopic bariatric surgery with anesthesia primarily based on dexmedetomidine or standard anesthetic management with inhalational agents and opioids. SETTING University hospital. METHODS From January 2014 to April 2018, 487 patients underwent laparoscopic bariatric surgery and met inclusion criteria (dexmedetomidine, n = 174 and standard anesthetic, n = 313 patients). In both groups, patients received preoperative PONV prophylaxis. We analyzed rates of PONV and moderate-to-deep sedation. A propensity score was calculated and outcomes were assessed using generalized estimating equations with inverse probability of treatment weighting. RESULTS Perioperative opioids and volatile anesthetics were reduced in dexmedetomidine patients. During anesthesia recovery the incidence of PONV was similar between dexmedetomidine and standard anesthetic patients (n = 37 [21.3%] versus n = 61 [19.5%], respectively; inverse probability of treatment weighting odds ratio = 1.35; 95% confidence interval .78-2.32, P = .281), and the incidence of sedation higher in dexmedetomidine patients (n = 86 [49.4%] versus n = 75 [24.0%]; inverse probability of treatment weighting odds ratio = 2.43; 95% confidence interval 1.47-4.03, P < 0.001). Rates of PONV and sedation were similar during the remainder of the hospital stay. A secondary sensitivity analysis was performed limited to dexmedetomidine patients who did not receive volatile and results were similar. CONCLUSIONS While dexmedetomidine-based anesthesia was associated with reduced opioid and volatile agents use, it was not associated with a reduction of PONV. The higher rates of moderate-to-deep sedation during anesthesia recovery observed with dexmedetomidine may be undesirable in morbidly obese patients.
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Affiliation(s)
| | | | | | - Juraj Sprung
- Department of Anesthesiology, Rochester, Minnesota
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Eustachian tube dysfunction in candidates for surgery for obstructive sleep apnoea syndrome. The Journal of Laryngology & Otology 2020; 134:81-85. [DOI: 10.1017/s002221512000002x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractBackgroundDefining the risk factors for Eustachian tube dysfunction can facilitate its prevention. It is hypothesised that Eustachian tube dysfunction as measured by the Eustachian Tube Dysfunction Questionnaire-7 is associated with obstructive sleep apnoea syndrome.MethodsThe questionnaire was systematically translated into Hebrew and validated in the accepted manner. This questionnaire was applied to obstructive sleep apnoea syndrome patients before and after expansion sphincter pharyngoplasty, in pre-set time intervals. The results were compared to those of controls from the general population.ResultsThirty-one patients (males:females = 19:12) were enrolled in the obstructive sleep apnoea syndrome group. Mean age was 43 years (range, 31–55 years) and mean body mass index was 28 kg/m2 (range, 27–30 kg/m2). Median apnoea-hypopnea index (pre-operatively) was 34 events per hour. The questionnaire scores in expansion sphincter pharyngoplasty candidates were significantly worse than in controls (p < 0.001). Expansion sphincter pharyngoplasty did not change Eustachian tube function in the long term, but was associated with additional self-limiting Eustachian tube dysfunction in the first two post-operative months.ConclusionEustachian tube dysfunction is significantly worse in patients with obstructive sleep apnoea syndrome compared to controls. Expansion sphincter pharyngoplasty is not associated with Eustachian tube function improvement.
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Missale F, Fragale M, Incandela F, Roustan V, Arceri C, Barbieri A, Canevari FR, Peretti G, Barbieri M. Outcome predictors for non-resective pharyngoplasty alone or as a part of multilevel surgery, in obstructive sleep apnea-hypopnea syndrome. Sleep Breath 2019; 24:1397-1406. [PMID: 31836994 DOI: 10.1007/s11325-019-01985-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Non-resective pharyngoplasty techniques have been shown to be effective to treat oropharyngeal collapse in patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS). The aim of our study is to evaluate outcome predictors in a cohort of patients affected by OSAHS and treated with non-resective pharyngoplasty, including variation of pharyngeal measures at the end of the surgical procedure. METHODS A cohort of patients affected by OSAHS, with palatal or lateral pharyngeal wall collapse, who underwent non-resective pharyngoplasty, were enrolled between 2014 and 2017. Surgical procedures encompassed non-resective pharyngoplasty by expansion sphincter pharyngoplasty (ESP) or barbed antero-lateral pharyngoplasty with barbed reposition pharyngoplasty (BRP) or barbed suspension pharyngoplasty (BSP) techniques, eventually associated with nasal surgery. Pharyngeal measures were recorded intraoperatively and their variation at the end of the procedure was considered. Surgical success was evaluated at least 6 months after surgery with respiratory polygraphy and ESS questionnaire. Outcome predictors were examined by multivariable logistic regression and ROC curve analysis. RESULTS Seventy patients met the study inclusion criteria. ESP, BRP, and BSP in a uni-/multilevel setting led to significant improvement of all respiratory polygraphic parameters and daily sleepiness (p < 0.0001). Outcome analysis showed that greater variation of antero-posterior pharyngeal measure was associated with success (p = 0.01), with an optimal cutoff value of 8.5 mm; low AHIpre, high ESSpre, and antero-lateral pharyngoplasty with barbed sutures were associated with a higher rate of cure (p < 0.05). CONCLUSIONS Non-resective pharyngoplasty is effective in treating OSAHS patients affected by palatal or lateral pharyngeal wall collapse, and intraoperative variation of antero-posterior width may be a useful tool to predict surgical success.
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Affiliation(s)
- Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy.
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery; Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Valeria Roustan
- Department of Otorhinolaryngology, Ospedale Santa Maria Delle Croci, Ravenna, Italy
| | - Carlotta Arceri
- Department of Anesthesiology, Hospital Policlinic San Martino, Genoa, Italy
| | - Andrea Barbieri
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
- Department of Otorhinolaryngology, ASL4 Liguria, Chiavari (GE), Italy
| | - Frank Rikki Canevari
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Marco Barbieri
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
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Labarca G, Dreyse J, Salas C, Gaete MI, Jorquera J. Performance of instruments aimed at detecting obstructive sleep apnea syndrome among individuals in Chile. ACTA ACUST UNITED AC 2019; 46:e20190015. [PMID: 31851221 PMCID: PMC7462683 DOI: 10.1590/1806-3713/e20190015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gonzalo Labarca
- . Facultad de Medicina, Universidad San Sebastián, Concepción, Chile
| | - Jorge Dreyse
- . Centro de Enfermedades Respiratorias, Clínica Las Condes, Santiago, Chile.,. Grupo de Estudio Trastornos Respiratorios del Sueño - GETRS - Clínica Las Condes, Santiago, Chile
| | - Constanza Salas
- . Centro de Enfermedades Respiratorias, Clínica Las Condes, Santiago, Chile.,. Grupo de Estudio Trastornos Respiratorios del Sueño - GETRS - Clínica Las Condes, Santiago, Chile
| | | | - Jorge Jorquera
- . Centro de Enfermedades Respiratorias, Clínica Las Condes, Santiago, Chile.,. Grupo de Estudio Trastornos Respiratorios del Sueño - GETRS - Clínica Las Condes, Santiago, Chile
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Salas C, Dreyse J, Contreras A, Nazar G, Astorquiza C, Cabezon R, Labarca G, Jorquera J. Differences in patients derived from otolaryngology and other specialties with sleep apnea. J Otolaryngol Head Neck Surg 2019; 48:53. [PMID: 31640800 PMCID: PMC6805651 DOI: 10.1186/s40463-019-0373-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Snoring is a main concern in patients who consult an otolaryngologist (ENT physicians) and patients who have cardiovascular comorbidities or excessive daytime sleepiness who usually consult with other specialists. The aim of this study was to describe the clinical differences in patients with obstructive sleep apnea (OSA) referred from ENT or other specialists. Methods A prospective study was carried out between June 2015 and July 2018 in a tertiary center. We included patients with suspected OSA referred by the Home Sleep Apnea Test (HSAT) from different specialties such as ENT or other specialties. The main outcome measures of our study were demographic characteristics, clinical characteristics, sleep questionnaire results and HSAT results between OSA patients referred from ENT or other specialists. We used a t-test and chi-squared test for analysis. The diagnostic accuracy of the sleep questionnaires was achieved using receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results A total of 481 patients were included. OSA was occurred in 82.4% of the subjects (90 in ENT and 306 in other specialties). Patients with OSA referred from other specialists were older than ENT patients (55 ± 13 vs 44 ± 12; p < 0.001), there was more obesity (IMC 31 ± 5.0 vs 28.7 ± 3.8; p < 0,001), a larger neck circumference (42.2 cm ± 3.7 vs 40.6 cm ± 3.0; p < 0.001) and more reported comorbidities (p < 0.001). ENT patients reported mild OSA (46% vs 31%, p = 0.015) and more positional apnea (62% vs 39%, p = 0.002). In this group, the STOP-BANG questionnaire showed an AUC 0.695 vs AUC 0.804, and for sensitivity, the best cutoff was 4 points. Patients referred from otorhinolaryngology are different from those referred from other specialties. Clinical evaluation and screening of OSA should be patient-centered according to these clinical findings.
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Affiliation(s)
- Constanza Salas
- Centro de Enfermedades Respiratorias y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
| | - Jorge Dreyse
- Centro de Enfermedades Respiratorias y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
| | - Andrea Contreras
- Neurología y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
| | - Gonzalo Nazar
- Otorrinolaringología y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
| | - Constanza Astorquiza
- Otorrinolaringología y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
| | - Rodrigo Cabezon
- Otorrinolaringología y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
| | - Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Lientur 1457, Concepcion, Chile.
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias y grupo de estudio trastornos respiratorios del sueño (GETRS), Clínica Las Condes, Las Condes, Chile
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Deljou A, Weingarten TN, Mahr MA, Sprung J, Martin DP. Postoperative Corneal Injuries: Incidence and Risk Factors. Anesth Analg 2019; 129:737-742. [PMID: 31425215 DOI: 10.1213/ane.0000000000003710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies of postoperative corneal injury rates relied on provider-initiated incident reports, which may underestimate the true incidence. Postoperative administration of proparacaine eye drops is used almost exclusively to diagnose corneal injury; therefore, identifying instances of administration may provide a better estimate of corneal injuries. We compared proparacaine administration versus provider-initiated reports to determine rates of corneal injury. In addition, potential associations between clinical variables and injury were assessed with a matched case-control study. METHODS The health records of 132,511 sequential adult postanesthesia recovery room admissions (January 1, 2011 to June 30, 2017) were reviewed to identify postoperative proparacaine administration and incident reports of corneal injury. Patients with corneal injury were matched with control patients at a 1:2 ratio to assess factors associated with injury. RESULTS Proparacaine drops were administered to 442 patients (425 patients received proparacaine for diagnosis and 17 patients received proparacaine for unrelated reasons). Incident reports identified 320 injuries, and the aggregate corneal injury count was 436 (incidence, 3.3 injuries [95% confidence interval {CI}, 3.0-3.6] per 1000 cases of general anesthesia). Proparacaine administration had a greater case ascertainment percentage than incident reporting (97.5% vs 73.4%; P < .001). The matched case-control analysis found greater risks associated with longer duration of anesthesia (odds ratio, 1.05 [95% CI, 1.03-1.07] per 10 minutes of anesthesia; P < .001) and nonsupine surgical position (odds ratio, 3.89 [95% CI, 2.17-6.98]; P < .001). Patients with injuries also had more evidence of sedation and agitation during anesthesia recovery. CONCLUSIONS Calculation of incidence by using the administration of a medication (proparacaine eye drops) that is almost exclusively used to diagnose a specific injury (corneal injury) showed higher case ascertainment percentage than incident-reporting methods. Similar strategies could be used to monitor the rates of other adverse events.
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Affiliation(s)
- Atousa Deljou
- From the Departments of Anesthesiology and Perioperative Medicine
| | | | | | - Juraj Sprung
- From the Departments of Anesthesiology and Perioperative Medicine
| | - David P Martin
- From the Departments of Anesthesiology and Perioperative Medicine
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The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173182. [PMID: 31480465 PMCID: PMC6747445 DOI: 10.3390/ijerph16173182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 08/24/2019] [Accepted: 08/25/2019] [Indexed: 11/17/2022]
Abstract
Oral appliance (OAm) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OAm therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OAm versus Bi-block OAm) remained eligible after applying the exclusion criteria. When comparing Mono-block OAm and Bi-block OAm, Mono-block OAm significantly reduced the apnea-hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; p = 0.0006), and patient preference for Mono-block OAm was significantly higher (2.06; 95%CI, 1.44 to 2.06; p < 0.0001). Lowest SpO2, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO2: -11.18; 95%CI, -26.90 to 4.54; p = 0.16, arousal index: 4.40; 95%CI, -6.00 to 14.80; p = 0.41, non-REM stage 3: -2.00; 95%CI, -6.00 to 14.80; p = 0.41, sleep efficiency: -1.42, 95%CI, -4.71 to 1.86; p = 0.40, ESS: 0.12; 95%CI, -1.55 to 1.79; p = 0.89, Snoring Scale: 0.55; 95%CI, -0.73 to 1.83, p = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, p = 1.00). In this systematic review, the use of Mono-block OAm was more effective than Bi-block OAm for OSA patients.
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Abdeen Y, Al-Halawani M, Kaako A, Hao IFY, Dazley J, Katpally R, Klukowicz A, Miller R, Slim J. Effect of the duration of protease inhibitor therapy in HIV-infected individuals on the severity of obstructive sleep apnea. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:65. [PMID: 31523251 PMCID: PMC6669999 DOI: 10.4103/jrms.jrms_892_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/21/2018] [Accepted: 04/23/2019] [Indexed: 11/04/2022]
Abstract
Background Protease inhibitors (PIs) are a vital part of the antiretroviral therapy. Long-term use of PIs may cause lipodystrophy, a clinical syndrome characterized by peripheral lipoatrophy and central fat accumulation, which may increase the risk of developing obstructive sleep apnea (OSA) in HIV-infected patients. We hypothesize that a longer duration of PIs' use might be associated with increasing severity of OSA in HIV-infected patients. Materials and Methods This was a retrospective cohort study of HIV-infected patients who were treated with PIs, who presented with symptoms suggestive of OSA, and underwent nocturnal polysomnography. The primary objective of the study is to evaluate the association between the duration of PIs' use and the severity of OSA. The duration of PIs' use measured in months was recorded for each patient. The primary outcome of interest was the apnea-hypopnea index (AHI) obtained at the time of the sleep study. Data were analyzed using univariate and multivariate linear regression between AHIs with PIs' use as well as other predictors. Results A total of 54 patients diagnosed with HIV and OSA were included in the study cohort for the analysis. Sleep study body mass index (BMI; P = 0.042) and change in BMI (ΔBMI; P = 0.027) were the only statistically significant independent predictors of AHI. The association between AHI and PIs' use duration was found to be nonlinear and nonsignificant. Gender differences evaluation suggested possible duration-related effect relationship between PIs and OSA severity among HIV-infected men exposed to PIs within a 66-month duration. Conclusion We did not observe a significant association between PIs' use duration and the severity of OSA.
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Affiliation(s)
- Yazan Abdeen
- Department of Pulmonary, Mercy Hospital, Fort Smith, AR 72903, USA
| | - Moh'd Al-Halawani
- Department of Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Ahmad Kaako
- Department of Internal Medicine, Mercy Hospital, Fort Smith, AR 72903, USA
| | - Ingrid Fang Ying Hao
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, NJ, USA
| | - Jason Dazley
- Department of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ, USA
| | - Ram Katpally
- Department of Pulmonary Medicine, Saint Michael's Medical Center, Newark, NJ, USA
| | - Alan Klukowicz
- Department of Pulmonary Medicine, Saint Michael's Medical Center, Newark, NJ, USA
| | - Richard Miller
- Department of Pulmonary Medicine, Saint Michael's Medical Center, Newark, NJ, USA
| | - Jihad Slim
- Department of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ, USA
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Lin HC, Su CL, Ong JH, Tsai KL, Chen YW, Lin CY, Chiang LL, Hung CH. Pulse Oximetry Monitor Feasible for Early Screening of Obstructive Sleep Apnea (OSA). J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00479-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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De Meyer MMD, Jacquet W, Vanderveken OM, Marks LAM. Systematic review of the different aspects of primary snoring. Sleep Med Rev 2019; 45:88-94. [PMID: 30978609 DOI: 10.1016/j.smrv.2019.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/04/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Primary snoring, also known as simple or non-apnoeic snoring, is regarded as the first stage of sleep disordered breathing without severe medical consequences for the snorer and co-sleeper. Although it is a highly prevalent phenomenon in the general population, our knowledge is limited because of the lack of a consensus on terminology. This systematic review of the aspects used in the definitions of simple/primary snoring was conducted to obtain an inventory of current practices and compare these definitions with the conceptual definition of the American Academy of Sleep Medicine. PubMed and Web of Science were searched from July 2016 onwards without any language limitations, and 362 references were obtained. After selection based on titles, 39 remained, among which 29 contained a definition or reference to a definition. In 69% of the studies, a cut-off <5 apnoea/Hypopnoea events per hour of sleep on the Apnoea-Hypopnoea Index was used. Despite this tendency, the cut-offs ranged from 0 to <15/h. Unfortunately, the cut-off and occasional requirements did not match the conceptual definition of the American Academy of Sleep Medicine. A consensus must be reached on an operational and clinically relevant definition based on the clear conceptual definition.
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Affiliation(s)
- Micheline M D De Meyer
- Special Needs in Oral Health, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium.
| | - Wolfgang Jacquet
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Educational Science EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Olivier M Vanderveken
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc A M Marks
- Special Needs in Oral Health, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium
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Alshehri KA, Bashamakh LF, Alshamrani HM, Alghamdi IO, Mahin BA, Alharbi AA, Alqulyti WM, Alshehri HZ, Alghamdi MT, Alhejaili FF. Pattern and severity of sleep apnea in a Saudi sleep center: The impact of obesity. J Family Community Med 2019; 26:127-132. [PMID: 31143086 PMCID: PMC6515767 DOI: 10.4103/jfcm.jfcm_16_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIM: The aim of this study was to estimate the effect of obesity on the severity of obstructive sleep apnea (OSA) by assessing the relationship between OSA and body mass index (BMI). MATERIALS AND METHODS: A cross-sectional study was conducted in 2017 among patients who had been referred to the sleep center at King Abdulaziz University Hospital (KAUH, Jeddah, Saudi Arabia) for polysomnography between January 2012 and September 2017. The data were abstracted from the medical records of these patients at KAUH. Initial data analysis included descriptive statistics; Chi-square test, t-test, and one-way ANOVA as appropriate were used to assess the associations between the variables. RESULTS: The study included 803 patients; the average age of the patients was 45.9 years and 56.5% were male. About 70.4% were obese, 54% of whom were classified as having Class 3 obesity. Approximately, 75% patients had OSA. The prevalence of OSA was higher among obese patients (77.7%) compared to nonobese patients (22.3%). Moreover, the severity of OSA was higher in obese patients, with 85.3% of obese patients considered as having severe OSA. CONCLUSION: Obesity is a considerable risk factor for developing OSA and could play a major role in increasing the severity of the disease. We encourage further studies on the impact of sedentary lifestyle and its association with OSA in Saudi Arabia, with an emphasis on the evaluation of the cost-effectiveness and burden of the disease.
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Affiliation(s)
- Khalid A Alshehri
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Lujain F Bashamakh
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hussein M Alshamrani
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ibtihal O Alghamdi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Bsmah A Mahin
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmed A Alharbi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Waleed M Alqulyti
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hisham Z Alshehri
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohannad T Alghamdi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Faris F Alhejaili
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Duman H, Özyurt S. Low serum bilirubin levels associated with subclinical atherosclerosis in patients with obstructive sleep apnea. Interv Med Appl Sci 2018; 10:179-185. [PMID: 30792909 PMCID: PMC6376353 DOI: 10.1556/1646.10.2018.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a chronic, progressive disease that can cause cardiovascular complications and atherosclerosis. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with OSA. Methods We enrolled 84 consecutive patients with OSA. The patients underwent ultrasonography, polysomnography, and echocardiography. Blood samples were obtained from all of the subjects, which were used for biochemical comparisons. The patients were divided into groups according to cIMT values (<0.9 vs. >0.9 mm). Results The patient population consisted of 84 OSA patients (mean age: 54.2 + 8.0 years, 62.9% male). The OSA patients with cIMT ≥0.9 had significantly elevated high-sensitive C-reactive protein (hsCRP), Oxygen desaturation index, apnea-hypopnea index (AHI), and significantly lower total and indirect bilirubin levels. Multivariate regression analyses revealed that total bilirubin, hsCRP, and AHI were the independent predictors of subclinical atherosclerosis. There was a negative correlation between total bilirubin and cIMT. Conclusions This study showed that high hsCRP and low serum total bilirubin levels could be paving the way for the development of subclinical atherosclerosis. Simple measures such as total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with OSA.
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Affiliation(s)
- Hakan Duman
- Faculty of Medicine, Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Songül Özyurt
- Faculty of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
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Hamre MC, Ekbom DC, Handlogten KS, Weingarten TN, Seelhammer TG. Anesthetic Management for Medialization Laryngoplasty Performed Under Concurrent Dexmedetomidine, Remifentanil, and Propofol Infusions. J Voice 2018; 34:134-139. [PMID: 30482475 DOI: 10.1016/j.jvoice.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Type I thyroplasty, or medialization larygoplasty (ML), is a procedure which improves the voice by medializing a vocal fold with a permanent implant. Anesthetic management of these cases is challenging because patients can require periods of deep sedation followed by fully awake moments for phonation to assess the implant size. We present our experience of ML with or without arytenoid adduction (AA) using a multimodal anesthetic regimen consisting of concurrent infusions of dexmedetomidine, remifentanil, and propofol. METHODS This is a retrospective case series of patients anesthetized using this protocol from June 1, 2015 through June 30, 2017. RESULTS Seventy-five consecutive ML with or without AA patients anesthetized with dexmedetomidine and remifentanil infusions were identified, of which 74 (98.7%) also received concurrent propofol infusions. Mean duration of sedation was 190.9 ± 36.9 minutes and surgery was 139 ± 35.3 minutes. Transient hypopnea treated with supplemental oxygen complicated 18 (24%) cases and bradycardia requiring pharmacologic treatment complicated 3 (4%) cases. There were no other adverse anesthetic complications. One patient required surgical re-exploration due to postsurgical bleeding after the initial hospital discharge. CONCLUSION In this cohort, a combination of remifentanil, dexmedetomidine and propofol infusions was well tolerated without serious adverse perioperative events.
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Affiliation(s)
- Megan C Hamre
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, MN, USA.
| | - Dale C Ekbom
- Mayo Clinic Department of Otolaryngology, Rochester, MN, USA
| | - Kathryn S Handlogten
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, MN, USA
| | - Toby N Weingarten
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, MN, USA
| | - Troy G Seelhammer
- Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, MN, USA
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Borsini EE, Blanco M, Ernst G, Montenegro P, Salvado A, Nigro C. Simulated intention-to-treat analysis based on clinical parameters of patients at high risk for sleep apnea derivated to respiratory polygraphy. ACTA ACUST UNITED AC 2018; 11:160-165. [PMID: 30455848 PMCID: PMC6201519 DOI: 10.5935/1984-0063.20180030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS) is a public health problem.
We designed a pilot study to validate empiric indication of CPAP therapy in
a population with moderate-to-high pre-test probabilities who underwent
self-administered home-based respiratory polygraphy (RP). Methods A cross-sectional simulation study was performed. CPAP therapy could be
indicated by two independent blind observers. Observer 1´s decision was
based on the results of STOP-BANG (SBQ) and Epworth Sleepiness Scale (ESS)
and Observer 2 used all objective data provided by RP + SBQ + ESS. Results We evaluated 1763 patients; 1060 men and 703 women (39.2%) with a mean age
of 53.6±13.8 and a body mass index (BMI) of 32.8±7.5 kg/m2. We
found evidence of mild (34.1%), moderate (26.6%), and severe (18.3%) There
were Apnea-Hypopnea Index (AHI) relationship between > 5 or < 5 SBQ
and RP AHI (p<0.05). BMI > 25 kg/m2 +
snoring (S) + observed apnea (O) + 1 of the following: ESS > 11,
hypertension (HT) or > 5 SBQ components showed sensitivity of 40% (CI95%:
37.3-43) and specificity of 95.1% (CI93.4-96.4). The performance of 5 SBQ
components with regard to gender and empirical CPAP therapy was; (women vs.
men): AUC-ROC 0.625 (CI95%: 0.599-0.651) vs. 0.70 (CI95%:
0.68-0.72), p<0.01, respectively. Conclusions STOP-BANG and ESS made it possible to indicate CPAP reliably (low rate of
false-positive results) in 20-40% of patients who needed such therapy
according to clinical history and RP results. These clinical criteria
performed better in male.
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Affiliation(s)
- Eduardo Enrique Borsini
- Hospital Británico de Buenos Aires, Sleep Units - Buenos Aires City - Buenos Aires - Argentina
| | - Magali Blanco
- Hospital Británico de Buenos Aires, Sleep Units - Buenos Aires City - Buenos Aires - Argentina
| | - Glenda Ernst
- Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina
| | - Paulina Montenegro
- Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina
| | - Alejandro Salvado
- Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina
| | - Carlos Nigro
- Hospital Alemán, Sleep Units - Buenos Aires City - Buenos Aires - Argentina
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Yang HK, Park SJ, Byun SJ, Park KH, Kim JW, Hwang JM. Obstructive sleep apnoea and increased risk of non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2018; 103:1123-1128. [PMID: 30413419 DOI: 10.1136/bjophthalmol-2018-312910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 09/30/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine whether the development of non-arteritic anterior ischaemic optic neuropathy (NAION) is increased among patients newly diagnosed with obstructive sleep apnoea (OSA) in a large general population. METHODS A 12-year nationwide, population-based, retrospective cohort study including 1 025 340 beneficiaries in the 2002-2013 Korean National Health Insurance Service database was performed. We identified 919 patients newly diagnosed with OSA aged ≥40 years and matched 9190 non-OSA controls using estimated propensity scores in reference to age, sex, demographics, comorbidities and co-medications. We applied Kaplan-Meier curves and Cox proportional hazard models to determine the risk of developing NAION in the OSA group compared with the non-OSA group. RESULTS The 10-year incidence probability of NAION was higher in the OSA group (0.92%; 95% CI 0.88 to 0.97) than the non-OSA group (0.42%; 95% CI 0.41 to 0.44, p=0.002, log-rank test). The OSA group was at increased risk of developing NAION compared with the non-OSA group (HR 3.80; 95% CI 1.46 to 9.90) after adjusting for demographics, comorbidities and co-medications. CONCLUSIONS Our results suggest that patients with newly diagnosed OSA have an increased risk of NAION, although the absolute risk of NAION is low.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Fields A, Huang J, Schroeder D, Sprung J, Weingarten T. Agitation in adults in the post-anaesthesia care unit after general anaesthesia. Br J Anaesth 2018; 121:1052-1058. [DOI: 10.1016/j.bja.2018.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/30/2018] [Accepted: 07/21/2018] [Indexed: 11/26/2022] Open
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Corneal Biomechanical Properties in Obstructive Sleep Apnea Syndrome. Eye Contact Lens 2018; 44 Suppl 2:S361-S364. [DOI: 10.1097/icl.0000000000000489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ma Z, Drinnan M, Hyde P, Munguia J. Mask interface for continuous positive airway pressure therapy: selection and design considerations. Expert Rev Med Devices 2018; 15:725-733. [PMID: 30227754 DOI: 10.1080/17434440.2018.1525291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Continuous positive airway pressure (CPAP) therapy is a clinical treatment for moderate or severe obstructive sleep apnea (OSA). Commercial CPAP mask designs normally come in standard sizes and the configuration is not commonly tailored to the patients' characteristics such as face topology, skin sensitivity, and severity of OSA syndrome; however, an optimal mask/interface selection is a key factor influencing the compliance and effectiveness of CPAP treatment. AREAS COVERED This review investigates the conventional CPAP mask design, its effect on OSA treatment, and the related risk factors that can lead to skin damage after long-term repeated use. Through a literature search on common databases, Scopus, PubMed, and Google Scholar, we identified reported facts on the influence of the mask interface and current trends toward customized devices. EXPERT COMMENTARY There is potential for optimizing the CPAP mask fit by adapting the interface to the patients' individual characteristics. This holds particularly true for users with abnormal features or simply outside conventional industry sizing standards. Enabling technologies for undertaking this adaptation include reverse engineering, computational modeling, and additive manufacturing. There is to date no integrated system that integrates those elements into a standard solution, but several studies have shown its effectiveness for specific cohorts.
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Affiliation(s)
- Zhichao Ma
- a Department of Mechanical Engineering , Newcastle University, School of Engineering , Newcastle upon Tyne , UK
| | - Michael Drinnan
- b Northern Medical Physical and Clinical Engineering department , NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Philip Hyde
- a Department of Mechanical Engineering , Newcastle University, School of Engineering , Newcastle upon Tyne , UK
| | - Javier Munguia
- a Department of Mechanical Engineering , Newcastle University, School of Engineering , Newcastle upon Tyne , UK
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Araie T, Okuno K, Ono Minagi H, Sakai T. Dental and skeletal changes associated with long-term oral appliance use for obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2018; 41:161-172. [PMID: 29628335 DOI: 10.1016/j.smrv.2018.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/27/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
An oral appliance (OA) is an effective treatment option for patients with obstructive sleep apnea (OSA), but dental and skeletal changes have been detected by many studies after long-term OA use. Better understanding of the long-term side effects may decrease discontinuation of OA use and assist clinicians to make informed decisions. Accordingly, a systematic review and meta-analysis were performed to evaluate the dental and skeletal changes associated with OAs designed to advance the mandible. The quality of the studies was determined by using the risk of bias assessment tool for non-randomized studies (RoBANS), and 12 studies were included in the meta-analysis. OA use was associated with a significant decrease of overjet (OJ) and overbite (OB), and it was suggested that both parameters decreased along with the duration of treatment. Meta-analysis also demonstrated a significant increase of L1-MP. However, there were no significant changes of skeletal modifications or mandibular rotation. Changes of incisor inclination were suggested to make a contribution to reduction of OJ and OB. In conclusion, long-term OA use was associated with dental changes. The results of this study provide information for clinicians about the long-term effects of OAs.
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Affiliation(s)
- Takafumi Araie
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Japan
| | - Kentaro Okuno
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Japan; Department of Geriatric Dentistry, Osaka Dental University, Japan.
| | - Hitomi Ono Minagi
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Japan
| | - Takayoshi Sakai
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Japan
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The use of flumazenil for benzodiazepine associated respiratory depression in postanesthesia recovery: risks and outcomes. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29631877 PMCID: PMC9391726 DOI: 10.1016/j.bjane.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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