Implications of depressive mood in OSAHS patients: insights from event-related potential

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic breathing disorder characterized by recurrent upper airway obstruction during sleep. Although previous studies have shown a link between OSAHS and depressive mood, the neurobiological mechanisms underlying mood disorders in OSAHS patients remain poorly understood. This study aims to investigate the emotion processing mechanism in OSAHS patients with depressive mood using event-related potentials (ERPs).

METHODS

Seventy-four OSAHS patients were divided into the depressive mood and non-depressive mood groups according to their Self-rating Depression Scale (SDS) scores. Patients underwent overnight polysomnography and completed various cognitive and emotional questionnaires. The patients were shown facial images displaying positive, neutral, and negative emotions and tasked to identify the emotion category, while their visual evoked potential was simultaneously recorded.

RESULTS

The two groups did not differ significantly in age, BMI, and years of education, but showed significant differences in their slow wave sleep ratio (P = 0.039), ESS (P = 0.006), MMSE (P < 0.001), and MOCA scores (P = 0.043). No significant difference was found in accuracy and response time on emotional face recognition between the two groups. N170 latency in the depressive group was significantly longer than the non-depressive group (P = 0.014 and 0.007) at the bilateral parieto-occipital lobe, while no significant difference in N170 amplitude was found. No significant difference in P300 amplitude or latency between the two groups. Furthermore, N170 amplitude at PO7 was positively correlated with the arousal index and negatively with MOCA scores (both P < 0.01).

CONCLUSION

OSAHS patients with depressive mood exhibit increased N170 latency and impaired facial emotion recognition ability. Special attention towards the depressive mood among OSAHS patients is warranted for its implications for patient care.

Altered Cortical Information Interaction During Respiratory Events in Children with Obstructive Sleep Apnea-Hypopnea Syndrome

Obstructive sleep apnea-hypopnea syndrome (OSAHS) significantly impairs children's growth and cognition. This study aims to elucidate the pathophysiological mechanisms underlying OSAHS in children, with a particular focus on the alterations in cortical information interaction during respiratory events. We analyzed sleep electroencephalography before, during, and after events, utilizing Symbolic Transfer Entropy (STE) for brain network construction and information flow assessment. The results showed a significant increase in STE after events in specific frequency bands during N2 and rapid eye movement (REM) stages, along with increased STE during N3 stage events. Moreover, a noteworthy rise in the information flow imbalance within and between hemispheres was found after events, displaying unique patterns in central sleep apnea and hypopnea. Importantly, some of these alterations were correlated with symptom severity. These findings highlight significant changes in brain region coordination and communication during respiratory events, offering novel insights into OSAHS pathophysiology in children.

Does oral appliance efficacy in treating obstructive sleep apnea depend on the appliance specialist's experience?

PURPOSE

In France, oral appliances (OAs) are the first-line treatment for moderate and second-line treatment for severe obstructive sleep apnea-hypopnea syndrome. In general, the sleep specialist refers his/her patient to the appliance specialist for the impressions and the fitting. However, is there a relationship between the volume of activity of the appliance specialist and the efficacy of this device?

METHODS

Our unit includes seven appliance otolaryngology specialists whose activities are highly variable (number of patients varying by a factor of almost 10). Data from a prospective follow-up registry of patients treated with an OA for moderate and severe obstructive sleep apnea-hypopnea syndrome were studied, and differences in outcomes between practitioners in the team were sought.

RESULTS

Among 859 patients, OAs significantly reduced the apnea-hypopnea index. Even if the patients were not completely comparable from one practitioner to another, there was a significant heterogeneity in efficacy (complete or partial response of the apnea-hypopnea index and failure of OAs) between practitioners (p = 0.0038; 0.0011; 0.0007 respectively), with better results in practitioners with a higher level of OA activity.

CONCLUSION

The findings suggest that it may be preferable to refer patients to OA practitioners who see a higher volume of patients with moderate or severe obstructive sleep apnea-hypopnea syndrome treated with an OA.

Clinical efficacy and mechanism study of mid-frequency anti-snoring device in treating moderate obstructive sleep apnea-hypopnea syndrome

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is primarily caused by airway obstruction due to narrowing and blockage in the nasal and nasopharyngeal, oropharyngeal, soft palate, and tongue base areas. The mid-frequency anti-snoring device is a new technology based on sublingual nerve stimulation. Its principle is to improve the degree of oropharyngeal airway stenosis in OSAHS patients under mid-frequency wave stimulation. Nevertheless, there is a lack of clinical application and imaging evidence.

AIM

To investigate the clinical efficacy and mechanisms of a mid-frequency anti-snoring device in treating moderate OSAHS.

METHODS

We selected 50 patients diagnosed with moderate OSAHS in our hospital between July 2022 and August 2023. They underwent a 4-wk treatment regimen involving the mid-frequency anti-snoring device during nighttime sleep. Following the treatment, we monitored and assessed the sleep apnea quality of life index and Epworth Sleepiness Scale scores. Additionally, we performed computed tomography scans of the oropharynx in the awake state, during snoring, and while using the mid-frequency anti-snoring device. Cross-sectional area measurements in different states were taken at the narrowest airway point in the soft palate posterior and retrolingual areas.

RESULTS

Compared to pretreatment measurements, patients exhibited a significant reduction in the apnea-hypopnea index, the percentage of time with oxygen saturation below 90%, snoring frequency, and the duration of the most prolonged apnea event. The lowest oxygen saturation showed a notable increase, and both sleep apnea quality of life index and Epworth Sleepiness Scale scores improved. Oropharyngeal computed tomography scans revealed that in OSAHS patients cross-sectional areas of the oropharyngeal airway in the soft palate posterior area and retrolingual area decreased during snoring compared to the awake state. Conversely, during mid-frequency anti-snoring device treatment, these areas increased compared to snoring.

CONCLUSION

The mid-frequency anti-snoring device demonstrates the potential to enhance various sleep parameters in patients with moderate OSAHS, thereby improving their quality of life and reducing daytime sleepiness. These therapeutic effects are attributed to the device's ability to ameliorate the narrowing of the oropharynx in OSAHS patients.

Obstructive Sleep-Disordered Breathing in Infants with Normal Awake Clinical Examination: Contribution of Drug-Induced Sleep Endoscopy

OBJECTIVES

To determine the cause of obstructive sleep-disordered breathing using drug-induced sleep endoscopy (DISE) in infants without co-morbidities and with normal clinical examination.

METHODS

This prospective study was conducted between December 2019 and June 2022 (31 mo). All infants referred for obstructive sleep-disordered breathing with normal clinical examination and flexible laryngoscopy were included and underwent DISE. The location of the obstructive sites was scored similarly according to the NAVOTEL scoring system, previously established and validated by authors' team.

RESULTS

Thirty-two infants were included. DISE identified an obstructive site in 94% of cases. The mean age was 16.4 mo, and the median was 16.7 mo. The obstructive sites found were isolated sleep laryngomalacia (37.4%), adenotonsillar hypertrophy (21.8%), isolated adenoidal hypertrophy (6.3%), adenotonsillar hypertrophy associated with sleep laryngomalacia (6.3%), circumferential upper airway narrowing (6.3%), glossoptosis (6.3%), isolated inferior turbinate hypertrophy (3.1%), adenoidal and tongue base hypertrophy (3.1%), and adenoidal hypertrophy with sleep laryngomalacia (3.1%). No obstructive causes could be found in 2 cases (6.3%). DISE identified an obstructive site in 30/32 patients (93.8%) and guided the surgical management in 26/32 cases (81.3%) during the same general anesthesia. The infants without surgical obstacles were referred for medical treatment.

CONCLUSIONS

DISE is an excellent diagnostic and pre-therapeutic tool in infants with no apparent cause at the awake examination to identify the obstructive sites and guide the treatment.

AHI estimation of OSAHS patients based on snoring classification and fusion model

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic and common sleep-breathing disease that could negatively influence lives of patients and cause serious concomitant diseases. Polysomnography(PSG) is the gold standard for diagnosing OSAHS, but it is expensive and requires overnight hospitalization. Snoring is a typical symptom of OSAHS. This study proposes an effective OSAHS screening method based on snoring sound analysis. Snores were labeled as OSAHS related snoring sounds and simple snoring sounds according to real-time PSG records. Three models were used, including acoustic features combined with XGBoost, Mel-spectrum combined with convolution neural network (CNN), and Mel-spectrum combined with residual neural network (ResNet). Further, the three models were fused by soft voting to detect these two types of snoring sounds. The subject's apnea-hypopnea index (AHI) was estimated according to these recognized snoring sounds. The accuracy and recall of the proposed fusion model achieved 83.44% and 85.27% respectively, and the predicted AHI has a Pearson correlation coefficient of 0.913 (R2 = 0.834, p < 0.001) with PSG. The results demonstrate the validity of predicting AHI based on analysis of snoring sound and show great potential for monitoring OSAHS at home.

The potential of tRF-21-U0EZY9X1B plasmatic level as a biomarker of children with obstructive sleep apnea-hypopnea syndrome

PURPOSE

We investigated changes in plasma transfer RNA related fragments (tRF) in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and the potential value as a disease marker.

METHODS

Firstly, we randomly selected five plasma samples from the case group and the control group for high-throughput RNA sequencing. Secondly, we screened one tRF with different expression between the two groups, amplified it by quantitative reverse transcription-PCR (qRT-PCR) and sequenced the amplified product. After confirming that the qRT-PCR results were consistent with the sequencing results and the sequence of the amplified product contained the original sequence of the tRF, we performed qRT-PCR on all samples. Then we analyzed the diagnostic value of the tRF and its correlation with some clinical data.

RESULTS

A total of 50 OSAHS children and 38 control children were included in this study. There were significant differences in height, serum creatinine (SCR) and total cholesterol (TC) between the two groups. The plasma expression levels of tRF-21-U0EZY9X1B (tRF-21) were significantly different between the two groups. Receiver operating characteristic curve (ROC) showed that it had valuable diagnostic index, with area under the curve (AUC) of 0.773, 86.71% and 63.16% sensitivity and specificity.

CONCLUSIONS

The expression levels of tRF-21 in the plasma of OSAHS children decreased significantly which were closely related to hemoglobin, mean corpuscular hemoglobin, triglyceride and creatine kinase-MB, may become novel biomarkers for the diagnosis of pediatric OSAHS.

Automatic identifying OSAHS patients and simple snorers based on Gaussian mixture models

Snoring is a typical symptom of obstructive sleep apnea-hypopnea syndrome (OSAHS). In this study, an effective OSAHS patient detection system based on subject independence using snoring sounds is presented. A series of acoustic features including Mel cepstral coefficient, bark sub-band feature, perceptual linear prediction coefficient, pitch frequency, formant, 800Hz power ratio, spectral entropy, and gammatone cepstral coefficient are extracted. The feature selection based on the Fisher ratio is conducted and the Gaussian mixture models (GMM) of OSAHS patients and simple snorers were established respectively. For the test subject, the difference in log-likelihood probabilities of the two GMMs is calculated to identify the OSAHS patients. The proposed model achieves 90% accuracy and 95.65% precision based on leave-one-subject-out cross-validation using selected features with a dimension of 100. The average prediction time of the proposed model is 0.134 ± 0.005s. The promising results demonstrate the effectiveness and low computational cost of diagnosing OSAHS patients using snoring sounds at home.

Molecular mechanism of the ESRRG-PERM1-CKMT2 signal axis in ovariectomized female rats with OSAHS

This study aims to investigate the role of ESRRG-PERM1-CKMT2 signal axis, estrogen and genioglossal muscle contractile times in the development of Obstructive sleep apnea-hypopnea syndrome (OSAHS). This is a randomized controlled trial, and a total of 48 female rats are included and divided into following four groups: control group, sham operation group, model group and treatment group. A OSAHS rat model is established and then ESRRG, PERM1 and CKMT2 protein are detected by western blotting. Genioglossal muscle contractile times and estrogen level are also by detected. Our outcomes show that the level of ESRRG, PERM1, CKMT2 protein in control group, sham operation group, and treatment group are significantly up-regulated compared with that in model group. Genioglossal muscle contractile times and estrogen level in control group, sham operation group, and treatment group are also remarkably higher than those in model group. In addition, compared to the number of OSAHS in model group, the number of OSAHS in control group, sham operation group and treatment group is obviously decreased. We can conclude that up-regulated of ESRRG, PERM1, CKMT2 and estrogen can prevent or inhibit the development of OSAHS.

Intermittent hypoxia is involved in gut microbial dysbiosis in type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome

BACKGROUND

Obstructive sleep apnea (OSA)-hypopnea syndrome (OSAHS) has been recognized as a comorbidity of type 2 diabetes mellitus (T2DM); more than half of T2DM patients suffer from OSAHS. Intermittent hypoxia (IH) plays an important role in metabolic diseases, such as obesity and OSAHS, through various mechanisms, including altering the gut microecological composition and function. Therefore, it is important to study the role of gut microbiota in T2DM patients with OSAHS, which has a high incidence and is prone to several complications.

AIM

To assess whether IH is involved in altering the fecal microbiome in T2DM patients with OSAHS.

METHODS

Seventy-eight participants were enrolled from Henan Province People’s Hospital and divided into healthy control (HC, n = 26), T2DM (n = 25), and T2DM + OSA (n = 27) groups based on their conditions. The fecal bacterial DNA of the research participants was extracted and subjected to 16S ribosomal RNA sequencing. The clinical indices, such as insulin resistance index, homocysteine (HCY) concentration, and the concentrations of inflammatory factors in the peripheral blood, were assessed and recorded.

RESULTS

Group T2DM + OSA had the highest apnea-hypopnea index (AHI) (2.3 vs 3.7 vs 13.7), oxygen desaturation index (0.65 vs 2.2 vs 9.1), HCY concentration (9.6 μmol/L vs 10.3 μmol/L vs 13.81 μmol/L) and C-reactive protein (CRP) concentrations (0.3 mg/L vs 1.43 mg/L vs 2.11 mg/L), and lowest mean oxygen saturation (97.05% vs 96.6% vs 94.7%) among the three groups. Twelve and fifteen key differences in amplicon sequence variants were identified when comparing group T2DM + OSA with groups T2DM and HC, respectively. We found progressively decreased levels of Faecalibacterium, Eubacterium, and Lachnospiraceae, and an increase in the level of Actinomyces, which strongly correlated with the HCY, CRP, fasting plasma glucose, and hemoglobin A1c concentrations, AHI, mean oxygen saturation, and insulin resistance index in group T2DM + OSA (P < 0.05).

CONCLUSION

For T2DM patients with OSAHS, IH may be involved in selective alterations of the gut microbiota, which may affect the pathophysiological development of T2DM and DM-related complications.

Blockade of adenosine A2A receptor alleviates cognitive dysfunction after chronic exposure to intermittent hypoxia in mice

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is widely known for its multiple systems damage, especially neurocognitive deficits in children. Since their discovery, adenosine A_2A receptors (A_2ARs) have been considered as key elements in signaling pathways mediating neurodegenerative diseases such as Huntington's and Alzheimer's, as well as cognitive function regulation. Herein, we investigated A_2AR role in cognitive impairment induced by chronic intermittent hypoxia (CIH). Mice were exposed to CIH 7 h every day for 4 weeks, and intraperitoneally injected with A_2AR agonist CGS21680 or A_2AR antagonist SCH58261 half an hour before IH exposure daily. The 8-arm radial arm maze was utilized to assess spatial memory after CIH exposures.To validate findings using pharmacology, the impact of intermittent hypoxia was investigated in A_2AR knockout mice. CIH-induced memory dysfunction was manifested by increased error rates in the radial arm maze test. The behavioral changes were associated with hippocampal pathology, neuronal apoptosis, and synaptic plasticity impairment. The stimulation of adenosine A_2AR exacerbated memory impairment with more serious neuropathological damage, attenuated long-term potentiation (LTP), syntaxin down-regulation, and increased BDNF protein. Moreover, apoptosis-promoting protein cleaved caspase-3 was upregulated while anti-apoptotic protein Bcl-2 was downregulated. Consistent with these findings, A_2AR inhibition with SCH58261 and A_2AR deletion exhibited the opposite result. Overall, these findings suggest that A_2AR plays a critical role in CIH-induced impairment of learning and memory by accelerating hippocampal neuronal apoptosis and reducing synaptic plasticity. Blockade of adenosine A_2A receptor alleviates cognitive dysfunction after chronic exposure to intermittent hypoxia in mice.

[Comparative Study of Clinical Manifestations and Sleep Structure in Children with Obstructive Sleep Apnea-hypopnea Syndrome with Different BMI]

OBJECTIVE

To compare and analyze the clinical manifestations and sleep structure of children with obstructive sleep apnea-hypopneasyndrome (OSAHS) with different body mass index (BMI).

METHODS

452 children who were diagnosed with OSAHS between December 2016 and February 2021 by the Department of Respiratory Medicine, Children's Hospital of Soochow University were included in the study. All of them did polysomnography (PSG). They were divided, according to their BMI, into the normal BMI group, the overweight group, and the obesity group. Their clinical data and PSG results were collected.

RESULTS

287 boys (63.5%) and 165 girls (36.5%) were enrolled, with their age ranging between 3 and 15, and the median age being 5.5 (4.5, 7.0). Their BMI ranged between 12.09 kg/m 2 and 38.48 kg/m 2, with the median being 16.29 kg/m 2. 275 cases (60.8%) had normal BMI, 76 cases (16.8%) were overweight, and 101 cases (22.3%) were obese. There was no significant difference in the distribution of clinical manifestations and severity of OSAHS among the three groups. The duration and proportion of rapid eye movement (REM) stage sleep in the obese group was lower than that of the overweight and the normal BMI groups ( P<0.05). The lowest oxyhemoglobin saturation (LSaO 2) of children in the overweight group was lower than that of the normal BMI group ( P=0.050). The oxygen desaturation index (ODI) of the obese group was higher than that of the normal BMI and the overweight groups ( P<0.05).

CONCLUSION

Obesity worsens the degree of hypoxia in children with OSAHS and affects their sleep structure.

Explainable fuzzy neural network with easy-to-obtain physiological features for screening obstructive sleep apnea-hypopnea syndrome

OBJECTIVE/BACKGROUND

Recently, several tools for screening obstructive sleep apnea-hypopnea syndrome (OSAHS) have been devised with varied shortcomings. To overcome these drawbacks, we aimed to propose a self-estimation method using an explainable prediction model with easy-to-obtain variables and evaluate its performance for predicting OSAHS.

PATIENTS/METHODS

This retrospective, cross-sectional study selected significant easy-to-obtain variables from patients, suspected of having OSAHS by regression analysis, and fed these variables into the proposed explainable fuzzy neural network (EFNN), a back propagation neural network (BPNN) and a stepwise regression model to compare the screening performance for OSAHS.

RESULTS

Of the 300 participants, three easily available features, such as waist circumference, mean blood pressure (BP) at the end of polysomnography and the difference in systolic BP between the end and start of polysomnography, were obtained from regression analysis with a five-fold cross-validation scheme. Feeding these three variables into the prediction models showed that the average prediction differences for apnea-hypopnea index (AHI) when using the EFNN, BPNN, and regression model were respectively 1.5 ± 18.2, 3.5 ± 19.1 and 0.1 ± 19.3, indicating none of the tested methods had good efficacy to predict the AHI values. The performance as determined by the sensitivity + specificity-1 value for screening moderate-to-severe OSAHS of the EFNN, BPNN and regression model were respectively 0.440, 0.414 and 0.380.

CONCLUSIONS

When fed with easy-to-obtain physiological features, the understandable EFNN should be the preferred method to predict moderate-to-severe OSAHS.

Postoperative secondary aggravation of obstructive sleep apnea-hypopnea syndrome and hypoxemia with bilateral carotid body tumor: A case report

BACKGROUND

Carotid body tumor (CBT) is a chemoreceptor tumor located in the carotid body, accounting for approximately 0.22% of head and neck tumors. Surgery is the main treatment method for the disease.

CASE SUMMARY

We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome (OSAHS) and hypoxia after surgical resection of bilateral CBTs. This patient was admitted, and relevant laboratory and imaging examinations, and polysomnography (PSG) were performed. After the definitive diagnosis, continuous positive airway pressure (CPAP) treatment was given, which achieved good efficacy.

CONCLUSION

This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs, and diagnosis by PSG and CPAP treatment are helpful for this patient.

Effectiveness of Continuous Positive Airway Pressure Versus Mandibular Advancement Device in Severe Obstructive Sleep Apnea Patients With Mandibular Retrognathia: A Prospective Clinical Trial

AIM

Some obstructive sleep apnea (OSA) patients may have mandibular retrognathia (ANB > 4.7° and SNB < 76.2°). Currently, there are no studies that have compared the effectiveness of continuous positive airway pressure (CPAP) versus mandibular advancement device (MAD) in severe OSA patients with mandibular retrognathia. We explored the efficacy of CPAP versus MAD for the treatment of severe OSA patients with mandibular retrognathia.

METHODS

A total of 105 patients were enrolled. Outcomes were assessed by using polysomnography, Epworth Sleepiness Scale (ESS), Snore Scale (SS), Self-rating Anxiety Scale (SAS), and compliance, before treatment and after 6 and 12 months of treatment.

RESULTS

Continuous positive airway pressure was superior to MAD in improving polysomnographic outcomes and SS score, but reported compliance was higher on MAD. There is no significant difference between the 2 treatments in terms of ESS score and SAS score. Obstructive sleep apnea patients with mandibular retrognathia showed greater improvement than those without mandibular retrognathia in terms of apnea-hypopnea index and oxygen desaturation index after MAD.

CONCLUSION

Continuous positive airway pressure and MAD are both effective in treating severe OSA patients with mandibular retrognathia. Mandibular advancement device is a good alternative to CPAP in severe OSA patients with mandibular retrognathia. Mandibular advancement device is more effective in treating OSA patients with mandibular retrognathia than those without. Trial registration: ChiCTR2000032541.

Effect of minimally invasive surgery on the sleep quality and work ability of patients with obstructive sleep apnea-hypopnea syndrome

OBJECTIVE

To explore the effect of minimally invasive surgical treatment on the sleep quality and work ability of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Fifty-one patients who underwent minimally invasive surgery in the Sleep Respiratory Disease Diagnostic and Treatment Center of the West China Fourth Hospital of Sichuan University from January 2017 to January 2019 were selected as study subjects. All subjects completed polysomnography monitoring (PSG), an Epworth sleepiness scale (ESS), and a work ability index (WAI) before and 1 year after the minimally invasive surgery so that the changes could be compared.

RESULTS

(1) The apnea-hypopnea index (AHI), microarousal index (MAI), ESS, longest duration of apnea, and longest duration of hypoventilation in OSAHS patients decreased, while the lowest blood oxygen saturation (LsaO₂) increased after minimally invasive surgery. The differences were statistically significant (p < 0.05). (2) The WAI questionnaire score increased from (37.76 ± 4.46) to (40.00 ± 4.53) after minimally invasive surgery (P < 0.05). (3) The change in the WAI questionnaire score after minimally invasive surgery was influenced by the occupational category and the change in ESS.

CONCLUSION

Minimally invasive surgical treatment shows significant benefit in improving the sleep quality and working ability of patients with OSAHS.

Evaluating the performance of five scoring systems for prescreening obstructive sleep apnea-hypopnea syndrome

PURPOSE

A comparison of all scoring systems used for screening for obstructive sleep apnea-hypopnea syndrome (OSAHS) is lacking. The aim of this investigation was to evaluate the performance of five scoring systems for screening for OSAHS, as well as to validate the use of the NoSAS and SACS in the Chinese population.

METHODS

Data were retrospectively collected from hospital-based, manned, overnight sleep monitoring studies for 105 consecutive outpatients using a portable monitor (PM) device.

RESULTS

The 105 participants had an average age of 46 years and were mostly men (75%). STOP-Bang, SACS, and NoSAS scoring exhibited moderate predictive values at different AHI cutoffs (AUC 0.761-0.853, 0.722-0.854, and 0.724-0.771 respectively), followed by the STOP and Berlin questionnaire (AUC 0.680-0.781vs 0.624-0.724). Both STOP-Bang and SACS showed excellent sensitivity (89.5-100% vs 93.4-94.6%) and negative predictive value (68-100% vs 77.3-90.9%), while STOP-Bang, STOP, and SACS showed low negative likelihood ratios (- LR) (0-0.2).

CONCLUSIONS

Our study indicated that the STOP-Bang questionnaire and the SACS both show better predictive value than other scoring systems among the five screening tools for OSAHS. Both scoring systems are simple and easy to implement for screening for OSAHS in the community and in hospitals.

Effect of motivational interviewing on postoperative weight control in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND

Obesity is an important factor to cause the obstructive sleep apnea-hypopnea syndrome (OSAHS). Higher body mass index (BMI) often results in more severe OSAHS. Currently, the common measures for controlling the weight mainly include diet control, increase exercise and so on. Motivational interviewing (MI) could explore the patient's internal state and make the patient realize his/her ambivalence, resulting in the change in his/her behavior. This process emphasizes respecting the patient's autonomy.

AIM

To evaluate the effect of MI on the weight control of patients with OSAHS.

METHODS

A randomized controlled study was conducted in 100 obese OSAHS patients undergoing surgical treatment at Shengjing Hospital of China Medical University. The patients were divided into an intervention group and a control group, with 50 cases each. The control group was given routine health education after the operation; in addition to the regular health education, the intervention group was given MI according to a predetermined plan. Obesity-related indicators, postoperative complications, and the sleep status of both groups were evaluated before and 6 mo after the intervention.

RESULTS

Patients in the intervention group had significantly improved body weight, BMI, and waist and neck circumferences compared with patients in the control group (P < 0.05). Regarding complications at 6 mo after operation, the incidence of cough and reflux in patients in the intervention group was significantly lower than that in the control group (P < 0.05). In addition, the Epworth Sleepiness Scale and Self-Rating Scale of Sleep scores of patients in the intervention group were significantly lower than those in the control group, and the sleep status of patients in the intervention group was improved (P < 0.05).

CONCLUSION

MI intervention has a significant advantage over postoperative routine health education. It can greatly change the lifestyle, further control the postoperative weight, reduce the occurrence of complications, improve the quality of sleep, and improve long-term postoperative efficacy in OSAHS patients.

Exploration of the Association Between Obesity and Cognitive Impairment in Chinese Children with Mild or Moderate Obstructive Sleep Apnea-Hypopnea Syndrome

PURPOSE

To explore the association between obesity and cognitive impairment in children with mild or moderate obstructive sleep apnea-hypopnea syndrome (OSAHS).

DESIGN AND METHODS

A total of 71 children with obesity and 71 age- and sex- matched children who were non-obese were included. The Wechsler Intelligence Scale for Children fourth edition (WISC-IV) was adopted to evaluate the cognition of the participating children. Pearson and partial correlation analysis were performed to investigate the relationships between neurocognitive functions and demographic and polysomnography parameters. Two-way Analysis of Variance was performed to evaluate the effect of obesity and apnea-hypopnea index (AHI) on cognitive functions.

RESULTS

Full-scale intelligence quotient (FSIQ, 92.4 ± 12.3 vs. 98.6 ± 13.1; P < 0.01), verbal comprehension index (VCI, 92.8 ± 10.8 vs. 98.7 ± 10.9; P < 0.01), working memory index (WMI, 92.6 ± 11.3 vs. 96.5 ± 11.0; P = 0.04) and perceptual reasoning index (PRI, 93.8 ± 12.1 vs. 99.2 ± 12.5; P < 0.01) were significantly lower in the children with obesity compared with those in the control group. Partial correlation analysis showed that FSIQ were negatively and significantly correlated with body mass index (BMI, r = -0.347, P < 0.01) and AHI (r = -0.304, P < 0.01). Two-way ANOVA revealed that both obesity and AHI had independent effects on FSIQ (both P < 0.05). The interaction between the effect of obesity and AHI on cognitive functions was not significant, indicating that obesity is a risk factor of cognitive impairment independent of AHI.

CONCLUSIONS

Obesity aggravates cognitive impairment in children with mild or moderate OSAHS.

PRACTICE IMPLICATIONS

Children diagnosed with OSAHS and obesity are recommended to control their body weight for the prevention, management and treatment of cognitive impairment.

Clinical features and risk factors in patients with asthma complicated with obstructive sleep apnea-hypopnea syndrome: a hospital-based study

PURPOSE

The current study was conducted to explore the clinical features and risk factors of patients with asthma complicated by obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Patients with asthma who underwent polysomnography in our hospital from August 2017 to December 2019 were enrolled in the study. Data on demographics, pulmonary function testing, polysomnography, blood gases, mean pulmonary artery pressure, and vascular endothelial growth factor (VEGF) were compared between the two groups.

RESULTS

Of 238 patients with asthma, 93 who also had OSAHS formed the observation group and were subclassified into mild (n = 33), moderate (n = 41), and severe (n = 19) categories, while 145 patients with asthma alone were assigned to the control group. No significant differences were found in sex, age, course of disease, or pulmonary function between the two groups (P > 0.05), while the observation group showed more frequent allergic rhinitis and had greater BMI, neck circumference, mean pulmonary artery pressure (mPAP), and VEGF than those in the control group (P < 0.001). The peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and FEV₁/FVC in the mild group and the moderate group were higher than those in the severe group (P < 0.001). The durations of AHI and SaO₂ < 90% in the mild group and the moderate group were shorter than that in the severe group, and the lowest level of SaO₂ in the mild group and the moderate group was higher than that in the severe group (P <  0.05). The mPAP and VEGF of the mild and moderate groups were lower than those of severe group (P < 0.001), with mild group lower than moderate group (P < 0.001).

CONCLUSION

Significant differences in allergic rhinitis, BMI, neck circumference, AHI, SaO2, mPAP, and VEGF were observed in patients with asthma complicated by OSAHS. These parameters are risk factors associated with asthma complicated by OSAHS.

Serum periostin and TNF-α levels in patients with obstructive sleep apnea-hypopnea syndrome

PURPOSE

Obstructive sleep apnea-hypopnea syndrome (OSAHS) may cause pulmonary diseases, and periostin plays an important role on the development of pulmonary diseases. In addition, periostin and pro-inflammatory cytokine TNF-α can regulate each other in vivo. This study aimed to observe the changes of serum periostin and TNF-α levels in patients with OSAHS compared with healthy volunteers and to investigate their correlation.

METHODS

A convenience sample of 67 patients with OSAHS in our hospital from December 2018 to December 2019 was selected and categorized into mild, moderate, and severe groups according to apnea-hypopnea index by polysomnography. In addition, 21 healthy volunteers were selected as the control group. Serum levels of periostin and TNF-α were determined by enzyme-linked immunosorbent assay (ELISA). Results were analyzed using the SPSS software.

RESULTS

Both serum periostin and TNF-α levels in all the three OSAHS groups were higher than those of the control group and increased with severity of OSAHS. The severe group had significantly higher serum periostin and TNF-α levels than the mild and moderate groups (p < 0.05). For patients with OSAHS, serum periostin and TNF-α levels positively correlated with the apnea-hypopnea index (AHI) (p < 0.01) and negatively correlated with the lowest saturation oxygen (LSaO₂) and mean saturation oxygen (MSaO₂) (both p < 0.01). In addition, there was a positive correlation between serum periostin and TNF-α levels in patients with OSAHS (p < 0.001).

CONCLUSIONS

Serum periostin and TNF-α levels were significantly increased in patients with OSAHS and may serve as a potential biomarker for severity of OSAHS. These findings suggest that it may be fruitful to study the role of periostin and TNF-α in OSAHS-induced pulmonary diseases.

Association of diabetic nephropathy with the severity of obstructive sleep apnea-hypopnea syndrome in patients with type 2 diabetes mellitus

This study aimed to analyze the effect of the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) on diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). A total of 322 patients with T2DM participated in this cross-sectional study. OSAHS was diagnosed according to the apnea-hypopnea index (AHI) and it was categorized as follows: normal, mild, moderate, and severe. Relevant clinical data retrieved from medical charts were cross-analyzed between different groups. The relationship between urinary albumin/creatinine ratio(UACR) and OSAHS parameters, which included AHI, lowest oxygen saturation (L-SaO₂), and mean oxygen saturation (M-SaO₂), was evaluated by partial correlation analysis. DN stages were classified into a non-DN group, a microalbuminuria group, and a macroalbuminuria group. Multiple factor logistic regression analysis was employed to analyze factors influencing DN. The results showed that mild OSAHS, moderate OSAHS, and severe OSAHS patients had a higher Body mass index (BMI), creatinine (CR) level, UACR, and a longer duration of T2DM (p < 0.05) than the non-OSAHS group. The prevalence of DN in the non-OSAHS, mild OSAHS, moderate OSAHS, and severe OSAHS groups was 18.4%, 19.2%, 34.6%, and 49.4%, respectively (p < 0.05). Multiple factor logistic regression analysis revealed that systolic blood pressure (SBP) (OR = 1.03), AHI (OR = 1.02), and duration of T2DM (OR = 1.04) were correlated with DN (p < 0.05). These findings revealed that OSAHS is highly prevalent in T2DM and AHI is independently associated with the presence of DN.

Part 3: sleep recordings

OBJECTIVES

The authors present the clinical practice guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) concerning the role of the ENT specialist in the management of pediatric obstructive sleep apnea hypopnea syndrome (POSAHS). Part 3 is dedicated to the place of sleep recordings in the diagnosis of POSAHS.

METHODS

A multidisciplinary work group was commissioned to carry out a review of the scientific literature on the above topic. Based on the articles retrieved and the group members' individual experience, guidelines were drafted and graded as A, B or C or Expert Opinion by decreasing level of evidence, then reviewed by an editorial group independent of the work group.

RESULTS

Sleep recordings are presented according to the American Sleep Disorders Association's classification as type 1, 2, 3 or 4. Their modalities, interpretation, indications, advantages and limitations are detailed.

[Sleep-related breathing disorders in adults: diagnosis, consequences and comorbidities]

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a collapse of the upper airways leading to a decrease (hypopneas) or interruption of air flow (apneas). Since its identification, only forty years ago, definitions, diagnostic techniques have evolved, the consequences of this syndrome have been widely studied but establishing it as an independent cardiovascular (CV) risk factor has come up against the existence of many confounding factors, such as obesity, high blood pressure (hypertension)… Paraclinical diagnosis is based on the results of poly(somno)graphy. Recommendations on measurement techniques and scoring are regularly published, evolving in parallel with technological progress, with the aim of standardizing and ensuring the reliability of the diagnosis. At the same time, large cohort studies were set up in the 1990s, allowing for transversal and longitudinal follow-up of thousands of patients. Finally, the pathophysiological mechanisms of the consequences of SAHOS were explored. OSA has been shown to be responsible for a particularly high accidental risk due to sleep fragmentation induced by abnormal respiratory events. It has been possible to establish an independent statistical relationship between SAHOS and CV diseases, metabolic disorders and more recently cancer, mainly explained by intermittent hypoxia. OSAHOS is a frequent disease, diagnosed on the basis of clinical signs and poly(somno)graphy, now established as an independent risk factor for morbidity and mortality (accidental and CV).

Effects of low-temperature plasma treatment on pulmonary function in children with obstructive sleep apnea-hypopnea syndrome

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related respiratory disease. Despite reports of low-temperature plasma radiofrequency ablation of tonsils and adenoids for the treatment of OSAHS, the effects on lung function and quality of life are unclear.

AIMS

This study aims to explore the effects of low-temperature plasma treatment on pulmonary function in children with OSAHS.

METHODS

A total of 110 children with OSAHS were included in this prospective study. Low-temperature plasma radiofrequency treatment and routine surgical treatment were performed in group A and group B, respectively. Maximal voluntary ventilation (MVV), forced vital capacity (FVC), and total lung capacity (TLC) were measured. OSA-18 survey was used to evaluate the quality of life 1 year after operation.

RESULTS

Group A had significantly higher effective treatment rate (P < 0.05) and lower operative period, bleeding volume, visual analog score, pseudomembrane detachment time, and time required to feed after operation than group B (all P < 0.001). There were no significant difference in the incidence of postoperative complications between the groups and MVV, FVC, and TLC between the groups before and after operation (all P > 0.05), and the above indexes in both groups were significantly increased after operation (all P < 0.05). OSA-18 scores in group A were significantly lower than group B after operation (P < 0.001).

CONCLUSIONS

Low-temperature plasma technique performed in OSAHS children has a good clinical effect, which can reduce the operation time, intraoperative blood loss, postoperative pain, pseudomembrane detachment time, hospitalization time, and improve pulmonary function and quality of life.

Endothelial Function of Patients with Morbid Obesity Submitted to Roux-en-Y Gastric Bypass With and Without Obstructive Sleep Apnea-Hypopnea Syndrome

BACKGROUND

Obesity is associated with obstructive sleep apnea-hypopnea syndrome (OSA) and both induce endothelial dysfunction. However, the effect of OSA on endothelial function after bariatric surgery has not been investigated yet.

OBJECTIVES

This study aims to evaluate the impact of weight loss on endothelial function in patients with and without obstructive sleep apnea (OSA) in the first 6 months after bariatric surgery.

SETTING

This study was conducted at a university hospital, in Brazil.

METHODS

The sample consisted of 56 patients homogeneously divided into groups with and without OSA. All patients underwent Roux-en-Y gastric bypass (RYGB), and the diagnosis of OSA was performed by polysomnography. The patients were evaluated preoperatively and 6 months after surgery. The evaluations included anthropometric measures, electrical bioimpedance, clinical symptoms of OSA, and endothelial function (flow-mediated dilation). RYGB improved the anthropometric, bioimpedance, and endothelial function results in both groups.

RESULTS

Patients presented a significant clinical improvement in OSA symptoms throughout the study. However, patients with OSA had an improvement in the endothelial function 2.5% lower (p < 0.001) than patients without APNEA syndrome.

CONCLUSION

This study demonstrates that the existence of OSA prior to bariatric surgery interferes in the improvement of endothelial function.

[The effect of hypothalamic-pituitary-thyroid axis hormone levels and depression in obstructive sleep apnea-hypopnea syndrome]

Objective: To explore the change of hypothalamic-pituitary-thyroid axis hormones and it's role in depression in obstructive sleep apnea-hypopnea syndrome. Methods: Seventy-three male OSAHS patients [age (39±11) years] and 13 male controls [age (36±7.5) years] were enrolled from August 2013 to May 2017 in the 1(st) Hospital of China Medical University. Overnight polysomnography and depression were assessed. The serum TRH, TSH, FT4 and FT3 levels were measured on the next morning. The relationship between depression and hypothalamic-pituitary-thyroid axis was analyzed. Results: Compared with the control group, severe hypoxia group had higher serum FT3 level [(4.5±0.6) ng/L vs. (5.4±0.7)ng/L, P<0.05)] and depression score (30±7 vs. 40±10, P<0.05). Further analysis revealed that serum FT3 level (5.0±0.5 ng/L vs. 5.5±0.7ng/L, P<0.05) and FT4 level [(16.2±1.9) ng/L vs. (18.2±2.3) ng/L, P<0.05] were lower in the patients with depression than those without. Conclusion: The decrease of serum FT3 and FT4 levels in OSAHS patients with severe hypoxia was closely related to the occurrence of depression.

Association of OSAHS Hypoxia Indicators with Early Renal Injury and Serum Fibroblast Growth Factor 21 in Obese Type 2 Diabetic Patients

OBJECTIVE

This study aimed to explore the association of obstructive sleep apnea-hypopnea syndrome (OSAHS) hypoxia indicators with early renal injury and serum fibroblast growth factor 21 (FGF21) in obese type 2 diabetic patients.

METHODS

A total of 109 obese patients with type 2 diabetes mellitus (T2DM) were recruited, including 70 males and 39 females, with an average age of 52.77 ± 13.57 years and average BMI of 29.08 ± 4.36 kg/m2. Overnight sleep monitoring was performed with a portable monitor to record respiratory parameters [apnea-hypopnea index (AHI), oxygen desaturation index (ODI), lowest oxygen saturation (LSaO2), mean oxygen saturation (MSaO2/MPO2) and cumulative time of oxygen saturation < 90% (CT < 90%)]. Ultrasonography was done to detect the quantitative liver fat content (LFC). The urine microalbumin and creatinine ratio (ACR) were determined by immunoturbidimetry. FGF21 was measured at baseline by enzyme-linked immunosorbent assay. Patients were divided into the proteinuria group (n = 42) and non-proteinuria group (n = 67). Correlation analysis and multivariate linear regression analysis were used to analyze the related data. In addition, patients were divided into the T2DM without OSAHS group (n = 16) and T2DM with OSAHS group (n = 93) according to the AHI value. The correlation analysis was used to assess the relationship between FGF21 and clinical variables.

RESULTS

(1) ACR positively correlated with waist circumference (WC), AHI, ODI, CT < 90% and LFC, but negatively with MSaO2 and LSaO2. (2) AHI, ODI, CT < 90% and LFC were independent risk factors for ACR, LSaO2 and MSaO2 was a protective factor. (3) Serum FGF21 decreased in the OSAHS group compared with the non-OSAHS group. After adjustment for age, WC and TG, FGF21 correlated negatively with AHI, but positively with MSaO2.

CONCLUSIONS

AHI, ODI, CT < 90% and LFC are independent risk factors for ACR. FGF21 is associated with hypoxia indicators, and improving OSAHS status and reducing liver fat content may be helpful for the prevention and treatment of early diabetic nephropathy (DN).

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15006225.

MicroRNA expression profile is altered in the upper airway skeletal muscle tissue of patients with obstructive sleep apnea-hypopnea syndrome

Objective

To investigate the involvement of microRNAs (miRNAs) in the pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods

In this study, we investigated miRNA profiles in the upper airway (UA) skeletal muscles of four patients with OSAHS and four matched controls using the miRCURY miRNA array. In another cohort of 12 OSAHS cases and 7 controls, the mRNA expression levels of interleukin (IL)-6 and Lin-28 homolog A (Lin28A), targets of the downregulated let-7 family members, were measured by real-time quantitative-PCR. The potential targets of the miRNAs were predicted by miRNA target prediction databases miRanda, Microcosm, and Targetscan.

Results

The array identified 370 differentially expressed miRNAs, of which 181 were upregulated and 189 were downregulated in OSAHS patients (based on a fold-change >2.0 and p < 0.05). Upregulation of IL-6 and Lin28A was validated by quantitative reverse transcription PCR. The 612 targets predicted by all three algorithms were subjected to gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The results revealed perturbations in signaling pathways and cellular functions.

Conclusion

This study demonstrated profoundly altered miRNA expression profiles in upper airway muscular tissues of patients with OSAHS, which might contribute to the formation and development of OSAHS.

Part 1: Interview and physical examination

OBJECTIVES

To present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This article focuses specifically on medical history and physical examination.

METHODS

A multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group.

RESULTS

At the end of the process, guidelines were established and graded regarding the following points: interview and analysis of the various interview scores recommended in the literature; clinical examination with awake upper-airway endoscopy; and indications for referral to non-ENT specialists.

Part 2: Diagnostic investigations apart from sleep studies

OBJECTIVES

To present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This manuscript specifically focuses on diagnostic investigations apart from sleep studies.

METHODS

A multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group.

RESULTS

At the end of the process, guidelines were established and graded regarding diagnostic investigations apart from sleep studies, in particular respiratory functional tests, biological markers, and morphologic assessment under induced sleep (drug-induced sleep endoscopy (DISE) and cine-MRI).

Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

OBJECTIVES/HYPOTHESIS

To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea-hypopnea syndrome (OSAHS) in awake patients.

STUDY DESIGN

Prospective study.

METHODS

Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal-epiglottic aerospace (RPEA), modified Cormack-Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS.

RESULTS

The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack-Lehane scoring (κ = 0.38). The presence of a mega-epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega-epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23-18.56, P = .024), modified Cormack-Lehane score of 2 (aOR: 15.3, 95% CI: 1.8-130.3, P = .012), or modified Cormack-Lehane score of 3 (aOR: 10.03, 95% CI: 1.3-78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01-1.14, P = .025).

CONCLUSIONS

Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega-epiglottis, and modified Cormack-Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients.

LEVEL OF EVIDENCE

2 Laryngoscope, 129:2782-2788, 2019.

Clinical usefulness of the body muscle-to-fat ratio for screening obstructive sleep apnea syndrome in patients with inadequately controlled type 2 diabetes mellitus

AIMS

To investigate whether body composition measures can be used for screening obstructive sleep apnea syndrome (OSAS) in patients with type 2 diabetes mellitus (T2DM) suspected of having OSAS.

METHODS

Subjects were 186 hospital inpatients with inadequately controlled T2DM. We measured the respiratory disturbance index (RDI) as an indicator of OSAS using a sheet-type breath detection monitor, defining OSAS as an RDI ≥ 19 events/hour. Elementary body composition was measured by bioelectrical impedance analysis using InBody770.

RESULTS

Simple logistic regression analysis identified body weight, body mass index (BMI), waist circumference, total body fat mass, body fat percentage, and body muscle-to-fat ratio (BMFR) as significantly associated with OSAS. The Nagelkerke R² test showed that the BMFR was the most suitable measure for screening OSAS. Multivariate logistic regression analysis demonstrated that BMFR was significantly and independently associated with OSAS. In receiver operating characteristic curve analysis, the area under the BMFR curve was 0.70 (P < 0.001), indicating that BMFR was significantly predictive of OSAS. Furthermore, BMFR was the most suitable measure for screening OSAS in a sub-group analysis of non-obese patients with relatively low BMI (<27.5 kg/m²).

CONCLUSIONS

In patients with T2DM, the BMFR is useful for screening OSAS in daily clinical practice.

French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome

OBJECTIVE

The authors present the guidelines of the French Society of ENT and Head & Neck Surgery (SFORL) on the role of the ENT physician in childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). This section of the guidelines concerns the roles of the various medical and surgical treatment options.

METHOD

A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Based on the retrieved articles and the group members' own experience, guidelines were drawn up, then read over by a reading group independent of the work-group. An editorial meeting then produced the final text.

RESULTS

Adenotonsillectomy is the reference treatment for childhood OSAHS with adenotonsillar hypertrophy. Respiratory assistance is recommended in children with severe OSAHS without nasal and/or oropharyngeal obstacle, after surgery in case of persistent OSAHS, in case of contraindications to surgery, in complex obstruction related to pharyngolaryngeal or laryngeal pathology or comorbidity, or as an alternative to tracheotomy. Nasal route corticosteroids may be used in childhood OSAHS in with associated nasal obstruction.

Detection on pharyngeal wall floppiness in patients with nonstructural factor-induced obstructive sleep apnea-hypopnea syndrome: Difference in position detection

OBJECTIVES/HYPOTHESIS

To evaluate changes in pharyngeal wall floppiness (PWF) between patients with obstructive sleep apnea-hypopnea syndrome induced by non-upper-airway structural factors and normal subjects, as well as the clinical significance using acoustic pharyngealmetry technology.

STUDY DESIGN

Cohort study.

METHODS

The obstructive sleep apnea (OSA) group (n = 102) and the normal control group (n = 50) were identified using the Eccovision Acoustic Pharyngometer measuring instrument. The volume of the pharyngeal cavity in the sitting and supine positions during expiration and inspiration was recorded, respectively, and the PWF index in the sitting and supine positions was calculated for further statistical analysis.

RESULTS

PWF in the sitting (P < .001) and supine positions (P < .001) in the OSA group was notably higher than that in the control group. PWF in the supine position in both the OSA group and control group was remarkably higher than that in the sitting position (P < .001, P = .025, respectively). The difference in PWF between the supine and sitting positions (ΔPWF) (PWF_supine-PWF_sit) was distinctly higher than in control group (P < .01). PWF was positively correlated with age (P < .001) but not with body mass index (P > .05).

CONCLUSIONS

PWF, quantified as elevated PWF, is an important nonstructural factor for the pathogenesis of OSA patients. PWF in the supine position can more accurately reflect airway collapsibility in OSA patients. Our pilot study of a novel observation may help us in the choice of proper surgical candidates for OSA procedures.

LEVEL OF EVIDENCE

3b Laryngoscope, 128:2200-2205, 2018.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study

PURPOSE

To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses.

RESULTS

The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05).

CONCLUSIONS

In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study

PURPOSE

To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses.

RESULTS

The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05).

CONCLUSIONS

In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

Corneal Neovascularization with Associated Lipid Keratopathy in a Patient with Obstructive Sleep Apnea-Hypopnea Syndrome Using a Continuous Positive Airway Pressure Machine

Objective

To report a case of corneal neovascularization with secondary lipid keratopathy in a patient treated with continuous positive airway pressure (CPAP) for obstructive sleep apnea-hypopnea syndrome (OSAHS).

Case Report

A 49-year-old male had been diagnosed with obstructive sleep apnea syndrome 10 years ago and has been treated with the application of a CPAP machine during night sleep ever since. For the past year, the patient had been complaining for ocular irritation and excessive tearing of the left eye on awakening. Slit-lamp biomicroscopy revealed the presence of neovascularization and lipid exudation in the inferior third of the cornea of the left eye. Ocular patching during night sleep resulted in recession of the reported symptoms and shrinkage of the neovascularization, while the area of lipid exudation ceased to enlarge.

Conclusion

To the best of our knowledge, this is the first report of corneal neovascularization in a patient using a CPAP machine for OSAHS.

Awareness of obstructive sleep apnea-hypopnea syndrome among the general population of the Lorraine Region of France

OBJECTIVE

Obstructive sleep apnea-hypopnea syndrome (OSAHS) seems to be underdiagnosed. The aim of this study was to assess awareness of OSAHS among the general population of the Lorraine Region of France.

METHODS

A descriptive epidemiological study was carried out from July to November 2015 in the Lorraine Region, using an anonymous questionnaire that assessed knowledge of OSAHS-related symptoms and complications. The survey was also circulated on the Internet via social media. Exclusion criteria comprised age under 18 years, refusal to fill out the questionnaire and linguistic barrier.

RESULTS

1307 subjects filled out the survey: 1020 on paper format and 287 via the Internet. About two-thirds of the population recognized a majority of symptoms. However, there was a significant lack of knowledge of complications, especially cardiological and neurological. Suffering from OSAHS, having had higher education, and being under 40 years of age, were factors linked to better awareness of the syndrome. Internet respondents also showed better awareness.

CONCLUSION

Despite encouraging results regarding OSAHS symptoms, the general population showed limited awareness of its complications. Innovative educational campaigns must be organized to inform practitioners and the general public about the disease and raise awareness of its complications.

Sleep architecture alterations in patients with periodic limb movements disorder during sleep and sleep breathing disorders

Introduction

Sleep movement disorders includes mainly periodic limb movement and others. The more frequent breathing disorders are: obstructive sleep apnea-hypopnea syndrome and primary snoring.

Objective

To compare sleep architecture in periodic limb movements and breathing disorders of different severity, and weight their interactions.

Methods

We compared sleep architecture in 160 patients, divided in six groups: periodic limb movements (n=25), obstructive apnea only (n=30), periodic limb movements/snoring (n=30), periodic limb movements/mild apnea (n=25), periodic limb movements/moderate apnea (n=25), periodic limb movements/severe apnea (n=26). Polysomnographic variables were compared by analysis of variance and Tukey test.

Results

We observed an increase of percentage of awakenings in the group with periodic limb movements/severe apnea. We found an increase of percentage of light sleep in the group with obstructive apnea only with respect to periodic limb movements group. The group with obstructive apnea only presented less rapid eye movements sleep in relation with group with periodic limb movements. We found an increase of awakenings in the group with periodic limb movements/severe apnea to the group with periodic limb movements only. Oxygen saturation showed a decrease in the group with periodic limb movements/severe apnea and obstructive apnea only group to periodic limb movements only group.

Conclusions

Periodic limb movements and breathing disorders, resulted in more additive changes in sleep architecture alterations, than as separately disorders, in a complex interaction. Research in these relations deserve more investigations.

[The syndrome of increased upper airways resistance: What are the clinical features and diagnostic procedures?]

The upper airway resistance syndrome "UARS" is a poorly defined entity, often described as a moderate variant of the obstructive sleep apnea syndrome. It is associated with respiratory effort-related arousal, absence of obstructive sleep apnea, and absence of significant desaturation. It is a relatively common condition that predominantly affects non-obese young adults, with no predominance in either sex. The degree of upper airway collapsibility during sleep of patients with UARS is intermediate between that of normal subjects and that of patients with mild-to-moderate sleep apnea syndrome. Craniofacial and palatal abnormalities are often noted. Patients frequently complain of a functional somatic syndrome, especially daytime sleepiness and chronic fatigue. Polysomnography with esophageal pressure measurements remains the gold standard diagnostic test. The absence of any neurological abnormality gives UARS a good prognosis and it is potentially reversible if treated early. However, some studies suggest that untreated UARS has an increased risk of arterial hypertension. It can also evolve into obstructive sleep apnea.

Workplace accidents, absenteeism and productivity in patients with sleep apnea

INTRODUCTION

Obstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity.

METHOD

One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results.

RESULTS

Patients with OSAHS had more sick leave lasting longer than 30days (16.6% vs. 7%, P=.049) and lower productivity (63.80% vs. 83.20%, P=.000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P>.050). None of the OSAHS-related variables was associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity.

CONCLUSIONS

OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients.

[Pain prevalence in patients with and without OSAHS subjected to a polysomnogram: A cross-sectional study]

BACKGROUND AND OBJECTIVES

Sleep disturbances apparently have a negative effect on pain or the appearance of pain itself. This suggests the need to determine whether there could be a relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and this phenomenon. The objective of this study was to determine the pain prevalence in a population who underwent polysomnography.

METHOD

A cross-sectional study of patients who underwent polisomnography, pain prevalence was measured with Mcgill pain questionnaire.

RESULTS

Data was obtained from 259 patients, and it was found that 69% suffered pain, and there was a prevalence of 81% OSAHS. Those with OSAHS had a 70% pain prevalence, with 64% for those without OSAHS.

CONCLUSIONS

A high pain prevalence was found this population, possibly related to the characteristic of the population, how the information was gathered, and not controlling for other illnesses related with pain.

[Usefulness of the basic exploration of the upper airways and neighbor structures in patients with adult obstructive sleep apnea-hypopnea syndrome]

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent disease in the general population, associated with an increase in the cardiovascular morbimortality. A basic and/or standardized otolaryngologic exploration could help us to detect the structural abnormalities that alter the upper airway collapsibility and offer a high pre-test risk factor, improve the CPAP adherence or even the possibility of offering alternative treatments. This article offers a revision of the exploration in OSAHS patients. We describe a guideline to identify the main structural abnormalities related to OSAHS. We also include a short algorithm for the diagnosis of OSAHS, when is suspected by primary care physicians.

Estrogen-mimicking isoflavone genistein prevents bone loss in a rat model of obstructive sleep apnea-hypopnea syndrome

OBJECTIVE

Intermittent hypoxia was introduced to mimic obstructive sleep apnea-hypopnea syndrome (OSAHS) in rats. Then, bone mass, bone strength and bone turnover were evaluated, and the influence of genistein on bone mass reduction was investigated in these rats.

METHODS

OSAHS animal model was established via chronic intermittent hypoxia, and genistein (2.5 mg/kg/day) was used to treat OSAHS rats. The bone mineral density (BMD), bone Histomorphometric indicators, bone biomechanics and expressions of genes related to bone formation and resorption (Runx2, Col I, ALP, Osteocalcin, OPG, RANKL and TRAP-5b) were measured after treatment.

RESULTS

The BMD in OSAHS+OVX group was significantly lower than that in OVX group (P<0.05). The BMD in OSAHS+OVX+Genistein group was markedly increased when compared with OSAHS+OVX group (P<0.05), accompanied by partial improvement of the OSAHS induced damage to the lumbar biomechanics. In OSAHS+OVX group, the expressions of Runx2, Col I, ALP and Osteocalcin were significantly reduced when compared with OVX group, and rats in OSAHS+OVX+Genistein group had significantly higher expressions of Runx2, Col I, ALP and Osteocalcin and reduced TRAP-5b expression as compared to OSAHS+OVX group (P<0.05).

CONCLUSIONS

Genistein can improve the reduction in bone mass and bone strength due to OSAHS in OVX rats, which may be attributed to the increase in bone formation and inhibition of bone resorption. Our findings suggest that genistein may be used to treat and prevent osteoporosis in postmenopausal women with OSAHS.