Obstructive sleep apnea hypopnea syndrome

Association between elevated homocysteine levels and obstructive sleep apnea hypopnea syndrome: a systematic review and updated meta-analysis

Objective

This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond to continuous positive airway pressure ventilation (CPAP) in terms of serum and plasma HCY levels.

Methods

To ascertain published articles about OSAHS, an exhaustive search was performed across medical databases, encompassing PubMed, Web of Science, EMBASE, CNKI, and Cochrane Library, until January 2, 2024. This study reviewed the literature regarding HCY levels in individuals with OSAHS and control groups, HCY levels under pre- and post-CPAP treatment, the Pearson/Spearman correlation coefficients between HCY levels and apnea-hypopnea index (AHI), and the hazard ratio (HR) of HCY levels concerning the occurrence of major adverse cerebrocardiovascular events (MACCEs) in patients with OSAHS. Meta-analyses were performed using weighted mean difference (WMD), correlation coefficients, and HR as effect variables. The statistical analysis was conducted using the R 4.1.2 and STATA 11.0 software packages.

Results

In total, 33 articles were selected for the final analysis. The OSAHS group exhibited significantly higher serum/plasma HCY levels than the control group (WMD = 4.25 μmol/L, 95% CI: 2.60-5.91, P< 0.001), particularly among individuals with moderate and severe OSAHS. Additionally, subgroup analysis using mean age, ethnicity, mean body mass index, and study design type unveiled significantly elevated levels of HCY in the serum/plasma of the OSAHS group compared to the control group. CPAP treatment can significantly decrease serum/plasma HCY levels in patients with OSAHS. Moreover, elevated HCY levels in individuals with OSAHS could be one of the risk factors for MACCEs (adjusted HR = 1.68, 95% CI = 1.10-2.58, P = 0.017). AHI scores show a positive correlation with serum/plasma HCY levels.

Conclusion

Patients with OSAHS had elevated serum/plasma HCY levels compared to healthy controls; however, CPAP therapy dramatically decreased HCY levels in patients with OSAHS. In patients with OSAHS, elevated HCY levels were linked with an increased risk of MACCEs, and HCY was positively connected with AHI values. HCY levels may serve as a useful clinical indicator for determining the severity and efficacy of OSAHS treatments.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024498806.

Could an increased risk of obstructive sleep apnoea be one of the determinants associated with disability in individuals with cardiovascular and cerebrovascular diseases?

PURPOSE

To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases.

METHODS

Cross-sectional study was conducted with 373 individuals (313 with cardiovascular or cerebrovascular diseases and 60 healthy). Disability was assessed by the 12-item World Health Organization Disability Assessment Schedule (WHODAS), and the risk of OSA was assessed by STOP-BANG. Anxiety and depression symptoms, daytime sleepiness, and cognition were assessed by the Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS), and Mini Mental State Examination (MMSE).

RESULTS

Greater disability was found in individuals with intermediate or high risk of OSA, considering healthy individuals (p=0.03), or individuals diagnosed with arrhythmia (p<0.01) or coronary artery disease (p=0.04). A high risk of OSA and higher WHODAS scores was significant among women as well as between OSA risk categories (p<0.01). Cognitive deficit and level of education also showed differences between OSA risk categories. Age, depression, and sleepiness were also associated with the subjects' disability (p<0.01). Gamma regression model showed higher WHODAS scores in female, in those with intermediate and high risk of OSA, and in those with depressive symptoms and cognitive deficit. Age also showed a correlation with higher WHODAS scores. The presence of all investigated cardio and cerebrovascular diseases showed an increase in the WHODAS score, implying a greater disability compared to healthy individuals.

CONCLUSION

Moderate and high risk of OSA is associated with disability, as well as gender, age, depressive symptoms, cognitive deficit, and cardiovascular diseases.

Tandem Mass Tag-Labeled Quantitative Proteome Analyses Identify C1R and A2M as Novel Serum Biomarkers in Pregnant Women with Obstructive Sleep Apnea

The aim of this study was to identify serum diagnostic biomarkers associated with the severity of obstructive sleep apnea (OSA) during pregnancy. Differentially expressed proteins (DEPs) were identified in the control (C), mild (O), and moderate (MO) OSA groups (n = 3 in each group). Bioinformatics analysis was conducted to identify the underlying functions, pathways, and networks of the proteins. Receiver operating characteristic curves were used to assess the diagnostic value of the identified DEPs. The enzyme-linked immunoassay was performed to detect serum levels of the complement C1r subcomponent (C1R) and alpha-2-macroglobulin (A2M) in 79 pregnant women with OSA (mild OSA [n = 32]; moderate OSA [n = 29], and severe OSA [n = 18]) and 65 healthy pregnant women without OSA. Pearson's correlation analysis was conducted to analyze the correlation between C1R and A2M levels and OSA clinicopathological factors. In total, 141 DEPs, 29 DEPs, and 103 DEPs were identified in the three groups (i.e., the mild OSA vs control group, the moderate OSA vs mild apnea group, and the moderate OSA vs control group, respectively). C1R and A2M were identified as continuously up-regulated proteins, and the levels of C1R and A2M were associated with OSA severity. C1R and A2M were found to be correlated with body mass index, systolic blood pressure, apnea-hypopnea index, oxygen desaturation index, time with saturation below 90%, and lowest SaO2. Adverse maternal and neonatal outcomes were observed in pregnant women with OSA. C1R and A2M have been identified as diagnostic biomarkers and are associated with the severity of OSA during pregnancy.

Assessing the contribution of mild high-altitude exposure to obstructive sleep apnea-hypopnea syndrome comorbidities

Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder. The lower atmospheric pressure and decreased oxygen levels of high-altitude areas can exacerbate the severity of OSAHS, but research into OSAHS in high-altitude areas remains limited. This study, from June 2015 to January 2020, involved 4,667 patients with suspected OSAHS and 38 healthy volunteers. The non-OSAHS group (AHI <5/h) had 395 patients, while the larger OSAHS group (AHI ≥5/h) comprised 4,272 patients. The significant size difference between the groups emphasized the study's focus on OSAHS, using the non-OSAHS mainly for comparison.

Methods

Sleep technicians monitored the OSAHS patient group overnight by polysomnography (PSG), the apnea-hypopnea index (AHI), the mean oxygen saturation (MSpO2), lowest oxygen saturation (LSpO2), the oxygen desaturation index (ODI) and the total sleep time with oxygen saturation less than 90% (TST-SpO2 <90%). Healthy volunteers self-monitored sleep patterns at home, using the CONTEC RS01 respiration sleep monitor with a wristwatch sleep apnea screen meter. The RSO1 wristwatch-style device has already been studied for consistency and sensitivity with the Alice-6 standard multi-lead sleep monitor and can be used for OSAHS screening in this region.

Results

LSpO2 recordings from healthy volunteers (86.36 ± 3.57%) and non-OSAHS (AHI <5/h) cohort (78.59 ± 11.99%) were much lower than previously reported normal values. Regression analysis identified no correlations between AHI levels and MSpO2 or TST-SpO2 <90%, weak correlations between AHI levels and LSpO2 or MSpO2, and a strongly significant correlation between AHI levels and the ODI (r = 0.76, p < 0.05). The data also indicated that the appropriate clinical thresholds for OSAHS patients living at mild high altitude are classified as mild, moderate, or severe based on LSpO2 saturation criteria of 0.85-0.90, 0.65-0.84, or <0.65, respectively.

Conclusion

The study findings suggest that individuals with an AHI score below 5 in OSAHS, who reside in high-altitude areas, also require closer monitoring due to the elevated risk of nocturnal hypoxia. Furthermore, the significant correlation between ODI values and the severity of OSAHS emphasizes the importance of considering treatment options. Additionally, the assessment of hypoxemia severity thresholds in OSAHS patients living in high-altitude regions provides valuable insights for refining diagnostic guidelines.

Effects of obstructive sleep apnea on retinal microvasculature

AIM

To detect retinal microvascular variations in obstructive sleep apnea syndrome patients.

METHODS

This prospective, observational case-control study included healthy controls and patients with mild, moderate, and severe obstructive sleep apnea syndrome. Vascular parameters, foveal avascular area, and flow areas in macula-centered, 6.00×6.00 mm2 scan size optical coherence tomography angiography images were compared.

RESULTS

The control group had the highest whole image, parafoveal, and perifoveal vessel density among the groups in both superficial and the deep capillary plexus (all P<0.05). Rapid eye movement sleep apnoea-hypopnoea index was reversely correlated with whole (Rho=-0.195, P=0.034), parafoveal (Rho=-0.242, P=0.008), perifoveal (Rho=-0.187, P=0.045) vessel density in the superficial capillary plexus, and whole (Rho=-0.186, P=0.046), parafoveal (Rho=-0.260, P=0.004), perifoveal (Rho=-0.189, P=0.043) vessel density in the deep capillary plexus, though the mean and non-rapid eye movement sleep apnoea-hypopnoea index related with only parafoveal vessel density in the superficial capillary plexus (Rho=-0.213, P=0.020; Rho=-0.191, P=0.038) and the deep capillary plexus (Rho=-0.254, P=0.005; Rho=-0.194, P=0.035).

CONCLUSION

This study shows decreased vessel density and its reverse correlation with the apnoea-hypopnoea index in patients with obstructive sleep apnea syndrome.

Assessment of Leptin Levels and Their Correlation With the Severity of Obstructive Sleep Apnea Syndrome: A Case-Control Study

Background Obstructive sleep apnea (OSA) is characterized by a combination of structural issues in the upper airway and imbalances in the respiratory control system. While numerous studies have linked OSA with obesity, it remains uncertain whether leptin, a hormone associated with fat, plays a role in the functional and anatomical defects that lead to OSA. Therefore, the aim of this study was to investigate whether leptin levels could be used as a predictor of OSA syndrome (OSAS). Methodology A case-control observational study was conducted, enrolling study participants who reported obesity (BMI > 30) within the range of >30 to <35 kg/m2, along with a short neck and a history of snoring, excessive daytime drowsiness, fatigue, or insomnia. Leptin levels and fasting blood sugar (FBS) were measured in all individuals. Additionally, the study evaluated the severity of OSAS using indicators such as the STOP BANG scores, apnea-hypopnea index, uvula grade score, and Epworth Sleepiness Scale scores. Results A total of 80 participants (40 cases and 40 controls) were included in the study. The mean leptin and FBS levels were significantly higher in cases compared to controls. Moreover, leptin levels exhibited a significant correlation with the severity indices of OSAS. Conclusion The study findings indicate that individuals with higher leptin levels tend to exhibit more severe OSAS symptoms. Furthermore, these elevated leptin levels contribute to the worsening of various OSA symptoms. Larger controlled studies have suggested that pharmacologically restoring the altered leptin levels may serve as a beneficial adjunct to treatment for alleviating OSAS symptoms.

A computed tomographic evaluation of effect of mandibular advancement device at two different horizontal jaw positions in patients with obstructive sleep apnea

Statement of problem

Studies pertaining to the objective assessments of the efficacy of mandibular advancement device in patients with obstructive sleep apnea are scarce.

Purpose

The purpose of this clinical study was to evaluate the effect of MAD at two different horizontal positions of mandible on upper airway dimensions through computed tomography.

Material and methods

Twenty-nine consenting participants satisfying predetermined inclusion and exclusion criteria were enrolled and an adjustable two-piece MAD was fabricated at 50% maximum mandibular protrusion and after 4 weeks was adjusted to 70% protrusion. CT scans were obtained at baseline, 4 weeks after delivering MAD with 50% mandibular protrusion, and then after 4 weeks with 70% mandibular protrusion. Cross sectional area with diameters (lateral and anteroposterior) of upper airway was measured at three specific anatomic levels (retropalatal-RP, retroglossal-RG, and epiglottal-EG). Data were analyzed using the Student t-test for parametric analysis.

Results

Intragroup comparison revealed a statistically significant increase in lateral & anteroposterior dimensions as well as cross sectional area at all three anatomical levels at 4 weeks after MAD with 50% mandibular protrusion compared with baseline and 4 weeks after MAD with 70% mandibular protrusion compared with baseline. However, the difference between lateral and anteroposterior dimensions with MAD at 70% protrusion compared with MAD at 50% protrusion was not statistically significant. The difference between cross-sectional area was found to be statistically significant.

Conclusion

Mandibular advancement device at 70% mandibular protrusion is more effective compared with the device at 50% protrusion in relieving oropharyngeal obstruction seen in OSA.

Comparative Study of Subjective and Objective Analysis in Diagnosis of Obstructive Sleep Apnea

The gold standard for diagnosis of Obstructive sleep apnea (OSA) is an overnight polysomnography (PSG). However, PSG is time consuming, labour intensive and expensive. In our country PSG is not available everywhere. Therefore, a simple and reliable method of identifying patients of OSA is important for its prompt diagnosis and treatment. This study looks at the efficacy of three questionnaires to serve as a screening test for the diagnosis of OSA in the Indian population. For the first time in India, a prospective study was conducted wherein patients with history of OSA underwent PSG and were asked to fill three questionnaires-Epworth Sleepiness Score (ESS), Berlin Questionnaire (BQ) and Stop Bang Questionnaire (SBQ). The scoring of these questionnaires were compared with the PSG results. SBQ had a high negative predictive value (NPV) and the probability of moderate and severe OSA steadily increases with higher SBQ scores. In comparison, ESS and BQ had low NPV. SBQ is a useful clinical tool to identify patients at high risk of OSA and can facilitate in the diagnosis of unrecognised OSA.

Systemic Lupus Erythematous and Obstructive Sleep Apnea: A Possible Association

Marked fatigue is common in patients with systemic lupus erythematosus (SLE). This study aimed to assess the association of sleep disorders, including obstructive sleep apnea (OSA), with SLE. Forty-two consecutive patients with SLE and 20 healthy controls were recruited and underwent a one-night ambulatory sleep examination. They completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and Functional Assessment of Chronic Illness Therapy (FACIT). SLE disease activity and damage were assessed by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). A significantly increased apnea/hypopnea index was noted in the SLE group compared to healthy controls (p = 0.004). SLE patients had higher rates of moderate-to-severe OSA (p = 0.04), PSQI (p = 0.001), and FACIT scores (p = 0.0008). Multivariate analysis revealed that the SDI was associated with OSA (p = 0.03). There was a positive association between SLEDAI-2K and moderate-to-severe OSA (p = 0.03). Patients with SLE had an increased prevalence of OSA and poorer quality of sleep compared to healthy controls. Our findings suggest that active disease and accumulated damage may be associated with OSA. These findings highlight the importance of identifying the presence of OSA in patients with SLE.

The efficacy of cryogenic plasma tonsillectomy in the treatment of obstructive sleep apnea-hypopnea syndrome in children: A meta-analysis

BACKGROUND

Obstructive sleep apnea hypopnea syndrome (OSAHS) refers to the apnea and hypopnea caused by partial or complete obstruction of the upper airway collapse during sleep. The cryogenic plasma tonsillectomy is mostly used for the clinical treatment of children with OSAHS.

AIMS

The objective of this meta-analysis is to investigate the clinical efficacy of cryogenic plasma tonsillectomy for OSAHS in children.

MATERIALS & METHODS

The literature search was conducted through China National Knowledge Infrastructure (CNKI), Wanfang Database, Embase, PubMed, and Web of Science databases. The search was from the establishment of each database to June 2022. Randomized controlled trials (RCTs) meeting the criteria for partial/total cryo-plasma tonsillectomy for treating patients with obstructive sleep apnea-hypopnea syndrome in children were included, with data extracted. The meta-analysis was performed using the Stata 16.0 and Review Manager 5.4. Seven RCTs were included in this study.

RESULTS

The results showed that the partial/complete cryo-plasma tonsillectomy in the experimental group had a better therapeutical effective rate than the control group of patients treated with conventional surgery [Odds ratio (OR) = 2.181, 95% CI: 1.306-3.645, P < 0.05]. Also, in terms of postoperative adverse reactions, the number of adverse reactions in the experimental group was significantly lower than in the control group (OR = 0.445, 95% CI: 0.287-0.689, P = 0.001). The analysis of surgical efficacy showed that the operative time, intraoperative blood loss, and postoperative pain score were all significantly lower than those of the control group. Furthermore, further analysis of the apnea-hypopnea index (AHI) and the lowest oxygen saturation (LSaO2) of the two groups showed that the cryo-plasma tonsillectomy treatment had higher LSaO2 levels than conventional treatment [Standardized mean difference (SMD) = 0.380, 95% CI: 0.094-0.667, P = 0.009].

CONCLUSION

The application of cryo-plasma tonsillectomy can significantly improve the treatment effect of OSAHS, reducing adverse reactions.

Smoking-Induced Disturbed Sleep. A Distinct Sleep-Related Disorder Pattern?

The relationship between smoking and sleep disorders has not been investigated sufficiently yet. Many aspects, especially regarding non-obstructive sleep apnea−hypopnea (OSA)-related disorders, are still to be addressed. All adult patients who visited a tertiary sleep clinic and provided information about their smoking history were included in this cross-sectional study. In total, 4347 patients were divided into current, former and never smokers, while current and former smokers were also grouped, forming a group of ever smokers. Sleep-related characteristics, derived from questionnaires and sleep studies, were compared between those groups. Ever smokers presented with significantly greater body mass index (BMI), neck and waist circumference and with increased frequency of metabolic and cardiovascular co-morbidities compared to never smokers. They also presented significantly higher apnea−hypopnea index (AHI) compared to never smokers (34.4 ± 24.6 events/h vs. 31.7 ± 23.6 events/h, p < 0.001) and were diagnosed more frequently with severe and moderate OSA (50.3% vs. 46.9% and 26.2% vs. 24.8% respectively). Epworth sleepiness scale (ESS) (p = 0.13) did not differ between groups. Ever smokers, compared to never smokers, presented more frequent episodes of sleep talking (30.8% vs. 26.6%, p = 0.004), abnormal movements (31.1% vs. 27.7%, p = 0.021), restless sleep (59.1% vs. 51.6%, p < 0.001) and leg movements (p = 0.002) during sleep. Those were more evident in current smokers and correlated significantly with increasing AHI. These significant findings suggest the existence of a smoking-induced disturbed sleep pattern.

Brody J, Chen H, Gottlieb DJ, Evans DS, Guo X, Gharib SA, Hale L, Hillman DR, Lutsey PL, Mukherjee S, Ochs-Balcom HM, Palmer LJ, Purcell S, Saxena R, Patel SR, Stone KL, Tranah GJ, Boerwinkle E, Lin X, Liu Y, Psaty BM, Vasan RS, Manichaikul A, Rich SS, Rotter JI, Sofer T, Redline S, Zhu X. Targeted Genome Sequencing Identifies Multiple Rare Variants in Caveolin-1 Associated with Obstructive Sleep Apnea

Rationale: Obstructive sleep apnea (OSA) is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. There is strong clinical and epidemiologic evidence supporting the importance of genetic factors influencing OSA but limited data implicating specific genes. Objectives: To search for rare variants contributing to OSA severity. Methods: Leveraging high-depth genomic sequencing data from the NHLBI Trans-Omics for Precision Medicine (TOPMed) program and imputed genotype data from multiple population-based studies, we performed linkage analysis in the CFS (Cleveland Family Study), followed by multistage gene-based association analyses in independent cohorts for apnea-hypopnea index (AHI) in a total of 7,708 individuals of European ancestry. Measurements and Main Results: Linkage analysis in the CFS identified a suggestive linkage peak on chromosome 7q31 (LOD = 2.31). Gene-based analysis identified 21 noncoding rare variants in CAV1 (Caveolin-1) associated with lower AHI after accounting for multiple comparisons (P = 7.4 × 10-8). These noncoding variants together significantly contributed to the linkage evidence (P < 10-3). Follow-up analysis revealed significant associations between these variants and increased CAV1 expression, and increased CAV1 expression in peripheral monocytes was associated with lower AHI (P = 0.024) and higher minimum overnight oxygen saturation (P = 0.007). Conclusions: Rare variants in CAV1, a membrane-scaffolding protein essential in multiple cellular and metabolic functions, are associated with higher CAV1 gene expression and lower OSA severity, suggesting a novel target for modulating OSA severity.

Obese patients experience more severe OSA than non-obese patients

To investigate whether previous exposure to obstructive sleep apnea (OSA) increases the risk of obesity in obese and nonobese patients. We identified 24,363 obese patients diagnosed between January 1, 2000, and December 31, 2015, in the Taiwan Longitudinal Health Insurance Database (LHID) 2005 National Health Insurance Research Database; 97,452 sex-, age- and index date-matched nonobese patients were identified from the same database. This study is based on the ninth edition of the International Classification of Sleep Disorders. Multiple logistic regression was used to analyze the previous exposure of obese patients to OSA. P < .05 was considered significant. The average age of 121,815 patients was 44.30 ± 15.64 years old; 42.77% were males, and 57.23% were females. Obese patients were more likely to be exposed to OSA than nonobese patients (adjusted odds ratio [AOR] = 2.927, 95% CI = 1.878-4.194, P < .001), and the more recent the exposure period was, the more severely obese the patient, with a dose-response effect (OSA exposure < 1 year, AOR = 3.895; OSA exposure 1 year, <5 years, AOR = 2.933; OSA exposure 5 years, AOR = 2.486). The probability of OSA exposure in obese patients was 2.927 times that in nonobese patients, and the longer the exposure duration was, the more severe the obesity situation, with a dose-response effect (OSA exposure < 1 year, AOR = 2.251; OSA exposure 1 year, <5 years, AOR = 2.986; OSA exposure 5 years, AOR = 3.452). The risk of obesity in subjects with OSA was found to be significantly higher in this nested case-control study; in particular, a longer exposure to OSA was associated with a higher likelihood of obesity, with a dose-response effect.

Obstructive Sleep Apnea in Underweight Children

OBJECTIVES

To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA.

STUDY DESIGN

Case-control study.

SETTING

University of Texas Southwestern Medical Center and Children's Medical Center of Dallas.

METHODS

Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P < .05.

RESULTS

An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA.

CONCLUSION

Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.

Quantification of the Impact of Intraoperative Ultrasound in Transoral Robotic Tongue Base Reduction

OBJECTIVES/HYPOTHESIS

Transoral robotic surgery (TORS) in the base of the tongue (BOT) reduction has been shown to decrease the apnea-hypopnea index (AHI) and improve daytime sleepiness in obstructive sleep apnea (OSA) patients. Intraoperative ultrasound (IOU) can be employed to guide the surgery and prevent massive bleeding.

STUDY DESIGN

Cohort study with historical control.

METHODS

A cohort study to compare the outcomes between OSA patients who received TORS with and without IOU assistance.

RESULTS

From 2016 to 2019, this study enrolled 80 OSA patients who underwent TORS in BOT: 57 in the IOU(+) and 23 in IOU(-) groups. The TORS with IOU presented with shorter operative time, less blood loss, and greater excised BOT volume. The IOU(+) group had greater improvement in the AHI and subjective questionnaire evaluation. The excised volume of BOT was significantly associated with the change in AHI.

CONCLUSION

The IOU could improve outcomes in BOT reduction surgery without raising the risk of surgical complications.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Efficacy of Low-Temperature Plasma-Assisted Unilateral/Bilateral Tonsillectomy and Adenoidectomy in Children with Obstructive Sleep Apnea Hypopnea Syndrome

Background

The aim of this study was to investigate the efficacy of low-temperature plasma-assisted bilateral or unilateral tonsillectomy (LTPABT or LTPAUT) and adenoidectomy in treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS).

Material/Methods

The present observational cohort study included a total of 244 children with OSAHS during December 2017 to December 2018. The patients were divided into the LTPABT group, the LTPAUT group, and the control group that received traditional bilateral tonsillectomy and adenoidectomy. The apnea hypopnea index (AHI) and the lowest oxygen saturation (LSaO₂) were measured. The patients’ pain condition was determined using the Visual Analog Score (VAS) and intraoperative indices were collected. Patients’ quality of life was assessed by OSA-18 scale and patients’ immune function was determined.

Results

The postoperative VAS scores were remarkably lower in the LTPABT and LTPAUT groups. At 6 months after surgery, the AHI significantly had decreased and LSaO₂ levels were significantly enhanced for all groups, and the AHI was significantly lower and LSaO₂ was markedly higher in the LTPABT group. The ratio of patients with efficacy of cured and remarkably effective was remarkably higher in the LTPABT group. The rates of postoperative hemorrhage and infection were significantly lower in the LTPABT and LTPAUT groups, and 4 cases showed tonsillar hyperplasia. OSA-18 scores were lowest in the LTPABT group. No significant difference was found in levels of IgM, IgA and IgG, and T lymphocyte subtypes.

Conclusions

The low-temperature plasma-assisted bilateral tonsillectomy combined with adenoidectomy had the best efficacy. None of the surgery methods influenced the patients’ immune function.

To Determine Pivotal Genes Driven by Methylated DNA in Obstructive Sleep Apnea Hypopnea Syndrome

Obstructive sleep apnea syndrome (OSAHS) is a widespread respiratory dysfunction that has attracted more and more attention in recent years. Recently, a large number of studies have shown that abnormal DNA methylation epigenetically silences genes necessary for the pathogenesis of human diseases. However, the exact mechanism of abnormal DNA methylation in OSAHS is still elusive. In this study, we downloaded the OSAHS data from the GEO database. Our data for the first time revealed 520 hypermethylated genes and 889 hypomethylated genes in OSAHS. Bioinformatics analysis revealed that these abnormal methylated genes exhibited an association with the regulation of angiogenesis, apoptosis, Wnt, and ERBB2 signaling pathways. PPI network analysis displayed the interactions among these genes and validated several hub genes, such as GPSM2, CCR8, TAS2R20, TAS2R4, and TAS2R5, which were related to regulating liganded Gi-activating GPCR and the transition of mitotic metaphase/anaphase. In conclusion, our study offers a new hint of understanding the molecular mechanisms in OSAHS progression and will provide OSAHS with newly generated innovative biomarkers.

[Correlation between transient receptor potential canonical channel with heart and kidney injure of rat model of obstructive sleep apnea hypopnea syndrome]

OBJECTIVE

To investigate the expression of transient receptor potential canonical channels (TRPCs) in the heart and kidney of rat model of obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODS

Eighteen male SD rats were randomly assigned to intermittent hypoxia (IH) group (n=9 ) and control group (n=9). In IH group, rats were placed in a chamber and exposed to intermittent hypoxia for 8h (10AM-6PM) daily. The expression of TRPC-related mRNA and protein in the heart and kidney tissue were detected by qRT-PCR and Western blotting, respectively.

RESULTS

The mRNA expressions of TRPC3/TRPC4/TRPC5 in heart tissues of IH group were increased significantly compared with the control group (all P>0.05); while there were no significant differences in the mRNA expressions of TRPC1/TRPC3/TRPC4/TRPC5/TRPC6/TRPC7 in kidney tissue between two groups (all P<0.05). The mRNA expressions of TRPC4, TRPC5 and TRPC6 in kidney tissues of IH group were lower than that in heart tissues (all P<0.05). The mRNA expression of TRPC7 in kidney tissues of control group was significantly higher than that in heart tissues (P<0.05). The expression of TRPC5 protein in heart tissues of IH group was significantly higher than that in the control group (P<0.05); while there was no significant differences in the expression of TRPC5/TRPC6/TRPC7 protein in kidney tissue between two groups (all P>0.05).

CONCLUSIONS

The IH rat model shows that TRPC5 channel is likely to be involved in the OSAHS induced pathophysiological changes in the myocardium and may become a target to prevent OSAHS related cardiac damage.

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy

Introduction

Upper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome.

Objective

To investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions.

Methods

Forty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared.

Results

Right middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002).

Conclusion

Mild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.

Relations between mandible-only advancement surgery, the extent of the posterior airway space, and the position of the hyoid bone in Class II patients: a three-dimensional analysis

The objective of the present study was to evaluate the relation between mandibular advancement, the three-dimensional extent of the posterior airway space (PAS), and the position of the hyoid bone, using cone-beam computed tomography (CT). Twenty-eight Class II patients (21 women (mean (SD) age 29 (9) years) and seven men (mean (SD) age 23 (6) years)), who had had mandibular-only advancement surgery (Obwegeser-Dal Pont) were included in the study. In each case, cone-beam CT scans were taken one week before and six months after operation, and a retrospective analysis made of the alterations of several airway variables (volume, mean cross-sectional area, and diameter) and the three-dimensional extent of mandibular and hyoid movement, by using IPlan® cranial software. A linear regression was also done to correlate mandibular advancement, the movement of the hyoid bone, and airway variables. There were significant postoperative increases in all volumetric PAS variables, and in most diametric and spherical variables (p<0.05). There was also a significant linear relation between forward displacement of the mandible and the movement of the hyoid bone (p<0.05). These results show that mandible-only advancement surgery causes an increase in most dimensions of the PAS. This intervention can be assumed to reduce airway resistance and therefore might be a suitable treatment option for patients with obstructive sleep apnoea syndrome.

Asymmetric Dimethylarginine (ADMA) and Symmetric Dimethylarginine (SDMA) Concentrations in Patients with Obesity and the Risk of Obstructive Sleep Apnea (OSA)

Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are endogenous inhibitors of nitric oxide (NO) synthesis, and play a critical role in the process of endothelial dysfunction, and are considered markers of oxidative stress. The aim of the present study was to explore relationships between ADMA and/or SDMA and the occurrence of OSA in obese patients as well as the effect of the endothelial nitric oxide synthase (eNOS) gene polymorphism, which may modify the influence of ADMA or SDMA on NO production. A total of 518 unrelated obese subjects were included in this study. Body weight, height and blood pressure were measured and data on self-reported smoking status were collected. Obstructive sleep apnea (OSA) was assessed by the apnea hypopnea index (AHI). Blood samples were collected to measure serum concentrations of glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, creatinine, HbA1c (%), folic acid, vitamin B₁₂, C-reactive protein (CRP), aspartate aminotransferase (ASP), alanine aminotransferase (ALT) and IL-6 by routine methods. The NOS3 gene G894T and 4a/4b polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. ADMA, SDMA and arginine concentrations were assessed simultaneously using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method. Adjusted multivariate logistic regression analysis showed a significant association between the occurrence of OSA and high serum ADMA levels, BMI above 40, age > 43 years, hypertension and male sex. Heterozygotes for the G894T eNOS polymorphism have the lowest serum concentrations of ADMA and SDMA, while no effect of the 4a/4b variants was observed. The results indicate that OSA in obese individuals can coexist with high ADMA levels, which appear as a potential OSA predictor.

Effectiveness of nasal continuous airway pressure therapy in patients with obstructive sleep apnea

OBJECTIVES

A prospective observational study was carried out with the aim of evaluating the effectiveness of nasal continuous positive airway pressure (nCPAP) therapy on the health-related quality of life (QoL) of patients with obstructive sleep apnea (OSA).

METHODS

The patients included in this study were those recently diagnosed with OSA (AHI > 5) and given nCPAP therapy, as well as being referred to a sleep laboratory for an assessment of their sleep disordered breathing. Prior to the start of nCPAP therapy and polysomnography evaluation, patients were asked to complete the validated Quebec sleep questionnaire (QSQ), and their baseline measurements were recorded.

RESULTS

Among the study population, 14.41% (n = 31) had mild OSA with an apnea and hypopnea index of 5 to 14.9 events/h, while 26.97% (n = 58) had moderate OSA and 40% (n = 86) had severe OSA. The overall average apnea and hypopnea index of the study population was 30.24 ± 9.73 events/h; mild OSA patients had an average apnea and hypopnea index of 10.09 ± 2.65 events/h, moderate OSA patients had 21.48 ± 4.40 events/h, and severe OSA patients had 59.16 ± 22.14 events/h. A significant difference was observed between the scores before treatment and after 6 months of therapy in all domains of the QSQ QoL scores (P < 0.0001).

CONCLUSION

Nasal continuous positive airway pressure treatment improved the QoL for patients with mild, moderate, and severe sleep apnea.

The influence of sleep apnea syndrome and intermittent hypoxia in carotid adventitial vasa vasorum

Subjects with sleep apnea-hypopnea syndrome (SAHS) show an increased carotid intima-media thickness. However, no data exist about earlier markers of atheromatous disease, such as the proliferation and expansion of the adventitial vasa vasorum (VV) to the avascular intima in this setting. Our aim was to assess carotid VV density and its relationship with sleep parameters in a cohort of obese patients without prior vascular events. A total of 55 subjects evaluated for bariatric surgery were prospectively recruited. A non-attended respiratory polygraphy was performed. The apnea-hypopnea index (AHI) and the cumulative percentage of time spent with oxygen saturation below 90% (CT90) were assessed. Serum concentrations of soluble intercellular adhesion molecule 1, P-selectin, lipocalin-2 and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. Contrast-enhanced carotid ultrasound was used to assess the VV density. Patients with SAHS (80%) showed a higher adventitial VV density (0.801±0.125 vs. 0.697±0.082, p = 0.005) and higher levels of sVCAM-1 (745.2±137.8 vs. 643.3±122.7 ng/ml, p = 0.035) than subjects with an AHI lower than 10 events/hour. In addition, a positive association exist between mean VV density and AHI (r = 0.445, p = 0.001) and CT90 (r = 0.399, p = 0.005). Finally, in the multiple linear regression analysis, female sex, fasting plasma glucose and AHI (but not CT90) were the only variables independently associated with the mean adventitial VV density (R² = 0.327). In conclusion, a high VV density is present in obese subjects with SAHS, and chronic intermittent hypoxia is pointed as an independent risk factor for the development of this early step of atheromatous disease.

Sympathetic Hyperactivity and Sleep Disorders in Individuals With Type 2 Diabetes

Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters. Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured. Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0-1375.0) vs. 210.0 (92.0-670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90. Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk.

Early Onset of Obesity and Adult Onset of Obesity as Factors Affecting Patient Characteristics Prior to Bariatric Surgery

BACKGROUND

Patients who are slated for bariatric surgery vary in terms of their age at onset of obesity, duration of obesity, and their health complications. Therefore, we aimed to explore a relationship between the age at onset of obesity, metabolic parameters, and health problems in bariatric surgery candidates.

METHODS

A total of 469 unrelated adults with obesity prior to bariatric surgery were included in this study. The study group consisted of 246 individuals who became obese < 20 years of age, and 223 individuals who became obese ≥ 20 years. Clinical, biochemical, anthropometric assessments, and DXA-derived measures were taken.

RESULTS

Patients with early onset of obesity had a higher total body fat mass, and higher body fat percentage, and a 1.84 times higher risk of BMI above 40 kg/m2 than patients with adult onset of obesity (≥ 20 years). Multivariable logistic regression demonstrated that, among bariatric surgery candidates with early onset of obesity, the frequency of hypertension and type 2 diabetes was significantly lower than that in cases with an adult onset of obesity, despite a longer duration of obesity and higher BMI.

CONCLUSIONS

The age at which an individual reaches obesity has a significant impact on patient characteristics on the day he or she is evaluated for bariatric surgery. A younger age at obesity onset is a predicting factor for a higher BMI in patients, but they are less likely to clinically manifest well-established consequences of obesity, such as diabetes or hypertension, compared to patients with adult onset of obesity.

Sleep disorders in adolescents and young adults: Insights into types, relationship to obesity and high altitude and possible lines of management

A sleep disorder is a medical disorder of the sleep pattern of a person that may be serious enough to interfere with normal physical, mental and emotional functioning. Disruptions in sleep can be caused by a variety of causes, from teeth grinding to night terrors. Sleep disorders are usually prevalent among adolescents and young adults, possibly due to factors related to life style, dietary habits, hormonal and emotional disturbances. Other factors that may precipitate sleep disorders include environmental, psychological and genetic factors. Sleep disorders may lead to serious psychological and mood disorders and may even affect the immune system. Management of sleep disorders depends on amelioration of the precipitating factors and the use of certain drugs that may help to restore the normal sleep-wake cycle. This review sheds light on sleep disorders in adolescents and young adults regarding their types, etiology, dangers and possible lines of management.

Insomnia and depressive symptoms in relation to unhealthy eating behaviors in bariatric surgery candidates

BACKGROUND

Alongside obesity, insomnia and depression are common public health problems. Sleep problems are currently believed to be associated with excessive food intake and metabolic disturbances. Therefore, we aimed to explore a relationship between insomnia, depressive symptoms and eating habits as well as metabolic parameters in bariatric surgery candidates.

METHODS

A total of 361 unrelated obese subjects were included in this study. Severity of sleep problems was measured with Athens Insomnia Scale (AIS) and the severity of depressive symptoms was assessed with the Beck Depression Inventory (BDI-II). Obstructive sleep apnea (OSA) was assessed by the Apnea Hypopnoea Index (AHI). Information was obtained about demographics, eating habits and lifestyle. Blood samples were collected to measure concentration of lipids (cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol), and glucose.

RESULTS

The median (interquartile range) score for AIS in the study participants was 5 (3-8) with a range of 0-24 and 47% (171) participants scored ≥6 (met criteria for diagnosis of insomnia). Statistically significant correlations were found between the AIS scores and serum triglycerides and glucose concentrations, and BDI-II total scores. The highest scores on AIS and BDI-II were found in participants with high frequency of snack food consumption, in physically inactive individuals as well as in those who self-reported eating at night or who declared more than 3 intense emotions associated with a desire-to-eat. Adjusted multivariate logistic regression analysis revealed that clinical insomnia was most strongly associated with daily consumption of snack foods, with the odds ratio of 3.26 (95% CI: 1.74-6.11), while depressive symptoms were strongly associated with both eating in response to ≥3 specific emotions with OR = 2.93 (95% CI: 1.26-6.78) as well as with daily consumption of snack foods with OR = 2.87 (95% CI: 1.16-5.14).

CONCLUSIONS

The results indicate that insomnia and depression in obese individuals are associated with eating habits, and suggest that in some patients these associations appears as major factors affecting obesity development.

Factors associated with undiagnosed obstructive sleep apnoea among hypertensive patients: A multisite cross-sectional survey study in Taiwan

AIMS AND OBJECTIVES

To investigate the distribution and risk factors associated with undiagnosed obstructive sleep apnoea among hypertensive patients.

BACKGROUND

Obstructive sleep Apnoea has been deemed a cardinal risk factor affecting cardiovascular event, and the condition is still frequently overlooked clinically. The lack of advanced diagnosis often causes hypertensive patients with obstructive sleep apnoea to miss opportunities for preventing chronic diseases.

DESIGN

A cross-sectional design.

METHODS

A total of 215 hypertensive participants were recruited from the cardiovascular outpatients of medical centre in northern and middle Taiwan. The Chinese version of Pittsburgh Sleep Quality Index, the Chinese version of the Epworth Sleep Scale and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting hypertensive patients with obstructive sleep apnoea, and a multinomial logistic regression analysis was used to examine the major influence factors for each obstructive sleep apnoea severity level.

RESULTS

81.9% of the hypertensive participants were found having obstructive sleep apnoea. Concerning to the obstructive sleep apnoea severity, 50.0% of participants had mild obstructive sleep apnoea. After controlling the confounding variables, the supine position (odds ratio, 1.04; 95% CI, 1.01-1.07), SO₂ (odds ratio, 0.58; 95% CI, 0.38-0.89) and oxygen desaturation index (odds ratio, 2.70; 95% CI, 1.18-6.18) were significantly associated with obstructive sleep apnoea. Furthermore, severe obstructive sleep apnoea was significantly correlated with gender (odds ratio, 0.04; 95% CI, 0.00-0.66), excessive daytime sleepiness (odds ratio, 20.27; 95% CI, 1.58-26.97) and oxygen desaturation index (odds ratio, 4.05; 95% CI, 1.86-8.81).

CONCLUSIONS

Nearly 82% of the hypertensive participants were found having undiagnosed obstructive sleep apnoea, and 80% of them were mild or moderate severity. Oxygen desaturation index, SO₂ and the supine position were found to be major predictors for obstructive sleep apnoea. Remarkably, oxygen desaturation index was the most significant predictor for mild, moderate and severe obstructive sleep apnoea.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should enhance their sensitivities to hypertensive patients at a high risk for obstructive sleep apnoea by actively assessing common obstructive sleep apnoea symptoms and providing strategies to alleviate obstructive sleep apnoea symptoms.

Occupation and Obstructive Sleep Apnea: A Meta-Analysis

OBJECTIVE

Obstructive sleep apnea (OSA) remains a prevalent condition, but its occupational burden is unclear. We carried out a systematic review to characterize the consistency and magnitude of occupational associations with OSA.

METHODS

We studied OSA within three occupational categories: commercial drivers, organic solvent-exposed workers, other selected occupations. We performed a meta-analysis on the prevalence of OSA among drivers and the risk of OSA associated with solvent exposure.

RESULTS

The pooled OSA prevalence in drivers was 41% (95% confidence interval [CI] 26% to 56%) for apnea hypopnea-index (AHI) is greater than 5, and 15% (95% CI 12% to 19%) for AHI is greater than 15. Exposure to solvents was associated with increased but non-statistically significant risk of OSA: summary relative risk, 2.38 (95% CI 0.89 to 6.32). Evidence of occupational association was inconsistent for other factors.

CONCLUSIONS

OSA is common among commercial drivers and potentially associated with occupations involving likely solvent exposure.

Frequency of Loud Snoring and Metabolic Syndrome among Korean Adults: Results from the Health Examinees (HEXA) Study

Studies regarding the association between snoring and metabolic abnormalities have been inconsistent. We examine whether snoring frequency and obstructive sleep apnea markers are associated with metabolic syndrome (MetS) among Koreans aged 40-69 years. A total of 72,885 subjects (24,856 men, 48,029 women) from the Health Examinees Gem study between 2009 and 2013 were included. Snoring frequency was grouped into five categories (never, 1-3/month, 1-3/week, 4-5/week, 6+/week). Obstructive sleep apnea markers included breathing interruptions and awakenings. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated through logistic regression. Compared with non-snorers, those who snore 6+/week were associated with increased odds for MetS (OR: 2.07, 95% CI: 1.91-2.25, p-trend < 0.0001 among men; OR: 1.45, CI: 1.33-1.58, p-trend < 0.0001 among women). Snoring frequency is associated with MetS and its components in both men and women. Snoring and obstructive sleep apnea markers are important indicators of sleep quality, which may facilitate early detection of sleep disorders and further complications such as MetS.

Obstructive sleep apnea is associated with an increased risk of colorectal neoplasia

BACKGROUND AND AIMS

A recent meta-analysis showed that obstructive sleep apnea (OSA) is associated with a higher prevalence of cancer and cancer-related mortality; however, little information is available on the association between OSA and colorectal neoplasia.

METHODS

We identified consecutive patients who underwent overnight polysomnography (PSG) and subsequent colonoscopy. We compared the prevalence of colorectal neoplasia between patients with or without OSA according to the results of PSG. For each patient with OSA, 1 or 2 controls matched for age (±5 years), sex, body mass index (BMI), and smoking who had undergone first-time screening colonoscopy were selected.

RESULTS

Of the 163 patients, 111 patients were diagnosed with OSA and 52 patients were within the normal range of the Apnea-Hypopnea Index. Of the 111 patients with OSA, 18 patients (16.2%) had advanced colorectal neoplasia, including 4 (3.6%) colorectal cancers. In the multivariate analyses, OSA was associated with an increased risk of advanced colorectal neoplasia after adjusting for factors including age and sex (mild: odds ratio [OR], 14.09; 95% confidence interval [CI], 1.55-127.83; P = .019; moderate or severe: OR, 14.12; 95% CI, 1.52-131.25; P = .020). Our case-control study revealed that the odds of detecting advanced colorectal neoplasia among patients with OSA were approximately 3.03 times greater than in the controls matched for age, sex, BMI, and smoking (OR, 3.03; 95% CI, 1.44-6.34; P = .002).

CONCLUSION

Physicians should be aware of the association between OSA and the development of colorectal neoplasia and explain the need for colonoscopy to patients with OSA.

Pharyngeal constrictor muscle fatty change may contribute to obstructive sleep apnea-hypopnea syndrome: a prospective observational study

CONCLUSIONS

Pharyngeal constrictor muscle injury and fatty changes may play important roles in the pathogenesis and progression of OSAHS.

OBJECTIVE

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a respiratory disorder caused by upper airway obstruction during sleep. The primary objectives of this study were to determine the ultrastructural characteristics of the pharyngeal constrictor muscle in patients with OSAHS.

METHODS

A pharyngeal constrictor muscle specimen was collected from all subjects. The muscle cell ultrastructure was observed under electron microscopy.

RESULTS

Eighteen male patients with OSAHS (OSAHS group) and 10 male body mass index-matched patients with chronic tonsillitis (control group) were enrolled in this study. All patients were obese adults. The apnea-hypopnea index (41.22 ± 17.29 vs 2.30 ± 1.10 events/h) was significantly higher and the lowest arterial oxygen saturation (76.00 ± 8.57% vs 97.00 ± 2.00%) was significantly lower in the OSAHS group than in the control group (both p < 0.001). Myofibril disorder, mitochondrial edema, and intramyocellular lipid droplets were observed in patients with OSAHS. There was a significant correlation between the number of lipid droplets and the apnea-hypopnea index.

Comparison of Heritability Estimation and Linkage Analysis for Multiple Traits Using Principal Component Analyses

A disease trait often can be characterized by multiple phenotypic measurements that can provide complementary information on disease etiology, physiology, or clinical manifestations. Given that multiple phenotypes may be correlated and reflect common underlying genetic mechanisms, the use of multivariate analysis of multiple traits may improve statistical power to detect genes and variants underlying complex traits. The literature, however, has been unclear as to the optimal approach for analyzing multiple correlated traits. In this study, heritability and linkage analysis was performed for six obstructive sleep apnea hypopnea syndrome (OSAHS) related phenotypes, as well as principal components of the phenotypes and principal components of the heritability (PCHs) using the data from Cleveland Family Study, which include both African and European American families. Our study demonstrates that principal components generally result in higher heritability and linkage evidence than individual traits. Furthermore, the PCHs can be transferred across populations, strongly suggesting that these PCHs reflect traits with common underlying genetic mechanisms for OSAHS across populations. Thus, PCHs can provide useful traits for using data on multiple phenotypes and for genetic studies of trans-ethnic populations.

Risk of obstructive sleep apnea, excessive daytime sleepiness and depressive symptoms in a Nigerian elderly population

OBJECTIVES

To evaluate the risk of obstructive sleep apnea (OSA) in a primary care population of elderly Nigerians and to determine its correlates.

METHODS

Clinical and demographic data of 414 elderly individuals in a primary care clinic were obtained. Their risk of OSA was estimated using Berlin questionnaire while Epworth sleepiness scale and the Center for Epidemiologic Studies Depression Scale (CESD-10) were also administered.

RESULTS

Of the 414 subjects, 96 (23.2%) met the criteria for a high risk for OSA with a male to female ratio of 1:1. Subjects at high OSA risk (high OSA risk group) were younger than those at low OSA risk (low OSA risk group) (71.4±6.8 vs 73.6±7.7, p=0.011). Mean body mass index (BMI, kg/m(2)) (27.3±5.8 vs 24.7±5.1, p<0.001) and waist circumference (WC, cm) (90.7±13.1 vs 86.5±13.9, p=0.011) were higher in the high OSA risk group compared with the low OSA risk group. A total of 215 (51.9%) and 62 (15.0%) subjects had clinically significant depressive symptoms (CESD-10 score≥10) and excessive daytime sleepiness (EDS), respectively. On regression, the odds of EDS, depressive symptoms, increased BMI and younger age were significantly higher in the high OSA risk group compared with the low OSA risk group.

CONCLUSIONS

High risk for OSA and depressive symptoms are common in our sample of elderly Nigerians. Depressive symptoms, EDS, BMI and age independently predict high OSA risk in the elderly.

Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review

AIMS

Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.

METHODS

A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.

RESULTS

Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.

CONCLUSIONS

The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

The effect of CPAP treatment on EEG of OSAS patients

PURPOSE

Continuous positive airway pressure (CPAP) is currently the most effective treatment method for obstructive sleep apnea syndrome (OSAS). The purpose of this study was to compare the sleep electroencephalogram (EEG) changes before and after the application of CPAP to OSAS patients.

METHODS

A retrospective study was conducted and 45 sequential patients who received both polysomnography (PSG) and CPAP titration were included. The raw data of sleep EEG were extracted and analyzed by engineers using two main factors: fractal dimension (FD) and the zero-crossing rate of detrended FD (zDFD). FD was an effective indicator reflecting the EEG complexity and zDFD was useful to reflect the variability of the EEG complexity. The FD and zDFD indexes of sleep EEG of 45 OSAS patients before and after CPAP titration were analyzed.

RESULTS

The age of 45 OSAS patients was 52.7 ± 5.6 years old and the patients include 12 females and 33 males. After CPAP treatment, FD of EEG in non-rapid eye movement (NREM) sleep decreased significantly (P < 0.05), while FD of EEG increased in rapid eye movement (REM) sleep (P < 0.05). Meanwhile, zDFD were decreased remarkably in both NREM and REM sleep after CPAP therapy (P < 0.05, respectively).

CONCLUSIONS

CPAP therapy had a significant influence on sleep EEG in patients with OSAHS, which lead to a more stable EEG pattern. This may be one of the mechanisms that CPAP could improve sleep quality and brain function of OSAS patients.

Comparisons of thyroid hormone, intelligence, attention, and quality of life in children with obstructive sleep apnea hypopnea syndrome before and after endoscopic adenoidectomy

Objective. The aim of this study was to compare the differences in thyroid hormone, intelligence, attention, and quality of life (QoL) of children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after endoscopic adenoidectomy. Method. A total of 35 OSAHS children (21 males and 14 females with a mean age of 6.81 ± 1.08 years) were included in this study for analyzing the levels of thyroid hormone, intelligence, attention, and QoL. There were 22 children underwent endoscopic adenoidectomy with bilateral tonsillectomy (BT), while the other 13 children who underwent endoscopic adenoidectomy without bilateral tonsillectomy without BT. Results. Our results revealed no significant difference in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels in OSAHS children before and after endoscopic adenoidectomy (all P > 0.05). However, there were significant differences in full-scale intelligence quotient (FIQ) (92.45 ± 5.88 versus 106.23 ± 7.39, P < 0.001), verbal intelligence quotient (VIQ) (94.17 ± 15.01 versus 103.91 ± 9.74, P = 0.006), and performance intelligence quotient (PIQ) (94.12 ± 11.04 versus 104.31 ± 10.05, P = 0.001), attention (98.48 ± 8.74 versus 106.87 ± 8.58, P < 0.001), and total OSA-18 scores (87.62 ± 17.15 versus 46.61 ± 10.15, P < 0.001) between before and after endoscopic adenoidectomy in OSAHS children. Conclusion. Our findings provided evidence that the intelligence, attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.

Obstructive sleep apnea syndrome: An important piece in the puzzle of cardiovascular risk factors

The obstructive sleep apnea syndrome (OSA) is a clinical entity characterized by recurring episodes of apnea and/or hypopnea during sleep, due to a total or partial collapse, respectively, of the upper airway. This collapse originates a set of pathophysiological changes that determine the appearance of several cardiovascular complications. OSA contributes for the development of hypertension, heart failure, arrhythmias and coronary heart disease. Nowadays it is recognized to be an important public health problem, taking into account not just its repercussions but also its prevalence, since the main risk factor for the disease is obesity, a growing problem worldwide, both in developed and developing countries. The present review summarizes the current knowledge about OSA, as regards its definition, pathophysiology, clinical manifestations, diagnosis, cardiovascular effects and treatment.

Effect of chronic continual- and intermittent hypoxia-induced systemic inflammation on the cardiovascular system in rats

PURPOSE

Obstructive sleep apnea syndrome (OSAS) has been recognized as an important risk factor for cardiovascular morbidity and mortality. However, the underlying mechanisms are poorly understood. Present study aimed to investigate the role of NF-κB-dependent inflammation pathways in pathophysiological responses of cardiovascular system in OSAS.

METHODS

Thirty male specific pathogen-free (SPF) Sprague-Dawley rats were randomly assigned to normoxia (N) group, continual hypoxia (CH) group, and intermittent hypoxia (IH) group (n = 10) and were exposed to N (21% O2), CH (8% O2), or IH (6-11% O2 for 10 s and 21% O2 for 80 s in every 90 s) for 8 h/day for 35 days. The hemodynamic and pathomorphologic effects of IH and CH exposure were investigated as well as the expression of NF-κB-dependent inflammation factors.

RESULTS

Chronic IH or CH significantly increased mean pulmonary arterial pressure (mPAP) in rats, while no significant changes occurred in mean carotid arterial pressure (mCAP). The ratio of right ventricle (RV) to left ventricle (LV) + septum (S) was significantly increased by both IH and CH, suggesting RV hypertrophy was induced by IH or CH. Elastic fiber staining showed an irregular pattern of elastic fiber distribution after hypoxia, and aortic tunica media thickness was increased. Both chronic IH and CH upregulated the expressions of transcription factor NF-κB and related pro-inflammatory cytokines and adhesion molecules.

CONCLUSIONS

The current study expands our understanding that both IH and CH could activate the expression of NF-κB and related inflammatory factors as well as cause pathophysiologic damage to the cardiovascular system in OSAS. All these results provide further support to an emerging hypothesis that activation of NF-κB-dependent inflammation may play a central role in the pathophysiology of cardiovascular dysfunction in OSAS.

Current and future directions in pediatric allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. In addition, it is associated with significant comorbidities and complications.

OBJECTIVE

The aim was to provide an update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric AR.

METHODS

Literature reviews in each of these areas were conducted, and the results were incorporated.

RESULTS

The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. The mainstay of current treatment strategies includes allergen avoidance, pharmacotherapy, and allergen specific immunotherapy.

CONCLUSIONS

In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.

Impact of Obstructive Sleep Apnea on Outcomes of Catheter Ablation of Atrial Fibrillation

Obstructive sleep apnea (OSA) is a growing epidemic in the United States and significantly contributes to the increasing prevalence of atrial fibrillation (AF) in the U.S.

POPULATION

Although a strong correlation between OSA and AF has been demonstrated, a causal relationship between these two conditions has not been definitively established. Evidence of OSA is an important consideration of AF management and impacts the success rate of catheter ablation. The presence of OSA tends to predict a lower success rate and higher complication rate for catheter ablation of AF. However, recent studies evaluating OSA as an independent risk predictor of AF recurrence following an ablation procedure have yielded conflicting results. A greater understanding of these conditions would allow for a more specific therapy targeting the type of AF associated with OSA. The following review provides a brief summary of obstructive sleep apnea etiology, focuses on the relationship between OSA and AF, and discusses the impact of OSA on the outcomes of catheter ablation of AF.