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Slouka D, Honnerova M, Hosek P, Gal B, Trcka O, Kostlivy T, Landsmanova J, Havel D, Baneckova M, Kucera R. Improved prediction of CPAP failure using T90, age and gender. J Appl Biomed 2019; 17:81. [PMID: 34907750 DOI: 10.32725/jab.2018.008] [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: 11/06/2018] [Accepted: 12/20/2018] [Indexed: 11/05/2022] Open
Abstract
Sleep apnea syndrome is associated with increased risk of cardiovascular disease. In treating older patients, there is a special emphasis put on minimally invasive and conservative procedures and a simple method for predicting the potential for treatment success is essential. Continuous positive airway pressure (CPAP) is the first choice for treatment, however, it is not always successful. In cases where CPAP was unsuccessful, treatment with bilevel positive airway pressure (BiPAP) is the next treatment option. In this study, we examine commonly evaluated respiratory parameters, obesity, and age relative to their ability to predict CPAP failure. We also tried to find differences in the predictive ability of these parameters in older and younger patients. The predictive ability, relative to CPAP failure, was examined for each individual parameter as well as for combinations of parameters. All variables had a statistical association with CPAP failure; failure prediction reliability ranged from poor to moderate. Combining T90, age, and gender can be used to find patients who will benefit from BiPAP as the first choice for treatment. An initial BiPAP indication can produce relevant reductions in treatment cost.
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Affiliation(s)
- David Slouka
- Charles University, Faculty of Medicine in Pilsen, Ear, Nose and Throat Department, Pilsen, Czech Republic
| | - Monika Honnerova
- Charles University, Faculty of Medicine in Pilsen, Department of Pneumology, Pilsen, Czech Republic
| | - Petr Hosek
- Charles University, Faculty of Medicine in Pilsen, Biomedical Center, Pilsen, Czech Republic
| | - Bretislav Gal
- Masaryk University, Faculty of Medicine, Ear, Nose and Throat Department, Brno, Czech Republic
| | - Ondrej Trcka
- Charles University, Faculty of Medicine in Pilsen, Ear, Nose and Throat Department, Pilsen, Czech Republic
| | - Tomas Kostlivy
- Charles University, Faculty of Medicine in Pilsen, Ear, Nose and Throat Department, Pilsen, Czech Republic
| | - Jana Landsmanova
- Charles University, Faculty of Medicine in Pilsen, Department of Obstetrics and Gynaecology, Pilsen, Czech Republic
| | - David Havel
- Charles University, Faculty of Medicine in Pilsen, Department of Pneumology, Pilsen, Czech Republic
| | - Martina Baneckova
- Charles University, Faculty of Medicine in Pilsen, Department of Pathology, Pilsen, Czech Republic
| | - Radek Kucera
- Charles University, Faculty of Medicine in Pilsen, Department of Nuclear Medicine Laboratory of Immunoanalysis, Pilsen, Czech Republic
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Yu H, Chen L, Li H, Xin H, Zhang J, Wei Z, Peng D. Abnormal resting-state functional connectivity of amygdala subregions in patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2019; 15:977-987. [PMID: 31114206 PMCID: PMC6489564 DOI: 10.2147/ndt.s191441] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/01/2019] [Indexed: 12/03/2022] Open
Abstract
Background: The amygdala is one of the core areas of the emotional circuits. Previous neuroimaging studies have revealed that patients with obstructive sleep apnea (OSA) have aberrant structure and function in several brain areas (including the amygdala). However, the resting-state functional connectivity (rs-FC) of amgydala subregions remains uncertain. Objective: To determine whether aberrant rs-FC exists between the amygdala subregions and other brain areas and whether such abnormalities are related to emotional disorders and cognitive impairment in OSA. Methods: The resting-state functional magnetic resonance imaging (rs-fMRI) data of 40 male severe OSA patients and 40 matched healthy controls (HCs) were collected. The rs-FC between the amygdala subregions and other brain areas was compared between the two groups. The correlations between aberrant rs-FC and clinical variables and neuropsychological assessments were evaluated. Results: Compared with the HCs, the OSA patients showed significantly increased rs-FC between the left dorsal amygdala (DA) and the anterior lobe of the cerebellum, among the left ventrolateral amygdala (VA), the left inferior frontal gyrus (IFG) and the left superior temporal gyrus (STG), and between the right VA and the left IFG. However, significantly decreased rs-FC was observed between the right DA and the right prefrontal cortex (PFC) in OSA patients. No regional differences in rs-FC were found between the OSA patients and HCs in the bilateral medial amygdala (MA). Conclusion: In this study, male severe OSA patients showed complex rs-FC patterns in the amygdala subregions, which may be the result of OSA-related selective damage to the amygdala, and abnormal rs-FC between the amygdala subregions and brain regions associated with emotional, cognitive and executive functions may partly explain the affective deficits and cognitive impairment observed in male severe OSA patients.
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Affiliation(s)
- Honghui Yu
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Liting Chen
- Department of Radiology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Haijun Li
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Huizhen Xin
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Juan Zhang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhipeng Wei
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Dechang Peng
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
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Oronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment: is there evidence for avoiding the oronasal route? Curr Opin Pulm Med 2018; 22:555-62. [PMID: 27607153 DOI: 10.1097/mcp.0000000000000318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment. RECENT FINDINGS One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea-hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies. SUMMARY Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. VIDEO ABSTRACT.
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da Silva BC, Kasai T, Coelho FM, Zatz R, Elias RM. Fluid Redistribution in Sleep Apnea: Therapeutic Implications in Edematous States. Front Med (Lausanne) 2018; 4:256. [PMID: 29404327 PMCID: PMC5786568 DOI: 10.3389/fmed.2017.00256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 12/14/2022] Open
Abstract
Sleep apnea (SA), a condition associated with increased cardiovascular risk, has been traditionally associated with obesity and aging. However, in patients with fluid-retaining states, such as congestive heart failure and end-stage renal disease, both prevalence and severity of SA are increased. Recently, fluid shift has been recognized to play an important role in the pathophysiology of SA, since the fluid retained in the legs during the day shifts rostrally while recumbent, leading to edema of upper airways. Such simple physics, observed even in healthy individuals, has great impact in patients with fluid overload. Correction of the excess fluid volume has risen as a potential target therapy to improve SA, by attenuation of nocturnal fluid shift. Such strategy has gained special attention, since the standard treatment for SA, the positive airway pressure, has low compliance rates among its users and has failed to reduce cardiovascular outcomes. This review focuses on the pathophysiology of edema and fluid shift, and summarizes the most relevant findings of studies that investigated the impact of treating volume overload on SA. We aim to expand horizons in the treatment of SA by calling attention to a potentially reversible condition, which is commonly underestimated in clinical practice.
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Affiliation(s)
- Bruno Caldin da Silva
- Renal Division, Department of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fernando Morgadinho Coelho
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roberto Zatz
- Renal Division, Department of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Rosilene M Elias
- Renal Division, Department of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Andrade RGSD, Piccin VS, Nascimento JA, Viana FML, Genta PR, Lorenzi-Filho G. Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea. J Bras Pneumol 2015; 40:658-68. [PMID: 25610507 PMCID: PMC4301251 DOI: 10.1590/s1806-37132014000600010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/27/2014] [Indexed: 11/22/2022] Open
Abstract
Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.
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Affiliation(s)
- Rafaela Garcia Santos de Andrade
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Vivien Schmeling Piccin
- University of São Paulo, School of Medicine, Heart Institute, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Juliana Araújo Nascimento
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Fernanda Madeiro Leite Viana
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Pedro Rodrigues Genta
- University of São Paulo, School of Medicine, Hospital das Clínicas, Boston, MA, USA. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil; and Postdoctoral Student, Division of Sleep Medicine, Brigham and Women's Hospital/Harvard University, Boston (MA) USA
| | - Geraldo Lorenzi-Filho
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil. Sleep Laboratory, Department of Pulmonology, Heart Institute, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
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Wang WH, He GP, Xiao XP, Gu C, Chen HY. Relationship between brain-derived neurotrophic factor and cognitive function of obstructive sleep apnea/hypopnea syndrome patients. ASIAN PAC J TROP MED 2013; 5:906-10. [PMID: 23146807 DOI: 10.1016/s1995-7645(12)60169-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 08/15/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To determine the relationship between the blood serum brain-derived neurotrophic factor (BDNF) level and cognitive function deterioration in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS), and to explore the possible mechanism of cognitive impairment. METHODS Twenty-eight male OSAHS patients and 14 normal males (as controls) were enrolled in the study. Polysomnography and the Montreal cognitive assessment (MoCA) were conducted. The blood serum BDNF levels were measured using ELISA. RESULTS The OSAHS group had significantly decreased blood serum BDNF levels compared with the control group (t = -10.912, P = 0.000). The blood serum BDNF level of the subjects was significantly positively associated with the MoCA score (r = 0.544, P = 0.000), significantly negatively associated with the apnea-hypopnea index (AHI) and shallow sleep (S1+S2) (AHI: r = -0.607, P = 0.000; S1+S2: r = -0.768, P = 0.000), and significantly positively associated with the lowest SaO(2) (LSO), slow wave sleep (S3+S4), and rapid eye movement sleep (REM) (LSO: r = 0.566, P = 0.000; S3+S4: r = 0.778, P = 0.000; REM: r = 0.575, P = 0.000). CONCLUSIONS OSAHS patients have significantly decreased blood serum BDNF levels compared with the control. Nocturnal hypoxia as well as the deprivation of slow wave sleep and REM may lead to the decreased serum BDNF level of OSAHS patients. This decreased blood serum BDNF level may contribute to the cognitive impairment in OSAHS.
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Affiliation(s)
- Wei-Hong Wang
- Medical College of Hunan Normal University, Changsha, Hunan, People's Republic of China.
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Santarnecchi E, Sicilia I, Richiardi J, Vatti G, Polizzotto NR, Marino D, Rocchi R, Van De Ville D, Rossi A. Altered cortical and subcortical local coherence in obstructive sleep apnea: a functional magnetic resonance imaging study. J Sleep Res 2012; 22:337-47. [PMID: 23171248 DOI: 10.1111/jsr.12006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/30/2012] [Indexed: 01/22/2023]
Abstract
Obstructive sleep apnea (OSA) syndrome is the most common sleep-related breathing disorder, characterized by excessive snoring and repetitive apneas and arousals, which leads to fragmented sleep and, most importantly, to intermittent nocturnal hypoxaemia during apneas. Considering previous studies about morphovolumetric alterations in sleep apnea, in this study we aimed to investigate for the first time the functional connectivity profile of OSA patients and age-gender-matched healthy controls, using resting-state functional magnetic resonance imaging (fMRI). Twenty severe OSA patients (mean age 43.2 ± 8 years; mean apnea-hypopnea index, 36.3 h(-1) ) and 20 non-apneic age-gender-body mass index (BMI)-matched controls underwent fMRI and polysomnographic (PSG) registration, as well as mood and sleepiness evaluation. Cerebro-cerebellar regional homogeneity (ReHo) values were calculated from fMRI acquisition, in order to identify pathology-related alterations in the local coherence of low-frequency signal (<0.1 Hz). Multivariate pattern classification was also performed using ReHo values as features. We found a significant pattern of cortical and subcortical abnormal local connectivity in OSA patients, suggesting an overall rearrangement of hemispheric connectivity balance, with a decrease of local coherence observed in right temporal, parietal and frontal lobe regions. Moreover, an increase in bilateral thalamic and somatosensory/motor cortices coherence have been found, a finding due possibly to an aberrant adaptation to incomplete sleep-wake transitions during nocturnal apneic episodes, induced by repetitive choke sensation and physical efforts attempting to restore breathing. Different hemispheric roles into sleep processes and a possible thalamus key role in OSA neurophysiopathology are intriguing issues that future studies should attempt to clarify.
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Affiliation(s)
- Emiliano Santarnecchi
- Department of Neurological and Sensorial Sciences, University of Siena, Viale Bracci 2, Siena, Italy.
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