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Stahl A, Dagan O, Nageris B, Ebner Y. Outcomes and safety of adenoidectomy in infants up to 12 months of age compared to older children. Eur Arch Otorhinolaryngol 2020; 277:2611-2617. [PMID: 32444966 DOI: 10.1007/s00405-020-06047-y] [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: 01/15/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the safety and outcomes of adenoidectomy for the treatment of sleep disordered breathing (SDB) in infants up to 12 months of age as compared to children ages 13-72 months METHODS: A retrospective analysis was performed by reviewing the medical records of children who underwent adenoidectomy from 2005 to 2018. The data of older age groups were also collected for comparison. The patients were divided into three groups: up to 12 months (infants), 13-36 months (toddlers) and 37-72 months (preschool). The data were collected from electronic medical records and from a telephone survey based on a modified version of the OSA-18 questionnaire. Postoperative complications, and short and long-term outcomes were compared. RESULTS Twenty-one patients met the inclusion criteria for the main study group (infants). They were compared with forty-four toddlers and thirty-two preschoolers. Among the infants, four (19%) needed additional surgical intervention, none of the toddlers and four (12.5%) preschoolers. There were no differences in subjective outcomes between age groups (p = 0.365) in the first year after surgery. One year after surgery, outcomes remained similar in all age groups (p = 0.302) with regard to SDB, but subjective improvements in mouth breathing and nasal discharge were better among the older children (p = 0.011 and p = 0.012), respectively. CONCLUSION The outcomes of adenoidectomy for the treatment of SDB in infants up to 12 months of age is similar to children ages 13-72 months.
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Affiliation(s)
- Avishai Stahl
- Department of Otolaryngology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.
| | - Or Dagan
- Department of Otolaryngology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Benny Nageris
- Department of Otolaryngology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Ebner
- Department of Otolaryngology, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel
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Lubas MM, Ware JC, Szklo-Coxe M. Sleep apnea and kidney transplant outcomes: findings from a 20-year (1997-2017) historical cohort study. Sleep Med 2019; 63:151-158. [PMID: 31669818 DOI: 10.1016/j.sleep.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/14/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE/BACKGROUND A historic cohort single-center study of kidney transplant recipients with graft loss examined the associations between sleep apnea and two transplant outcomes, death with a functioning graft (DWFG), and graft survival time. PATIENT/METHODS Adult patients who received transplants and experienced graft failure or DWFG from January 1, 1997 to January 1, 2017 constituted the cohort (n = 322). Data for the study were obtained by merging two secondary data sources: the Organ Procurement and Transplantation Network (OPTN) database and the transplant center's medical records. A Cox regression modeled the association of diagnosed sleep apnea, stratified by year-of transplant surgery, with graft survival time. Using backward elimination, this model was adjusted for recipient age, race/ethnicity, gender, functional status, donor age, and antigen mismatch. RESULTS No statistically significant differences were found for proportions of DWFG in those with, versus without, sleep apnea, informing our censoring approach. When examining graft survival time, the Cox regression model was stratified given a sleep apnea and year-of-transplant interaction (p < 0.01, adjusted model). For patients transplanted between 1997 and 2008, sleep apnea was statistically significantly associated with a decreased risk of graft failure or cardiovascular-related DWFG [adjusted Hazard Ratio (aHR) = 0.63, 95%CI, 0.42-0.94]. For patients transplanted between 2009 and 2017, sleep apnea statistically significantly increased the risk of graft failure or cardiovascular-related DWFG (aHR = 2.61, 95%CI, 1.13-6.00). CONCLUSIONS In a cohort of transplant recipients with graft loss, sleep apnea increased the risk of graft loss nearly three-fold among patients transplanted between 2009 and 2017. Similar DWFG proportions by sleep apnea presence indicate this risk is likely driven by renal failure, not mortality. Further research on whether treatment of sleep apnea can improve graft survival is warranted.
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Affiliation(s)
- Margaret M Lubas
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - J Catesby Ware
- Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Mariana Szklo-Coxe
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA; Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
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CHIN K. Overcoming sleep disordered breathing and ensuring sufficient good sleep time for a healthy life expectancy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:609-629. [PMID: 29021511 PMCID: PMC5743861 DOI: 10.2183/pjab.93.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
Recent advances in basic and clinical medicine have resulted in major improvements in human health. Currently sleep has been considered an essential factor in maintaining and promoting a healthy life expectancy. Sleep disorders include more than 60 diseases. Sleep disordered breathings (SDB) have 17 disorders, including sleep apnea. SDB usually induces hypoxemia and hypercapnia, which would have significant effects on cells, organs, and the whole body. We have investigated SDB for nearly 35 years. We found that SDB has significant associations with humoral factors, including coagulation systems, the body's protective factors against diseases, and metabolic and organ diseases. Currently we have been giving attention to the associations among SDB, short sleep duration, and obesity. In addition, SDB is important not only in the home but under critical care such as in the perioperative stage. In this review, I would like to describe several aspects of SDB in relation to systemic diseases and overall health based mainly on our published reports.
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Affiliation(s)
- Kazuo CHIN
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Balakrishnan K, James KT, Weaver EM. Predicting CPAP Use and Treatment Outcomes Using Composite Indices of Sleep Apnea Severity. J Clin Sleep Med 2016; 12:849-54. [PMID: 26857052 DOI: 10.5664/jcsm.5884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/13/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Measures of baseline sleep apnea disease burden (apnea-hypopnea index, Epworth Sleepiness Scale) predict continuous positive airway pressure (CPAP) adherence, but composite indices of sleep apnea severity (Sleep Apnea Severity Index, Modified Sleep Apnea Severity Index) may be more robust measures of disease burden. We tested the relative prognostic ability of each measure of sleep apnea disease burden to predict subsequent CPAP adherence and subjective sleep outcomes. METHODS Prospective cohort study at a tertiary academic sleep center. Patients (n = 323) underwent initial diagnostic polysomnography for suspected obstructive sleep apnea and 6 mo of subsequent CPAP therapy. RESULTS Baseline apnea-hypopnea index and both composite indices predicted adherence to CPAP therapy at 6 mo in multivariate analyses (all p ≤ 0.001). Baseline Epworth Sleepiness Scale did not predict CPAP adherence (p = 0.22). Both composite indices were statistically stronger predictors of CPAP adherence at 6 mo than apnea-hypopnea index (p < 0.001). In multivariate analyses, baseline apnea-hypopnea index (p < 0.05) and both composite indices (both p < 0.04) predicted change in Pittsburgh Sleep Quality Index, whereas only the composite indices predicted changes in Sleep Apnea Quality of Life Index (both p < 0.001). Adjustment for treatment adherence did not affect the relationship of the composite indices with change in Sleep Apnea Quality of Life Index (both p ≤ 0.005). CONCLUSIONS Composite indices of baseline sleep apnea severity better predict objective CPAP adherence and subjective treatment outcomes than baseline apnea-hypopnea index and baseline Epworth Sleepiness Scale.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN
| | - Kathryn T James
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA.,Comparative Effectiveness, Cost & Outcome Research Center, University of Washington and Harborview Medical Center, Seattle, WA
| | - Edward M Weaver
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA.,Comparative Effectiveness, Cost & Outcome Research Center, University of Washington and Harborview Medical Center, Seattle, WA.,Surgery Service, Department of Veterans Affairs Medical Center, Seattle, WA.,University of Washington Sleep Center, Harborview Medical Center, Seattle, WA
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Sharples L, Glover M, Clutterbuck-James A, Bennett M, Jordan J, Chadwick R, Pittman M, East C, Cameron M, Davies M, Oscroft N, Smith I, Morrell M, Fox-Rushby J, Quinnell T. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure. Health Technol Assess 2015; 18:1-296. [PMID: 25359435 DOI: 10.3310/hta18670] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1. All MADs improved disease-specific QoL. Compliance was lower for SP1, which was unpopular at trial exit. At 4 weeks, all devices were cost-effective at £20,000/quality-adjusted life-year (QALY), with SP2 the best value below £39,800/QALY. META-ANALYSIS A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH patients comparing MAD with conservative management (CM), MADs with CPAP or CPAP with CM. MADs and CPAP significantly improved AHI [MAD -9.3/hour (p < 0.001); CPAP -25.4/hour (p < 0.001)]. Effect difference between CPAP and MADs was 7.0/hour (p < 0.001), favouring CPAP. No trials compared CPAP with MADs in mild OSAH. MAD and CPAP reduced the ESS score similarly [MAD 1.6 (p < 0.001); CPAP 1.6 (p < 0.001)]. LONG-TERM COST-EFFECTIVENESS An existing model assessed lifetime cost-utility of MAD and CPAP in mild to moderate OSAH, using the revised meta-analysis to update input values. The TOMADO provided utility estimates, mapping ESS score to European Quality of Life-5 Dimensions three-level version for device cost-utility. Using SP2 as the standard device, MADs produced higher mean costs and mean QALYs than CM [incremental cost-effectiveness ratio (ICER) £6687/QALY]. From a willingness to pay (WTP) of £15,367/QALY, CPAP is cost-effective, although the likelihood of MADs (p = 0.48) and CPAP (p = 0.49) being cost-effective is very similar. Both were better than CM, but there was much uncertainty in the choice between CPAP and MAD (at a WTP £20,000/QALY, the probability of being the most cost-effective was 47% for MAD and 52% for CPAP). When SP2 lifespan increased to 18 months, the ICER for CPAP compared with MAD became £44,066. The ICER for SP1 compared with CM was £1552, and for bMAD compared with CM the ICER was £13,836. The ICER for CPAP compared with SP1 was £89,182, but CPAP produced lower mean costs and higher mean QALYs than bMAD. Differential compliance rates for CPAP reduces cost-effectiveness so MADs become less costly and more clinically effective with CPAP compliance 90% of SP2. CONCLUSIONS Mandibular advancement devices are clinically effective and cost-effective in mild to moderate OSAH. A semi-bespoke MAD is the appropriate first choice in most patients in the short term. Future work should explore whether or not adjustable MADs give additional clinical and cost benefits. Further data on longer-term cardiovascular risk and its risk factors would reduce uncertainty in the health economic model and improve precision of effectiveness estimates. TRIAL REGISTRATION This trial is registered as ISRCTN02309506. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Linda Sharples
- University of Leeds Clinical Trials Research Unit, Leeds, UK
| | - Matthew Glover
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | | | - Maxine Bennett
- Medical Research Council Biostatistics Unit, Cambridge, UK
| | - Jake Jordan
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | - Rebecca Chadwick
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Marcus Pittman
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Clare East
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Malcolm Cameron
- Maxillofacial Unit, Addenbrooke's NHS Foundation Trust, Cambridge, UK
| | - Mike Davies
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Nick Oscroft
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Ian Smith
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Mary Morrell
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Timothy Quinnell
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
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Cost-effectiveness of obstructive sleep apnea screening for patients with diabetes or chronic kidney disease. Sleep Breath 2015; 19:1081-92. [DOI: 10.1007/s11325-015-1134-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/27/2014] [Accepted: 01/23/2015] [Indexed: 01/28/2023]
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7
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Chin K. New insights in the management of patients with obstructive sleep apnea. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
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Robison JG, Wilson C, Otteson TD, Chakravorty SS, Mehta DK. Analysis of outcomes in treatment of obstructive sleep apnea in infants. Laryngoscope 2013; 123:2306-14. [DOI: 10.1002/lary.23685] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/28/2012] [Accepted: 07/25/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Jacob G. Robison
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
| | - Caleb Wilson
- University of Pittsburgh College of Medicine; Pittsburgh; Pennsylvania; U.S.A
| | - Todd D. Otteson
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
| | - Sangeeta S. Chakravorty
- Department of Pediatrics; Division of Pediatric Pulmonology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
| | - Deepak K. Mehta
- Department of Pediatric Otolaryngology; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; U.S.A
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Chin K. [108th Scientific Meeting of the Japanese Society of Internal Medicine: symposium: 2. Correlation between pulmonary diseases and whole body; (3) sleep apnea syndrome and life style related diseases]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:2509-2516. [PMID: 22117343 DOI: 10.2169/naika.100.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Japan
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Chaves Loureiro C, Drummond M, Winck JC, Almeida J. Paradoxical reaction of blood pressure on sleep apnoea patients treated with Positive Airway Pressure. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 17:53-8. [PMID: 21477566 DOI: 10.1016/s2173-5115(11)70014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Obstructive Sleep Apnoea Syndrome (OSAS) patients may develop hypertension and Positive Airway Pressure (PAP) is an effective treatment in blood pressure (BP) control. OBJECTIVES Analyse a hypertensive OSAS population with unexpected BP rise after PAP usage and verify correlations between BP rise, either with OSAS severity index or nocturnal ventilatory support compliance. METHODS Descriptive, retrospective analysis of 30 patients with PAP treated OSA, for one year, on average, and with previous controlled hypertension, who developed a rise in BP, defined as augmentation of > 5 mmHg in systolic (SBP) and/or diastolic BP (DBP), after PAP usage. Co-relational analysis of BP increase, with OSAS severity indexes and therapy compliance, using Pearson coefficient. RESULTS Of 508 consecutive patients followed in our Department, treated with nocturnal ventilatory support, 30 evolved with BP rise after initiating treatment (age 58 ± 10.8 years; Apnoea-Hypopnoea Index [AHI], 46.1 ± 18.68). After PAP usage, mean blood pressure (MBP), Systolic BP (SBP) and Diastolic BP (DBP) variation was 16 ± 15 mmHg, 20 ± 25 mmHg and 6 ± 19.4 mmHg, respectively. No patient showed significant BMI increase. Epworth Sleepiness Scale (ESS) value decreased 8.9 ± 5.48 points. MBP, SBP and DBP variations were not correlated with P90/P95, residual AHI, leaks or PAP compliance. CONCLUSIONS No specific characteristics were identified in the group who developed a rise in BP with PAP usage. No correlations were found between rises in BP and OSAS severity indexes or PAP compliance. Neither BMI nor variation in wakefulness status explained the rise in BP. Studies relate polymorphisms of β1-adrenoreceptors with different BP responses to ventilatory support. More studies are needed to clarify the cause of this paradoxical response.
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Affiliation(s)
- C Chaves Loureiro
- Pneumology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
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Usui Y, Takata Y, Inoue Y, Tomiyama H, Kurohane S, Hashimura Y, Kato K, Saruhara H, Asano K, Shiina K, Yamashina A. Severe obstructive sleep apnea impairs left ventricular diastolic function in non-obese men. Sleep Med 2011; 14:155-9. [PMID: 21377928 DOI: 10.1016/j.sleep.2010.09.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/03/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether obstructive sleep apnea (OSA) contributes directly to left ventricular (LV) diastolic dysfunction. METHODS Seventy-four non-obese male OSA (apnea hypopnea index (AHI)⩾5/h) patients without cardiac disease, hypertension or diabetes were enrolled. Echocardiography, pulse wave velocity (PWV) measurements and laboratory testing were performed in all patients. LV diastolic function was assessed by the transmitral flow velocity (E/A ratio), and mitral annular velocity (Ea) was derived from tissue Doppler imaging (TDI). RESULTS The E/A ratio and Ea in the severe OSA group (AHI⩾30/h) was significantly lower than those in the mild to moderate OSA group (5⩽AHI<30/h) (P<0.0001), whereas the S/D ratio, an indicator of pulmonary vein flow velocity, in the severe OSA group was significantly higher than that in the mild to moderate OSA group (P=0.04). AHI exhibited a statistically significant inverse correlation with the E/A ratio (r=-0.47, P=0.0001), but not with relative wall thickness (RWT), LV mass index (LVMI) or PWV. RWT, LVMI and PWV exhibited an inverse correlation with the E/A ratio. Multivariate linear regression analysis revealed that severe OSA was independently associated with the E/A ratio even after adjusting for age, insulin resistance, blood pressure, LV geometry, and PWV (β=-0.23, P=0.001). CONCLUSIONS These results indicate that severe OSA itself may contribute directly to LV diastolic dysfunction irrespective of LV geometry, arterial stiffness, obesity and its associated cardiovascular risk factors.
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Affiliation(s)
- Yasuhiro Usui
- Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
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Chaves Loureiro C, Drummond M, Winck J, Almeida J. Reacção paradoxal da pressão arterial ao tratamento com pressão positiva na via aérea em doentes com apneia do sono. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011. [DOI: 10.1016/s0873-2159(11)70014-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sim JJ, Rasgon SA, Derose SF. Review article: Managing sleep apnoea in kidney diseases. Nephrology (Carlton) 2010; 15:146-52. [PMID: 20470271 DOI: 10.1111/j.1440-1797.2009.01260.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A higher prevalence of sleep apnoea (SA) has been observed in the chronic kidney disease (CKD) population compared with estimates in the general population. Increased rates of SA have been described in patients with various renal-related diagnoses including dialysis, renal transplant, early-stage CKD and proteinuria. The mechanism or underlying aetiology for this association is different for each type of kidney disease. The extracellular fluid volume and metabolic derangements that characterize the uremic state likely contributes to SA in the dialysis population. SA causing direct renal insults from haemodynamic changes, ischaemic stress, or an intermediary condition such as hypertension, can lead to early CKD and proteinuria. While renal transplantation has cured SA in some patients, the post-transplant state is itself a risk factor for SA. The high prevalence of SA in kidney disease and the associated clinical implications warrant vigilance in diagnosis and treatment of SA in the CKD patient. This review focuses on the prevalence of SA in patients with CKD including dialysis and transplant patients, and those with early-stage CKD and proteinuria. SA may vary in form and aetiology depending on type or stage of CKD. Based on these associations, we discuss our rationale for recommendations on screening and management of SA specific to the CKD population.
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Affiliation(s)
- John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
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Long-term nasal continuous positive airway pressure treatment lowers blood pressure in patients with obstructive sleep apnea regardless of age. Hypertens Res 2010; 33:1025-31. [DOI: 10.1038/hr.2010.133] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Effects of long-term treatment for obstructive sleep apnea on pulse wave velocity. Hypertens Res 2010; 33:844-9. [DOI: 10.1038/hr.2010.77] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bakker J, Campbell A, Neill A. Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep 2010; 33:523-9. [PMID: 20394322 DOI: 10.1093/sleep/33.4.523] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) can be limited by suboptimal compliance. C-Flex technology (Philips Respironics, PA, USA) reduces pressure during expiration, aiming to improve comfort and therefore compliance. This may be of particular relevance to patients requiring high pressures. Many studies thus far have suffered from design limitations and small sample sizes. This study aimed to compare compliance with C-Flex and CPAP, as well as analyzing objective and subjective sleepiness and vigilance. DESIGN Three-month, double-blinded, parallel-arm randomized controlled trial. SETTING A university-based sleep laboratory. PATIENTS 76 consecutive patients with severe OSA (mean +/- SD AHI 60.2 +/- 32.9 events/hour, ESS 13.6 +/- 4.5/24, BMI 35.6 +/- 7.8 kg/m2), without significant cardiac, respiratory, psychiatric, or sleep comorbidities. INTERVENTIONS Patients were randomized to C-Flex (dip level 2) or CPAP. MEASUREMENTS AND RESULTS Patients underwent titration with C-Flex/CPAP (mean pressure 11.6 cm H2O). Modified maintenance of wakefulness tests (mod-MWT), psychomotor vigilance tasks (PVT) and questionnaires were administered at baseline and after one and 3 months. Median compliance was 5.51 and 5.89 h/night in the C-Flex and CPAP groups respectively (P = 0.82). There were no significant differences between groups in terms of PVT reaction time, subjective sleepiness, sleep quality, health-related quality of life, or treatment comfort. There was no significant difference between the groups regarding the change in mod-MWT sleep latency values. CONCLUSIONS In patients with severe OSA both CPAP and C-Flex resulted in substantial improvements in sleepiness, vigilance, and quality of life. The use of C-Flex did not result in greater compliance, and neither treatment appeared superior.
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Affiliation(s)
- Jessie Bakker
- WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand.
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Idris I, Hall AP, O'Reilly J, Barnett A, Allen M, Andrews R, Grunstein P, Lewis K, Goenka N, Wilding JP. Obstructive sleep apnoea in patients with type 2 diabetes: aetiology and implications for clinical care. Diabetes Obes Metab 2009; 11:733-41. [PMID: 19508352 DOI: 10.1111/j.1463-1326.2009.01045.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recent attention has been drawn to the close association between obstructive sleep apnoea (OSA) and type 2 diabetes mellitus (T2DM). Debate has included much discussion about cause and effect with mechanisms proposed whereby one condition might cause the other. However, both clearly share a common phenotype, namely, obesity that overlaps considerably with the other components of the metabolic syndrome, hypertension and hyperlipidaemia. It would therefore appear likely that all are manifestations of the same basic pathological processes. Possible interacting aetiological mechanisms are reviewed along with treatment options. A recent report by the International Diabetes Federation has made recommendations to raise awareness of possible OSA in patients with T2DM and also for screening for hypertension, hyperlipidaemia and T2DM in patients with known OSA. The clinical implications are discussed.
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Affiliation(s)
- Iskandar Idris
- Department of Diabetes and Endocrinology, Sherwood Forest Hospitals Foundation Trust, Nottinghamshire, UK.
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18
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The price of obstructive sleep apnea-hypopnea: hypertension and other ill effects. Am J Hypertens 2009; 22:474-83. [PMID: 19265785 DOI: 10.1038/ajh.2009.43] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This review addresses the cardiovascular, cerebrovascular, and metabolic consequences that accompany obstructive sleep apnea-hypopnea (OSAH) in conjunction with the mechanistic pathways implicated in mediating these effects. Particular emphasis is placed on the association with hypertension (HTN). Varying levels of evidence support a role of OSAH in perpetuating sustained HTN, nocturnal HTN, and difficult to control HTN as well as in contributing to the occurrences of nondipping of blood pressure (BP) and increased BP variability. In this context, the emergence of matched designs, adjusted analyses, meta-analyses as well as longitudinal and interventional studies strengthens causal inferences drawn from older observational studies, which suffered from such limitations as confounding.
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19
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MIDDLETON S, VERMEULEN W, BYTH K, SULLIVAN CE, MIDDLETON PG. Treatment of obstructive sleep apnoea in Samoa progressively reduces daytime blood pressure over 6 months. Respirology 2009; 14:404-10. [DOI: 10.1111/j.1440-1843.2009.01510.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Oga T, Chin K, Tabuchi A, Kawato M, Morimoto T, Takahashi K, Handa T, Takahashi K, Taniguchi R, Kondo H, Mishima M, Kita T, Horiuchi H. Effects of Obstructive Sleep Apnea with Intermittent Hypoxia on Platelet Aggregability. J Atheroscler Thromb 2009; 16:862-9. [DOI: 10.5551/jat.2188] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University
| | - Arata Tabuchi
- Department of Geriatric Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Kawato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Morimoto
- Center for Medical Education, Graduate School of Medicine, Kyoto University
| | - Kenichi Takahashi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Kanako Takahashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Ryoji Taniguchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hirokazu Kondo
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Toru Kita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hisanori Horiuchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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21
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Phillips CL, Yee B, Yang Q, Villaneuva AT, Hedner J, Berend N, Grunstein R. Effects of Continuous Positive Airway Pressure Treatment and Withdrawal in Patients With Obstructive Sleep Apnea on Arterial Stiffness and Central BP*. Chest 2008; 134:94-100. [DOI: 10.1378/chest.07-3121] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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22
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Yamauchi M, Kimura H. Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complications. Antioxid Redox Signal 2008; 10:755-68. [PMID: 18177236 DOI: 10.1089/ars.2007.1946] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a major public health problem because of its high prevalence in morbidity and mortality. A growing body of evidence suggests that OSA is an important risk factor for cardiovascular diseases. Although the mechanism for the initiation and aggravation of cardiovascular disease has not been fully elucidated, one theorized mechanism is intermittent hypoxia, which is produced by each sleep-disordered breathing event. This repeated hypoxia and reoxygenation cycle is similar to hypoxia-reperfusion injury, which initiates oxidative stress. Recent studies have suggested that OSA is associated with increased levels of oxidative stress or antioxidant deficiencies or both. Oxidative stress is involved in the activation of redox-sensitive transcription factors, which regulate downstream products such as inflammatory cytokines, chemokines, and adhesion molecules. This pathway may be able to explain the pathogenesis of atherosclerosis, a common pathologic factor underlying all types of cardiovascular disease. In addition, endothelial dysfunction derived from oxidative stress can contribute to cardiovascular diseases. This review summarizes current available evidence for and against the occurrence of oxidative stress in OSA and discusses the putative pathways initiating cardiovascular consequences associated with OSA.
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Affiliation(s)
- Motoo Yamauchi
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan.
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23
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Sim JJ, Rasgon SA, Derose SF. Sleep Apnea and Hypertension: Prevalence in Chronic Kidney Disease. J Clin Hypertens (Greenwich) 2007; 9:837-41. [DOI: 10.1111/j.1524-6175.2007.07176.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John J. Sim
- From the Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles;1 and the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena,2 CA
| | - Scott A. Rasgon
- From the Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles;1 and the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena,2 CA
| | - Stephen F. Derose
- From the Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles;1 and the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena,2 CA
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24
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Abstract
Insomnia is not a normal part of aging, but nighttime sleep in older adults is often disrupted, leading to excessive daytime sleepiness and other physical, psychological, and cognitive changes that affect overall health. Even so, clinicians often pay little attention to sleep in this population. The sleep of older adults tends to be less deep than that of younger people, and coexisting conditions and treatment effects can more easily disrupt sleep. This article reviews the current literature on sleep disruption in older adults and suggests ways that nurses can apply the information in intervening to improve sleep in their older patients.
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Affiliation(s)
- Catherine Cole
- University of Arkansas for Medical Sciences College of Nursing in Little Rock, USA.
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25
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Insalaco G, Salvaggio A, Marrone O. What effect on blood pressure can we expect from continuous positive airway pressure treatment in obstructive sleep apnoea? J Hypertens 2007; 24:1927-30. [PMID: 16957550 DOI: 10.1097/01.hjh.0000244939.11675.b9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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