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Min HJ, Park JS, Kim KS, Kang M, Seo JH, Yoon JH, Kim CH, Cho HJ. Serum high-mobility group box 1 protein level correlates with the lowest SaO 2 in patients with sleep apnea: a preliminary study. Braz J Otorhinolaryngol 2021; 88:875-881. [PMID: 33461910 PMCID: PMC9615530 DOI: 10.1016/j.bjorl.2020.11.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Serum level of high-mobility group box 1 protein is reportedly correlated with the severity of obstructive sleep apnea. Objective We tried to evaluate the possibility of using the serum high-mobility group box 1 protein level as a biologic marker in obstructive sleep apnea patients. Methods We generated a chronic intermittent hypoxia murine model that reflected human obstructive sleep apnea. Obstructive sleep apnea patients who underwent polysomnography were prospectively enrolled. Serum samples were obtained from mice and obstructive sleep apnea patients, and the serum high-mobility group box1 protein level was measured by enzyme-linked immunosorbent assay. Results Serum high-mobility group box 1 protein level was 56.16 ± 30.33 ng/mL in chronic intermittent hypoxia and 18.63 ± 6.20 ng/mL in control mice (p < 0.05). The mean apnea-hypopnea index and respiratory disturbance index values of enrolled obstructive sleep apnea patients were 50.35 ± 27.96 and 51.56 ± 28.53, respectively, and the mean serum high-mobility group box 1 protein level was 30.13 ± 19.97 ng/mL. The apnea–hypopnea index and respiratory disturbance index were not significantly correlated with the serum high-mobility group box 1 protein level (p > 0.05). Instead, this protein level was significantly correlated with lowest arterial oxygen concentration (SaO2) (p < 0.05). Conclusion High-mobility group box 1 protein may be involved in the pathogenesis of obstructive sleep apnea, and the possibility of this protein being a useful biologic marker in obstructive sleep apnea should be further evaluated.
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Affiliation(s)
- Hyun Jin Min
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea; Chung-Ang University Hospital, Biomedical Research Institute, Seoul, Republic of Korea
| | - Joon Soon Park
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Kyung Soo Kim
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Miran Kang
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea
| | - Ju Hee Seo
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea
| | - Joo-Heon Yoon
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea; Yonsei University College of Medicine, The Airway Mucus Institute, Seoul, Republic of Korea
| | - Chang-Hoon Kim
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea; Yonsei University College of Medicine, The Airway Mucus Institute, Seoul, Republic of Korea
| | - Hyung-Ju Cho
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea; Yonsei University College of Medicine, The Airway Mucus Institute, Seoul, Republic of Korea.
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Rodrigues MM, Carvalho PHDA, Gabrielli MFR, Lopes RN, Garcia Junior OA, Pereira Filho VA, Passeri LA. How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters. Braz J Otorhinolaryngol 2020; 88:296-302. [PMID: 32782124 PMCID: PMC9422712 DOI: 10.1016/j.bjorl.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/29/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. Objective This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. Methods The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. Results Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results. Conclusion Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence 3b - Individual case-control study.
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Affiliation(s)
- Marcos Marques Rodrigues
- Universidade de Araraquara (Uniara), Faculdade de Medicina, Divisão de Otorrinolaringologia, Araraquara, SP, Brazil
| | - Pedro Henrique de Azambuja Carvalho
- Universidade Estadual de São Paulo (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Araraquara, SP, Brazil.
| | - Mário Francisco Real Gabrielli
- Universidade Estadual de São Paulo (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Divisão de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Ricardo Nasser Lopes
- Universidade de Araraquara (Uniara), Faculdade de Medicina, Divisão de Otorrinolaringologia, Araraquara, SP, Brazil
| | | | - Valfrido Antonio Pereira Filho
- Universidade Estadual de São Paulo (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Divisão de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Luis Augusto Passeri
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, São Paulo, SP, Brasil
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Chen VG, Fonseca VMGD, Amaral JB, Camargo-Kosugi CM, Moreira G, Kosugi EM, Fujita RR. Inflammatory markers in palatine tonsils of children with obstructive sleep apnea syndrome. Braz J Otorhinolaryngol 2018; 86:23-29. [PMID: 30213594 PMCID: PMC9422537 DOI: 10.1016/j.bjorl.2018.08.001] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/26/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstrutive sleep apnea syndrome is characterized by repeated episodes of upper airway obstruction, associated with intermittent hypoxia and hypercapnia, and the main risk factor in childhood is adenotonsillar hypertrophy. The lymphocytes in these structures are responsible for local and systemic immune responses. Objective Verify the levels of the inflammatory markers, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, CRP and α1-GP, in the tonsils of children with and without obstructive sleep apnea syndrome. Methods This cross-sectional prospective study included 34 children with complains of snoring, difficulty breathing during sleep or recurrent tonsillitis. Patients underwent to a complete otorhinolaryngological examination, nasal endoscopy and polysomnography and were divided into two groups with 17 children each: obstructive sleep apnea syndrome group and control group. All underwent an adenotonsillectomy. Cytokines were measured in the collected tonsils (ELISA and Multiplex methods). Results Statistically significant increasing were observed between IL-8 and IL-10 cytokines of patients with obstructive sleep apnea when compared to the control group; also between c-reactive protein and α1-GP of the tonsils cortical region in children with obstructive sleep apnea syndrome when compared with the medullary region. There were no statistically significant differences for the remaining inflammatory mediators. Conclusion After the analysis of the levels of pro and anti-inflammatory markers (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, CRP, α1-GP) in the tonsils, we observed higher levels of markers IL-8 and IL-10 in pediatric patients with obstructive sleep apnea syndrome.
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Affiliation(s)
- Vitor Guo Chen
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Viviane Maria Guerreiro da Fonseca
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Jônatas Bussador Amaral
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço - Centro de Pesquisa Translacional de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Cíntia Meirelles Camargo-Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço - Centro de Pesquisa Translacional de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Gustavo Moreira
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Instituto do Sono, São Paulo, SP, Brazil
| | - Eduardo Macoto Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Sun S, Zhai H, Zhu M, Wen P, He X, Wang H. Insulin resistance is associated with Sfrp5 in obstructive sleep apnea. Braz J Otorhinolaryngol 2018; 85:739-745. [PMID: 30120048 PMCID: PMC9443029 DOI: 10.1016/j.bjorl.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/19/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Obstructive sleep apnea, a common disease, is usually complicated by insulin resistance and type 2 diabetes mellitus. Adipokine is considered to play an important role in the development of insulin resistance and type 2 diabetes mellitus in obstructive sleep apnea. Objective To assess whether secreted frizzled-related protein 5, a new adipokine, is involved in untreated obstructive sleep apnea patients. Methods Seventy-six subjects with obstructive sleep apnea and thirty-three control subjects without obstructive sleep apnea were recruited and matched in terms of body mass index and age. The fasting secreted frizzled-related protein 5 plasma concentration was tested using ELISA. In addition, the correlation between secreted frizzled-related protein 5 and the homeostasis model assessment of insulin resistance was obtained. Multiple linear regression analysis models with stepwise selection were performed to determine the independent associations between various factors and secreted frizzled-related protein 5. Results Plasma secreted frizzled-related protein 5 levels were significantly lower in the obstructive sleep apnea group than in the control group (obstructive sleep apnea group: 28.44 ± 13.25 ng/L; control group: 34.16 ± 13.51 ng/L; p = 0.023). In addition, secreted frizzled-related protein 5 was negatively correlated with homeostasis model assessment of insulin resistance but positively correlated with the mean and lowest oxygen saturation with or without adjusting for age, gender, body mass index, neck circumference, waist circumference and waist-to-hip ratio. The multiple linear regression analysis showed there was an independent negative association between secreted frizzled-related protein 5 and homeostasis model assessment of insulin resistance. Conclusion Secreted frizzled-related protein 5 was involved in obstructive sleep apnea and the decrease in secreted frizzled-related protein 5 was directly proportional to the severity of obstructive sleep apnea. There was an independent negative correlation between homeostasis model assessment of insulin resistance and secreted frizzled-related protein 5 in the obstructive sleep apnea group. Secreted frizzled-related protein 5 might be a therapeutic target for insulin resistance in obstructive sleep apnea.
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Affiliation(s)
- Shibo Sun
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China; First Department of Respiratory Medicine, First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Huifen Zhai
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mei Zhu
- Department of Otolaryngological Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peili Wen
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xin He
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haoyan Wang
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Rodrigues MM, Pereira Filho VA, Gabrielli MFR, Oliveira TFMD, Batatinha JAP, Passeri LA. Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30001-0. [PMID: 28233709 PMCID: PMC9442808 DOI: 10.1016/j.bjorl.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 06/14/2016] [Accepted: 12/10/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. OBJECTIVE To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. METHODS A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. RESULTS The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: -0.415 (p=0.025), 0.186 (p=0.334) and -0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: -0.206 (p=0.304), -0.155 (p=0.439) and 0.242 (p=0.284). CONCLUSION There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.
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Affiliation(s)
- Marcos Marques Rodrigues
- Universidade de Araraquara, Faculdade de Medicina da Araraquara, Divisão de Otorrinolaringologia, Araraquara, SP, Brazil.
| | - Valfrido Antonio Pereira Filho
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Programa de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Mário Francisco Real Gabrielli
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Programa de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Talles Fernando Medeiros de Oliveira
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Ortodontia, Araraquara, SP, Brazil
| | | | - Luis Augusto Passeri
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Medicina e Ciências, Departamento de Cirurgia, Cirurgia Oral e Maxilofacial, Campinas, SP, Brazil
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Matsumura E, Matas CG, Magliaro FCL, Pedreño RM, Lorenzi-Filho G, Sanches SGG, Carvallo RMM. Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea. Braz J Otorhinolaryngol 2016; 84:S1808-8694(16)30233-6. [PMID: 28024827 PMCID: PMC9442879 DOI: 10.1016/j.bjorl.2016.10.014] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/09/2016] [Accepted: 10/31/2016] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea causes changes in normal sleep architecture, fragmenting it chronically with intermittent hypoxia, leading to serious health consequences in the long term. It is believed that the occurrence of respiratory events during sleep, such as apnea and hypopnea, can impair the transmission of nerve impulses along the auditory pathway that are highly dependent on the supply of oxygen. However, this association is not well established in the literature. OBJECTIVE To compare the evaluation of peripheral auditory pathway and brainstem among individuals with and without obstructive sleep apnea. METHODS The sample consisted of 38 adult males, mean age of 35.8 (±7.2), divided into four groups matched for age and Body Mass Index. The groups were classified based on polysomnography in: control (n=10), mild obstructive sleep apnea (n=11) moderate obstructive sleep apnea (n=8) and severe obstructive sleep apnea (n=9). All study subjects denied a history of risk for hearing loss and underwent audiometry, tympanometry, acoustic reflex and Brainstem Auditory Evoked Response. Statistical analyses were performed using three-factor ANOVA, 2-factor ANOVA, chi-square test, and Fisher's exact test. The significance level for all tests was 5%. RESULTS There was no difference between the groups for hearing thresholds, tympanometry and evaluated Brainstem Auditory Evoked Response parameters. An association was observed between the presence of obstructive sleep apnea and changes in absolute latency of wave V (p=0.03). There was an association between moderate obstructive sleep apnea and change of the latency of wave V (p=0.01). CONCLUSION The presence of obstructive sleep apnea is associated with changes in nerve conduction of acoustic stimuli in the auditory pathway in the brainstem. The increase in obstructive sleep apnea severity does not promote worsening of responses assessed by audiometry, tympanometry and Brainstem Auditory Evoked Response.
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Affiliation(s)
- Erika Matsumura
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Carla Gentile Matas
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Fernanda Cristina Leite Magliaro
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Raquel Meirelles Pedreño
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Universidade de São Paulo (USP), Faculdade de Medicina, Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), São Paulo, Brazil
| | - Seisse Gabriela Gandolfi Sanches
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Renata Mota Mamede Carvallo
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brazil.
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Ghiciuc CM, Dima-Cozma LC, Bercea RM, Lupusoru CE, Mihaescu T, Cozma S, Patacchioli FR. Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study. Braz J Otorhinolaryngol 2016; 82:529-35. [PMID: 26749455 PMCID: PMC9444622 DOI: 10.1016/j.bjorl.2015.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/23/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients. OBJECTIVE The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C). METHODS Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities. RESULTS AND CONCLUSION The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.
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Affiliation(s)
| | - Lucia Corina Dima-Cozma
- University of Medicine and Pharmacy Grigore T. Popa, School of Medicine, Department of Internal Medicine, Iasi, Romania
| | - Raluca Mihaela Bercea
- University of Medicine and Pharmacy Grigore T. Popa, Clinic of Pulmonary Diseases, Iasi, Romania
| | - Catalina Elena Lupusoru
- University of Medicine and Pharmacy Grigore T. Popa, Department of Pharmacology, Iasi, Romania
| | - Traian Mihaescu
- University of Medicine and Pharmacy Grigore T. Popa, Clinic of Pulmonary Diseases, Iasi, Romania
| | - Sebastian Cozma
- University of Medicine and Pharmacy Grigore T. Popa, Department of Otorhinolaryngology, Iasi, Romania
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Yegïn Y, Çelik M, Kaya KH, Koç AK, Kayhan FT. Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system. Braz J Otorhinolaryngol 2017; 83:445-50. [PMID: 27388956 DOI: 10.1016/j.bjorl.2016.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/23/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed. Objective To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS. Methods The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test). Results There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%). Conclusion We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.
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Migueis DP, Thuler LCS, Lemes LNDA, Moreira CSS, Joffily L, Araujo-Melo MHD. Systematic review: the influence of nasal obstruction on sleep apnea. Braz J Otorhinolaryngol 2016; 82:223-31. [PMID: 26830959 PMCID: PMC9449074 DOI: 10.1016/j.bjorl.2015.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to cardiovascular morbidity and mortality, as well as to metabolic, neurological, and behavioral consequences. It is currently believed that nasal obstruction compromises the quality of sleep when it results in breathing disorders and fragmentation of sleep. However, recent studies have failed to objectively associate sleep quality and nasal obstruction. Objective The aim of this systematic review is to evaluate the influence of nasal obstruction on OSAS and polysomnographic indices associated with respiratory events. Methods Eleven original articles published from 2003 to 2013 were selected, which addressed surgical and non-surgical treatment for nasal obstruction, performing polysomnography type 1 before and after the intervention. Results/conclusions In most trials, nasal obstruction was not related to the apnea–hypopnea index (AHI), indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM) sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation.
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Affiliation(s)
- Debora Petrungaro Migueis
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Luiz Claudio Santos Thuler
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil; Clinical Investigation Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | | | - Chirlene Santos Souza Moreira
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Lucia Joffily
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Maria Helena de Araujo-Melo
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil; Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
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Subramanyam R, Fleck R, McAuliffe J, Radhakrishnan R, Jung D, Patino M, Mahmoud M. Upper airway morphology in Down Syndrome patients under dexmedetomidine sedation. Braz J Anesthesiol 2015; 66:388-94. [PMID: 27343789 DOI: 10.1016/j.bjane.2014.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/29/2014] [Accepted: 11/26/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with Down Syndrome are vulnerable to significant upper airway obstruction due to relative macroglossia and dynamic airway collapse. The objective of this study was to compare the upper airway dimensions of children with Down Syndrome and obstructive sleep apnea with normal airway under dexmedetomidine sedation. METHODS IRB approval was obtained. In this retrospective study, clinically indicated dynamic sagittal midline magnetic resonance images of the upper airway were obtained under low (1mcg/kg/h) and high (3mcg/kg/h) dose dexmedetomidine. Airway anteroposterior diameters and sectional areas were measured as minimum and maximum dimensions by two independent observers at soft palate (nasopharyngeal airway) and at base of the tongue (retroglossal airway). RESULTS AND CONCLUSIONS Minimum anteroposterior diameter and minimum sectional area at nasopharynx and retroglossal airway were significantly reduced in Down Syndrome compared to normal airway at both low and high dose dexmedetomidine. However, there were no significant differences between low and high dose dexmedetomidine in both Down Syndrome and normal airway. The mean apnea hypopnea index in Down Syndrome was 16±11. Under dexmedetomidine sedation, children with Down Syndrome and obstructive sleep apnea when compared to normal airway children show significant reductions in airway dimensions most pronounced at the narrowest points in the nasopharyngeal and retroglossal airways.
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Affiliation(s)
- Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, OH, USA.
| | - Robert Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - John McAuliffe
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Dorothy Jung
- Department of Radiology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Mario Patino
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, OH, USA
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Vidigal TA, Haddad FLM, Cabral RFP, Oliveira MCS, Cavalcante RR, Bittencourt LRA, Tufik S, Gregório LC. New clinical staging for pharyngeal surgery in obstructive sleep apnea patients. Braz J Otorhinolaryngol 2014; 80:490-6. [PMID: 25457068 PMCID: PMC9442696 DOI: 10.1016/j.bjorl.2014.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/01/2014] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. OBJECTIVE To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. METHODS A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. RESULTS The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. CONCLUSION The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).
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Affiliation(s)
- Tatiana Aguiar Vidigal
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernanda Louise Martinho Haddad
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | | | | | | | - Lia Rita Azeredo Bittencourt
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Tufik
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Luis Carlos Gregório
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Xará D, Mendonça J, Pereira H, Santos A, Abelha FJ. Adverse respiratory events after general anesthesia in patients at high risk of obstructive sleep apnea syndrome. Braz J Anesthesiol 2014; 65:359-66. [PMID: 26323734 DOI: 10.1016/j.bjane.2014.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/23/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. METHODS This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann-Whitney test, the chi-square test and the Fisher exact test were used for comparisons. RESULTS Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24kg/m(2), p<0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p<0.001), dyslipidemia (46% versus 17%, p<0.001) and insulin-treated diabetes mellitus (17% versus 2%, p=0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p=0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p<0.001), mild to moderate desaturation (15% versus 0%, p=0.001) and inability to breathe deeply (34% versus 9%, p=0.001). CONCLUSION After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications.
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Affiliation(s)
- Daniela Xará
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Júlia Mendonça
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Helder Pereira
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Alice Santos
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal
| | - Fernando José Abelha
- Department of Anaesthesiology, Centro Hospitalar de São João, Porto, Portugal; Anaesthesiology and Perioperative Care Unit, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Surgical Department of Faculty of Medicine, University of Porto, Portugal.
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Pereira H, Xará D, Mendonça J, Santos A, Abelha FJ. Patients with a high risk for obstructive sleep apnea syndrome: postoperative respiratory complications. Rev Port Pneumol 2013; 19:144-51. [PMID: 23731773 DOI: 10.1016/j.rppneu.2013.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 10/03/2012] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND STOP-BANG score (snore; tired; observed apnea; arterial pressure; body mass index; age; neck circumference and gender) can predict the risk of a patient having Obstructive Syndrome Apnea (OSA). The aim of this study was to evaluate the incidence STOP-BANG score≥3, in surgical patients admitted to the Post-Anesthesia Care Unit (PACU). METHODS Observational, prospective study conducted in a post-anesthesia care unit (PACU) during three weeks (2011). The study population consisted of adult patients after noncardiac and non-neurological surgery. Patients were classified as high risk of OSA (HR-OSA) if STOP-BANG score≥3 and Low-risk of OSA (LR-OSA) if STOP-BANG score<3 (LR-OSA). Patient demographics, intraoperative and postoperative data were collected. Patient characteristics were compared using Mann-Whitney U-test, t-test for independent groups, and chi-square or Fisher's exact test. RESULTS A total of 357 patients were admitted to PACU; 340 met the inclusion criteria. 179 (52%) were considered HR-OSA. These patients were older, more likely to be masculine, had higher BMI, higher ASA physical status, higher incidence of ischemic heart disease, heart failure, hypertension, dyslipidemia and underwent more frequently insulin treatment for diabetes. These patients had more frequently mild/moderated hypoxia in the PACU (9% vs. 3%, p=0.012) and had a higher incidence of residual neuromuscular blockade (NMB) (20% vs. 16%, p=0.035). Patients with HR-OSA had a longer hospital stay. CONCLUSIONS Patients with HR-OSA had an important incidence among patients scheduled for surgery in our hospital. These patients had more co-morbidities and were more prone to post-operative complications.
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Affiliation(s)
- H Pereira
- Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal
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