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Ramamurthy MB, Jayaprakash S. Introduction to Pediatric Sleep Medicine. Indian J Pediatr 2023; 90:927-933. [PMID: 37378884 DOI: 10.1007/s12098-023-04697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Sleep is a key component of life to maintain our health, performance, safety and quality of life. In fact, sleep has been implicated in the optimal functioning of all organ systems - brain, heart, lung, metabolism, immune function, and hormonal balance too. One of the most common reasons for poor-quality sleep in children is a group of conditions termed sleep disordered breathing (SDB). Obstructive sleep apnea (OSA) is the most severe form of SDB. A good history and clinical examination is likely to reveal features of SDB including snoring, restless sleep, morning sleepiness, irritability or exhibit signs of hyperactivity. Examination may also reveal evidence of underlying pathology e.g., Craniofacial abnormalities, obesity and neuromuscular disorders that creates higher risk of developing SDB. Further investigation using polysomnography (PSG) is considered a gold-standard assessment of SDB and allows for scoring using Obstructive Apnoea-Hypopnea scale. Adenotonsillectomy is used as the first-line management in patients who otherwise have normal anatomy. Parents often approach their pediatricians with concerns regarding their child's sleeping habits and given the significant role sleep has on child development, it is essential that doctors are equipped to provide good care and advice for this population. This article aims to summarise presentation of SDB and common risk factors, investigations and management options to aid clinicians in managing SDB.
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Affiliation(s)
- Mahesh Babu Ramamurthy
- Department of Pediatrics, KTP-National University Children's Medical Institute, National University Hospital, Singapore, Singapore.
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Ding L, Peng J, Song L, Zhang X. Automatically detecting apnea-hypopnea snoring signal based on VGG19 + LSTM. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, Pizzarotti S, Zilioli A, Misirocchi F, Mutti C. Sleep medicine: Practice, challenges and new frontiers. Front Neurol 2022; 13:966659. [PMID: 36313516 PMCID: PMC9616008 DOI: 10.3389/fneur.2022.966659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.
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Affiliation(s)
- Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- *Correspondence: Liborio Parrino
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szucs
- Department of Behavioral Sciences, National Institute of Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Nicoletta Azzi
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Francesco Rausa
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Silvia Pizzarotti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Alessandro Zilioli
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Francesco Misirocchi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
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Vizcarra-Escobar D, Duque KR, Barbagelata-Agüero F, Vizcarra JA. Quality of life in upper airway resistance syndrome. J Clin Sleep Med 2022; 18:1263-1270. [PMID: 34931609 PMCID: PMC9059598 DOI: 10.5664/jcsm.9838] [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: 08/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the health-related quality of life (HRQoL) in patients with upper airway respiratory syndrome (UARS) and obstructive sleep apnea (OSA) compared to the general population (GP) in Lima, Peru, and to explore the variables associated with differences in HRQoL in patients with UARS. METHODS This was a retrospective study of medical and polysomnography records from 2009-2014 in a referral sleep medicine center for patients aged 18-64 years. UARS was defined by polysomnography as follows: apnea-hypopnea index < 5 events/h, oxygen saturation ≥ 92%, respiratory effort-related arousal index ≥ 5. HRQoL was assessed using the 36-Item Short Form Survey (version 1) questionnaire validated in Peru. The GP HRQoL was obtained from a population-based survey. Linear and logistic regression analyses were conducted. RESULTS We reviewed 1,329 polysomnograms and selected 888. UARS and OSA were diagnosed in 93 and 795 participants, respectively. The GP cohort consisted of 641 participants. Total HRQoL mean scores (95% confidence interval) in patients with UARS, patients with OSA, and the GP were 67.4 (63.7-71.1), 66.9 (65.4-68.4), and 82.9 (81.6-84.3), respectively. Patients with UARS and patients with OSA had a 5.5 times (95% confidence interval, 3.3-9.2) and 6.2 times (95% confidence interval, 4.6-8.4) greater probability of having a low total HRQoL score compared to patients in the GP, respectively. In patients with UARS, muscle pain, use of psychotropic medication, obesity, and depression were negatively correlated with the total HRQoL score. CONCLUSIONS The impact of OSA and UARS on HRQoL is similar between disease groups and markedly worse when compared to the impact in the GP. In patients with UARS, the presence of muscle pain, obesity, female sex, depression, and use of psychotropic medication negatively impacted HRQoL. CITATION Vizcarra-Escobar D, Duque KR, Barbagelata-Agüero F, Vizcarra JA. Quality of life in upper airway resistance syndrome. J Clin Sleep Med. 2022;18(5):1263-1270.
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Affiliation(s)
- Darwin Vizcarra-Escobar
- Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Perú
- Universidad Peruana Cayetano Heredia, Facultad de Medicina, Lima, Perú
| | - Kevin R. Duque
- Hypnos Instituto del Sueño, Clínica San Felipe, Lima, Perú
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
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Tufik SB, Pires GN, Palombini L, Andersen ML, Tufik S. Prevalence of Upper Airway Resistance Syndrome in the São Paulo Epidemiologic Sleep Study. Sleep Med 2022; 91:43-50. [DOI: 10.1016/j.sleep.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
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de Godoy LBM, Sousa KMM, Palombini LDO, Poyares D, Dal-Fabbro C, Guimarães TM, Tufik S, Togeiro SM. Long term oral appliance therapy decreases stress symptoms in patients with upper airway resistance syndrome. J Clin Sleep Med 2020; 16:1857-1862. [PMID: 32686643 DOI: 10.5664/jcsm.8698] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the long-term effects of a mandibular advancement device (MAD) on stress symptoms and cognitive function in patients with upper airway resistance syndrome (UARS) compared with placebo. METHODS This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized into 2 groups: placebo and MAD groups. UARS criteria were the presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea-hypopnea index ≤ 5 events/h and a respiratory disturbance index > 5 events/h of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Rey Auditory-Verbal Learning Test, the Logical Memory test, the Stroop Color Test, the Trail Making Test, the Digit Symbol Substitution Test, and Inventory of Stress Symptoms. Cognition protocol was defined based on the most used neuropsychological tests in the literature. Evaluations were performed before and after 1.5 years of treatment. RESULTS Mean adherence to placebo and to MAD was 6.6 ± 2.6 and 6.1 ± 2.4 h/night, respectively. Side effects reported by MAD group were minor and short-term. There was no statistically significant difference in Rey Auditory-Verbal Learning Test, Logical Memory test, Stroop Color Test, Trail Making Test, and Digit Symbol Substitution Test before and after 1.5 years of treatment in both groups. Inventory of Stress Symptoms score decreased at the alert phase and the resistance phase after 1.5 years of MAD treatment compared to the placebo. CONCLUSIONS Mandibular advancement devices were effective in decreasing stress symptoms in UARS patients after 1.5 years of treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Efficacy of Oral Appliance for Upper Airway Resistance Syndrome; URL: https://clinicaltrials.gov/ct2/show/record/NCT02636621; Identifier: NTC02636621.
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Affiliation(s)
- Luciana B M de Godoy
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ksdy M M Sousa
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cibele Dal-Fabbro
- Instituto do Sono, São Paulo, Brazil.,Center for Advanced Research in Sleep Medicine, CIUSSS NIM and Faculty of Dental Medicine, Université de Montréal, Montréal, Canada
| | - Thais M Guimarães
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sonia M Togeiro
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Elkahwagi M, Elokda M, Elghannam D, Elsobki A. Role of autologous platelet-rich fibrin in relocation pharyngoplasty for obstructive sleep apnoea. Int J Oral Maxillofac Surg 2020; 49:200-206. [DOI: 10.1016/j.ijom.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/26/2019] [Accepted: 05/31/2019] [Indexed: 12/30/2022]
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Talmant J, Talmant JC, Deniaud J, Amat P. [Etiological treatment of Obstructive Sleep Apnea]. Orthod Fr 2019; 90:423-428. [PMID: 34643527 DOI: 10.1051/orthodfr/2019021] [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: 06/13/2023]
Abstract
Research in the field of Obstructive Sleep Apnea (OSA) has been organized, and has profoundly transformed the quality of life of apneic patients, while even inviting dentofacial orthopedists to contribute to their symptomatic treatment. However, among the points still to be elucidated, the initial cause of the snoring that destabilizes the pharynx occupies a place apart. The objective of this article was to develop the proposal by Jacques Talmant regarding a mechanism capable of explaining the onset of OSA and for a therapy to treat pharyngeal destabilization during sleep. Based on published data, the etiopathogenesis of snoring and its consequences are described. Structural changes secondary to the vibratory trauma caused by snoring can affect each component of the pharyngeal structures and contribute to the collapsibility of this airway segment. By directly optimizing the development of ventilatory capabilities in their patients, orthodontists contribute, indirectly, to optimizing their cardiovascular and neuropsychological functions.
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Affiliation(s)
- Jacques Talmant
- 18, chemin de la Grimaudière, 44240 La Chapelle-sur-Erdre, France
| | | | | | - Philippe Amat
- 19, place des Comtes du Maine, 72000 Le Mans, France
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9
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Arnold WC, Guilleminault C. Upper airway resistance syndrome 2018: non-hypoxic sleep-disordered breathing. Expert Rev Respir Med 2019; 13:317-326. [PMID: 30689957 DOI: 10.1080/17476348.2019.1575731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Upper airway resistance syndrome (UARS) as obstructive sleep apnea syndrome (OSAS) has been described as abnormal breathing during sleep, based on the recording technologies and knowledge of the time. These terms have advanced the field, but are they still useful? Area Covered: Historically, the definition of UARS syndrome was aimed at recognizing pathology not covered by 'OSAS' and to prompt specialists to go further than the obvious. It aimed at pushing specialists to recognize pathologies earlier and to elicit research in the developmental features of sleep-disordered-breathing (SDB). The technology used to monitor SDB changed over-time, allowing recognition of SDB differently but not necessarily better. Expert Commentary: Currently, we have a better understanding of the development of SDB, and its evolution with aging, leading to co-morbid-OSA. However, the real issue is to recognize the problems much earlier, and to understand what can be done to prevent its development. The notions of OSA, UARS, apnea hypopnea index are only historical. There is enough knowledge to date to go beyond these definitions, to recognize problems differently and to lead to the prevention of the factors leading to SDB. The recognition of non-hypoxic sleep-disordered breathing is a step in this direction.
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Affiliation(s)
- William C Arnold
- a Sleep Medicine , Stanford University , Redwood City , CA , USA
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Himanen SL, Martikkala L, Sulkamo S, Rutanen A, Huupponen E, Tenhunen M, Saunamäki T. Prolonged partial obstruction during sleep is a NREM phenomenon. Respir Physiol Neurobiol 2018; 255:43-49. [PMID: 29803760 DOI: 10.1016/j.resp.2018.05.009] [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: 04/03/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Prolonged partial obstruction (PPO) is a common finding in sleep studies. Although not verified, it seems to emerge in deep sleep. We study the effect of PPO on sleep architecture or sleep electroencephalography (EEG) frequency. METHODS Fifteen OSA patients, 15 PPO + OSA patients and 15 healthy subjects underwent a polysomnography. PPO was detected from Emfit mattress signal. Visual sleep parameters and median NREM sleep frequency of the EEG channels were evaluated. RESULTS The amount of deep sleep (N3) did not differ between the PPO + OSA and control groups (medians 11.8% and 13.8%). PPO + OSA-patients' N3 consisted mostly of PPO. PPO + OSA patients had lighter sleep than healthy controls in three brain areas (Fp2-A1, C4-A1, O1-A2, p-values < 0.05). CONCLUSION PPO evolved in NREM sleep and especially in N3 indicating that upper airway obstruction does not always ameliorate in deep sleep but changes the type. Even if PPO + OSA-patients had N3, their NREM sleep was lighter in three EEG locations. This might reflect impaired recovery function of sleep.
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Affiliation(s)
- Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Lauri Martikkala
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Saramia Sulkamo
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Rutanen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Eero Huupponen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Department of Medical Physics, Tampere University Hospital, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Tiia Saunamäki
- Tampere University Hospital, Department of Neurology and Rehabilitation, Tampere, Finland
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Godoy LBM, Palombini L, Poyares D, Dal-Fabbro C, Guimarães TM, Klichouvicz PC, Tufik S, Togeiro SM. Long-Term Oral Appliance Therapy Improves Daytime Function and Mood in Upper Airway Resistance Syndrome Patients. Sleep 2017; 40:4555269. [PMID: 29045745 DOI: 10.1093/sleep/zsx175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To evaluate the long-term effects of an oral appliance on clinical symptoms, respiratory sleep parameters, sleep quality, and sustained attention in patients with upper airway resistance syndrome (UARS) were compared with placebo. Methods This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes of Sleep Questionnaire, the Beck Anxiety and Depression Inventories, underwent full-night polysomnography, multiple sleep latency test, and Psychomotor Vigilance Test (PVT). Evaluations were performed before and after 1.5 years of treatment. Results RDI, number of respiratory effort-related arousal, percentage of total sleep time with flow limitation, and arousal index significantly decreased after 1.5 years of MAD treatment. PSQI total score improved, severity of depression symptoms decreased, and mean reaction time in the PVT, based on the first measurement taken at 8:00 am, significantly decreased (p = .03) at the end of the protocol. Conclusions The MAD was effective in decreasing respiratory events in UARS patients. For UARS, 1.5 years of oral appliance therapy also improved sleep quality and sustained attention, and decreased the severity of depression symptoms. Clinical Trial Efficacy of Oral Appliance for Upper Airway Resistance Syndrome: Randomized, Parallel, Placebo-Controlled Study, NCT02636621.
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Affiliation(s)
- Luciana B M Godoy
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Luciana Palombini
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Dalva Poyares
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Cibele Dal-Fabbro
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Thaís Moura Guimarães
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Priscila Calixto Klichouvicz
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
| | - Sonia Maria Togeiro
- Departamento de Psicobiologia, Disciplina de Medicina e Biologia do Sono, Universidade Federal de São Paulo, Brazil
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Lin C, Lo MT, Guilleminault C. Exploring the Abnormal Modulation of the Autonomic Systems during Nasal Flow Limitation in Upper Airway Resistance Syndrome by Hilbert-Huang Transform. Front Med (Lausanne) 2017; 4:161. [PMID: 29034238 PMCID: PMC5625011 DOI: 10.3389/fmed.2017.00161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 09/14/2017] [Indexed: 11/28/2022] Open
Abstract
Patients with nasal flow limitation and upper airway resistance syndrome (UARS) during sleep can present with low blood pressure and disturbing symptoms associated with hypervagotony. We hypothesized that the dynamic changes of the autonomic system related to inspiratory flow limitation can be quantified by the developed analytic technique applied on beat-to-beat heart rate (RR intervals) and finger photoplethysmography (PPG).
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Affiliation(s)
- Chen Lin
- Stanford University Sleep Medicine Division, Stanford University, Redwood, CA, United States.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Christian Guilleminault
- Stanford University Sleep Medicine Division, Stanford University, Redwood, CA, United States
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Spinowitz S, Kim M, Park SY. Patterns of Upper Airway Obstruction on Drug-Induced Sleep Endoscopy in Patients with Sleep-Disordered Breathing with AHI <5. OTO Open 2017; 1:2473974X17721483. [PMID: 30480190 PMCID: PMC6239036 DOI: 10.1177/2473974x17721483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/09/2017] [Accepted: 06/28/2017] [Indexed: 01/29/2023] Open
Abstract
Objective To describe the patterns of upper airway obstruction in patients with
sleep-disordered breathing with apnea-hypopnea index (AHI) <5 using
drug-induced sleep endoscopy (DISE). Study Design Retrospective study. Setting Tertiary care center. Subjects and Methods Inclusion of patients with sleep-disordered breathing with AHI <5 on
polysomnography who underwent DISE. Patients <18 years of age were
excluded. DISE findings were reported with the VOTEL classification system:
the level of collapse was described as occurring at the velum, oropharynx,
tongue base, epiglottis, and the lingual tonsils. The degree of collapse was
reported as complete, partial, or none. The pattern of the obstruction was
described as anteroposterior, lateral, or concentric when applicable. Results A total of 54 patients with sleep-disordered breathing with AHI <5
underwent DISE. Ages ranged from 19 to 65 years. DISE was performed alone in
7% (n = 4) of patients and in conjunction with surgery in 93% (n = 50) of
patients. The velum was the most frequent site of upper airway obstruction
(85%, n = 46), followed by base of tongue (63%, n = 34), epiglottis (39%, n
= 21), lingual tonsils (35%, n = 19), and oropharynx (31%, n = 17).
Eighty-three percent (n = 45) of patients had multiple levels of upper
airway obstruction, and 15% (n = 8) had a single level of upper airway
obstruction. Conclusion Patients with sleep-disordered breathing with AHI <5 have significant
upper airway obstruction as seen on DISE. DISE findings indicate that a
majority of these patients have multiple levels of upper airway obstruction,
which can lead to significant symptoms.
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Affiliation(s)
- Sam Spinowitz
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Mimi Kim
- Department of Epidemiology and Population Health at the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven Y Park
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
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Moldofsky H, Rothman L, Kleinman R, Rhind SG, Richardson JD. Disturbed EEG sleep, paranoid cognition and somatic symptoms identify veterans with post-traumatic stress disorder. BJPsych Open 2016; 2:359-365. [PMID: 29018561 PMCID: PMC5609777 DOI: 10.1192/bjpo.bp.116.003483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic post-traumatic stress disorder (PTSD) behavioural symptoms and medically unexplainable somatic symptoms are reported to occur following the stressful experience of military combatants in war zones. AIMS To determine the contribution of disordered EEG sleep physiology in those military combatants who have unexplainable physical symptoms and PTSD behavioural difficulties following war-zone exposure. METHOD This case-controlled study compared 59 veterans with chronic sleep disturbance with 39 veterans with DSM-IV and clinician-administered PTSD Scale diagnosed PTSD who were unresponsive to pharmacological and psychological treatments. All had standardised EEG polysomnography, computerised sleep EEG cyclical alternating pattern (CAP) as a measure of sleep stability, self-ratings of combat exposure, paranoid cognition and hostility subscales of Symptom Checklist-90, Beck Depression Inventory and the Wahler Physical Symptom Inventory. Statistical group comparisons employed linear models, logistic regression and chi-square automatic interaction detection (CHAID)-like decision trees. RESULTS Veterans with PTSD were more likely than those without PTSD to show disturbances in non-rapid eye movement (REM) and REM sleep including delayed sleep onset, less efficient EEG sleep, less stage 4 (deep) non-REM sleep, reduced REM and delayed onset to REM. There were no group differences in the prevalence of obstructive sleep apnoeas/hypopnoeas and periodic leg movements, but sleep-disturbed, non-PTSD military had more EEG CAP sleep instability. Rank order determinants for the diagnosis of PTSD comprise paranoid thinking, onset to REM sleep, combat history and somatic symptoms. Decision-tree analysis showed that a specific military event (combat), delayed onset to REM sleep, paranoid thinking and medically unexplainable somatic pain and fatigue characterise chronic PTSD. More PTSD veterans reported domestic and social misbehaviour. CONCLUSIONS Military combat, disturbed REM/non-REM EEG sleep, paranoid ideation and medically unexplained chronic musculoskeletal pain and fatigue are key factors in determining PTSD disability following war-zone exposure. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Harvey Moldofsky
- Harvey Moldofsky, MD, Dip. Psych., FRCPC, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lorne Rothman
- Lorne Rothman, PhD, SAS (Canada) Institute, Inc., Toronto, Ontario, Canada
| | - Robert Kleinman
- Robert Kleinman, MD, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Shawn G. Rhind
- Shawn G. Rhind, PhD, Individual Behaviour and Performance Section, Toronto Research Centre, Defence Research and Development Canada, Toronto, Ontario, Canada
| | - J. Donald Richardson
- J. Donald Richardson, MD, FRCPC, Operational Stress Injury Clinic, Parkwood Hospital, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Department of Psychiatry & Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada
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Abstract
INTRODUCTION Dentists can be the first professionals to recognize a patient's potential sleep problem since they typically have more frequent contact with their patients than do physicians. It is important that dentists have a reasonable understanding of sleep disorders and how to assess their patients if they suspect such a problem so that a timely referral can be made or treatment can be provided as appropriate. OBJECTIVE To review the key literature relevant to sleep-disordered breathing (SDB) characteristics and diagnosis, including history, examination, and investigation with an emphasis on radiographic airway analyses. CONCLUSION The authors present a concise explanation of SDB conditions and an outline for thorough patient examination and evaluation, including radiographic airway analyses. Limited two-dimensional and three-dimensional norms exist for adult patients with no SDB and even less so for children. Much more research is needed, particularly in the pediatric population.
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Affiliation(s)
- Ahmed I Masoud
- a Department of Orthodontics, Faculty of Dentistry , King Abdulaziz University , Jeddah , Saudi Arabia.,b Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA.,c Graduate Program in Neuroscience , University of Illinois , Chicago , IL , USA
| | - Gregory W Jackson
- b Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA
| | - David W Carley
- d Departments of Biobehavioral Health Science, Medicine and Bioengineering , University of Illinois , Chicago , IL , USA
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Anttalainen U, Tenhunen M, Rimpilä V, Polo O, Rauhala E, Himanen SL, Saaresranta T. Prolonged partial upper airway obstruction during sleep - an underdiagnosed phenotype of sleep-disordered breathing. Eur Clin Respir J 2016; 3:31806. [PMID: 27608271 PMCID: PMC5015642 DOI: 10.3402/ecrj.v3.31806] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/10/2016] [Indexed: 12/31/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea-hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland;
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- Department of Medical Physics, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Ville Rimpilä
- School of Medicine, University of Tampere, Tampere, Finland
| | - Olli Polo
- Unesta Research Center, Tampere, Finland
- Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland
| | - Esa Rauhala
- Department of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
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de Godoy LBM, Luz GP, Palombini LO, e Silva LO, Hoshino W, Guimarães TM, Tufik S, Bittencourt L, Togeiro SM. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea. PLoS One 2016; 11:e0156244. [PMID: 27228081 PMCID: PMC4881892 DOI: 10.1371/journal.pone.0156244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/11/2016] [Indexed: 12/26/2022] Open
Abstract
Purpose To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS), mild Obstructive Sleep Apnea (OSA) and normal individuals. Methods UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale—ESS—≥ 10) and/or fatigue (Modified Fatigue Impact Scale—MFIS—≥ 38) associated to Apnea/hypopnea index (AHI) ≤ 5 and Respiratory Disturbance Index (RDI) > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10) and/or fatigue (MFIS ≥ 38) associated to AHI ≥ 5 and ≤ 15 events/hour. “Control group” criteria were AHI < 5 events/hour and RDI ≤ 5 events/hour and ESS ≤ 9, without any sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in “control group”), adjusted for age, gender, body mass index (BMI) and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT) was performed five times (each two hours) from 8 a.m. to 4 p.m. Results UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire—FOSQ—and Pittsburgh Sleep Quality Index—PSQI: p < 0.05) and more fatigue than mild OSA patients (p = 0.003) and scored significantly higher in both Beck inventories than “control group” (p < 0.02). UARS patients had more lapses early in the morning (in time 1) compared to the results in the afternoon (time 5) than mild OSA (p = 0.02). Mild OSA patients had more lapses in times 2 than in time 5 compared to “control group” (p = 0.04). Conclusions UARS patients have a worse sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.
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Affiliation(s)
| | - Gabriela Pontes Luz
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, Brasil
| | | | | | - Wilson Hoshino
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, Brasil
| | | | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, Brasil
| | - Lia Bittencourt
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, Brasil
| | - Sonia Maria Togeiro
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, Brasil
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18
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Quo S, Guilleminault C. A lot is missing: the Orcade study. Sleep Med 2016; 19:126-7. [DOI: 10.1016/j.sleep.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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Tenhunen M, Hasan J, Himanen SL. Assessment of respiratory effort during sleep with noninvasive techniques. Sleep Med Rev 2015; 24:103-4. [PMID: 26462415 DOI: 10.1016/j.smrv.2015.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Mirja Tenhunen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; Department of Electronics and Communication Engineering and BioMediTech, Tampere University of Technology, Tampere, Finland; Department of Medical Physics, Tampere University Hospital, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland.
| | - Joel Hasan
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
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Suzuki M, Furukawa T, Sugimoto A, Katada K, Kotani R, Yoshizawa T. Relationship between Oral Flow Patterns, Nasal Obstruction, and Respiratory Events during Sleep. J Clin Sleep Med 2015; 11:855-60. [PMID: 25766699 DOI: 10.5664/jcsm.4932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 02/06/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep breathing patterns are altered by nasal obstruction and respiratory events. This study aimed to describe the relationships between specific sleep oral flow (OF) patterns, nasal airway obstruction, and respiratory events. METHODS Nasal flow and OF were measured simultaneously by polysomnography in 85 adults during sleep. OF was measured 2 cm in front of the lips using a pressure sensor. RESULTS OF could be classified into three patterns: postrespiratory event OF (postevent OF), during-respiratory event OF (during-event OF), and spontaneous arousal-related OF (SpAr-related OF). Postevent OFs begin at the end of airflow reduction, are preceded by respiratory arousal, and are accompanied by postapneic hyperventilation; during-event OFs occur during nasal flow reduction; and SpAr-related OFs to OF begin during stable breathing, and are preceded by spontaneous arousal but are rarely accompanied by apnea/hypopnea. Multivariate regression showed that nasal obstruction was predictive of SpAr-related OF. The relative frequency of SpAr-related OF events was negatively correlated with the apnea-hypopnea index. The fraction of SpAr-related OF duration relative to total OF duration was significantly greater in patients with nasal obstruction than in those without. CONCLUSION SpAr-related OF was associated with nasal obstruction, but not respiratory events. This pattern thus functions as a "nasal obstruction bypass", mainly in normal subjects and patients with mild sleep disordered breathing (SDB). By contrast, the other two types were related to respiratory events and were typical patterns seen in patients with moderate and severe SDB.
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Affiliation(s)
- Masaaki Suzuki
- Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Tokyo, Japan
| | - Taiji Furukawa
- Department of Laboratory Medicine, Teikyo University School of Medicine, Chiba, Japan
| | - Akira Sugimoto
- Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Tokyo, Japan
| | - Koji Katada
- Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Tokyo, Japan
| | - Ryosuke Kotani
- Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Tokyo, Japan
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21
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New insights on the pathophysiology of inspiratory flow limitation during sleep. Lung 2015; 193:387-92. [PMID: 25827757 DOI: 10.1007/s00408-015-9714-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Inspiratory flow limitation (IFL) is defined as a "flattened shape" of inspiratory airflow contour detected by nasal cannula pressure during sleep and can indicate increased upper airway resistance especially in mild sleep-related breathing disorders (SRBD). The objective of this study was to investigate the association between upper airway abnormalities and IFL in patients with mild SRBD. METHODS This study was derived from a general population study consisting of selected individuals with apnea-hypopnea index (AHI) below 5 events/h of sleep, ("no obstructive sleep apnea" group) and individuals with AHI between 5 and 15 events/h ("mild obstructive sleep apnea" group). A total of 754 individuals were divided into four groups: group 1: AHI <5/h and <30 % of total sleep time (TST) with IFL (515 individuals), group 2: AHI <5/h and >30 % of TST with IFL (46 individuals), group 3: AHI: 5-15/h and <30 % of TST with IFL (168 individuals), and group 4: AHI: 5-15/h and >30 % of TST with IFL (25 individuals). RESULTS Individuals with complains of oral breathing demonstrated a risk 2.7-fold larger of being group 4 compared with group 3. Abnormal nasal structure increased the chances of being in group 4 3.2-fold in comparison to group 1. Individuals with voluminous lateral wall demonstrated a risk 4.2-fold larger of being group 4 compared with group 3. CONCLUSION More than 30 % of TST with IFL detected in sleep studies was associated with nasal and palatal anatomical abnormalities in mild SRBD patients.
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de Godoy LB, Palombini LO, Guilleminault C, Poyares D, Tufik S, Togeiro SM. Treatment of upper airway resistance syndrome in adults: Where do we stand? Sleep Sci 2015; 8:42-8. [PMID: 26483942 PMCID: PMC4608900 DOI: 10.1016/j.slsci.2015.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To evaluate the available literature regarding Upper Airway Resistance Syndrome (UARS) treatment. METHODS Keywords "Upper Airway Resistance Syndrome," "Sleep-related Breathing Disorder treatment," "Obstructive Sleep Apnea treatment" and "flow limitation and sleep" were used in main databases. RESULTS We found 27 articles describing UARS treatment. Nasal continuous positive airway pressure (CPAP) has been the mainstay therapy prescribed but with limited effectiveness. Studies about surgical treatments had methodological limitations. Oral appliances seem to be effective but their efficacy is not yet established. CONCLUSION Randomized controlled trials with larger numbers of patients and long-term follow-up are important to establish UARS treatment options.
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Affiliation(s)
- Luciana B.M. de Godoy
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Luciana O. Palombini
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Dalva Poyares
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sonia M. Togeiro
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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23
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Upper-Airway Resistance Syndrome: A Short History. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Heart rate variability evaluation of Emfit sleep mattress breathing categories in NREM sleep. Clin Neurophysiol 2014; 126:967-74. [PMID: 25241203 DOI: 10.1016/j.clinph.2014.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Heart rate variability (HRV) analysis of obstructive sleep apnea patients reveals an increase in sympathetic activity. Sleep disordered breathing (SDB) can be also assessed with sleep mattress sensors, as the Emfit sensor, by dividing the signal into different breathing categories. In addition to normal breathing (NB) and periodic apneas/hypopneas (POB), the sleep mattress unveils a breathing category consisting of sustained partial obstruction (increased respiratory resistance, IRR). The aim of our study was to evaluate HRV during these three breathing categories in NREM sleep. METHODS 53 patients with suspected SDB underwent an overnight polysomnography with an Emfit mattress. The Emfit signal was scored in 3-min epochs according to the established rules. The NB, POB, and IRR epochs were combined to as long NB, POB and IRR periods as possible and HRV was calculated from at least 6-min epochs. RESULTS The meanHR did not differ between the breathing categories. HRV parameters revealed an increase in sympathetic activity during POB. The mean LF/HF ratio was highest during POB (3.0) and lowest during IRR (1.3). During NB it was 1.7 (all p-values ⩽ 0.001). Interestingly sympathetic activity decreased and parasympathetic activity increased during IRR as compared to NB (the mean HF power was 1113.8 ms(2) during IRR and 928.4 ms(2) during NB). CONCLUSIONS The HRV findings during POB resembled HRV results of sleep apnea patients but during sustained prolonged partial obstruction a shift towards parasympathetic activity was achieved. SIGNIFICANCE The findings encourage the use of sleep mattresses in SDB diagnostics. In addition the findings suggest that sustained partial obstruction represents its own SDB entity.
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Screening sleep disordered breathing in stroke unit. SLEEP DISORDERS 2014; 2014:317615. [PMID: 24991437 PMCID: PMC4058514 DOI: 10.1155/2014/317615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022]
Abstract
In acute stroke, OSA has been found to impair rehabilitation and increase mortality but the effect of central apnea is more unclear. The aim of the present study was to evaluate the feasibility of using limited ambulatory recording system (sleep mattress to evaluate nocturnal breathing and EOG-electrodes for sleep staging) in sleep disordered breathing (SDB) diagnostics in mild acute cerebral ischemia patients and to discover the prevalence of various SDB-patterns among these patients. 42 patients with mild ischemic stroke or transient ischemic attack were studied. OSA was found in 22 patients (52.4%). Central apnea was found in two patients (4.8%) and sustained partial obstruction in only one patient (2.4%). Sleep staging with EOG-electrodes only yielded a similar outcome as scoring with standard rules. OSA was found to be common even after mild stroke. Its early diagnosis and treatment would be favourable in order to improve recovery and reduce mortality. Our results suggest that OSA can be assessed by a limited recording setting with EOG-electrodes, sleep mattress, and pulse oximetry.
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Deary V, Ellis JG, Wilson JA, Coulter C, Barclay NL. Simple snoring: not quite so simple after all? Sleep Med Rev 2014; 18:453-62. [PMID: 24888523 DOI: 10.1016/j.smrv.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/07/2014] [Accepted: 04/29/2014] [Indexed: 01/26/2023]
Abstract
Simple snoring (SS), in the absence of obstructive sleep apnoea (OSA), is a common problem, yet our understanding of its causes and consequences is incomplete. Our understanding is blurred by the lack of consistency in the definition of snoring, methods of assessment, and degree of concomitant complaints. Further, it remains contentious whether SS is independently associated with daytime sleepiness, or adverse health outcomes including cardiovascular disease and metabolic syndrome. Regardless of this lack of clarity, it is likely that SS exists on one end of a continuum, with OSA at its polar end. This possibility highlights the necessity of considering an otherwise 'annoying' complaint, as a serious risk factor for the development and progression of sleep apnoea, and consequent poor health outcomes. In this review, we: 1) highlight variation in prevalence estimates of snoring; 2) review the literature surrounding the distinctions between SS, upper airway resistance syndrome (UARS) and OSA; 3) present the risk factors for SS, in as far as it is distinguishable from UARS and OSA; and 4) describe common correlates of snoring, including cardiovascular disease, metabolic syndrome, and daytime sleepiness.
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Affiliation(s)
- Vincent Deary
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Department of Otolaryngology, Head and Neck Surgery, Newcastle University, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Nicola L Barclay
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK.
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Lee EK, Gutcher ST, Douglass AB. Is sleep-disordered breathing associated with miscarriages? An emerging hypothesis. Med Hypotheses 2014; 82:481-5. [DOI: 10.1016/j.mehy.2014.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/29/2014] [Indexed: 12/17/2022]
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Díaz JA, Arancibia JM, Bassi A, Vivaldi EA. Envelope analysis of the airflow signal to improve polysomnographic assessment of sleep disordered breathing. Sleep 2014; 37:199-208. [PMID: 24470709 DOI: 10.5665/sleep.3338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVES Given the detailed respiratory waveform signal provided by the nasal cannula in polysomnographic (PSG) studies, to quantify sleep breathing disturbances by extracting a continuous variable based on the coefficient of variation of the envelope of that signal. DESIGN Application of an algorithm for envelope analysis to standard nasal cannula signal from actual polysomnographic studies. SETTING PSG recordings from a sleep disorders center were analyzed by an algorithm developed on the Igor scientific data analysis software. PATIENTS OR PARTICIPANTS Recordings representative of different degrees of sleep disordered breathing (SDB) severity or illustrative of the covariation between breathing and particularly relevant factors and variables. INTERVENTIONS The method calculated the coefficient of variation of the envelope for each 30-second epoch. The normalized version of that coefficient was defined as the respiratory disturbance variable (RDV). The method outcome was the all-night set of RDV values represented as a time series. MEASUREMENTS AND RESULTS RDV quantitatively reflected departure from normal sinusoidal breathing at each epoch, providing an intensity scale for disordered breathing. RDV dynamics configured itself in recognizable patterns for the airflow limitation (e.g., in UARS) and the apnea/hypopnea regimes. RDV reliably highlighted clinically meaningful associations with staging, body position, oximetry, or CPAP titration. CONCLUSIONS Respiratory disturbance variable can assess sleep breathing disturbances as a gradual phenomenon while providing a comprehensible and detailed representation of its dynamics. It may thus improve clinical diagnosis and provide a revealing descriptive tool for mechanistic sleep disordered breathing modeling. Respiratory disturbance variable may contribute to attaining simplified screening methodologies, novel diagnostic criteria, and insightful research tools.
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Affiliation(s)
- Javier A Díaz
- Laboratorio de Sueño y Cronobiología, Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - José M Arancibia
- Laboratorio de Sueño y Cronobiología, Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Alejandro Bassi
- Laboratorio de Sueño y Cronobiología, Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ennio A Vivaldi
- Laboratorio de Sueño y Cronobiología, Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Palombini LO, Tufik S, Rapoport DM, Ayappa IA, Guilleminault C, de Godoy LBM, Castro LS, Bittencourt L. Inspiratory flow limitation in a normal population of adults in São Paulo, Brazil. Sleep 2013; 36:1663-8. [PMID: 24179299 PMCID: PMC3792383 DOI: 10.5665/sleep.3122] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Inspiratory flow limitation (IFL) during sleep occurs when airflow remains constant despite an increase in respiratory effort. This respiratory event has been recognized as an important parameter for identifying sleep breathing disorders. The purpose of this study was to investigate how much IFL normal individuals can present during sleep. DESIGN Cross-sectional study derived from a general population sample. SETTING A "normal" asymptomatic sample derived from the epidemiological cohort of São Paulo. PATIENTS AND PARTICIPANTS This study was derived from a general population study involving questionnaires and nocturnal polysomnography of 1,042 individuals. A subgroup defined as a nonsymptomatic healthy group was used as the normal group. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS All participants answered several questionnaires and underwent full nocturnal polysomnography. IFL was manually scored, and the percentage of IFL of total sleep time was considered for final analysis. The distribution of the percentage of IFL was analyzed, and associated factors (age, sex, and body mass index) were calculated. There were 95% of normal individuals who exhibited IFL during less than 30% of the total sleep time. Body mass index was positively associated with IFL. CONCLUSIONS Inspiratory flow limitation can be observed in the polysomnography of normal individuals, with an influence of body weight on percentage of inspiratory flow limitation. However, only 5% of asymptomatic individuals will have more than 30% of total sleep time with inspiratory flow limitation. This suggests that only levels of inspiratory flow limitation > 30% be considered in the process of diagnosing obstructive sleep apnea in the absence of an apnea-hypopnea index > 5 and that < 30% of inspiratory flow limitation may be a normal finding in many patients.
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Affiliation(s)
- Luciana O. Palombini
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - Sergio Tufik
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - David M. Rapoport
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, NY
| | - Indu A. Ayappa
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, NY
| | | | - Luciana B. M. de Godoy
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - Laura S. Castro
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - Lia Bittencourt
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
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30
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Tenhunen M, Elomaa E, Sistonen H, Rauhala E, Himanen SL. Emfit movement sensor in evaluating nocturnal breathing. Respir Physiol Neurobiol 2013; 187:183-9. [PMID: 23583829 DOI: 10.1016/j.resp.2013.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/22/2013] [Accepted: 03/21/2013] [Indexed: 10/27/2022]
Abstract
Obstructive sleep apnea (OSA) diagnostics by the movement sensors static charge-sensitive bed (SCSB) and electromechanical film transducer (Emfit) is based on dividing the signal into different breathing patterns. The usage of non-invasive mattress sensors in diagnosing OSA is particularly tempting if patient has many other non sleep-related monitoring sensors. However, a systematic comparison of the apnea-hypopnea index (AHI) with Emfit-parameters is lacking. In addition to periodic breathing, SCSB and Emfit visualize episodes of sustained negative increases in intrathoracic pressure (increased respiratory resistance, IRR), of which relevance is still ambiguous. Our aim is to compare Emfit-parameters with the AHI and to provide a description of the patients suffering from IRR. Time percentage with all obstructive periodic Emfit breathing patterns (OPTotal%) showed the best correlation with the AHI. The OPTotal percentage of 21 yielded to excellent accuracy in detecting subjects with an AHI of 15/h or more. Patients with IRR received high scores in GHQ-12-questionnaire. An Emfit movement sensor might offer additional information in OSA diagnostics especially if nasal pressure transducer cannot be used.
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Affiliation(s)
- Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland.
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Sleep-disordered breathing in premenopausal women: Differences between younger (less than 30years old) and older women. Sleep Med 2012; 13:656-62. [DOI: 10.1016/j.sleep.2012.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 01/14/2012] [Accepted: 02/11/2012] [Indexed: 11/19/2022]
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Guilleminault C, Los Reyes VD. Upper-airway resistance syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:401-9. [PMID: 21056201 DOI: 10.1016/b978-0-444-52006-7.00026-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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UARS presenting with the symptoms of anxiety and depression. Open Med (Wars) 2010. [DOI: 10.2478/s11536-009-0127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractUpper airway resistance syndrome (UARS) is a condition where the apnea-hypopnea index is less than 5 and respiratory-effort related arousal index is more than 10. The clinical presentation of UARS may be the same as obstructive sleep apnea-hypopnea syndrome (OSAS); it sometimes shows up with symptoms hardly suggestive of a sleep-disordered breathing. A 17 year-old male patient had applied to a local psychiatry clinic and complained of chronic fatigue, insomnia, behavioral and academic problems and was treated for anxiety and depression. After a period of unresponsive treatment, he was sent to a sleep center for evaluation of insomnia, which turned out to be a fragmented, unrefreshing sleep episode. Polysomnographical evaluation revealed that he had UARS without OSAS. His complaints decreased dramatically after he received CPAP treatment. This case shows that UARS should be considered in young patients with functional somatic syndromes even if the clinical presentation does not apparently imply the condition.
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Tenhunen M, Rauhala E, Virkkala J, Polo O, Saastamoinen A, Himanen SL. Increased respiratory effort during sleep is non-invasively detected with movement sensor. Sleep Breath 2010; 15:737-46. [PMID: 20960067 DOI: 10.1007/s11325-010-0430-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/04/2010] [Accepted: 10/06/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Measuring breathing effort during sleep with an oesophageal pressure sensor remains technically challenging and has not become routine practice. The aim of the present work was to investigate whether increased thoracic pressure during sleep can be detected with the Emfit movement sensor. Experimental data suggest that increased respiratory efforts with the intrathoracic pressure variation induce high-frequency spikes in the Emfit signal, but this has not been systematically examined. METHODS Polysomnography, oesophageal pressure and Emfit signal were recorded in 32 patients with suspected sleep-disordered breathing. Increased respiratory effort was defined as oesophageal pressure below -8 cmH(2)O during inspiration. The epochs of normal breathing, periodic breathing patterns and sustained spiking labelled as increased respiratory resistance (IRR) were defined on the Emfit signal according to established rules. RESULTS Compared to normal breathing, the proportion of increased respiratory effort was higher during all periodic breathing with spiking. The highest proportion (18-23%) occurred during IRR, which is characterised by sustained spiking. CONCLUSION The Emfit movement sensor is a non-invasive alternative to the oesophageal pressure sensor in the assessment of the respiratory effort during sleep. In particular, the Emfit sensor enhances detection of non-apnoeic sleep-disordered breathing, the significance of which should not be ignored.
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Affiliation(s)
- Mirja Tenhunen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland.
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Pirila-Parkkinen K, Lopponen H, Nieminen P, Tolonen U, Pirttiniemi P. Cephalometric evaluation of children with nocturnal sleep-disordered breathing. Eur J Orthod 2010; 32:662-71. [DOI: 10.1093/ejo/cjp162] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The consequences of poor quality and/or inadequate sleep in children and adolescents have become a major public health concern, and one in which pediatric health care professionals have become increasingly involved. In particular, insufficient and/or fragmented sleep resulting from primary sleep disorders such as obstructive sleep apnea (OSA), often compounded by the presence of comorbid sleep disorders as well as by voluntary sleep curtailment related to lifestyle and environmental factors, has been implicated in a host of negative consequences. These range from metabolic dysfunction and increased cardiovascular morbidity to impairments in mood and academic performance. The following review will focus on what is currently known about the effects of sleep disordered breathing (SDB) specifically on neurobehavioral and neurocognitive function in children. Because of the scarcity of literature on the cognitive and behavioral impact of sleep disorders in infants and very young children, this review will target largely the preschool/school-aged child and adolescent populations. In addition, the focus will be on a review of the most recent literature, as a supplement to several excellent previous reviews on the topic.
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Affiliation(s)
- Judith A Owens
- Department of Ambulatory Pediatrics, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
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Tenhunen M, Rauhala E, Huupponen E, Saastamoinen A, Kulkas A, Himanen SL. High frequency components of tracheal sound are emphasized during prolonged flow limitation. Physiol Meas 2009; 30:467-78. [PMID: 19349649 DOI: 10.1088/0967-3334/30/5/004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tantrakul V, Guilleminault C. Chronic sleep complaints in premenopausal women and their association with sleep-disordered breathing. Lung 2009; 187:82-92. [PMID: 19219502 DOI: 10.1007/s00408-009-9137-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/20/2009] [Indexed: 01/23/2023]
Abstract
BACKGROUND In clinical practice, we have found that premenopausal women have delayed diagnosis of sleep-disordered breathing (SDB). METHODS During a 4-year period, we systematically collected the clinical and polysomnographic variables for all women referred for sleep complaints using preestablished questionnaires, scales, clinical grid, polygraphic montage, and scoring criteria. The variables collected on premenopausal SDB women were analyzed and compared to those of postmenopausal women within 5 years of menopause. RESULTS Of 977 women, 316 were premenopausal with SDB. Complaints of chronic insomnia and sleepwalking were the most common reasons for referral, had been present for a mean of 6.4 +/- 5.4 years, and had lead to unsuccessful symptomatic treatment. The normal-weight premenopausal SDB group had anatomically small upper airways, while those with body mass index (BMI) >/= 25 kg/m(2) complained more frequently of snoring and daytime sleepiness and their clinical presentation was closer to those of the postmenopausal SDB comparison group. Premenopausal women often had a low apnea-hypopnea index (AHI), but there was a discrepancy between the low AHI and the amount of continuous positive airway pressure (CPAP) needed to control the SDB, and there was a need for higher pressures in overweight premenopausal SDB women (mean 9.1 +/- 1.9 and 10.1 +/- 2.6 cmH(2)O). CONCLUSION Normal-weight premenopausal SDB women often present with atypical sleep complaints of chronic insomnia and parasomnias. Clinical attention paid to craniofacial features and use of specific scales such as Mallampati help with the suspicion of the presence of SDB, and a low AHI is unrelated to the positive clinical impact of nasal CPAP treatment.
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Affiliation(s)
- Visasiri Tantrakul
- Stanford University Sleep Medicine Program, 401 Quarry Road, Suite 3301, Stanford, CA, 94305, USA
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Segev Y, Berdugo-Boura N, Porati O, Tarasiuk A. Upper airway loading induces growth retardation and change in local chondrocyte IGF-I expression is reversed by stimulation of GH release in juvenile rats. J Appl Physiol (1985) 2008; 105:1602-9. [PMID: 18787088 DOI: 10.1152/japplphysiol.90772.2008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic resistive airway loading (CAL) impairs growth in juvenile rats. The effects of CAL on epiphyseal growth plate (EGP) structure and insulin-like growth factor (IGF)-I gene expression have not been explored. Little is known about whether stimulants of endogenous growth hormone (GH) secretion can normalize this growth impairment. This study explored the effect of CAL on circulating and EGP GH/IGF-I pathway GH and the effect of ritanserin (endogenous GH stimulant) on somatic growth and the GH/IGF-I axis. We hypothesized that CAL would lead to a decrease in body temperature (Tb) and alterations of GH/IGF-I pathways, consequently leading to growth retardation. The tracheae of 22-day-old male rats were obstructed by tracheal banding (38 sham-operated control, 42 CAL). Tibial EGP morphometry, liver and EGP IGF mRNA, and serum GH and IGF-I levels were analyzed with quantitative real-time PCR and ELISA. Tb and locomotion activity (MA) were measured with telemetric transmitters inserted into the abdominal cavity. CAL animals had lower Tb and MA despite preserved food consumption. CAL impaired both tibial and tail length gains. Tail and tibial length gains inversely correlated with tracheal resistance. Circulating GH and IGF-I, liver and EGP IGF-I mRNA, and EGP width were decreased in the CAL group. Ritanserin administration to CAL animals normalized circulating and local EGP GH and IGF-I levels and minimized the longitudinal growth impairment. We conclude that CAL causes growth delay associated with alterations in the GH/IGF-I axis. Stimulation of GH release by ritanserin restored both global and local GH/IGF-I pathways, yet growth parameters were only partially restored.
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Affiliation(s)
- Yael Segev
- Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 105, Beer-Sheva 84105, Israel.
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Rains JC. Chronic headache and potentially modifiable risk factors: screening and behavioral management of sleep disorders. Headache 2008; 48:32-9. [PMID: 18184283 DOI: 10.1111/j.1526-4610.2007.00972.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sleep-related variables have been identified among risk factors for frequent and severe headache conditions. It has been postulated that migraine, chronic daily headache, and perhaps other forms of chronic headache are progressive disorders. Thus, sleep and other modifiable risk factors may be clinical targets for prevention of headache progression or chronification. The present paper is part of the special series of papers entitled "Chronification of Headache" describing the empirical evidence, future research directions, proposed mechanisms, and risk factors implicated in headache chronification as well as several papers addressing individual risk factors (ie, sleep disorders, medication overuse, psychiatric disorders, stress, obesity). Understanding the link between risk factors and headache may yield novel preventative and therapeutic approaches in the management of headache. The present paper in the special series reviews epidemiological research as a means of quantifying the relationship between chronic headache and sleep disorders (sleep-disordered breathing, insomnia, circadian rhythm disorders, parasomnias) discusses screening for early detection and treatment of more severe and prevalent sleep disorders, and discusses fundamental sleep regulation strategies aimed at headache prevention for at-risk individuals.
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Affiliation(s)
- Jeanetta C Rains
- Center for Sleep Evaluation at Elliot Hospital, Manchester, NH 03103-3599, USA
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Halbower AC, Ishman SL, McGinley BM. Childhood obstructive sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges. Chest 2008; 132:2030-41. [PMID: 18079240 DOI: 10.1378/chest.06-2827] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Childhood sleep-disordered breathing (SDB) has been known to be associated with health and cognitive impacts for more than a century, and yet our understanding of this disorder is in its infancy. Neuropsychological consequences in children with snoring or subtle breathing disturbances not meeting the traditional definition of sleep apnea suggest that "benign, or primary snoring" may be clinically significant, and that the true prevalence of SDB might be underestimated. There is no standard definition of SDB in children. The polysomnographic technology used in many sleep laboratories may be inadequate to diagnose serious but subtle forms of clinically important airflow limitation. In the last several years, advances in digital technology as well as new observational studies of respiratory and arousal patterns in large populations of healthy children have led to alternative views of what constitutes sleep-related breathing and arousal abnormalities that may refine our diagnostic criteria. This article reviews our knowledge of childhood SDB, highlights recent advances in technology, and discusses diagnostic and treatment strategies that will advance the management of children with pediatric SDB.
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Affiliation(s)
- Ann C Halbower
- Department of Pediatrics, John Hopkins University, Baltimore, MD, USA.
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Anttalainen U, Saaresranta T, Kalleinen N, Aittokallio J, Vahlberg T, Polo O. Gender differences in age and BMI distributions in partial upper airway obstruction during sleep. Respir Physiol Neurobiol 2007; 159:219-26. [PMID: 17869189 DOI: 10.1016/j.resp.2007.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 07/27/2007] [Accepted: 07/27/2007] [Indexed: 11/18/2022]
Abstract
The obstructive sleep apnea-hypopnea syndrome occurs more frequently and with higher apnea-hypopnea indices in men than in women. To investigate the gender differences we extended our respiratory analyses during sleep to cover not only periodic obstruction (apnea and hypopnea) but also nonperiodic partial upper airway obstruction during sleep and their associations with increasing age or body mass index (BMI). The clinical sleep recordings with the static-charge-sensitive bed (SCSB) and oximeter were reviewed in 233 age and BMI-matched men-women pairs. Periodic obstruction increased with increasing BMI only in men. Nonperiodic partial obstruction increased with moderate to morbid obesity in women and men after the age of 65 years. Our findings suggest that while partial upper airway obstruction increases with increasing age and BMI in both genders, men have a gender specific BMI dependent predisposition for periodic obstruction (obstructive sleep apnea). The apnea-hypopnea index is likely to underestimate the impact of sleep-disordered breathing, particularly in elderly patients.
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Affiliation(s)
- Ulla Anttalainen
- Department of Pulmonary Diseases, Turku University Central Hospital, Turku University, Turku, Finland.
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Rauhala E, Himanen SL, Saastamoinen A, Polo O. Prolonged spiking in the Emfit sensor in patients with sleep-disordered breathing is characterized by increase in transcutaneous carbon dioxide. Physiol Meas 2007; 28:1163-73. [PMID: 17906385 DOI: 10.1088/0967-3334/28/10/003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A phenomenon of prolonged spiking in movement sensors, such as static-charge-sensitive bed or Emfit (electromechanical film) sensors, has been connected to an increase in carbon dioxide tension in wakefulness. Spiking is also a common finding in sleep studies. This made us hypothesize that carbon dioxide changes might also happen in sleep during prolonged spiking episodes in Emfit sheet. We examined four different kinds of breathing pattern episodes: normal breathing, episodes of repetitive apnea, episodes of repetitive hypopnea and episodes with prolonged spiking lasting at least 3 min. One hundred and fifteen episodes from 19 polysomnograms were finally admitted to the study according to the protocol. The changes in the transcutaneous carbon dioxide tension (TcCO(2)) were defined for different breathing patterns. During prolonged spiking episodes the TcCO(2) increased significantly and differed statistically from the TcCO(2) changes of normal breathing and periodic breathing patterns (episodes of apnea and hypopnea). The rise in TcCO(2) during prolonged spiking episodes might suggest that prolonged spiking is representing another type of breathing disturbance during sleep differing from periodic breathing patterns. The Emfit sensor as a small, flexible and non-invasive sensor might provide useful additional information about breathing during sleep.
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Affiliation(s)
- E Rauhala
- Department of Clinical Neurophysiology, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland.
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Herzog M, Schmidt A, Bremert T, Herzog B, Hosemann W, Kaftan H. Analysed snoring sounds correlate to obstructive sleep disordered breathing. Eur Arch Otorhinolaryngol 2007; 265:105-13. [PMID: 17680262 DOI: 10.1007/s00405-007-0408-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 07/17/2007] [Indexed: 10/23/2022]
Abstract
Snoring occurs as a major symptom in patients with sleep disordered breathing (SDB). The aetiology of snoring remains still unclear despite various attempts to localize snoring. The correlation between different snoring sounds and the severity of SDB has not yet been investigated in a larger population. The aim of this study was to record and analyse snoring sounds and to correlate the obtained data with clinical and polysomnographical parameters. Sixty male patients with suspected SDB and reported snoring underwent a clinical examination and night time polysomnography. The parallel digitally recorded snoring sounds were analysed by fast fourier transformation (FFT). Peak intensity was determined from the power spectrum. The periodicity of snoring was classified into rhythmic and non-rhythmic snoring according to the presence of air flow interruptions due to obstructive apneas. Patients with primary snoring revealed peak intensities between 100 and 300 Hz. Patients with an obstructive sleep apnea syndrome (OSAS) revealed peak intensities above 1,000 Hz. Polysomnographical data (AHI, mean and minimum SpO(2)) as well as body mass index (BMI) correlated with peak intensity of the power spectrum. None of the parameters of the clinical examination correlated with peak intensity. Frequency analysis of snoring sounds provides a useful diagnostic tool to distinguish between different patterns of snoring and respective SDB. The topodiagnosis of snoring is not possible by means of frequency analysis or clinical examination alone. Acoustical analysis of snoring sounds seems a promising additional diagnostic tool to verify different types of SDB in snoring patients.
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Affiliation(s)
- Michael Herzog
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ernst-Moritz-Arndt University, Walther-Rathenau-Street 43-45, 17487, Greifswald, Germany.
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Abstract
Sleep apnea syndrome (SAS), a common disorder, is characterized by repetitive episodes of cessation of breathing during sleep, resulting in hypoxemia and sleep disruption. The consequences of the abnormal breathing during sleep include daytime sleepiness, neurocognitive dysfunction, development of cardiovascular disorders, metabolic dysfunction, and impaired quality of life. There are two types of SAS: obstructive sleep apnea syndrome (OSAS) and central sleep apnea syndrome (CSAS). OSAS is a prevalent disorder in which there is snoring, repetitive apneic episodes, and daytime sleepiness. Anatomical conditions causing upper airway obstruction (obesity or craniofacial abnormalities such as retrognathia or micrognathia) can cause OSAS. CSAS, much less common than OSAS, is a disorder characterized by cessation of breathing which is caused by reduced respiratory drive from the central nervous system to the muscles of respiration. The latter condition is common in patients with heart failure and cerebral neurologic diseases. The diagnosis of SAS requires assessment of subjective symptoms and apneic episodes during sleep documented by polysomnography. Treatments of OSAS include continuous positive airway pressure (CPAP), oral appliances, and surgery; patients with CSAS are treated with oxygen, adaptive servo-ventilation, or CPAP. With assessment and treatment of the SAS, patients usually have resolution of their disabling symptoms, subsequently resulting in improved quality of life.
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