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Schwab RJ, Erus G. We Can Use Machine Learning to Predict Obstructive Sleep Apnea. Am J Respir Crit Care Med 2024. [PMID: 38701391 DOI: 10.1164/rccm.202403-0666ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/02/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Richard J Schwab
- University of Pennsylvania, 6572, Sleep Division, Philadelphia, Pennsylvania, United States;
| | - Guray Erus
- University of Pennsylvania, 6572, 2. Director of Research, Center for Biomedical Image Computing and Analytics (CBICA), , Philadelphia, Pennsylvania, United States
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Thuler ER, Parekh MH, Rodin JG, Seay EG, Wiemken A, Keenan BT, Schwab RJ, Schwartz AR, Dedhia RC. Association Between Soft Tissue Measures From Computed Tomography and Upper Airway Collapsibility on Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2024. [PMID: 38613204 DOI: 10.1002/ohn.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Positive airway pressure (PAP) titration during drug-induced sleep endoscopy (DISE) provides objective measures of upper airway collapsibility. While skeletal measurements relate to collapsibility measures on DISE, the influence of soft tissue dimensions on upper airway collapsibility is not known. We analyzed the relationship of measures of upper airway soft tissue volumes, specifically soft palate, pharyngeal lateral walls, and tongue, with metrics of collapsibility. STUDY DESIGN Cross-sectional analysis from a prospective cohort. SETTING Academic medical center. METHODS Patients seeking PAP alternative therapies for obstructive sleep apnea (OSA) underwent standardized supine computed tomography (CT) acquisition and DISE protocols. The CT analysis primarily focused on soft tissue volumes and, secondarily, on airway and skeletal volumetric measures. DISE with PAP administration (DISE-PAP) enabled the determination of the pressure at which inspiratory airflow first commenced (pharyngeal critical pressure, PcritA) and the pressure at which inspiratory flow limitation was abolished (pharyngeal opening pressure, PhOP). Both unadjusted and adjusted correlation analyses were performed to understand the relationship between upper airway anatomy and either PcritA or PhOP. RESULTS One hundred thirty-nine subjects completed both CT and DISE-PAP. On average, patients were male (70.5%), white (84.2%), middle-aged (56.6 ± 13.5 years), and overweight (29.6 ± 4.7 kg/m2), with moderate-severe apnea-hypopnea index (29.7 ± 21.3 events/h). Adjusted for age, sex, body mass index, and skeletal volumes, soft palate, and lateral pharyngeal wall volumes were not associated with PhOP or PcritA, but a larger tongue was associated with more positive PhOP (⍴ = 0.20, P = .02), and more positive PcritA (⍴ = 0.16, P = .07). Exploratory analyses revealed smaller minimum cross-sectional retropalatal area and intramandibular volume were also associated with increased collapsibility measures. CONCLUSION After controlling for clinical factors and skeletal volume, greater tongue volume was associated with more severe collapsibility during DISE. These results, in concert with previous work, suggest that greater tongue volume in a smaller skeletal dimensions contribute to the severity of airway collapsibility, a key driver of OSA pathogenesis.
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Affiliation(s)
- Eric R Thuler
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Manan H Parekh
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jules G Rodin
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Everett G Seay
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Wiemken
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brendan T Keenan
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard J Schwab
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alan R Schwartz
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Sleep Medicine, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru
| | - Raj C Dedhia
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Malhotra A, Bednarik J, Chakladar S, Dunn JP, Weaver T, Grunstein R, Fietze I, Redline S, Azarbarzin A, Sands SA, Schwab RJ, Bunck MC. Tirzepatide for the treatment of obstructive sleep apnea: Rationale, design, and sample baseline characteristics of the SURMOUNT -OSA phase 3 trial. Contemp Clin Trials 2024; 141:107516. [PMID: 38547961 DOI: 10.1016/j.cct.2024.107516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Weight reduction is a standard recommendation for obstructive sleep apnea (OSA) treatment in people with obesity or overweight; however, weight loss can be challenging to achieve and maintain without bariatric surgery. Currently, no approved anti-obesity medication has demonstrated effectiveness in OSA management. This study is evaluating the efficacy and safety of tirzepatide for treatment of moderate to severe OSA in people with obesity. METHODS SURMOUNT-OSA, a randomized, placebo -controlled, 52-week phase 3 trial, is investigating the efficacy and safety of tirzepatide for treatment of moderate to severe OSA (apnea hypopnea- index ≥15 events/h) in participants with obesity (body mass index ≥30 kg/m2) and an established OSA diagnosis. SURMOUNT-OSA is made of 2 intervention-specific appendices (ISAs): ISA-1 includes participants with no current OSA treatment, and ISA-2 includes participants using positive airway pressure therapy. Overall, 469 participants have been randomized 1:1 to receive tirzepatide or placebo across the master protocol (ISA-1, n = 234; ISA-2, n = 235). All participants are also receiving lifestyle intervention for weight reduction. RESULTS The primary endpoint for the individual ISAs is the difference in apnea hypopnea- index response, as measured by polysomnography, between tirzepatide and placebo arms at week 52. Secondary endpoints include sleep apnea-specific hypoxic burden, functional outcomes, and cardiometabolic biomarkers. The trial employs digital wearables, including home sleep testing to capture time to improvement and accelerometry for daily physical activity assessment, to evaluate exploratory outcomes. CONCLUSION SURMOUNT-OSA brings a novel design to investigate if tirzepatide provides clinically meaningful improvement in obesity-related OSA by targeting the underlying etiology. TRIAL REGISTRATION ClinicalTrials.gov, NCT05412004.
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Affiliation(s)
- Atul Malhotra
- University of California San Diego, La Jolla, CA, USA.
| | | | | | | | - Terri Weaver
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ron Grunstein
- Woolcock Institute of Medical Research and Royal Prince Alfred Hospital, Sydney, Australia
| | - Ingo Fietze
- Centre of Sleep Medicine, Charité University Hospital Berlin, Berlin, Germany
| | | | | | | | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Schwab RJ, Lin TC, Wiemken A, Dedhia RC, Wehrli FW, Keenan BT. State-Dependent Biomechanical Behavior of Oropharyngeal Structures in Apneics and Controls: A Proof-of-Concept Study. Ann Am Thorac Soc 2024. [PMID: 38507612 DOI: 10.1513/annalsats.202309-847oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale: Apneics have reduced airway caliber during sleep. The biomechanical changes in upper airway anatomy contributing to this airway narrowing are largely unknown. Objectives: To investigate the state-dependent (wake vs. sleep) biomechanical behavior of the upper airway soft-tissue and craniofacial structures. Methods: Upper airway magnetic resonance imaging was performed in 15 sleep-deprived controls (AHI<5; 0.3±0.5 events/hour) and 12 sleep-deprived apneics (AHI≥5; 35.2±18.1 events/hour) during wake and sleep and analyzed for airway measures and soft-tissue/mandibular movement. Results: In the retropalatal region, controls showed sleep-dependent reductions (p≤0.037) in average cross-sectional airway area (CSA), minimum CSA, anteroposterior, and lateral dimensions. Apneics showed sleep-dependent reductions (p≤0.002) in average CSA, minimum CSA, anteroposterior and lateral dimensions. In the retroglossal region, controls had no sleep-dependent airway reductions. However, apneics had sleep-dependent reductions in minimal CSA (p=0.001) and lateral dimensions (p=0.014). Controls only showed sleep-dependent posterior movement of the anterior-inferior tongue octant (p=0.039), while apneics showed posterior movement of the soft palate (p=0.006) and all tongue octants (p≤0.012). Sleep-dependent medial movement of the lateral walls was seen at the retropalatal minimum level (p=0.013) in controls and the retropalatal and retroglossal minimum levels (p≤0.017) in apneics. There was posterior movement of the mandible in apneics (p≤0.017). Conclusion: During sleep, controls and apneics showed reductions in retropalatal airway caliber; only apneics showed retroglossal airway narrowing. Reductions in anteroposterior and lateral airway dimensions were primarily due to posterior soft palate, tongue and mandibular movement and medial lateral walls movement. These data provide important initial insights into obstructive sleep apnea pathogenesis.
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Affiliation(s)
- Richard J Schwab
- University of Pennsylvania Perelman School of Medicine, 14640, Division of Sleep Medicine / Department of Medicine, Philadelphia, Pennsylvania, United States;
| | - Theodore C Lin
- University of Pennsylvania Perelman School of Medicine, 14640, Division of Sleep Medicine / Department of Medicine, Philadelphia, Pennsylvania, United States
- Temple University, 6558, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, Pennsylvania, United States
| | - Andrew Wiemken
- University of Pennsylvania Perelman School of Medicine, 14640, Division of Sleep Medicine / Department of Medicine, Philadelphia, Pennsylvania, United States
| | - Raj C Dedhia
- University of Pennsylvania Perelman School of Medicine, 14640, Division of Sleep Medicine / Department of Medicine, Philadelphia, Pennsylvania, United States
- University of Pennsylvania Perelman School of Medicine, 14640, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, Pennsylvania, United States
| | - Felix W Wehrli
- University of Pennsylvania Perelman School of Medicine, 14640, Laboratory for Structural, Physiologic and Functional Imaging (LSPFI), Department of Radiology, Philadelphia, Pennsylvania, United States
| | - Brendan T Keenan
- University of Pennsylvania Perelman School of Medicine, 14640, Division of Sleep Medicine / Department of Medicine, Philadelphia, Pennsylvania, United States
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Xu J, Wiemken A, Langham MC, Rao H, Nabbout M, Caporale AS, Schwab RJ, Detre JA, Wehrli FW. Sleep-stage-dependent alterations in cerebral oxygen metabolism quantified by magnetic resonance. J Neurosci Res 2024; 102:e25313. [PMID: 38415989 DOI: 10.1002/jnr.25313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
A key function of sleep is to provide a regular period of reduced brain metabolism, which is critical for maintenance of healthy brain function. The purpose of this work was to quantify the sleep-stage-dependent changes in brain energetics in terms of cerebral metabolic rate of oxygen (CMRO2 ) as a function of sleep stage using quantitative magnetic resonance imaging (MRI) with concurrent electroencephalography (EEG) during sleep in the scanner. Twenty-two young and older subjects with regular sleep hygiene and Pittsburgh Sleep Quality Index (PSQI) in the normal range were recruited for the study. Cerebral blood flow (CBF) and venous oxygen saturation (SvO2 ) were obtained simultaneously at 3 Tesla field strength and 2.7-s temporal resolution during an 80-min time series using OxFlow, an in-house developed imaging sequence. The method yields whole-brain CMRO2 in absolute physiologic units via Fick's Principle. Nineteen subjects yielded evaluable data free of subject motion artifacts. Among these subjects, 10 achieved slow-wave (N3) sleep, 16 achieved N2 sleep, and 19 achieved N1 sleep while undergoing the MRI protocol during scanning. Mean CMRO2 was 98 ± 7(μmol min-1 )/100 g awake, declining progressively toward deepest sleep stage: 94 ± 10.8 (N1), 91 ± 11.4 (N2), and 76 ± 9.0 μmol min-1 /100 g (N3), with each level differing significantly from the wake state. The technology described is able to quantify cerebral oxygen metabolism in absolute physiologic units along with non-REM sleep stage, indicating brain oxygen consumption to be closely associated with depth of sleep, with deeper sleep stages exhibiting progressively lower CMRO2 levels.
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Affiliation(s)
- Jing Xu
- Laboratory for Structural, Physiological, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Wiemken
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Langham
- Laboratory for Structural, Physiological, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hengyi Rao
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marianne Nabbout
- Laboratory for Structural, Physiological, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alessandra S Caporale
- Laboratory for Structural, Physiological, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurosciences, Imaging and Clinical Sciences, 'G. d'Annunzio University' of Chieti-Pescara, Chieti, Italy
- Institute for Advanced Biomedical Technologies (ITAB), 'G. d'Annunzio University' of Chieti-Pescara, Chieti, Italy
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Felix W Wehrli
- Laboratory for Structural, Physiological, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Nance RM, Fohner AE, McClelland RL, Redline S, Nick Bryan R, Desiderio L, Habes M, Longstreth WT, Schwab RJ, Wiemken AS, Heckbert SR. The Association of Upper Airway Anatomy with Brain Structure: The Multi-Ethnic Study of Atherosclerosis. Brain Imaging Behav 2024:10.1007/s11682-023-00843-w. [PMID: 38194040 DOI: 10.1007/s11682-023-00843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
Sleep apnea, affecting an estimated 1 in 4 American adults, has been reported to be associated with both brain structural abnormality and impaired cognitive function. Obstructive sleep apnea is known to be affected by upper airway anatomy. To better understand the contribution of upper airway anatomy to pathways linking sleep apnea with impaired cognitive function, we investigated the association of upper airway anatomy with structural brain abnormalities. Based in the Multi-Ethnic Study of Atherosclerosis, a longitudinal cohort study of community-dwelling adults, a comprehensive sleep study and an MRI of the upper airway and brain were performed on 578 participants. Machine learning models were used to select from 74 upper airway measures those measures most associated with selected regional brain volumes and white matter hyperintensity volume. Linear regression assessed associations between the selected upper airway measures, sleep measures, and brain structure. Maxillary divergence was positively associated with hippocampus volume, and mandible length was negatively associated with total white and gray matter volume. Both coefficients were small (coefficients per standard deviation 0.063 mL, p = 0.04, and - 7.0 mL, p < 0.001 respectively), and not affected by adjustment for sleep study measures. Self-reported snoring >2 times per week was associated with larger hippocampus volume (coefficient 0.164 mL, p = 0.007), and higher percentage of time in the N3 sleep stage was associated with larger total white and gray matter volume (4.8 mL, p = 0.004). Despite associations of two upper airway anatomy measures with brain volume, the evidence did not suggest that these upper airway and brain structure associations were acting primarily through the pathway of sleep disturbance.
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Affiliation(s)
- Robin M Nance
- University of Washington, Seattle, WA, USA.
- , 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
| | - Alison E Fohner
- Department of Epidemiology & Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | | | - Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mohamad Habes
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, USA
| | - Richard J Schwab
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew S Wiemken
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Keenan BT, Magalang UJ, Schwab RJ. A Need for Understanding Clinically Meaningful Differences in Endotypes Derived From Polysomnography. Chest 2023; 164:e160-e161. [PMID: 37945205 DOI: 10.1016/j.chest.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Nance RM, Fohner AE, McClelland RL, Redline S, Bryan RN, Fitzpatrick A, Habes M, Longstreth WT, Schwab RJ, Wiemken AS, Heckbert SR. The association of upper airway anatomy with cognitive test performance: the Multi-Ethnic Study of Atherosclerosis. BMC Neurol 2023; 23:394. [PMID: 37907860 PMCID: PMC10617161 DOI: 10.1186/s12883-023-03443-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Numerous upper airway anatomy characteristics are risk factors for sleep apnea, which affects 26% of older Americans, and more severe sleep apnea is associated with cognitive impairment. This study explores the pathophysiology and links between upper airway anatomy, sleep, and cognition. METHODS Participants in the Multi-Ethnic Study of Atherosclerosis underwent an upper airway MRI, polysomnography to assess sleep measures including the apnea-hypopnea index (AHI) and completed the Cognitive Abilities Screening Instrument (CASI). Two model selection techniques selected from among 67 upper airway measures those that are most strongly associated with CASI score. The associations of selected upper airway measures with AHI, AHI with CASI score, and selected upper airway anatomy measures with CASI score, both alone and after adjustment for AHI, were assessed using linear regression. RESULTS Soft palate volume, maxillary divergence, and upper facial height were significantly positively associated with higher CASI score, indicating better cognition. The coefficients were small, with a 1 standard deviation (SD) increase in these variables being associated with a 0.83, 0.75, and 0.70 point higher CASI score, respectively. Additional adjustment for AHI very slightly attenuated these associations. Larger soft palate volume was significantly associated with higher AHI (15% higher AHI (95% CI 2%,28%) per SD). Higher AHI was marginally associated with higher CASI score (0.43 (95% CI 0.01,0.85) per AHI doubling). CONCLUSIONS Three upper airway measures were weakly but significantly associated with higher global cognitive test performance. Sleep apnea did not appear to be the mechanism through which these upper airway and cognition associations were acting. Further research on the selected upper airway measures is recommended.
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Affiliation(s)
- Robin M Nance
- University of Washington, 325 9th Ave, Box 359931, Seattle, 98104, USA.
| | - Alison E Fohner
- Department of Epidemiology & Cardiovascular Health Research Unit, University of Washington, Seattle, USA
| | | | - Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | | | - Mohamad Habes
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, USA
| | - Richard J Schwab
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew S Wiemken
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
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Keenan BT, Magalang UJ, Schwab RJ. Night-to-night reliability and agreement of physiological endotypes: two steps forward, one step back. Sleep 2023; 46:zsad116. [PMID: 37074871 PMCID: PMC10424163 DOI: 10.1093/sleep/zsad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 04/20/2023] Open
Affiliation(s)
- Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Smith BM, Wiemken A, Hoffman EA, Keenan BT, Allen NB, Bertoni AG, Jacobs DR, Michos ED, Watson KE, Redline S, Schwab RJ, Barr RG, Heckbert SR. Upper and Lower Airway Dysanapsis and Airflow Obstruction Among Older Adults. Am J Respir Crit Care Med 2022; 206:913-917. [PMID: 35679318 DOI: 10.1164/rccm.202202-0353le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Benjamin M Smith
- McGill University, Respiratory Medicine, Montreal, Quebec, Canada.,Columbia University, Medicine, New York, New York, United States;
| | - Andrew Wiemken
- University of Pennsylvania, 6572, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania, United States
| | - Eric A Hoffman
- University of Iowa Carver College of Medicine, Radiology, Iowa City, Iowa, United States
| | - Brendan T Keenan
- University of Pennsylvania Perelman School of Medicine, 14640, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania, United States
| | | | - Alain G Bertoni
- Wake Forest University, Department of Epidemiology and Prevention, Winston-Salem, North Carolina, United States
| | - David R Jacobs
- University of Minnesota, Epidemiology, Minneapolis, Minnesota, United States
| | - Erin D Michos
- Johns Hopkins University, Medicine, Baltimore, Maryland, United States
| | - Karol E Watson
- University of California at Los Angeles, Medicine, Los Angeles, California, United States
| | - Susan Redline
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, United States.,Harvard Medical School, Division of Sleep Medicine, Boston, Massachusetts, United States
| | - Richard J Schwab
- University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - R Graham Barr
- Columbia University, Epidemiology, New York, New York, United States
| | - Susan R Heckbert
- University of Washington, Cardiovascular Health Research Unit, Seattle, Washington, United States.,University of Washington, Department of Epidemiology, Seattle, Washington, United States.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
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12
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Wu PH, Rodríguez-Soto AE, Wiemken A, Englund EK, Rodgers ZB, Langham MC, Schwab RJ, Detre JA, Guo W, Wehrli FW. MRI evaluation of cerebral metabolic rate of oxygen (CMRO 2) in obstructive sleep apnea. J Cereb Blood Flow Metab 2022; 42:1049-1060. [PMID: 34994242 PMCID: PMC9125486 DOI: 10.1177/0271678x211071018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 01/09/2023]
Abstract
Patients with obstructive sleep apnea (OSA) are at elevated risk of developing systemic vascular disease and cognitive dysfunction. Here, cerebral oxygen metabolism was assessed in patients with OSA by means of a magnetic resonance-based method involving simultaneous measurements of cerebral blood flow rate and venous oxygen saturation in the superior sagittal sinus for a period of 10 minutes at an effective temporal resolution of 1.3 seconds before, during, and after repeated 24-second breath-holds mimicking spontaneous apneas, yielding, along with pulse oximetry-derived arterial saturation, whole-brain CMRO2 via Fick's Principle. Enrolled subjects were classified based on their apnea-hypopnea indices into OSA (N = 31) and non-sleep apnea reference subjects (NSA = 21), and further compared with young healthy subjects (YH, N = 10). OSA and NSA subjects were matched for age and body mass index. CMRO2 was lower in OSA than in the YH group during normal breathing (105.6 ± 14.1 versus 123.7 ± 22.8 μmol O2/min/100g, P = 0.01). Further, the fractional change in CMRO2 in response to a breath-hold challenge was larger in OSA than in the YH group (15.2 ± 9.2 versus 8.5 ± 3.4%, P = 0.04). However, there was no significant difference in CMRO2 between OSA and NSA subjects. The data suggest altered brain oxygen metabolism in OSA and possibly in NSA as well.
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Affiliation(s)
- Pei-Hsin Wu
- Department of Radiology, University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
- Department of Electrical Engineering, National Sun Yat-sen University, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ana E Rodríguez-Soto
- Department of Radiology, University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Wiemken
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erin K Englund
- Department of Radiology, University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary B Rodgers
- Department of Radiology, University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Wensheng Guo
- Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
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13
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Yu JL, Wiemken A, Schultz SM, Keenan BT, Sehgal CM, Schwab RJ. A comparison of ultrasound echo intensity to magnetic resonance imaging as a metric for tongue fat evaluation. Sleep 2021; 45:6486313. [PMID: 34963001 PMCID: PMC8842321 DOI: 10.1093/sleep/zsab295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Tongue fat is associated with obstructive sleep apnea (OSA). Magnetic resonance imaging (MRI) is the standard for quantifying tongue fat. Ultrasound echo intensity has been shown to correlate to the fat content in skeletal muscles but has yet to be studied in the tongue. The objective of this study is to evaluate the relationship between ultrasound echo intensity and tongue fat. METHODS Ultrasound coronal cross-sections of ex-vivo cow tongues were recorded at baseline and following three 1 mL serial injections of fat into the tongue. In humans, adults with and without OSA had submental ultrasound coronal cross-sections of their posterior tongue. The average echo intensity of the tongues (cow/human) was calculated in ImageJ software. Head and neck MRIs were obtained on human subjects to quantify tongue fat volume. Echo intensity was compared to injected fat volume or MRI-derived tongue fat percentage. RESULTS Echo intensity in cow tongues showed a positive correlation to injected fat volume (rho = 0.93, p < .001). In human subjects, echo intensity of the tongue base strongly correlated with MRI-calculated fat percentage for both the posterior tongue (rho = 0.95, p < .001) and entire tongue (rho = 0.62, p < .001). Larger tongue fat percentages (rho = 0.38, p = .001) and higher echo intensity (rho = 0.27, p = .024) were associated with more severe apnea-hypopnea index, adjusted for age, body mass index, sex, and race. CONCLUSIONS Ultrasound echo intensity is a viable surrogate measure for tongue fat volume and may provide a convenient modality to characterize tongue fat in OSA.
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Affiliation(s)
- Jason L Yu
- Department of Otorhinolaryngology—Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Wiemken
- Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan M Schultz
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brendan T Keenan
- Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chandra M Sehgal
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard J Schwab
- Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Corresponding author. Richard J. Schwab, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, 3624 Market St., Suite 201, Philadelphia, PA 19104, USA.
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14
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Keenan BT, Webster JC, Wiemken AS, Lavi-Romer N, Nguyen T, Svenson KL, Galante RJ, Churchill GA, Pickup S, Pack AI, Schwab RJ. Heritability of fat distributions in male mice from the founder strains of the Diversity Outbred mouse population. G3 (Bethesda) 2021; 11:6171186. [PMID: 33720343 PMCID: PMC8104956 DOI: 10.1093/g3journal/jkab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/08/2021] [Indexed: 01/22/2023]
Abstract
Specific fat distributions are risk factors for complex diseases, including coronary heart disease and obstructive sleep apnea. To demonstrate the utility of high-diversity mouse models for elucidating genetic associations, we describe the phenotyping and heritability of fat distributions within the five classical inbred and three wild-derived founder mouse strains of the Collaborative Cross and Diversity Outbred mice. Measurements of subcutaneous and internal fat volumes in the abdomen, thorax and neck, and fat volumes in the tongue and pericardium were obtained using magnetic resonance imaging in male mice from the A/J (n = 12), C57BL/6J (n = 17), 129S1/SvlmJ (n = 12), NOD/LtJ (n = 14), NZO/HILtJ (n = 12), CAST/EiJ (n = 14), PWK/PhJ (n = 12), and WSB/EiJ (n = 15) strains. Phenotypes were compared across strains using analysis of variance and heritability estimated as the proportion of phenotypic variability attributable to strain. Heritability ranged from 44 to 91% across traits, including >70% heritability of tongue fat. A majority of heritability estimates remained significant controlling for body weight, suggesting genetic influences independent of general obesity. Principal components analysis supports genetic influences on overall obesity and specific to increased pericardial and intra-neck fat. Thus, among the founder strains of the Collaborative Cross and Diversity Outbred mice, we observed significant heritability of subcutaneous and internal fat volumes in the neck, thorax and abdomen, pericardial fat volume and tongue fat volume, consistent with genetic architecture playing an important role in explaining trait variability. Findings pave the way for studies utilizing high-diversity mouse models to identify genes affecting fat distributions and, in turn, influencing risk for associated complex disorders.
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Affiliation(s)
- Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeanette C Webster
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrew S Wiemken
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nir Lavi-Romer
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Teresa Nguyen
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Raymond J Galante
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Stephen Pickup
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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15
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Cielo CM, Keenan BT, Wiemken A, Tapia IE, Kelly A, Schwab RJ. Neck fat and obstructive sleep apnea in obese adolescents. Sleep 2021; 44:6308852. [PMID: 34165571 DOI: 10.1093/sleep/zsab158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Increased neck circumference, a surrogate for the neck fat that can narrow the upper airway in obese individuals, is a risk factor for obstructive sleep apnea syndrome (OSAS) in adults, but the association between neck fat and OSAS in adolescent males and females is unknown. We hypothesized that obese adolescents with OSAS have more neck fat than controls, females more neck fat than males, and that neck fat correlates with obesity and OSAS severity. METHODS Obese adolescents with OSAS and obese and normal-weight controls underwent upper airway magnetic resonance imaging, polysomnography, and anthropometrics, including neck circumference measurement. Intra-neck and subcutaneous neck fat measurements were manually segmented and compared among the three groups using ANOVA and between males and females using t-tests. The relationship between polysomnographic parameters and neck fat measurements was assessed in adolescents with OSAS using Pearson correlations. RESULTS One-hundred nineteen adolescents (38 females) were studied: 39 obese with OSAS, 34 obese controls, and 46 normal-weight controls. Neck fat was not greater in adolescents with OSAS compared to obese controls (p=0.35), and neck fat volume was not related to OSAS severity (p=0.36). However, obese adolescents had more neck fat than normal-weight controls (p<0.001), and neck fat volume correlated with neck circumference (r=0.53, p<0.001). Females had significantly greater cross-sectional neck fat than males (p<0.001). CONCLUSIONS While neck fat is associated with obesity and neck circumference in adolescents and is greater in females versus males, it does not appear to correlate with presence and severity of OSAS.
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Affiliation(s)
- Christopher M Cielo
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia.,University of Pennsylvania, Philadelphia, PA, USA
| | - Brendan T Keenan
- University of Pennsylvania, Philadelphia, PA, USA.,Division of Sleep Medicine, Department of Medicine
| | - Andrew Wiemken
- University of Pennsylvania, Philadelphia, PA, USA.,Division of Sleep Medicine, Department of Medicine
| | - Ignacio E Tapia
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia.,University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Kelly
- University of Pennsylvania, Philadelphia, PA, USA.,Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia
| | - Richard J Schwab
- University of Pennsylvania, Philadelphia, PA, USA.,Division of Sleep Medicine, Department of Medicine
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16
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Xu L, Keenan BT, Maislin D, Gislason T, Benediktsdóttir B, Gudmundsdóttir S, Gardarsdottir M, Staley B, Pack FM, Guo X, Feng Y, Chahwala J, Manaktala P, Hussein A, Reddy-Koppula M, Hashmath Z, Lee J, Townsend RR, Schwab RJ, Pack AI, Kuna ST, Chirinos JA. Effect of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on Cardiac Remodeling as Assessed by Cardiac Biomarker and Magnetic Resonance Imaging in Nonobese and Obese Adults. Hypertension 2021; 77:980-992. [PMID: 33461313 DOI: 10.1161/hypertensionaha.120.15882] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It is unknown whether obesity modifies the effect of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on cardiac remodeling and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. We compared NT-proBNP and cardiac magnetic resonance imaging in adults without OSA (n=56) and nonobese (n=73; body mass index <30 kg/m2) and obese (n=136; body mass index ≥30 kg/m2) adults with OSA. We also investigated these traits in nonobese (n=45) and obese (n=78) participants with OSA adherent to 4 months of PAP treatment. At baseline, left ventricular mass to end-diastolic volume ratio, a measure of left ventricular concentricity, was greater in both nonobese and obese participants with OSA compared with those without OSA. Participants with OSA and obesity exhibited reduced phasic right atrial function. No significant differences in baseline NT-proBNP were observed across groups. The effect of PAP treatment on NT-proBNP and left atrial volume index was significantly modified by obesity. In nonobese participants, PAP therapy was associated with a decrease in NT-proBNP (P<0.0001) without a change in left atrial volume index, whereas in obese participants, PAP was associated with an increase in left atrial volume index (P=0.006) without a change in NT-proBNP. OSA was associated with left ventricular concentric remodeling independent of obesity and right atrial dysfunction in participants who were obese. PAP treatment was associated with reduced NT-proBNP in nonobese participants with OSA, but left atrial enlargement in obese participants with OSA, suggesting that PAP-induced reduction in BNP release (which is known to occur during obstructive apnea episodes) may lead to volume retention in obese participants with OSA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01578031.
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Affiliation(s)
- Liyue Xu
- From the Sleep Center, Peking University People's Hospital, Beijing, China (L.X.).,Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - David Maislin
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Thorarinn Gislason
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Bryndís Benediktsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Sigrun Gudmundsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik
| | | | - Bethany Staley
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Frances M Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Xiaofeng Guo
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.F.)
| | - Jugal Chahwala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Pritika Manaktala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Anila Hussein
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Maheshwara Reddy-Koppula
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Zeba Hashmath
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Jonathan Lee
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Samuel T Kuna
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia.,Sleep Medicine Section, Crescenz Veterans Affairs Medical Center, Philadelphia (S.T.K.)
| | - Julio A Chirinos
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
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17
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Schwab RJ, Keenan BT, Sarwer DB, Pack AI. Reply to Kawada: Weight Loss and Upper Airway Anatomy in Patients with Obstructive Sleep Apnea. Am J Respir Crit Care Med 2021; 203:270-271. [PMID: 33074713 PMCID: PMC7874422 DOI: 10.1164/rccm.202009-3632le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - David B. Sarwer
- College of Public Health at Temple UniversityPhiladelphia, Pennsylvania
| | - Allan I. Pack
- University of PennsylvaniaPhiladelphia, Pennsylvaniaand
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18
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Abstract
The ability to remotely monitor positive airway pressure therapy adherence and efficacy provides a unique opportunity for the field of sleep medicine to quickly and efficiently improve patient adherence. Smaller randomized studies and larger-scale retrospective evaluations show that telemedicine interventions leveraging these data can increase average usage and efficiency of care. However, more evidence on the impact of these programs on longer-term adherence and improving patient-reported outcomes is needed. Combining data from remote monitoring with clinical information in electronic health records may prove to be invaluable to the future of clinical sleep medicine practice and research.
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Affiliation(s)
- Brendan T Keenan
- Biostatistics Core, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Translational Research Laboratories, 125 South 31st Street, Suite 2100, Office 2121, Philadelphia, PA 19104, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, University of Pennsylvania Medical Center, 3624 Market Street, Suite 205, Philadelphia, PA 19104, USA.
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19
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Kezirian EJ, Simmons M, Schwab RJ, Cistulli P, Li KK, Weaver EM, Goldberg AN, Malhotra A. Making Sense of the Noise: Toward Rational Treatment for Obstructive Sleep Apnea. Am J Respir Crit Care Med 2020; 202:1503-1508. [PMID: 32697596 DOI: 10.1164/rccm.202005-1939pp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Eric J Kezirian
- University of Southern California Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael Simmons
- Encino Center for Sleep and TMJ Disorders, Encino, California
| | - Richard J Schwab
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Peter Cistulli
- Sleep Research Group, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kasey K Li
- Sleep Apnea Surgery Center, East Palo Alto, California
| | - Edward M Weaver
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington.,Surgery Service, Department of Veterans Affairs Medical Center, Seattle, Washington
| | - Andrew N Goldberg
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California; and
| | - Atul Malhotra
- Department of Medicine, University of California, San Diego, San Diego, California
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20
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Lee CH, Seay EG, Reese JW, Wu X, Schwab RJ, Keenan B, Dedhia RC. Clinical Radiographic Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2020; 164:1122-1127. [PMID: 33048610 DOI: 10.1177/0194599820963141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if clinically acquired cephalometric measurements, specifically soft palate size, can predict hypoglossal nerve stimulation outcomes. STUDY DESIGN Combined prospective cohort study and retrospective review. SETTING US sleep otolaryngology training program. METHODS Adults with obstructive sleep apnea and apneahypopnea index greater than 15 events/h who underwent hypoglossal nerve stimulation. Eligible subjects had diagnostic preoperative sleep studies and full-night efficacy postoperative studies for analysis. Lateral neck x-rays were obtained as part of routine clinical care and measured for key cephalometric variables by trained head and neck radiologists. Continuous variables were compared using the Student t test, while χ2 testing was used for categorical variables. RESULTS Fifty-one patients met all study criteria. On average, patients were white, middle aged, and overweight. Following hypoglossal nerve stimulation, the overall cohort achieved a significant apnea-hypopnea index reduction from 36.7 events/h to 20.6 events/h (P < .01) and a response rate of 47% (defined as apnea-hypopnea index reduction >50% and apnea-hypopnea index <20 events/h). On average, therapy responders had significantly thinner soft palates than nonresponders (13.4 ± 3.8 mm vs 16.0 ± 3.4 mm, P = .045). CONCLUSIONS Patient-specific anatomic factors, specifically soft palate thickness, may help identify optimal candidates for hypoglossal nerve stimulation. A larger, prospective study including both anatomic and physiologic variables is required to validate these findings.
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Affiliation(s)
- Clara H Lee
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, USA
| | - Everett G Seay
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James W Reese
- Baylor Radiologists: A Radiology Partners Affiliated Practice, Houston, Texas, USA
| | - Xin Wu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raj C Dedhia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Sprung VS, Kemp GJ, Wilding JP, Adams V, Murphy K, Burgess M, Emegbo S, Thomas M, Needham AJ, Weimken A, Schwab RJ, Manuel A, Craig SE, Cuthbertson DJ. Randomised, cOntrolled Multicentre trial of 26 weeks subcutaneous liraglutide (a glucagon-like peptide-1 receptor Agonist), with or without contiNuous positive airway pressure (CPAP), in patients with type 2 diabetes mellitus (T2DM) and obstructive sleep apnoEa (OSA) (ROMANCE): study protocol assessing the effects of weight loss on the apnea-hypnoea index (AHI). BMJ Open 2020; 10:e038856. [PMID: 32699168 PMCID: PMC7380950 DOI: 10.1136/bmjopen-2020-038856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) and type 2 diabetes mellitus (T2DM) often occur concurrently, and untreated OSA may potentially amplify the high risk of cardiovascular disease in T2DM. Compliance with continuous positive airway pressure (CPAP), the conventional treatment for OSA, can be poor and considering weight loss is the most effective treatment for OSA. This trial examines whether the glucagon-like peptide-1 receptor agonist liraglutide, a glucose-lowering therapy associated with significant weight loss used in T2DM, can improve the severity and symptoms of OSA. METHODS AND ANALYSIS This is an outpatient, single-centred, open-labelled, prospective, phase IV randomised controlled trial in a two-by-two factorial design. One hundred and thirty-two patients with newly diagnosed OSA (apnoea-hypopnoea index (AHI) ≥15 events/hour), and existing obesity and T2DM (glycated haemoglobin (HbA1c) ≥47 mmol/mol), will be recruited from diabetes and sleep medicine outpatient clinics in primary and secondary care settings across Liverpool. Patients will be allocated equally, using computer-generated random, permuted blocks of unequal sizes, to each of the four treatment arms for 26 weeks: (i) liraglutide (1.8 mg once per day) alone, (ii) liraglutide 1.8 mg once per day with CPAP, (iii) CPAP alone (conventional care) or (iv) no treatment (control). The primary outcome measure is change in OSA severity, determined by AHI. Secondary outcome measures include effects on glycaemic control (glycated haemoglobin (HbA1c)), body weight and quality of life measures. Exploratory measures include measures of physical activity, MRI-derived measures of regional body composition including fat mass (abdominal subcutaneous, visceral, neck and liver fat) and skeletal muscle mass (cross-sectional analysis of thigh), indices of cardiac function (using transthoracic echocardiography) and endothelial function. ETHICAL APPROVAL The study has been approved by the North West Liverpool Central Research Ethics Committee (14/NW/1019) and it is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. TRIAL REGISTRATION NUMBERS ISRCTN16250774. EUDRACT No. 2014-000988-41. UTN U1111-1139-0677.
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Affiliation(s)
- Victoria S Sprung
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Graham J Kemp
- Department of Musculoskeletal & Ageing Science, University of Liverpool, Liverpool, Merseyside, UK
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - John Ph Wilding
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Valerie Adams
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Kieran Murphy
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Malcolm Burgess
- Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Emegbo
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Thomas
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Andrew Weimken
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard J Schwab
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ari Manuel
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sonya E Craig
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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22
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Jenks CM, Yu JL, Schmitt KA, Schwab RJ, Thaler ER. Prospective Determination of Airway Response to Upper Airway Stimulation: A New Opportunity for Advanced Device Titration. Laryngoscope 2020; 131:218-223. [PMID: 32557705 DOI: 10.1002/lary.28758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Response to upper airway stimulation (UAS) is associated with the degree of airway opening during stimulation. UAS programming may affect this opening. The objective of this study was to examine airway changes in response to five different electrode configurations programmable within the Inspire UAS system. STUDY DESIGN Prospective single-arm cohort study. METHODS Subjects who underwent UAS implantation were recruited for a prospective single-arm cohort study during UAS device activation. Functional thresholds were recorded for all settings. Awake nasopharyngoscopy was performed to examine the retropalatal (RP) and retroglossal (RG) regions at rest and during activation with all settings at their functional thresholds. Cross-sectional measurements were made by two blinded reviewers and reported as percent change in airway size. RESULTS Sixteen patients were included. The standard setting (+-+) resulted in the greatest change in RP area in 43.8% of patients. An alternative setting resulted in greatest change in 56.2% of patients (--- and o-o in 18.8% each, -o- in 12.5%, and -+- in 6.3% of patients). Average response to all five settings was utilized to classify degree of palatoglossal coupling. Most patients had some enlargement (20%-70% change in RP area, 43.8%) or no enlargement (<20% change, 43.8%), whereas a minority of patients (12.5%) had marked enlargement (>70% change). RP and RG expansion were not correlated. CONCLUSION Degree of RP expansion varied among patients and settings. Although the standard setting resulted in greatest RP change in a plurality of patients, over half had a greater response to an alternative setting. Future studies should address whether choice of setting based on RP expansion results in improved outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:218-223, 2021.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason L Yu
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Division of Sleep Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Katherine A Schmitt
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Richard J Schwab
- Division of Sleep Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Erica R Thaler
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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23
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Wu PH, Rodríguez-Soto AE, Rodgers ZB, Englund EK, Wiemken A, Langham MC, Detre JA, Schwab RJ, Guo W, Wehrli FW. MRI evaluation of cerebrovascular reactivity in obstructive sleep apnea. J Cereb Blood Flow Metab 2020; 40:1328-1337. [PMID: 31307289 PMCID: PMC7238371 DOI: 10.1177/0271678x19862182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by intermittent obstruction of the airways during sleep. Cerebrovascular reactivity (CVR) is an index of cerebral vessels' ability to respond to a vasoactive stimulus, such as increased CO2. We hypothesized that OSA alters CVR, expressed as a breath-hold index (BHI) defined as the rate of change in CBF or BOLD signal during a controlled breath-hold stimulus mimicking spontaneous apneas by being both hypercapnic and hypoxic. In 37 OSA and 23 matched non sleep apnea (NSA) subjects, we obtained high temporal resolution CBF and BOLD MRI data before, during, and between five consecutive BH stimuli of 24 s, each averaged to yield a single BHI value. Greater BHI was observed in OSA relative to NSA as derived from whole-brain CBF (78.6 ± 29.6 vs. 60.0 ± 20.0 mL/min2/100 g, P = 0.010) as well as from flow velocity in the superior sagittal sinus (0.48 ± 0.18 vs. 0.36 ± 0.10 cm/s2, P = 0.014). Similarly, BOLD-based BHI was greater in OSA in whole brain (0.19 ± 0.08 vs. 0.15 ± 0.03%/s, P = 0.009), gray matter (0.22 ± 0.09 vs. 0.17 ± 0.03%/s, P = 0.011), and white matter (0.14 ± 0.06 vs. 0.10 ± 0.02%/s, P = 0.010). The greater CVR is not currently understood but may represent a compensatory mechanism of the brain to maintain oxygen supply during intermittent apneas.
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Affiliation(s)
- Pei-Hsin Wu
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Ana E Rodríguez-Soto
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Zachary B Rodgers
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Erin K Englund
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Andrew Wiemken
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
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24
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Webster JC, Keenan B, Schwab RJ. 0562 Differences in Upper Airway Soft Tissue Volumes Between African American and Caucasian Patients with Obstructive Sleep Apnea Using Magnetic Resonance Imaging. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Research suggests greater obstructive sleep apnea (OSA) severity in African-Americans than Caucasians. However, the underlying mechanisms causing this ethnic disparity are unknown. To evaluate possible mechanisms, we compared the size of the tongue between African American and Caucasian OSA patients using magnetic resonance imaging (MRI), controlling for age, body mass index (BMI) and apnea-hypoxia index (AHI). Given prior evidence of more severe OSA in African Americans, we hypothesized these patients would have larger soft tissue volumes compared to Caucasians.
Methods
Upper airway soft tissue volumes, (total tongue, tongue fat, lateral walls, pterygoids, total soft tissue) were quantified using MRI and compared between Caucasian (n=133) and African American (n=175) patients with moderate OSA. Analyses were conducted using regression models controlling for age, sex, BMI and AHI.
Results
Among all OSA patients, African Americans had higher BMI than Caucasians (40.0±8.6 vs. 37.1±8.1 kg/m2, p=0.0024) and a higher proportion of females (66.3% vs. 36.1%; p<0.0001). There were no significant differences in age (p=0.143) or AHI (p=0.314). Controlling for these covariates, there were no differences between African American and Caucasian OSA patients in tongue fat volume (mean [95% confidence interval] difference = 479 [-3156, 4115] mm3; p=0.794). However, African Americans had a 13,286 (6,439, 20,132) mm3 larger total tongue volume compared to Caucasians (p=0.0002). Larger volumes in African Americans were also observed for the soft palate (p<0.0001), retropalatal lateral walls (p=0.003), pterygoid (p=0.034) and total soft tissue volume (p=0.0003).
Conclusion
African Americans were observed to have larger volumes of the tongue, soft palate, retropalatal lateral walls, pterygoids and total soft tissue volume compared to Caucasians, although there were no differences in AHI and tongue fat volume. The study contributes to the overall understanding of ethnic-specific pathology of OSA and can potentially influence how African Americans and Caucasians are diagnosed and treated specifically for the disease.
Support
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Affiliation(s)
- J C Webster
- University of Pennsylvania, Philadelphia, PA
| | - B Keenan
- The University of Pennsylvania, Philadelphia, PA
| | - R J Schwab
- The University of Pennsylvania, Philadelphia, PA
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25
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Xu L, Keenan BT, Wiemken AS, Pack AI, Schwab RJ. 0569 Soft Palate Fat Between Lean Adults with Obstructive Sleep Apnea and Healthy Control. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Previous studies have shown that obese patients with obstructive sleep apnea (OSA) have a significantly greater percentage of fat tissue in soft palate than normal subjects. However, the influence of soft palate fat is not clear in non-obese adults with OSA. This study compared the volume of fat in the soft palate between lean adults with OSA and lean controls.
Methods
We examined soft palate fat in 21 lean OSA cases and 16 lean controls with body mass index (BMI) <25 kg/m2. All subjects underwent a magnetic resonance imaging (MRI) with three-point Dixon scan. We used volumetric reconstruction algorithms to quantify the amount of soft palate fat, which was compared between apnecis and controls. Analysis reproducibility was quantified using intraclass correlation coefficients (ICC) from repeated analyses of 20 randomly-chosen MRIs.
Results
Analysis of soft palate fat was highly reproducible, with an ICC (95% confidence interval) of 0.968 (0.923, 0.987). Lean apneics were younger than lean controls (45.3±13.0 vs. 62.1±10.4 years; p<0.0001). No significant differences between apneics and controls were observed in the average BMI (23.4±2.2 vs. 23.5 ± 2.6 kg/m2; p=0.824), the fat pads volume (4198±1728 vs. 3880±1544 mm3; p=0.646), and the proportion of males (61.9% vs. 68.8%; p=0.666). In unadjusted analyses, the lean OSA group showed significantly higher soft palate fat volume than lean controls (7605±2109 vs. 5327±1783 mm3; p=0.003). When adjusting for age, gender and BMI, no differences was observed between groups in soft palate fat volume (p=0.122) and fat pads volume (p=0.702).
Conclusion
Analysis of soft palate fat volume from Dixon MRI is highly reproducible. Our results indicate no significant difference in deposition of fat at soft palate between lean patients with OSA and lean controls when accounting for age, gender and BMI.
Support
This study is supported by National Institutes of Health Grant: 2P01HL094307-06A1. LX is supported by Young Elite Scientists Sponsorship Program of China Association for Science and Technology.
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Affiliation(s)
- L Xu
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Philadelphia, PA
| | - B T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Philadelphia, PA
| | - A S Wiemken
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Philadelphia, PA
| | - A I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Philadelphia, PA
| | - R J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Philadelphia, PA
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26
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Xu L, Keenan BT, Wiemken AS, Chi L, Staley B, Wang Z, Wang J, Benedikstdottir B, Juliusson S, Pack AI, Gislason T, Schwab RJ. Differences in three-dimensional upper airway anatomy between Asian and European patients with obstructive sleep apnea. Sleep 2020; 43:zsz273. [PMID: 31735957 PMCID: PMC7215269 DOI: 10.1093/sleep/zsz273] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/01/2019] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES This study evaluated differences in upper airway, soft tissues and craniofacial structures between Asians from China and Europeans from Iceland with OSA using three-dimensional magnetic resonance imaging (MRI). METHODS Airway sizes, soft tissue volumes, and craniofacial dimensions were compared between Icelandic (N = 108) and Chinese (N = 57) patients with oxygen desaturation index (ODI) ≥ 10 events/h matched for age, gender, and ODI. Mixed effects models adjusting for height or BMI and residual differences in age and ODI were utilized. RESULTS In our matched sample, compared to Icelandic OSA patients, Chinese patients had smaller BMI (p < 0.0001) and neck circumference (p = 0.011). In covariate adjusted analyses, Chinese showed smaller retropalatal airway size (p ≤ 0.002), and smaller combined soft tissues, tongue, fat pads, and pterygoid (all p ≤ 0.0001), but male Chinese demonstrated a larger soft palate volume (p ≤ 0.001). For craniofacial dimensions, Chinese demonstrated bigger ANB angle (p ≤ 0.0196), differently shaped mandibles, including shorter corpus length (p < 0.0001) but longer ramus length (p < 0.0001), and a wider (p < 0.0001) and shallower (p ≤ 0.0001) maxilla. CONCLUSIONS Compared to Icelandic patients of similar age, gender and ODI, Chinese patients had smaller retropalatal airway and combined soft tissue, but bigger soft palate volume (in males), and differently shaped mandible and maxilla with more bony restrictions. Results support an ethnic difference in upper airway anatomy related to OSA, which may inform targeted therapies.
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Affiliation(s)
- Liyue Xu
- Department of Respiratory Medicine, Peking University People’s Hospital, Beijing, China
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew S Wiemken
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Luqi Chi
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, MO
| | - Bethany Staley
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Zhifang Wang
- Department of Respiratory Medicine, Datong, China
| | - Jianjun Wang
- Department of Radiology, Shanxi Tongcoal General Hospital, Datong, China
| | | | - Sigurdur Juliusson
- ENT Department, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Thorarinn Gislason
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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27
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Wang SH, Keenan BT, Wiemken A, Zang Y, Staley B, Sarwer DB, Torigian DA, Williams N, Pack AI, Schwab RJ. Effect of Weight Loss on Upper Airway Anatomy and the Apnea-Hypopnea Index. The Importance of Tongue Fat. Am J Respir Crit Care Med 2020; 201:718-727. [PMID: 31918559 PMCID: PMC7068828 DOI: 10.1164/rccm.201903-0692oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022] Open
Abstract
Rationale: Obesity is the primary risk factor for obstructive sleep apnea (OSA). Tongue fat is increased in obese persons with OSA, and may explain the relationship between obesity and OSA. Weight loss improves OSA, but the mechanism is unknown.Objectives: To determine the effect of weight loss on upper airway anatomy in subjects with obesity and OSA. We hypothesized that weight loss would decrease soft tissue volumes and tongue fat, and that these changes would correlate with reductions in apnea-hypopnea index (AHI).Methods: A total of 67 individuals with obesity and OSA (AHI ≥ 10 events/h) underwent a sleep study and upper airway and abdominal magnetic resonance imaging before and after a weight loss intervention (intensive lifestyle modification or bariatric surgery). Airway sizes and soft tissue, tongue fat, and abdominal fat volumes were quantified. Associations between weight loss and changes in these structures, and relationships to AHI changes, were examined.Measurements and Main Results: Weight loss was significantly associated with reductions in tongue fat and pterygoid and total lateral wall volumes. Reductions in tongue fat were strongly correlated with reductions in AHI (Pearson's rho = 0.62, P < 0.0001); results remained after controlling for weight loss (Pearson's rho = 0.36, P = 0.014). Reduction in tongue fat volume was the primary upper airway mediator of the relationship between weight loss and AHI improvement.Conclusions: Weight loss reduced volumes of several upper airway soft tissues in subjects with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.
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Affiliation(s)
- Stephen H. Wang
- Albert Einstein College of Medicine, Bronx, New York
- Center for Sleep and Circadian Neurobiology
| | | | | | | | | | - David B. Sarwer
- Center for Obesity Research and Education at the College of Public Health at Temple University, Philadelphia, Pennsylvania
| | | | | | - Allan I. Pack
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Richard J. Schwab
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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28
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Ackrivo J, Hansen-Flaschen J, Jones BL, Wileyto EP, Schwab RJ, Elman L, Kawut SM. Classifying Patients with Amyotrophic Lateral Sclerosis by Changes in FVC. A Group-based Trajectory Analysis. Am J Respir Crit Care Med 2019; 200:1513-1521. [PMID: 31322417 PMCID: PMC6909832 DOI: 10.1164/rccm.201902-0344oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022] Open
Abstract
Rationale: A model for stratifying progression of respiratory muscle weakness in amyotrophic lateral sclerosis (ALS) would identify disease mechanisms and phenotypes suitable for future investigations. This study sought to categorize progression of FVC after presentation to an outpatient ALS clinic.Objectives: To identify clinical phenotypes of ALS respiratory progression based on FVC trajectories over time.Methods: We derived a group-based trajectory model from a single-center cohort of 837 patients with ALS who presented between 2006 and 2015. We applied our model to the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database with 7,461 patients with ALS. Baseline characteristics at first visit were used as predictors of trajectory group membership. The primary outcome was trajectory of FVC over time in months.Measurements and Main Results: We found three trajectories of FVC over time, termed "stable low," "rapid progressor," and "slow progressor." Compared with the slow progressors, the rapid progressors had shorter diagnosis delay, more bulbar-onset disease, and a lower ALS Functional Rating Scale-Revised (ALSFRS-R) total score at baseline. The stable low group had a shorter diagnosis delay, lower body mass index, more bulbar-onset disease, lower ALSFRS-R total score, and were more likely to have an ALSFRS-R orthopnea score lower than 4 compared with the slow progressors. We found that projected group membership predicted respiratory insufficiency in the PRO-ACT cohort (concordance statistic = 0.78, 95% CI, 0.76-0.79).Conclusions: We derived a group-based trajectory model for FVC progression in ALS, which validated against the outcome of respiratory insufficiency in an external cohort. Future studies may focus on patients predicted to be rapid progressors.
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Affiliation(s)
| | | | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Lauren Elman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Steven M. Kawut
- Department of Medicine
- Center for Clinical Epidemiology and Biostatistics, and
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29
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Kuna ST, Townsend RR, Keenan BT, Maislin D, Gislason T, Benediktsdóttir B, Gudmundsdóttir S, Arnardóttir ES, Sifferman A, Staley B, Pack FM, Guo X, Schwab RJ, Maislin G, Chirinos JA, Pack AI. Blood pressure response to treatment of obese vs non-obese adults with sleep apnea. J Clin Hypertens (Greenwich) 2019; 21:1580-1590. [PMID: 31532580 DOI: 10.1111/jch.13689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022]
Abstract
Many patients with obstructive sleep apnea (OSA), but not all, have a reduction in blood pressure (BP) with positive airway pressure (PAP) treatment. Our objective was to determine whether the BP response following PAP treatment is related to obesity. A total of 188 adults with OSA underwent 24-hour BP monitoring and 24-hour urinary norepinephrine collection at baseline. Obesity was assessed by waist circumference, body mass index, and abdominal visceral fat volume. Participants adherent to PAP treatment were reassessed after 4 months. Primary outcomes were 24-hour mean arterial pressure (MAP) and 24-hour urinary norepinephrine level. Obstructive sleep apnea participants had a significant reduction in 24-hour MAP following PAP treatment (-1.22 [95% CI: -2.38, -0.06] mm Hg; P = .039). No significant correlations were present with any of the 3 obesity measures for BP or urinary norepinephrine measures at baseline in all OSA participants or for changes in BP measures in participants adherent to PAP treatment. Changes in BP measures following treatment were not correlated with baseline or change in urinary norepinephrine. Similar results were obtained when BP or urinary norepinephrine measures were compared between participants dichotomized using the sex-specific median of each obesity measure. Greater reductions in urinary norepinephrine were correlated with higher waist circumference (rho = -0.21, P = .037), with a greater decrease from baseline in obese compared to non-obese participants (-6.26 [-8.82, -3.69] vs -2.14 [-4.63, 0.35] ng/mg creatinine; P = .027). The results indicate that the BP response to PAP treatment in adults with OSA is not related to obesity or urinary norepinephrine levels.
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Affiliation(s)
- Samuel T Kuna
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.,Sleep Medicine Section, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brendan T Keenan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Maislin
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Thorarinn Gislason
- Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Bryndís Benediktsdóttir
- Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigrun Gudmundsdóttir
- Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Erna Sif Arnardóttir
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland.,Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Andrea Sifferman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth Staley
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Frances M Pack
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaofeng Guo
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard J Schwab
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.,Biomedical Statistical Consulting, Wynnewood, PA, USA
| | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allan I Pack
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
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30
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Schwab RJ, Wang SH, Verbraecken J, Vanderveken OM, Van de Heyning P, Vos WG, DeBacker JW, Keenan BT, Ni Q, DeBacker W. Anatomic predictors of response and mechanism of action of upper airway stimulation therapy in patients with obstructive sleep apnea. Sleep 2019; 41:4954016. [PMID: 29590480 DOI: 10.1093/sleep/zsy021] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Indexed: 01/15/2023] Open
Abstract
Study Objectives Upper airway stimulation has been shown to be an effective treatment for some patients with obstructive sleep apnea. However, the mechanism by which hypoglossal nerve stimulation increases upper airway caliber is not clear. Therefore, the objective of this study was to identify the mechanism of action of upper airway stimulation. We hypothesized that, with upper airway stimulation, responders would show greater airway opening in the retroglossal (base of the tongue) region, greater hyoid movement toward the mandible, and greater anterior motion in the posterior, inferior region of the tongue compared with nonresponders. Methods Seven participants with obstructive sleep apnea who had been successfully treated with upper airway stimulation (responders) and six participants who were not successfully treated (nonresponders) underwent computed tomography imaging during wakefulness with and without hypoglossal nerve stimulation. Responders reduced their apnea-hypopnea index (AHI) by 22.63 ± 6.54 events per hour, whereas nonresponders had no change in their AHI (0.17 ± 14.04 events per hour). We examined differences in upper airway caliber, the volume of the upper airway soft tissue structures, craniofacial relationships, and centroid tongue and soft palate movement between responders and nonresponders with and without hypoglossal nerve stimulation. Results Our data indicate that compared with nonresponders, responders had a smaller baseline soft palate volume and, with stimulation, had (1) a greater increase in retroglossal airway size; (2) increased shortening of the mandible-hyoid distance; and (3) greater anterior displacement of the tongue. Conclusions These results suggest that smaller soft palate volumes at baseline and greater tongue movement anteriorly with stimulation improve the response to upper airway stimulation.
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Affiliation(s)
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | - Quan Ni
- Inspire Medical Systems, Maple Grove, MN
| | - Wilfried DeBacker
- Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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31
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Ackrivo J, Hansen-Flaschen J, Wileyto EP, Schwab RJ, Elman L, Kawut SM. Development of a prognostic model of respiratory insufficiency or death in amyotrophic lateral sclerosis. Eur Respir J 2019; 53:13993003.02237-2018. [PMID: 30728207 DOI: 10.1183/13993003.02237-2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 01/17/2019] [Indexed: 11/05/2022]
Abstract
A clinically useful model to prognose onset of respiratory insufficiency in amyotrophic lateral sclerosis (ALS) would inform disease interventions, communication and clinical trial design. We aimed to derive and validate a clinical prognostic model for respiratory insufficiency within 6 months of presentation to an outpatient ALS clinic.We used multivariable logistic regression and internal cross-validation to derive a clinical prognostic model using a single-centre cohort of 765 ALS patients who presented between 2006 and 2015. External validation was performed using the multicentre Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database with 7083 ALS patients. Predictors included baseline characteristics at first outpatient visit. The primary outcome was respiratory insufficiency within 6 months, defined by initiation of noninvasive ventilation, forced vital capacity (FVC) <50% predicted, tracheostomy, or death.Of 765 patients in our centre, 300 (39%) had respiratory insufficiency or death within 6 months. Six baseline characteristics (diagnosis age, delay between symptom onset and diagnosis, FVC, symptom onset site, amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) total score and ALSFRS-R dyspnoea score) were used to prognose the risk of the primary outcome. The derivation cohort c-statistic was 0.86 (95% CI 0.84-0.89) and internal cross-validation produced a c-statistic of 0.86 (95% CI 0.85-0.87). External validation of the model using the PRO-ACT cohort produced a c-statistic of 0.74 (95% CI 0.72-0.75).We derived and externally validated a clinical prognostic rule for respiratory insufficiency in ALS. Future studies should investigate interventions on equivalent high-risk patients.
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Affiliation(s)
- Jason Ackrivo
- Dept of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John Hansen-Flaschen
- Dept of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Richard J Schwab
- Dept of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Elman
- Dept of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,These authors contributed equally
| | - Steven M Kawut
- Dept of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,These authors contributed equally
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32
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Sutherland K, Keenan BT, Bittencourt L, Chen NH, Gislason T, Leinwand S, Magalang UJ, Maislin G, Mazzotti DR, McArdle N, Mindel J, Pack AI, Penzel T, Singh B, Tufik S, Schwab RJ, Cistulli PA. A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples. J Clin Sleep Med 2019; 15:629-639. [PMID: 30952214 DOI: 10.5664/jcsm.7730] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a global health issue and is associated with obesity and oropharyngeal crowding. Global data are limited on the effect of ethnicity and sex on these relationships. We compare associations between the apnea-hypopnea index (AHI) and these risk factors across ethnicities and sexes within sleep clinics. METHODS This is a cross-sectional, multicenter study of patients with OSA from eight sleep centers representing the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Four distinct ethnic groups were analyzed, using a structured questionnaire: Caucasians (Australia, Iceland, Germany, United States), African Americans (United States), Asians (Taiwan), and South Americans (Brazil). Regression analyses and interaction tests were used to assess ethnic and sex differences in relationships between AHI and anthropometric measures (body mass index [BMI], neck circumference, waist circumference) or Mallampati score. RESULTS Analyses included 1,585 individuals from four ethnic groups: Caucasian (60.6%), African American (17.5%), Asian (13.1%), and South American (8.9%). BMI was most strongly associated with AHI in South Americans (7.8% increase in AHI per 1 kg/m2 increase in BMI; P < .0001) and most weakly in African Americans (1.9% increase in AHI per 1 kg/m2 increase in BMI; P = .002). In Caucasians and South Americans, associations were stronger in males than females. Mallampati score differed between ethnicities but did not influence AHI differently across groups. CONCLUSIONS We demonstrate ethnic and sex variations in associations between obesity and OSA. For similar BMI increases, South American patients show greatest AHI increases compared to African Americans. Findings highlight the importance of considering ethnicity and sex in clinical assessments of OSA risk.
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Affiliation(s)
- Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lia Bittencourt
- Disciplilna de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine; Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali -The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sarah Leinwand
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Greg Maislin
- Division of Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital; University of Western Australia, Perth, Western Australia, Australia
| | - Jesse Mindel
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Penzel
- Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital; University of Western Australia, Perth, Western Australia, Australia
| | - Sergio Tufik
- Disciplilna de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Richard J Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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33
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Xu L, Keenan BT, Wiemken A, Staley B, Chi L, Pack AI, Gislason T, Schwab RJ. 0438 Upper Airway Anatomical Differences between Chinese and Caucasian Patients with Obstructive Sleep Apnea. Sleep 2019. [DOI: 10.1093/sleep/zsz067.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liyue Xu
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Luqi Chi
- Washington University School of Medicine, Washington DC, MO, USA
| | - Allan I Pack
- University of Pennsylvania, Philadelphia, PA, USA
| | - Thorarinn Gislason
- Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
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34
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Keenan BT, Kim J, Singh B, Bittencourt L, Chen NH, Cistulli PA, Magalang UJ, McArdle N, Mindel JW, Benediktsdottir B, Arnardottir ES, Prochnow LK, Penzel T, Sanner B, Schwab RJ, Shin C, Sutherland K, Tufik S, Maislin G, Gislason T, Pack AI. Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep 2019; 41:4791307. [PMID: 29315434 DOI: 10.1093/sleep/zsx214] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022] Open
Abstract
Study Objectives A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average. Conclusions Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.
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Affiliation(s)
- Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Jinyoung Kim
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Bhajan Singh
- Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia
| | - Lia Bittencourt
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ning-Hung Chen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Peter A Cistulli
- Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia
| | - Ulysses J Magalang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nigel McArdle
- Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia
| | - Jesse W Mindel
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bryndis Benediktsdottir
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Erna Sif Arnardottir
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lisa Kristin Prochnow
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Bernd Sanner
- Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany
| | - Richard J Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Chol Shin
- Pulmonary, Critical Care and Sleep Disorder Center, Korea University Medical Center Ansan Hospital, Seoul, South Korea
| | - Kate Sutherland
- Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
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35
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Feng Y, Keenan BT, Wang S, Leinwand S, Wiemken A, Pack AI, Schwab RJ. Dynamic Upper Airway Imaging during Wakefulness in Obese Subjects with and without Sleep Apnea. Am J Respir Crit Care Med 2018; 198:1435-1443. [PMID: 30040909 PMCID: PMC6290952 DOI: 10.1164/rccm.201711-2171oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/24/2018] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Obesity is a major risk factor for obstructive sleep apnea. Although greater dimensional changes in the upper airway during wake respiration have been noted in patients with apnea compared with control subjects, whether these differences remain in the presence of obesity is unknown. OBJECTIVES To evaluate upper airway anatomic characteristics and airway compliance (distensibility) in obese subjects with obstructive sleep apnea compared with obese control subjects. METHODS Dynamic magnetic resonance imaging was performed in 157 obese subjects with apnea and 46 obese control subjects during wakefulness in the midsagittal and three axial upper airway regions (retropalatal, retroglossal, epiglottal). Differences in measurements between subjects with apnea and control subjects, and correlations with apnea-hypopnea index among subjects with apnea, were examined. MEASUREMENTS AND MAIN RESULTS Measurements included airway areas and linear dimensions. Subject-specific coefficients of variation were calculated to examine variability in airway size. Controlling for covariates, the retropalatal area during respiration was significantly smaller in subjects with apnea than control subjects, based on the average (P = 0.003), maximum (P = 0.004), and minimum (P = 0.001) airway area. Airway narrowing was observed in anteroposterior and lateral dimensions (adjusted P < 0.05). Results were similar in an age, sex, and body mass index-matched subsample. There were significant correlations between apnea-hypopnea index and dynamic measures of airway caliber in the retropalatal and retroglossal regions among subjects with apnea. CONCLUSIONS Upper airway caliber during respiration was significantly narrower in obese subjects with apnea than obese control subjects in the retropalatal region. These findings provide further evidence that retropalatal airway narrowing plays an important role in the pathogenesis of obstructive sleep apnea in obese subjects.
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Affiliation(s)
- Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; and
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan T. Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Wang
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Leinwand
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Wiemken
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan I. Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard J. Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
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36
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Lin TC, Keenan BT, Brake LA, Azad N, Nguyen TT, Wiemken AS, Schwab RJ. 0447 Upper Airway and Surrounding Soft-Tissue Changes During Sleep in Apneics and Controls. Sleep 2018. [DOI: 10.1093/sleep/zsy061.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T C Lin
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - B T Keenan
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - L A Brake
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - N Azad
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T T Nguyen
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A S Wiemken
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - R J Schwab
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
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37
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Brake LA, Lin TC, Hoge C, Keenan BT, Loro E, Azad N, Nguyen T, Wiemken AS, Mellia JA, Schwab RJ. 0131 Changes in the Composition and Mechanical Properties of the Tongue Following Weight Gain in Zucker Rats. Sleep 2018. [DOI: 10.1093/sleep/zsy061.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L A Brake
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T C Lin
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - C Hoge
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - B T Keenan
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - E Loro
- University of Pennsylvania Perelman School of Medicine, Department of Physiology and Pennsylvania Muscle Institute, Philadelphia, PA
| | - N Azad
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T Nguyen
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A S Wiemken
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - J A Mellia
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - R J Schwab
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
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38
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Nguyen TT, Keenan BT, Galante R, Wiemken AS, Lin TC, Azad N, Brake LA, Schwab RJ, Pack AI. 0136 Evaluation of MRI-Based Soft-Tissue and Craniofacial Phenotypes in Diversity Outbred Mice and Founder Strains. Sleep 2018. [DOI: 10.1093/sleep/zsy061.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T T Nguyen
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - B T Keenan
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - R Galante
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A S Wiemken
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T C Lin
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - N Azad
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - L A Brake
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - R J Schwab
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A I Pack
- University of Pennsylvania, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
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Schwab RJ, Doghramji K, Strollo P, Mehra R, Keenan BT, Strohl K, Iber C. 0538 Predictors of Success of Upper Airway Stimulation for Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R J Schwab
- University of Pennsylvania, Philadelphia, PA
| | - K Doghramji
- Thomas Jefferson University, Philadelphia, PA
| | - P Strollo
- University of Pittsburgh, Pittsburgh, PA
| | - R Mehra
- Cleveland Clinic Foundation, Cleveland, OH
| | - B T Keenan
- University of Pennsylvania, Philadelphia, PA
| | - K Strohl
- University Hospital Cleveland, Cleveland, OH
| | - C Iber
- University of Minnesota, Minneapolis, MN
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Azad N, Brake LA, Keenan BT, Leinwand SE, Wiemken AS, Nguyen TT, Lin TC, Schwab RJ. 0095 The Effect of Chronic Intermittent Hypoxia (CIH) on Spatial Learning in Rats. Sleep 2018. [DOI: 10.1093/sleep/zsy061.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Azad
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - L A Brake
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - B T Keenan
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - S E Leinwand
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A S Wiemken
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T T Nguyen
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T C Lin
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - R J Schwab
- University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
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Lin TC, Keenan BT, Brake LA, Azad N, Nguyen TT, Wiemken AS, Schwab RJ. 0449 Effect Of Neck-bending On Upper Airway (UA) Caliber And Surrounding Soft-tissues In Controls And Apneics. Sleep 2018. [DOI: 10.1093/sleep/zsy061.448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T C Lin
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - B T Keenan
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - L A Brake
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - N Azad
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T T Nguyen
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A S Wiemken
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - R J Schwab
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
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Brake LA, Lin TC, Keenan BT, Azad N, Nguyen TT, Wiemken AS, Goldberg AN, Schwab RJ. 0448 Quantitative Evaluation of the Upper Airway during the Muller Maneuver in Controls and Apneics. Sleep 2018. [DOI: 10.1093/sleep/zsy061.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L A Brake
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T C Lin
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - B T Keenan
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - N Azad
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - T T Nguyen
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A S Wiemken
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
| | - A N Goldberg
- University of California San Francisco, San Francisco, CA
| | - R J Schwab
- University of Pennsylvania School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, PA
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Loro E, Wang SH, Schwab RJ, Khurana TS. <em>In Vivo</em> Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue. J Vis Exp 2017. [DOI: 10.3791/56006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Schwab RJ, Leinwand SE, Bearn CB, Maislin G, Rao RB, Nagaraja A, Wang S, Keenan BT. Digital Morphometrics: A New Upper Airway Phenotyping Paradigm in OSA. Chest 2017; 152:330-342. [PMID: 28526655 DOI: 10.1016/j.chest.2017.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/06/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA. METHODS Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour). RESULTS The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P < .001) and controlling for age, sex, race, and BMI (P = .015 and P = .018, respectively). Measures of tongue size were larger in subjects with OSA vs control subjects in unadjusted models and controlling for age, sex, and race but nonsignificant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA. CONCLUSIONS Measures of tongue size, airway visibility, and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA.
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Affiliation(s)
- Richard J Schwab
- Division of Sleep Medicine, Philadelphia, PA; Center for Sleep & Circadian Neurobiology, Philadelphia, PA.
| | | | - Cary B Bearn
- Center for Sleep & Circadian Neurobiology, Philadelphia, PA
| | - Greg Maislin
- Division of Sleep Medicine, Philadelphia, PA; Center for Sleep & Circadian Neurobiology, Philadelphia, PA
| | - Ramya Bhat Rao
- Center for Sleep & Circadian Neurobiology, Philadelphia, PA
| | | | - Stephen Wang
- Center for Sleep & Circadian Neurobiology, Philadelphia, PA
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Sutherland K, Keenan BT, Bittencourt L, Chen N, Gislason T, Magalang U, Maislin G, Mazzotti DR, McArdle N, Pack AI, Penzel T, Singh B, Schwab RJ, Cistulli PA. 0458 ANTHROPOMETRIC DIFFERENCES IN OSA ACROSS FOUR ETHNIC GROUPS IN OSA ACROSS FOUR ETHNIC GROUPS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Doghramji K, Heiser C, Schwab RJ, Strollo PJ. 0577 PATIENT OUTCOMES AND THERAPY ADHERENCE OF UPPER AIRWAY STIMULATION FOR TREATMENT OF OSA: PRELIMINARY RESULTS FROM THE MULTI-CENTER ADHERE REGISTRY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lin C, Wiemken AS, Leinwand SE, Wang SH, Keenan BT, Wang J, Wang Z, Sun Y, Li X, Qu W, Gislason T, Benediktsdottir B, Chi L, Schwab RJ. 0435 INTERETHNIC COMPARISON OF INTER-MANDIBULAR AND SOFT TISSUE VOLUMES AMONG NATIVE CHINESE, ICELANDIC CAUCASIAN AND AFRICAN-AMERICAN APNEICS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sutherland K, Keenan BT, Bittencourt L, Chen N, Gislason T, Magalang U, Maislin G, Mazzotti DR, McArdle N, Pack AI, Penzel T, Singh B, Schwab RJ, Cistulli PA. 0453 CRANIOFACIAL PHOTOGRAPHIC MEASUREMENTS AND RELATIONSHIP TO OSA SEVERITY ACROSS FOUR ETHNIC GROUPS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hoge C, Mellia JA, Helgeson S, Chen Z, Leinwand SE, Wiemken AS, Schwab RJ. 0443 THE EFFECT OF WEIGHT LOSS ON MAXIMAL TONGUE FORCE IN OBSTRUCTIVE SLEEP APNEA (OSA). Sleep 2017. [DOI: 10.1093/sleepj/zsx050.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mellia JA, Hoge C, Helgeson S, Chen Z, Leinwand SE, Wiemken AS, Schwab RJ. 0425 ASSOCIATION BETWEEN TONGUE VOLUME AND TONGUE FORCE IN OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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