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Bruun SN, Hansen C, Sonnesen L. Sleepiness in children with severe malocclusion compared with in children with neutral occlusion. Am J Orthod Dentofacial Orthop 2024; 165:593-601. [PMID: 38363255 DOI: 10.1016/j.ajodo.2023.12.009] [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: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The study aimed to compare daytime sleepiness in children with severe malocclusion with healthy children with neutral occlusion (controls) and to analyze associations between daytime sleepiness and craniofacial morphology in children with severe malocclusion. METHODS In 120 children with severe malocclusion (73 girls, 47 boys; mean age, 11.96 years; mean body mass index [BMI] score, 18.97 kg/m2) and 35 controls (18 girls, 17 boys; mean age, 11.97 years; mean BMI score, 20.28 kg/m2), sleep and daytime sleepiness were recorded using Epworth Sleepiness Scale and Berlin Questionnaire. Occlusion was registered clinically, and craniofacial morphology was assessed on lateral cephalograms. Differences in daytime sleepiness and sleep between the groups and associations between daytime sleepiness and sleep and craniofacial morphology were analyzed by a general linear model adjusted for age, gender, and BMI score. RESULTS Daytime sleepiness occurred significantly more often in children with malocclusion than in control subjects (P = 0.015). There was a tendency for children with malocclusion to feel extremely tired during the day more often than controls (P = 0.054). There was no significant difference between the groups in sleeping hours during night-time, but the amount of sleep was negatively associated with age (P <0.001) and BMI score (P = 0.004). Only maxillary inclination was significantly associated with daytime sleepiness (P = 0.043). CONCLUSIONS Daytime sleepiness occurred significantly more often in children with severe malocclusion than in those with neutral occlusion, and the association between daytime sleepiness and craniofacial morphology may exist. The results might prove valuable in interdisciplinary collaboration between medical doctors and orthodontists in diagnostics, prevention, and treatment of children at risk for sleep-disordered breathing.
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Affiliation(s)
- Sanne Nygaard Bruun
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Hansen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Alqudah AM, Elwali A, Kupiak B, Hajipour F, Jacobson N, Moussavi Z. Obstructive sleep apnea detection during wakefulness: a comprehensive methodological review. Med Biol Eng Comput 2024; 62:1277-1311. [PMID: 38279078 PMCID: PMC11021303 DOI: 10.1007/s11517-024-03020-3] [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: 06/25/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic condition affecting up to 1 billion people, globally. Despite this spread, OSA is still thought to be underdiagnosed. Lack of diagnosis is largely attributed to the high cost, resource-intensive, and time-consuming nature of existing diagnostic technologies during sleep. As individuals with OSA do not show many symptoms other than daytime sleepiness, predicting OSA while the individual is awake (wakefulness) is quite challenging. However, research especially in the last decade has shown promising results for quick and accurate methodologies to predict OSA during wakefulness. Furthermore, advances in machine learning algorithms offer new ways to analyze the measured data with more precision. With a widening research outlook, the present review compares methodologies for OSA screening during wakefulness, and recommendations are made for avenues of future research and study designs.
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Affiliation(s)
- Ali Mohammad Alqudah
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Ahmed Elwali
- Biomedical Engineering Program, Marian University, 3200 Cold Sprint Road, Indianapolis, IN, 46222-1997, USA
| | - Brendan Kupiak
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | | | - Natasha Jacobson
- Biosystems Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
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Goyal A, Meena R, Gupta S, Kar A, Ali R, Bohra A, Solanki V, Chaudhary P, Pakhare A. Sex-specific differences in presenting symptoms of obstructive sleep apnea. Lung India 2024; 41:115-120. [PMID: 38700405 PMCID: PMC10959312 DOI: 10.4103/lungindia.lungindia_235_22] [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: 05/02/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms. METHODOLOGY Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females. RESULTS Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P<0.001) and more obese (BMI 35.26 ± 7.17 v/s 29.58 ± 5.49 Kg/m2; P<0.001). Waist and hip circumference were significantly higher in the female patients (P = 0.009 and <0.001 respectively). Morning headache, nocturia, fatigability (P < 0.001), and depression (P = 0.005) was more common in females (P = 0.036). Hypersomnia was more commonly seen in males (P < 0.001). Mean diastolic blood pressure was significantly higher in males, although no difference was seen in Systolic BP. Females had higher mean Fasting Blood glucose (FBS) (P = 0.02). Apnea hypopnea index was significantly higher in females {P = 0.01}. CONCLUSION Women with OSA are more obese, elderly, and with higher fasting blood glucose than males at the time of diagnosis. Females have a higher prevalence of symptoms like fatigability, depression, nocturia and early morning headache and had more severe AHI than males.
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Affiliation(s)
| | | | - Suruchi Gupta
- Community and Family Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | - Avishek Kar
- Pulmonary Medicine, AIIMS Raipur, Chhattisgarh, India
| | - Rashida Ali
- Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | - Arwa Bohra
- Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | | | | | - Abhijit Pakhare
- Community and Family Medicine, AIIMS Bhopal, Madhya Pradesh, India
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4
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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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5
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Korkalainen H, Kainulainen S, Islind AS, Óskarsdóttir M, Strassberger C, Nikkonen S, Töyräs J, Kulkas A, Grote L, Hedner J, Sund R, Hrubos-Strom H, Saavedra JM, Ólafsdóttir KA, Ágústsson JS, Terrill PI, McNicholas WT, Arnardóttir ES, Leppänen T. Review and perspective on sleep-disordered breathing research and translation to clinics. Sleep Med Rev 2024; 73:101874. [PMID: 38091850 DOI: 10.1016/j.smrv.2023.101874] [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: 04/06/2023] [Revised: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
Sleep-disordered breathing, ranging from habitual snoring to severe obstructive sleep apnea, is a prevalent public health issue. Despite rising interest in sleep and awareness of sleep disorders, sleep research and diagnostic practices still rely on outdated metrics and laborious methods reducing the diagnostic capacity and preventing timely diagnosis and treatment. Consequently, a significant portion of individuals affected by sleep-disordered breathing remain undiagnosed or are misdiagnosed. Taking advantage of state-of-the-art scientific, technological, and computational advances could be an effective way to optimize the diagnostic and treatment pathways. We discuss state-of-the-art multidisciplinary research, review the shortcomings in the current practices of SDB diagnosis and management in adult populations, and provide possible future directions. We critically review the opportunities for modern data analysis methods and machine learning to combine multimodal information, provide a perspective on the pitfalls of big data analysis, and discuss approaches for developing analysis strategies that overcome current limitations. We argue that large-scale and multidisciplinary collaborative efforts based on clinical, scientific, and technical knowledge and rigorous clinical validation and implementation of the outcomes in practice are needed to move the research of sleep-disordered breathing forward, thus increasing the quality of diagnostics and treatment.
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Affiliation(s)
- Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sigridur Islind
- Department of Computer Science, Reykjavik University, Reykjavik, Iceland; Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland
| | - María Óskarsdóttir
- Department of Computer Science, Reykjavik University, Reykjavik, Iceland
| | - Christian Strassberger
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Hedner
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Reijo Sund
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harald Hrubos-Strom
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Jose M Saavedra
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Physical Activity, Physical Education, Sport and Health (PAPESH) Research Group, Department of Sports Science, Reykjavik University, Reykjavik, Iceland
| | | | | | - Philip I Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- School of Medicine, University College Dublin, and Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin Ireland
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
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Li Y, Ji C, Sun W, Xiong H, Li Z, Huang X, Fan T, Xian J, Huang Y. Characteristics and Mechanism of Upper Airway Collapse Revealed by Dynamic MRI During Natural Sleep in Patients with Severe Obstructive Sleep Apnea. Nat Sci Sleep 2023; 15:885-902. [PMID: 37933249 PMCID: PMC10625767 DOI: 10.2147/nss.s423303] [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: 05/28/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose Upper airway collapse during sleep in patients with obstructive sleep apnea (OSA) is a complex and dynamic phenomenon. By observing and analyzing the dynamic changes in the upper airway and its surrounding tissues during airway obstruction, we aim to reveal dynamic characteristics in different obstruction patterns, and the relationship between anatomical features during normal breathing and dynamic characteristics of airway obstruction. Patients and Methods Dynamic MRI was performed in 23 male patients (age range 26-63) with severe OSA diagnosed by overnight polysomnography, and obstruction events were identified from their images. Dynamic changes in parameters of the upper airway and surrounding tissues were measured to assess the key characteristics in different obstruction patterns. Results We categorized airway obstruction into four types based on the obstruction location and motion characteristics of tissues during collapse, and detailed the alterations in the airway and surrounding tissues under each obstruction pattern. In all 112 obstruction events extracted from the dynamic images of 23 patients, type A (retropalatal obstruction caused by the soft palate separated from the tongue), BI, BII (both retropalatal obstructions caused by the soft palate attached to the tongue, and C (retropalatal and retroglossal obstruction caused by the soft palate and the tongue), accounted for 28.6%, 44.6%, 12.5%, and 14.3% respectively. In severe OSA patients with tongue and palatal obstruction related to type B or C, the more posterior hyoid position, shorter distance between tongue and uvula, and wider retropalatal space, the larger the tongue displacement and deformation during collapse, and the greater the reduction in airway space. Conclusion There are multiple airway obstruction patterns, each with its own anatomical characteristics and behaviors during collapse. Hyoid position, tongue and uvula distance, and retropalatal space play an important role in airway collapse and should be paid more attention in the treatment of OSA.
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Affiliation(s)
- Yuqi Li
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Changjin Ji
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Weiao Sun
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Huahui Xiong
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaoqing Huang
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Tingting Fan
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yaqi Huang
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
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Park DY, Cho JH, Jung YG, Choi JH, Kim DK, Kim SW, Kim HJ, Kim HY, Park SK, Park CS, Yang HC, Lee SH, Cho HJ. Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2023; 16:201-216. [PMID: 36791806 PMCID: PMC10471902 DOI: 10.21053/ceo.2022.01361] [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: 09/29/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Soon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Chae Yang
- 9Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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8
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Plećaš D, Mraz N, Patanaude AM, Pribić T, Pavlinac Dodig I, Pecotić R, Lauc G, Polašek O, Đogaš Z. Not-So-Sweet Dreams: Plasma and IgG N-Glycome in the Severe Form of the Obstructive Sleep Apnea. Biomolecules 2023; 13:880. [PMID: 37371460 DOI: 10.3390/biom13060880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent disease associated with increased risk for cardiovascular and metabolic diseases and shortened lifespan. The aim of this study was to explore the possibility of using N-glycome as a biomarker for the severe form of OSA. Seventy subjects who underwent a whole-night polysomnography/polygraphy and had apnea-hypopnea index (AHI) over 30 were compared to 23 controls (AHI under 5). Plasma samples were used to extract 39 glycan peaks using ultra-high-performance liquid chromatography (UPLC) and 27 IgG peaks using capillary gel electrophoresis (CGE). We also measured glycan age, a molecular proxy for biological aging. Three plasma and one IgG peaks were significant in a multivariate model controlling for the effects of age, sex, and body mass index. These included decreased GP24 (disialylated triantennary glycans as major structure) and GP28 (trigalactosylated, triantennary, disialylated, and trisialylated glycans), and increased GP32 (trisialylated triantennary glycan). Only one IgG glycan peak was significantly increased (P26), which contains biantennary digalactosylated glycans with core fucose. Patients with severe OSA exhibited accelerated biological aging, with a median of 6.9 years more than their chronological age (p < 0.001). Plasma N-glycome can be used as a biomarker for severe OSA.
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Affiliation(s)
- Doris Plećaš
- Mediterranean Institute for Life Sciences, 21000 Split, Croatia
| | - Nikol Mraz
- Genos Glycoscience Ltd., 10000 Zagreb, Croatia
| | | | - Tea Pribić
- Genos Glycoscience Ltd., 10000 Zagreb, Croatia
| | - Ivana Pavlinac Dodig
- Department for Neuroscience, School of Medicine, Sleep Medicine Center, University of Split, 21000 Split, Croatia
| | - Renata Pecotić
- Department for Neuroscience, School of Medicine, Sleep Medicine Center, University of Split, 21000 Split, Croatia
| | - Gordan Lauc
- Genos Glycoscience Ltd., 10000 Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Ozren Polašek
- Department of Public Health, School of Medicine, University of Split, 21000 Split, Croatia
- Department of General Courses, Algebra University, 10000 Zagreb, Croatia
| | - Zoran Đogaš
- Department for Neuroscience, School of Medicine, Sleep Medicine Center, University of Split, 21000 Split, Croatia
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10
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A Bidirectional Association Between Obstructive Sleep Apnea and Metabolic-Associated Fatty Liver Disease. Endocrinol Metab Clin North Am 2023. [PMID: 37495341 DOI: 10.1016/j.ecl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Obesity is considered a twentieth-century epidemic and is a growing concern among health professionals. Obesity and its complications contribute to multiple chronic illnesses, such as type 2 diabetes (T2D), metabolic syndrome, obstructive sleep apnea (OSA), malignancy, and cardiovascular and liver diseases. In the last two decades, a bidirectional association between OSA and metabolic-associated fatty liver disease (MAFLD), independent of obesity, has been established. Both conditions have similar risk factors and metabolic comorbidities that may imply a common disease pathway. This review compiles the evidence and delineates the relationship between OSA and MAFLD from a clinical and diagnostic aspect.
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11
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Chaszczewska-Markowska M, Górna K, Bogunia-Kubik K, Brzecka A, Kosacka M. The Influence of Comorbidities on Chemokine and Cytokine Profile in Obstructive Sleep Apnea Patients: Preliminary Results. J Clin Med 2023; 12:jcm12030801. [PMID: 36769452 PMCID: PMC9918226 DOI: 10.3390/jcm12030801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard to their possible association with cardiovascular diseases. MATERIAL AND METHODS This cross-sectional study was performed on 61 newly diagnosed OSA patients. For the measurement of the plasma concentration of chemokines and cytokines, the magnetic bead-based multiplex assay for the Luminex® platform was used. RESULTS In the patients with concomitant COPD, there were increased levels of pro-inflammatory cytokines (CCL11, CD-40 ligand) and decreased anti-inflammatory cytokine (IL-10), while in diabetes, there were increased levels of pro-inflammatory cytokines (IL-6, TRIAL). Obesity was associated with increased levels of both pro-inflammatory (IL-13) and anti-inflammatory (IL-1RA) cytokines. Hypertension was associated with increased levels of both pro-inflammatory (CCL3) and anti-inflammatory (IL-10) cytokines. Increased daytime pCO2, low mean nocturnal SaO2, and the oxygen desaturation index were associated with increased levels of pro-inflammatory cytokines (CXCL1, PDGF-AB, TNF-α, and IL-15). CONCLUSIONS In OSA patients with concomitant diabetes and COPD, elevated levels of certain pro-inflammatory and decreased levels of certain anti-inflammatory cytokines may favor the persistence of a chronic inflammatory state with further consequences. Nocturnal hypoxemia, frequent episodes of desaturation, and increased daytime pCO2 are factors contributing to the chronic inflammatory state in OSA patients.
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Affiliation(s)
- Monika Chaszczewska-Markowska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Katarzyna Górna
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
- Correspondence:
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
| | - Monika Kosacka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
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12
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Patel M, Yarlagadda H, Upadhyay S, Neupane R, Qureshi U, Raco JD, Jain R, Jain R. Disturbed Sleep is Not Good for the Heart: A Narrative Review. Curr Cardiol Rev 2023; 19:e301122211378. [PMID: 36453501 PMCID: PMC10280991 DOI: 10.2174/1573403x19666221130100141] [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: 04/25/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
Sleep-related breathing disorders, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), have a major impact on cardiovascular function. It has shown an association with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and congestive heart failure (CHF). This review focuses on highlighting the relationship between sleep apnea and CHF. We discuss the underlying pathophysiology, which involves the mechanical, neurohormonal, and inflammatory mechanisms; in addition, the similarities and differentiating clinical features of OSA in patients with CHF and without CHF. We have also discussed several treatment strategies, including weight loss, continuous positive airway pressure (CPAP), supplemental oxygen therapy, theophylline, acetazolamide, mandibular advancement device, and hypoglossal nerve stimulation (HGNS). We conclude that since there are several overlapping clinical features in patients with OSA with Heart Failure (HF) and without HF, early detection and treatment are crucial to decrease the risk of HF, coronary artery disease, and stroke.
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Affiliation(s)
- Meet Patel
- Department of Internal Medicine, Tianjin Medical University, Tianjin, P.R. China
| | | | | | - Ritesh Neupane
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Umer Qureshi
- Penn State College of Medicine, Hershey, PA, USA
| | - Joseph D. Raco
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Rahul Jain
- Avalon University School of Medicine, Willemstad, Curaçao
| | - Rohit Jain
- Avalon University School of Medicine, Willemstad, Curaçao
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13
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Zhang QQ, Guo RX, Xie M, Qiang Y, Shi Y, Liu XH, Cheng L, Liu HQ, Luo HN. Hypoxia in non-rapid eye movement sleep in children with otitis media with effusion. J Int Med Res 2022; 50:3000605221133659. [PMID: 36310499 PMCID: PMC9619286 DOI: 10.1177/03000605221133659] [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] [Indexed: 11/06/2022] Open
Abstract
Objective This study aimed to analyze the status of hypoxia in non-rapid eye movement (NREM) sleep in children with otitis media with effusion (OME). Methods A total of 232 children with OME and/or adenotonsillar hypertrophy were enrolled in this retrospective study between August 2020 and November 2021. Polysomnographic monitoring was carried out, and the differences in polysomnographic results between the experimental group (children with OME and adenotonsillar hypertrophy) and control group (children with adenotonsillar hypertrophy only) were compared. Results The lowest oxygen saturation level during sleep was significantly lower in the experimental group (n = 36) than in the control group (n = 196). However, the apnea-hypopnea index, respiratory disorder index, apnea index, obstructive apnea index, obstructive apnea-hypopnea index, and mixed apnea-hypopnea index were significantly higher in the experimental group than in the control group. More importantly, the apnea-hypopnea index, the oxygen desaturation index, oxygen desaturation events, the average heart rate during NREM sleep, and the NREM stage in total sleep time were also significantly higher in the experimental group than in the control group. Conclusions Hypoxia during NREM sleep may affect the severity of OME in children.
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Affiliation(s)
- Qing-Qing Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Rui-Xin Guo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Meng Xie
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Yin Qiang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Yao Shi
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Xiao-Hong Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Long Cheng
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Hai-Qin Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Hua-Nan Luo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
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14
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Hoffman K, Mansoor E, Panhwar MS, Regueiro M, Cooper G, Qazi T. Prevalence of Obstructive Sleep Apnea Is Increased in Patients With Inflammatory Bowel Disease: A Large, Multi-Network Study. CROHN'S & COLITIS 360 2022; 4:otac026. [PMID: 36777429 PMCID: PMC9802032 DOI: 10.1093/crocol/otac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
Background Crohn's disease (CD) and ulcerative colitis (UC) involve an inflammatory state where sleep dysregulation is common. Little is known about implications, if any, of inflammatory bowel disease (IBD) on the development of obstructive sleep apnea (OSA). This study aims to investigate if IBD patients are at higher risk for OSA. Methods This retrospective multivariate analysis utilized a commercial database named Explorys (IBM Watson). We identified patients from 1/2015 to 1/2020 with UC and CD. Cohorts of these patients with and without OSA were then created and prevalence values were obtained. A multivariate analysis was used to correct for several potential confounding variables. Results The overall prevalence of OSA was 7.8% in UC and 7.2% in CD, as compared with a prevalence of 4.3% in non-IBD patients (odds ratio [OR] for UC: 1.9 [95% CI 1.86-1.94, P < .0001], OR for CD: 1.72 [95% CI 1.69-1.76, P < .0001]). In multivariate analysis, age above 65, Caucasian race, male sex, obesity, smoking, hypertension, and diabetes were all independent risk factors for the development of OSA, with obesity being the most significant. After controlling for the listed variables in the multivariate analysis, IBD was an independent risk factor associated with OSA (OR 1.46, 95% CI 1.43-1.48). Conclusions In this large population-based study, IBD was independently associated with increased prevalence of OSA. This has implications for screening for OSA in IBD, as well as management of other risk factors for OSA in IBD.
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Affiliation(s)
- Kyle Hoffman
- Address correspondence to: Kyle Hoffman, MD, 11100 Euclid Ave, Cleveland, OH 44106, USA ()
| | - Emad Mansoor
- Cleveland Louis Stokes VA Medical Center, Division of Gastroenterology and Liver Disease, Cleveland, Ohio, USA
| | - Muhammad Siyab Panhwar
- Department of Medicine, Tulane University Medical Center, Section of Cardiology, New Orleans, Louisiana, USA
| | - Miguel Regueiro
- Cleveland Clinic Foundation, Department of Gastroenterology, Cleveland, Ohio, USA
| | - Gregory Cooper
- Case Western Reserve University/University Hospitals Cleveland Medical Center, Division of Gastroenterology, Cleveland, Ohio, USA
| | - Taha Qazi
- Cleveland Clinic Foundation, Department of Gastroenterology, Cleveland, Ohio, USA
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15
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Mhandire DZ, Burns DP, Roger AL, O'Halloran KD, ElMallah MK. Breathing in Duchenne muscular dystrophy: Translation to therapy. J Physiol 2022; 600:3465-3482. [PMID: 35620971 PMCID: PMC9357048 DOI: 10.1113/jp281671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disease caused by a deficiency in dystrophin - a structural protein which stabilizes muscle during contraction. Dystrophin deficiency adversely affects the respiratory system leading to sleep-disordered breathing, hypoventilation, and weakness of the expiratory and inspiratory musculature, which culminate in severe respiratory dysfunction. Muscle degeneration associated respiratory impairment in neuromuscular disease is a result of disruptions at multiple sites of the respiratory control network, including sensory and motor pathways. As a result of this pathology, respiratory failure is a leading cause of premature death in DMD patients. Currently available treatments for DMD respiratory insufficiency attenuate respiratory symptoms without completely reversing the underlying pathophysiology. This underscores the need to develop curative therapies to improve quality of life and longevity of DMD patients. This review summarises research findings on the pathophysiology of respiratory insufficiencies in DMD disease in humans and animal models, the clinical interventions available to ameliorate symptoms, and gene-based therapeutic strategies uncovered by preclinical animal studies. Abstract figure legend: Summary of the therapeutic strategies for respiratory insufficiency in DMD (Duchenne muscular dystrophy). Treatment options currently in clinical use only attenuate respiratory symptoms without reversing the underlying pathology of DMD-associated respiratory insufficiencies. Ongoing preclinical and clinical research is aimed at developing curative therapies that both improve quality of life and longevity of DMD patients. AAV - adeno-associated virus, PPMO - Peptide-conjugated phosphorodiamidate morpholino oligomer This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Doreen Z Mhandire
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center Box 2644, Durham, North Carolina, 27710, USA
| | - David P Burns
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Angela L Roger
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center Box 2644, Durham, North Carolina, 27710, USA
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Mai K ElMallah
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center Box 2644, Durham, North Carolina, 27710, USA
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16
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Fernandes M, Mari L, Chiaravalloti A, Paoli B, Nuccetelli M, Izzi F, Giambrone MP, Camedda R, Bernardini S, Schillaci O, Mercuri NB, Placidi F, Liguori C. 18F-FDG PET, cognitive functioning, and CSF biomarkers in patients with obstructive sleep apnoea before and after continuous positive airway pressure treatment. J Neurol 2022; 269:5356-5367. [PMID: 35608659 PMCID: PMC9468130 DOI: 10.1007/s00415-022-11182-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Introduction Dysregulation of cerebral glucose consumption, alterations in cerebrospinal fluid (CSF) biomarkers, and cognitive impairment have been reported in patients with obstructive sleep apnoea (OSA). On these bases, OSA has been considered a risk factor for Alzheimer’s disease (AD). This study aimed to measure cognitive performance, CSF biomarkers, and cerebral glucose consumption in OSA patients and to evaluate the effects of continuous positive airway pressure (CPAP) treatment on these biomarkers over a 12-month period. Methods Thirty-four OSA patients and 34 controls underwent 18F-fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET), cognitive evaluation, and CSF analysis. A subgroup of 12 OSA patients treated with beneficial CPAP and performing the 12-month follow-up was included in the longitudinal analysis, and cognitive evaluation and 18F-FDG PET were repeated. Results Significantly reduced glucose consumption was observed in the bilateral praecuneus, posterior cingulate cortex, and frontal areas in OSA patients than controls. At baseline, OSA patients also showed lower β-amyloid42 and higher phosphorylated-tau CSF levels than controls. Increased total tau and phosphorylated tau levels correlated with a reduction in brain glucose consumption in a cluster of different brain areas. In the longitudinal analysis, OSA patients showed an improvement in cognition and a global increase in cerebral 18F-FDG uptake. Conclusions Cognitive impairment, reduced cerebral glucose consumption, and alterations in CSF biomarkers were observed in OSA patients, which may reinforce the hypothesis of AD neurodegenerative processes triggered by OSA. Notably, cognition and brain glucose consumption improved after beneficial CPAP treatment. Further studies are needed to evaluate the long-term effects of CPAP treatment on these AD biomarkers.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Rome, Italy
| | - Luisa Mari
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Barbara Paoli
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Rome, Italy
| | - Marzia Nuccetelli
- Department of Clinical Biochemistry and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Izzi
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | | | - Riccardo Camedda
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Sergio Bernardini
- Department of Clinical Biochemistry and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.,IRCSS Santa Lucia Foundation, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Rome, Italy. .,Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.
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Zhang CJ, Li H, Xiong YZ, Chang Y, Yang F, Ma XL, Wang XT, Shimosawa T, Ji ES, Xu QY. Chronic intermittent hypoxia induces renal fibrosis through MR activation. Exp Gerontol 2022; 163:111780. [DOI: 10.1016/j.exger.2022.111780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
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18
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Huh G, Han KD, Park YM, Park CS, Lee KN, Lee EY, Cho JH. Comorbidities associated with high-risk obstructive sleep apnea based on the STOP-BANG questionnaire: a nationwide population-based study. Korean J Intern Med 2022; 38:80-92. [PMID: 36353789 PMCID: PMC9816691 DOI: 10.3904/kjim.2022.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND/AIMS We investigated the prevalence, associated factors, and comorbidities of high-risk obstructive sleep apnea (OSA) as determined by the STOP-BANG questionnaire in a Korean adult population. METHODS Data were obtained from 7,650 adults (aged ≥ 40 years) who participated in the Korea National Health and Nutrition Examination Survey (2019-2020). Multiple logistic regression analyses were used to evaluate the association of socioeconomic status, lifestyle related factors, and comorbidities with high-risk OSA (STOP-BANG score, 5-8). RESULTS The prevalence of high-risk OSA according to the STOP-BANG questionnaire was 12.0 %. Older age, male, current smoking, heavy alcohol consumption, and more comorbidities were associated with higher STOP-BANG scores. In multivariable adjusted analysis, diabetes mellitus (DM) (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.25 to 1.97), hypertension (OR, 4.81; 95% CI, 3.88 to 5.97), and obesity (OR, 2.02; 95% CI, 1.60 to 2.56) were associated with high risk of OSA, and when hypertension, DM, and obesity were combined, the risk increased synergistically (OR, 3.88; 95% CI, 2.94 to 5.11). CONCLUSION According to the STOP-BANG questionnaire, the high risk of OSA was more common in males, and was associated with chronic metabolic disease, particularly in those with DM, hypertension, and obesity combined. Active OSA screening, prevention, and management may be beneficial to improving health outcomes related to OSA in these populations.
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Affiliation(s)
- Gene Huh
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Yong-Moon Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chan-Soon Park
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu-Na Lee
- Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hae Cho
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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19
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Airway morphology and its influence on OSA severity and surgical intervention: a retrospective study. AUSTRALASIAN ORTHODONTIC JOURNAL 2022. [DOI: 10.2478/aoj-2022-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction: The aim was to assess the relationship between airway morphology and surgical intervention in a cohort of patients presenting with increased body mass index (BMI) and a confirmed diagnosis of obstructive sleep apnoea (OSA). A secondary aim was to revisit the relationship between morphology and OSA severity.
Methods: A retrospective analysis was conducted of pre-operative maxillofacial 3D-CT scans of thirty-two patients with a confirmed diagnosis of OSA who received treatment from an ear nose and throat specialist (ENT). Lateral cephalograms were imported into Quick Ceph Studio (Quick Ceph Systems Inc, San Diego, CA, USA) after which linear and angular measurements of selected hard and soft tissues were obtained. 3D-CT images were loaded into the software program 3dMDVultus (3dMD) which permitted 3D visualisation of the airway. Measurements were repeated 3 times on the images of six patients after an interval of two weeks to establish the intraclass correlation coefficient (ICC) for intra-examiner accuracy and reliability. Logistic regression was applied to determine the relationships between morphology, OSA and surgical treatments.
Results: A positive correlation was found between age and the apnoea-hypopnea index (AHI). Morphological measurements of the airway did not exhibit a positive relationship with OSA severity. Posterior airway space at the level of the uvula and tongue, the length of the soft palate and position of the hyoid bone were significantly associated with BMI. No variables were found to be correlated with uvulopalatopharyngoplasty (UPPP) surgery. Notwithstanding, airway length and posterior airway space at the level of the uvula tip were significantly associated with tongue channelling.
Conclusions: Radiographic airway assessment is an invaluable and opportunistic tool for screening OSA but requires judicial use in its prescription and interpretation. There is little correlation between OSA severity and airway morphology and between surgical intervention and morphology. Additional factors need to be considered before a treatment modality is considered and is best managed in a multidisciplinary setting.
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20
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Leigh C, Faigenblum M, Fine P, Blizard R, Leung A. General dental practitioners' knowledge and opinions of snoring and sleep-related breathing disorders. Br Dent J 2021; 231:569-574. [PMID: 34773028 PMCID: PMC8589666 DOI: 10.1038/s41415-021-3573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022]
Abstract
Aims There is increasing recognition that sleep disturbances can affect lifestyle, economy and health. General dental practitioners (GDPs) can play a vital role in helping to identify at-risk patients through screening as well as aid in the management of these conditions. The aim of this study was to assess the knowledge of UK-based GDPs in relation to sleep-related breathing disorders (SRBDs).Material and methods A questionnaire was developed to assess GDPs' knowledge of SRBDs and their current practice in relation to the management of SRBDs, and identify the factors associated with improved knowledge and management. A volunteer sample was recruited from social media platforms and conference attendees.Results In total, 152 GDPs completed the questionnaire; 101 (66% [95% CI 59%,74%]) agreed that GDPs should ask their patients about sleep disorders, while only 82 (54% [95% CI 46%,62%]) confirmed that they actually asked their patients about the problem. On a 22-point knowledge scale, the mean score was 12.93 (95%CI 12.23, 13.63). Postgraduate education (F = 5.47; p = 0.001), increasing age (r = 0.23; p = 0.005) and GDP workplace (F = 4.98; p = 0.008) contributed to a higher knowledge score. GDPs were strongly in favour of having more information (N = 141; 93% [95% CI 87%,97%]).Conclusion Although GDPs' knowledge of SRBDs was better than anticipated, they clearly felt a need for further information and training. There is a compelling case to include this subject in the undergraduate dental curriculum.
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Affiliation(s)
| | | | - Peter Fine
- UCL Eastman Dental Institute, London, UK.
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21
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Pickering L, Main KM, Sehested A, Mathiasen R, Feldt-Rasmussen U, Klose M, Kotagal S, Jennum PJ. Brain tumours result in sleep disorders in children and adolescents. Sleep Med 2021; 88:13-21. [PMID: 34715527 DOI: 10.1016/j.sleep.2021.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbances are frequently reported in children with brain tumours. The objective of our cross-sectional study was to systematically examine sleep in these children. We hypothesised that children with tumours involving the sleep-wake-regulatory areas have an altered sleep-wake-regulation. METHODS Sixty-one patients aged 0-18 years and with a diagnosis of a primary brain or cervical medullary tumour were included. They were categorised based upon tumour location into two groups - those affecting the sleep-wake regulatory regions, i.e. brain stem, basal forebrain, hypothalamus, thalamus, and posterior fossa compressing the brain stem and those that did not. Sleep history, questionnaire surveys, polysomnography, and multiple sleep latency test were used, as indicated clinically. Surveys included Pediatric Daytime Sleepiness Scale, Children's Sleep Habits Questionnaire, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale. RESULTS Patients with tumours involving the sleep-wake regulatory areas were sleepier/more fatigued (p = 0.03). Sleep apnoea was observed in 86% of all the patients and comorbid narcolepsy in 8%, without group differences (p ≥ 0.12). Patients with tumours involving the sleep-wake-regulatory areas had more emotional problems (p = 0.04), were more affected by mental health problems (p < 0.001), and had poorer quality of life (p ≤ 0.03). CONCLUSIONS Many children with brain tumours suffer from disturbed sleep, poor mental health, and low quality of life. We recommend that systematic sleep evaluation is included in their routine care along with psychological and social support.
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Affiliation(s)
- Line Pickering
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 17, DK-2600, Glostrup, Denmark.
| | - Katharina M Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark; Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Suresh Kotagal
- Department of Neurology and the Center for Sleep Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 17, DK-2600, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
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22
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Kerbrat A, Vinuesa O, Lavergne F, Aversenq E, Graml A, Kerbrat JB, Trost O, Goudot P. Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:361-366. [PMID: 34118470 DOI: 10.1016/j.jormas.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). METHODS 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. RESULTS Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). CONCLUSION The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.
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Affiliation(s)
- A Kerbrat
- Resident, Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, 81 Boulevard de l'hopital, 75013 Paris, France.
| | | | - F Lavergne
- ResMed Science center - Saint-Priest, France
| | - E Aversenq
- ResMed Science center - Saint-Priest, France
| | - A Graml
- ResMed Science center, Munich, Germany
| | - J B Kerbrat
- Chief of the department of Orthodontics, Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, France
| | - O Trost
- Professor,Chief of the Service de Stomatologie et de Chirurgie Maxillo-faciale du CHU de Rouen, France
| | - P Goudot
- Professor, Chief of the Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, France
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Abstract
PURPOSE OF REVIEW Summarize the effects of opioids on sleep including sleep architecture, sleep disordered breathing (SDB) and restless legs syndrome. RECENT FINDINGS Opioids are associated with the development of central sleep apnea (CSA) and ataxic breathing. Recent reports suggest that adaptive servo-ventilation may be an effective treatment for CSA associated with opioids. SUMMARY Opioids have multiple effects on sleep, sleep architecture and SDB. Although originally described with methadone use, most commonly used opioids have also been shown to affect sleep. In patients on chronic methadone, sleep architecture changes include decreases in N3 and REM sleep. However, in patients with chronic nonmalignant pain, opioids improve sleep quality and sleep time. Opioids, generally at a morphine equivalent dose more than 100 mg/day, are associated with an increased incidence of CSA and ataxic breathing as well as obstructive sleep apnea. Other risk factors may include concomitant use of other medications such as antidepressants, gabapentinoids and benzodiazepines. Opioid-induced CSA can be potentially treated with adaptive servo-ventilation. Finally, opioids are a potential therapeutic option for restless legs syndrome unresponsive to dopamine agonists and other medications. However, use in patients with restless legs syndrome should proceed with caution, taking into account the risk for dependence and development of SDB.
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24
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Dalianis G, Trivli A, Limnopoulou A, Stavrakis A, Terzidou C, Detorakis ET, Kozobolis V, Labiris G. Association of obstructive sleep apnea/hypopnea syndrome with glaucomatous optic neuropathy and ocular blood flow. Exp Ther Med 2021; 21:657. [PMID: 33968187 PMCID: PMC8097189 DOI: 10.3892/etm.2021.10089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to investigate the prevalence of glaucomatous optic neuropathy in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). In total, 83 subjects (45 cases of severe OSAHS and 38 controls) underwent polysomnographic assessment and were evaluated for the severity of the disease using the Apnea-Hypopnea index. A detailed ophthalmologic exam was then performed, including measurement of the intraocular pressure (IOP) with a Goldmann applanation tonometer and Pascal dynamic contour tonometer (DCT), recording of the ocular pulse amplitude measured by the Pascal DCT, standard automated perimetry and retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness evaluation using optical coherence tomography. Ocular blood flow was assessed using color Doppler imaging (CDI) and ophthalmic artery indices were evaluated, including peak systolic blood velocity, end diastolic blood velocity and resistivity index (RI). There was a significant difference in the mean IOP between controls (11.03±3.85 mmHg) and cases of severe OSAHS (18.06±3.39 mmHg) when the IOP was measured by DCT (P<0.0001), but not with the Goldmann applanation tonometer (IOP, 13.97±2.85 mmHg for controls and 14.89±3.21 mmHg for cases of severe OSAHS; P=0.0877). Significant negative correlations were observed between RNFL thickness and RI (P=0.0011) in cases of severe OSAHS, as well as between GCC thickness and RI (P<0.008) in all subjects. Furthermore, a negative correlation between RI and RNFL thickness in severe cases of OSAHS suggested a hemodynamically induced vulnerability of RNFL in OSAHS. The correlation between RI and GCC thickness in all subjects suggested that impaired perfusion, more prominent in OSAHS, leads to structural changes. Therefore, cases of severe OSAHS should be monitored for changes in RNFL and GCC thickness, as well as CDI findings. Furthermore, patients with increased ophthalmic artery RIs should be monitored for changes in the GCC, regardless of the etiology of the RI increase.
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Affiliation(s)
- Georgios Dalianis
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Alexandra Trivli
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Aliki Limnopoulou
- Department of Ophthalmology, Public Health Center, Athens 10679, Greece
| | - Andreas Stavrakis
- Department of Sleep Apnea, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Chryssa Terzidou
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | | | - Vassilios Kozobolis
- Eye Institute Thrace, Alexandroupolis 68131, Greece.,Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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25
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Chen S, Wang J, Liu D, Lei L, Wu W, Liu Z, Lee C. Open oral cavity has little effects on upper airway aerodynamics in children with obstructive sleep apnea syndrome: A computational fluid dynamics study based on patient-specific models. J Biomech 2021; 121:110383. [PMID: 33848827 DOI: 10.1016/j.jbiomech.2021.110383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/10/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common disorder with recurrent pharyngeal airway collapse and sleep disruption. Recently, great progress has been made in investigating the physical mechanism of OSAS development and treatment using computational fluid dynamics (CFD). However, previous studies always neglected the oral cavity artificially in the patient's upper airway CFD model, but did not give any specific explanation. The oral cavity effect on the OSAS upper airway flow is still a matter of unclear. This paper reconstructed the patient-specific upper airway models based on the cone beam computed tomography images of ten children subjects (seven boys and three girls) and used CFD to simulate both the steady and unsteady expiration and inspiration states in the upper airway model with or without the oral cavity. A series of pressure measurement experiments based on the in vitro 1:1 scaled airway model were performed to validate the reliability of the present CFD methods. Finally, the CFD results indicate that the open oral cavity is almost a region of flow stasis with constant pressure, and both the upper airway aerodynamics with and without the oral cavity have the similar trends, with the maximum average relative difference less than 6%. The present study shows that the open oral cavity causes very little impacts on the upper airway flow of the children patients with OSAS using the nasal respiration only, and confirms the reasonability of ignoring the oral cavity for CFD simulation.
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Affiliation(s)
- Shuai Chen
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan 250012, China
| | - Jingying Wang
- School of Energy and Power Engineering, Shandong University, Jinan 250061, China.
| | - Dongxu Liu
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan 250012, China.
| | - Li Lei
- School of Energy and Power Engineering, Shandong University, Jinan 250061, China
| | - Wei Wu
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China; Department of Stomatology, Weifang People's Hospital, Weifang 261041, China
| | - Zhenggang Liu
- School of Energy and Power Engineering, Shandong University, Jinan 250061, China
| | - Chunhian Lee
- School of Energy and Power Engineering, Shandong University, Jinan 250061, China
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26
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Brownlow JA, Miller KE, Gehrman PR. Treatment of Sleep Comorbidities in Posttraumatic Stress Disorder. ACTA ACUST UNITED AC 2021; 7:301-316. [PMID: 33552844 DOI: 10.1007/s40501-020-00222-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of the review Sleep disturbances, insomnia and recurrent nightmares in particular, are among the most frequently endorsed symptoms of posttraumatic stress disorder (PTSD). The present review provides a summary of the prevalence estimates and methodological challenges presented by sleep disturbances in PTSD, highlights the recent evidence for empirically supported psychotherapeutic and pharmacological interventions for comorbid sleep disturbances implicated in PTSD, and provides a summary of recent findings on integrated and sequential treatment approaches to ameliorate comorbid sleep disturbances in PTSD. Recent Findings Insomnia, recurrent nightmares, and other sleep disorders are commonly endorsed among individuals with PTSD; however, several methodological challenges contribute to the varying prevalence estimates. Targeted sleep-focused therapeutic interventions can improve sleep symptoms and mitigate daytime PTSD symptoms. Recently, attention has focused on the role of integrated and sequential approaches, suggesting that comprehensively treating sleep disturbances in PTSD is likely to require novel treatment modalities. Summary Evidence is growing on the development, course, and treatment of comorbid sleep disturbances in PTSD. Further, interventions targeting sleep disturbances in PTSD show promise in reducing symptoms. However, longitudinal investigations and additional rigorous controlled trials with diverse populations are needed to identify key features associated with treatment response in order to alleviate symptoms.
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Affiliation(s)
- Janeese A Brownlow
- Department of Psychology, College of Health & Behavioral Sciences, Delaware State University, Dover, Delaware, USA.,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine E Miller
- Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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27
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Sleep Disorders in dogs: A Pathophysiological and Clinical Review. Top Companion Anim Med 2021; 43:100516. [PMID: 33556640 DOI: 10.1016/j.tcam.2021.100516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 12/11/2022]
Abstract
Sleep is a fundamental process in mammals, including domestic dogs. Disturbances in sleep affect physiological functions like cognitive and physical performance, immune response, pain sensation and increase the risk of diseases. In dogs, sleep can be affected by several conditions, with narcolepsy, REM sleep behavior disorder and sleep breathing disorders being the most frequent causes. Furthermore, sleep disturbances can be a symptom of other primary diseases where they can contribute to the worsening of clinical signs. This review describes reciprocally interacting sleep and wakefulness promoting systems and how their dysfunction can explain the pathophysiological mechanisms of sleep disorders. Additionally, this work discusses the clinical characteristics, diagnostic tools and available treatments for these disorders while highlighting areas in where further studies are needed so as to improve their treatment and prevention.
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28
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Hajipour F, Giannouli E, Moussavi Z. Acoustic characterization of upper airway variations from wakefulness to sleep with respect to obstructive sleep apnea. Med Biol Eng Comput 2020; 58:2375-2385. [PMID: 32719933 DOI: 10.1007/s11517-020-02234-5] [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: 02/07/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
The upper airway (UA) is in general thicker and narrower in obstructive sleep apnea (OSA) population than in normal. Additionally, the UA changes during sleep are much more in the OSA population. The UA changes can alter the tracheal breathing sound (TBS) characteristics. Therefore, we hypothesize the TBS changes from wakefulness to sleep are significantly correlated to the OSA severity; thus, they may represent the physiological characteristics of the UA. To investigate our hypothesis, we recorded TBS of 18 mild-OSA (AHI < 15) and 22 moderate/severe-OSA (AHI > 15) during daytime (wakefulness) and then during sleep. The power spectral density (PSD) of the TBS was calculated and compared within the two OSA groups and between wakefulness and sleep. The average PSD of the mild-OSA group in the low-frequency range (< 280 Hz) was found to be decreased significantly from wakefulness to sleep (p-value < 10-4). On the other hand, the average PSD of the moderate/severe-OSA group in the high-frequency range (> 900 Hz) increased marginally significantly from wakefulness to sleep (p-value < 9 × 10-3). Our findings show that the changes in spectral characteristics of TBS from wakefulness to sleep correlate with the severity of OSA and can represent physiological variations of UA. Therefore, TBS analysis has the potentials to assist with diagnosis and clinical management decisions in OSA patients based on their OSA severity stratification; thus, obviating the need for more expensive and time-consuming sleep studies. Graphical abstract Tracheal breathing sound (TBS) changes from wakefulness to sleep and their correlation with Obstructive sleep apnea (OSA) were investigated in individuals with different levels of OSA severity. We also assessed the classification power of the spectral characteristics of these TBS for screening purposes. Consequently, we analyzed and compared spectral characteristics of TBS recorded during wakefulness (a combination of mouth and nasal TBS) to those during sleep for mild and moderate/severe OSA groups.
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Affiliation(s)
- Farahnaz Hajipour
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada.
| | - Eleni Giannouli
- Department of Internal Medicine, Section of Respirology, University of Manitoba, Winnipeg, MB, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada.,Department of Electrical & Computer Engineering, University of Manitoba, Winnipeg, MB, Canada
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Emara TA, Khazbak AO, Mohammed O, Elgaml M, Zidan A, Hosny SM. Changes in Serum Leptin Level After Multilevel Surgery in Patients with Obstructive Sleep Apnea. Laryngoscope 2020; 131:E665-E670. [PMID: 32640082 DOI: 10.1002/lary.28908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Leptin hormone plays an important role in metabolic control and is elevated in obstructive sleep apnea (OSA). The aim of this study was to assess the hypothesis that surgical treatment will reduce leptin levels in OSA patients. STUDY DESIGN Prospective study. SUBJECTS AND METHODS Twenty-three patients with multilevel OSA underwent modified genioglossus muscle advancement with anterolateral advancement pharyngoplasty between April 2018 and September 2019. Serum leptin level was measured preoperatively and 3 months postoperatively for all patients and 18 control subjects. All patients were evaluated before and 3 months after surgery by history taking, clinical examination, polysomnography, cephalometry, and Epworth Sleepiness Scale. RESULTS Preoperatively, patients with OSA had a higher Leptin level (18.46 ± 4.73 ng/mL) than did control subjects (7.07 ± 1.26 ng/mL) (P < .001). Surgery resulted in a significant reduction in the level of leptin from 18.46 ± 4.73 ng/mL to 8.03 ± 2.22 ng/mL (P < .001). Reductions in leptin level was correlated with changes in apnea hypopnea index (AHI) (r = 0.61, P = .002) and minimum oxygen saturation (SaO2) (r = -0.54, P = .008). CONCLUSION Effective multilevel surgery in the form of modified genioglossus muscle advancement with anterolateral advancement pharyngoplasty could significantly reduce leptin level in OSA patients and this reduction is correlated with the degree of OSA improvement in term of AHI and SaO2. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E665-E670, 2021.
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Affiliation(s)
- Tarek A Emara
- Otorhinolaryngology-Head & Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa O Khazbak
- Otorhinolaryngology-Head & Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Omnya Mohammed
- Otorhinolaryngology-Head & Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Elgaml
- Otorhinolaryngology-Head & Neck Surgery Department, Al Ahrar Teaching Hospital, Zagazig, Egypt
| | - Amal Zidan
- Clinical Pathology Department, Zagazig University, Zagazig, Egypt
| | - Sameh M Hosny
- Otorhinolaryngology-Head & Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Chen H, Eckert DJ, van der Stelt PF, Guo J, Ge S, Emami E, Almeida FR, Huynh NT. Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients: A systematic review and meta-analysis. Sleep Med Rev 2020; 49:101229. [DOI: 10.1016/j.smrv.2019.101229] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
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Xiao R, Trask DK, Kominsky AH. Preoperative Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2020; 162:400-407. [DOI: 10.1177/0194599820901499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Hypoglossal nerve stimulation (HGNS) is an effective treatment for patients with obstructive sleep apnea (OSA) who fail continuous positive airway pressure (CPAP). We assessed the relationship between patient characteristics and response to HGNS. Study Design Retrospective cohort study. Setting Single tertiary care institution. Subjects and Methods This study included CPAP-intolerant patients with moderate to severe OSA after HGNS system implantation from November 2015 to December 2017. Patient measures, drug-induced sleep endoscopy (DISE) findings, and apnea-hypopnea indices (AHIs) were recorded. Results Forty-eight patients underwent implantation with the following median measures: age, 66 years; body mass index, 28.6; and neck circumference, 41.0 cm. Patients were classified by Friedman tongue position (II, 27%; III, 56%; IV, 17%) and Mallampati grade (I, 25%; II, 50%; III, 23%; IV, 2%). By DISE, 71% had anterior-posterior palatal collapse. Additionally, 38% had lateral oropharynx collapse; 50%, tongue base collapse; and 27%, epiglottis collapse. Following implantation, median AHI improved from 38.5 to 2.7 ( P < .001), and 92% of patients had no worse than mild OSA (8% moderate). Patients with Friedman tongue position grade II/III experienced greater change in AHI as compared with grade IV (94.2% vs 73.8%, P < .001). Patients with Mallampati score I/II experienced greater improvement versus score III/IV (94.7% vs 66.5%, P < .001). No DISE findings, including any obstruction or collapse, were associated with change in AHI. Conclusion This study further confirms HGNS as an effective treatment of CPAP-intolerant OSA. Office measures such as Friedman tongue position IV and Mallampati III/IV were associated with mildly decreased response. DISE findings were not associated with patient response.
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Affiliation(s)
- Roy Xiao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas K. Trask
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alan H. Kominsky
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Scotti C, Porta R, Olivares A, Comini L, Cinelli A, Scalvini S, Vitacca M. Nocturnal Hypoxemia Impacts Right Ventricle Diastolic Function in Obstructive Sleep Apnea: A Retrospective Observational Study. J Clin Med 2020; 9:E162. [PMID: 31936097 PMCID: PMC7019852 DOI: 10.3390/jcm9010162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/24/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA), although a growing healthcare problem and documented risk factor for cardiovascular diseases, is still under-diagnosed in cardiac patients. To investigate the correlation between OSA and echocardiographic parameters of right ventricle diastolic (RVD) dysfunction, in particular trans-tricuspid E-wave deceleration time (EDT), we retrospectively analyzed data of 103 pure (comorbidity-free) OSA patients with comprehensive echocardiographic examination (ETT). Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean nighttime oxyhemoglobin saturation (SpO2), time elapsed with SpO2 < 90% (T90) and mean peak desaturation of nocturnal events (Mdes, graded as mild, medium or severe) were compared with echocardiographic parameters. We found RVD dysfunction present in 58.3% of patients. Altered EDT correlated significantly with mean SpO2, T90, and Mdes (p < 0.01, all). Nocturnal desaturators had a significantly worse EDT than non-desaturators (p = 0.027) and a higher risk of prolonged EDT (odds ratio, OR = 2.86). EDT differed significantly according to Mdes severity (p = 0.005) with a higher risk of prolonged EDT in medium/severe vs. mild Mdes (OR = 3.44). EDT detected the presence of RVD dysfunction in 58.3% of our pure OSA patients. It correlated poorly with AHI severity but strongly with nocturnal desaturation severity, independently of age. This ETT marker may be useful for deciding appropriate diagnostic and therapeutic strategies.
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Affiliation(s)
- Carla Scotti
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy; (A.C.); (S.S.)
| | - Roberto Porta
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy; (R.P.); (M.V.)
| | - Adriana Olivares
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, 25065 Lumezzane, Italy; (A.O.); (L.C.)
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, 25065 Lumezzane, Italy; (A.O.); (L.C.)
| | - Angelo Cinelli
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy; (A.C.); (S.S.)
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy; (A.C.); (S.S.)
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane, Italy; (R.P.); (M.V.)
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Nourizadeh N, Rasoulian B, Majidi MR, Ardani AR, Rezaeitalab F, Asadpour H. Sleep quality after endoscopic sinus surgery in patients with sinonasal polyposis. Auris Nasus Larynx 2019; 46:866-870. [DOI: 10.1016/j.anl.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 01/19/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
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Moscarino S, Kötter F, Brandt M, Modabber A, Kniha K, Hölzle F, Wolf M, Möhlhenrich SC. Influence of different surgical concepts for moderate skeletal class II and III treatment on the nasopharyngeal airway space. J Craniomaxillofac Surg 2019; 47:1489-1497. [DOI: 10.1016/j.jcms.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/12/2019] [Accepted: 07/14/2019] [Indexed: 11/28/2022] Open
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Lin CY, Chen CN, Kang KT, Hsiao TY, Lee PL, Hsu WC. Ultrasonographic Evaluation of Upper Airway Structures in Children With Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2019; 144:897-905. [PMID: 30242332 DOI: 10.1001/jamaoto.2018.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Adenotonsillar hypertrophy is an important cause of obstructive sleep apnea (OSA) in children. However, residual OSA and abnormal polysomnographic findings have been reported in up to 75% of cases after adenotonsillectomy. Other anatomical and functional factors that influence upper airway structures, including the lateral pharyngeal wall, have rarely been studied in children with OSA. Objective To determine whether the upper airway structures can be evaluated using head and neck ultrasonography and if there is an association between the ultrasonographic measurements for these structures and severity of OSA seen on polysomnography in children. Design, Setting, and Participants Prospective, single-center, observational study of 82 children younger than 18 years with a diagnosis of sleep-disordered breathing (20 with primary snoring, 62 with OSA, as determined by the apnea-hypopnea index) and admitted to a tertiary teaching hospital for adenotonsillectomy. Exposures Ultrasonography and polysomnography. Main Outcomes and Measures Ultrasonographic measurements of upper airway structures. Results Of the 82 children studied, 62 (76%) were boys; mean (SD) age, 7.7 (6.2). There was no significant difference found in tonsillar dimensions or volume between the children with OSA and those with primary snoring. However, the mean (SD) total lateral pharyngeal wall and the total neck thicknesses at the retropalatal level were both greater in children with OSA than in those with primary snoring at rest (24.9 [4.4] mm vs 21.3 [2.6] mm; difference, 3.61 mm; 95% CI of difference, 1.48-5.74 mm for lateral pharyngeal wall; and 59.9 [14.4] mm vs 49.9 [11.2] mm; difference, 10.9 mm, 95% CI of difference, 3.8-17.9 mm for the total neck). Conclusions and Relevance Estimated tonsillar volume measured using ultrasonography had no relationship with the apnea-hypopnea index in childhood sleep-disordered breathing. However, the lateral pharyngeal wall was significantly thicker in children with OSA than in those with primary snoring at rest.
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Affiliation(s)
- Che-Yi Lin
- Department of Otolaryngology, College of Medicine, National Taiwan University, and National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, College of Medicine, National Taiwan University, and National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, College of Medicine, National Taiwan University, and National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, College of Medicine, National Taiwan University, and National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, College of Medicine, National Taiwan University, and National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
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Staub C. Concept of diverse sleep treatments in physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1505948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cristina Staub
- Ausgeschlafen.ch: Physiotherapy and Sleep Consulting, Zürich, Switzerland
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Miranda VSGD, Buffon G, Vidor DCGM. Orofacial myofunctional profile of patients with sleep disorders: relationship with result of polysomnography. Codas 2019; 31:e20180183. [PMID: 31066751 DOI: 10.1590/2317-1782/20182018183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/14/2018] [Indexed: 01/17/2024] Open
Abstract
PURPOSE This study aims to characterize the orofacial myofunctional profile of patients with sleep disorders and to relate them to the severity of the polysomnography result. METHODS A cross-sectional, field study of patients referred to polysomnography with a random sample of adult patients of both genders complaining of snoring who were not receiving any form of treatment for sleep disorder. An anthroposcopic speech-language evaluation was performed and the results of the polysomnography examination were collected in order to respond to the objectives of the study. RESULTS There was a significant association between the severity of the sleep disorder and environmental variables, such as smoking and alcoholism; also with individual characteristics, such as race, body mass index, waist circumference and systemic arterial hypertension. From the point of view of the myofunctional characteristics, there was a positive relationship between the severity of Obstructive Sleep Apnea and Hypopnea Syndrome with mental muscle contraction, Mallampati class, tongue dorsum elevation, tongue thickness, uvula characteristics, extension and mobility of the soft palate, and alteration in the respiratory pattern. CONCLUSION This study made it possible to describe a trend of the existence of orofacial myofunctional alterations in individuals with Sleep Apnea and Obstructive Hypopnea Syndrome and also revealed that the greater the degree of impairment of orofacial structures, the greater the degree of disturbance is also revealed.
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Affiliation(s)
| | - Gabriela Buffon
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
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Chen H, Aarab G, Lobbezoo F, De Lange J, Van der Stelt P, Darendeliler MA, Cistulli PA, Sutherland K, Dalci O. Differences in three-dimensional craniofacial anatomy between responders and non-responders to mandibular advancement splint treatment in obstructive sleep apnoea patients. Eur J Orthod 2019; 41:308-315. [DOI: 10.1093/ejo/cjy085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hui Chen
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Department of Orthodontics, School of Stomatology, Shandong University and Key Laboratory of Oral Biomedicine of Shandong, Jinan, China
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Jan De Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Van der Stelt
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, New South Wales, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, and Charles Perkins Centre, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, and Charles Perkins Centre, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Oyku Dalci
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, New South Wales, Australia
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Framnes SN, Arble DM. The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease. Front Endocrinol (Lausanne) 2018; 9:440. [PMID: 30127766 PMCID: PMC6087747 DOI: 10.3389/fendo.2018.00440] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, effecting 17% of the total population and 40-70% of the obese population (1, 2). Multiple studies have identified OSA as a critical risk factor for the development of obesity, diabetes, and cardiovascular diseases (3-5). Moreover, emerging evidence indicates that metabolic disorders can exacerbate OSA, creating a bidirectional relationship between OSA and metabolic physiology. In this review, we explore the relationship between glycemic control, insulin, and leptin as both contributing factors and products of OSA. We conclude that while insulin and leptin action may contribute to the development of OSA, further research is required to determine the mechanistic actions and relative contributions independent of body weight. In addition to increasing our understanding of the etiology, further research into the physiological mechanisms underlying OSA can lead to the development of improved treatment options for individuals with OSA.
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Affiliation(s)
| | - Deanna M. Arble
- Department of Biological Sciences, Marquette University, Milwaukee, WI, United States
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Toschi-Dias E, Trombetta IC, Silva VJD, Maki-Nunes C, Cepeda FX, Alves MJNN, Carvalho GL, Drager LF, Lorenzi-Filho G, Negrão CE, Rondon MUPB. Diet associated with exercise improves baroreflex control of sympathetic nerve activity in metabolic syndrome and sleep apnea patients. Sleep Breath 2018; 23:143-151. [PMID: 29948856 DOI: 10.1007/s11325-018-1675-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE We tested the hypothesis that (i) diet associated with exercise would improve arterial baroreflex (ABR) control in metabolic syndrome (MetS) patients with and without obstructive sleep apnea (OSA) and (ii) the effects of this intervention would be more pronounced in patients with OSA. METHODS Forty-six MetS patients without (noOSA) and with OSA (apnea-hypopnea index, AHI > 15 events/h) were allocated to no treatment (control, C) or hypocaloric diet (- 500 kcal/day) associated with exercise (40 min, bicycle exercise, 3 times/week) for 4 months (treatment, T), resulting in four groups: noOSA-C (n = 10), OSA-C (n = 12), noOSA-T (n = 13), and OSA-T (n = 11). Muscle sympathetic nerve activity (MSNA), beat-to-beat BP, and spontaneous arterial baroreflex function of MSNA (ABRMSNA, gain and time delay) were assessed at study entry and end. RESULTS No significant changes occurred in C groups. In contrast, treatment in both patients with and without OSA led to a significant decrease in weight (P < 0.05) and the number of MetS factors (P = 0.03). AHI declined only in the OSA-T group (31 ± 5 to 17 ± 4 events/h, P < 0.05). Systolic BP decreased in both treatment groups, and diastolic BP decreased significantly only in the noOSA-T group. Treatment decreased MSNA in both groups. Compared with baseline, ABRMSNA gain increased in both OSA-T (13 ± 1 vs. 24 ± 2 a.u./mmHg, P = 0.01) and noOSA-T (27 ± 3 vs. 37 ± 3 a.u./mmHg, P = 0.03) groups. The time delay of ABRMSNA was reduced only in the OSA-T group (4.1 ± 0.2 s vs. 2.8 ± 0.3 s, P = 0.04). CONCLUSIONS Diet associated with exercise improves baroreflex control of sympathetic nerve activity and MetS components in patients with MetS regardless of OSA.
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Affiliation(s)
- Edgar Toschi-Dias
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil.
| | | | - Valdo J D Silva
- Biological Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Cristiane Maki-Nunes
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Felipe X Cepeda
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | | | - Glauce L Carvalho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Luciano F Drager
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Carlos E Negrão
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil.,School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
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Gottsauner-Wolf S, Laimer J, Bruckmoser E. Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea. J Oral Maxillofac Surg 2018; 76:1093.e1-1093.e21. [DOI: 10.1016/j.joms.2017.11.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
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Castaneda A, Jauregui-Maldonado E, Ratnani I, Varon J, Surani S. Correlation between metabolic syndrome and sleep apnea. World J Diabetes 2018; 9:66-71. [PMID: 29765510 PMCID: PMC5951892 DOI: 10.4239/wjd.v9.i4.66] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/06/2018] [Accepted: 05/10/2018] [Indexed: 02/05/2023] Open
Abstract
The so-called “metabolic syndrome” (MS), constitutes a cluster of metabolic and cardiovascular abnormalities, including fasting glucose, blood pressure, triglycerides, high density lipoprotein cholesterol (HDL-C), and waist circumference that arise from insulin resistance. Obstructive sleep apnea (OSA) syndrome is characterized by recurrent episodes of partial or complete obstruction of the upper airway, involving cessation or significant decreased airflow, with intermittent hypoxemia, frequent arousals from sleep and recurrent oxyhemoglobin desaturations that interfere with normal sleep patterns generating difficulty falling asleep, unrefreshing sleep and loud snoring. The relation between these two entities is known as “Syndrome Z”, and there is no question about the impact of these risk factors on health and disease. This clinical condition presents a growing epidemic Worldwide, affecting approximately 60% of the general population with both MS and OSA due to the constant increase of body mass index in humans. This article presents evidence-based data that focuses on the direct relationship between MS and OSA.
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Affiliation(s)
| | | | - Iqbal Ratnani
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX 77030, United States
| | - Joseph Varon
- Department of Acute and Continuing Care. The University of Texas Health Science Center Houston, TX 77030, United States
| | - Salim Surani
- Division of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Health Science Center, Corpus Christi, TX 78404, United States
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Chen H, Aarab G, de Lange J, van der Stelt P, Lobbezoo F. The Effects of Noncontinuous Positive Airway Pressure Therapies on the Aerodynamic Characteristics of the Upper Airway of Obstructive Sleep Apnea Patients: A Systematic Review. J Oral Maxillofac Surg 2018; 76:1559.e1-1559.e11. [PMID: 29567436 DOI: 10.1016/j.joms.2018.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE The effects of noncontinuous positive airway pressure (non-CPAP) therapies on the airflow in the upper airway in obstructive sleep apnea (OSA) patients are not completely clear yet. Therefore, the primary aim of this systematic review was to determine the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway in OSA patients. MATERIALS AND METHODS A PICO (population or patient, intervention, comparison, outcome) search strategy, focusing on the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway (ie, velocity, wall shear stress, wall static pressure, airway resistance, pressure drop, and pressure effort) of OSA patients, was conducted in the following databases: MEDLINE (PubMed), Embase (Excerpta Medica), and Web of Science. In this systematic review, the inclusion criteria were 1) adults diagnosed with OSA by polysomnography, 2) treatment outcome assessed by a second polysomnography, and 3) computational fluid dynamics (CFD) applied. RESULTS Of 51 unique studies retrieved, 9 fulfilled the criteria for this systematic review. Seven studies were on maxillomandibular advancement (MMA) surgery, and 2 were on mandibular advancement device (MAD) therapy. The aerodynamic characteristics of the upper airway improved in OSA patients who underwent MMA surgery. However, the studies on MMA surgery included only responders to MMA surgery. In the responders to MAD therapy, the velocity, wall static pressure, and airway resistance of the upper airway decreased. In nonresponders to MAD therapy, the wall static pressure and airway resistance of the upper airway increased. CONCLUSIONS This systematic review suggests that MMA surgery and MAD therapy may improve several aerodynamic characteristics of the upper airway in OSA patients by CFD analysis. However, because of limitations of the selected studies, there is not enough evidence yet to support CFD analysis as a routine tool to predict the treatment outcome in OSA patients.
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Affiliation(s)
- Hui Chen
- Researcher, Department of Oral Radiology and Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Orthodontics, School of Dentistry, Shandong University, Jinan, China; and Key Laboratory of Oral Biomedicine of Shandong, Jinan, China.
| | - Ghizlane Aarab
- Department Head and Associate Professor, Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan de Lange
- Department Head and Professor, Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam and Academic Medical Center, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul van der Stelt
- Professor, Department of Oral Radiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frank Lobbezoo
- Vice-Dean and Professor, Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Parisi V, Paolillo S, Rengo G, Formisano R, Petraglia L, Grieco F, D'Amore C, Dellegrottaglie S, Marciano C, Ferrara N, Leosco D, Filardi PP. Sleep-disordered breathing and epicardial adipose tissue in patients with heart failure. Nutr Metab Cardiovasc Dis 2018; 28:126-132. [PMID: 29198416 DOI: 10.1016/j.numecd.2017.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Sleep-disordered breathing (SDB) is common in patients with heart failure (HF), contributes to the progression of cardiac disease, and is associated with adverse prognosis. Previous evidence indicates that epicardial adipose tissue (EAT) is independently associated with sleep apnea in obese individuals. We explored the relationship between SDB and EAT in HF patients. METHODS AND RESULTS EAT thickness was assessed by echocardiography in 66 patients with systolic HF undergoing nocturnal cardiorespiratory monitoring. A significantly higher EAT thickness was found in patients with SDB than in those without SDB (10.7 ± 2.8 mm vs. 8.3 ± 1.8 mm; p = 0.001). Among SDB patients, higher EAT thickness was found in both those with prevalent obstructive sleep apnea (OSA) and those with prevalent central sleep apnea (CSA). Of interest, EAT thickness was significantly higher in CSA than in OSA patients (11.9 ± 2.9 vs. 10.1 ± 2.5 p = 0.022). Circulating plasma norepinephrine levels were higher in CSA than in OSA patients (2.19 ± 1.25 vs. 1.22 ± 0.92 ng/ml, p = 0.019). According to the apnea-hypopnea index (AHI), patients were then stratified in three groups of SDB severity: Group 1, mild SDB; Group 2, moderate SDB; Group 3, severe SDB. EAT thickness progressively and significantly increased from Group 1 to Group 3 (ANOVA p < 0.001). At univariate analysis, only left ventricular ejection fraction and AHI significantly correlated with EAT (p = 0.019 and p < 0.0001, respectively). At multivariate analysis, AHI was the only independent predictor of EAT (β = 0.552, p < 0.001). CONCLUSIONS Our results suggest an association between the presence and severity of sleep apneas and cardiac visceral adiposity in HF patients.
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Affiliation(s)
- V Parisi
- Department of Translational Medical Sciences, Naples, Italy
| | - S Paolillo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
| | - G Rengo
- Department of Translational Medical Sciences, Naples, Italy
| | - R Formisano
- Department of Translational Medical Sciences, Naples, Italy
| | - L Petraglia
- Department of Translational Medical Sciences, Naples, Italy
| | - F Grieco
- Department of Translational Medical Sciences, Naples, Italy
| | - C D'Amore
- Department of Advanced Biomedical Science, Naples, Italy
| | | | - C Marciano
- Istituto Diagnostico Varelli, Naples, Italy
| | - N Ferrara
- Department of Translational Medical Sciences, Naples, Italy
| | - D Leosco
- Department of Translational Medical Sciences, Naples, Italy.
| | - P P Filardi
- Department of Advanced Biomedical Science, Naples, Italy
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Fernandez RC, Moore VM, Van Ryswyk EM, Varcoe TJ, Rodgers RJ, March WA, Moran LJ, Avery JC, McEvoy RD, Davies MJ. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep 2018; 10:45-64. [PMID: 29440941 PMCID: PMC5799701 DOI: 10.2147/nss.s127475] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight. There are several, possibly bidirectional, pathways through which PCOS is associated with sleep disturbances. The pathophysiology of PCOS involves hyperandrogenemia, a form of insulin resistance unique to affected women, and possible changes in cortisol and melatonin secretion, arguably reflecting altered hypothalamic-pituitary-adrenal function. Psychological and behavioral pathways are also likely to play a role, as anxiety and depression, smoking, alcohol use and lack of physical activity are also common among women with PCOS, partly in response to the distressing symptoms they experience. The specific impact of sleep disturbances on the health of women with PCOS is not yet clear; however, both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term and increased risk of type 2 diabetes. Both immediate quality of life and longer-term health of women with PCOS are likely to benefit from diagnosis and management of sleep disorders as part of interdisciplinary health care.
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Affiliation(s)
- Renae C Fernandez
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
- The University of Adelaide, School of Public Health, Adelaide, SA, Australia
| | - Vivienne M Moore
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, School of Public Health, Adelaide, SA, Australia
- The University of Adelaide, Fay Gale Centre for Research on Gender, Adelaide, SA, Australia
| | - Emer M Van Ryswyk
- Adelaide Institute for Sleep Health, Flinders Centre for Research Excellence, Flinders University of South Australia, Bedford Park, SA, Australia
| | - Tamara J Varcoe
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
| | - Raymond J Rodgers
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
| | - Wendy A March
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, School of Public Health, Adelaide, SA, Australia
| | - Lisa J Moran
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jodie C Avery
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, Flinders Centre for Research Excellence, Flinders University of South Australia, Bedford Park, SA, Australia
- Adelaide Sleep Health, Southern Adelaide Local Health Network, Repatriation General Hospital, Daw Park, SA, Australia
| | - Michael J Davies
- The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
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Palatal implant surgery effectiveness in treatment of obstructive sleep apnea: A numerical method with 3D patient-specific geometries. J Biomech 2018; 66:86-94. [PMID: 29162228 DOI: 10.1016/j.jbiomech.2017.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022]
Abstract
Obstructive sleep apnea (OSA) affects a large percentage of the population and is increasingly recognized as a major global health problem. One surgical procedure for OSA is to implant polyethylene (PET) material into the soft palate, but its efficacy remains to be discussed. In this study, we provide input to this topic based on numerical simulations. Three 3 dimensional (3D) soft palate finite element models including mouth-close and mouth-open cases were created based on three patient-specific computed tomography (CT) images. A simplified material modeling approach with the Neo-Hookean material model was applied, and nonlinear geometry was accounted for. Young's modulus for the implant material was obtained from uniaxial tests, and the PET implant pillars were inserted to the 3D soft palate model. With the finite element model, we designed different surgical schemes and investigated their efficacy with respect to avoiding the soft palate collapse. Several pillar schemes were tested, including different placement directions, different placement positions, different settings for the radius and the array parameters of the implant pillars, and different Young's moduli for the pillars. Based on our simulation results, the longitudinal-direction implant surgery improved the stiffness of the soft palate to a small degree, and implanting in the transverse direction was evaluated to be a good choice for improving the existing surgical scheme. In addition, the Young's modulus of the polyethylene material implants has an influence on the reinforcement efficacy of the soft palate.
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Chen H, Li Y, Reiber JH, de Lange J, Tu S, van der Stelt P, Lobbezoo F, Aarab G. Analyses of aerodynamic characteristics of the oropharynx applying CBCT: obstructive sleep apnea patients versus control subjects. Dentomaxillofac Radiol 2018; 47:20170238. [PMID: 29076751 DOI: 10.1259/dmfr.20170238] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the most relevant aerodynamic characteristic of the oropharynx related to the collapse of the upper airway in obstructive sleep apnea (OSA) patients; and to determine the correlation between the most relevant aerodynamic characteristic(s) of the oropharynx and anatomical characteristics of the oropharynx in OSA patients. METHODS 31 mild to moderate OSA patients (mean ± SD age = 43.5 ± 9.7 years) and 13 control subjects (mean ± SD age = 48.5 ± 16.2 years) were included in this prospective study. The diagnosis of OSA patients was based on an overnight polysomnographic recording. To exclude the presence of OSA in the control subjects, they were asked to fill out a validated questionnaire to determine the risk of OSA. NewTom5G cone beam CT (CBCT) scans were obtained from both OSA patients and control subjects. Computational models of the oropharynx were reconstructed based on CBCT images. The aerodynamic characteristics of the oropharynx were calculated based on these computational models. Pearson correlation analysis was used to analyse the correlation between the most relevant aerodynamic characteristic(s) and anatomical characteristics of the oropharynx in OSA patients. RESULTS Compared with controls, the airway resistance during expiration (Rex) of the OSA patients was significantly higher (p = 0.04). There was a significant negative correlation between Rex and the minimum cross-sectional area (CSAmin) of the oropharynx (r = -0.41, p = 0.02), and between Rex and the volume of the oropharynx (r = -0.48, p = 0.01) in OSA patients. After excluding an outlier, there is only significant correlation between Rex and the CSAmin of the oropharynx (r = -0.45, p = 0.01). CONCLUSIONS Within the limitations of this study, we concluded that the most relevant aerodynamic characteristic of the oropharynx in the collapse of the upper airway in OSA patients is Rex. Therefore, the repetitive collapse of the upper airway in OSA patients may be explained by a high Rex, which is related to the CSAmin of the oropharynx.
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Affiliation(s)
- Hui Chen
- 1 Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands.,2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Yingguang Li
- 3 Division of Image Processing, Department of Radiology, Leiden University Medical Centre , Leiden University Medical Centre , Leiden , The Netherlands
| | - Johan Hc Reiber
- 3 Division of Image Processing, Department of Radiology, Leiden University Medical Centre , Leiden University Medical Centre , Leiden , The Netherlands
| | - Jan de Lange
- 4 Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam (ACTA) and Academic Medical Centre (AMC), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA) and Academic Medical Centre (AMC), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Shengxian Tu
- 5 Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University , Shanghai , China
| | - Paul van der Stelt
- 1 Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Frank Lobbezoo
- 2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Ghizlane Aarab
- 2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
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Abstract
RATIONALE Owing to resource limitations, the testing of patients for obstructive sleep apnea (OSA) is often delayed. There is a need to accurately triage and expedite testing in those with a high pretest probability of OSA. Acoustic pharyngometry is a simple, noninvasive technique used to assess the upper airway cross-sectional area (UA-XSA), which is known to be reduced in those with OSA. OBJECTIVES To determine the discriminative ability and predictive value of UA-XSA measurements by acoustic pharyngometry for OSA. METHODS We conducted a cross-sectional study with a clinical cohort of consecutive adults with suspected OSA who had undergone both polysomnography and acoustic pharyngometry. OSA was defined as an apnea-hypopnea index greater than or equal to 5. Multivariable logistic regression analyses and receiver operating characteristic curves were used. MEASUREMENTS AND MAIN RESULTS The cohort included 576 subjects, 87% of whom had OSA and 64% of whom were men. The subjects' median body mass index (BMI) was 30.3 kg/m2, and their median age was 57 years. The median UA-XSA at FRC when sitting was significantly smaller in those with OSA compared with those without OSA (3.3 cm2 [interquartile range, 2.7-3.8] vs. 3.7 cm2 [interquartile range, of 2.9-4.2]). When the analysis was controlled for age, sex, BMI, and comorbidities, the odds of OSA increased for every 1-cm2 decrease in the mean UA-XSA FRC when sitting (odds ratio, 1.62; 95% confidence interval, 1.23-2.13). The mean UA-XSA provided fair discrimination for OSA (area under the curve, 0.60). A cutoff value of 3.75 cm2, the point with the best sum of sensitivity and specificity, had sensitivity of 73% and specificity of 46%. The magnitude of the incremental discriminative value of UA-XSA over clinical variables (age, sex, BMI, and comorbidities) was small and nonsignificant (P = 0.5). CONCLUSIONS The mean UA-XSA at FRC when sitting or supine provided no further significant advantage over clinical variables for the discernment of OSA.
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Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients. Sleep Breath 2017; 22:721-728. [DOI: 10.1007/s11325-017-1603-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 11/08/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
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