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Kumar D, Woodson BT, Garcia GJM. Phenotypes of Velopharyngeal Tube Law in Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2024. [PMID: 39360341 DOI: 10.1002/ohn.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 09/05/2024] [Accepted: 09/15/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVE The biomechanics of upper airway collapse in obstructive sleep apnea (OSA) remains poorly understood. The goal of this study is to compare the area-pressure relationship (tube law) of the velopharynx at peak inspiration and peak expiration. STUDY DESIGN Cross-sectional. SETTING Academic tertiary medical center. METHODS The velopharyngeal tube law was quantified in a convenience sample of 20 OSA patients via step reductions in nasal mask pressure during drug induced sleep endoscopy (DISE). The velopharyngeal airspace cross-sectional area was estimated from endoscopy while luminal pressure was recorded with a catheter. The tube law was quantified for nasal mask pressures from 14 to 0 cmH2O at peak inspiration and at peak expiration in all patients. The tube law was also quantified during the breathing cycle at a constant nasal mask pressure of 4 cmH2O in 3 patients representing different phenotypes. RESULTS Velopharyngeal compliance (the slope of the tube law) was not statistically different in the peak inspiration versus peak expiration tube laws. Three phenotypes were observed, namely inspiratory collapse (phenotype 1), expiratory collapse (phenotype 2 = palatal prolapse), and a mostly stable airway during inspiration and expiration that collapsed as CPAP was reduced (phenotype 3). CONCLUSION Velopharyngeal compliance is not significantly different at peak inspiration and peak expiration, which suggests that muscle tone is low when luminal pressure is above the closing pressure. Additional studies are needed to investigate how different phenotypes of velopharyngeal collapse may affect therapeutic outcomes.
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Affiliation(s)
- Devesh Kumar
- Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, USA
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, USA
| | - B Tucker Woodson
- Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, USA
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, USA
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, USA
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Galtieri R, Salles C, Kushida CA, Meira E Cruz M, Souza-Machado A. Morphometric measures and desaturations: Proposal for an index with improved accuracy for obstructive sleep apnea screening. Sleep Med 2024; 122:258-265. [PMID: 39217970 DOI: 10.1016/j.sleep.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/12/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
STUDY OBJECTIVE To evaluate the sensitivity and specificity of the combined Kushida morphometric model (KMM) and the oxygen desaturation index (ODI) for screening individuals with obstructive sleep apnea. METHODS Diagnostic test study with adults >18 years, both sexes, polysomnography, body mass index, neck circumference and intraoral measurements. RESULTS 144 patients were invited; of these, 75 met the exclusion criteria. 55 individuals presented AHI ≥5 ev/h and 14, an AHI <5 ev/h. Three AHI cut-off points were evaluated: AHI ≥5, ≥15, ≥30 ev/h. When adopting the cut-off point of AHI ≥5 ev/h, the KMM showed sensitivity (SE) = 60.0 %, specificity (SP) = 71.4 % and 95 % confidence interval of the area under the curve (95 % CI of AUC) = 0.655; the combination of KMM and ODI (KMM + ODI) revealed SE = 73.0 %, SP = 71.4 % (95 % CI of AUC = 0.779) and the ODI showed SE = 76.4 % and SP = 92.9 % (95 % CI of AUC = 0.815). At the cut-off point of AHI ≥15 ev/h, the KMM presented SE = 64.1 %, SP = 76.7 % (95 % CI of AUC = 0.735); the KMM + ODI showed SE = 82.1 %, SP = 83.3 % (95 % CI of AUC = 0.895); and the ODI presented SE = 76.9 %, SP = 100.0 % (95 % CI of AUC = 0.903). For the cut-off point of AHI ≥30 ev/h, the KMM showed SE = 56.0 %, SP = 77.2 % (95 % CI of AUC = 0.722); the KMM + ODI revealed SE = 92.0 %, SP = 79.5 % (95 % CI of AUC = 0.926); and the ODI showed SE = 92.0 %, SP = 90.9 % (95 % CI of AUC = 0.941). CONCLUSION The combination of oxygen desaturation index and Kushida morphometric model improved the sensitivity and specificity of this model regardless of obstructive sleep apnea severity suggesting greater effectiveness in risk prediction.
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Affiliation(s)
- Ranuzia Galtieri
- Post Graduate Program in Interactive Processes of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.
| | - Cristina Salles
- Professor Edgard Santos University Hospital - Federal University of Bahia, Salvador, Brazil
| | | | - Miguel Meira E Cruz
- Sleep Unit, Cardiovascular Center of the University of Lisbon, Lisbon School of Medicine, Lisbon, Portugal
| | - Adelmir Souza-Machado
- Post Graduate Program in Interactive Processes of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
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Ferreira I, Guerra P, Pinto N, Alfaiate D, Pereira A. Evaluation of wakefulness electroencephalogram in OSA patients. Sleep Breath 2024; 28:2037-2043. [PMID: 39028483 DOI: 10.1007/s11325-024-03116-y] [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: 01/02/2024] [Revised: 06/07/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) has been associated with an elevated cardiovascular risk, increased daytime sleepiness, cognitive decline, and slower electroencephalographic activity (EEG). This study assesses EEG patterns during wakefulness in OSA patients compared to those without sleep-disordered breathing. MATERIALS AND METHODS This retrospective study analyzed 30 OSA patients with an Apnea/Hypopnea Index (AHI) of 15 or higher, as well as 29 individuals without sleep-disordered breathing (AHI of 5 or lower) who underwent hospital polysomnography and met all inclusion criteria. Sociodemographic and EEG data were obtained from the sleep laboratory database. Blinded EEG analysis was conducted by two observers, assessing activity in the frontal, central, and occipital regions. RESULTS No significant differences were observed in EEG activity between OSA and non-OSA patients. However, a weak correlation was found between decreased C3 EEG frequency and higher AHI (p = 0.033), as well as increased total sleep time and higher O2 EEG frequency (p = 0.038). Lower amplitudes in C3 (p = 0.043) and O1 (p = 0.031) were correlated with reduced average oxygen saturation. CONCLUSION Our findings suggest that OSA-related hypoxemia may impact neuronal activity, highlighting the need to address this sleep-disordered breathing in order to potentially prevent the cognitive decline observed in OSA patients.
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Affiliation(s)
- Isabel Ferreira
- Instituto Politécnico de Castelo Branco Health School, Castelo Branco, Portugal
| | | | - Nuno Pinto
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Daniel Alfaiate
- Instituto Politécnico de Castelo Branco Health School, Castelo Branco, Portugal.
- Médio Tejo Hospital Center, Torres Novas, Portugal.
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Khawaja T, Nied M, Wilgor A, Neeland IJ. Impact of Visceral and Hepatic Fat on Cardiometabolic Health. Curr Cardiol Rep 2024:10.1007/s11886-024-02127-1. [PMID: 39235730 DOI: 10.1007/s11886-024-02127-1] [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] [Accepted: 08/22/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE OF REVIEW Body fat distribution plays a significant role in the cardiometabolic consequences of obesity. We review the impact of visceral and hepatic fat and highlight important interventions. RECENT FINDINGS Several epidemiologic studies have established a clear association between visceral fat and cardiovascular disease. The association between hepatic fat and cardiovascular disease is less clear with discordant results. Novel evidence demonstrates sodium glucose co-transporter-2 (SGLT2) inhibitors facilitate modest weight loss and reductions in ectopic fat depots in patient with type 2 diabetes. Glucagon-like peptide-1 (GLP-1) receptor agonists have been associated with decreased visceral/hepatic fat and reductions in MACE in populations with type 2 diabetes and with overweight/obesity. Clear associations between visceral fat and cardiometabolic outcomes have been established, whereas the impact of hepatic fat remains less clear. Lifestyle modification and pharmacologic interventions remain the initial therapies, while surgical intervention is associated with improved long-term outcomes. Emerging therapies have demonstrated a profound impact on body fat distribution and cardiometabolic risk.
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Affiliation(s)
- Tasveer Khawaja
- Harrington Heart and Vascular Institute, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH, USA
- Department of Medicine, University Hospitals Cleveland and Case Western Reserve University, 11100 Euclid Ave. Mailstop Lakeside, Cleveland, OH, USA
| | - Matthew Nied
- Department of Medicine, University Hospitals Cleveland and Case Western Reserve University, 11100 Euclid Ave. Mailstop Lakeside, Cleveland, OH, USA
| | - Abigail Wilgor
- Department of Medicine, University Hospitals Cleveland and Case Western Reserve University, 11100 Euclid Ave. Mailstop Lakeside, Cleveland, OH, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH, USA.
- Department of Medicine, University Hospitals Cleveland and Case Western Reserve University, 11100 Euclid Ave. Mailstop Lakeside, Cleveland, OH, USA.
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Silva MVFP, Lustosa TC, Lins-Filho OL, Clímaco DCS, Patriota TC, Magalhães JA, Queiroga F, Cabral MM, Medeiros AK, Neto LO, Rodrigues VK, Drager LF, Pedrosa RP. Validation of a Portable Respiratory Monitoring System for the Diagnosis of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease: A Crossectional Study. Sleep Sci 2024; 17:e221-e226. [PMID: 39268343 PMCID: PMC11390165 DOI: 10.1055/s-0044-1782530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2024] Open
Abstract
Introduction Portable respiratory monitoring (PM) has been used to diagnose obstructive sleep apnea (OSA) in the general population. However, its validation in patients with both OSA and chronic obstructive pulmonary disease (COPD), remains unclear. Objective The aim of the study was to validate PM for the diagnosis of OSA in patients with COPD. Materials and Methods In this crossectional study, COPD patients were submitted simultaneously to polysomnography (PSG) and PM. Moreover, the risk for OSA was verified by the Berlin, NoSAS, and STOP-BANG questionnaires. Sensitivity, specificity, positive predictive value, and negative predictive value for PM were calculated for the cutoff points of the hypopnea apnea index (AHI) of 5, 15, and 30 events/hour, as well as for the questionnaires. The Bland-Altman test and correlation analyses between the AHI of the PSG and PM were performed. Results A total of 103 patients were evaluated (age 67.5 ± 9.9 years, 60% men). The STOP-BANG questionnaire had the highest sensitivity for OSA diagnosis, at 94.4% (72.7-99.9%). The sensitivity of PM decreased (87.0, 66.7, and 44.4%), and the specificity increased 40.0, 78.6, and 100.0%) as the AHI cutoff point increased from 5, 15, and 30. The Bland-Altman test indicated good limits of agreement (AHI = 5.5 ± 11.7 events/hour). Therefore, the AHI results of the PM showed a strong and positive correlation with those of the PSG (r = 0.70, p < 0.0001). Conclusion The PM test can be a useful tool for OSA diagnosis in patients with COPD.
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Affiliation(s)
| | | | | | | | | | | | - Fernando Queiroga
- Osvaldo Cruz Tertiary Hospital, Universidade de Pernambuco, Recife, PE, Brazil
| | | | | | - Luiz Oliveira Neto
- Sleep and Heart Laboratory, Universidade de Pernambuco, Recife, PE, Brazil
| | | | - Luciano F Drager
- Unidade de Hipertensão, Instituto do Coração(InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Pinto Pedrosa
- Sleep and Heart Laboratory, Universidade de Pernambuco, Recife, PE, Brazil
- PROCAPE, Universidade de Pernambuco, Recife, PE, Brazil
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Thuler ER, Parekh MH, Rodin JG, Seay EG, Wiemken A, Keenan BT, Schwab RJ, Schwartz AR, Dedhia RC. Association Between Soft Tissue Measures From Computed Tomography and Upper Airway Collapsibility on Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2024; 171:578-587. [PMID: 38613204 DOI: 10.1002/ohn.772] [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: 11/30/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Positive airway pressure (PAP) titration during drug-induced sleep endoscopy (DISE) provides objective measures of upper airway collapsibility. While skeletal measurements relate to collapsibility measures on DISE, the influence of soft tissue dimensions on upper airway collapsibility is not known. We analyzed the relationship of measures of upper airway soft tissue volumes, specifically soft palate, pharyngeal lateral walls, and tongue, with metrics of collapsibility. STUDY DESIGN Cross-sectional analysis from a prospective cohort. SETTING Academic medical center. METHODS Patients seeking PAP alternative therapies for obstructive sleep apnea (OSA) underwent standardized supine computed tomography (CT) acquisition and DISE protocols. The CT analysis primarily focused on soft tissue volumes and, secondarily, on airway and skeletal volumetric measures. DISE with PAP administration (DISE-PAP) enabled the determination of the pressure at which inspiratory airflow first commenced (pharyngeal critical pressure, PcritA) and the pressure at which inspiratory flow limitation was abolished (pharyngeal opening pressure, PhOP). Both unadjusted and adjusted correlation analyses were performed to understand the relationship between upper airway anatomy and either PcritA or PhOP. RESULTS One hundred thirty-nine subjects completed both CT and DISE-PAP. On average, patients were male (70.5%), white (84.2%), middle-aged (56.6 ± 13.5 years), and overweight (29.6 ± 4.7 kg/m2), with moderate-severe apnea-hypopnea index (29.7 ± 21.3 events/h). Adjusted for age, sex, body mass index, and skeletal volumes, soft palate, and lateral pharyngeal wall volumes were not associated with PhOP or PcritA, but a larger tongue was associated with more positive PhOP (⍴ = 0.20, P = .02), and more positive PcritA (⍴ = 0.16, P = .07). Exploratory analyses revealed smaller minimum cross-sectional retropalatal area and intramandibular volume were also associated with increased collapsibility measures. CONCLUSION After controlling for clinical factors and skeletal volume, greater tongue volume was associated with more severe collapsibility during DISE. These results, in concert with previous work, suggest that greater tongue volume in a smaller skeletal dimensions contribute to the severity of airway collapsibility, a key driver of OSA pathogenesis.
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Affiliation(s)
- Eric R Thuler
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Manan H Parekh
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jules G Rodin
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Everett G Seay
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Wiemken
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brendan T Keenan
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard J Schwab
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alan R Schwartz
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Sleep Medicine, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru
| | - Raj C Dedhia
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Ding C, Mao L, Lu Y, Wu S, Ji W. Does obstructive sleep apnea-induced intermittent hypoxia increase the incidence of solitary pulmonary nodules, thyroid nodules, and other disorders? A retrospective study based on 750 cardiovascular disease patients. Sleep Breath 2024; 28:1553-1562. [PMID: 38627339 PMCID: PMC11303425 DOI: 10.1007/s11325-024-03036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/09/2024] [Accepted: 04/08/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been shown to be an important risk factor for cardiovascular disease (CVD), and intermittent hypoxia is an important pathogenetic factor for it. In the clinic, it was found that most CVD patients combined with OSA were also combined with solitary pulmonary nodules (SPN) or thyroid nodules (TN). Are these disorders related to intermittent hypoxia? One study showed that intermittent hypoxia is a pathogenic factor for lung cancer in mice, but there have been no clinical reports. So we conducted a retrospective study to explore whether intermittent hypoxia caused by OSA increases the incidence of SPN, TN, and other disorders. METHODS We selected 750 patients with cardiovascular disease (CVD), who were divided into the control group and the OSA group according to the result of portable sleep monitoring. Retrospectively analyzed the comorbidities that patients with OSA are prone to and explored the correlation between OSA and those comorbidities. RESULTS The incidence of SPN, TN, cervical spondylosis, and carotid-artery plaques was higher in the OSA group than in the control group. These diseases are significantly associated with OSA (p < 0.05), and their incidence increased with an elevated apnea-hypopnea index. After excluding interference from age, gender, BMI, smoking history, history of lung disease, and history of tumors, OSA showed a significant correlation with SPN. After excluding age, gender, BMI, and thyroid disease, OSA was associated with TN. Patients with comorbidities have lower nocturnal oxygen saturation and more extended periods of apnea. Logistic multiple regression results revealed that male, advanced age, obesity, CS, and nasal septum deviation were independent risk factors for OSA. CONCLUSIONS Patients combined with OSA may further develop more comorbidities, such as SPN, TN, and carotid-artery plaques. It may be related to intermittent hypoxia caused by OSA.
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Affiliation(s)
- Chen Ding
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Libo Mao
- Department of Cardiology, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, Shandong, China
| | - Yinghong Lu
- Department of Cardiology, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, Shandong, China
| | - Sai Wu
- Department of Cardiology, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, Shandong, China
| | - Wenyan Ji
- Department of Cardiology, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, Shandong, China.
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Kazmierski RH. Obstructive sleep apnea: What is an orthodontist's role? Prog Orthod 2024; 25:21. [PMID: 38945976 PMCID: PMC11214936 DOI: 10.1186/s40510-024-00524-4] [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: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. RESULTS Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. CONCLUSIONS Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.
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Affiliation(s)
- Robert H Kazmierski
- Solo Private Orthodontic Practice, 110 Marter Ave., Suite 404, Moorestown, NJ, 08057, USA.
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Kim S, Lee KY, Siddiquee AT, Kim HJ, Nam HR, Ko CS, Kim NH, Shin C. Gender differences in association between expiratory dynamic airway collapse and severity of obstructive sleep apnea. Eur Radiol 2024; 34:3730-3741. [PMID: 37962598 PMCID: PMC11166772 DOI: 10.1007/s00330-023-10322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Repetitive unbalances and tensions generated by inspiratory efforts against an obstructive upper airway during sleep predispose the development of expiratory central airway collapse. In addition, structures of the upper airway between men and women have differences and could be the reasons for differences in obstructive sleep apnea (OSA) prevalence between genders. The present study aimed to evaluate the association between parameters of expiratory dynamic tracheal collapse measured using chest multidetector CT and objectively measured OSA severity between men and women. MATERIALS AND METHODS A total of 901 participants who underwent chest CT and overnight in-home polysomnography from the Korean Genome and Epidemiology Study were cross-sectionally analyzed (women: 46.2%). The participants were divided into three groups based on OSA severity by apnea-hypopnea index (AHI). Multivariate linear regression analysis was performed to determine the effects of central airway collapse after adjustment for cardiovascular-related covariates. RESULTS In a multivariate analysis, percentages of expiratory lumen structure reductions involving area, diameter, and perimeter were associated with AHI (all p values < 0.05) and with OSA severity (moderate-to-severe OSA than no OSA: β = 3.30%, p = 0.03; β = 2.05%, p = 0.02; β = 1.97%, p = 0.02, respectively) in women, whereas men had only a greater percentage of expiratory wall thickness reduction in moderate-to-severe OSA than no OSA (β = 0.72%, p = 0.003). In addition, women with both mild OSA and moderate-to-severe OSA had higher expiratory tracheal collapse than men without OSA, and a moderate effect of sex was observed (p for interaction = 0.007). CONCLUSION The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men. CLINICAL RELEVANCE STATEMENT Differences of pharyngeal structures and inherent features of airways by genders may affect the dissimilarities in vulnerability to sleep apnea between men and women. KEY POINTS • The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men. • Women with over mild OSA had higher expiratory tracheal collapse than men without OSA, and moderate effect of sex was observed. • Structural differences of airway may affect differences in susceptibility of sleep apnea between genders.
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Affiliation(s)
- Soriul Kim
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, #123, Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Republic of Korea.
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Ali Tanweer Siddiquee
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyeon Jin Kim
- Department of Neurology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hye Ryeong Nam
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chang Seop Ko
- Department of Radiology, Korea University Ansan Hospital, #123, Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Republic of Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chol Shin
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea.
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea.
- Division of Respiratory and Critical Care, Department of Internal Medicine, Korea University Ansan Hospital, #123, Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Republic of Korea.
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Shi X, Sutherland K, Lobbezoo F, Berkhout E, de Lange J, Cistulli PA, Darendeliler MA, Dalci O, Aarab G. Upper airway morphology in adults with positional obstructive sleep apnea. Sleep Breath 2024; 28:193-201. [PMID: 37466758 PMCID: PMC10954840 DOI: 10.1007/s11325-023-02879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To compare the anatomical balance and shape of the upper airway in the supine position between adults with positional obstructive sleep apnea (POSA) and adults with non-positional OSA (NPOSA). METHODS Adults diagnosed with OSA (apnea-hypopnea index (AHI) > 10 events/h) were assessed for eligibility. POSA was defined as the supine AHI more than twice the AHI in non-supine positions; otherwise, patients were classified as NPOSA. Cone beam computed tomography (CBCT) imaging was performed for every participant while awake in the supine position. The anatomical balance was calculated as the ratio of the tongue size to the maxillomandibular enclosure size. The upper airway shape was calculated as the ratio of the anteroposterior dimension to the lateral dimension at the location of the minimal cross-sectional area of the upper airway (CSAmin-shape). RESULTS Of 47 participants (28 males, median age [interquartile range] 56 [46 to 63] years, median AHI 27.8 [15.0 to 33.8]), 34 participants were classified as having POSA (72%). The POSA group tended to have a higher proportion of males and a lower AHI than the NPOSA group (P = 0.07 and 0.07, respectively). After controlling for both sex and AHI, the anatomical balance and CSAmin-shape were not significantly different between both groups (P = 0.18 and 0.73, respectively). CONCLUSION Adults with POSA and adults with NPOSA have similar anatomical balance and shape of their upper airway in the supine position. TRIAL REGISTRATION This study was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR Trial ACTRN12611000409976).
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Affiliation(s)
- Xiaoxin Shi
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands.
- Department of Oral Radiology & Digital Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
| | - Kate Sutherland
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
- Charles Perkins Centre and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, Australia
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands
| | - Erwin Berkhout
- Department of Oral Radiology & Digital Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Peter A Cistulli
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
- Charles Perkins Centre and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, Australia
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, University of Sydney, Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia
| | - Oyku Dalci
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, University of Sydney, Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands
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11
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Qin H, Fietze I, Mazzotti DR, Steenbergen N, Kraemer JF, Glos M, Wessel N, Song L, Penzel T, Zhang X. Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring. J Sleep Res 2024; 33:e14020. [PMID: 37709966 DOI: 10.1111/jsr.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
Obstructive sleep apnea is a highly prevalent sleep-related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter-individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea-Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea-Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea-Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.
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Affiliation(s)
- Hua Qin
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- The Fourth People's Hospital of Guangyuan, Guangyuan, China
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Information Processing and Analytics Group, School of Library and Information Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medicine, Medical School Berlin, Berlin, Germany
| | - Lijun Song
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Xiaowen Zhang
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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12
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Ren Y, Cui X, Zhu X, Guo H, Zhou Q, Yuan P, Cheng H, Wu W. Effect of Weight Loss on the Apnea Hypopnea Index is Related to Waist Circumference in Chinese Adults with Overweight and Obesity. Diabetes Metab Syndr Obes 2024; 17:453-463. [PMID: 38299196 PMCID: PMC10829506 DOI: 10.2147/dmso.s442738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose The present study aimed to evaluate the efficiency of traditional anthropometric and body composition parameters in predicting apnea hypopnea index (AHI) change after weight loss. Patients and Methods Chinese adults with overweight and obesity were included into this study containing two parts. A cross-sectional study was conducted in 137 individuals using the baseline data from two weight loss intervention trials. The second part was the weight-loss intervention study conducted in 60 overweight and obese patients with obstructive sleep apnea (OSA). All participants underwent physical examination, bioelectrical impedance analysis and overnight polysomnography. Multivariate linear regression models were used to identify the most accurate parameters to predict AHI and the mediation analysis to evaluate the mediators between weight loss and AHI reduction. Results Waist circumference (WC), body mass index and fat mass were positively associated with AHI after adjusting multiple collinearities in the cross-sectional study. After weight-loss intervention, body weight decreased from 94.6 ± 15.3 to 88.0 ± 13.9 kg, and AHI decreased from 41.9 (13.0,66.9) to 20.7 (8.7,51.2) events/h. Among these parameters, only percentage changes in WC and AHI across the intervention were positively intercorrelated after controlling for covariates (adjusted r = 0.271, P = 0.041). The mediation analysis supported WC as a mediator between weight loss and AHI reduction (standardized indirect effect [95% CI] = 4.272[0.936,7.999]). Conclusion Both general and abdominal obesity are of high prognostic value for OSA. WC as an easily accessible parameter mediates the effects of weight loss in decreasing OSA severity.
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Affiliation(s)
- Ye Ren
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Xiaochuan Cui
- Department of Sleep Center, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Xiaowen Zhu
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Hua Guo
- Department of Sleep Center, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Qunyan Zhou
- Department of Nutrition Department, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Peng Yuan
- Department of Rehabilitation, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Haiyan Cheng
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
| | - Wenjun Wu
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People’s Republic of China
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13
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Kashiwazaki R, Jensen AM, Haemer M, Friedman NR. The Effects of Adenotonsillectomy for Obstructive Sleep Apnea on Growth Trajectory in Children With Obesity. Otolaryngol Head Neck Surg 2024; 170:277-283. [PMID: 37668178 DOI: 10.1002/ohn.512] [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: 05/24/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To analyze the growth trajectory of children with obesity before and after adenotonsillectomy (T&A). We hypothesize that T&A will not affect the growth trajectory but children in a multidisciplinary weight management program (MWMP) will have a healthier growth trajectory. STUDY DESIGN Retrospective review. SETTING Tertiary Children's Hospital. METHODS Body mass index (BMI) trajectories of nonsyndromic children with obesity and obstructive sleep apnea (OSA) who underwent T&A were analyzed. A linear mixed effects model was fit to the BMI expressed as a percentage of the 95th percentile (%BMIp95 ) data. Covariates included demographic variables, pre- and postoperative participation in an MWMP, baseline obesity class, and time. We explored clinically meaningful interactions. BMI slope estimates before and after surgery were calculated and compared for baseline obesity classification and postoperative MWMP visits. RESULTS A total of 177 patients, 58% male with a mean age of 9.7 years at the time of surgery, were studied. Higher baseline obesity class (II and III), time, the interaction between obesity class III and elapsed time relative to surgical date, and the interaction between obesity class III and the postsurgical period were all significantly associated with the outcome of %BMIp95 (P < .05). There was a significantly higher %BMIp95 trajectory following surgery in patients with baseline obesity class III who did not have any postoperative MWMP visits (P < .001). Preoperative obesity visits, however, were not significantly associated with postoperative growth. CONCLUSION The association between T&A and weight trajectory depends upon obesity class and participation in a MWMP. Coordinated care of children with obesity between otolaryngologists and an MWMP may improve OSA and obesity outcomes. LEVEL OF EVIDENCE The level of evidence: 3.
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Affiliation(s)
- Ryota Kashiwazaki
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alexandria M Jensen
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Matthew Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Norman R Friedman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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14
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Heinzinger CM, Thompson NR, Milinovich A, Diniz Araujo ML, Orbea CP, Foldvary‐Schaefer N, Haouzi P, Faulx M, Van Wagoner DR, Chung MK, Mehra R. Sleep-Disordered Breathing, Hypoxia, and Pulmonary Physiologic Influences in Atrial Fibrillation. J Am Heart Assoc 2023; 12:e031462. [PMID: 37947123 PMCID: PMC10727289 DOI: 10.1161/jaha.123.031462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND We leverage a large clinical cohort to elucidate sleep-disordered breathing and sleep-related hypoxia in incident atrial fibrillation (AF) development given the yet unclear contributions of sleep-related hypoxia and pulmonary physiology in sleep-disordered breathing and AF. METHODS AND RESULTS Patients who underwent sleep studies at Cleveland Clinic January 2, 2000, to December 30, 2015, comprised this retrospective cohort. Cox proportional hazards models were used to examine apnea hypopnea index, percentage time oxygen saturation <90%, minimum and mean oxygen saturation, and maximum end-tidal carbon dioxide on incident AF adjusted for age, sex, race, body mass index, cardiopulmonary disease and risk factors, antiarrhythmic medications, and positive airway pressure. Those with spirometry were additionally adjusted for forced expiratory volume in 1 second, forced vital capacity, and forced expiratory volume in 1 second/forced vital capacity. This cohort (n=42 057) was 50.7±14.1 years, 51.3% men, 74.1% White individuals, had median body mass index 33.2 kg/m2, and 1947 (4.6%) developed AF over 5 years. A 10-unit apnea hypopnea index increase was associated with 2% higher AF risk (hazard ratio [HR], 1.02 [95% CI, 1.00-1.03]). A 10-unit increase in percentage time oxygen saturation <90% and 10-unit decreases in mean and minimum oxygen saturation were associated with 6% (HR, 1.06 [95% CI, 1.04-1.08]), 30% (HR, 1.30 [95% CI, 1.18-1.42]), and 9% (HR, 1.09 [95% CI, 1.03-1.15]) higher AF risk, respectively. After adjustment for spirometry (n=9683 with available data), only hypoxia remained significantly associated with incident AF, although all coefficients were stable. CONCLUSIONS Sleep-related hypoxia was associated with incident AF in this clinical cohort, consistent across 3 measures of hypoxia, persistent after adjustment for pulmonary physiologic impairment. Findings identify a strong role for sleep-related hypoxia in AF development without pulmonary physiologic interdependence.
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Affiliation(s)
| | - Nicolas R. Thompson
- Department of Quantitative Health SciencesCleveland ClinicClevelandOH
- Neurological Institute Center for Outcomes Research & EvaluationCleveland ClinicClevelandOH
| | - Alex Milinovich
- Department of Quantitative Health SciencesCleveland ClinicClevelandOH
| | | | - Cinthya Pena Orbea
- Sleep Disorders Center, Neurological InstituteCleveland ClinicClevelandOH
| | | | | | - Michael Faulx
- Heart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | | | - Mina K. Chung
- Heart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
- Lerner Research InstituteCleveland ClinicClevelandOH
| | - Reena Mehra
- Sleep Disorders Center, Neurological InstituteCleveland ClinicClevelandOH
- Respiratory InstituteCleveland ClinicClevelandOH
- Heart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
- Lerner Research InstituteCleveland ClinicClevelandOH
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15
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Choudhury N, Deshmukh P. Obstructive Sleep Apnea in Adults and Ear, Nose, and Throat (ENT) Health: A Narrative Review. Cureus 2023; 15:e47637. [PMID: 38022002 PMCID: PMC10668538 DOI: 10.7759/cureus.47637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Obstructive sleep apnea (OSA), a form of sleep-disordered breathing, is a significant health concern that leads to substantial morbidity. The collapse or occlusion of the upper airway, which results in reduced or cessation of airflow, is the pathophysiology of sleep apnea. The condition has been attributed to numerous cardiovascular, metabolic, and neuropsychological issues and carries serious health concerns. The ensuing intermittent hypoxia and sleep disruption set off a chain of physiological reactions that aid in developing endothelial dysfunction, systemic inflammation, and oxidative stress. The following line of treatment depends on the appropriate diagnosis of sleep apnea and the underlying cause. The gold standard for diagnosis is polysomnography (PSG), which assesses different physiological parameters during sleep. However, because polysomnography is expensive, patients may use more friendly screening and diagnostic testing kits, like home sleep apnea testing. The clinical symptoms and head and neck history may reveal essential risk factors. The primary objectives of management treatments for sleep apnea are to lessen symptoms, enhance sleep quality, and reduce any health concerns that may be present. It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently. The primary treatment for moderate to severe sleep apnea is continuous positive airway pressure (CPAP) therapy, which includes administering pressurized air to keep the airway open while you sleep. Oral appliances, positional therapy, surgery, and complementary therapies are other treatment choices that can be adapted to each patient's needs and preferences. The goal of the review is to evaluate the morphological and functional aspects of the upper airway, including the nose and throat, that influence the onset and severity of OSA. With a focus on the interaction between otorhinolaryngologists, sleep medicine specialists, and other healthcare professionals, we aim to consider how OSA affects otorhinolaryngology-related medical issues, look at any potential reciprocal relationships, and provide a summary of the interdisciplinary management strategy for OSA. We tried to analyse the various surgical and non-surgical therapy options for OSA management available in the otorhinolaryngology field for improving OSA symptoms and results.
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Affiliation(s)
- Nishtha Choudhury
- Ear Nose and Throat, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Ear Nose and Throat, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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16
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Qian Y, Dharmage SC, Hamilton GS, Lodge CJ, Lowe AJ, Zhang J, Bowatte G, Perret JL, Senaratna CV. Longitudinal risk factors for obstructive sleep apnea: A systematic review. Sleep Med Rev 2023; 71:101838. [PMID: 37639973 DOI: 10.1016/j.smrv.2023.101838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
Despite substantial disease burden, existing evidence on the risk factors for obstructive sleep apnea (OSA) have been derived primarily from cross-sectional studies without determining temporality. Therefore, we aimed to systematically synthesize the literature on longitudinal risk factors for sleep study-assessed OSA and questionnaire-assessed probable OSA from cohort studies in the general adult population settings. We systematically searched Embase and Medline (on OVID) databases. Eleven studies met the inclusion criteria. Meta-analyses were not conducted due to methodological heterogeneity of exposure and outcome measurements. There was consistent evidence that weight gain was associated with incident (n = 2) and greater severity (n = 2) of OSA. One study each observed an association of higher baseline body-mass index, male sex, asthma, a specific genetic polymorphism in rs12415421, and insulin resistance/hyperglycemia, with incident OSA. Long-term exposure to ambient air pollution (NO2, n = 1) was associated with OSA, and menopausal transitions (n = 1) with higher apnea-hypopnea index. There were no eligible studies on long-term smoking or alcohol use. In conclusion, approximately 10% increase in weight, especially in males, might alert clinicians to consider potential or worsening OSA. Large, well-designed longitudinal studies are needed to consolidate knowledge on other associations with OSA development, especially on potentially modifiable risk factors.
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Affiliation(s)
- Yaoyao Qian
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia; School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, Australia.
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia; Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Melbourne, Australia
| | - Jingwen Zhang
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia; The Institute for Breathing and Sleep (IBAS) Melbourne, 145 Studley Rd, Heidelberg, VIC, 3084, Australia
| | - Chamara V Senaratna
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
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17
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Ernst G, Dalzotto P, Saban M, Ferraro FM, Salvado A, Borsini EE. The Cervical Fat Tissue Volume is a Predictor for Moderate to Severe OSA. Sleep Sci 2023; 16:e323-e328. [PMID: 38196763 PMCID: PMC10773506 DOI: 10.1055/s-0043-1772827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/27/2022] [Indexed: 01/11/2024] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a disorder characterized by recurrent pharyngeal obstruction during sleep, in which upper airway anatomy plays a key role in its pathogenesis. The aim of this study was to describe whether the quantification of cervical fat tissue volume (CFTV) obtained by Computed Tomography (CT)cephalometry is related to the severity of OSA. Methods Retrospective study between 2018 and 2020 in those patients > 18 years old, with diagnosis of OSA who performed a volumetric cephalometric imaging. Three-dimensional reconstruction of the images was performed and CFTV was measured. Results 91 patients were included in this study of which: without OSA (n: 7), mild (n: 19), moderate (n: 39) and severe OSA (n: 26). We observed a progressive increase of CFTV related to OSA severity has been observed (without OSA: 58.9 ml (47.9-87.5), mild: 59.1ml (48.4-78.3), moderate: 71 ml (42.6-127.1) and severe OSA 103.6 ml (81-153); p < 0.01); nevertheless, no differences were found in the airway volume and neck area. It was showed a significant correlation between CFTV and OSA indicators: AHI, ODI and T90 (Sp r: 0.48; 0.38 and 0.36; p < 0.01 respectively). CFTV cut-off value to discriminate AHI >15 ev/h with best sensitivity-specificity relationship was 64.1 ml with an area under the curve of 0.6 ± 0.06. Multivariate analysis showed that CFTV is a predictor for moderate to severe OSA (OR:3.05, IC95%: 1.14-8.17). Conclusion Cervical fat quantification by CT cephalometry correlates with OSA severity in adults. Fat volume > 64.1 ml increased more than three times the risk of OSA moderate to severe.
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Affiliation(s)
- Glenda Ernst
- Hospital Británico, Neumonología, CABA, Buenos Aires, Argentina
| | - Pablo Dalzotto
- Hospital Británico, Diagnóstico por Imágenes, CABA, Buenos Aires, Argentina
| | - Melina Saban
- Hospital Británico, Neumonología, CABA, Buenos Aires, Argentina
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18
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Thuler E, Seay EG, Woo J, Lee J, Jafari N, Keenan BT, Dedhia RC, Schwartz AR. Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2023; 169:412-421. [PMID: 36939430 DOI: 10.1002/ohn.258] [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: 09/26/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility. STUDY DESIGN Cross-sectional analysis in a prospective cohort. SETTING University Hospital. METHODS A cross-sectional analysis was conducted in a cohort of consecutive patients from the positive airway pressure (PAP) alternatives clinic who underwent computed tomography (CT) analysis and drug-induced sleep endoscopy for characterization of upper airway collapsibility. PAP titration was used to determine pharyngeal critical pressure (PCRIT ) and pharyngeal opening pressure (PhOP). CT metrics included: Transverse maxillary dimensions (interpremolar and intermolar distances) and pharyngeal length (posterior nasal spine to hyoid distance). RESULTS The cohort (n = 103) of severe obstructive sleep apnea (Apnea and Hipopnea Index 32.1 ± 21.3 events/h) was predominantly male (71.8%), Caucasian (81.6%), middle-aged (54.4 ± 14.3 years), and obese (body mass index [BMI] = 30.0 ± 4.9 kg/m2 ). Reduced transverse maxillary dimensions were associated with higher PCRIT (intermolar distance: β [95% confidence interval, CI] = -.25 [-0.14, -0.36] cmH2 O/mm; p = .03) and PhOP (Interpremolar distance: β = -.25 [-0.14, -0.36] cmH2 O/mm; p = .02). Longer pharyngeal length was also associated with higher PCRIT (β = .11 [0.08, 0.14] cmH2 O/mm, p = .04) and PhOP (β [95% CI] = .06 [0.03, 0.09] cmH2 O/mm, p = .04). These associations persisted after adjustments for sex, age, height, and BMI. CONCLUSION Our results further the concept that skeletal restriction in the transverse dimension and hyoid descent are associated with elevations in pharyngeal collapsibility during sleep, suggesting a role of transverse deficiency in the pathogenesis of airway obstruction.
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Affiliation(s)
- Eric Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Everett G Seay
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Woo
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jane Lee
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Niusha Jafari
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alan R Schwartz
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Otorhinolaryngology, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru
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19
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Sutherland K, Smith G, Lowth AB, Sarkissian N, Liebman S, Grieve SM, Cistulli PA. The effect of surgical weight loss on upper airway fat in obstructive sleep apnoea. Sleep Breath 2023; 27:1333-1341. [PMID: 36301383 PMCID: PMC10427513 DOI: 10.1007/s11325-022-02734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Obesity is a reversible risk factor for obstructive sleep apnoea (OSA). Weight loss can potentially improve OSA by reducing fat around and within tissues surrounding the upper airway, but imaging studies are limited. Our aim was to study the effects of large amounts of weight loss on the upper airway and volume and fat content of multiple surrounding soft tissues. METHODS Participants undergoing bariatric surgery were recruited. Magnetic resonance imaging (MRI) was performed at baseline and six-months after surgery. Volumetric analysis of the airway space, tongue, pharyngeal lateral walls, and soft palate were performed as well as calculation of intra-tissue fat content from Dixon imaging sequences. RESULTS Among 18 participants (89% women), the group experienced 27.4 ± 4.7% reduction in body weight. Velopharyngeal airway volume increased (large effect; Cohen's d [95% CI], 0.8 [0.1, 1.4]) and tongue (large effect; Cohen's d [95% CI], - 1.4 [- 2.1, - 0.7]) and pharyngeal lateral wall (Cohen's d [95% CI], - 0.7 [- 1.2, - 0.1]) volumes decreased. Intra-tissue fat decreased following weight loss in the tongue, tongue base, lateral walls, and soft palate. There was a greater effect of weight loss on intra-tissue fat than parapharyngeal fat pad volume (medium effect; Cohen's d [95% CI], - 0.5 [- 1.2, 0.1], p = 0.083). CONCLUSION The study showed an increase in velopharyngeal volume, reduction in tongue volume, and reduced intra-tissue fat in multiple upper airway soft tissues following weight loss in OSA. Further studies are needed to assess the effect of these anatomical changes on upper airway function and its relationship to OSA improvement.
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Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia.
- Department Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Garett Smith
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, NSW, Australia
- Discipline of Surgery, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Aimee B Lowth
- Sleep Research Group, Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
- Department Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nina Sarkissian
- Sleep Research Group, Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
- Department Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Steven Liebman
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, NSW, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, and Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre and Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia
- Department Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
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20
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Lu N, Yin F. Relationship Between Hyperuricemia-Waist Phenotype and Obstructive Sleep Apnea in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:1505-1513. [PMID: 37252008 PMCID: PMC10224684 DOI: 10.2147/dmso.s408637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Objective This study aimed to propose the hyperuricemia-waist (HUAW) phenotype and investigate the relationship between the HUAW phenotype and obstructive sleep apnea (OSA) in type 2 diabetes mellitus (T2DM). Methods We enrolled 255 patients with T2DM (165 male and 90 female) from the First Hospital of Qinhuangdao. The sleep test was performed, and serum uric acid (UA) levels and waist circumference (WC) were calculated. The HUAW phenotype was defined as serum UA concentrations ≥420 μmol/L and WC ≥90 cm (male) and ≥85 cm (female). The participants were categorized into four phenotype groups based on the mentioned cutoffs: normal WC and normal UA concentrations (group A); normal WC and elevated UA concentrations (group B); enlarged WC and normal UA concentrations (group C); and enlarged WC and elevated UA concentrations (group D). Among these participants, 17.6% were characterized by the HUAW phenotype, 80.0% had OSA, and 47.0% had moderate-to-severe OSA. The prevalence of OSA was 43.4%, 71.4%, 89.7%, and 97.8% in groups A, B, C, and D, respectively. The prevalence of moderate-to-severe OSA was 7.5%, 28.6%, 56.9%, and 72.7% in groups A, B, C, and D, respectively. After adjusting for age, sex, duration of diabetes, glycosylated hemoglobin A1c, smoking, and drinking, the HUAW phenotype was found to be significantly associated with OSA and moderate-to-severe OSA. Conclusion The present study proposed the HUAW phenotype and demonstrated that in T2DM, the HUAW phenotype was associated with OSA, especially with moderate-to-severe OSA. Unlike T2DM without the HUAW phenotype, T2DM with the HUAW phenotype showed a significantly higher prevalence of OSA, especially moderate-to-severe OSA. Thus, early sleep studies should be routinely examined in individuals with T2DM who display the HUAW phenotype.
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Affiliation(s)
- Na Lu
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Fuzai Yin
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
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21
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Ruan B, Nagappa M, Rashid-Kolvear M, Zhang K, Waseem R, Englesakis M, Chung F. The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: A systematic review and meta-analysis. J Clin Anesth 2023; 88:111144. [PMID: 37172556 DOI: 10.1016/j.jclinane.2023.111144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness of supplemental oxygen therapy and high-flow nasal cannula (HFNC) therapy in patients with obstructive sleep apnea (OSA) in different clinical settings to assess its application to surgical patients in the postoperative setting. DESIGN A systematic search was conducted on MEDLINE and other databases from 1946 to December 16th, 2021. Title and abstract screening were conducted independently, and the lead investigators resolved conflicts. Meta-analyses were performed using a random-effects model and are presented as mean difference and standardized mean difference with 95% confidence intervals. These were calculated using RevMan 5.4. PATIENTS 1395 and 228 OSA patients underwent oxygen therapy and HFNC therapy respectively. INTERVENTIONS Oxygen therapy and HFNC therapy. MEASUREMENTS Apnea-hypopnea index (AHI), oxyhemoglobin saturation (SpO2), cumulative time with SPO2 < 90% (CT90). MAIN RESULTS Twenty-seven oxygen therapy studies were included in the review, with ten randomized controlled trials (RCT), seven randomized crossovers, seven non-randomized crossovers, and three prospective cohorts. Pooled analyses showed that oxygen therapy significantly reduced AHI by 31% and increased SpO2 by 5% versus baseline, and CPAP significantly reduced AHI by 84%, and increased SpO2 by 3% versus baseline. CPAP was 53% more effective in reducing AHI than oxygen therapy, but both treatments had similar effectiveness in increasing SpO2. Nine HFNC studies were included in the review, with five prospective cohorts, three randomized crossovers, and one RCT. Pooled analyses showed that HFNC therapy significantly reduced AHI by 36% but did not substantially increase SpO2. CONCLUSIONS Oxygen therapy effectively reduces AHI and increases SpO2 in patients with OSA. CPAP is more effective in reducing AHI than oxygen therapy. HFNC therapy is effective in reducing AHI. Although both oxygen therapy and HFNC therapy effectively reduce AHI, more research is needed to draw conclusions on clinical outcomes.
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Affiliation(s)
- Brandon Ruan
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Kevin Zhang
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada
| | - Rida Waseem
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada
| | | | - Frances Chung
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada.
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22
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Comparative study of a wearable intelligent sleep monitor and polysomnography monitor for the diagnosis of obstructive sleep apnea. Sleep Breath 2023; 27:205-212. [PMID: 35347656 PMCID: PMC9992231 DOI: 10.1007/s11325-022-02599-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Due to the lack of an objective population-based screening tool for obstructive sleep apnea (OSA), a large number of patients with potential OSA have not been identified in the general population. Our study compared an objective wearable sleep monitoring device with polysomnography (PSG) to provide a reference for OSA screening in a large population. METHODS Using a self-control method, patients admitted to our sleep center from July 2020 to March 2021 were selected for overnight PSG and wearable intelligent sleep monitor (WISM) at the same time. The sensitivity and specificity of the device for the diagnosis of OSA were evaluated. RESULTS A total of 196 participants (mean age: 45.1 ± 12.3 years [18-80 years]; 168 men [86%]) completed both PSG and WISM monitoring. Using an apnea-hypopnea index (AHI) ≥ 5 events/h as the diagnostic criterion, the sensitivity, specificity, kappa value, and area under the receiver operating characteristic curve of the WISM for OSA diagnosis were 93%, 77%, 0.6, and 0.95, respectively. Using an AHI ≥ 15 events/h as the diagnostic criterion for moderate-to-severe OSA, these values were 92%, 89%, 0.8, and 0.95, respectively. The mean difference in the AHI between PSG and the artificial intelligence oxygen desaturation index from the WISM was 6.8 events/h (95% confidence interval: - 13.1 to 26.7). CONCLUSION Compared with the PSG, WISM exhibits good sensitivity and specificity for the diagnosis of OSA. This small, simple, and easy-to-use device is more suitable for OSA screening in a large population because of its single-step application procedure.
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23
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Chen H, Emami E, Kauffmann C, Rompré P, Almeida F, Schmittbuhl M, van der Stelt P, Ge S, Lavigne G, Huynh N. Airway Phenotypes and Nocturnal Wearing of Dentures in Elders with Sleep Apnea. J Dent Res 2023; 102:263-269. [PMID: 36333889 DOI: 10.1177/00220345221133278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to examine to what extent the anatomic characteristics of the upper airway can influence the effect of nocturnal wearing of dentures on the sleep of edentulous elders with untreated sleep apnea. This study used the data from a randomized crossover clinical trial and an exploratory approach to address its objectives. Cone beam computed tomography scans of 65 edentulous individuals (female, n = 37; male, n = 28; mean ± SD age, 74.54 ± 6.42 y) with untreated obstructive sleep apnea (OSA) were used to identify anatomic variables. Polysomnography data were collected by means of one portable overnight recording. The respiratory variable values, including apnea-hypopnea index (AHI), with and without denture worn during sleep were used to calculate the change. Statistical analyses included multiple linear regressions, cluster analysis, and binary logistic regressions. A receiver operator characteristic curve was used to illustrate the accuracy of the statistical model. The regression model explained 15.8% (R2) of AHI change. An increase in the lateral dimension of the minimum cross-sectional area was associated with a decrease in AHI, oxygen desaturation index, and respiratory arousal index changes (P ≤ 0.041). Furthermore, an increase in the length of the hypopharynx was associated with an increase in AHI and oxygen desaturation index changes (P ≤ 0.027). An increase in the lateral dimension of the minimum cross-sectional area of the upper airway was associated with a decreased likelihood of being in the group having a worsened AHI (odds ratio = 0.85; 95% CI, 0.76 to 0.95; P = 0.006). An increase in the length of the oropharynx was associated with an increased likelihood of having increased AHI (odds ratio = 1.10; 95% CI, 1.01 to 1.20; P = 0.026). The nocturnal aggravation of respiratory variables in edentulous individuals with OSA who wear dentures at night can be linked to certain anatomic characteristics of the upper airway. Replication of these findings may open novel avenues for personalized advice regarding nocturnal wearing of dentures in edentulous individuals with OSA (ClinicalTrials.gov: NCT01868295).
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Affiliation(s)
- H Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.,Faculty of Dental Medicine, Université de Montréal, Montreal, Canada
| | - E Emami
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - C Kauffmann
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - P Rompré
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada
| | - F Almeida
- Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - M Schmittbuhl
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - P van der Stelt
- Academic Centre for Dentistry Amsterdam, Amsterdam, the Netherlands
| | - S Ge
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - G Lavigne
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - N Huynh
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
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Garcia GJM, Wolf JJ, Campbell DA, Bailey RS, Sparapani RA, Welzig CM, Woodson BT. Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance. Physiol Rep 2023; 11:e15558. [PMID: 36756800 PMCID: PMC9909385 DOI: 10.14814/phy2.15558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 02/10/2023] Open
Abstract
Mandibular advancement devices (MADs) are frequently prescribed for obstructive sleep apnea (OSA) patients, but approximately one third of patients experience no therapeutic benefit. Understanding the mechanisms by which MADs prevent pharyngeal collapse may help optimize MAD therapy. This study quantified the relative contributions of changes in airspace cross-sectional area (CSA) versus changes in velopharyngeal compliance in determining MAD efficacy. Sixteen patients with moderate to severe OSA (mean apnea-hypopnea index of 32 ± 15 events/h) underwent measurements of the velopharyngeal closing pressure (PCLOSE ) during drug induced sedated endoscopy (DISE) via stepwise reductions in nasal mask pressure and recording of the intraluminal pressure with a catheter. Airspace CSA was estimated from video endoscopy. Pharyngeal compliance was defined as the slope of the area-pressure relationship of the velopharyngeal airspace. MAD therapy reduced PCLOSE from a median of 0.5 cmH2 O pre-advancement to a median of -2.6 cmH2 O post-advancement (p = 0.0009), increased the minimal CSA at the velopharynx by approximately 20 mm2 (p = 0.0067), but did not have a statistically significant effect on velopharyngeal compliance (p = 0.23). PCLOSE had a strong correlation with CSA but did not correlate with velopharyngeal compliance. Our results suggest that MADs reduce velopharyngeal collapsibility by increasing airway size as opposed to affecting velopharyngeal compliance. This contradicts the speculation of previous literature that the effectiveness of MADs is partially due to a reduction in velopharyngeal compliance resulting from stretching of the soft palate. These findings suggest that quantification of velopharyngeal CSA pre- and post-MAD advancement has potential as a biomarker to predict the success of MAD therapy.
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Affiliation(s)
- Guilherme J. M. Garcia
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
- Joint Department of Biomedical EngineeringMarquette University & The Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Josiah J. Wolf
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
- Joint Department of Biomedical EngineeringMarquette University & The Medical College of WisconsinMilwaukeeWisconsinUSA
| | - David A. Campbell
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
- Joint Department of Biomedical EngineeringMarquette University & The Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Ryan S. Bailey
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
- Joint Department of Biomedical EngineeringMarquette University & The Medical College of WisconsinMilwaukeeWisconsinUSA
| | | | - Charles M. Welzig
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
| | - B. Tucker Woodson
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
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25
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Hu B, Yin G, Fu S, Zhang B, Shang Y, Zhang Y, Ye J. The influence of mouth opening on pharyngeal pressure loss and its underlying mechanism: A computational fluid dynamic analysis. Front Bioeng Biotechnol 2023; 10:1081465. [PMID: 36698641 PMCID: PMC9868155 DOI: 10.3389/fbioe.2022.1081465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective: During inspiration, mechanical energy generated from respiratory muscle produces a negative pressure gradient to fulfill enough pulmonary ventilation. The pressure loss, a surrogate for energy loss, is considered as the portion of negative pressure without converting into the kinetic energy of airflow. Mouth opening (MO) during sleep is a common symptom in patients with obstructive sleep apnoea-hypopnea syndrome (OSAHS). This study aimed to evaluate the effects of mouth opening on pharyngeal pressure loss using computational fluid dynamics (CFD) simulation. Methods: A total of four subjects who were morphologically distinct in the pharyngeal characteristics based on Friedman tongue position (FTP) grades were selected. Upper airway computed tomography (CT) scan was performed under two conditions: Mouth closing (MC) and mouth opening, in order to reconstruct the upper airway models. computational fluid dynamics was used to simulate the flow on the two different occasions: Mouth closing and mouth opening. Results: The pharyngeal jet was the typical aerodynamic feature and its formation and development were different from mouth closing to mouth opening in subjects with different Friedman tongue position grades. For FTP I with mouth closing, a pharyngeal jet gradually formed with proximity to the velopharyngeal minimum area plane (planeAmin). Downstream the planeAmin, the jet impingement on the pharyngeal wall resulted in the frictional loss associated with wall shear stress (WSS). A rapid luminal expansion led to flow separation and large recirculation region, corresponding to the interior flow loss. They all contributed to the pharyngeal total pressure loss. While for FTP I with mouth opening, the improved velopharyngeal constriction led to smoother flow and a lower total pressure loss. For FTP IV, the narrower the planeAmin after mouth opening, the stronger the jet formation and its impingement on the pharyngeal wall, predicting a higher frictional loss resulted from higher WSS. Besides, a longer length of the mouth opening-associated constant constrictive segment was another important morphological factor promoting frictional loss. Conclusion: For certain OSAHS patients with higher Friedman tongue position grade, mouth opening-related stronger jet formation, more jet breakdown and stronger jet flow separation might contribute to the increased pharyngeal pressure loss. It might require compensation from more inspiratory negative static pressure that would potentially increase the severity of OSAHS.
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Affiliation(s)
- Bin Hu
- Department of Otolaryngology-Head Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoping Yin
- Department of Otolaryngology-Head Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Sleep Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song Fu
- School of Aeronautics and Astronautics, Tsinghua University, Beijing, China
| | - Baoshou Zhang
- School of Aeronautics and Astronautics, Tsinghua University, Beijing, China
| | - Yan Shang
- School of Aeronautics and Astronautics, Tsinghua University, Beijing, China
| | - Yuhuan Zhang
- Sleep Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingying Ye
- Department of Otolaryngology-Head Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Sleep Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,*Correspondence: Jingying Ye,
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26
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Hartfield PJ, Janczy J, Sharma A, Newsome HA, Sparapani RA, Rhee JS, Woodson BT, Garcia GJM. Anatomical determinants of upper airway collapsibility in obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2022; 68:101741. [PMID: 36634409 DOI: 10.1016/j.smrv.2022.101741] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
Upper airway (UA) collapsibility is one of the key factors that determine the severity of obstructive sleep apnea (OSA). Interventions for OSA are aimed at reducing UA collapsibility, but selecting the optimal alternative intervention for patients who fail CPAP is challenging because currently no validated method predicts how anatomical changes affect UA collapsibility. The gold standard objective measure of UA collapsibility is the pharyngeal critical pressure (Pcrit). A systematic literature review and meta-analysis were performed to identify the anatomical factors with the strongest correlation with Pcrit. A search using the PRISMA methodology was performed on PubMed for English language scientific papers that correlated Pcrit to anatomic variables and OSA severity as measured by the apnea-hypopnea index (AHI). A total of 29 papers that matched eligibility criteria were included in the quantitative synthesis. The meta-analysis suggested that AHI has only a moderate correlation with Pcrit (estimated Pearson correlation coefficient r = 0.46). The meta-analysis identified four key anatomical variables associated with UA collapsibility, namely hyoid position (r = 0.53), tongue volume (r = 0.51), pharyngeal length (r = 0.50), and waist circumference (r = 0.49). In the future, biomechanical models that quantify the relative importance of these anatomical factors in determining UA collapsibility may help identify the optimal intervention for each patient. Many anatomical and structural factors such as airspace cross-sectional areas, epiglottic collapse, and palatal prolapse have inadequate data and require further research.
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Affiliation(s)
- Phillip J Hartfield
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jaroslaw Janczy
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abhay Sharma
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hillary A Newsome
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rodney A Sparapani
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Tucker Woodson
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA.
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27
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Zou H, Jia Q, Yang W, Zhang Z, Miao J. Clinical and Polysomnographic Characteristics of Nonobese and Obese Chinese Patients With Obstructive Sleep Apnea. J Clin Neurophysiol 2022; 39:631-636. [PMID: 33587387 DOI: 10.1097/wnp.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Obesity is a risk factor associated with the onset and exacerbation of obstructive sleep apnea (OSA). However, the majority of OSA patients in Asian populations are nonobese. To date, there have been insufficient large-scale studies of the differences in the clinical and polysomnographic features of obese and nonobese OSA patients in this population, and few studies have sought to identify predictors of OSA severity in affected obese and nonobese patients. METHODS We conducted a case-matched retrospective study, including 652 consecutive Chinese OSA patients (326 nonobese and 326 obese) to assess differences in demographic, clinical, and polysomnographic data between these two groups. Independent predictors of OSA severity were identified through multivariate linear regression analysis. RESULTS The age and gender distributions of our obese and nonobese OSA patient cohorts did not differ significantly ( P > 0.05), and rates of comorbidities were comparable in these two patient groups ( P > 0.05). Nonobese patients were more likely to report atypical symptoms of OSA, including insomnia ( P < 0.001), irritability ( P < 0.05), and depressive symptoms ( P < 0.01), whereas obese patients were more likely to report typical symptoms of OSA, such as habitual snoring ( P < 0.001), witnessed apnea ( P < 0.05), and daytime sleepiness ( P < 0.001). Relative to nonobese patients, those who were obese exhibited significantly higher apnea-hypopnea index during total sleep time ( P < 0.001), apnea-hypopnea index during nonrapid eye movement sleep ( P < 0.001), and apnea-hypopnea index during rapid eye movement sleep ( P < 0.001), in addition to lower average oxygen saturation ( P < 0.001), minimal oxygen saturation ( P < 0.001), and a higher oxygen desaturation index ( P < 0.001) and arousal index ( P < 0.001). Total sleep time was, on average, shorter for nonobese patients ( P < 0.05), who also exhibited decreased sleep efficiency and more frequent awakening relative to obese patients ( P < 0.05). A multivariate linear regression analysis revealed that neck circumference and waist circumference were independent predictors of OSA severity in obese patients ( P < 0.05). CONCLUSIONS On average, OSA was typically less severe in nonobese patients, who were also more likely to experience atypical OSA symptoms relative to obese patients. These results also suggest that the differential contributions of body fat accumulation and distribution to OSA severity may offer insights into the pathogenesis, clinical manifestations, and optimal management of this condition in nonobese and obese patient populations. It is vital that clinicians consider these differences to properly diagnose and treat this debilitating condition.
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Affiliation(s)
- Huili Zou
- Department of Neurology, Xi'an Daxing Hospital, Xi'an City, Shaanxi Province, China
- Sleep Disorders Center, Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an City, Shaanxi Province, China; and
| | - Qingge Jia
- Xi'an International Medical Center, Northwest University, Xi'an City, Shaanxi Province, China
| | - Weiyi Yang
- Department of Neurology, Xi'an Daxing Hospital, Xi'an City, Shaanxi Province, China
- Sleep Disorders Center, Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an City, Shaanxi Province, China; and
| | - Zhuo Zhang
- Sleep Disorders Center, Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an City, Shaanxi Province, China; and
| | - Jianting Miao
- Department of Neurology, Xi'an Daxing Hospital, Xi'an City, Shaanxi Province, China
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The Heritability of Upper Airway Dimensions Using MRI Scans in Twins. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction: Obstructive sleep apnea (OSA) is a common disorder characterized by the repetitive collapse of the upper airways during sleep, most likely in the oropharyngeal region. Anatomical factors significantly contribute to the disease development; however, the heritability of the upper airway dimensions, which lead to the collapsibility of the upper airways, is less known. In the current study, we aimed to quantify the impact of heritable and environmental factors on the upper airway dimensions in twins using magnetic resonance imaging (MRI). Methods: We completed head and neck MRI imaging on 110 (66 monozygotic and 44 dizygotic, age median and Q1–Q3: 53 (44–63.75) years) adult twins from the Hungarian Twin Registry. We completed cephalometric, soft tissue and fatty tissue space measurements on T1- and T2-weighted images in sagittal, coronal and axial planes. For the analysis of the genetic and environmental, the determination of the measured parameters was performed with an ACE twin statistical model. Results: We found a strong genetic determination in the anteroposterior diameter of the tongue and the thickness of the submental fatty tissue of the neck. Other parameters of the tongue, soft palate and uvula have shown moderate heritability, while we found strong environmental determination in the thickness of the parapharyngeal fatty tissue, the thickness of the pharyngeal wall, and the smallest diameter of the posterior upper airways. Conclusion: Our twin study can help better understand the genetic and environmental background of anatomical structures involved in the development of sleep apnea.
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Fong WCG, Rafiq I, Harvey M, Stanescu S, Ainsworth B, Varkonyi-Sepp J, Mistry H, Kyyaly MA, Barber C, Freeman A, Wilkinson T, Djukanovic R, Dennison P, Haitchi HM, Kurukulaaratchy RJ. The Detrimental Clinical Associations of Anxiety and Depression with Difficult Asthma Outcomes. J Pers Med 2022; 12:jpm12050686. [PMID: 35629109 PMCID: PMC9142921 DOI: 10.3390/jpm12050686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/27/2022] [Accepted: 04/06/2022] [Indexed: 01/04/2023] Open
Abstract
Difficult asthma describes asthma in which comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence impede good asthma control. The association of anxiety and depression with difficult asthma outcomes (exacerbations, hospital admissions, asthma control, etc.) is unclear. This study assessed the clinical associations of anxiety and depression with difficult asthma outcomes in patients with a specialist diagnosis of difficult asthma. Using real-world data, we retrospectively phenotyped patients from the Wessex Asthma Cohort of Difficult Asthma (N = 441) using clinical diagnoses of anxiety and depression against those without anxiety or depression (controls). Additionally, we stratified patients by severity of psychological distress using the Hospital Anxiety and Depression Scale (HADS). We found that depression and/or anxiety were reported in 43.1% of subjects and were associated with worse disease-related questionnaire scores. Each psychological comorbidity group showed differential associations with difficult asthma outcomes. Anxiety alone (7.9%) was associated with dysfunctional breathing and more hospitalisations [anxiety, median (IQR): 0 (2) vs. controls: 0 (0)], while depression alone (11.6%) was associated with obesity and obstructive sleep apnoea. The dual anxiety and depression group (23.6%) displayed multimorbidity, worse asthma outcomes, female predominance and earlier asthma onset. Worse HADS-A scores in patients with anxiety were associated with worse subjective outcomes (questionnaire scores), while worse HADS-D scores in patients with depression were associated with worse objective (ICU admissions and maintenance oral corticosteroid requirements) and subjective outcomes. In conclusion, anxiety and depression are common in difficult asthma but exert differential detrimental effects. Difficult asthma patients with dual anxiety and depression experience worse asthma outcomes alongside worse measures of psychological distress. There is a severity-gradient association of HADS scores with worse difficult asthma outcomes. Collectively, our findings highlight the need for holistic, multidisciplinary approaches that promote early identification and management of anxiety and depression in difficult asthma patients.
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Affiliation(s)
- Wei Chern Gavin Fong
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight PO30 5TG, UK
| | - Ishmail Rafiq
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
| | - Matthew Harvey
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Sabina Stanescu
- Department of Psychology, University of Southampton, Southampton SO17 1BJ, UK;
| | - Ben Ainsworth
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
- Department of Psychology, University of Bath, Bath BA2 7AY, UK
| | - Judit Varkonyi-Sepp
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Heena Mistry
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight PO30 5TG, UK
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Mohammed Aref Kyyaly
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight PO30 5TG, UK
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Clair Barber
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Anna Freeman
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Tom Wilkinson
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Ratko Djukanovic
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Paddy Dennison
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Hans Michael Haitchi
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
| | - Ramesh J. Kurukulaaratchy
- School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK; (W.C.G.F.); (J.V.-S.); (H.M.); (M.A.K.); (A.F.); (T.W.); (R.D.); (H.M.H.)
- David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight PO30 5TG, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.H.); (B.A.); (C.B.); (P.D.)
- Correspondence:
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Abstract
Pediatric obstructive sleep apnea (OSA) is a common entity that can cause both daytime and nighttime issues. Children with symptoms should be screened for OSA. If possible, polysomnography should be performed to evaluate symptomatic children. Depending on the severity, first-line options for treatment of pediatric OSA may include observation, weight loss, medication, or surgery. Even after adenotonsillectomy, about 20% of children will have persistent OSA. Sleep endoscopy and cine MRI are tools that may be used to identify sites of obstruction, which in turn can help in the selection of site-specific treatment.
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Affiliation(s)
- Pakkay Ngai
- Division of Pediatric Pulmonology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN 3rd Floor, Hackensack, NJ 07601, USA
| | - Michael Chee
- Division of Pediatric Otolaryngology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, 30 Prospect Avenue, WFAN PC-311, Hackensack, NJ 07601, USA.
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Liu W, Zhou L, Zhao D, Wu X, Yue F, Yang H, Jin M, Xiong M, Hu K. Development and Validation of a Prognostic Nomogram in Lung Cancer With Obstructive Sleep Apnea Syndrome. Front Med (Lausanne) 2022; 9:810907. [PMID: 35372417 PMCID: PMC8971712 DOI: 10.3389/fmed.2022.810907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
To analyze the prognostic factors and survival rate of lung cancer patients with obstructive sleep apnea (OSA) by nomogram. The nomogram was established by a development cohort (n = 90), and the validation cohort included 38 patients. Factors in the nomogram were identified by Cox hazard analysis. We tested the accuracy of the nomograms by discrimination and calibration, and plotted decision curves to assess the benefits of nomogram-assisted decisions. There were significant difference in sex, apnea hypopnea index (AHI), Tumor Node Metastasis (TNM), coronary heart disease, lowest arterial oxygen saturation [LSpO2 (%)], oxygen below 90% of the time [T90% (min)], the percentage of the total recorded time spend below 90% oxygen saturation (TS90%) and oxygen desaturation index (ODI4) between lung cancer subgroup and lung cancer with OSA subgroup (P < 0.05). Lung cancer patients with OSA age, AHI, TNM, cancer types, BMI and ODI4 were independent prognostic factor. Based on these six factors, a nomogram model was established. The c-index of internal verification was 0.802 (95% CI 0.767–0.885). The ROC curve analysis for the nomogram show 1-year survival (AUC = 0.827), 3-year survival (AUC = 0.867), 5-year survival (AUC = 0.801) in the development cohort were good accuracy. The calibration curve shows that this prediction model is in good agreement. Decision curve analysis (DCA) suggests that the net benefit of decision-making with this nomogram is higher, especially in the probability interval of <20% threshold. The nomogram can predict the prognosis of patients and guide individualized treatment.
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Affiliation(s)
- Wei Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Zhou
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Dong Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Wu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fang Yue
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Haizhen Yang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Meng Jin
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Ke Hu
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Smoking Obstructive Sleep Apnea: Arguments for a Distinctive Phenotype and a Personalized Intervention. J Pers Med 2022; 12:jpm12020293. [PMID: 35207781 PMCID: PMC8875333 DOI: 10.3390/jpm12020293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This is the first study that aims to define smoking, with obstructive sleep apnea (OSA), as a phenotype (SOSA). Moreover, we wanted to demonstrate the deleterious effects of the continuation of smoking on OSA. Methods: The cross-sectional study highlighted four dimensions of SOSA: the demographic and anthropometric features, the symptoms, the comorbidities, and the sleep study parameters. This study compared these characteristics between current smokers (CS), those who have never smoked (NS), and ex-smokers (ES) with OSA. Results: More men (83.95% in CS, versus 66.67% in NS) and an earlier onset of OSA (average age = 50.05 in CS, versus 52.26 in NS, p = 0.04) were recorded among CS. The distinguishing symptom of CS was daytime sleepiness, with an Epworth score that was significantly higher than in NS. Chronic obstructive pulmonary disease (COPD) was significantly more prevalent in CS (38.27%) than in NS (1.51%) (p < 0.001). The severity of OSA, consisting of a higher apnea-hypopnea index, a higher oxygen desaturation index, and a longer time spent below 90% oxygen saturation during sleep was significantly influenced by smoking. Conclusions: The SOSA phenotype includes younger male patients with a higher waist circumference, suggesting central obesity. They have a higher prevalence of COPD and a greater severity of OSA, in correlation with the number of pack-years of smoking.
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Castro MCZ, dos Santos CM, Lucas RE, de Felício CM, Dantas RO. Oral motor function in obesity. J Oral Rehabil 2022; 49:529-534. [DOI: 10.1111/joor.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Claudia Maria de Felício
- Department of Ophtalmology, Otorhynolaryngology and Head and Neck Surgery Ribeirão Preto Medical School University of São Paulo Ribeirão Preto SP Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine Ribeirão Preto Medical School University of São Paulo Ribeirão Preto SP Brazil
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Yanari S, Sasaki A, Umemura A, Ishigaki Y, Nikai H, Nishijima T, Sakurai S. Therapeutic effect of laparoscopic sleeve gastrectomy on obstructive sleep apnea and relationship of type 2 diabetes in Japanese patients with severe obesity. J Diabetes Investig 2022; 13:1073-1085. [PMID: 35080135 PMCID: PMC9153837 DOI: 10.1111/jdi.13755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION Obstructive sleep apnea (OSA) is among the most important obesity-related diseases, and offers the potential for accelerated the early onset and progression of Type 2 diabetes (T2D). The aim of the present study was to clarify the therapeutic effect of laparoscopic sleeve gastrectomy (LSG) on OSA in severely obese Japanese patients and to find correlations between OSA improvements and β cell function (BCF). MATERIALS AND METHODS Between September 2013 and December 2019, 61 patients who underwent LSG were enrolled. The apnea-hypopnea index (AHI) was used to diagnose OSA. The tongue area (TA), uvula area (UA), and other parameters were measured using cone-beam computed tomography. Regarding BCF parameters, the homeostasis model assessment of beta-cell function (HOMA-β), insulinogenic, Matsuda, and disposition indexes were used to evaluate the improvement in BCF. Improvement of OSA was defined as AHI < 15. RESULTS The improvement rate of OSA was 51.8% (29/56). The change in AHI was significantly correlated with the excess weight-loss percentage (ρ = 0.501), changes in TA (ρ = 0.350), and UA (ρ = 0.341). Multivariate analysis revealed that preoperative AHI and postoperative HbA1c were independent prognostic factors of OSA non-improvement. HOMA-β (P < 0.001), the insulinogenic index (P < 0.001), and the disposition index (P = 0.019) of patients with AHI of < 15 were significantly higher than those in patients with AHI of ≥ 15. CONCLUSIONS LSG is a promising procedure for severely obese patients with OSA. BCF recovery was found to be significantly higher in patients with OSA improvement.
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Affiliation(s)
- Shingo Yanari
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Yasushi Ishigaki
- Department of Internal Medicine, Devision of Diabetes and Metabolism and Endocrine Medicine Field, Iwate Medical University, Iwate, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Tsuguo Nishijima
- Division of Behavioral Sleep Medicine, Iwate Medical University, Iwate, Japan
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Tang H, Zhou Q, Zheng F, Wu T, Tang YD, Jiang J. The Causal Effects of Lipid Profiles on Sleep Apnea. Front Nutr 2022; 9:910690. [PMID: 35799595 PMCID: PMC9253611 DOI: 10.3389/fnut.2022.910690] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Observational studies have suggested that lipid profiles were associated with risk of sleep apnea (SA). However, the specific lipid types and whether this relationship has a causal effect are uncertain. This study conducted two-sample Mendelian randomization (MR) and multivariable Mendelian randomization (MVMR) to investigate the potential causal relationship between lipid profiles and risk of SA. Materials and Methods We used the largest genome-wide association study (GWAS) on European participants on the UK Biobank. After a rigorous single nucleotide polymorphism screening process to remove confounding effects, we performed MR and MVMR to explore the causal relationship between lipid profiles and SA risk. Results Both MR and MVMR showed causal effects of increased triglyceride on SA risk [MR: per 10 units, odds ratio (OR): 1.0156; 95% CI: 1.0057-1.0257; P value = 0.002; MVMR: per 10 units, OR: 1.0229; 95% CI: 1.0051-1.0411; P value = 0.011]. The sensitivity analysis including Cochran's Q test, MR-Egger intercept, and MR pleiotropy residual sum and outlier (MR-PRESSO) test indicated that our findings were robust. The causal effects of triglyceride on SA did not change after adjusting for potential confounders (obesity, age, sex, and airway obstruction). Conclusion Genetically increased triglyceride levels have independent causal effects on risk of sleep apnea without the confounding effects of obesity, suggesting that lowering triglyceride concentrations may help to reduce the risk of sleep apnea.
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Affiliation(s)
- Hongyi Tang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qing Zhou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology, Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu Zheng
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tong Wu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology, Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Jiuhui Jiang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
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Ng SS, Tam WW, Lee RW, Chan TO, Yiu K, Yuen BT, Wong KT, Woo J, Ma RC, Chan KK, Ko FW, Cistulli PA, Hui DS. Effect of Weight Loss and CPAP on OSA and Metabolic Profile Stratified by Craniofacial Phenotype: A Randomized Clinical Trial. Am J Respir Crit Care Med 2021; 205:711-720. [PMID: 34936531 DOI: 10.1164/rccm.202106-1401oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Craniofacial structure is thought to modulate the effect of weight loss on OSA, but whether this affects metabolic profile after weight loss compared with continuous positive airway pressure(CPAP) is unknown among obese Chinese patients with obstructive sleep apnea(OSA). OBJECTIVES To compare the change in metabolic profile between lifestyle modification program(LMP), stratified by craniofacial phenotype, and CPAP therapy for 6 months. METHODS We randomly assigned 194 patients with BMI≥25kg/m2 and moderate-to-severe OSA to receive LMP or CPAP therapy for 6 months in a 2:1 ratio. Assessments included computed tomography for assessing maxillomandibular volume(MMV), high sensitivity C-reactive protein(hsCRP) and insulin sensitivity. Measurements and Main Results(mean±SD or median[interquartile range]): Among 128 and 66 subjects in LMP group and CPAP group, respectively, hsCRP reduced more in LMP group than the CPAP group (-0.7[-1.4 to -0.0]mg/L vs -0.3[-0.9 to 0.4]mg/L, p=0.012). More patients in LMP group achieved low hsCRP(<1mg/L) than the CPAP group(21.1% vs 9.1%, p=0.04). Insulin sensitivity improved only in LMP group with 3.1(95%CI 1.5-6.6) times more patients with normal glucose regulation after intervention. LMP group was stratified into LMP-small MMV(n=64) and LMP-large MMV(n=64) groups according to the median MMV value of 233.2cm3. There was no significant difference in hsCRP(-0.7[-1.3 to 0.1] vs -0.7[-1.5 to -0.2], p=0.884) and insulin sensitivity(0.5[-0.2 to 1.9] vs 0.6[0.1 to 2.0], p=0.4860) between LMP-small and LMP-large MMV groups. CONCLUSION Weight reduction improved subclinical inflammation and insulin sensitivity more than CPAP among obese Chinese patients with moderate to severe OSA, and this effect was not influenced by craniofacial structure. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT03287973.
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Affiliation(s)
- Susanna Ss Ng
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Wilson Ws Tam
- National University of Singapore, 37580, Alice Lee Centre for Nursing Studies, Singapore, Singapore
| | - Richard Ww Lee
- Gosford Hospital, 90112, Department of Respiratory and Sleep Medicine, Gosford, New South Wales, Australia
| | - Tat-On Chan
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Karen Yiu
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Brian Ty Yuen
- Prince of Wales Hospital, 13621, Department of Imaging & Interventional Radiology, Hong Kong, Hong Kong
| | - Ka-Tak Wong
- Prince of Wales Hospital, 13621, Department of Imaging & Interventional Radiology, Hong Kong, Hong Kong
| | - Jean Woo
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Ronald Cw Ma
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong.,The Chinese University of Hong Kong Hong Kong Institute of Diabetes and Obesity, 596882, Hong Kong, Hong Kong
| | - Ken Kp Chan
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Fanny Ws Ko
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Peter A Cistulli
- The University of Sydney Faculty of Medicine and Health, 522555, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - David S Hui
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong;
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The potential effects of obesity on predicting outcomes of velopharyngeal surgery for obstructive sleep apnea. Eur Arch Otorhinolaryngol 2021; 279:1951-1956. [PMID: 34783887 DOI: 10.1007/s00405-021-07175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore the outcome associated factors of velopharyngeal surgery for treating obstructive sleep apnea (OSA) and the effects of obesity. METHODS A total of 175 adult OSA patients who underwent velopharyngeal surgery, including the revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) alone or the combination of H-UPPP and transpalatal advancement pharyngoplasty, were retrospectively studied. The pre-operative information of these patients, including physical examination, polysomnography (PSG), and upper airway CT, were collected for analysis. Post-operative PSG used for evaluation of surgical outcomes were all done 3-6 months after surgery. RESULTS The overall AHI decreased significantly from 59.7 ± 18.8 events/h to 22.1 ± 18.8 events/h after surgery (P < 0.001), and there were 104 responders (59.4%). Tonsil size, the percentage of time with oxygen saturation below 90% (CT90), the vertical distance between the lower margin of the mandible and the lower margin of the hyoid (MH), and surgical methods were independently associated with treatment outcomes. The independent associated factors for surgical success were large tonsil size and combined surgical methods in non-obese patients (BMI < 27.5 kg/m2) and were large tonsil size, short MH, and low CT90 in obese patients (BMI ≥ 27.5 kg/m2), respectively. CONCLUSIONS Although BMI is not directly associated with surgical outcomes of velopharyngeal procedures, the outcomes associated factors in obese and non-obese OSA patients were not entirely the same. Obesity should be taken into accounts in pre-operative patient selection of such surgery.
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Vural H, Akyol S. Electronegative LDL: Could it be a Potential Biomarker for Organ Interactions? JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2021. [DOI: 10.29333/jcei/11271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rodrigues GD, Fiorelli EM, Furlan L, Montano N, Tobaldini E. Obesity and sleep disturbances: The "chicken or the egg" question. Eur J Intern Med 2021; 92:11-16. [PMID: 33994249 DOI: 10.1016/j.ejim.2021.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
Obesity and sleep disturbances are common conditions in modern societies and accumulating evidence support a close bidirectional causal relationship between these two conditions. Indeed, from one side sleep loss seems to affect energy intake and expenditure through its direct effects on hormone-mediated sensations of satiety and hunger and through the influence on hedonic and psychological aspects of food consumption. Sleep deprived patients have been shown to experiment excessive daytime sleepiness, fatigue, and tiredness that, in a vicious circle, enhances physical inactivity and weight gain. On the other side, obesity is a well-known risk factor for several sleep disorders. This narrative review will discuss the main pathophysiological mechanisms that link sleep loss to obesity and metabolic syndrome with particular attention to the three most common sleep disorders (insomnia, obstructive sleep apnoea syndrome, restless leg syndrome).
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Affiliation(s)
- Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói, 24210-130, Brazil; Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Elisa M Fiorelli
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ludovico Furlan
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Eleonora Tobaldini
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Wang X, Chen H, Jia L, Xu X, Guo J. The relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea in adults. Eur J Orthod 2021; 44:78-85. [PMID: 34268561 DOI: 10.1093/ejo/cjab014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea (OSA) using cone beam computed tomography (CBCT). METHODS This was a prospective observational study, consisted of 95 adult OSA whose polysomnography and CBCT were available. Three-dimensional craniofacial and upper airway anatomical analysis were performed using 12 CBCT variables, including sagittal and vertical jaw relationships, maxillary width, the volume, length and minimum axial area of upper airway. The severity of OSA was evaluated through the apnea-hypopnea index (AHI). A hierarchical regression was performed to analyze the relationship between OSA severity and craniofacial and upper airway anatomical variables after controlling patients' demographic characteristics (gender, age, and BMI). RESULTS After controlling patients' gender, age, and BMI, individual CBCT variables including MAA, V-RPA, L-RPA and Go-Me were related to AHI. The final hierarchical regression model with demographic variables in Step 1 and CBCT variables (MAA, L-RPA and Go-Me) in Step 2 indicated that CBCT variables added additional explanatory power for AHI (ΔF(3,88) = 5.176, P = 0.002). Among these variables, L-RPA and Go-Me were statistically significant (P < 0.05). LIMITATION The OSA severity was expressed by AHI alone. CONCLUSIONS Three-dimensional craniofacial and upper airway morphology played an essential role in OSA severity. The most relevant anatomical characteristic with OSA severity were the length of retropalatal airway and mandibular body, which could be used to recognize severe OSA patients and as estimators for selecting the most appropriate treatment modality for OSA patients.
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Affiliation(s)
- Xiaoya Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.,Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Hui Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Lu Jia
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
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Tan SN, Yang HC, Lim SC. Anatomy and Pathophysiology of Upper Airway Obstructive Sleep Apnoea: Review of the Current Literature. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2020.00829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pae EK, Harper RM. Elevated Hyoid Bone Position in Response to Mandibular Advancing Appliance Predicts Effectiveness of the Appliance for Obstructive Sleep Apnea. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.672936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The objective was to determine whether hyoid bone elevation induced by an anterior mandibular positioning appliance (AMP) predicts the effectiveness of the AMP in patients with obstructive sleep apnea (OSA). Fifteen patients (12 males and 3 females) underwent polysomnographic recordings and lateral cephalograms before and after AMP use of at least 6 months. Measurements of sleep variables and upper airway morphology were compared between pre-AMP and with-AMP states. The AMP appliance reduced apnea-hypopnea indices (AHI) ~53% (33.77 ± 3.29 vs. 15.85 ± 3.78, P = 0.0013). Cephalograms of the oropharyngeal airway showed that the hyoid bone moved superiorly toward the inferior mandibular border (Δ H-MP) ~5 mm (23.4 ± 1.44 vs. 18.27 ± 1.86, P = 0.0377), with the AMP inserted in the oral cavity; no airway measurement other than hyoid bone position changed. No significant correlations emerged between AHI improvement (Δ AHI) and amounts of hyoid elevation (Δ H-MP) when all patients were pooled. However, when the samples were subcategorized, the correlation coefficients increased significantly (P < 0.01) in both subgroups. This outcome suggests the presence of two distinct types among the “Good-Responders” to AMP appliance use. Overall use of the AMP appliance is effective; however, the effectiveness of the appliance appears to depend on the mode of hyoid elevations, likely resulting from muscle responsiveness in patients with AMP use. The results suggest that Δ H-MP measurements may be a useful marker to segregate patients with tongue and hyoid muscles responsive to AMP from those not-so-responsive.
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Soose RJ, Faber K, Greenberg H, Boon M, Woodson T, Strollo P. Post-implant care pathway: lessons learned and recommendations after 5 years of clinical implementation of hypoglossal nerve stimulation therapy. Sleep 2021; 44:S4-S10. [PMID: 33313900 DOI: 10.1093/sleep/zsaa279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Hypoglossal nerve stimulation (HNS) therapy is now an established and widely-available obstructive sleep apnea (OSA) treatment alternative for continuous positive airway pressure (CPAP)-intolerant patients. Additionally, the HNS body of literature is robust with strong data on safety, efficacy, and durability-from the 5-year STAR Trial outcomes, to post-approval studies of independent institutions, to the multicenter ADHERE registry which recently reported outcomes on over 1,000 patients and is poised to enroll 5,000 HNS patients total. Nevertheless, now with thousands of implanted patients across hundreds of certified centers, and that number growing rapidly, the post-implant management of the HNS patient represents the next critical frontier. Post-implant patient management (therapy titration, troubleshooting, adjustments, and adherence monitoring) across a longitudinal care model is key to ensuring long-term therapy success and optimizing patient outcomes and health benefits. As with CPAP, patient education and close clinical monitoring are often essential to successful long-term management. Although many HNS patients are clear responders with excellent comfort and adherence as well as effective improvement in symptomatic and objective outcome measures, and even a smaller subset is clear non-responders, there is a growing body of patients somewhere in the middle: good outcomes but not great; partial but incomplete response. These are the patients in whom a standardized best-practice approach to treatment monitoring and targeted therapy modifications is likely critical to optimizing long-term outcomes.
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Affiliation(s)
- Ryan J Soose
- University of Pittsburgh Medical Center, Otolaryngology, UPMC Mercy, Suite, Pittsburgh
| | - Kevin Faber
- Sanford Health Sleep Medicine, University Dr S, Fargo
| | - Harly Greenberg
- Hofstra Northwell School of Medicine at Hofstra University, Medicine, New Hyde Park
| | - Maurits Boon
- Thomas Jefferson University, Otolaryngology-Head & Neck Surgery, Philadelphia
| | - Tucker Woodson
- Medical College of Wisconsin, Otolaryngology and Human Communication, Milwaukee
| | - Patrick Strollo
- Medical College of Wisconsin, Otolaryngology and Human Communication, Milwaukee
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[Obstructive sleep apnea and asthma: Clinical implications]. Rev Mal Respir 2021; 38:506-513. [PMID: 34020837 DOI: 10.1016/j.rmr.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
Obstructive sleep apnea (OSA) and asthma are common respiratory diseases that can coexist in the same patient. Epidemiological and pathophysiological data suggest an independent link between these two diseases. Specially, OSA is frequently associated with non-eosinophilic and with poorly-controlled asthma. Common comorbidities including obesity, gastroesophageal reflux and rhinitis may promote this association. The impact of OSA treatment on the clinical and functional control of asthma has been extensively investigated. Numerous non-randomized studies suggest that continuous positive pressure treatment is likely to improve asthma symptoms, the control of the disease and quality of life in asthmatics with OSA. However, this impact has not been confirmed in the limited randomized trial available. To date, the optimal treatment approach in asthmatics with OSA is the best treatment of each disease separately and the recognition and treatment of comorbidities. When indicated, obesity surgery has a major impact on both diseases.
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A Phenotypic Approach for Personalised Management of Obstructive Sleep Apnoea. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sutherland K, Chapman JL, Cayanan EA, Lowth AB, Hoyos CM, Wong KKH, Yee BJ, Grunstein RR, Cistulli PA, Marshall NS. Does craniofacial morphology relate to sleep apnea severity reduction following weight loss intervention? A patient-level meta-analysis. Sleep 2021; 44:5921144. [PMID: 33045087 DOI: 10.1093/sleep/zsaa207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/16/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Obesity is a common and reversible risk factor for obstructive sleep apnea (OSA). However, there is substantial unexplained variability in the amount of OSA improvement for any given amount of weight loss. Facial photography is a simple, inexpensive, and radiation-free method for craniofacial assessment. Our aims were (1) to determine whether facial measurements can explain OSA changes, beyond weight loss magnitude and (2) whether facial morphology relates to how effective weight loss will be for OSA improvement. METHODS We combined data from three weight loss intervention trials in which participants had standardized pre-intervention facial photography (N = 91; 70.3% male, mean ± SD weight loss 10.4 ± 9.6% with 20.5 ± 51.2% apnea-hypopnea index [AHI] reduction). Three skeletal-type craniofacial measurements (mandibular length, lower face height, and maxilla-mandible relationship angle) were assessed for relationship to AHI change following weight loss intervention. RESULTS Weight and AHI changes were moderately correlated (rho = 0.3, p = 0.002). In linear regression, an increased maxilla-mandible relationship angle related to AHI improvement (β [95% CI] -1.7 [-2.9, -0.5], p = 0.004). Maxilla-mandible relationship angle explained 10% in the variance in AHI over the amount predicted by weight loss amount (20%). The relationship between weight change and AHI was unaffected by the maxilla-mandible relationship angle (interaction term p > 0.05). CONCLUSIONS Regardless of facial morphology, weight loss is similarly moderately predictive of OSA improvement. Increased maxilla-mandible relationship angle, suggestive of retrognathia, was weakly predictive of OSA response to weight loss. Although this is unlikely to be clinically useful, exploration in other ethnic groups may be warranted.
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Affiliation(s)
- Kate Sutherland
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia
| | - Julia L Chapman
- NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Elizabeth A Cayanan
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia
| | - Aimee B Lowth
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia
| | - Camilla M Hoyos
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia.,School of Psychology, and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Keith K H Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Brendon J Yee
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Ronald R Grunstein
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia
| | - Nathaniel S Marshall
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NeuroSleep NHMRC Centre or Research Excellence and Woolcock Institute of Medical Research, Sydney, Australia
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Rique GLN, Rique MC, Augusto de Souza Bonifácio T, Andrade MJO, dos Santos NA. Effects of vertical gastrectomy on sleep quality, eating behavior, and metabolic parameters in obese adults: a case study. BIOL RHYTHM RES 2021. [DOI: 10.1080/09291016.2021.1906504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gabriela Lemos Negri Rique
- Perception, Neurosciences, and Behavior Laboratory, Psychology Department, Federal University of Paraiba, João Pessoa, Brazil
| | | | | | - Michael Jackson Oliveira Andrade
- Neurosciences, Chronobiology, and Sleep Psychology Laboratory, Psychology Department, Minas Gerais State University, Divinópolis, Brazil
| | - Natanael Antonio dos Santos
- Perception, Neurosciences, and Behavior Laboratory, Psychology Department, Federal University of Paraiba, João Pessoa, Brazil
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Lidocaine combined with magnesium sulfate preserved hemodynamic stability during general anesthesia without prolonging neuromuscular blockade: a randomized, double-blind, controlled trial. BMC Anesthesiol 2021; 21:91. [PMID: 33773580 PMCID: PMC8004390 DOI: 10.1186/s12871-021-01311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/21/2021] [Indexed: 12/05/2022] Open
Abstract
Background Lidocaine and magnesium sulfate have become increasingly utilized in general anesthesia. The present study evaluated the effects of these drugs, isolated or combined, on hemodynamic parameters as well as on the cisatracurium-induced neuromuscular blockade (NMB). Methods At a university hospital, 64 patients, ASA physical status I and II, undergoing elective surgery with similar pain stimuli were randomly assigned to four groups. Patients received a bolus of lidocaine and magnesium sulfate before the tracheal intubation and a continuous infusion during the operation as follows: 3 mg.kg− 1 and 3 mg.kg− 1.h− 1 (lidocaine - L group), 40 mg.kg− 1 and 20 mg.kg− 1.h− 1 (magnesium - M group), equal doses of both drugs (magnesium plus lidocaine - ML group), and an equivalent volume of isotonic solution (control - C group). Hemodynamic parameters and neuromuscular blockade features were continuously monitored until spontaneous recovery of the train of four (TOF) ratio (TOFR > 0.9). Results The magnesium sulfate significantly prolonged all NMB recovery features, without changing the speed of onset of cisatracurium. The addition of lidocaine to Magnesium Sulfate did not influence the cisatracurium neuromuscular blockade. A similar finding was observed when this drug was used alone, with a significantly smaller fluctuation of mean arterial pressure (MAP) and heart rate (HR) measures during anesthesia induction and maintenance. Interestingly, the percentage of patients who achieved a TOFR of 90% without reaching T1–95% was higher in the M and ML groups. Than in the C and L groups. There were no adverse events reported in this study. Conclusion Intravenous lidocaine plays a significant role in the hemodynamic stability of patients under general anesthesia without exerting any additional impact on the NMB, even combined with magnesium sulfate. Aside from prolonging all NMB recovery characteristics without altering the onset speed, magnesium sulfate enhances the TOF recovery rate without T1 recovery. Our findings may aid clinical decisions involving the use of these drugs by encouraging their association in multimodal anesthesia or other therapeutic purposes. Trial registration NCT02483611 (registration date: 06-29-2015). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01311-y.
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Pepito DL, Mohammed JM, Hardin KA. Obstructive Sleep Apnea and Asthma: More Than Chance? CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00271-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract
Purpose of Review
To discuss the current evidence regarding the association and mechanistic interaction between asthma and obstructive sleep apnea (OSA).
Recent Findings
The co-existence of OSA is highly prevalent in asthmatics and significantly associated with increased severity, decreased control, more frequent exacerbations, and hospitalizations despite medical management. Pre-existing asthma may also be a risk factor for new onset OSA. Rhinitis, obesity, and gastro-esophageal reflux are risk factors in both conditions. The obese asthmatic with OSA may present a unique phenotype. Positive airway pressure in severe asthma improves outcomes.
Summary
Pathophysiologic mechanisms and co-morbidities overlap between OSA and asthma, but the exact link has yet to be confirmed. Screening for OSA is recommended in those with severe asthma. Further investigations are needed to delineate the cellular processes with therapeutic targets. Similarly, prospective investigations are needed to evaluate the longitudinal relationship in pre-existing asthma and the development of OSA.
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Zhang Z, Wang Y, Li H, Ni L, Liu X. Age-specific markers of adiposity in patients with obstructive sleep apnea. Sleep Med 2021; 83:196-203. [PMID: 34044357 DOI: 10.1016/j.sleep.2021.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Adiposity can have varying effects on the individual depending upon its distribution pattern. We assessed age-related distribution of adipose tissue by anthropometric measures and bioelectrical impedance analysis, as well as their association with obstructive sleep apnea (OSA) severity. METHODS Participants were 169 elderly (aged ≥ 65 years) and 142 non-elderly (aged < 65 years) referred for overnight polysomnography. The associations between obesity parameters and apnea-hypopnea index (AHI) were determine by univariate and multivariate linear regression analyses. Area under receiver operating characteristic curve (AUC) was used to access the predicting performance of some parameters. RESULTS Compared with non-elderly, elderly showed higher conicity index and visceral adiposity (VA)/subcutaneous adiposity (SA), lower body mass index (BMI), neck circumference, waist circumference, hip circumference and SA. Multiple regression analyses revealed that VA and VA/SA were independently associated with AHI in elderly (explained 17.2% of the AHI 0.5 variability), while BMI and VA/SA were independently associated with AHI in non-elderly (explained 25.9% of the AHI 0.5 variability), after adjusting for age, sex, cigarette smoking, alcohol drinking and main comorbidities. In elderly, VA over 128 cm2 and VA/SA less than 0.41 resulted in sensitivity, specificity and AUC of 0.382, 0.790, 0.580 and 0.176, 0.947, 0.553 in predicting moderate-to-severe OSA, respectively. In non-elderly, BMI over 24.7 kg/m2 and VA/SA over 0.54 resulted in sensitivity, specificity and AUC of 0.883, 0.484, 0.704 and 0.550, 0.710, 0.667 in predicting moderate-to-severe OSA, respectively. CONCLUSIONS VA is strongly associated with OSA severity in elderly, independently of general obesity as per BMI standards, while general adiposity appears to be more strongly associated with OSA severity in non-elderly. Our study supports age-specific approaches should be developed with respect to prediction and treatment of OSA.
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Affiliation(s)
- Zhigang Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China.
| | - Yanjun Wang
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hong Li
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
| | - Lianfang Ni
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
| | - Xinmin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
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