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Sunderram J, Legard A, De Resende A, Black K, Udasin IG, Lu SE, Romero Castillo H, Ravi SS, Mullins AE, de la Hoz RE, Rapoport DM, Ayappa I. Lack of association of impaired upper airway sensation with the presence or absence of obstructive sleep apnoea or chronic rhinosinusitis in World Trade Center responders. Occup Environ Med 2024; 81:302-307. [PMID: 38871449 PMCID: PMC11239276 DOI: 10.1136/oemed-2023-109262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Examine sensory function of the upper airway in four groups of subjects recruited from the World Trade Centre General Responder Cohort (WTCGRC), with/without obstructive sleep apnoea (OSA), and with/without chronic rhinosinusitis (CRS). METHODS Upper airway sensory function was determined using 2-point discrimination (2-PD) and vibration threshold (VT) in 163 WTCGRC subjects with both OSA and CRS (cases), OSA or CRS alone and without OSA or CRS (controls). Presence of OSA was determined from clinical sleep studies or home sleep testing. Presence of CRS was determined by nasal symptom questionnaire. The relationship between the presence of OSA and CRS and upper airway sensory impairment was assessed using linear regression analysis with each of 2PD and VT sensory threshold values as the dependent variable; OSA, CRS and their interaction were the independent variables. Age, gender and body mass index were covariates in the statistical model. The primary analysis was comparison of OSA+CRS versus controls (no OSA and no CRS) evaluated by linear contrasts. RESULTS There were no differences in 2-PD or VT in those with OSA+CRS, OSA and CRS alone or controls. However, both 2-PD and VT were significantly higher in the WTCGRC controls compared with values seen in historical controls using the same methodology (median 2-PD 13.0; CI (11.0 to 13.5) vs 10.5; CI (8 to 11); VT: mean±SEM (9.3±0.6 vs 2.2±0.1)). CONCLUSION While no differences were found in upper airway sensation between cases of OSA and CRS versus controls in the WTGRC population, there was evidence of impaired upper airway sensation in the WTGRC overall.
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Affiliation(s)
- Jag Sunderram
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicia Legard
- Environmental and Occupational Health Sciences Institute, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Adriana De Resende
- Environmental and Occupational Health Sciences Institute, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Iris G Udasin
- Environmental and Occupational Health Sciences Institute, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Shou-En Lu
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, New Jersey, USA
| | - Horacio Romero Castillo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sri Saranya Ravi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Anna E Mullins
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Rafael E de la Hoz
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David M Rapoport
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Indu Ayappa
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Wallace ES, Carberry JC, Toson B, Eckert DJ. A Systematic Review and Meta-Analysis of Upper Airway Sensation in Obstructive Sleep Apnea – Implications for Pathogenesis, Treatment and Future Research Directions. Sleep Med Rev 2022; 62:101589. [DOI: 10.1016/j.smrv.2022.101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
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An Y, Gao F, Su X, Zhou C, Huang J, Chen S, Liu T, Lu Z. Characteristics of pharyngeal paraesthesia symptoms in patients with obstructive sleep apnoea. Sleep Breath 2021; 25:2163-2169. [PMID: 33604802 DOI: 10.1007/s11325-021-02325-z] [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: 10/19/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate pharyngeal paraesthesia symptoms in patients with obstructive sleep apnoea (OSA). MATERIAL AND METHODS Patients with snoring and suspected OSA as well as age-matched controls were recruited. All participants underwent nocturnal polysomnography (PSG) and pharyngeal paraesthesia assessment using the Glasgow-Edinburgh throat scale (GETS). The incidence and severity of pharyngeal paraesthesia symptoms were compared between the groups. RESULTS A total of 280 patients who snored or were suspected of having OSA and 35 healthy, age-matched controls were recruited. The total pharyngeal paraesthesia symptom score was significantly higher in the OSA group than in the healthy group (12 [5, 23] vs. 3 [0, 9]; p < 0.001). The most frequent pharyngeal paraesthesia symptoms in the snore patients were Q7 (catarrh down the throat) and Q3 (discomfort/irritation in the throat), which are related to the irritability of the throat. The incidence of Q7 (OSA, 58% vs. controls, 14%; χ2 = 23.66; p < 0.001), Q3 (OSA, 46% vs. controls, 3%; χ2 = 23.07; p < 0.001), Q1 (feeling of something stuck in the throat; OSA, 33% vs. controls, 6%; χ2 = 11.00; p = 0.001), Q6 (swelling in the throat; OSA, 31% vs. controls, 0%; χ2 = 14.53; p < 0.001), Q9 (want to swallow all the time; OSA, 20% vs. controls, 6%; χ2 = 6.28; p = 0.012), Q5 (throat closing off; OSA, 24% vs. controls, 6%; χ2 = 6.16; p = 0.013), and Q2 (pain in the throat; OSA, 23% vs. controls, 6%; χ2 = 5.32; p = 0.021) was significantly higher in the OSA group than in the controls CONCLUSIONS: Patients with obstructive sleep apnoea have higher pharyngeal paraesthesia symptoms scores and tend to have irritated throats compared to healthy controls. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03506178.
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Affiliation(s)
- Yunsong An
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China.
| | - Fei Gao
- Department of Otolaryngology-Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, China.,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Xiaomei Su
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Chuan Zhou
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Jiayu Huang
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Tao Liu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshanerlu Street, Yuexiu District, Guangzhou, China.
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Svanborg E, Ulander M, Broström A, Sunnergren O. Palatal Sensory Function Worsens in Untreated Snorers but not in CPAP-Treated Patients With Sleep Apnea, Indicating Vibration-Induced Nervous Lesions. Chest 2020; 157:1296-1303. [PMID: 32059960 DOI: 10.1016/j.chest.2020.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Signs of both motor and sensory nervous lesions have previously been shown in the upper airway of patients with OSA and habitual snorers. Snoring per se may damage all upper airway neurons over time, thereby causing progression to manifest sleep apnea. To test this hypothesis, nonsnoring subjects, untreated snorers, and CPAP-treated patients underwent repeated sensory testing of the soft palate in a prospective long-term study. METHODS Cold detection threshold (CDT) testing at the soft palate and lip with a thermode and nocturnal respiratory recordings were performed in 2008 to 2009 with retesting 6 to 7 years later. RESULTS In 25 untreated snorers, palatal CDT worsened from a median (25th-75th percentile range) 4.2°C (3.2-5.9) to 11.0°C (7.0-17.4) (P < .001). The apnea-hypopnea index increased from a median 7.0 to 14.0 events/h (P < .05). There was no significant correlation between changes in CDT and the apnea-hypopnea index. In 21 nonsnoring control subjects, palatal CDT increased from a median 3.2°C to 5.6°C (P < .005). In 19 CPAP-treated patients, palatal CDT did not significantly change; eight patients had improved values. CDTs worsened significantly more in the snorers group than in the control subjects (P < .05) and the CPAP-treated patients (P < .001). There was no significant difference between control subjects and CPAP-treated patients. CONCLUSIONS CDT worsened considerably over time in untreated snorers, significantly more than in nonsnoring control subjects and CPAP-treated patients. Untreated snorers therefore risk developing poor sensitivity in the upper airway. In contrast, efficient treatment of OSA seems to protect the sensory innervation, as the CPAP-treated group maintained their sensitivity to cold and, in some cases, the sensitivity even improved.
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Affiliation(s)
- Eva Svanborg
- Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Martin Ulander
- Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden
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An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:1347-1353. [PMID: 31538606 PMCID: PMC6760391 DOI: 10.5664/jcsm.7756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/20/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system. METHODS A total of 32 patients with OSA and 18 healthy control patients were included in the study. All participants were selected based on medical history, physical examination, and nocturnal polysomnography (PSG) and divided into two groups. The palatal sensory status of participants was examined with a Neurometer current perception threshold (CPT) system. The system was used to deliver an electrical stimulus at three different frequencies (2,000 Hz, 250 Hz, and 5 Hz) by an investigator blinded to the PSG results. RESULTS There were no significant differences in the CPT values of the hard palate between the patients with OSA and control patients at any of the three stimulation frequencies. The differences in the CPT values of the soft palate between these groups failed to show any statistical significance at 250 Hz and 5 Hz. However, the patients with OSA showed significantly higher CPT values of the soft palate at 2,000 Hz than the age-matched healthy control patients (256.56 ± 129.34 versus 372.13 ± 152.06; P = .009). CONCLUSIONS Our study revealed an impairment of 2,000 Hz-related sensory nerve function of the soft palate among patients with OSA. The CPT test could be a useful tool for the quantitative and selective assessment of the sensory nerve function in patients with OSA. Additional research is required to evaluate the different types of sensory nerve dysfunctions among such patients. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: The Effects of Nasal Airflow on Upper Airway Dilator Muscles During Sleep; Identifier: NCT03506178; URL: https://clinicaltrials.gov/ct2/show/NCT03506178. CITATION An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative evaluation of the function of the sensory nerve fibers of the palate in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(9):1347-1353.
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Affiliation(s)
- Yunsong An
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Fei Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Xiu Ding
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University; State Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing, China
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De Meyer MMD, Jacquet W, Vanderveken OM, Marks LAM. Systematic review of the different aspects of primary snoring. Sleep Med Rev 2019; 45:88-94. [PMID: 30978609 DOI: 10.1016/j.smrv.2019.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/04/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Primary snoring, also known as simple or non-apnoeic snoring, is regarded as the first stage of sleep disordered breathing without severe medical consequences for the snorer and co-sleeper. Although it is a highly prevalent phenomenon in the general population, our knowledge is limited because of the lack of a consensus on terminology. This systematic review of the aspects used in the definitions of simple/primary snoring was conducted to obtain an inventory of current practices and compare these definitions with the conceptual definition of the American Academy of Sleep Medicine. PubMed and Web of Science were searched from July 2016 onwards without any language limitations, and 362 references were obtained. After selection based on titles, 39 remained, among which 29 contained a definition or reference to a definition. In 69% of the studies, a cut-off <5 apnoea/Hypopnoea events per hour of sleep on the Apnoea-Hypopnoea Index was used. Despite this tendency, the cut-offs ranged from 0 to <15/h. Unfortunately, the cut-off and occasional requirements did not match the conceptual definition of the American Academy of Sleep Medicine. A consensus must be reached on an operational and clinically relevant definition based on the clear conceptual definition.
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Affiliation(s)
- Micheline M D De Meyer
- Special Needs in Oral Health, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium.
| | - Wolfgang Jacquet
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Educational Science EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Olivier M Vanderveken
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc A M Marks
- Special Needs in Oral Health, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium
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Investigation of smell and taste function in patients with obstructive sleep apnoea syndrome. The Journal of Laryngology & Otology 2019; 133:376-379. [DOI: 10.1017/s0022215119000768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThis study investigated the relationship between disease severity and taste and smell functions in patients with obstructive sleep apnoea syndrome.MethodsA total of 65 patients with recurrent upper airway obstruction during sleep were included. Participants were divided into four groups according to apnoea-hypopnoea index, obtained on polysomnography. Smell and taste tests were performed on these patients.ResultsA significant difference was observed between the smell thresholds of the groups for the identification test (p = 0.016). In the taste test, significant differences were observed between the groups in terms of sweet, sour, salty and bitter taste test thresholds (p = 0.029, p = 0.0005, p = 0.001 and p = 0.017, respectively).ConclusionAs sleep apnoea severity increased (according to the apnoea-hypopnoea index) in obstructive sleep apnoea syndrome patients, the taste and smell thresholds decreased due to the effect of neuropathy and inflammation in the upper respiratory tract.
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Shah F, Franklin KA, Holmlund T, Levring Jäghagen E, Berggren D, Forsgren S, Stål P. Desmin and dystrophin abnormalities in upper airway muscles of snorers and patients with sleep apnea. Respir Res 2019; 20:31. [PMID: 30764835 PMCID: PMC6376723 DOI: 10.1186/s12931-019-0999-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/04/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pathophysiology of obstruction and swallowing dysfunction in snores and sleep apnea patients remains unclear. Neuropathy and to some extent myopathy have been suggested as contributing causes. Recently we reported an absence and an abnormal isoform of two cytoskeletal proteins, desmin, and dystrophin, in upper airway muscles of healthy humans. These cytoskeletal proteins are considered vital for muscle function. We aimed to investigate for muscle cytoskeletal abnormalities in upper airways and its association with swallowing dysfunction and severity of sleep apnea. METHODS Cytoskeletal proteins desmin and dystrophin were morphologically evaluated in the uvula muscle of 22 patients undergoing soft palate surgery due to snoring and sleep apnea and in 10 healthy controls. The muscles were analysed with immunohistochemical methods, and swallowing function was assessed using videoradiography. RESULTS Desmin displayed a disorganized pattern in 21 ± 13% of the muscle fibres in patients, while these fibers were not present in controls. Muscle fibres lacking desmin were present in both patients and controls, but the proportion was higher in patients (25 ± 12% vs. 14 ± 7%, p = 0.009). The overall desmin abnormalities were significantly more frequent in patients than in controls (46 ± 18% vs. 14 ± 7%, p < 0.001). In patients, the C-terminus of the dystrophin molecule was absent in 19 ± 18% of the desmin-abnormal muscle fibres. Patients with swallowing dysfunction had 55 ± 10% desmin-abnormal muscle fibres vs. 22 ± 6% in patients without swallowing dysfunction, p = 0.002. CONCLUSION Cytoskeletal abnormalities in soft palate muscles most likely contribute to pharyngeal dysfunction in snorers and sleep apnea patients. Plausible causes for the presence of these abnormalities is traumatic snoring vibrations, tissue stretch or muscle overload.
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Affiliation(s)
- Farhan Shah
- Department of Integrative Medical Biology, Laboratory of Muscle Biology, Umeå University, SE-901 87 Umeå, Sweden
| | - Karl A. Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Thorbjörn Holmlund
- Department of Clinical Sciences, Otolaryngology, Umeå University, Umeå, Sweden
| | - Eva Levring Jäghagen
- Department of Odontology, Oral and Maxillofacial Radiology, Umeå University, Umeå, Sweden
| | - Diana Berggren
- Department of Clinical Sciences, Otolaryngology, Umeå University, Umeå, Sweden
| | - Sture Forsgren
- Department of Integrative Medical Biology, Laboratory of Muscle Biology, Umeå University, SE-901 87 Umeå, Sweden
| | - Per Stål
- Department of Integrative Medical Biology, Laboratory of Muscle Biology, Umeå University, SE-901 87 Umeå, Sweden
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Mu L, Chen J, Li J, Arnold M, Sobotka S, Nyirenda T, Fowkes M, Christopherson M, Sanders I. Sensory Innervation of the Human Soft Palate. Anat Rec (Hoboken) 2018; 301:1861-1870. [PMID: 30079585 DOI: 10.1002/ar.23864] [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: 12/12/2017] [Revised: 03/20/2018] [Accepted: 03/24/2018] [Indexed: 01/18/2023]
Abstract
The human soft palate plays an important role in respiration, swallowing, and speech. These motor activities depend on reflexes mediated by sensory nerve endings. To date, the details of human sensory innervation to the soft palate have not been demonstrated. In this study, eight adult human whole-mount (soft palate-tongue-pharynx-larynx-upper esophagus) specimens were obtained from autopsy. Each specimen was bisected in the midline, forming two equal and symmetrical halves. Eight hemi-specimens were processed with Sihler's stain, a whole-mount nerve staining technique. The remaining eight hemi-soft palates were used for immunohistochemical study. The soft palatal mucosa was dissected from the oral and nasal sides and prepared for neurofilament staining. Our results showed that the sensory nerve fibers formed a dense nerve plexus in the lamina propria of the soft palatal mucosa. There was a significant difference in the innervation density between both sides. Specifically, the oral side had higher density of sensory nerve fibers than the nasal side of the soft palate. The mean number and percent area of the sensory nerve fibers in the mucosa of the nasal side was 78% and 72% of those in the mucosa of the oral side, respectively (P < 0.0001). The data presented here could be helpful for further investigating the morphological and quantitative alterations in the sensory nerves in certain upper airway disorders involving the soft palate such as obstructive sleep apnea (OSA) and for designing effective therapeutic strategies to treat OSA. Anat Rec, 301:1861-1870, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Liancai Mu
- From Upper Airway Research Laboratory, Department of Biomedical Research, Hackensack University Medical Center, Hackensack, New Jersey 07601
| | - Jingming Chen
- From Upper Airway Research Laboratory, Department of Biomedical Research, Hackensack University Medical Center, Hackensack, New Jersey 07601
| | - Jing Li
- From Upper Airway Research Laboratory, Department of Biomedical Research, Hackensack University Medical Center, Hackensack, New Jersey 07601
| | - Matthew Arnold
- From Upper Airway Research Laboratory, Department of Biomedical Research, Hackensack University Medical Center, Hackensack, New Jersey 07601
| | - Stanislaw Sobotka
- From Upper Airway Research Laboratory, Department of Biomedical Research, Hackensack University Medical Center, Hackensack, New Jersey 07601.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Themba Nyirenda
- From Upper Airway Research Laboratory, Department of Biomedical Research, Hackensack University Medical Center, Hackensack, New Jersey 07601
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | | | - Ira Sanders
- Linguaflex, Inc, 322 North Shore Drive, Suite 200, Pittsburgh, Pennsylvania 15212
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Podnar S, Dolenc Grošelj L. Neuropathic changes in the tongue protruder muscles in patients with snoring or obstructive sleep apnea. Neurophysiol Clin 2018; 48:269-275. [PMID: 29910146 DOI: 10.1016/j.neucli.2018.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Both myopathic and neuropathic tongue protruder muscle changes have been demonstrated to occur in obstructive sleep apnea (OSA) patients using different methods. We tried to elucidate this dilemma using quantitative electromyographic (EMG) methods. METHODS In a group of consecutive patients with suspected OSA a full overnight polysomnography (PSG) and quantitative needle EMG of the tongue protruder, biceps brachii and vastus lateralis muscles were performed. EMG findings were compared to control subjects. RESULTS Of 23 patients, 8 were classified as simple snorers and the remaining 15 as OSA patients by PSG. Motor unit potential (MUP) parameters obtained in tongue protruder muscles, but not biceps brachii or vastus lateralis muscles, were significantly larger in patients compared to controls. However, no correlation was found between tongue protruder muscle MUP parameters and patient characteristics. DISCUSSION Our study confirmed previous findings of neuropathic changes in the tongue protruder muscles of OSA patients, and extended these to simple snorers. Changes were limited to the upper airway muscle, and could not been explained by the severity or duration of the sleep breathing disorder. The possible role of denervation injury caused by the upper airway vibrations should be tested in the future by appropriately designed studies.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia.
| | - Leja Dolenc Grošelj
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia
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11
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Patel JA, Ray BJ, Fernandez-Salvador C, Gouveia C, Zaghi S, Camacho M. Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: A systematic review. Am J Otolaryngol 2018. [PMID: 29525140 DOI: 10.1016/j.amjoto.2018.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. METHODS PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. RESULTS 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. CONCLUSIONS Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea.
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Affiliation(s)
- Jagatkumar A Patel
- F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA.
| | - Bryan J Ray
- F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA
| | - Camilo Fernandez-Salvador
- Tripler Army Medical Center, Division of Otolaryngology-Head and Neck Surgery, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA
| | - Christopher Gouveia
- Northwestern University, Feinberg School of Medicine, Department of Otolaryngology - Head and Neck Surgery, 676 N. St. Clair, Suite 1325, Chicago, IL 60611, USA
| | - Soroush Zaghi
- UCLA Medical Center, Santa Monica, Santa Monica, CA 90404, USA
| | - Macario Camacho
- Tripler Army Medical Center, Division of Otolaryngology-Head and Neck Surgery, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA
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Arnardottir ES, Gislason T. Quantifying Airflow Limitation and Snoring During Sleep. Sleep Med Clin 2016; 11:421-434. [DOI: 10.1016/j.jsmc.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Tapia IE, Kim JY, Cornaglia MA, Traylor J, Samuel GJ, McDonough JM, Marcus CL. Upper Airway Vibration Perception in School-Aged Children with Obstructive Sleep Apnea. Sleep 2016; 39:1647-52. [PMID: 27253764 DOI: 10.5665/sleep.6084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/09/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Children with the obstructive sleep apnea (OSA) have impaired upper airway two-point discrimination compared to controls. In addition, blunted vibration threshold detection (VT) in the palate has been recognized in adults with OSA, but has not been studied in children. Both findings are indicative of a defect in the afferent limb of the upper airway dilator reflex that could prevent upper airway dilation secondary to airway loading, resulting in airway collapse. We hypothesized that children with OSA have impaired palate VT compared to controls, and that this improves after OSA treatment. METHODS Case-control study. Children with OSA and healthy non-snoring controls underwent polysomnography and palate VT measurements. Children with OSA were retested after adenotonsillectomy. RESULTS 29 children with OSA (median [interquartile range] age = 9.5 [7.5-12.6] years, obstructive apnea-hypopnea index [OAHI] = 11.3 [5.7-19.5] events/h, BMI z = 1.8 [1.3-2.1]) and 32 controls (age = 11.2 [9.3-13.5] years, P = 0.1; OAHI = 0.5 [0.1-0.7] events/h, P < 0.001; BMI z = 1 [0.3-1.7], P = 0.004) were tested. OSA palate VT (1.0 [0.8-1.5] vibration units) was similar to that of controls (1 [0.8-1.3], P = 0.37). 20 children with OSA were retested 4.4 (3.2-7.1) months after treatment. OAHI decreased from 13.1 (5.8-19) to 0.6 (0.2-2.5) events per hour (P < 0.001) postoperatively, but palate VT did not change (before = 1 [0.7-1.5], after = 1.2 [0.8-1.4], P = 0.37). CONCLUSIONS Children with OSA and controls have similar palate VT. Unlike in adults, palate VT does not seem to be affected by childhood OSA.
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Affiliation(s)
- Ignacio E Tapia
- Sleep Center, The Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ji Young Kim
- Biostatistics Core, Clinical and Translational Research Center, The Children's Hospital of Philadelphia. Philadelphia, PA
| | | | - Joel Traylor
- Sleep Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - George J Samuel
- Sleep Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Carole L Marcus
- Sleep Center, The Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Jeong KH, Yang Y, Choi HR, Cho JH, Kim GT, Kim JK. Assessment of Change in Palatal Sensation in Obstructive Sleep Apnea Patients by Using Two-Point Palatal Discrimination. Clin Exp Otorhinolaryngol 2016; 9:226-32. [PMID: 27095515 PMCID: PMC4996111 DOI: 10.21053/ceo.2015.01375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives. Patients with obstructive sleep apnea syndrome (OSAS) have impaired responses to inspiratory resistive loading during sleep. This may be due, in part, to a change in the upper airway sensation. Therefore, we hypothesized that patients with OSAS have diminished upper airway sensation due to snoring. Methods. A total of 53 participants were selected based on clinical evaluation and polysomnography. Two-point discrimination was measured with modified calipers in the tongue and soft palate. Results. A total of 10 participants were included in the control group, 12 participants in the simple snoring group, and 27 participants in the OSAS group. There were 12 patients in the impaired sensation group of the OSAS group. On comparing polysomnography, patients with impairment of their palatal sensory input in two-point discrimination (TPD) had a more protracted duration of the longest snoring episode than those with simple snoring and normal sensation. Patients with decreased sensory input in TPD had longer average duration of snoring episodes and relative snoring time than those with simple snoring and normal sensory input in cold uvular TPD. Comparison of the cold uvular TPD for normal sensation and impaired sensation in patients with OSAS after treatment showed a different trend. Conclusion. Impaired sensation of the soft palate was correlated with the longest snoring episode duration, average snoring episode duration, and relative snoring time. It is helpful in detecting the early stage of neural degradation in OSAS patients by assessing snoring components of polysomnography and TPD in the soft palate.
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Affiliation(s)
- Kyung-Hwa Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Youngsoo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Rang Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Gee-Tae Kim
- Department of Biomedical Engineering, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Kook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
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Kalchiem-Dekel O, Westreich R, Regev A, Novack V, Goldberg M, Maimon N. Snoring intensity and excessive daytime sleepiness in subjects without obstructive sleep apnea. Laryngoscope 2016; 126:1696-701. [DOI: 10.1002/lary.25876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/10/2015] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Or Kalchiem-Dekel
- Institute of Pulmonology and Department of Medicine B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Roi Westreich
- Institute of Pulmonology and Department of Medicine B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Adi Regev
- Clinical Research Center, Soroka University Medical Center; Beer-Sheva Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center; Beer-Sheva Israel
| | - Mordechai Goldberg
- Clinical Research Center, Soroka University Medical Center; Beer-Sheva Israel
| | - Nimrod Maimon
- Institute of Pulmonology and Department of Medicine B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev; Beer-Sheva Israel
- Division of Respirology; Department of Medicine; University of Toronto and University Health Network; Toronto Ontario Canada
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16
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Cho SH. Clinical Implications of Snoring. JOURNAL OF RHINOLOGY 2016. [DOI: 10.18787/jr.2016.23.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seok Hyun Cho
- Department of Otorhinolaryngology, College of Medicine, Hanyang University, Seoul, Korea
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17
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Achuthan S, Medhi B. A systematic review of the pharmacological approaches against snoring: can we count on the chickens that have hatched? Sleep Breath 2015; 19:1035-42. [DOI: 10.1007/s11325-015-1123-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/19/2014] [Accepted: 01/14/2015] [Indexed: 11/25/2022]
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18
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Deary V, Ellis JG, Wilson JA, Coulter C, Barclay NL. Simple snoring: not quite so simple after all? Sleep Med Rev 2014; 18:453-62. [PMID: 24888523 DOI: 10.1016/j.smrv.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/07/2014] [Accepted: 04/29/2014] [Indexed: 01/26/2023]
Abstract
Simple snoring (SS), in the absence of obstructive sleep apnoea (OSA), is a common problem, yet our understanding of its causes and consequences is incomplete. Our understanding is blurred by the lack of consistency in the definition of snoring, methods of assessment, and degree of concomitant complaints. Further, it remains contentious whether SS is independently associated with daytime sleepiness, or adverse health outcomes including cardiovascular disease and metabolic syndrome. Regardless of this lack of clarity, it is likely that SS exists on one end of a continuum, with OSA at its polar end. This possibility highlights the necessity of considering an otherwise 'annoying' complaint, as a serious risk factor for the development and progression of sleep apnoea, and consequent poor health outcomes. In this review, we: 1) highlight variation in prevalence estimates of snoring; 2) review the literature surrounding the distinctions between SS, upper airway resistance syndrome (UARS) and OSA; 3) present the risk factors for SS, in as far as it is distinguishable from UARS and OSA; and 4) describe common correlates of snoring, including cardiovascular disease, metabolic syndrome, and daytime sleepiness.
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Affiliation(s)
- Vincent Deary
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Department of Otolaryngology, Head and Neck Surgery, Newcastle University, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Nicola L Barclay
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle upon Tyne, UK.
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20
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Kim SW, Park HW, Won SJ, Jeon SY, Jin HR, Lee SJ, Chang DY, Kim DW. Palatal sensory threshold reflects nocturnal hypoxemia and airway occlusion in snorers and obstructive sleep apnea patients. J Clin Sleep Med 2013; 9:1179-86. [PMID: 24235900 DOI: 10.5664/jcsm.3164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Upper airway sensory deficit has been reported to be associated with snoring or obstructive sleep apnea. There are limited data on the correlation between disease severity and upper airway sensation. In this study, we investigated the relationship between clinical parameters and standardized palatal sensory threshold (SPST) using Semmes Weinstein monofilaments. METHODS We recruited 40 snorers and 19 control subjects. Palatal sensory threshold was measured in all study subjects, using Semmes Weinstein monofilaments. Standardized palatal sensory threshold was determined by subtraction of hard palate sensation from uvular sensation. All subjects with snoring underwent a modified Muller maneuver during wakefulness before polysomnography. RESULTS SPST was higher in snorers than in control subjects, but did not differ according to the severity of obstructive sleep apnea. Patients with higher SPST (≥ 0.45 g/mm(2)) were older and had more severe hypoxemia indices: lower nadir oxyhemoglobin saturation (SpO2) and higher percentage of sleep time at < 90% SpO2. Adjusted for age, sex, neck circumference, and body mass index, SPST was correlated with the apnea-hypopnea index and hypoxemia indices. With a cutoff value ≥ 0.45 g/mm(2), the sensitivity of SPST for nocturnal hypoxemia (nadir SpO2, < 80%) was 81.3%. Patients with higher SPST (≥ 0.45 g/mm(2)) showed more airway occlusion in modified Muller maneuver, than those with lower values. CONCLUSIONS The SPST measured using Semmes Weinstein monofilaments reflects nocturnal hypoxemia and airway occlusion. This test provides a potential tissue marker of the severity of hypoxemia in patients who snore.
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Affiliation(s)
- Sang-Wook Kim
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea ; Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, South Korea
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Tsai YJ, Ramar K, Liang YJ, Chiu PH, Powell N, Chi CY, Lung TC, Wen-Yang Lin W, Tseng PJ, Wu MY, Chien KC, Weaver EM, Lee FP, Lin CM, Chen KC, Chiang RPY. Peripheral neuropathology of the upper airway in obstructive sleep apnea syndrome. Sleep Med Rev 2013; 17:161-8. [DOI: 10.1016/j.smrv.2012.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
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Valham F, Sahlin C, Stenlund H, Franklin KA. Ambient temperature and obstructive sleep apnea: effects on sleep, sleep apnea, and morning alertness. Sleep 2012; 35:513-7. [PMID: 22467989 PMCID: PMC3296793 DOI: 10.5665/sleep.1736] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The aim of the study was to investigate the effect of ambient temperature on sleep, sleep apnea, and morning alertness in patients with obstructive sleep apnea. DESIGN Randomized controlled trial. SETTING In-hospital investigations. PARTICIPANTS Forty patients with obstructive sleep apnea naïve to treatment, with an apnea-hypopnea index of 10-30. INTERVENTIONS Three different nights in room temperatures of 16°C, 20°C, and 24°C. MEASUREMENTS Overnight polysomnography and Karolinska Sleepiness Scale. RESULTS The obstructive apnea-hypopnea index was 30 ± 17 at 16°C room temperature, 28 ± 17 at 20°C, and 24 ± 18 at 24°C. The obstructive apnea-hypopnea index was higher at 16°C room temperature versus 24°C (P = 0.001) and at 20°C room temperature versus 24°C (P = 0.033). Total sleep time was a mean of 30 min longer (P = 0.009), mean sleep efficiency was higher (77 ± 11% versus 71 ± 13% respectively, P = 0.012), and the patients were significantly more alert according to the Karolinska Sleepiness Scale (P < 0.028) in the morning at 16°C room temperature versus 24°C. The amount of sleep in different sleep stages was not affected by room temperature. CONCLUSIONS Untreated patients with obstructive sleep apnea sleep longer, have better sleep efficiency, and are more alert in the morning after a night's sleep at 16°C room temperature compared with 24°C, but obstructive sleep apnea is more severe at 16°C and 20°C compared with 24°C. CLINICAL TRIAL INFORMATION This study is registered in ClinicalTrials.gov number NCT00544752.
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Affiliation(s)
- Fredrik Valham
- Department of Internal Medicine, Umeå University, Umeå, Sweden.
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Sunnergren O, Broström A, Svanborg E. Soft palate sensory neuropathy in the pathogenesis of obstructive sleep apnea. Laryngoscope 2011; 121:451-6. [DOI: 10.1002/lary.21371] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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