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"It is better to know some of the questions than all of the answers". The diagnosis of the Obstructive Sleep Apnea/Hypopnea Syndrome by questionnaires. Pulmonology 2019; 25:134-136. [PMID: 31176477 DOI: 10.1016/j.pulmoe.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chérrez-Ojeda I, Calderón JC, Fernández García A, Jeffe DB, Santoro I, Vanegas E, Cherrez A, Cano J, Betancourt F, Simancas-Racines D. Obstructive sleep apnea knowledge and attitudes among recent medical graduates training in Ecuador. Multidiscip Respir Med 2018; 13:5. [PMID: 29484178 PMCID: PMC5820797 DOI: 10.1186/s40248-018-0117-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/29/2018] [Indexed: 02/12/2023] Open
Abstract
Background We aimed to assess recent Latin American medical school graduates' knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians. Methods Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates' data with data collected in 2010-2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly. Results Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%; p < 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception-recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1.03-2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP. Conclusions OSA-focused educational interventions during medical school should help to improve recent medical graduates' abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students' exposure to sleep education.
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Affiliation(s)
- Iván Chérrez-Ojeda
- 1Universidad Espiritu Santo, Samborondon, Ecuador.,Respiralab Research Group, Respiralab, Guayaquil, Ecuador
| | - Juan Carlos Calderón
- 1Universidad Espiritu Santo, Samborondon, Ecuador.,Respiralab Research Group, Respiralab, Guayaquil, Ecuador
| | | | - Donna B Jeffe
- 3Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Ilka Santoro
- 4Department of Medicine, University Federal of Sao Paulo, Sao Paulo, Brazil
| | - Emanuel Vanegas
- 1Universidad Espiritu Santo, Samborondon, Ecuador.,Respiralab Research Group, Respiralab, Guayaquil, Ecuador
| | - Annia Cherrez
- 5School of Medicine, University of Heidelberg, Heidelberg, Germany
| | - José Cano
- 1Universidad Espiritu Santo, Samborondon, Ecuador.,Respiralab Research Group, Respiralab, Guayaquil, Ecuador
| | | | - Daniel Simancas-Racines
- 6Centro de Investigación en Salud Pública y Epidemiologia Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
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Prevalence of obstructive sleep apnoea in REM behaviour disorder: response to continuous positive airway pressure therapy. Sleep Breath 2017; 22:825-830. [PMID: 28951996 PMCID: PMC6133117 DOI: 10.1007/s11325-017-1563-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 08/20/2017] [Accepted: 08/28/2017] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Rapid eye movement behaviour disorder (RBD) is a parasomnia in which there is loss of muscle atonia during rapid eye movement (REM) sleep, resulting in dream enactment. The aims of this study were to determine the prevalence of obstructive sleep apnoea (OSA) in RBD patients and determine whether continuous positive airway pressure (CPAP) therapy improved RBD symptoms in patients with concomitant RBD and OSA. METHODS A questionnaire was mailed to 120 patients identified from a tertiary sleep centre with RBD meeting full International Classification for Sleep Disorders-3 (ICSD-3) criteria. Patients were diagnosed as having OSA if they had an apnoea-hypopnea index (AHI) ≥ 5. The questionnaire focused on CPAP-use, compliance and complications. Standard statistical analysis was undertaken using SPSS (v.21, IBM). RESULTS One hundred and seven of the potential participants (89.2%) had an OSA diagnosis. Out of 72 who responded to the questionnaire, (60%) 27 patients were using CPAP therapy. CPAP therapy improved RBD symptoms in 45.8% of this group. Despite this positive response to treatment in nearly half of CPAP-users, there was no significant difference in subjective or objective CPAP compliance between those who reported RBD improvement and those who did not. Subjective compliance with CPAP was over-reported, with mean usage being 7.17 ± 1.7 h per night compared to objective mean compliance of 5.71 ± 1.7. CONCLUSIONS OSA is a very common co-morbidity of RBD. CPAP therapy might improve self-reported RBD symptoms further, in addition to standard RBD treatment. However, further research into its topic is necessary.
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Riha RL. Diagnostic approaches to respiratory sleep disorders. J Thorac Dis 2015; 7:1373-84. [PMID: 26380763 DOI: 10.3978/j.issn.2072-1439.2015.08.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/13/2015] [Indexed: 12/18/2022]
Abstract
Sleep disordered breathing (SDB) comprises a number of breathing disturbances occurring during sleep including snoring, the obstructive sleep apnoea/hypopnea syndrome (OSAHS), central sleep apnoea (CSA) and hypoventilation syndromes. This review focuses on sleep disordered breathing and diagnostic approaches in adults, in particular clinical assessment and overnight assessment during sleep. Although diagnostic approaches to respiratory sleep disorders are reasonably straightforward, they do require a degree of clinical acumen when it comes to assessing severity and management options. Diagnosing respiratory sleep disorders on clinical features alone has limitations. Monitoring and measuring respiration during sleep has undergone many advances in the last 40 years in respect of quality and validity, largely regarding OSAHS. Despite the improvement in our diagnostic standards and recognition of sleep disordered breathing, many limitations still need to be overcome. Apart from assessing the individual patient, population screening for sleep disorders continues to preoccupy health professionals and policy makers in many countries. Research in the field is pushing current boundaries in terms of simplifying diagnosis and enhancing screening for sleep disordered breathing in large populations. At present, a number of these newer approaches require further validation.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Scotland, UK
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Akhan G, Songu M, Ayik SO, Altay C, Kalemci S. Correlation between hippocampal sulcus width and severity of obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2014; 272:3763-8. [PMID: 25502740 DOI: 10.1007/s00405-014-3422-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/28/2014] [Indexed: 12/28/2022]
Abstract
The aim of the present study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) severity and the hippocampal sulcus width in a cohort of subjects with OSAS and controls. A total of 149 OSAS patients and 60 nonapneic controls were included in the study. Overnight polysomnograpy was performed in all patients. Hippocampal sulcus width of the patients was measured by a radiologist blinded to the diagnosis of the patients. Other variables noted for each patient were as follows: gender, age, body mass index, apnea hypopnea index, Epworth sleepiness scale, sleep efficacy, mean saturation, lowest O2 saturation, longest apnea duration, neck circumference, waist circumference, hip circumference. A total of 149 OSAS patients were divided into three groups: mild OSAS (n = 54), moderate OSAS (n = 40), severe OSAS (n = 55) groups. The control group consisted of patients with AHI <5 (n = 60). Hippocampal sulcus width was 1.6 ± 0.83 mm in the control group; while 1.9 ± 0.81 mm in mild OSAS, 2.1 ± 0.60 mm in moderate OSAS, and 2.9 ± 0.58 mm in severe OSAS groups (p < 0.001). Correlation analysis of variables revealed that apnea hypopnea index (rs = 0.483, p < 0.001) was positively correlated with hippocampal sulcus width. Our findings demonstrated that severity of OSAS might be associated with various pathologic mechanisms including increased hippocampal sulcus width.
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Affiliation(s)
- Galip Akhan
- Faculty of Medicine, Department of Neurology, Izmir Katip Celebi University, Izmir, Turkey
| | - Murat Songu
- Department of Otorhinolaryngology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.
| | - Sibel Oktem Ayik
- Faculty of Medicine, Department of Chest Diseases, Izmir Katip Celebi University, Izmir, Turkey
| | - Canan Altay
- Faculty of Medicine, Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Serdar Kalemci
- Faculty of Medicine, Department of Chest Diseases, Mugla University, Mugla, Turkey
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Pataka A, Riha RL. Continuous Positive Airway Pressure and Cardiovascular Events in Patients with Obstructive Sleep Apnea. Curr Cardiol Rep 2013; 15:385. [DOI: 10.1007/s11886-013-0385-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Seetho IW, Wilding JPH. Screening for obstructive sleep apnoea in obesity and diabetes--potential for future approaches. Eur J Clin Invest 2013; 43:640-55. [PMID: 23586795 DOI: 10.1111/eci.12083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/07/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is recognised that sleep-disordered breathing (SDB), in particular, obstructive sleep apnoea (OSA) is associated with obesity and diabetes. The complications of OSA include dysregulation of metabolic and cardiovascular homeostasis. With the growing population of diabetes and obesity globally, it is becoming apparent that identifying and screening patients who are at risk is becoming increasingly crucial. Many patients may remain unaware of the potential diagnosis and continue to be undiagnosed. The high prevalence of OSA poses a demanding challenge to healthcare providers in order to provide sufficient resources and facilities for patient diagnosis and treatment. DESIGN In this article, we review the evidence in favour of screening populations deemed to be at increased risk of OSA, with particular reference to patients with obesity and diabetes. We consider the recent advances in potential screening methods that may allow new prognostic and predictive tools to be developed. A detailed search of Medline and Web of Science electronic databases for relevant articles in English was performed. RESULTS Apart from the use of screening tools such as questionnaires and clinical decision models, there is increasing evidence to suggest that there are differences in biological parameters in patients with OSA. Although further studies are required, there may be potential for such biomarkers to contribute to and augment the screening process. However, the significance of such biological tools remains to be elucidated. CONCLUSIONS A fundamental role for improved screening in patients with conditions such as obesity and diabetes can enable early interventions that may improve health outcomes relating to the adverse consequences of OSA. The future will see further research being carried out in the development of potential screening methods with emphasis on the selection of patients at risk of sleep disorders, thereby allowing more detailed physiological studies to be carried out where needed.
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Affiliation(s)
- Ian W Seetho
- Department of Obesity & Endocrinology, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
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Asghari A, Mohammadi F, Kamrava SK, Tavakoli S, Farhadi M. Severity of depression and anxiety in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2013; 269:2549-53. [PMID: 22298252 DOI: 10.1007/s00405-012-1942-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder which can result in mood problems. The aim of this study was to evaluate the severity of depression and anxiety symptoms as the most prevalent psychological disturbances present in different severity of OSA. We performed a cross-sectional study of 685 recently diagnosed sleep-disordered patients, over the age of 18, referred to Noor Sleep Lab from August 2008 to November 2010. The participants filled the Beck depression inventory-II (BDI-II) and the Beck anxiety inventory (BAI) to assess the depression and anxiety symptoms. We collected other characteristics of subjects such as age, sex, body mass index (BMI) and Epworth sleepiness scale (ESS). Apnea hypopnea index (AHI) was determined by an overnight polysomnography. Mean age of the participants was 47.63 years (SD 11.73). More than half of patient had some degrees of depression and anxiety. AHI showed no significant correlation with BDI (p = 0.105, r = -0.070) or BAI (p = 0.712, r = -0.016). Obesity was not either correlated with depression or anxiety (p = 0.18, r = 0.05). Nonetheless, ESS was weakly correlated with depression (p = 0.001, r = 0.148) and anxiety scores (p = 0.006, r = 0.120). BMI and ESS means were significantly higher in patients with severe OSA (p = 0.000). In comparison with men, the severity of depressive and anxiety symptoms was significantly higher in women (p = 0.000). In this cross-sectional study of patients with sleep problems, OSA was not associated with severity of depression and anxiety symptoms.
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Affiliation(s)
- Alimohamad Asghari
- Head and Neck Surgery, Department and Research Center of Otolaryngology, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Farid-Moayer M, Siegel LC, Black J. A feasibility evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Ther Adv Respir Dis 2012. [DOI: 10.1177/1753465812468043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: This feasibility study examined the initial-use safety and potential utility of a novel noninvasive oral pressure therapy (OPT) system designed to reduce airway obstruction during sleep. Methods: This was a single-center, proof-of-concept, single-treatment-night study in which subjects with obstructive sleep apnea (OSA) underwent a baseline polysomnography (PSG) study followed by PSG during use of an OPT system. The OPT system is composed of a bedside console, a polymer mouthpiece, and a flexible tube connecting the mouthpiece to the console. The console contains a pump that creates vacuum intended to pull the soft palate anteriorly and stabilize the tongue to reduce obstruction during sleep. Results: Fifty-four men and 17 women, aged 53.2 ± 11.5 years (mean ± SD) had a baseline apnea–hypopnea index (AHI) greater than 5 events per hour. OPT was generally well tolerated with no serious adverse events. OPT significantly decreased AHI from 34.4 ± 28.9 events per hour (mean ± SD) at baseline to 20.7 ± 23.3 ( p < 0.001). Treatment produced an AHI less than 10 in 48% of the subjects. OPT significantly improved oxygen desaturation index ( p < 0.001) and increased the percentage of the night with oxygen saturation of 90% or greater ( p = 0.028). Stage-N1 sleep shifts, total sleep-stage shifts, awakenings and the percentage of sleep time spent in N1 sleep were significantly reduced with treatment. Conclusion: This proof-of-concept study suggests that OPT can produce clinically relevant relief of OSA in certain subjects who are readily identified by PSG during trial use of the noninvasive system. OPT shows promise as a new treatment option for OSA in appropriate patients.
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Affiliation(s)
- Mehran Farid-Moayer
- Peninsula Sleep Center, Suite 707, 1828 El Camino Real, Burlingame, CA 94010, USA
| | - Lawrence C. Siegel
- Stanford University School of Medicine and ApniCure, Inc., Palo Alto, CA, USA
| | - Jed Black
- Stanford Center for Sleep Research and Medicine, Stanford University School of Medicine, Redwood City, CA, USA
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Guo Q, Wang Y, Li QY, Li M, Wan HY. Levels of thioredoxin are related to the severity of obstructive sleep apnea: based on oxidative stress concept. Sleep Breath 2012; 17:311-6. [DOI: 10.1007/s11325-012-0692-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/16/2012] [Accepted: 03/08/2012] [Indexed: 12/19/2022]
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