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Chaves Junior CM, Adriano Araújo VM, Estanislau IMG, Candéa JDJ, Moro A, de Bruin VMS, Bruin PFC, Fonteles CS. A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea. Cranio 2024; 42:387-393. [PMID: 34511055 DOI: 10.1080/08869634.2021.1977055] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Evaluate the influence of obesity on the polysomnographic and cephalometric parameters in obstructive sleep apnea (OSA). METHODS Fifty records of male patients with OSA, containing information on dental, medical, polysomnographic, and cephalometric exams were selected. The degree of obesity was based on Body Mass Index (BMI). Group I comprised normal or overweight individuals (BMI ≤ 29.9 kg/m2), whereas Group II consisted of obese individuals (BMI ≥ 29.9 kg/m2). RESULTS BMI significantly correlated with apnea and hypopnea index (p < 0.0005), minimal oxyhemoglobin saturation (p < 0.0005), and two cephalometric variables (soft palate length, p = 0.01 and width, p = 0.01). Group II showed a significant correlation with the position of the hyoid bone (p = 0.02). Soft palate length and width significantly differed between groups (p = 0.014; 0.016). CONCLUSION Obese males present wider and longer soft palate dimensions, and patients with a greater BMI present a more inferiorly positioned hyoid bone.
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Affiliation(s)
- Cauby Maia Chaves Junior
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Vilana Maria Adriano Araújo
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Ilanna Mara Gomes Estanislau
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Juliana de Jesus Candéa
- Department of Clinical Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Moro
- Postgraduate Program in Dentistry, Federal University of Paraná, Curitiba, Brazil
| | | | | | - Cristiane S Fonteles
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
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Gauld C, Baillieul S, Martin VP, Richaud A, Lopez R, Pelou M, Abi-Saab P, Coelho J, Philip P, Pépin JL, Micoulaud-Franchi JA. Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms? J Clin Sleep Med 2024; 20:1105-1117. [PMID: 38420966 PMCID: PMC11217627 DOI: 10.5664/jcsm.11086] [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: 07/02/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a heterogeneous condition covering many clinical phenotypes in terms of the diversity of symptoms. Patient-based OSA screening questionnaires used in routine practice contain significantly varying contents that can impact the reliability and validity of the screening. We investigated to what extent common patient-based OSA screening questionnaires differ or overlap in their item content by conducting a rigorous, methodical, and quantified content overlap analysis. METHODS We conducted an item content analysis of 11 OSA screening questionnaires validated in adult populations and characterized their overlap using a 4-step approach: (1) selection of OSA screening questionnaires, (2) item extraction and selection, (3) extraction of symptoms from items, and (4) assessment of content overlap with the Jaccard index (from 0, no overlap, to 1, full overlap). RESULTS We extracted 72 items that provided 25 distinct symptoms from 11 selected OSA questionnaires. The overlap between them was weak (mean Jaccard index: 0.224; ranging from 0.138 to 0.329). All questionnaires contained symptoms of the "OSA symptom" dimension (eg, snoring or witnessed apneas). The STOP-BANG (0.329) and the Berlin (0.280) questionnaires exhibited the highest overlap content. Ten symptoms (40%) were investigated in only 1 questionnaire. CONCLUSIONS The heterogeneity of content and the low overlap across these questionnaires reflect the challenges of screening OSA. The different OSA questionnaires potentially capture varying aspects of the disorder, with the risk of biased results in studies. Suggestions are made for better OSA screening and refinement of clinical OSA phenotypes. CITATION Gauld C, Baillieul S, Martin VP, et al. Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms? J Clin Sleep Med. 2024;20(7):1105-1117.
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Affiliation(s)
- Christophe Gauld
- Service Psychopathologie du Développement de l’Enfant et de l’Adolescent, Hospices Civils de Lyon and Université de Lyon 1, Lyon, France
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS and Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Baillieul
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Vincent P. Martin
- University Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence, France
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | | | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, Montpellier, France
- Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, Montpellier, France
| | - Marie Pelou
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - Poeiti Abi-Saab
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - Julien Coelho
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux, France
| | - Pierre Philip
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux, France
| | - Jean Louis Pépin
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux, France
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3
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Kwon HS, Kim SJ, Shin KJ, Kim S, Yun J, Bae J, Tak HJ, Lee NR, Kim HJ. The Effect of the Lacticaseibacillus paracasei BEPC22 and Lactiplantibacillus plantarum BELP53 Combination (BN-202M) on Body Fat Percentage Loss in Overweight Individuals: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients 2024; 16:1993. [PMID: 38999741 PMCID: PMC11243028 DOI: 10.3390/nu16131993] [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: 06/06/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/14/2024] Open
Abstract
BN-202M is derived from humans and consists of two strains, Lacticaseibacillus paracasei BEPC22 and Lactiplantibacillus plantarum BELP53. Body fat reduction effect and safety of BN-202M were assessed in overweight participants. A total of 150 participants were randomly assigned to the BN-202M and placebo groups at a 1:1 ratio. Dual-energy X-ray absorptiometry was used to objectively measure body fat. After 12 weeks of oral administration, the body fat percentage (-0.10 ± 1.32% vs. 0.48 ± 1.10%; p = 0.009) and body fat mass (-0.24 ± 1.19 kg vs. 0.23 ± 1.05 kg; p = 0.023) of the BN-202M group decreased significantly compared to those of the placebo group. The body weight (-0.58 kg, p = 0.004) and body mass index (BMI; -0.23, p = 0.003) was found to decrease significantly at 12 weeks in the BN-202M group, but not in the placebo group. Metabolome analysis revealed that β-alanine, 3-aminoisobutyric acid, glutamic acid, and octopamine decreased in the weight-decreased BN-202M post-intake group. In the gut microbiota analysis, Akkermansia showed a statistically significant increase in the BN-202M group post-intake compared to the placebo group. No serious adverse events were observed in either group. These results suggest that BN-202M is safe and effective for reducing body fat and weight.
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Affiliation(s)
- Han-Seul Kwon
- Department of Korean Obstetrics and Gynecology, College of Korean Medicine, Semyung University, Jecheon 27136, Republic of Korea;
| | - Seok-Jin Kim
- R&D Center, Hecto Healthcare Co., Ltd., Seoul 06142, Republic of Korea (J.Y.)
| | - Kum-Joo Shin
- R&D Center, Hecto Healthcare Co., Ltd., Seoul 06142, Republic of Korea (J.Y.)
| | - Sanghoon Kim
- R&D Center, Hecto Healthcare Co., Ltd., Seoul 06142, Republic of Korea (J.Y.)
| | - Jongbok Yun
- R&D Center, Hecto Healthcare Co., Ltd., Seoul 06142, Republic of Korea (J.Y.)
| | - Jaewoong Bae
- R&D Center, Hecto Healthcare Co., Ltd., Seoul 06142, Republic of Korea (J.Y.)
| | - Hyun-Ji Tak
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
| | - Na-Rae Lee
- Research Institute for Bioactive-Metabolome Network, Konkuk University, Seoul 05029, Republic of Korea
| | - Hyeong-Jun Kim
- Department of Korean Obstetrics and Gynecology, College of Korean Medicine, Semyung University, Jecheon 27136, Republic of Korea;
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4
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Hawks ZW, Beck ED, Jung L, Fonseca LM, Sliwinski MJ, Weinstock RS, Grinspoon E, Xu I, Strong RW, Singh S, Van Dongen HPA, Frumkin MR, Bulger J, Cleveland MJ, Janess K, Kudva YC, Pratley R, Rickels MR, Rizvi SR, Chaytor NS, Germine LT. Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes. NPJ Digit Med 2024; 7:59. [PMID: 38499605 PMCID: PMC10948782 DOI: 10.1038/s41746-024-01036-5] [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: 03/13/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.
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Affiliation(s)
- Z W Hawks
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - E D Beck
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - L Jung
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - L M Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - M J Sliwinski
- Department of Human Development and Family Studies, Center for Healthy Aging, Pennsylvania State University, State College, PA, USA
| | | | - E Grinspoon
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - I Xu
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - R W Strong
- The Many Brains Project, Belmont, MA, USA
| | - S Singh
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - H P A Van Dongen
- Sleep and Performance Research Center & Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - M R Frumkin
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - J Bulger
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - M J Cleveland
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - K Janess
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Y C Kudva
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - R Pratley
- AdventHealth Translational Research Institute, Orlando, FL, USA
| | - M R Rickels
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S R Rizvi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - N S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - L T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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5
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Vacca M, Spanetta M, Ballesio A, Fernandes M, Placidi F, Izzi F, Lombardo C, Mercuri NB, Laganà G, Liguori C. The Sleepiness-Depression Link in Obstructive Sleep Apnea: Preliminary Results on the Mediation of Impulsivity. J Clin Med 2023; 12:6467. [PMID: 37892605 PMCID: PMC10607807 DOI: 10.3390/jcm12206467] [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: 09/04/2023] [Revised: 09/23/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Emotional impulsivity has been found to be relevant in explaining the association between sleep problems and depressive symptoms, suggesting the potential role of impulsivity as a key underlying mechanism of this link. The objective of this study was to take a preliminary step in understanding the mediating role of impulsivity in the relation between excessive daytime sleepiness (EDS) and depression in patients with obstructive sleep apnea syndrome (OSAS) and to compare psychological and demographic characteristics between different levels of daytime sleepiness. METHODS A total of 138 patients with OSAS underwent polygraphic cardiorespiratory monitoring and completed a series of questionnaires investigating perceived sleepiness, depression, impulsivity, and other psychological characteristics. A mediational model was tested in order to assess whether impulsivity mediated the relation between sleepiness and depressive symptoms while controlling for the effects of age, sex, BMI, and oxygen saturation parameters. RESULTS the mediation model showed that there was a significant indirect effect of impulsivity in the sleepiness-depression link (αβ = 0.084 [0.0243-0.1617]). CONCLUSIONS The here-presented results showed that the sleepiness-depression link is not direct as previous studies asserted, but instead it may be better explained by impulsivity. Research and practical implications are discussed.
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Affiliation(s)
- Mariacarolina Vacca
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | | | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.F.); (F.P.); (N.B.M.)
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.F.); (F.P.); (N.B.M.)
- Sleep Medicine Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Francesca Izzi
- Sleep Medicine Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Caterina Lombardo
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.F.); (F.P.); (N.B.M.)
- Sleep Medicine Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Giuseppina Laganà
- Department of Orthodontics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.F.); (F.P.); (N.B.M.)
- Sleep Medicine Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
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6
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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: 62] [Impact Index Per Article: 62.0] [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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7
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Association of Obstructive Sleep Apnea and Atrial Fibrillation in Acute Ischemic Stroke: A Cross-Sectional Study. J Pers Med 2023; 13:jpm13030527. [PMID: 36983709 PMCID: PMC10051494 DOI: 10.3390/jpm13030527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke.
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8
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Frange C, Franco AM, Brasil E, Hirata RP, Lino JA, Mortari DM, Ykeda DS, Leocádio-Miguel MA, D’Aurea CVR, Silva LOE, Telles SCL, Furlan SF, Peruchi BB, Leite CF, Yagihara FT, Campos LD, Ulhôa MA, Cruz MGDR, Beidacki R, Santos RB, de Queiroz SS, Barreto S, Piccin VS, Coelho FMS, Studart L, Assis M, Drager LF. Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines. Sleep Sci 2022; 15:515-573. [PMID: 36419815 PMCID: PMC9670776 DOI: 10.5935/1984-0063.20220083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 08/13/2024] Open
Abstract
This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.
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Affiliation(s)
- Cristina Frange
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
| | - Aline Marques Franco
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Neurociências e Ciências do
Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de
São Paulo (FMRP-USP) - Ribeirão Preto - SP - Brazil
| | - Evelyn Brasil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Terapia Intensiva, Hospital Israelita Albert
Einstein (HIAE) - São Paulo - SP - Brazil
| | - Raquel Pastrello Hirata
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Pesquisa em Fisioterapia Pulmonar,
Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL) - Londrina -
PR - Brazil
| | - Juliana Arcanjo Lino
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Ciências Médicas, Universidade Federal do
Ceará (UFC) - Fortaleza - CE - Brazil
| | - Daiana Moreira Mortari
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal do Rio Grande do Sul - Porto Alegre - RS -
Brazil
| | - Daisy Satomi Ykeda
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Curso de Fisioterapia, Universidade Estadual do Piauí
(UESPI) - Teresina - PI - Brazil
| | - Mario André Leocádio-Miguel
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisiologia e Comportamento, Universidade Federal do
Rio Grande do Norte - Natal - RN - Brazil
| | | | - Luciana Oliveira e Silva
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Ciências da Saúde, Universidade
Federal de Uberlândia (UFU) - Uberlândia - MG - Brazil
| | | | - Sofia Fontanello Furlan
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
| | - Bruno Búrigo Peruchi
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Neurociência, Universidade do Estado
de Santa Catarina (UNESC) - Criciúma - SC - Brazil
| | - Camila Ferreira Leite
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, UFC; Programas de Mestrado em
Fisioterapia e Funcionalidade, e Mestrado em Ciências Cardiovasculares, UFC -
Fortaleza - CE - Brazil
| | - Fabiana Tokie Yagihara
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Setor de Neurofisiologia Clínica, Departamento de
Neurologia e Neurocirurgia, EPM, UNIFESP - São Paulo - SP - Brazil
| | | | - Melissa Araújo Ulhôa
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto Metropolitano de Ensino Superior, Faculdade de Medicina
do Vale do Aço (UNIVAÇO) - Ipatinga - MG - Brazil
| | | | - Ricardo Beidacki
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Faculdade Inspirar, Unidade Porto Alegre - Porto Alegre - RS -
Brazil
| | - Ronaldo Batista Santos
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, Hospital Universitário, USP -
São Paulo - Brazil
| | | | - Simone Barreto
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto do Sono, Associação Fundo Incentivo
à Pesquisa - São Paulo - Brazil
| | - Vivien Schmeling Piccin
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório do Sono, Divisão de Pneumologia do
Instituto do Coração (InCor), FMUSP, USP - São Paulo - SP -
Brazil
| | - Fernando Morgadinho Santos Coelho
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Psicobiologia, EPM, UNIFESP - São Paulo -
SP - Brazil
| | - Luciana Studart
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal de Pernambuco - Recife - PE - Brazil
| | - Marcia Assis
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Clínica do Sono de Curitiba, Hospital São Lucas -
Curitiba - PR - Brazil
| | - Luciano F. Drager
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
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Duarte RLDM, Togeiro SMGP, Palombini LDO, Rizzatti FPG, Fagondes SC, Magalhães-da-Silveira FJ, Cabral MM, Genta PR, Lorenzi-Filho G, Clímaco DCS, Drager LF, Codeço VM, Viegas CADA, Rabahi MF. Brazilian Thoracic Association Consensus on Sleep-disordered Breathing. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220106. [PMID: 35830079 PMCID: PMC9262434 DOI: 10.36416/1806-3756/e20220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022]
Abstract
Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.
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Affiliation(s)
| | - Sonia Maria Guimarães Pereira Togeiro
- . Disciplina de Clínica Médica, Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Instituto do Sono, São Paulo (SP) Brasil
| | | | | | - Simone Chaves Fagondes
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | | | - Pedro Rodrigues Genta
- . Laboratório de Investigação Médica 63 - LIM 63 (Laboratório do Sono) - Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | - Geraldo Lorenzi-Filho
- . Laboratório de Investigação Médica 63 - LIM 63 (Laboratório do Sono) - Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | | | - Luciano Ferreira Drager
- . Unidade de Hipertensão, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | - Vitor Martins Codeço
- . Hospital Regional da Asa Norte, Secretaria de Estado de Saúde do Distrito Federal, Brasília (DF) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás - UFG - Goiânia (GO) Brasil
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10
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Pitta RM, Cerazi BG, Queiroga L, Ritti Dias RM, de Mello MT, Cesena FHY, Rica RL, Baker JS, Sommer M, Cucato GG, Bocalini DS, Kauffman O. Are physical inactivity, sitting time and screen time associated with obstructive sleep apnea in adults? A cross-sectional study. SAO PAULO MED J 2022; 140:171-181. [PMID: 35195233 PMCID: PMC9610257 DOI: 10.1590/1516-3180.2020.0651.r2.08062021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sitting time, screen time and low physical activity (PA) levels have been associated with several diseases and all-cause mortality. PA is related to better sleep quality and absence of daytime sleepiness, along with lower risks of obstructive syndrome apnea (OSA). However, studies on the relationship between sitting time, screen time and OSA are scarce in the literature. OBJECTIVE To analyze associations between PA levels, sitting time, screen time and OSA among adults with suspected sleep disorder. DESIGN AND SETTING Cross-sectional study conducted at Hospital Israelita Albert Einstein. METHODS Data were collected from 369 adults with suspected sleep disorders who visited the hospital's neurophysiology clinic between August 2015 and January 2017. RESULTS Correlations between hypopnea and PA indicators were demonstrated for total sitting time (0.123; P = 0.019) and total screen time (0.108; P = 0.038). There was also a correlation between latency for rapid-eye-movement sleep (REM_LAT) and total sitting time (0.103; P = 0.047) and a negative correlation between mean oxyhemoglobin saturation (SaO_Avg) and total PA time (-0.103; P = 0.048). There were no associations between PA parameters and apnea-hypopnea index. After adjusting for confounding factors (body mass index, age and gender), sitting time and screen time were not associated with OSA. CONCLUSION After adjusting for anthropometric and clinical factors, excessive sitting time or screen time was not associated with OSA in adults suspected of sleep disorders. Age, gender, hypertension, body mass index and waist circumference were associated with OSA.
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Affiliation(s)
- Rafael Mathias Pitta
- MSc. Professor, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Bruno Gion Cerazi
- MSc. Professor, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Luana Queiroga
- MSc. Professor, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | | | - Marco Túlio de Mello
- PhD. Professor, Sports Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Fernando Henpin Yue Cesena
- MD, PhD. Attending Physician, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Roberta Luksevicius Rica
- MSc, PhD. Professor, Department of Physical Education, Estácio de Sá University, Vitória (ES), Brazil.
| | - Julien Steven Baker
- PhD, DSc. Professor, Department of Sport, and Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
| | - Marcio Sommer
- MD, PhD. Attending Physician, Sciences of aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
| | - Gabriel Grizzo Cucato
- PhD. Professor, Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom.
| | - Danilo Sales Bocalini
- PhD. Professor, Physical Education and Sports Center, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.
| | - Oskar Kauffman
- MD, PhD. Attending Physician, Sciences of Aging, Hospital Israelita Albert Einstein (HIAE), São Paulo (SP), Brazil.
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11
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Abstract
AbstractThe following review is designed to explore the pathophysiology of sleep apnea in aging women. The review initially introduces four endotypes (i.e., a more collapsible airway, upper airway muscle responsiveness, arousal threshold, and loop gain) that may have a role in the initiation of obstructive sleep apnea. Thereafter, sex differences in the prevalence of sleep apnea are considered along with differences in the prevalence that exist between younger and older women. Following this discussion, we consider how each endotype might contribute to the increase in prevalence of sleep apnea in aging women. Lastly, we address how modifications in one form of respiratory plasticity, long-term facilitation, that might serve to mitigate apneic events in younger women may be modified in aging women with obstructive sleep apnea. Overall, the published literature indicates that the prevalence of sleep apnea is increased in aging women. This increase is linked primarily to a more collapsible airway and possibly to reduced responsiveness of upper airway muscle activity. In contrast, modifications in loop gain or the arousal threshold do not appear to have a role in the increased prevalence of sleep apnea in aging women. Moreover, we suggest that mitigation of long-term facilitation could contribute to the increased prevalence of sleep apnea in aging women.
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12
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Kinkead R, Gagnon M, Joseph V, Sériès F, Ambrozio-Marques D. Stress and Loss of Ovarian Function: Novel Insights into the Origins of Sex-Based Differences in the Manifestations of Respiratory Control Disorders During Sleep. Clin Chest Med 2021; 42:391-405. [PMID: 34353446 DOI: 10.1016/j.ccm.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The respiratory system of women and men develops and functions in distinct neuroendocrine milieus. Despite differences in anatomy and neural control, homeostasis of arterial blood gases is ensured in healthy individuals regardless of sex. This convergence in function differs from the sex-based differences observed in many respiratory diseases. Sleep-disordered breathing (SDB) results mainly from episodes of upper airway closure. This complex and multifactorial respiratory disorder shows significant sexual dimorphism in its clinical manifestations and comorbidities. Guided by recent progress from basic research, this review discusses the hypothesis that stress is necessary to reveal the sexual dimorphism of SDB.
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Affiliation(s)
- Richard Kinkead
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada.
| | - Marianne Gagnon
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada
| | - Vincent Joseph
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada
| | - Frédéric Sériès
- Department of Medicine, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Québec, Canada
| | - Danuzia Ambrozio-Marques
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada
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13
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Chen H, Zheng Z, Chen R, Zeng Y, Li N, Zhu J, Zhong Y, Liu H, Lu J, Zhang N, Hong C. A meta-analysis of the diagnostic value of NoSAS in patients with sleep apnea syndrome. Sleep Breath 2021; 26:519-531. [PMID: 34106436 DOI: 10.1007/s11325-021-02410-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The NoSAS score is a new tool widely used in recent years to screen for obstructive sleep apnea. A number of studies have shown that the NoSAS score is more accurate than previous tools, such as the Berlin, STOP-Bang, and STOP questionnaires. Therefore, this meta-analysis assessed the diagnostic value of the NoSAS score for sleep apnea syndrome in comparison to polysomnography. METHODS Two researchers searched the PubMed, EMBASE, Cochrane, and Web of Science databases through November 13, 2020. This paper used Endnote9.3 software to manage the literature and RevMan 5.3 and STATA12.0 software to perform the meta-analysis. RESULTS A total of 10 studies were included in this meta-analysis, including 14,510 patients. The meta-analysis showed that the pooled sensitivity was 0.798 (95% CI 0.757, 0.833), the pooled specificity was 0.582 (95% CI 0.510, 0.651), the positive likelihood ratio was 1.909 (95% CI 1.652, 2.206), the negative likelihood ratio was 0.347 (95% CI 0.300, 0.403), the diagnostic OR was 5.495 (95% CI 4.348, 6.945), and the area under the SROC curve was 0.77 (95% CI 0.73, 0.80). The NoSAS score has good efficacy in identifying patients likely to have obstructive sleep apnea. CONCLUSION The NoSAS score can accurately identify patients likely to have obstructive sleep apnea. Therefore, in the absence of polysomnography, one should use the NoSAS score to evaluate patients with suspected sleep apnea syndrome.
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Affiliation(s)
- Huimin Chen
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangdong Medical University, Guangzhou, China
| | - Zhenzhen Zheng
- Department of Respiration, The Second Affiliated Hospital of Guangdong Medical University, Guangzhou, China
| | - Riken Chen
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Zeng
- Department of Respiration, The Second Affiliated Hospital of Guangdong Medical University, Guangzhou, China
| | - Nanhong Li
- Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Guangzhou, China
| | - Jinru Zhu
- Department of Respiration, The Second Affiliated Hospital of Guangdong Medical University, Guangzhou, China
| | - Yue Zhong
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haimin Liu
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianmin Lu
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nuofu Zhang
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Cheng Hong
- China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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14
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-lab titration? J Clin Sleep Med 2021; 17:1815-1820. [PMID: 33908344 DOI: 10.5664/jcsm.9282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The first-choice therapy for adults with moderate/severe obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. METHODS This cross-sectional study was conducted in adults diagnosed with moderate/severe OSA (baseline apnea-hypopnea index [AHI] ≥ 15.0/h), who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep-lab setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). RESULTS A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values as delineated during the titration; all p-values > 0.005. However, the median residual AHI was significantly higher in males versus females: 2.7/h versus 2.2/h (p = 0.008). Body mass index [BMI] (β: 0.292, p < 0.001), baseline AHI (β: 0.167, p < 0.001), and age (β: 0.065, p = 0.035) were independent predictors of the therapeutic CPAP level settings. CONCLUSIONS Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95th percentile CPAP requirement during an auto-adjusting CPAP titration.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab - Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil.,Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO
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15
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Ren Y, Cao C, Liang X, Ju Z, Zhang L, Cui X, Wang G. Validation of manufacturers' laryngeal mask airway size selection standard: a large retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:196. [PMID: 33708823 PMCID: PMC7940924 DOI: 10.21037/atm-20-4838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Laryngeal mask airway (LMA) is a prominent supraglottic airway device, widely used especially in difficult airway management. However, the LMA sizes recommended by the manufacturers are not always well matched in clinical practice, which leads to complications. To date, there are rare models to validate whether the manufacturers’ standard is suitable for use in clinical practice. Methods A total of 58,956 patients undergoing general anesthesia using LMA device were included in the study between January 1, 2011 and December 31, 2018, to validate the adherence rate of LMA sizes according to the manufacturers’ recommendations. A logistic regression analysis was performed based on the actual LMA size used in clinical practice to establish separately size selection guidelines with gender, weight, and age as variables in adults, adolescents, and children. Results LMA insertions were analyzed in 50,776 (86.1%) adults, 3,548 (6%) adolescents, and 4,632 (7.9%) children. Suitability of manufacturers’ recommendations was higher in children [male: 86.02%; female: 85.09%] than adults [male: 72.75%; female: 78.13%] or adolescents [male: 73.4%; female: 70.79%]. For adults and adolescents, LMA size was better predicted using the regression model rather than the manufacturers’ recommendations [male adults: 82.4% (81.16–83.57%) vs. 73.21% (71.79–74.59%), P<0.05; female adults: 87.82% (86.65–88.9%) vs. 77.07% (75.6–78.48%), P<0.05; male adolescents: 79.45% (74.86–83.4%) vs. 72.05% (67.09–76.53%), P<0.05; female adolescents: 78.4% (71.11–84.31%) vs. 72.22% (64.54–78.82%), P<0.05]. For children, there was equal performance suitability using the regression model and the manufacturers’ recommendations. Conclusions The model-based guidelines may provide more accurate directions for LMA size selection for adolescents and adults than the manufacturers’ weight-based recommendations, whereas the manufacturers’ recommendation in children is consistent with clinical practice.
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Affiliation(s)
- Yaoyao Ren
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Cuicui Cao
- School of Management, Huazhong University of Science and Technology, Wuhan, China
| | - Xuan Liang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhihai Ju
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ling Zhang
- School of Public Health, Capital Medical University, Beijing, China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Katz SL, Blinder H, Naik T, Barrowman N, Narang I. Does neck circumference predict obstructive sleep apnea in children with obesity? Sleep Med 2021; 78:88-93. [PMID: 33418431 DOI: 10.1016/j.sleep.2020.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) affects 10-50% of children with obesity, but its identification is challenging and wait times for testing are long. Previous studies suggest that neck circumference (NC) and neck-to-height ratio (NHR) may predict OSA. Our objectives were to 1) evaluate associations of NC and NHR with OSA; 2) model NHR as a predictor of OSA, adjusting for age, sex, and Tanner stage; and 3) identify thresholds of NHR associated with OSA, in children with obesity. METHODS Participants were aged 8-17 years, with obesity (BMI >95%ile), undergoing polysomnography. Associations between NC and NHR with OSA were evaluated. NHR, age, sex and self-reported Tanner stage (early/late) were included in a negative binomial multiple regression model to predict obstructive apnea hypopnea index (OAHI). RESULTS 71 children participated, with median age 14.8 years (IQR 12.6, 16.0), 54% male, median BMI z-score 2.5 (IQR 2.3, 2.7), and 77% late Tanner stage. OSA was severe in 18 children (25.4%), moderate in 12 (16.9%), and mild in 18 (25.4%). In the model, each 0.01 increase in NHR was associated with a 55% increase in OAHI (95% CI: 36%, 80%); boys had a 119% higher OAHI than girls (95% CI: 10%, 337%). Threshold NHR associated with moderate-severe OSA was 0.25 in females and 0.23 in males. CONCLUSIONS NHR and male sex independently predict OSA severity in children with obesity, adjusting for age and Tanner stage. Children with obesity and NHR above identified thresholds are more likely to have moderate-severe OSA, and may benefit from earlier polysomnography.
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Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada.
| | - Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada
| | - Tanvi Naik
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 5B2, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
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Neves Junior JAS, Fernandes APA, Tardelli MA, Yamashita AM, Moura SMPGT, Tufik S, Silva HCAD. Cutoff points in STOP-Bang questionnaire for obstructive sleep apnea. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:561-569. [PMID: 33053014 DOI: 10.1590/0004-282x20200086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) is a public health problem of high prevalence and impacts on quality of life, anesthetic complications and cardiovascular diseases. In view of the difficulty in accessing the polysomnography, it is necessary to validate other methods for OSAS diagnostic screening in clinical practice in our country, such as the STOP-Bang questionnaire. OBJECTIVE To validate the STOP-Bang questionnaire in Brazilians and evaluate optimal cutoff points. METHODS After translation and back-translation, STOP-Bang questionnaire was applied to 71 individuals previously submitted to polysomnography and classified into control, mild, moderate or severe OSAS. RESULTS The majority of patients was male (59.2%), white (79%), aged 48.9±13.9 years, and with neck circumference >40 centimeters (73.8%). STOP-Bang score was higher in OSAS mild (median/inter-quartis 25-75%: 5/3.5-6), moderate (4.5/4-5) and severe (5/4-6), versus control (2.5/1-4). The receiver operating characteristic (ROC) curve indicate that scores 3, 4 and 6, present the best specificity values (100, 80 and 92.9%) with acceptable sensitivity (60, 66.7 and 50%) in the mild, moderate and severe OSAS subgroups, respectively. In OSAS group analysis (Apnea Hypopnea Index [AHI] ≥5, <15, ≥15 - <30, ≥30), STOP-Bang cutoff point of 6 was optimal to detect OSAS. CONCLUSION STOP-Bang Brazilian version identified OSAS patients with lower sensitivity and higher specificity compared to previous studies. Different cutoff points would improve the performance to detect patients with more severe OSAS.
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Affiliation(s)
- Jose Apolinário Silva Neves Junior
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | - Ana Paula Andrade Fernandes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | - Maria Angela Tardelli
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | - Américo Massafuni Yamashita
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | | | - Sérgio Tufik
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Psychobiology, Sleep and Respiratory Divisions, São Paulo SP, Brazil
| | - Helga Cristina Almeida da Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
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Miller CA, Hwang SJ, Cotter MM, Vorperian HK. Developmental morphology of the cervical vertebrae and the emergence of sexual dimorphism in size and shape: A computed tomography study. Anat Rec (Hoboken) 2020; 304:1692-1708. [PMID: 33119940 DOI: 10.1002/ar.24559] [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: 05/05/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 01/18/2023]
Abstract
Cervical vertebral bodies undergo substantial morphological development during the first two decades of life that are used clinically to visually determine skeletal maturation with the cervical vertebral maturation index (CVMI). CVMI defines six stages that capture the morphological transformations from 6 years to 18 years. However, CVMI has poor reproducibility given its qualitative nature and does not account for sexual dimorphism. This study aims to quantify the morphological development of the cervical vertebral bodies C2-C7 in size (height and depth) and shape and examine the emergence of sexual dimorphism. Using 115 (70 M;45F) computed tomography studies from typically developing individuals ages 6 months to 20 years, landmarks were placed at the margins of the C2-C7 cervical vertebral bodies in the midsagittal plane for size and shape analysis. Findings revealed a dichotomy in the growth trends of height versus depth. The C2-C7 growth in depth gained the majority of the adult size by age 5 years, while the C3-C7 growth in height displayed two periods of accelerated growth during early childhood and puberty. Significant sex differences were found in height and depth growth trends and the form-space ontogenetic trajectories during puberty, with minor but evident differences emerging at age 3 years. Female C2-C7 depth measures were smaller than males at all ages. However, sex differences in height became evident due to males continuing to grow after females reach maturity. Findings quantify the morphological developmental stages of CVMI and emphasize the need to account for sex differences when assessing skeletal maturation.
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Affiliation(s)
- Courtney A Miller
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Seong Jae Hwang
- Department of Computer Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meghan M Cotter
- Gross Anatomy Teaching Group, Medical Education Office, Madison, Wisconsin, USA.,Academic Affairs, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Houri K Vorperian
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Are the International Classification of Functioning, Disability and Health (ICF) domains considered in the obstructive sleep apnea instruments? An integrative review. Sleep Breath 2020; 25:1089-1100. [PMID: 32865728 DOI: 10.1007/s11325-020-02173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive Sleep Apnea (OSA) is related to cardiovascular, metabolic, and neurocognitive diseases. Furthermore, OSA symptoms, such as excessive sleepiness, fatigue, and mood disorders, may interfere in functioning. The assessment of this aspect in patients with OSA is not frequent and no specific instrument is available in the literature. Our aim is to identify if the International Classification of Functioning, Disability and Health (ICF) domains are considered in the validated instruments used to assess patients with OSA. METHODS In this integrative literature review, three databases were searched: Pubmed, Embase, and LILACS. Bibliographic survey was carried out in 2020, between March and July. Articles published in English, Portuguese, and Spanish with validated tools to assess OSA in adults were included. RESULTS Thirty instruments have undergone a process of concept extraction and coding according to the ICF, generating a total of 769 significant concepts. It was observed that the function domain was the most prevalent, making 42% (n = 323) of the concepts, followed by domains of activity (16%), participation (10%), environmental factors (5%), personal factor (5%), and structure (1%). Only one instrument, the "Sleep Apnea Quality of Life Index (SAQLI)," encompasses all domains of the ICF in its constructs. CONCLUSION In the analyzed instruments, the function domain prevails, with most concepts related to sleep functions. Only one validated instrument included in this research covered all the ICF domains. This instrument closely matched the recommended way of assessing functioning, though it approached the domains in an unbalanced way.
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Wang X, Li W, Zhou J, Wei Z, Li X, Xu J, Zhang F, Wang W. Smoking and sleep apnea duration mediated the sex difference in daytime sleepiness in OSA patients. Sleep Breath 2020; 25:289-297. [PMID: 32529520 DOI: 10.1007/s11325-020-02109-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Daytime sleepiness is a common symptom of obstructive sleep apnea (OSA) and is more common in men, but the underlying mechanism remains unclear. The aim of this study was to assess whether or not sex differences in daytime sleepiness persisted after controlling for age and OSA severity and to explore the factors contributing to daytime sleepiness in patients with OSA. METHODS A total of 104 pairs of patients with OSA, matched by age and apnea-hypopnea index (AHI), were enrolled in this retrospective study. Demographic data were collected; daytime sleepiness was measured by the Epworth Sleepiness Scale (ESS); and polysomnography (PSG) was performed on each participant. These measurements were compared between sexes, and the factors affecting daytime sleepiness were explored with correlation and multivariate linear regression analyses. RESULTS Men had significantly higher ESS scores (p = 0.021) than women. Regarding demographics, BMI, neck/height ratio, and proportion of habitual smoking and alcohol intake were significantly higher in men. Regarding PSG findings, men had more rapid eye movement sleep, a longer mean apnea-hypopnea duration, and a longer mean apnea duration (MAD). Regression analysis showed that two sex-associated variables, habitual smoking (β = 0.189, p = 0.006) and MAD (β = 0.154, p = 0.024), had the strongest association with ESS scores. Further analysis revealed that MAD was significantly influenced by apnea index (β = 0.306, p < 0.001) and sex (β = - 0.193, p = 0.003). CONCLUSION The sex difference in daytime sleepiness persists in patients with OSA, even after matching AHI and age. The difference is mediated by sex-specific smoking habits and sex differences in apnea duration.
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Affiliation(s)
- Xingjian Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenyang Li
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiawei Zhou
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhijing Wei
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaomeng Li
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiahuan Xu
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Fang Zhang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China.
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Gomes MF, Giannasi LC, Fillietaz-Bacigalupo E, de Mancilha GP, de Carvalho Silva GR, Soviero LD, da Silva GYS, Nazario LDM, Dutra MTDS, Silvestre PR, de Oliveira LVF, Nacif SR, de Oliveira EF, Serafim IM, Pereira BD, Greca AR, Goulart MDGV, Rode SDM, Tanaka MH, Koga-Ito CY, Amorim JBDO, Salgado MAC. Evaluation of the masticatory biomechanical function in Down syndrome and its Influence on sleep disorders, body adiposity and salivary parameters. J Oral Rehabil 2020; 47:1007-1022. [PMID: 32463923 DOI: 10.1111/joor.13023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the phenotypic features of the masticatory biomechanics in atypical subjects with Down syndrome (DS). Its influence was analysed on sleep disorders, body adiposity and its risks, and some physicochemical properties of saliva. METHODS Seventy subjects were enrolled to assess masticatory biomechanical function and divided into two groups: DS and control groups. Electrical activities of the masseter and temporal muscles (at rest and in maximum voluntary clench-MVC), maximum bite force-MBF and maximum mouth opening-MMO were investigated. Among the atypical subjects, just 24 participants underwent the anthropometry, the polysomnography II and the saliva testing (salivary flow rate-SFR, buffer capacity-BC and salivary cortisol levels, morning/SC-AM and night/SC-PM). RESULTS MVC and MBF values showed high statistical significance in the control group (P < .001) than in the DS group of 35. MMO values were slightly increased in the DS group in relation to the control group. Overweight and obesity were found in both genders. Atypical women showed higher risk to develop cardiovascular-metabolic diseases than in atypical men. OSA severe was 20% for atypical women and 42.8% for atypical men, whereas snoring index was present in all genders. SFR was reduced in 100% of atypical subjects (hyposalivation in 10% women and 28.5% men). Furthermore, 100% BC, 66.6% SC-AM and 91.6% SC-PM showed normal patterns. CONCLUSION Masseter and temporal muscle hypotonia was found in all atypical subjects with DS. This muscle dysfunction strongly was related to overweight/obesity, risks for development of cardiovascular/metabolic diseases, OSA severity, successive snoring episodes and salivary flow reduction in DS.
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Affiliation(s)
- Mônica Fernandes Gomes
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Lilian Chrystiane Giannasi
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Elaine Fillietaz-Bacigalupo
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Gabriela Pinto de Mancilha
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Gabriela Raine de Carvalho Silva
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Laura Dias Soviero
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Gabriella Yasmin Santos da Silva
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Letícia de Miguel Nazario
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Marignês Theotonio Dos Santos Dutra
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | | | | | | | | | - Irene Moreira Serafim
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Bruna Dicieri Pereira
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Amanda Reis Greca
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Maria das Graças Vilela Goulart
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Sigmar de Mello Rode
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | | | - Cristiane Yumi Koga-Ito
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - José Benedito de Oliveira Amorim
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
| | - Miguel Angel Castillo Salgado
- Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) and Multiprofessional Service of Oral Medicine for People with Disability and Caregivers (SEMMO) of the Institute of Science and Technology, São José dos Campos Campus, São Paulo State University-UNESP, São Paulo, Brazil
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Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients. J Clin Med 2020; 9:jcm9010130. [PMID: 31947711 PMCID: PMC7019723 DOI: 10.3390/jcm9010130] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Gender affects the clinical presentation of obstructive sleep apnea (OSA). The classic OSA symptoms, such as sleepiness, snoring, and apnea, are not so frequent in women. Objectives: To evaluate possible gender differences in questionnaires used for OSA prediction, such as the Epworth Sleepiness Scale (ESS), STOP, STOP Bang (SB), Berlin Questionnaire (BQ), Athens Insomnia Scale (AIS), and Fatigue Scale (FS). Methods: 350 males were matched with 350 women referred to a sleep clinic, according to OSA severity. All responded to the questionnaires and underwent a sleep study. Cardiovascular disease (CVD) patients were separately analyzed. Results: ESS did not differ between genders. SB was higher in males, whereas STOP, BQ, AIS, and FS were higher in females. BQ presented the highest sensitivity in both genders, whereas STOP exhibited the highest specificity in males and ESS in females. AIS and FS were more sensitive and SB more specific in females, whereas BQ was more specific in males. For severe OSA, the predictive values of SB and BQ were almost similar for both genders; however AIS and FS were higher in women. CVD patients presented higher scores, independent of gender, except for AIS, which was higher in females. Conclusion: Gender-specific evaluation of questionnaires is necessary to prevent OSA under-diagnosis.
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Duarte RL, Magalhães-da-Silveira FJ, Oliveira-E-Sá TS, Silva JA, Mello FC, Gozal D. Obstructive Sleep Apnea Screening with a 4-Item Instrument, Named GOAL Questionnaire: Development, Validation and Comparative Study with No-Apnea, STOP-Bang, and NoSAS. Nat Sci Sleep 2020; 12:57-67. [PMID: 32158294 PMCID: PMC6986247 DOI: 10.2147/nss.s238255] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a very prevalent disorder. Here, we aimed to develop and validate a practical questionnaire with yes-or-no answers, and to compare its performance with other well-validated instruments: No-Apnea, STOP-Bang, and NoSAS. METHODS A cross-sectional study containing consecutively selected sleep-lab subjects underwent full polysomnography. A 4-item model, named GOAL questionnaire (gender, obesity, age, and loud snoring), was developed and subsequently validated, with item-scoring of 0-4 points (≥2 points indicating high risk for OSA). Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated using contingency tables. OSA severity was classified based on conventionally accepted apnea/hypopnea index thresholds: ≥5.0/h (OSA≥5), ≥15.0/h (OSA≥15), and ≥30.0/h (OSA≥30). RESULTS Overall, 7377 adults were grouped into two large and independent cohorts: derivation (n = 3771) and validation (n = 3606). In the derivation cohort, screening of OSA≥5, OSA≥15, and OSA≥30 revealed that GOAL questionnaire achieved sensitivity ranging from 83.3% to 94.0% and specificity ranging from 62.4% to 38.5%. In the validation cohort, screening of OSA≥5, OSA≥15, and OSA≥30, corroborated validation steps with sensitivity ranging from 83.7% to 94.2% and specificity from 63.4% to 37.7%. In both cohorts, discriminatory ability of GOAL questionnaire for screening of OSA≥5, OSA≥15, and OSA≥30 was similar to No-Apnea, STOP-Bang or NoSAS. CONCLUSION All four instruments had similar performance, leading to a possible greater practical implementation of the GOAL questionnaire, a simple instrument with only four parameters easily obtained during clinical evaluation.
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Affiliation(s)
- Ricardo Lm Duarte
- Sleep - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Rio de Janeiro, Brazil.,Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Tiago S Oliveira-E-Sá
- Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Joana A Silva
- Clínica São Vicente, Rede D'Or, Rio de Janeiro, Brazil
| | - Fernanda Cq Mello
- Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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Kim H, Lee M, Hwangbo Y, Yang KI. Automatic Derivation of Continuous Positive Airway Pressure Settings: Comparison with In-Laboratory Titration. J Clin Neurol 2020; 16:314-320. [PMID: 32319249 PMCID: PMC7174110 DOI: 10.3988/jcn.2020.16.2.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 01/12/2023] Open
Abstract
Background and Purpose This study was designed to investigate differences in the final recommended pressure setting between that derived from an autotitrating continuous positive airway pressure (APAP) device and manual in-laboratory continuous positive airway pressure (CPAP) titration, as well as the factors that influence pressure differences in patients with obstructive sleep apnea (OSA). Methods This study enrolled 50 patients with OSA. All patients underwent both APAP titration and manual CPAP titration. We obtained the average device pressure ≤90% of the time (APAP90) from the downloaded manual for the APAP machine and the optimal pressure obtained by manual CPAP titration (CPAPmanual). We placed the subjects into three groups based on the pressure difference (ΔP) obtained by subtracting CPAPmanual from APAP90: 1) Prequal (ΔP=0), 2) CPAPmanual+ (ΔP ≤−1), and 3) APAP90+ (ΔP ≥1). Regression analysis was conducted to identify predictive factors associated with ΔP. Results The values of APAP90 and CPAPmanual were 9.50±3.03 cmH2O and 9.48±2.71 cmH2O (mean±SD), respectively (p=0.95). The Prequal, CPAPmanual+, and APAP90+ groups comprised 9 (18%), 23 (46%), and 18 (36%) subjects, respectively. Regression analyses revealed that male sex [β=3.539, 95% confidence interval (CI)=0.040–7.039], body mass index (BMI) (β=0.186, 95% CI=0.020–0.352), and average usage per day (β=0.768, 95% CI=0.077–1.459) were associated with ΔP. Conclusions While the mean pressure in the overall cohort did not differ significantly between APAP90 and CPAPmanual, there was a discordance majority showing different single pressures obtained when applying the two titration methods. Being Male, having an increased BMI, and having an increased average usage per day of APAP were significantly correlated with increased ΔP in this study.
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Affiliation(s)
- Hyeyun Kim
- Department of Neurology, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Korea
| | - Mija Lee
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Young Hwangbo
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
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Cho SH, Jeon JY, Jang KS, Kim SY, Kim KR, Ryu S, Hwang KG. Gender-specific cephalometric features related to obesity in sleep apnea patients: trilogy of soft palate-mandible-hyoid bone. Maxillofac Plast Reconstr Surg 2019; 41:58. [PMID: 31879661 PMCID: PMC6904695 DOI: 10.1186/s40902-019-0242-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to investigate the relationship between gender-specific and obesity-related airway anatomy in patients with obstructive sleep apnea (OSA) by using cephalometric analyses. Methods We retrospectively evaluated 206 patients with suspected OSA undergoing polysomnography and anthropometric measurements such as body mass index, neck circumference, and waist-hip ratio. We checked lateral cephalometry to measure tissue landmarks including angle from A point to nasion to B point (ANB), soft palate length (SPL), soft palate thickness (SPT), retropalatal space (RPS), retrolingual space (RLS), and mandibular plane to hyoid (MPH). Results Male with OSA showed significantly increased SPL (P = .006) compared with controls. SPL and MPH had significant correlation with apnea-hypopnea index (AHI) and central obesity. Female with OSA showed significantly increased ANB (P = .013) and SPT (P = .004) compared with controls. The receiver operating characteristic curves revealed that SPT in male and ANB and SPT in female were significant in model 1 (AHI ≥ 5) and model 2 (AHI ≥ 15). MPH was also significant for male in model 2. Conclusion Male and female with OSA had distinct anatomic features of the upper airway and different interactions among soft palate, mandible, and hyoid bone.
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Affiliation(s)
- Seok Hyun Cho
- 1Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Jae-Yun Jeon
- 2Department of Dentistry/Oral and Maxillofacial Surgery, School of Medicine, Hanyang University, 222-1 Wangshimniro, Seongdong-gu, Seoul, 133-792 Korea
| | - Kun-Soo Jang
- 2Department of Dentistry/Oral and Maxillofacial Surgery, School of Medicine, Hanyang University, 222-1 Wangshimniro, Seongdong-gu, Seoul, 133-792 Korea
| | - Sang Yoon Kim
- 3Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Vienna, USA
| | - Kyung Rae Kim
- 1Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Seungho Ryu
- 5Department of Occupational Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kyung-Gyun Hwang
- 2Department of Dentistry/Oral and Maxillofacial Surgery, School of Medicine, Hanyang University, 222-1 Wangshimniro, Seongdong-gu, Seoul, 133-792 Korea
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Zhang Z, Cheng J, Yang W, Zou H, Su C, Miao J. Gender differences in clinical manifestations and polysomnographic findings in Chinese patients with obstructive sleep apnea. Sleep Breath 2019; 24:1019-1026. [DOI: 10.1007/s11325-019-01943-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
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Godoroja D, Sorbello M, Margarson M. Airway management in obese patients: The need for lean strategies. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Öztürk NAA, Dilektaşlı AG, Çetinoğlu ED, Ursavaş A, Karadağ M. Diagnostic Accuracy of a Modified STOP-BANG Questionnaire with National Anthropometric Obesity Indexes. Turk Thorac J 2019; 20:103-107. [PMID: 30958981 DOI: 10.5152/turkthoracj.2018.18074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a very common sleep-related disorder and has many medical complications. Although the STOP-BANG questionnaire is an attractive screening tool because of high sensitivity, it lacks power in specificity. The aim of the present study was to evaluate and compare the diagnostic accuracy of standard STOP-BANG and a modified STOP-BANG questionnaire, using national cut-off values for neck circumference that determined OSA, in a sleep center population. MATERIALS AND METHODS One hundred eighty-five participants who were referred to the sleep-disordered breathing clinic were consecutively enrolled. We used 40 cm and 36 cm as the cut-off values for neck circumference, thus scoring patients accordingly and creating a modified STOP-BANG score with national anthropometric obesity indexes. RESULTS The median neck circumferences were 41 (39-44) cm, 40 (37-42) cm, and 43 (40-45) cm for total population, female gender, and male gender, respectively. The mean STOP-BANG score was 4.5±1.5, and the mean modified STOP-BANG score was 4.9±1.5. Discrimination of OSA measured by area under the curve for both questionnaires is comparable (p>0.05). Sensitivity to define OSA (apnea-hypopnea index (AHI)≥5) was 92.2% and 93.8% for original and modified STOP-BANG questionnaire, respectively. Sensitivity for moderate (AHI≥15) and severe OSA (AHI≥30) was identical for both questionnaires. CONCLUSION The STOP-BANG questionnaire has an excellent sensitivity, but modest specificity and adding national obesity indexes for neck circumference achieved similar results in terms of sensitivity and specificity with the original questionnaire.
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Affiliation(s)
| | - Aslı Görek Dilektaşlı
- Department of Pulmonary Medicine, Uludağ University School of Medicine, Bursa, Turkey
| | | | - Ahmet Ursavaş
- Department of Pulmonary Medicine, Uludağ University School of Medicine, Bursa, Turkey
| | - Mehmet Karadağ
- Department of Pulmonary Medicine, Uludağ University School of Medicine, Bursa, Turkey
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Miller CA, Hwang SJ, Cotter MM, Vorperian HK. Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography. J Anat 2019; 234:764-777. [PMID: 30945292 DOI: 10.1111/joa.12976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 11/28/2022] Open
Abstract
The size and shape of human cervical vertebral bodies serve as a reference for measurement or treatment planning in multiple disciplines. It is therefore necessary to understand thoroughly the developmental changes in the cervical vertebrae in relation to the changing biomechanical demands on the neck during the first two decades of life. To delineate sex-specific changes in human cervical vertebral bodies, 23 landmarks were placed in the midsagittal plane to define the boundaries of C2 to C7 in 123 (73 M; 50 F) computed tomography scans from individuals, ages 6 months to 19 years. Size was calculated as the geometric area, from which sex-specific growth trend, rate, and type for each vertebral body were determined, as well as length measures of local deformation-based morphometry vectors from the centroid to each landmark. Additionally, for each of the four pubertal-staged age cohorts, sex-specific vertebral body wireframes were superimposed using generalized Procrustes analysis to determine sex-specific changes in form (size and shape) and shape alone. Our findings reveal that C2 was unique in achieving more of its adult size by 5 years, particularly in females. In contrast, C3-C7 had a second period of accelerated growth during puberty. The vertebrae of males and females were significantly different in size, particularly after puberty, when males had larger cervical vertebral bodies. Male growth outpaced female growth around age 10 years and persisted until around age 19-20 years, whereas females completed growth earlier, around age 17-18 years. The greatest shape differences between males and females occurred during puberty. Both sexes had similar growth in the superoinferior height, but males also displayed more growth in anteroposterior depth. Such prominent sex differences in size, shape, and form are likely the result of differences in growth rate and growth duration. Female vertebrae are thus not simply smaller versions of the male vertebrae. Additional research is needed to further quantify growth and help improve age- and sex-specific guidance in clinical practice.
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Affiliation(s)
- Courtney A Miller
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Seong Jae Hwang
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Meghan M Cotter
- Medical Education Office, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Houri K Vorperian
- Vocal Tract Development Lab, Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
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Duarte RLDM, Fonseca LBDM, Magalhães-da-Silveira FJ, Silveira EAD, Rabahi MF. Validation of the STOP-Bang questionnaire as a means of screening for obstructive sleep apnea in adults in Brazil. ACTA ACUST UNITED AC 2019; 43:456-463. [PMID: 29340495 PMCID: PMC5792046 DOI: 10.1590/s1806-37562017000000139] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/03/2017] [Indexed: 12/17/2022]
Abstract
Objective: To validate the Portuguese-language version of the STOP-Bang (acronym for Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire, culturally adapted for use in Brazil, as a means of screening for obstructive sleep apnea (OSA) in adults. Methods: In this validation study, we enrolled patients ≥ 18 years of age, recruited between May of 2015 and November of 2016. All patients completed the STOP-Bang questionnaire and underwent overnight polysomnography. To evaluate the performance of the questionnaire, we used contingency tables and areas under the (receiver operating characteristic) curve (AUCs). Results: We included 456 patients. The mean age was 43.7 ± 12.5 years, and 291 (63.8%) of the patients were male. On the basis of the apnea-hypopnea index (AHI), we categorized OSA as mild/moderate/severe (any OSA; AHI ≥ 5 events/h), moderate/severe (AHI ≥ 15 events/h), or severe (AHI ≥ 30 events/h). The overall prevalence of OSA was 78.3%, compared with 52.0%, and 28.5% for moderate/severe and severe OSA, respectively. The most common score on the STOP-Bang questionnaire was 4 points (n = 106), followed by 3 points (n = 85) and 5 points (n = 82). An increase in the score was paralleled by a reduction in sensitivity with a corresponding increase in specificity for all AHI cut-off points. The AUCs obtained for the identification of any, moderate/severe, and severe OSA were: 0.743, 0.731, and 0.779, respectively. For any OSA, the score on the questionnaire (cut-off, ≥ 3 points) presented sensitivity, specificity, and accuracy of 83.5%, 45.5%, and 75.2%, respectively. Conclusions: The STOP-Bang questionnaire performed adequately for OSA screening, indicating that it could be used as an effective screening tool for the disorder.
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Affiliation(s)
- Ricardo Luiz de Menezes Duarte
- . Sleep - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Rio de Janeiro (RJ) Brasil.,. Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Lorena Barbosa de Moraes Fonseca
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, Goiânia (GO) Brasil.,. Hospital Geral de Goiânia Dr. Alberto Rassi, Goiânia (GO) Brasil.,. Clínica do Aparelho Respiratório, Goiânia (GO) Brasil
| | | | | | - Marcelo Fouad Rabahi
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, Goiânia (GO) Brasil.,. Hospital Geral de Goiânia Dr. Alberto Rassi, Goiânia (GO) Brasil.,. Clínica do Aparelho Respiratório, Goiânia (GO) Brasil
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Diniz AP, Fajardo VC, Freitas SND, Oliveira FLPD, Nascimento Neto RMD, Pimenta FAP, Machado-Coelho GLL. Indicadores de adiposidade como método de rastreamento para polissonografia em trabalhadores de turno. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2019. [DOI: 10.1590/2317-6369000026317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: verificar o potencial discriminatório dos indicadores de adiposidade na predição da apneia obstrutiva do sono (AOS) em trabalhadores de turnos. Métodos: estudo transversal realizado em uma empresa de extração de minério de ferro, em Minas Gerais, Brasil. Dados antropométricos foram coletados e polissonografia (PSG) foi realizada em 118 trabalhadores de turno do sexo masculino que possuíam ao menos um fator de risco global para doença cardiovascular. Resultados: a prevalência de AOS na amostra foi de 84,7%. Entre os indicadores de adiposidade usados para predizerem a AOS (≥ 5 eventos/hora), o índice de massa corporal (IMC), a circunferência da cintura (CC), a relação cintura/estatura (RCE) e a gordura corporal total (GCT), revelaram valores de sensibilidade acima de 70%. Gordura visceral (GV), circunferência do pescoço (CP) e relação pescoço-estatura (RPE) foram as mais efetivas em identificar corretamente trabalhadores sem AOS (valores de especificidade acima de 70%). As áreas sob a curva de Característica de Operação do Receptor (COR) para CC e RPE foram maiores que 0,7, o que indicou que o teste foi eficaz na discriminação de indivíduos com AOS. Conclusões: alterações nos indicadores de adiposidade abdominal e cervical têm relação significativa com a presença de AOS e demostraram eficácia como método de rastreamento para PSG. CC e RPE são considerados bons indicadores para predizerem a AOS.
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Maresky HS, Klar MM, Tepper J, Gavriel H, Ziv Baran T, Shapiro CM, Tal S. Mandibular width as a novel anthropometric measure for assessing obstructive sleep apnea risk. Medicine (Baltimore) 2019; 98:e14040. [PMID: 30681560 PMCID: PMC6358386 DOI: 10.1097/md.0000000000014040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Craniofacial abnormalities are a known obstructive sleep apnea (OSA) risk factor, but still need to be better characterized. This study investigates the relationship between mandibular width and the risk of developing OSA.We retrospectively analyzed 3D reconstructions of head and neck computed tomography (CT) scans at our institution for mandibular width, neck circumference, neck fat volume (NFV), airway volume (AWV), and NFV:AWV ratio. Age, gender, and BMI were also documented. Patients were contacted to complete a STOP-BANG survey to assess OSA risk. Only patients with reconstructable scans and completed STOP-BANG questionnaires were included in the study. Survey results were analyzed to assess the correlation between mandible width and STOP-BANG. Mandible association was also compared to the associations of the other known risk factors.The final analysis included 427 patients with a mean age of 58.98 years (standard deviation = 16.77), 56% of whom were male. Mandibular width was found to positively correlate with STOP-BANG score (r = .416, P < .001). Statistically significant differences between mandible size for each risk group was seen (P < .001). After controlling for age and sex, mandible size was significantly different only for the low risk vs. high risk groups (odds ratio = 1.11; 95% confidence interval = 1.03-1.20; P = .007). Furthermore, when stratified according to mandible size, the small mandible group (<77.50 mm) predominantly consisted of low risk patients; the medium size mandible group (77.50-84.40 mm) was predominated by intermediate risk patients, and large mandible (>84.40 mm) was predominantly seen in high risk patients. Mandible width expressed a stronger association than NFV:AWV ratio, but neck circumference and NFV had stronger associations than did mandible width.In addition to previously documented OSA risk factors, mandibular width is positively correlated with OSA as an independent risk factor. Observation of a wide mandible (jaw) should raise awareness of OSA risk and increase screening methods when appropriate.
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Affiliation(s)
- Hillel S. Maresky
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontaria, Canada
| | - Miriam M. Klar
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jaron Tepper
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine
| | - Tomer Ziv Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Colin M. Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sigal Tal
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Prevalence of sleep-disordered breathing among women working in the aged care services in Japan. Int Arch Occup Environ Health 2018; 92:309-316. [DOI: 10.1007/s00420-018-1381-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
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Loh JMR, Toh ST. Rethinking neck circumference in STOP-BANG for Asian OSA. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818810272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The STOP-BANG questionnaire is a simple screening tool for obstructive sleep apnoea (OSA) which has been validated for use in Asian populations. The original cut-off values for neck circumference were defined based on Caucasian populations. This study aims to validate the neck circumference component of the STOP-BANG score in Asians. Methods: A retrospective analysis of all patients suspected of having OSA who underwent a diagnostic polysomnography at a tertiary sleep centre in Singapore over the course of 1 year was conducted. Neck circumference was measured and correlated to the presence of OSA. A receiver operating curve was performed to obtain the optimal cut-off value for screening OSA in Asian patients. Results: 591 Asian subjects with OSA were analysed. The optimal neck circumference predictive for OSA was found to be 39 cm in males and 35 cm in females, with a sensitivity of 83.4% and 84.6% respectively. The existing STOP-BANG cut-off of 40 cm had 71% and 32% sensitivity in Asian males and females, respectively. Conclusion: The STOP-BANG cut-off value for neck circumference for screening for sleep apnoea in Asian males can be maintained at 40 cm, but the neck circumference value used for screening Asian females should be lowered to 35 cm.
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Affiliation(s)
| | - Song-Tar Toh
- Department of Otolaryngology, Singapore General Hospital, Singapore
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de Menezes Duarte RL, Magalhães-da-Silveira FJ, Gozal D. Screening for Sleep Apnea: When and How? CURRENT SLEEP MEDICINE REPORTS 2018. [DOI: 10.1007/s40675-018-0120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al Shaikh YG, Haytham Shieb MM, Koruturk S, Alghefari A, Hassan Z, Mussa BM. The symptoms and risk of sleep apnea among adults in the United Arab Emirates. Ann Thorac Med 2018; 13:168-174. [PMID: 30123336 PMCID: PMC6073781 DOI: 10.4103/atm.atm_245_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION: Recently, sleeping disorders and snoring are being recognized as a public health concern with various risk factors and health consequences. The main objective of the present study was to determine the prevalence of snoring and sleep apnea among adults (20–60 years) in Sharjah (United Arab Emirates, UAE) and assess the major risk factors as well as the general knowledge among the population. METHODS: A self-administrated Questionnaire of five sections including both Berlin questionnaire (BQ) and the Epworth Sleepiness Scales (ESS) were given to a randomly selected population in Sharjah between the ages of 20–60 years. Data were analyzed using SPSS software version 22.0. RESULTS: Nearly 34.2% of the study population reported to be snorers, and 43.2% of snorers were at high risk of sleep apnea based on the BQ. Gender was significantly associated with snoring (P = 0.038), as 40.8% of males reported snoring compared to 28.7% of females. Elderlies (50–60 years) were at a higher risk, and obesity (body mass index >30) was considered to be a powerful risk factor as 46.8% of the obese participants reported snoring. Those who scored higher on the ESS were more likely to be snorers (P = 0.001) and were likely to fall into the high-risk category in the BQ (P = 0.007). In addition, smoking (P = 0.005), hypertension (P = 0.005), and nasal septal deviation (P = 0.024) were also considered as risk factors. CONCLUSION: Prevalence and major risk factors within the UAE are similar to those in other countries. Sleeping disorders and snoring campaigns and management facilities should be considered to raise the awareness about these issues and manage their risk factors.
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Affiliation(s)
- Yazan Ghazi Al Shaikh
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Sema Koruturk
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Alghefari
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Zainab Hassan
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Bashair Mohammed Mussa
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Mieno Y, Hayashi M, Sakakibara H, Takahashi H, Fujita S, Isogai S, Goto Y, Uozu S, Okazawa M, Imaizumi K. Gender Differences in the Clinical Features of Sleep Apnea Syndrome. Intern Med 2018; 57:2157-2163. [PMID: 29607972 PMCID: PMC6120817 DOI: 10.2169/internalmedicine.7570-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Sleep apnea syndrome is more prevalent among men than women and is frequently accompanied by metabolic syndrome (MetS). However, gender differences in the effect of sleep-disordered breathing (SDB) leading to the risk of MetS remain unclear. The aim of our study was to investigate the clinical characteristics of SDB in women and the differential influence of SDB on MetS between genders. Methods In a single-center retrospective study, we compared the data of 1,809 consecutive SDB patients by gender to clarify the characteristics of sleep disorders in women. We also compared the prevalence of MetS and its related abnormalities by gender. A logistic regression analysis was used to determine the contributory factors for MetS. Results The mean age and proportion of patients over 50 years of age were higher in women than in men. SDB was milder in women than in men according to polysomnography findings. Elevated Hemoglobin A1c levels and hyperlipidemia were less frequent in women than in men. The MetS prevalence was similar in women and men (30.0% vs. 35.2%). A logistic regression analysis showed that the apnea-hypopnea index (AHI) was an independent risk factor for MetS in both genders, but that female gender was independently associated with a decreased prevalence of MetS and its related abnormalities. Conclusion Female SDB patients tend to be older with milder apnea and sleepiness than male SDB patients. A higher AHI is a significant risk factor for MetS in both genders, although female gender is an independent inhibitory factor for developing MetS in SDB patients.
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Affiliation(s)
- Yuki Mieno
- Department of Respiratory Medicine, Fujita Health University, Japan
| | | | | | | | - Shiho Fujita
- Department of Laboratory Medicine, Fujita Health University, Japan
| | - Sumito Isogai
- Department of Respiratory Medicine, Fujita Health University, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University, Japan
| | - Sakurako Uozu
- Department of Respiratory Medicine, Fujita Health University, Japan
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Duarte RLM, Rabahi MF, Magalhães-da-Silveira FJ, de Oliveira-E-Sá TS, Mello FCQ, Gozal D. Simplifying the Screening of Obstructive Sleep Apnea With a 2-Item Model, No-Apnea: A Cross-Sectional Study. J Clin Sleep Med 2018; 14:1097-1107. [PMID: 29991419 DOI: 10.5664/jcsm.7202] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/23/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To develop and validate a practical model for obstructive sleep apnea (OSA) screening in adults based on objectively assessed criteria, and then compare it with two widely used tools, namely STOP-BANG and NoSAS. METHODS This is a retrospective study of an existing database of consecutive outpatients who were referred for polysomnography for suspected sleep-disordered breathing by their primary care physicians. Area under the curve (AUC) and 2 × 2 contingency tables were employed to obtain the performance of the new instrument. RESULTS A total of 4,072 subjects were randomly allocated into two independent cohorts: one for derivation (n = 2,037) and one for validation (n = 2,035). A mnemonic model, named No-Apnea, with two variables (neck circumference and age) was developed (total score: 0-9 points). We used the cutoff ≥ 3 to classify patients at high risk of having OSA. OSA severity was categorized by apnea-hypopnea index (AHI): any OSA (AHI 5 ≥ events/h; OSA-5), moderate/ severe OSA (AHI 15 ≥ events/h; OSA-15); and severe OSA (AHI 30 ≥ events/h; OSA-30). In the derivation cohort, the AUCs for screening of OSA-5, OSA-15, and OSA-30 were: 0.784, 0.758, and 0.754; respectively. The rate of subjects correctly screened was 78.1%, 68.8%, and 54.4%, respectively for OSA-5, OSA-15, and OSA-30. Subsequently, the model was validated confirming its reproducibility. In both cohorts, No-Apnea discrimination was similar to STOP-BANG or NoSAS. CONCLUSIONS The No-Apnea, a 2-item model, appears to be a useful and practical tool for OSA screening, mainly when limited resources constrain referral evaluation. Despite its simplicity when compared to previously validated tools (STOP-BANG and NoSAS), the instrument exhibits similar performance characteristics.
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Affiliation(s)
- Ricardo L M Duarte
- Sleep - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Rio de Janeiro, Brazil.,Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo F Rabahi
- Faculdade de Medicina, Universidade Federal de Goiás, Goiás, Brazil
| | | | - Tiago S de Oliveira-E-Sá
- Hospital de Santa Marta - Centro Hospitalar Lisboa Central, Portugal.,NOVA Medical School - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Fernanda C Q Mello
- Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois
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Correlations between Waist and Neck Circumferences and Obstructive Sleep Apnea Characteristics. ACTA ACUST UNITED AC 2018; 2:111-118. [PMID: 30637368 DOI: 10.1007/s41782-018-0041-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The body mass index (BMI), an estimate of body fat, provides a rather imprecise indication of risk for obstructive sleep apnea (OSA). We examined whether other measures, including waist and neck circumference, provide improved indicators of risk in treatment-naïve OSA subjects. METHODS We studied 59 OSA subjects [age, 48.8±10.0 years; BMI, 31.9±6.6 kg/m2; apnea-hypopnea-index (AHI), 38.5±23.0 events/hour; sleep efficiency index (SEI, n=52), 78.6±14.4%; lowest oxygen saturation (SaO2 nadir), 79.5±8.0%; systolic blood pressure (BP), 127.4±15.7 mmHg; diastolic BP, 80.1±9.1 mmHg; 43 male), and determined waist and neck circumferences (waist, 107.4±15.3 cm; neck, 41.8±4.7 cm), daytime sleepiness [Epworth sleepiness scale (ESS), 8.7±4.6], sleep quality [Pittsburgh sleep quality index (PSQI), 8.5±4.1], depression levels [Beck depression inventory II (BDI-II), 6.6±5.7), and anxiety levels [Beck anxiety inventory (BAI), 6.2±7.2]. We used partial correlation procedures (covariates, age and gender) to examine associations between BMI, waist, and neck circumferences vs. AHI, sleep, and neuropsychological variables. RESULTS BMI, waist, and neck circumferences were significantly correlated with SaO2 nadir (BMI; r=-0.423, p=0.001; waist; r=-0.457, p<0.001; neck; r=-0.263, p=0.048), AHI (BMI; r=0.349, p=0.008; waist; r=0.459, p<0.001; neck; r=0.276, p=0.038), and systolic BP (BMI; r=0.354, p=0.007; waist; r=0.321, p=0.015; neck; r=0.388, p=0.003). SEI was significantly correlated with waist circumference (r=0.28, p=0.049), but higher with BMI (r=0.291, p=0.04). CONCLUSIONS No other significant waist or neck correlations emerged. This study suggests that waist and neck measures correlate better than BMI with select disease severity (SaO2 nadir and AHI) in OSA subjects. The findings offer an easily-measured, ancillary means to assess OSA risk.
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Brockmann PE, Koren D, Kheirandish-Gozal L, Gozal D. Gender dimorphism in pediatric OSA: Is it for real? Respir Physiol Neurobiol 2017; 245:83-88. [DOI: 10.1016/j.resp.2016.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/19/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
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Liao CD, Rau CL, Liou TH, Tsauo JY, Lin LF. Effects of Linearly Polarized Near-Infrared Irradiation Near the Stellate Ganglion Region on Pain and Heart Rate Variability in Patients with Neuropathic Pain. PAIN MEDICINE 2017; 18:488-503. [PMID: 27452896 DOI: 10.1093/pm/pnw145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Neuropathic pain associated with sympathetic overactivity can be effectively relieved by light irradiating the region near stellate ganglion (SGI), applied as an alternative to a conventional sympathetic blockade. The clinical effect of SGI on heart rate variability (HRV) and its association with pain outcomes require investigation. Objective This study attempted to identify the effects of SGI on pain outcomes and HRV indices and to determine the association between pain and HRV outcomes. Design A prospective double-blind, randomized study. Setting An outpatient pain medicine clinic. Subjects and Methods A total of 44 patients were enrolled and randomized into the experimental group ( n = 22) and control group ( n = 22). The experimental group received 12 sessions (twice weekly) of standard SGI, whereas the control group received the same protocol with sham irradiation. Pain and HRV were measured before and after each irradiation session. All outcome measures used in the first- and second-half treatment courses were analyzed. Results Pain and HRV outcome measures of the experimental group significantly improved after SGI when compared with the control group in both courses. Considering time and frequency domains, the changes in HRV in the second-half treatment course exceeded those in the first-half treatment course. Pain was significantly associated with postirradiated HRV indices ( P < 0.001). Conclusions Twelve sessions of SGI exerted time-dependent positive effects on pain and sympathovagal imbalance. HRV outcomes, including time and frequency domains, were an independent indicator of the clinical efficiency of SGI for treating pain in patients with neuropathic pain.
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Affiliation(s)
- Chun-De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Lun Rau
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,School of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan
| | - Jau-Yih Tsauo
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Review of and Updates on Hypertension in Obstructive Sleep Apnea. Int J Hypertens 2017; 2017:1848375. [PMID: 29147581 PMCID: PMC5632858 DOI: 10.1155/2017/1848375] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder as is hypertension (HTN) in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN). The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities.
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Godoroja DD, Cioc DA. Identification of significant obstructive sleep apnoea in the obese patient: development of the novel DX-OSA score. Rom J Anaesth Intensive Care 2017; 23:111-121. [PMID: 28913484 DOI: 10.21454/rjaic.7518/232.dxo] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in obese surgical patients. We investigated the extent to which anthropometric measurements can be used to identify the presence of significant OSA (Apnoea/Hypopnoea Index (AHI) ≥ 20) in adult patients. MATERIALS AND METHODS We prospectively studied 1357 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), gender, neck circumference, STOP-Bang score, SpO2, neck and trunk fat (by dual X-ray absorptiometry) were recorded. All patients with a STOP-Bang score ≥ 5 underwent polysomnography. Auto-titrated Positive Airway Pressure (APAP) therapy was instituted when AHI ≥ 20/h. Predictors of OSA were identified and their cut-off values determined. RESULTS In total, 1357 patients were screened; 345 patients underwent preoperative polysomnography; 190 had AHI ≥ 20/h and received APAP treatment. The novel Dual X-Ray-Obstructive Sleep Apnoea (DX-OSA) score was derived from the data. The score included 6 items: the STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and Expiratory Reserve Volume (ERV), and its sensitivity, specificity, positive-predictive values, negative-predictive values, likelihood ratios, and post-test probabilities determined. At a cut-off of 3, the DX-OSA score had the same sensitivity as the STOP-bang score, but better specificity. The lowest likelihood ratio was found for STOP-Bang and the highest for the DX-OSA score (OSA probability > 83%). CONCLUSION The DX-OSA score may be useful for identifying obese patients with significant OSA who require CPAP (continuous positive airway pressure) treatment, and CPAP could be commenced without the need for polysomnography, therefore, without delaying surgery.
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Affiliation(s)
- Daniela D Godoroja
- Ponderas Hospital, Bucharest, Romania, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
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Lozo T, Komnenov D, Badr MS, Mateika JH. Sex differences in sleep disordered breathing in adults. Respir Physiol Neurobiol 2016; 245:65-75. [PMID: 27836648 DOI: 10.1016/j.resp.2016.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
The prevalence of sleep disordered breathing is greater in men compared to women. This disparity could be due to sex differences in the diagnosis and presentation of sleep apnea, and the pathophysiological mechanisms that instigate this disorder. Women tend to report more non-typical symptoms of sleep apnea compared to men, and the presentation of apneic events are more prevalent in rapid compared to non-rapid eye movement sleep. In addition, there is evidence of sex differences in upper airway structure and mechanics and in neural mechanisms that impact on the control of breathing. The purpose of this review is to summarize the literature that addresses sex differences in sleep-disordered breathing, and to discuss the influence that upper airway mechanics, chemoreflex properties, and sex hormones have in modulating breathing during sleep in men and women.
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Affiliation(s)
- Tijana Lozo
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - Dragana Komnenov
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - M Safwan Badr
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Biomedical Engineering, Wayne State University Detroit, MI 48201, United States
| | - Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States.
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Jeong JI, Gu S, Cho J, Hong SD, Kim SJ, Dhong HJ, Chung SK, Kim HY. Impact of gender and sleep position on relationships between anthropometric parameters and obstructive sleep apnea syndrome. Sleep Breath 2016; 21:535-541. [PMID: 27704328 DOI: 10.1007/s11325-016-1413-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Considering the mechanisms by which obesity affects obstructive sleep apnea syndrome (OSAS) and the differences of fat distribution depending on gender, associations between anthropometric parameters, and OSAS may differ depending on gender or sleep position. We analyzed the impact of gender and sleep position on the relationship between fat distribution and development of OSAS. METHODS One thousand thirty-two consecutive subjects were analyzed. Recorded anthropometric measurements and overnight polysomnographic data of the subjects were reviewed retrospectively. The presence of OSAS was defined by the respiratory disturbance index (RDI) ≥5 with documented symptoms of excessive daytime sleepiness. RESULTS Eight hundred fifty-eight males and 174 females were included. Male subjects had significantly higher body mass index (BMI), larger waist circumference (WC), and lower percent of overall body fat (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The severity of OSAS was significantly higher in male subjects (RDI 26.9 ± 22.4 in males vs. 10.2 ± 13.8 in females, P < 0.0001). In male subjects, BMI, WC, and overall body fat were significantly associated with severity of OSAS and had larger impacts on supine RDI than lateral RDI. Overall body fat was not associated with severity of OSAS in female subjects, and there were no significant differences of the associations between all anthropometric parameters and RDIs depending on sleep position. CONCLUSIONS Evaluation of the correlation of anthropometric data with severity of OSAS should consider sleep position as well as gender.
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Affiliation(s)
- Jong In Jeong
- Department of Otolaryngology, Keimyung University School of Medicine, Daegu, South Korea
| | - Seonhye Gu
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkunkwan University, Seoul, South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Hun-Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Seung-Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
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Edelstein AI, Suleiman LI, Alvarez AP, Sacotte RM, Qin CD, Beal MD, Manning DW. The Interaction of Obesity and Metabolic Syndrome in Determining Risk of Complication Following Total Joint Arthroplasty. J Arthroplasty 2016; 31:192-6. [PMID: 27421583 DOI: 10.1016/j.arth.2016.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The arthroplasty population is increasingly comorbid, and current quality improvement initiatives demand accurate risk stratification. Metabolic syndrome (MetS) has been identified as a risk factor for adverse events after arthroplasty; however, its interaction with obesity in contributing to risk is unclear. METHODS A retrospective analysis of all Medicare patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution from 2009 to 2013 investigated the interaction between MetS, body mass index (BMI), and risk for Centers for Medicare and Medicaid Services (CMS)-reportable complications, readmission, and discharge disposition. RESULTS A total of 1462 patients (942 TKA, 538 THA) were included, of which 16.2% had MetS. Regression analysis found that MetS was significantly related to risk of CMS complications (odds ratio [OR] = 1.96, 95% confidence interval [CI] 1.16-3.31, P = .012) and nonhome discharge (OR = 1.78, 95% CI 1.39-2.27, P < .001), but not readmission (OR = 1.23, 95% CI 0.7-2.18, P = .485). Within the MetS cohort, increasing BMI was not associated with increasing complications (P = .726) or readmissions (P = .206) but was associated with nonhome discharge (OR = 1.191 per unit increase in BMI, 95% CI 1.038-1.246, P = .001). CONCLUSION MetS increases risk for CMS-reportable complications and nonhome discharge disposition after THA and TKA regardless of BMI. Obesity is of less value than MetS in assessing overall risk for complication after THA and TKA.
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Affiliation(s)
- Adam I Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew P Alvarez
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ryan M Sacotte
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Charles D Qin
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew D Beal
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David W Manning
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lin Z, Si Q, Xiaoyi Z. Obstructive sleep apnoea in patients with epilepsy: a meta-analysis. Sleep Breath 2016; 21:263-270. [PMID: 27473532 DOI: 10.1007/s11325-016-1391-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/03/2016] [Accepted: 07/25/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to accurately determine the prevalence of obstructive sleep apnoea (OSA) in patients with epilepsy (PWE) and to evaluate the efficacy of seizure control after treating OSA. METHODS Articles were identified through a search of both MEDLINE and Embase. The articles were collected and data were extracted independently by two authors. OSA was described using the following terms: Apnoea/hypopnoea index (AHI) and respiratory disturbance index (RDI). The variables were calculated using DerSimonian and Laird's random-effects model and odds ratio (OR). RESULTS The prevalence of mild-to-severe OSA in PWE was determined to be 33.4 % (95 % CI 20.8-46.1 %), and PWE are more susceptible to OSA as compared to healthy controls (OR 2.36; 95 % CI 1.33-4.18). Males were shown to be more susceptible to OSA than females (OR 3.00; 95 % CI 2.25-3.99). The results also indicated that the prevalence of OSA in patients with refractory epilepsy is not higher than the prevalence of OSA in PWE overall (17.5 vs 33.4 %). The prevalence of OSA was not found to be significantly different for different seizure types or in the number of antiepileptic drugs (AEDs). Patients that had been treated with continuous positive airway pressure (CPAP) were shown to have better seizure control than those untreated (OR 5.26; 95 % CI 2.04-13.5). CONCLUSIONS The prevalence of OSA in PWE is higher than in the general population. Additionally, the results of our study suggest that CPAP treatment results in a reduction of seizures.
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Affiliation(s)
- Zhang Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qi Si
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zou Xiaoyi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Becerra MB, Becerra BJ, Teodorescu M. Healthcare burden of obstructive sleep apnea and obesity among asthma hospitalizations: Results from the U.S.-based Nationwide Inpatient Sample. Respir Med 2016; 117:230-6. [PMID: 27492536 DOI: 10.1016/j.rmed.2016.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies have highlighted the significant comorbidities of both obesity and obstructive sleep apnea (OSA) among asthma patients in outpatient settings, but such data in the inpatient setting is sparse. METHODS Using 2009-2011 U.S. Nationwide Inpatient Sample; survey-weighted regression analyses were conducted to address the role of obesity, OSA, and both obesity and OSA on length of stay (LOS), total hospital charges, need for respiratory therapy, and disposition among adults with primary asthma hospitalization (n = 179,789). RESULTS Males had a higher prevalence of OSA than females (5.23% vs. 3.88%), while females had a higher prevalence of obesity (17.21% vs. 8.95%) and both obesity and OSA (7.11% vs. 6.19%). Increased hospital LOS was associated with presence of obesity (incidence rate ratio [IRR] males = 1.07, IRR females = 1.08), OSA (IRR males = 1.07, IRR females = 1.14), and both obesity and OSA (IRR males = 1.19, IRR females = 1.24). Increased total hospital charges was related to obesity (8.64% for males and 9.61% for females), OSA (15.39% for males and 19.13% for females), and both comorbidities (24.94% for males and 28.50% for females). Presence of OSA alone increased odds of need for respiratory therapy for males (odds ratio [OR] = 2.56) and females (OR = 3.22), as did presence of both comorbidities (OR males = 2.85, OR females = 3.60). Odds of routine disposition was lower among females with both comorbidities (OR = 0.82). CONCLUSION Compared to obesity alone, OSA and both obesity and OSA are associated with increased health resource utilization and poorer inpatient outcomes. This demonstrates the need for further clinical investigations of early detection of OSA among such at-risk populations.
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Affiliation(s)
- Monideepa B Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, USA
| | | | - Mihaela Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veteran's Hospital, Madison, WI, USA; Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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The Association of Brain-Derived Neurotrophic Factor Gene Polymorphism with Obstructive Sleep Apnea Syndrome and Obesity. Lung 2016; 194:839-46. [PMID: 27166632 DOI: 10.1007/s00408-016-9894-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Obesity represents a major risk factor for Obstructive Sleep Apnea Syndrome (OSAS). Brain-derived neurotrophic factor (BDNF) affects the mechanisms that regulate weight, eating behavior, and metabolism. This project aims to investigate the possible association of BDNF gene polymorphism with obesity and OSAS, and to contribute knowledge to the understanding of the pathophysiology of OSAS. METHODS The subjects included in this study were selected among the individuals who were hospitalized in the Erciyes University Medical School Chest Diseases Sleep Medicine Laboratory. Subjects were divided into four groups based on the presence of OSAS and/or obesity. Group 1 included OSAS+ obesity+ patients, Group 2 included OSAS+ obesity- patients, Group 3 included OSAS- obesity+ patients, and Group 4 included OSAS- obesity- patients. The targeted patient number per each study group was 45, but only 32 patients could be enrolled into Group 3. RESULTS Out of a total number of 167 subjects, 117 (70.1 %) had BDNF 196G/G, 48 (28.7 %) had BDNF 196G/A, and 2 (1.2 %) had BDNF 196A/A genotype. Of 48 subjects having BDNF 196G/A genotype, 32 (66.6 %) were obese, and 16 (33.3 %) were non-obese. Out of 90 subjects with OSAS, 64 (71.1 %) had BDNF 196G/G, and 25 (27.8 %) had BDNF 196G/A genotype. Out of 77 subjects without OSAS, BDNF 196G/G, and BDNF 196G/A genotypes were detected in 53 (68.8 %) and 23 (29.9 %) subjects, respectively. A statistically significant difference was demonstrated between the four study groups in terms of BDNF rs6265 polymorphism (p = 0.013). This difference was attributed to OSAS+ obesity- Group, in which BDNF 196G/G genotype was more common and BDNF 196G/A polymorphism was less common than the patients in other groups. CONCLUSION In conclusion, BDNF 196G/A genotype was found to be more frequent among obese patients compared to the non-obese individuals, but it was not significantly related to OSAS in the present study. BDNF196G/G genotype was more common and BDNF 196G/A polymorphism was less common among OSAS+ obesity- subjects compared to the other study groups.
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Katz LEL, Gralewski KA, Abrams P, Brar PC, Gallagher PR, Lipman TH, Brooks LJ, Koren D. Insulin-like growth factor-I and insulin-like growth factor binding protein-1 are related to cardiovascular disease biomarkers in obese adolescents. Pediatr Diabetes 2016; 17:77-86. [PMID: 25491378 PMCID: PMC4608856 DOI: 10.1111/pedi.12242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/18/2014] [Accepted: 10/20/2014] [Indexed: 12/28/2022] Open
Abstract
CONTEXT Insulin-like growth factor (IGF)-I and IGF binding protein (IGFBP)-1 have been linked to cardiovascular disease (CVD) risk and pathophysiology in adults, but there are limited data in youth. OBJECTIVE The aim of the study was to examine the relationship between IGF and IGFBP-1 with traditional and non-traditional CVD risk factors including inflammatory markers and body composition in an obese pediatric cohort. DESIGN A cross-sectional study. SETTING The study was carried out at a university children's hospital. SUBJECTS Sixty-one obese non-diabetic adolescents. OUTCOMES Fasting IGF-I, IGFBP-1, lipoprotein profiles, high-sensitivity C-reactive protein (hsCRP), and total adiponectin as well as insulin sensitivity measures, blood pressure (BP), and anthropometrics. RESULTS IGFBP-1 was negatively associated with insulin sensitivity measures, body mass index (BMI), and diastolic BP in males. IGF-I was negatively associated with hsCRP (r = -0.479, p < 0.0005), and IGFBP-1 was positively associated with adiponectin (r = 0.545, p < 0.0005). The IGF-I/CRP and IGFBP-1/adiponectin associations remained significant when controlling for both BMI and insulin sensitivity index (SI ). Both IGF-I and IGFBP-1 were negatively associated with waist circumference (r = -0.327 and r = -0.275, respectively) and sagittal abdominal diameter (r = -0.333 and r = -0.371, respectively), while IGFBP-1 was negatively associated with fat mass (r = -0.347, p = 0.01) as well as neck circumference and fat-free mass in males. Controlling for BMI z-score and SI , IGFBP-1 remained negatively associated with diastolic blood pressure (r = 0.706, p = 0.001 and neck circumference (r = -0.548, p = 0.15) in males. CONCLUSIONS IGF-I and IGFBP-1 associate with CVD risk markers and may add to clinical assessments of cardiometabolic dysfunction in youth.
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Affiliation(s)
- Lorraine E Levitt Katz
- Department of Pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kevin A Gralewski
- Department of Pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA
| | - Pamela Abrams
- St. Luke's University Health Network, Center for Diabetes and Endocrinology, Allentown, PA, USA
| | - Preneet C Brar
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Paul R Gallagher
- Biostatistics Core, The Children's Hospital of Philadelphia, Clinical and Translation Research Center, Philadelphia, PA, USA
| | - Terri H Lipman
- Department of Pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA
| | - Lee J Brooks
- Department of Pediatrics, Division of Pediatric Pulmonology of and Sleep Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA
| | - Dorit Koren
- Department of Pediatrics and Medicine, Section of Adult and Pediatric Diabetes, Endocrinology and Metabolism, University of Chicago, Chicago, IL, USA
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