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Huang EI, Huang SY, Lin YC, Lin CM, Lin CK, Hsu CY, Huang YC, Su JA. Respiratory Arousals in Patients with Very Severe Obstructive Sleep Apnea and How They Change after a Non-Framework Surgery. Healthcare (Basel) 2022; 10:healthcare10050902. [PMID: 35628039 PMCID: PMC9140339 DOI: 10.3390/healthcare10050902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
Respiratory arousal is the change from a state of sleep to a state of wakefulness following an apnea or hypopnea. In patients with obstructive sleep apnea (OSA), it could have a helpful role to activate upper airway muscles and the resumption of airflow and an opposing role to contribute to greater ventilatory instability, continue cycling, and likely exacerbate OSA. Patients with very severe OSA (apnea-hypopnea index (AHI) ≥ 60 events/h) may have specific chemical (e.g., possible awake hypercapnic hypoxemia) and mechanical (e.g., restricted dilator muscles) stimuli to initiate a respiratory arousal. Little was reported about how respiratory arousal presents in this distinct subgroup, how it relates to AHI, Epworth Sleepiness Scale (ESS), body mass index (BMI), and oxygen saturation, and how a non-framework surgery may change it. Here, in 27 patients with very severe OSA, we show respiratory arousal index was correlated with each of AHI, mean oxyhemoglobin saturation of pulse oximetry (SpO2), mean desaturation, and desaturation index, but not in BMI or ESS. The mean (53.5 events/h) was higher than other reports with less severe OSAs in the literature. The respiratory arousal index can be reduced by about half (45.3%) after a non-framework multilevel surgery in these patients.
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Affiliation(s)
- Ethan I. Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Sleep Center, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (S.-Y.H.); (Y.-C.L.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
| | - Shu-Yi Huang
- Sleep Center, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (S.-Y.H.); (Y.-C.L.)
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.L.); (C.-K.L.)
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Yu-Ching Lin
- Sleep Center, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (S.-Y.H.); (Y.-C.L.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.L.); (C.-K.L.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Chieh-Mo Lin
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.L.); (C.-K.L.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chin-Kuo Lin
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.L.); (C.-K.L.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chia-Yu Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-Y.H.); (Y.-C.H.)
| | - Ying-Chih Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-Y.H.); (Y.-C.H.)
| | - Jian-An Su
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
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Negative impact of the hypopnea index or duration increase after a non-frame work surgery in patients with very severe obstructive sleep apnea. Sci Rep 2022; 12:2251. [PMID: 35145170 PMCID: PMC8831531 DOI: 10.1038/s41598-022-06293-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
A non-framework surgery could change the postoperative components of breathing disturbances and increase the frequency or duration of hypopnea in patients with very severe obstructive sleep apnea (OSA). Either an increase of hypopnea index, which increases apnea–hypopnea index (AHI), or an increase of its duration raises the concern of worsening the oxygen desaturation and so morbidity and mortality associated with OSA. It is unclear how the oxygen saturation would change in those having increased frequency or duration of hypopneas after the surgery. Here in 17 patients with AHI ≥ 60 events/h, having increased frequency or duration of hypopneas after the non-framework surgery, the results show that the surgery improved oxygen saturation by reducing obstructive-apnea index (36.1 events/h) and duration (8.6 s/event), despite it increased hypopnea index (16.8 events/h) and duration (9.8 s/event). The surgery improved the average of the mean oxyhemoglobin saturation of pulse oximetry (SpO2) by 2.8% (toward a ceiling mean of 94.3%), mean minimal SpO2 by 7.5%, and mean desaturation by 5%. The results suggest sufficient apnea reduction and shift from apnea to hypopnea may mask the negative impact of the increase of hypopnea index or duration and improve postoperative mean SpO2, minimal SpO2, and mean desaturation.
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Probable Change of Sleep Parameters after Resection and Reconstruction Surgeries in Patients with Oral Cavity or Oropharyngeal Cancers. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7408497. [PMID: 34631887 PMCID: PMC8500743 DOI: 10.1155/2021/7408497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
In patients of oral cavity or oropharyngeal cancers, resection of the tumor and reconstruction of the defect may reduce the framework, add a bulky flap, alter the tissue flexibility, and contribute to postoperative obstructive sleep apnea (OSA). Postoperative OSA and the potential consequences may decrease the survival rate and reduce patients' quality of life. It is unclear whether the surgery is associated with postoperative OSA. Here, we compared the polysomnographies (PSGs) before and after the surgery in 15 patients of oral cavity or oropharyngeal cancers (out of 68 patients of head and neck cancers) without a chemo- or radio-therapy. Each patient received the second PSG before the start of any indicated adjuvant therapy to prevent its interference. There were 14 men and 1 woman, with a mean age and a standard deviation (SD, same in the following) of 56.2 ± 12.8 years. There were 6 tongue cancers, 5 buccal cancers, 2 tonsil cancer, 1 lower gum cancer, and 1 trigone cancer. The results show that the surgery changed sleep parameters insignificantly in apnea-hypopnea index (AHI), mean oxyhemoglobin saturation of pulse oximetry (SpO2), minimum SpO2, mean desaturation, and desaturation index but increased mean heart rate in the patients with free flaps. These results hint that the effect of surgery on developing OSA was small in this sample, with a longer plate or a larger framework for a bulkier free flap. It needs future studies with a large sample size to generalize this first observation.
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A Non-Framework Multilevel Surgery May Reduce Mean Heart Rate in Patients with Very Severe Obstructive Apnea Having Confined Retroglossal Space and Framework. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10228094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An elevated mean heart rate in untreated patients of obstructive sleep apnea (OSA) may lead to a higher risk of mortality and the development of various cardiovascular diseases. The elevation may positively relate to the severity of OSA and present in both wakefulness and sleep. A reduction in heart rate has been presented in reports of treating OSA patients with continuous positive airway pressure (CPAP). However, patients with very severe OSA may refuse use of CPAP devices and advocated surgeries, such as direct skeletal surgery or tracheostomy. It is unclear whether the non-framework multilevel surgery we reported previously can overcome the unfavorable anatomy and reduce mean heart rate, which serves as a risk factor of mortality. Here, we show that multilevel surgery reduced the mean heart rate from 68.6 to 62.7 with a mean reduction of 5.9 beats/min. The results suggest that the surgery may reduce the risk of consequences and mortality associated with an elevated mean heart rate, such as various cardiovascular diseases. We disclose these findings, along with the variations and possible risks to our future patients with very severe OSA who refuse or cannot use a CPAP device or reject direct skeletal surgery.
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