Article

The Occurrence of Sleep-Disordered Breathing Among Middle-Aged Adults

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Abstract

Limited data have suggested that sleep-disordered breathing, a condition of repeated episodes of apnea and hypopnea during sleep, is prevalent among adults. Data from the Wisconsin Sleep Cohort Study, a longitudinal study of the natural history of cardiopulmonary disorders of sleep, were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health. A random sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep (the apnea-hypopnea score). We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score (> or = 5, > or = 10, and > or = 15); we used logistic regression to investigate risk factors. The estimated prevalence of sleep-disordered breathing, defined as an apnea-hypopnea score of 5 or higher, was 9 percent for women and 24 percent for men. We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome (an apnea-hypopnea score of 5 or higher and daytime hypersomnolence). Male sex and obesity were strongly associated with the presence of sleep-disordered breathing. Habitual snorers, both men and women, tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher. The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women. Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence.

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... The Wisconsin Sleep Questionnaire (WSQ) is a short tool devised to investigate sleep problems such as snoring, apnea, and other difficulties while going to sleep, during sleep, and after sleep, etc. [33,34]. It was adapted from the Basic Northern Sleep Questionnaire developed by Scandinavian authors [33,35]. ...
... The Wisconsin Sleep Questionnaire (WSQ) is a short tool devised to investigate sleep problems such as snoring, apnea, and other difficulties while going to sleep, during sleep, and after sleep, etc. [33,34]. It was adapted from the Basic Northern Sleep Questionnaire developed by Scandinavian authors [33,35]. It comprises of 10 questions of snoring and sleep-related breathing disorder, five questions for altered sleep, five questions for individual and family medical history, and twelve items on daily routine, education, job duration, sex, anthropometric information, etc. [33,34]. ...
... It was adapted from the Basic Northern Sleep Questionnaire developed by Scandinavian authors [33,35]. It comprises of 10 questions of snoring and sleep-related breathing disorder, five questions for altered sleep, five questions for individual and family medical history, and twelve items on daily routine, education, job duration, sex, anthropometric information, etc. [33,34]. This questionnaire was used in Winconsin Cohort which started in 1993 and it was established that this a good questionnaire to diagnose sleep-breathing disorders [33]. ...
Article
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Sleep problems are reported by most people with musculoskeletal diseases. Pain, which is a common symptom of these diseases, has a bidirectional association with sleep. Hence, sleep examination should be an important element of the routine evaluation of patients with these diseases. Sleep questionnaires have proven to be effective method for assessing sleep disorders and various sleep domains. They can aid in a full assessment of an individual’s sleep and related factors. These tools provide a subjective assessment of the patient's sleep, allowing the physiotherapist to deliver effective treatment to patients with musculoskeletal disorders who have issues with sleep. Sleep questionnaires are useful for determining a patient's normal sleep context and are simple to administer. However, they also have limitations because of their subjective nature. The present review provides an overview of questionnaires that a physiotherapist can use to assess sleep with hopes that it will facilitate the development of a concept and the relevance of sleep assessment in musculoskeletal physiotherapy.
... Males are more vulnerable to OSA than females. Around 4% of males and 2% of females in the world population are having OSA [2,6]. Heinzer et al. also reported the occurrence of sleep-related breathing disorders in around 49.7% of males and 23.4% of females in the Swiss population [7]. ...
... Alotair and BaHammam also noted significantly higher AHI in males than in females [30]. Further, some of the earlier studies showed an association of SDB with the male gender and stated that SDB could be accurately predicted in obese males [6,31]. This could be attributed to habitual snoring and breathing cessations, which are considered primary symptoms of OSA, and are more frequent in males than their female counterparts [32]. ...
Article
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Purpose The current study is the first attempt to screen obstructive sleep apnea (OSA) risk in adult populations of Chhattisgarh, India. A few predictors of OSA, such as socio-demographic variables, excessive daytime sleepiness (EDS), behavioral sleep variables, and chronotype were also investigated. Methods Five hundred eleven (167 males and 344 females) randomly chosen healthy subjects participated in the study. The STOP-BANG and Modified Berlin Questionnaires (MBQ) were used for the screening of OSA. The Epworth Sleepiness Scale was used to determine excessive daytime sleepiness. The Morningness–Eveningness Questionnaire (MEQ) and Munich Chronotype Questionnaire (MCTQ) were used to determine the chronotype and behavioral sleep variables of each subject. Results It was observed that 11% of the studied population was at risk of OSA obtained through MBQ. The STOP-BANG score significantly differed as a function of gender, family type, habitat, and chronotype. The Principal Component Analysis revealed behavioral sleep variables, demographic variables, EDS, and chronotype as the important correlates of OSA. The variables namely sleep latency and sleep inertia on both workdays and free days contributed to 22% variability in the dataset; whereas age, BMI and BSA together explained 19% variability. The ESS score and other associated factors explained the 20% variability in the dataset. Conclusions The study delivers an early warning and underscores that about 11% of young adults from Chhattisgarh have a higher OSA risk. Sleep latency and sleep inertia could be associated with OSA risk more prominently followed by BMI and BSA.
... La AOS es un problema de salud pública 41,42 . En población general su prevalencia oscila entre el 9% y el 38% [41][42][43][44] , y alcanza el 28% en América Latina, haciendo necesarias estrategias prácticas para 1000 millones de afectados en el mundo 45,46 . ...
... La AOS es un problema de salud pública 41,42 . En población general su prevalencia oscila entre el 9% y el 38% [41][42][43][44] , y alcanza el 28% en América Latina, haciendo necesarias estrategias prácticas para 1000 millones de afectados en el mundo 45,46 . El diagnóstico de AOS se con rma mediante una PSG o una poligrafía respiratoria (PR) en la población con probabilidad clínica moderada o alta [47][48][49] . ...
Article
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La obesidad es un problema de salud pública que produce cambios en la función respiratoria y el sueño. El síndrome de obesidad e hipoventilación (SOH) se define por: hipoventilación en vigilia (PaCO2>45 mmHg), IMC≥30 kg/m2 en adultos o > percentilo 95 en niños y cuando la causa no es una enfermedad del parénquima pulmonar, pared torácica o vías aéreas, uso de medicación, tras-tornos neurológicos ni síndromes de hipoventilación alveolar centrales. Su prevalencia es ≈0.4% en la población general. La mayoría de los pacientes permanecen sin tratar hasta que un evento banal desenmascara la hipercapnia o desencadena falla respiratoria. El 90% tiene apnea obstructiva del sueño (AOS) coexistente, correspondiendo a AOS severa (índice de apneas-hipopneas [IAH]>30 ev/h) en el 70%. El tratamiento depende de la situación clínica (aguda o crónica). En la insuficiencia respiratoria aguda el tratamiento es la ventilación no invasiva (VNI). Después de la estabilización de la hipercapnia, se puede considerar una prueba terapéutica con CPAP si existe AOS severa. En el SOH estable con AOS severa se sugiere CPAP como primera línea, aun-que la VNI es la alternativa si los síntomas no mejoran, la hipercapnia persiste, el IAH no se reduce o la CPAP se tolera mal. En pacientes sin AOS severa la recomendación es el VNI. Las intervenciones que reducen el 25-30% el peso corporal (cirugía bariátrica derivativa) son necesarias para mejorar la hipoventilación. El manejo multidisciplinario con una mirada holística multidimensional es necesario a todos los niveles; individual, familiar, social y sanitario.
... 3 In the Wisconsin Sleep Cohort Study, the prevalences were 24% and 9% in men and women aged 30-60 years, respectively. 1 However, many patients with SDB, including severe SDB, remain undiagnosed. In the Wisconsin Sleep Cohort Study, 93% and 82% of women and men with moderate-to-severe sleep apnoea, respectively, had not been diagnosed. ...
... Use of the Bi-LSTM-CNN classifier was associated with the best accuracy for desaturation classification. 1 The mean accuracy of independent test sets was 84.3%. AHI was calculated by dividing the number of events by the duration of the record. ...
Article
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Purpose: Misdiagnosis and missed diagnosis of sleep-disordered breathing (SDB) is common because polysomnography (PSG) is time-consuming, expensive, and uncomfortable. The use of recording methods based on the oxygen saturation (SpO2) signals detected by wearable devices is impractical and inaccurate for extracting signal features and detecting apnoeic events. We propose a method to automatically detect the apnoea-based SpO2 signal segments and compute the apnoea-hypopnea index (AHI) for SDB screening and grading. Patients and methods: First, apnoea-related desaturation segments in raw SpO2 signals were detected; global features were extracted from whole night signals. Then, the SpO2 signal segments and global features were fed into a bi-directional long short-term memory convolutional neural network model to identify apnoea-related and non-apnoea-related events. The apnoea-related segments were used to assess the AHI. Results: The model was trained on 500 individuals and tested on 8131 individuals from two public hospitals and one private centre. In the testing data, the classification accuracy for apnoea-related segments was 84.3%. Individuals with SDB (AHI 15) were identified with a mean accuracy of 88.95%. Conclusion: Using automatic SDB detection based on SpO2 signals can accurately screen for SDB.
... Its symptoms include snoring, apnea, and lethargy. Men and obesity are strongly associated with the presence of sleep-disordered breathing [13]. The relationship between OSA and hypertension has been extensively studied in the past years. ...
... Among them, Belgium had the highest centrality (0.37) which meant Belgium cooperated more with other countries, such as USA, Germany, and Italy. In addition, it should be mentioned that although Norway, Denmark, Estonia, Finland, and Croatia were the top five countries for the centrality, but they had not been marked in Fig. 3 yet because of the small quantity of publications (16,18,13,20, and 14 respectively). ...
Article
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Objectives The purpose of this study was to systematically analyze the studies of hypertension associated with obstructive sleep apnea to assess the current status and hot spots in this field. Methods We searched the Web of Science Core Collection for publications related to hypertension associated with obstructive sleep apnea published before July 3, 2021. Bibliometric analyses and science mappings were carried out using the CiteSpace 5.8.R1 and Microsoft Office Excel 2019. CiteSpace 5.8.R1 was used to visualize the distribution of research fields, analyze co-occurring keywords and burst terms to detect trends and frontiers, and identify leading collaborations among countries, authors, and institutions. Microsoft Office Excel 2019 was used to make bar graphs, histograms and line graphs. Results According to the search strategy, a total of 7263 published articles and reviews were retrieved. The research on hypertension associated with obstructive sleep apnea has been developing quickly at present. Sleep and Breathing was the most productive journal. The USA was a major producing country and Harvard Medical School was the most productive institution in this field. In the field of hypertension associated with obstructive sleep apnea, the main research hotspots were continuous positive airway pressure, cardiovascular disease, and obesity. Conclusions The present study provides a new perspective for the study of hypertension associated with obstructive sleep apnea and valuable information for researchers to find potential partners and cooperative institutions, hot issues and research frontiers.
... Obstructive sleep apnea (OSA) is a disorder characterized by episodic cessation of breathing due to repeated upper airway partial (hypopnea) or total (apnea) obstructions [1,2]. These events lead to activation of the sympathetic nervous system, sleep fragmentation, intermittent hypoxemia and, in the case of syndrome (OSAS), to excessive daytime sleepiness [3,4]. ...
... This study aimed at providing reliable estimates of the extent of OSA consequences in Italy and assessing the societal economic burden associated with OSA in the adult population by performing a COI analysis. Several studies demonstrated that OSA is a severely underdiagnosed condition worldwide [1,132,133]. We estimated a prevalence of moderate-severe OSA in Italy ranging from approximately 4 to 12 million patients (9% to 27% of the adult population). ...
Article
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Background Obstructive sleep apnea (OSA) is a risk factor for several diseases and is correlated with other non-medical consequences that increase the disease’s clinical and economic burden. However, OSA’s impact is highly underestimated, also due to substantial diagnosis gaps. Objective This study aims at assessing the economic burden of OSA in the adult population in Italy by performing a cost-of-illness analysis with a societal perspective. In particular, we aimed at estimating the magnitude of the burden caused by conditions for which OSA is a proven risk factor. Methods A systematic literature review on systematic reviews and meta-analyses, integrated by expert opinion, was performed to identify all clinical and non-clinical conditions significantly influenced by OSA. Using the Population Attributable Fraction methodology, a portion of their prevalence and costs was attributed to OSA. The total economic burden of OSA for the society was estimated by summing the costs of each condition influenced by the disease, the costs due to OSA’s diagnosis and treatment and the economic value of quality of life lost due to OSA’s undertreatment. Results Twenty-six clinical (e.g., diabetes) and non-clinical (e.g., car accidents) conditions were found to be significantly influenced by OSA, contributing to an economic burden ranging from €10.7 to €32.0 billion/year in Italy. The cost of impaired quality of life due to OSA undertreatment is between €2.8 and €9.0 billion/year. These costs are substantially higher than those currently borne to diagnose and treat OSA (€234 million/year). Conclusions This study demonstrates that the economic burden due to OSA is substantial, also due to low diagnosis and treatment rates. Providing reliable estimates of the economic impact of OSA at a societal level may increase awareness of the disease burden and help to guide evidence-based policies and prioritisation for healthcare, ultimately ensuring appropriate diagnostic and therapeutic pathways for patients.
... Obstructive sleep apnea/hypopnea syndrome (OSAS) is the most common type of sleep-related breathing disorders [1,2]. OSAS is characterized by recurrent nocturnal episodes of partial or complete obstruction of the upper airway, despite an ongoing breathing effort [3][4][5]. ...
... Obstructive sleep apnea/hypopnea syndrome Sleep disordered breathing (SDB) refers to a wide spectrum of pathophysiologic conditions that are characterized by an abnormal respiratory pattern during sleep. Clinically, there is a diversity of sleeprelated disorders that are defined by partial or complete resistance to airflow through the upper airway [1][2][3][4][5]. SDB is widely prevalent in the general population, while OSAS represents the most frequent form of SDB. ...
Article
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Purpose The retina may provide a window to estimate systemic vascular status; therefore, there has been interest in identifying microcirculation characteristics that possibly reflect hypoxic alterations in obstructive sleep apnea/hypopnea syndrome (OSAS). Emerging evidence has suggested that retinal microvasculature investigation holds the potential to characterize the pathophysiology involved in ocular manifestations of OSAS. The advent of optical coherence tomography angiography (OCT-A) has attracted significant attention as this technique offers detailed analysis of the retinal capillary plexus. Methods A detailed literature search was performed in PubMed database until December 2021. We identified and reviewed all papers referring to the alterations of the retinal capillary plexus in OSAS using OCT-A. Results A comprehensive update indicates that microcirculation alterations of the retinal capillary plexus utilizing OCT-A may differ with severity of OSAS and imply the potential underlying pathophysiology of ocular manifestations. The reviewed series have revealed variability concerning microvasculature characteristics at the macular and the peripapillary area. Further studies are warranted to establish the OCT-A parameters as biomarkers regarding the evaluation of OSAS in clinical practice. Conclusion Retinal capillary plexus characteristics as seen on OCT-A reflect microvasculature alterations, potentially leading to concomitant ocular comorbidity in the context of OSAS. The reviewed literature may confirm the diagnostic and prognostic value of OCT-A in the assessment of the pathophysiology of ocular manifestations in OSAS and highlight unmet needs to be addressed by future research.
... In the work entitled "A Bag-of-Audio-Words Approach for Snore Sounds' Excitation Localisation" [345], openXBOW was applied to a chunk-level audio classification task, namely, the classification of snore sounds. This task from the health care domain is highly relevant as habitual snoring is prevalent in society [346] and can lead to obstructive sleep apnea, a syndrome where the airflow during sleep is partially or fully blocked [347]. Cardiovascular diseases or stroke can result from this [348]. ...
Thesis
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Computer audition is omnipresent in everyday life, in applications ranging from personalised virtual agents to health care. From a technical point of view, the goal is to robustly classify the content of an audio signal in terms of a defined set of labels, such as, e.g., the acoustic scene, a medical diagnosis, or, in the case of speech, what is said or how it is said. Typical approaches employ machine learning (ML), which means that task-specific models are trained by means of examples. Despite recent successes in neural network-based end-to-end learning, taking the raw audio signal as input, models relying on hand-crafted acoustic features are still superior in some domains, especially for tasks where data is scarce. One major issue is nevertheless that a sequence of acoustic low-level descriptors (LLDs) cannot be fed directly into many ML algorithms as they require a static and fixed-length input. Moreover, also for dynamic classifiers, compressing the information of the LLDs over a temporal block by summarising them can be beneficial. However, the type of instance-level representation has a fundamental impact on the performance of the model. In this thesis, the so-called bag-of-audio-words (BoAW) representation is investigated as an alternative to the standard approach of statistical functionals. BoAW is an unsupervised method of representation learning, inspired from the bag-of-words method in natural language processing, forming a histogram of the terms present in a document. The toolkit openXBOW is introduced, enabling systematic learning and optimisation of these feature representations, unified across arbitrary modalities of numeric or symbolic descriptors. A number of experiments on BoAW are presented and discussed, focussing on a large number of potential applications and corresponding databases, ranging from emotion recognition in speech to medical diagnosis. The evaluations include a comparison of different acoustic LLD sets and configurations of the BoAW generation process. The key findings are that BoAW features are a meaningful alternative to statistical functionals, offering certain benefits, while being able to preserve the advantages of functionals, such as data-independence. Furthermore, it is shown that both representations are complementary and their fusion improves the performance of a machine listening system.
... Consistent with the findings from other epidemiological sleep studies, [23][24][25] the main factors associated with SDB on univariate analyses in our study were male sex, older age, overweight or obesity, large neck circumference, abdominal obesity, snoring, hypertension, diabetes, alcohol consumption, and smoking. In the multivariable analysis, only older age, male sex, neck circumference, abdominal obesity, overweight or obesity, and snoring remained independently associated with SDB. ...
Article
Background Data on the prevalence of sleep-disordered breathing (SDB) in the African general population are scarce, and a better understanding is urgently needed. Our study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large sample in Benin, west Africa. Methods In the Benin Society and Sleep (BeSAS) cross-sectional study, participants aged 25 years and older were recruited from both urban and rural areas. Rural participants were recruited from Tanve, a village located 200 km north of Cotonou, and urban participants were recruited from Cotonou. The participants underwent respiratory polygraphy at home using a type-3 device that measures airflow through a nasal pressure sensor, respiratory effort (thoracic movement), and pulse oximetry. Clinical and morphometric data were also collected. SDB severity categories were defined according to the apnoea–hypopnoea index (AHI), with mild-to-severe SDB (AHI ≥5/h), moderate-to-severe SDB (AHI ≥15/h), and severe SDB (AHI ≥30/h). Findings The study was completed from April 4, 2018 to Jan 15, 2021. Of 2909 participants recruited in the BeSAS study, 2168 (74·5%) underwent respiratory polygraphy. For the 1810 participants with complete polygraphic data (mean age 46 years, SD 15; 1163 [64·2%] women), the prevalence of mild-to-severe SDB (AHI ≥5/h) was 43·2% (95% CI 40·9–45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2–13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0–3·5). Factors independently associated with SDB were advanced age, male sex, large neck circumference, abdominal obesity, overweight or obesity, and snoring. After multivariable adjustment, severe SDB was independently associated with hypertension in women (odds ratio 3·99, 95% CI 1·04–15·33; ptrend=0·044), but not in men (odds ratio 0·67, 0·22–2·05; Ptrend=0·63). Interpretation The BeSAS study provides the first large-scale objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries. Funding Ligue Pulmonaire Vaudoise, Switzerland.
... estimated OSA to have a prevalence between 1% and 4% in the general population. [5][6][7][8] This prevalence is much higher in patients undergoing elective surgery, especially primary total joint arthroplasty (TJA), which has been estimated to be between 6.7% and 8.7%. 3,8,9 However, the reported prevalence of OSA has increased over time, in part, because of the increasing rates of obesity and increasing life span, both of which are known causes of osteoarthritis and reflect the increased demand for TJA. ...
Article
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Introduction: Obstructive sleep apnea (OSA) is a known risk factor for venous thromboembolism (VTE), defined as pulmonary embolism (PE) or deep vein thrombosis (DVT); however, little is known about its effect on VTE rates after total joint arthroplasty (TJA). This study sought to determine whether patients with OSA who undergo TJA are at greater risk for developing VTE versus those without OSA. Methods: A retrospective analysis was conducted on 12,963 consecutive primary TJA patients at a single institution from 2016 to 2019. Patient demographic data were collected through query of the electronic medical record, and patients with a previous history of OSA and VTE within a 90-day postoperative period were captured using the International Classification of Disease, 10th revision diagnosis and procedure codes. Results: Nine hundred thirty-five patients with OSA were identified. PE (0.6% versus 0.24%, P = 0.023) and DVT (0.1% versus 0.04%, P = 0.37) rates were greater for patients with OSA. A multivariate logistic regression revealed that patients with OSA had a higher odds of PE (odds ratio [OR] 3.821, P = 0.023), but not DVT (OR 1.971, P = 0.563) when accounting for significant demographic differences. Female sex and total knee arthroplasty were also associated with a higher odds of PE (OR 3.453 for sex, P = 0.05; OR 3.243 for surgery type, P = 0.041), but not DVT (OR 2.042 for sex, P = 0.534; OR 1.941 for surgery type, P = 0.565). Conclusion: Female patients with OSA may be at greater risk for VTE, specifically PE, after total knee arthroplasty. More attention toward screening procedures, perioperative monitoring protocols, and VTE prophylaxis may be warranted in populations at risk.
... Obstructive sleep apnea (OSA) is a respiratory disease characterized by repetitive airway collapse during sleep along with a cession (apnea)/reduction of airflow (hyponea) [1]. Given its high prevalence in obese individuals and the current global rise of obesity, OSA is estimated to be as prevalent as diabetes in developed countries [2]. Over 50% of obese people suffer from OSA, whether they are male or female [3,4]. ...
Article
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Background Adiposity is a well-established risk factor for obstructive sleep apnea (OSA), but whether a combination of preferable anthropometric measurements may improve the accuracy of detecting OSA is unknown. This study aimed to explore the accuracies of the waist-hip ratio (WHR) in conjunction with the body mass index (BMI) when identifying the severity of OSA. Design A total of 2012 participants in the China-Japan Friendship Hospital from January 2018 to December 2019 underwent anthropometric measurements and an overnight home sleep test (HST). The 244 subjects who met the criteria for obstructive sleep apnea (apnea–hypopnea index (AHI) ≥ 5 events/hour) were divided into four groups: Group A (55 patients with WHR ≥ 0.9 and BMI ≥ 28 kg/m²); Group B (12 patients with WHR < 0.9 and BMI ≥ 28 kg/m²); Group C (69 patients with WHR ≥ 0.9 and BMI < 28 kg/m²); and group D (108 patients with WHR < 0.9 and BMI < 28 kg/m²). Results The AHI, apnea index (AI), hypopnea index (HI), and oxygen desaturation index (ODI) were significantly different among the 4 groups (p < 0.05). The WHR was positively correlated with AHI (r = 0.22, p < 0.001), AI (r = 0.270, p = 0.004), and ODI (r = 0.286, p = 0.0022) and negatively correlated with lowest oxygen pulse saturation (LSpO2) (r = 0.246, p = 0.008) only in nonobese patients. Moreover, the WHR was found to be a screening marker for moderate-to-severe OSA in Group D (p < 0.05). When used to identify severe OSA in Group D, the WHR cut-off point of 0.873 yielded a sensitivity of 65% and specificity of 56% (p < 0.05). Conclusion In nonobese male OSA patients, WHR is a moderate screening marker for moderate-to-severe OSA and an independent risk factor for OSA severity.
... Snoring is the sound produced by the upper airway tissues vibrating during sleep. Snoring is typical behavior, occurring in 44 % of men and 28 % of women aged 30 to 60 [1]. The cause of snoring is that the air between the larynx and the nose is not circulated precisely when inhaling but sometimes also on exhalation. ...
Chapter
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Snore is the sound emitted when the upper respiratory tract tissues vibrate during sleep, occurring in 44% of men and 28% of women aged 30 to 60. Snore is also a symptom of obstructive sleep apnea (OSA). In addition to being uncomfortable around people, snore can also warn of some health risks. Snore detection can be helpful in monitoring and diagnosing OSA. This study proposes a method for snore detection using convolution neural networks and data augmentation. The dataset was collected from different sources, consisting of 1,000 sound signals, divided into two classes: Snore and Non-snore. First, the sound signals are extracted from the log-mel spectrogram features using the Discrete Fourier transform, then normalized and reasonably and smoothly distributed. An augmented image datastore was created for automatic augmentation and resizing the log-mel spectrograms to increase the training data's effectiveness and help prevent overfitting. Nine convolutional neural networks were used for snore detection with input is log-mel spectrogram images. The best performance was achieved among all networks with an overall accuracy of 99.00% by ResNet-18.
... Obstructive sleep apnea (OSA) is one sleep disorder characterized by repeated blockage or narrowing of the upper airway during sleep that results in sleep fragmentation and dips in blood oxygenation, or intermittent hypoxia. Based on the reported medical diagnosis of OSA, estimates in adults with DS range from 13 to 49% [5][6][7][8], compared with 2 to 6% in adults without DS [9,10]. However, studies of direct measures of OSA ...
Article
We determined the extent to which obstructive sleep apnea (OSA) is associated with increased cerebrovascular disease and amyloid burden, and the relation of the two processes across clinical Alzheimer’s disease (AD) diagnostic groups in adults with Down syndrome (DS). Adults with DS from the Biomarkers of Alzheimer’s Disease in Down Syndrome (ADDS) study were included given available research MRI (n=116; 50±8 years; 42% women) and amyloid PET scans (n=71; 50±7 years; 39% women) at the time of analysis. Participants were characterized as cognitively-stable (CS; 64%), with mild cognitive impairment-DS (MCI-DS; 23%), with possible AD dementia (5%), or with definite AD dementia (8%). OSA was determined via medical records and interviews. Models tested the effect of OSA on MRI-derived cerebrovascular biomarkers and PET-derived amyloid burden, and the moderating effect of OSA and AD diagnosis on biomarkers. OSA was reported in 39% of participants, which did not differ by clinical AD diagnostic group. OSA was not associated with cerebrovascular biomarkers, but was associated with greater cortical amyloid burden. White matter hyperintensity (WMH) volume (primarily in the parietal lobe), enlarged perivascular spaces, and cortical and striatal amyloid burden were greater across clinical AD diagnostic groups (CS<MCI-DS<possible AD<definite AD). OSA increased the differences in WMH volumes across clinical AD diagnostic groups, primarily in the frontal and temporal lobes. Adults with DS and OSA had greater amyloid burden, and greater cerebrovascular disease with AD. Importantly, OSA may be a modifiable risk factor that can be targeted for intervention in this population at risk for AD.
... Among the various risk factors responsible for obstructive sleep apnea (OSA), nasal obstruction (NO) demands close attention. NO not only induces oral breathing that exacerbates apnea but is also directly linked to low adherence to continuous positive airway pressure (CPAP) treatment or a decrease in the frequency of oral appliance (OA) use [1][2][3][4]. Hence, the treatment of NO is key to the treatment of OSA. ...
Article
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Nasal obstruction requires close attention, as it is a risk factor for obstructive sleep apnea (OSA). This study evaluated airflow rates of our newly designed nasal breathing stent (NBS) compared with those of existing nasal dilators in 10 adult men. We hypothesized that the NBS would expand the nasal passage more than the other nasal dilators by means of airflow measurements. We compared airflow measurements between the NBS and three existing appliances and no appliance. Velocity measurements were recorded by analyzing 499 videographic images when each appliance was placed next to a steam generator at 0, 5, and 10 mm from the outlet port for airflow visualization. The peak nasal inspiratory flow (PNIF) rate was measured using an inspiratory flow meter. The NBS resulted in significantly higher airflow velocity measurements at all distances from the outlet port and a higher PNIF rate than the other appliances. Thus, the NBS offers a significantly decreased resistance to air movement compared with other appliances. Future in-depth investigations are required to demonstrate the use of NBS as a nasal dilator in conjunction with continuous positive airway pressure/oral appliance treatments in patients with OSA.
... Obstructive sleep apnea (OSA) is a highly prevalent medical condition characterized by recurrent episodes of partial or complete obstruction of the upper airways during sleep. Common symptoms are loud snoring, witnessed apneas, and daytime fatigue or sleepiness (1). It is associated with various mental health conditions such as depression, anxiety, and post-traumatic stress disorder. ...
Article
Background: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that often is associated with several psychiatric conditions. Job loss is a stressful life event that can also affect mental health and socioeconomic status (SES). We investigated whether there was an association between the prevalence of OSA and several psychiatric conditions within a cohort of persons who recently became unemployed and whether SES was a contributing factor. Methods: Data from 292 participants who completed the screening evaluation of the Assessing Daily Activity Patterns through occupational Transitions (ADAPT) Study were used to assess the association between the prevalence of OSA, and current and past depression, and past suicidality. A type III sleep home sleep monitor was used to identify the presence of OSA and assess its severity. Depression and suicidality were ascertained using the Mini-international neuropsychiatric interview. Years of education was used as a proxy for SES. Results: There were no significant associations between severity of OSA, SES and current depression, past depression, and suicidality. Past suicidality was noted to be more common among those who were single/widowed (17.4%) or those who were divorced or separated (11.1%) (p=0.027). Current depression was more common among Hispanics in comparison to non-Hispanics. Furthermore, prevalence rates of both depression and past suicidality were higher than previous reports in general populations. Conclusions: Within a cohort of individuals who experienced recent job loss, there was no association between OSA and depression or past suicidality. Prevalence rates of both depression and past suicidality were higher than previous reports in the general population.
... OSAS, defined as repeated episodes of apnoea/hypopnoea during sleep, is a prevalent syndrome affecting 5-10% of the adult population [37]. Continuous positive airway pressure (CPAP) is currently the most effective treatment option to improve breathing disturbances, sleep quality and daytime symptoms [38]. ...
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Once reserved for the fittest, worldwide altitude travel has become increasingly accessible for ageing and less fit people. As a result, more and more individuals with varying degrees of respiratory conditions wish to travel to altitude destinations. Exposure to a hypobaric hypoxic environment at altitude challenges the human body and leads to a series of physiological adaptive mechanisms. These changes, as well as general altitude related risks have been well described in healthy individuals. However, limited data are available on the risks faced by patients with pre-existing lung disease. A comprehensive literature search was conducted. First, we aimed in this review to evaluate health risks of moderate and high terrestrial altitude travel by patients with pre-existing lung disease, including chronic obstructive pulmonary disease, sleep apnoea syndrome, asthma, bullous or cystic lung disease, pulmonary hypertension and interstitial lung disease. Second, we seek to summarise for each underlying lung disease, a personalized pre-travel assessment as well as measures to prevent, monitor and mitigate worsening of underlying respiratory disease during travel.
... It affects approximately 4% to 5% of all middle-aged men. 1 Untreated OSA is strongly associated with an increase of hypertension, coronary artery disease, myocardial infarction, stroke and even sudden death. [2][3][4][5][6][7] Previous studies have shown a relationship between OSA and nocturia and polyuria, which are related to lower urinary tract symptoms (LUTS). ...
Article
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Objective: To determine the presence of lower urinary tract symptoms (LUTS), and overactive bladder (OAB) symptoms in men with obstructive sleep apnea/hypopnea syndrome (OSA) and the effects of transoral robotic surgery (TORS) for the treatment of OSA on these conditions. Materials and methods: One hundred twenty-three patients with a diagnosis of OSA were prospectively enrolled. The evaluations of LUTS and OAB symptoms were based on self-administered questionnaires containing international prostate symptom score (IPSS) and OAB symptom score (OABSS), respectively. Men with an OABSS urgency score of ≥2 and sum score of ≥3 were considered to have OAB. The therapeutic outcomes were assessed at baseline, and 12 weeks after TORS-OSA Surgery. Results: There were significant differences in IPSS, and OABSS according to OSA severity. After TORS-OSA surgery, significant improvements on OSA severity, daytime quality of life (QoL) and nighttime sleep quality were observed. TORS-OSA surgery was also associated with a statistically significant improvement of LUTS, LUTS QoL score, and OAB symptoms (IPSS 22.1% decrease; IPSS QoL score 21.1% decrease; OABSS17.4% decrease) at post-operative 3 months' follow-up. The presence of OAB, and severe nocturia was significantly reduced from 22.8% to 11.4% (p=0.001), 5.7% to 0.8% (p=0.031) after TORS-OSA surgery. There were no patients who had acute airway compromise or massive bleeding peri- or post-operatively. Conclusion: TORS upper airway surgery could improve LUTS and OAB symptoms on male patients with OSA in addition to improvement of major parameters of sleep study and sleep-related QoL.
... Excessive daytime sleepiness is a common symptom in patients with OSA. OSA is associated with sleep fragmentation, insomnia, intermittent hypoxia, insulin resistance, hypertension, dyslipidemia, metabolic syndrome and cardiovascular consequences [1][2][3][4][5] . Metabolic syndrome consists of metabolic risk factors including central obesity, hypertension, hyperglycemia, and dyslipidemia [6][7][8] . ...
Article
Objective: Several studies confirmed a positive association between obstructive sleep apnea (OSA) and metabolic syndrome. Continuous positive airway pressure (CPAP) is the main treatment for patients with moderate and severe OSA. CPAP therapy in adults with OSA results in reduction in sleepiness, blood pressure and improvement of metabolic profile. In this study, we aimed to evaluate the effects of CPAP therapy on various components of metabolic syndrome and subjective sleep parameters in patients with OSA. Material and Methods: In this prospective trial study, 28 patients with moderate and severe OSA enrolled. Patients were asked to fill out the validated Persian version of questionnaires including Epworth sleepiness scale, insomnia severity index, STOP-BANG and Beck depression inventory - II, before and after treatment with CPAP. Weight and blood pressure were recorded before and after treatment. Only 14 patients agreed to blood sampling before and after CPAP therapy (at least 3 months of treatment). Fasting blood samples were analyzed for measuring the levels of FBS (fasting blood sugar), TG (triglyceride), total cholesterol, HDL, LDL, AST, and ALT. Results: Diastolic blood pressure, ISI and STOP-BANG score significantly decreased after treatment (p-value: 0.008, 0.022 and 0.004, respectively). FBS and TG levels decreased after treatment, but only TG levels had significant difference (p-value: 0.46 and 0.016, respectively). Discussion: CPAP therapy had positive effects on diastolic blood pressure, TG levels and ISI score. More studies with larger sample size and longer follow-up periods are warranted to investigate the effects of CPAP therapy on blood pressure, and metabolic parameters.
... Die Prävalenz von SBAS scheint mit dem Alter zuzunehmen, die Stärke der SBAS mit zunehmendem Alter jedoch abzunehmen (16,17,22,23 ...
... Obstructive sleep apnea (OSA) is a common breathing disorder characterized by repetitive narrowing or occlusion of the upper airway during sleep. 1 Impairment in the anatomical components of the upper airway (eg, a narrow/collapsible pharynx) and other physiological traits/endotypes, such as respiratory control stability/loop gain, the respiratory arousal threshold, and upper airway muscle function, play a major role in mediating the propensity for OSA. 2 Impaired upper airway muscle function or elevated loop gain, via destabilization of upper airway patency and breathing, are estimated to be key pathogenic contributors for more than half of all OSA patients. 2 Current treatments however, such as continuous positive airway pressure (CPAP), mandibular advancement devices, and surgery, primarily target the anatomical endotype, with variable efficacy, compliance and patient outcomes. ...
Article
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Rationale: There are widespread histaminergic projections throughout the brain, including hypoglossal nuclei, that modulate pharyngeal muscle tone and respiratory control. Hence, histaminergic stimulation pharmacologically may increase pharyngeal muscle tone and stabilize respiratory control (loop gain) to reduce obstructive sleep apnea (OSA) severity. Antimuscarinics also increase REM pharyngeal muscle tone in rats. Thus, a combination of histaminergic and anti-muscarinic drugs may be a novel target for OSA pharmacotherapy. However, this has not been investigated. Accordingly, we aimed to test the effects of betahistine (Beta), an H3-autoreceptor antagonist which thereby increases histamine levels, in combination with the antimuscarinic oxybutynin (Oxy), on OSA severity, OSA endotypes, polysomnography parameters and next-day sleepiness and alertness. Methods: Thirteen adults with OSA received either Beta-Oxy (96-5mg) or placebo according to a randomized, crossover, double-blind design, prior to polysomnography. Participants completed the Karolinska Sleep Scale and Leeds Sleep Evaluation Questionnaire and a driving simulation task to quantify next-day sleepiness and alertness. OSA endotypes were estimated through validated algorithms using polysomnography. Results: Compared to placebo, Beta-Oxy increased respiratory control sensitivity (loop gain) (0.52[0.24] vs 0.60[0.34], median [IQR], P = 0.021) without systematically changing OSA severity (34.4±17.2 vs 40.3±27.3 events/h, mean±SD, P = 0.124), sleep efficiency, arousal index or markers of hypoxemia. Beta-Oxy was well tolerated and did not worsen next-day sleepiness/alertness. Conclusion: Rather than stabilize breathing during sleep, Beta-Oxy increases loop gain, which is likely to be deleterious for most people with OSA. However, in certain conditions characterized by blunted respiratory control (eg, obesity hypoventilation syndrome), interventions to increase loop gain may be beneficial.
... Therefore, OSAHS may increase the risk for coronary heart disease, which, in turn, may further aggravate OSAHS. Male sex is one of the risk factors for coronary heart disease and OSAHS [13]. The results of the present study also support an association between the male sex and the risk for coronary heart disease and OSAHS. ...
Article
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Purpose To investigate the prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and analyze the effects of OSAHS on the incidence of post-OPCABG complications, length of stay in intensive care unit (ICU) and hospitalization, and hospital expense. Materials and methods This prospective study included patients undergoing OPCABG at Beijing An Zhen hospital from January 2018 to December 2018. OSAHS was diagnosed by using a portable sleep monitor before surgery. Results Among 74 patients, the prevalence of OSAHS and moderate to severe OSAHS (apnea hypopnea index (AHI) ≥ 15) was 70% and 53%, respectively. Compared with the no to mild OSAHS group (AHI < 15), the moderate to severe OSAHS group presented a lower ejection fraction (P = 0.013). Between these two groups, the incidence of post-OPCABG complications; the duration of intubation, ICU stay, and hospitalization; and the hospital expense did not differ. Notably, the ejection fraction was significantly negatively correlated with the duration of ICU stay and hospital expense. Conclusions Patients undergoing OPCABG with severe OSAHS are likely to exhibit a low ejection fraction and poor heart function, which may require a longer ICU stay and incur higher hospital expenses.
... Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most frequent in the SBD group, characterized by frequent episodes of upper airway obstruction during sleep causing repetitive arousals and sleep disruption [3]. ...
Article
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Background Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two frequent coincident sleep disorders. The association of PLMS with OSAS severity and predictors of PLMS in OSAS patients were investigated. Material and method This is a retrospective study that enrolled adult patients ≥ 16 years old who visited the sleep unit at Mouwasat Hospital, Saudi Arabia, between January 2021 and October 2021. All were subjected to full medical history, clinical examination, Epworth Sleepiness (ESS), STOP-Bang questionnaires, and standard overnight polysomnography. Subjects were subdivided into two groups based on PSG findings: group I, OSA patients (153). Patients were classified into mild n = 57 (AHI ≥ 5 and < 15), moderate n = 35 (AHI ≥ 15 and < 30), and severe n = 61 (AHI ≥ 30). Group II, control group included 100 subjects. Result There was a higher frequency of PLMS in OSA patients vs control group (with a statistically significant value). The study showed a statistically significantly positive correlation between PLMI and each of AHI, hypopnea index, desaturation index, and PLMs with arousal index, in contrast; it had a statistically significantly negative correlation with BMI among the OSA group. By performing multivariate logistic regression to predict the possible factors associated with the existence of PLMS among the OSA group, it was showed that the apnea index and desaturation index were statistically significant predictors. Conclusion The present study showed that OSA patients with PLM were older; had greater AHI, hypopnea index, desaturation index, and PLMs with arousal index; and had lower BMI. Further studies are needed for better understanding this complex relationship.
... OSA is a serious respiratory sleep disorder that is associated with systemic and cardiovascular, respiratory, and neurological dysfunction [1]. The condition is diagnosed with repetition in full or partial episodes of collapsing of the upper airway while sleeping, resulting in reduced airflow. ...
Article
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Objective: Obstructive Sleep Apnea (OSA) is a heterogeneous disorder with a complex interplay of genetic and environmental factors. Over the years, with advancement in genotyping and sequencing techniques, various loci have shown an association with OSA. It is pertinent to understand the status of these associated variants in different ethnic groups. The aim of the study was to assess the genetic affinity among different population groups by evaluating the risk allele frequencies of variants associated with OSA. Method: The variants associated with OSA were obtained from the GWAS catalog with a significant p value of <5 × 10-7; 95 variants were obtained (www.ebi.ac.uk/gwas). Further, the variants were narrowed down on the basis of risk allele frequencies (>5%). The fst was calculated to assess the genetic affinity between super population groups and among the sub-population groups present in the 1000 genome project. Result: The fst values observed indicated all super populations were genetically related (SAS, AMR, EAS and EUR) except in the African (AFR) population group. Further, the closely related super population i.e., SAS, AMR, EAS and EUR when bifurcated on the basis of sub-population groups shows population stratification and SAS population groups form separate clusters on the MDS plot. Conclusion: The study highlights genetic heterogeneity among different population groups that gets diluted and results are biased when the samples are pooled irrespective of their endogamous groups. Our results provide insight to researchers to target specific endogamous groups for future studies on OSA.
... Obstructive sleep apnea (OSA) is characterized by intermittent obstruction of the upper airway and recurrent episodes of apnea and hypopnea during sleep [1][2][3]. OSA is associated with obesity and abnormal maxillofacial morphology, such as micrognathia and mandibular recession [4]. Its symptoms include snoring, frequent urination at night, (BMI) < 25.0, (2) Epworth Sleepiness Scale score < 11, (3) regular nighttime sleep, and (4) adequate dentition to support the OA. ...
Article
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This study aimed to analyze the efficacy of maxillary oral appliance (MOA) designs on respiratory variables during sleep. At baseline, 23 participants underwent a sleep test with a portable device for two nights and were categorized as participants with mild obstructive sleep apnea (mild-OSA) (n = 13) and without OSA (w/o-OSA) (n = 10). Three types of MOAs, standard-OA (S-OA), palatal covering-OA (PC-OA), and vertically increasing-OA (VI-OA), were each worn for three nights, and sleep tests with each MOA were performed with a portable device for two nights. Based on the average of the respiratory event index (REI) values for the two nights for each MOA, w/o-OSA participants with an REI ≥ 5.0 were defined as the exacerbation group and those with an REI < 5.0 as the non-exacerbation group. In mild-OSA participants, an REI ≥ 15.0 or REI ≥ baseline REI × 1.5 were defined as the exacerbation group and those with an REI < 15.0 and REI < baseline REI × 1.5 were defined as the non-exacerbation group. The percentage of the exacerbation and non-exacerbation groups with MOA was evaluated in the w/o-OSA and mild-OSA participants. The maxillary and mandibular dental-arch dimension was compared by dentition model analysis. The exacerbation group in w/o-OSA participants (n = 10) comprised 10.0% participants (n = 1) with S-OA, 40.0% (n = 4) with PC-OA, and 30.0% (n = 3) with VI-OA. The exacerbation group in the mild-OSA participants (n = 13) comprised 15.4% subjects (n = 2) with S-OA, 23.1% (n = 3) with PC-OA, and 23.1% (n = 3) in VI-OA. In the model analysis for w/o-OSA, the posterior dental arch width was significantly greater in the exacerbation group than in the non-exacerbation group wearing S-OA (p < 0.05). In addition, the ratio of the maxillary to mandibular dental arch width (anterior dental arch width) was significantly greater in the exacerbation group than in the non-exacerbation group for both PC-OA and VI-OA (p < 0.05). In mild-OSA, the maxillary and mandibular dental arch lengths and the ratio of maxillary to mandibular dental arch width (posterior dental arch width) were significantly smaller in the exacerbation group than in the non-exacerbation group for S-OA (p < 0.05). This study confirmed that wearing an MOA by w/o-OSA and mild-OSA participants may increase the REI during sleep and that PC-OA and VI-OA may increase the REI more than S-OA. The maxillary and mandibular dental-arch dimensions may affect the REI when using an MOA.
... It is also necessary to highlight that several aspects can influence the evaluated outcomes, such as the health conditions and other characteristics of the patients. The risk factors for OSA include obesity [25], age ≥ 40 years [26], and male sex [27]. Among these factors, obesity has a direct relationship with the oropharyngeal region. ...
Article
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Objective To assess whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with obstructive sleep apnea (OSA). Materials and methods A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to determine whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with OSA. An electronic search was performed in four databases, PubMed/MEDLINE, Cochrane Library, Web of Science, and SCOPUS, and in the gray literature (TRIALS) until November 2021. This review included clinical trials, randomized clinical trials, and studies in which patients using conventional complete dentures were diagnosed with OSA using polysomnography and the cardiorespiratory parameters were measured using oximetry or polysomnography during sleep. Results In total, 788 references were found in the database, and 12 articles were selected for full reading. Six articles were selected for qualitative and quantitative analyses after applying the inclusion and exclusion criteria and reading the full article. The meta-analysis showed that mean oxygen saturation (SpO2) increased with the use of complete dentures (p = 0.001), but the other parameters showed no significant differences between those wearing and not wearing dentures during sleep. Conclusions The mean SpO2 reduced in patients wearing complete dentures, but the other cardiorespiratory parameters evaluated were not affected. Clinical relevance This study indicates a possible influence of the use of complete dentures on the mean SpO2 during sleep. The use of complete denture could aid other treatments in improving respiratory and sleep quality.
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Objectives Obstructive sleep apnoea (OSA) is often linked to cardiovascular disease. A limited number of studies have reported an association between OSA and left ventricular diastolic dysfunction (LVDD). However, prior studies were performed on small patient populations. Studies have shown a high prevalence of OSA among first responders to the 9/11 World Trade Center (WTC) terrorist attack. We investigated the relationship between OSA and LVDD in a large population of WTC responders. Design Cross-sectional study. Setting One-time screening programme as part of the WTC-CHEST Study ( NCT10466218 ), performed at a quaternary medical centre in New York City, from November 2011 to June 2014. Participants A total of 1007 participants with mean age of 51 years of mostly non-Hispanic white men were evaluated. Patients from the WTC Health Program-Clinical Center of Excellence, who were over the age of 39 years, were eligible to participate. Results Evaluation of those without OSA diagnosis showed no significant association with LVDD when comparing those screened (Berlin Questionnaire) as OSA high risk versus OSA low risk (p=0.101). Among those diagnosed with LVDD, there was a significant association when comparing those with and without patient-reported OSA (OR 1.50, 95% CI 1.13 to 2.00, p=0.005), but the significance was not maintained after adjusting for pertinent variables (OR 1.3, 0.94 to 1.75, p=0.119). Notably, comparing those with OSA diagnosis and those low risk of OSA, the OR for LVDD was significant (1.69, 1.24 to 2.31, p=0.001), and after adjusting for waist–hip ratio, diabetes and coronary artery calcium score percentile, the relationship remained significant (OR 1.45, 1.03 to 2.04, p=0.032). Conclusion The strong association of OSA with LVDD in this population may inform future guidelines to recommend screening for LVDD in high-risk asymptomatic patients with OSA.
Article
This study was conducted to determine the efficacy of a customized mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). Eight patients (M = 3; F = 5; mean age = 56.3 ± 9.4) with a diagnosis of OSA confirmed by polysomnography (PSG) were recruited on the basis of the following inclusion criteria: apnea-hypopnea index (AHI) > 5, age between 18 and 75 years, body mass index (BMI) < 25, and PSG data available at baseline (T0). All were treated with the new NOA® MAD by OrthoApnea (NOA®) for at least 3 months; PSG with NOA in situ was performed after 3 months of treatment (T1). The following parameters were calculated at T0 and T1: AHI, supine AHI, oxygen desaturation index (ODI), percentage of recording time spent with oxygen saturation <90% (SpO2 < 90%), and mean oxygen desaturation (MeanSpO2%). Data were submitted for statistical analysis. The baseline values were AHI = 21.33 ± 14.79, supine AHI = 35.64 ± 12.80, ODI = 17.51 ± 13.5, SpO2 < 90% = 7.82 ± 17.08, and MeanSpO2% = 93.45 ± 1.86. Four patients had mild OSA (5 > AHI < 15), one moderate OSA (15 > AHI < 30), and three severe OSA (AHI > 30). After treatment with NOA®, statistically significant improvements in AHI (8.6 ± 4.21) and supine AHI (11.21 ± 7.26) were recorded. OrthoApnea NOA® could be an effective alternative in the treatment of OSA: the device improved the PSG parameters assessed.
Article
To test a diagnostic tool's cost effectiveness, timeliness, and accuracy, one must focus on basic information. Merely examining the end results without regard for operating characteristics creates problems for the practitioner and patient alike. If the tool is capable of diagnosing only some of the patients studied, with the disturbing possibility that patients whose diagnoses are missed will not receive care, the practitioner should look elsewhere for a diagnostic tool that performs with greater accuracy despite the additional cost. As the demand for sleep diagnostic testing increases, accuracy and efficiency of diagnostic modalities becomes increasingly important. An alternative tool to standard attended polysomnography would be desirable but is probably unlikely. The results of missing a diagnosis or of mismanaging a patient with SDB can be serious indeed. The practitioner should thoroughly assess the patient and order the appropriate diagnostic study that will provide information that gives the patient the best opportunity for a desirable outcome. Sleepy patients are counting on practitioners everywhere to help them by using all the tools available. Countless mothers driving with children on the roads with these sleepy individuals are counting on the practitioner as well. Therefore, it behooves everyone who manages or wants to manage patients with SDB to offer uncompromising care to the patient with minimal regard to the health insurance industry's cost-cutting strategies. Dentists are and should be an integral part of the team caring for a patient with SDB. As part of the team, the dentist must know what tests to order and why to order them. As a referrer, whether to an otolaryngologist, allergist, pulmonologist, neurologist, or sleep center, the dentist is critical in the early detection of a prevalent nocturnal breathing problem. Many patients will present with early warning signs before related comorbidities develop that are potentially fatal to the patient and to health care economics. As part of the treatment and management team of the patient with SDB, dentists have the opportunity to intervene on their behalf before the disorder worsens. The proper diagnostic tools, when understood and used, will facilitate patient care, minimize risk, and decrease the long-term costs associated with mismanagement or improper diagnosis.
Article
The relationship between cancers and obstructive sleep apnea (OSA) has been discussed for decades. However, the previous meta-analysis led to opposite conclusions. To further investigate this controversial issue, we performed this systematic review and meta-analysis update. PubMed, Embase, and the Cochrane Library were systematically searched and studies on “cancer and OSA” were all included. Two reviewers independently searched articles, extracted data, and assessed the quality of included studies. Moreover, the overall incidence of cancer and OSA in corresponding populations was calculated. Of the 1434 titles identified, 22 articles involving more than 32.1 million patients were included in this meta-analysis. An overall incidence of OSA positive individuals in cancer was 46 (95%CI, 27–67)%, and the prevalence of cancers in OSA patients reached 1.53 (95%CI, 1.01–2.31) times higher than non-OSA individuals. This meta-analysis indicated that there was a high prevalence of OSA in cancer patients, and individuals with OSA were more likely to develop tumors, and the incidence was related to the severity of OSA.
Chapter
The impact of sleep disorders on society has become a major public health concern. This applies to many aspects, from accidents to health‐related concerns as well as many disease processes. Because of this the importance of sleep is now more important than ever. The pressures and demands of life are a major factor, affecting all ages. The most commonly encountered sleep disorders that the dentist may encounter need to be considered as well as the role of the dentist in addressing these.
Chapter
Positive airway pressure (PAP) therapy, more commonly known as continuous positive airway pressure (CPAP), is considered the primary therapy for a sleep‐related breathing disorder (SRBD). There are also different types of PAP therapy. This can be effective but adherence and compliance is oftentimes an issue. It is important for anyone involved in the management of an SRBD to have a basic understanding of PAP therapy, how it functions and the benefits it offers. Of importance to the dentist is the growing interest in combination therapy utilizing an oral appliance (OA) with PAP therapy.
Article
Introduction Oxidative stress and airway inflammation are important in the pathophysiology of obstructive sleep apnea syndrome (OSAS). We examined the levels of inflammation and oxidative stress parameters in patients without OSAS and grouped as mild, moderate, and severe OSAS according to the apnea-hypopnea index (AHI). In addition, we investigated the changes in these parameters in patients whose airway obstruction was resolved by surgical treatment. Materials and method The groups included 18 patients with an AHI below 5 (group 1), 28 patients with an AHI between 5 and 15 (group 2), 25 patients with an AHI between 15 and 30 (group 3), and 30 patients with an AHI of over 30 (group 4). Blood samples were collected from patients following the induction of anesthesia (1st measurement), after the operation (2nd measurement), on the postoperative 3rd day (3rd measurement), and at the postoperative 2nd month (4th measurement). Arylesterase (ARE), paraoxonase (PON), nitrotyrosine (NT), leukocyte, CRP, and HDL were measured. Results The inter-group comparisons revealed differences in the 3rd measurement of leukocyte count and CRP value, in the 3rd and 4th measurements of HDL ( p < 0.05). No significant difference was observed in the inter-group or intra-group comparisons for ARE, PON, and NT values ( p > 0.05). Conclusion We observed that CRP, HDL PON, ARE, NT levels, and the leukocyte count were not related to the severity of OSAS in patients with OSAS. The difference observed in CRP and leukocyte count may be due to the continuous effect of the inflammatory effect of surgery in the early post-operative period. We thought that the increase in HDL in all groups after the 5th postoperative day was due to the surgical correction of airway obstruction. As a result, we concluded that CRP, HDL, PON, ARE, NT, and leukocyte levels are not markers for OSAS.
Book
Obstructive sleep apnoea (OSA) can be described as repetitive collapse and reopening of the upper airway during sleep, impairing oxygenation and resulting in intermittent hypoxemia and hypercapnia. It occurs due to obstruction caused by collapse of soft tissue structures in the oropharynx or hypopharynx. The diagnosis of OSA is based on the evaluation of clinical symptoms and risk factors, as well as a formal sleep study evaluation. This book compiles the latest approaches in treatment and management of sleep apnea.
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Although snoring is the most common subjective symptom in obstructive sleep apnea (OSA), an international consensus on the definition of snoring is lacking. This study aimed to define snoring by analyzing correlations between snoring parameters and the apnea hypopnea index (AHI). We retrospectively analyzed the polysomnography data of patients with OSA. A snoring event was defined when airflow pressure was > 200 microbar. We included four snoring parameters. Snoring percentage was defined as the cumulative time of snoring events divided by total sleep time. A snoring episode was defined as the occurrence of ≥ 3 consecutive snoring events, and the snoring episode index was defined as the number of snoring episodes per hour. The average and longest durations of snoring episodes were also investigated. The study enrolled 5035 patients. Their mean AHI was 26.5/h and the mean snoring episode index was 19.2/h. Although the four snoring parameters showed significant correlations with the AHI, the snoring episode index showed the strongest positive correlation with the AHI (r = 0.741, P < 0.001). The snoring episode index may be used as a definition of snoring from the perspective of a highly positive correlation with the AHI.
Article
Background: After the publication of the Japanese Circulation Society guideline of sleep-disordered breathing (SDB) in 2010, with new evidence and changes to the health insurance system, trends in the practice pattern for SDB in patients with cardiovascular disease (CVD) might have changed.Methods and Results: This study evaluated the temporal changes in the practice pattern for SDB by using a nationwide claim database, the Japanese Registry of All Cardiac and Vascular Diseases - Diagnosis Procedure Combination (JROAD-DPC), from 2012 to 2019. The main findings were: (1) the number of CVD patients diagnosed with SDB increased (especially those with atrial fibrillation [AF] and heart failure [HF]); (2) the number of diagnostic tests for SDB performed during hospitalization increased for AF patients (from 1.3% in 2012 to 1.8% in 2019), whereas it decreased for other CVD patients; (3) the number of patients diagnosed with SDB increased in each type of CVD, except for patients with acute myocardial infarction (AMI); (4) continuous positive airway pressure (CPAP) treatment increased for AF patients (from 15.2% to 17.5%); (5) CPAP treatment decreased for patients with angina pectoris (AP) and AMI, and any treatment decreased for HF patients (from 46.1% to 39.7%); and (6) SDB was treated more often in HF patients than in AF, AP, and AMI patients (41.7% vs. 17.2%, 19.1% and 20.4%, respectively). Conclusions: The practice pattern for SDB in CVD patients has changed from 2012 to 2019.
Article
Key points: Sex-differences in the control of breathing have been well studied, but whether there are differences in the sympathetic neurocirculatory responses to chemoreflex activation between healthy women and men is incompletely understood. We observed that compared to young men, young women displayed augmented increases in muscle sympathetic nerve activity during both hypercapnic hyperoxia (central chemoreflex activation) and hypercapnic hypoxia (central and peripheral chemoreflex activation) but had attenuated increases in minute ventilation. In contrast, no sex-differences were found in either muscle sympathetic nerve activity or minute ventilation responses to isocapnic hypoxia (peripheral chemoreceptor stimulation). Young women have blunted ventilatory but augmented sympathetic responses to central (hypercapnic hyperoxia) and combined central and peripheral chemoreflex activation (hypercapnic hypoxia), compared to young men. The possible causative association between the reduced ventilation and heightened sympathetic responses in young women awaits validation. Abstract: The purpose of this study was to determine whether there are sex-differences in the cardiorespiratory and sympathetic neurocirculatory responses to central, peripheral, and combined central and peripheral chemoreflex activation. Ten women (29±6 years, 22.8±2.4 kg/m2 : mean±SD) and ten men (30±7 years, 24.8±3.2 kg/m2 ) undertook randomized 5-min breathing trials of: room air (eucapnia), isocapnic hypoxia (10% oxygen [O2 ]; peripheral chemoreflex activation), hypercapnic hyperoxia (7% carbon dioxide [CO2 ], 50% O2 ; central chemoreflex activation) and hypercapnic hypoxia (7% CO2 , 10% O2 ). Control trials of isocapnic hyperoxia (peripheral chemoreflex inhibition) and hypocapnic hyperoxia (central and peripheral chemoreflex inhibition) were also included. Muscle sympathetic nerve activity (MSNA; microneurography), mean arterial pressure (MAP; finger photoplethysmography) and minute ventilation (V̇E ; pneumotachometer) were measured. Total MSNA (P = 1.000 and P = 0.616), MAP (P = 0.265) and V̇E (P = 0.587 and P = 0.472) were not different in men and women during eucapnia and during isocapnic hypoxia. Women exhibited attenuated increases in V̇E during hypercapnic hyperoxia (27.3±6.3 vs. 39.5±7.5 L/min, P < 0.0001) and hypercapnic hypoxia (40.9±9.1 vs. 53.8±13.3 L/min, P < 0.0001) compared to men, however, total MSNA responses were augmented in women (hypercapnic hyperoxia 378±215 vs. 258±107%, P = 0.017; hypercapnic hypoxia 607±290 vs. 362±268%, P < 0.0001). No sex-differences in total MSNA, MAP and V̇E were observed during isocapnic hyperoxia and hypocapnic hyperoxia. Our results indicate that young women have augmented sympathetic responses to central chemoreflex activation, which explains the augmented MSNA response to combined central and peripheral chemoreflex activation. Abstract figure legend The sympathetic neurocirculatory and cardiorespiratory responses to chemoreflex activation were compared in healthy women and men. We show that compared to young men, young women display augmented increases in muscle sympathetic nerve activity during both central chemoreflex activation (hypercapnic hyperoxia) and combined central and peripheral chemoreflex activation (hypercapnic hypoxia) but have attenuated increases in minute ventilation. This article is protected by copyright. All rights reserved.
Chapter
The prediction of the menstrual cycle phase and fertility window by easily measurable bio-signals is an unmet need and such technological development will greatly contribute to women's QoL. Although many studies have reported differences in autonomic indices of heart rate variability (HRV) between follicular and luteal phases, they have not yet reached the level that can predict the menstrual cycle phases. The recent development of wearable sensors-enabled heart rate monitoring during daily life. The long-term heart rate data obtained by them carry plenty of information, and the information that can be extracted by conventional HRV analysis is only a limited part of it. This chapter introduces comprehensive analyses of long-term heart rate data that may be useful for revealing their associations with the menstrual cycle phase.
Chapter
Obstructive sleep apnea (OSA) is a prevalent health condition in which anatomical factors lead to increased upper airway resistance causing repeated episodes of pharyngeal collapse and subsequent arousal from sleep. These apneic episodes result in hypoxemia and sympathetic nervous system activation. In the setting of anesthesia and postoperative analgesia, patients with OSA are at higher risk for increased frequency of disordered breathing events and cardiopulmonary complications. Several anesthesia and sleep societies have proposed guidelines for perioperative management of this patient population; however, the impact of the implementation of these recommended practices remains unclear.
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Obstructive sleep apnea (OSA) is the leading cause of referral to sleep laboratories worldwide, accounting for at least 75–80% of diagnoses. In the last few decades, there have been considerable advances in knowledge regarding the underlying mechanisms, diagnostic approaches, treatment options, and the impact of OSA on personal as well as public health of OSA. The current definitions of sleep apnea are not uniform, but most of them attempt to characterize the frequency of sleep-disordered breathing events (e.g., AHI “Apnea–Hypopnea Index” or RDI “Respiratory Disturbance Index”) along with the severity (e.g., oxygen desaturation) of each event (e.g., complete (apnea) and partial (hypopnea) cessation of breathing during sleep). Newer approaches using wearable technologies and novel analyses using signal processing may help to improve diagnostic and prognostic approaches.
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Obstructive sleep apnea (OSA) is found at all stages of life, in all races, and with all shapes and sizes of people, and can rise to the level of a disorder (OSAHS). Early detection of it improves waketime sleepiness and inattention, quality of life, and a reduction in medical costs. The questions being addressed are how OSA conditions affect morbidity and interact with chronic medical conditions. OSA is a complex disease in which no one feature or genetic set point or biological marker alone sets it apart as a diagnosis. Risk factors and complaints are not causal. It is sleep that precipitates disordered breathing, and added to it are the tendency for the upper airway to close, ventilatory instability with sleep and its stages, and the degree of upper airway muscle activation in sleep or in response to upper airway closure. Besides summarizing the population prevalence of OSA, the chapter examines presentations and recognition of OSA in pathways for several non-sleep outpatient and inpatient populations and considers whether ascertainment or preventative measures to manage OSA might be helpful. The chapter will introduce the epidemiologic data in each setting rather than review all datasets in a disorder in which OSA may contribute to its pathophysiology.
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Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea are frequently associated with polycystic ovary syndrome (PCOS) but remain underrecognized. Women with PCOS have a 2–4 times higher risk of NAFLD independent of body mass index than healthy weight-matched controls. Insulin resistance and hyperandrogenemia together play a central role in the pathogenesis of NAFLD. Timely diagnosis of NAFLD is important because its progression can lead to nonalcoholic steatohepatitis and/or advanced liver fibrosis that can eventually result in liver-related mortality. The presence of NAFLD has also been associated with increased risks of type 2 diabetes, cardiovascular events, overall mortality, and extrahepatic cancers. The treatment of NAFLD in PCOS should include lifestyle interventions. Glucagon-like peptide 1 receptor agonists have shown promising results in patients with PCOS and NAFLD, but future randomized trails are needed to confirm this benefit. Likewise, the use of combined oral estrogen-progestin contraceptives may provide a benefit by decreasing hyperandrogenemia. Sleep disordered breathing is common among women with PCOS and is responsible for a number of cardiometabolic derangements. Obstructive sleep apnea is most often found in overweight and obese women with PCOS, but as is the case with NAFLD, its prevalence exceeds that of women who are of similar weight without PCOS. Left untreated, obstructive sleep apnea can precipitate or exacerbate insulin resistance, glucose intolerance, and hypertension.
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Background and objective: A variety of diseases, including obesity, type ‖ diabetes, and cardiovascular diseases are associated with obstructive sleep apnea syndrome (OSAS), and decreased adiponectin levels have been shown to be associated with an increased risk of these diseases. However, the association of blood levels of adiponectin in OSAS patients is a challenging and unknown issue with conflicting results. Therefore, we performed a systematic review and a meta-analysis to evaluate plasma/serum adiponectin levels in adult patients with OSAS. Materials and methods: A comprehensive search in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) was performed in literature dated older than 12 March 2022, to retrieve the relevant articles. Effect sizes were calculated to show the standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of adiponectin between the OSAS patients and controls. The software RevMan 5.3, NCSS 21.0.2, CMA 2.0, trial sequential analysis (TSA) 0.9.5.10 beta, and GetData Graph Digitizer 2.26 were used for data synthesis in the meta-analysis. Results: A total of 28 articles including 36 studies were entered into the meta-analysis. The results showed that pooled SMD was -0.71 (95% CI: -0.92, 0.50; p < 0.00001; I2 = 79%) for plasma/serum levels of adiponectin in OSAS cases compared to the controls. The subgroup analyses showed that the geographical region and the Apnea-Hypopnea-Index (AHI) could be confounding factors in the pooled analysis of plasma/serum adiponectin levels. The sensitivity analysis showed the stability of the results. The radial and L'Abbé plots confirmed evidence of heterogeneity. Trial sequential analysis showed sufficient cases in the meta-analysis. Conclusions: With sufficient cases and stable results, the main finding of the meta-analysis identified significantly reduced plasma/serum levels of adiponectin in OSAS cases compared with the controls. This result suggests a potential role of adiponectin in the pathogenesis of OSAS.
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We aim to investigate the frequency and type of sleep problems in memory clinic patients with subjective cognitive decline (SCD) and their association with cognition, mental health, brain magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) biomarkers. Three hundred eight subjects (65 ± 8 years, 44% female) were selected from the Subjective Cognitive Impairment Cohort (SCIENCe) project. All subjects answered two sleep questionnaires, Berlin Questionnaire (sleep apnea) and Pittsburgh Sleep Quality Index (sleep quality) and underwent a standardized memory clinic work‐up. One hundred ninety‐eight (64%) subjects reported sleep problems, based on 107 (35%) positive screenings on sleep apnea and 162 (53%) on poor sleep quality. Subjects with sleep problems reported more severe depressive symptoms, more anxiety, and more severe SCD. Cognitive tests, MRI, and CSF biomarkers did not differ between groups. Our results suggest that improvement of sleep quality and behaviors are potential leads for treatment in many subjects with SCD to relieve the experienced cognitive complaints.
Article
Obstructive sleep apnea (OSA) is characterised by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. OSA is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary, and neuropsychiatric, and there is growing evidence of bidirectional relationships between OSA and comorbidity, especially for heart failure, metabolic syndrome, and stroke. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.
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Excessive daytime sleepiness (EDS) is a complaint affecting half of patients with obstructive sleep apnea (OSA) and can persist in some patients despite normalization of breathing, oxygenation, and sleep quality with primary OSA therapy, such as continuous positive airway pressure (CPAP). EDS is often overlooked and underdiscussed in the primary care setting and in the follow-up of CPAP-treated patients due to difficult assessment of such a multidimensional symptom. This review aims to provide suggestions for procedures that can be implemented into routine clinical practice to identify, evaluate, and manage EDS in patients with OSA, including how to appropriately use various self-report and objective assessments along the clinical pathway. In addition, examples of when it is appropriate for a healthcare provider to refer a patient to a sleep specialist for evaluation are discussed. Despite certain limitations of this method, healthcare professionals (HCPs) should screen all patients diagnosed with OSA for EDS with the Epworth Sleepiness Scale. If a patient is suspected of having EDS, it needs to be confirmed that the underlying airway obstruction is being optimally treated with CPAP or another OSA primary treatment. If the patient continues to experience EDS despite adherence to primary OSA therapy, the treating clinician should review the patient in clinic and, when appropriate, using questionnaires, physical exams, laboratory tests, or objective assessments to rule out other potential causes of EDS. After a differential diagnosis of residual EDS has been established, the clinician may consider pharmacologic treatment which may include a wake-promoting agent.
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These are the final results of a survey of sleep-disordered breathing, which examined objective and subjective information from a large randomly selected elderly sample. We randomly selected 427 elderly people aged 65 yr and over in the city of San Diego, California. Twenty-four percent had an apnea index, AI, greater than or equal to 5 and 62% had a respiratory disturbance index, RDI, greater than or equal to 10. Correlates of sleep-disordered breathing included high relative weight and reports of snoring, breathing cessation at night, nocturnal wandering or confusion, daytime sleepiness and depression. Body mass index, falling asleep at inappropriate times, male gender, no alcohol within 2 hr of bedtime and napping were the best predictors of sleep-disordered breathing. Despite statistical significance, all of the associations between interview variables and apnea indices were small. No combination of demographic variables and symptoms allowed highly reliable prediction of AI or RDI.
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Night-to-night variability of breathing and oxygenation during sleep was examined with portable monitoring equipment in 30 residents of a retirement village. Subjects had a variety of health problems as might be expected in the elderly, but all were living independently in self-contained units. None had clinical features to suggest obstructive sleep apnea. Two pairs of consecutive nights were studied, separated by 4-6 months. Satisfactory recordings on all four nights were obtained in 15 subjects, and in these subjects variability of measurements was examined across nights 1-4 using the kappa (K) statistic. There was low but significant agreement in estimated total sleep time (K = 0.23, p less than 0.01) and estimated wakefulness after sleep onset (K = 0.18, p less than 0.05) as assessed with a wrist actigraph. Good agreement was found among measures of disturbed breathing during sleep whether expressed in terms of numbers of events [respiratory disturbance index (RDI), K = 0.62, p less than 0.0001], their duration (event minutes, K = 0.53, p less than 0.0001), or associated disturbance of oxygenation (% cumulative time less than 90% SaO2, K = 0.50, p less than 0.001, n = 9). Twenty-eight subjects had at least two nights' satisfactory recordings. Although some of these individuals showed considerable variation in RDI, this had little overall effect on classification of them into normal (RDI less than or equal to 15) and abnormal groups. The accuracy of the first night's recording in predicting classification derived from recording on three or four nights was 83%.(ABSTRACT TRUNCATED AT 250 WORDS)
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A simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography. These two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome (OSAS). A static charge sensitive bed (SCSB) was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements. Periods of obstructive apneas gave a diamond-shaped periodic respiration movement pattern in the SCSB, usually accompanied by repetitive oxygen desaturations. The average number of desaturations greater than or equal to 4 percent per sleeping hour was termed the oxygen desaturation index (ODI) and compared with the apnea index (AI). In the whole population they were well correlated (p less than 0.0001, R2 = 0.41), but in individual cases there were considerable discrepancies. Patients with periodic respiration movements less than 18 percent of total sleeping time and ODI less than 2 never had AI greater than or equal to 5, whereas patients with periodic respiration greater than 45 percent and ODI greater than 6 always had AI greater than or equal to 5. Fifty-one of the 77 patients fulfilled these criteria. A bradycardia response to apneas was absent in 29 percent of patients with AI greater than or equal to 5. A combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of OSAS in a majority of patients with clinical symptoms. In borderline patients, further investigations should be performed.
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To characterise the relation between pharyngeal anatomy and sleep related disordered breathing, 17 men with complaints of snoring were studied by all night polysomnography. Ten of them had obstructive sleep apnoea (mean (SD) apnoea-hypopnoea index 56.3 (41.7), age 52 (10) years, body mass index 31.4 (5.3) kg/m2); whereas seven were simple snorers (apnoea-hypopnoea index 6.7 (4.6), age 40 (17) years, body mass index 25.9 (4.3) kg/m2). The pharynx was studied by magnetic resonance imaging in all patients and in a group of eight healthy subjects (age 27 (6) years, body mass index 21.8 (2.2) kg/m2, both significantly lower than in the patients; p less than 0.05). On the midsagittal section and six transverse sections equally spaced between the nasopharynx and the hypopharynx several anatomical measurements were performed. Results showed that there was no difference between groups in most magnetic resonance imaging measurements, but that on transverse sections the pharyngeal cross section had an elliptic shape with the long axis oriented in the coronal plane in normal subjects, whereas in apnoeic and snoring patients the pharynx was circular or had an elliptic shape but with the long axis oriented in the sagittal plane. It is suggested that the change in pharyngeal cross sectional shape, secondary to a reduction in pharyngeal transverse diameter, may be related to the risk of developing sleep related disordered breathing.
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The generally accepted polysomnographic criteria for diagnosis of sleep apnea is exceeded by elderly subjects with such frequency that the validity of its application to this age group has been questioned. We studied a group of elderly volunteers with nocturnal polysomnography and partitioned them into 2 groups based upon an apnea index of greater than or less than 5 per hour. The results of a protocol evaluating the presence of potential complications of sleep apnea including cardiac arrhythmias, systemic hypertension, cor pulmonale, daytime sleepiness, and cognitive impairment were compared for the 2 groups. No excess incidence of cardiovascular complications was found. Although an increase in daytime sleep tendency was shown for the group with more frequent apneas, no appreciable deficits in cognitive performance were demonstrated. Although apnea during sleep in the elderly may be associated with an increase in daytime sleepiness, it may not necessarily result in other physiologic or neuropsychologic consequences. Therapeutic intervention for these abnormalities should be carefully considered prior to the institution of treatment in light of these observations.
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Recent reports have suggested that flow volume curve abnormalities may be of interest in the diagnosis of obstructive sleep apnea syndromes by showing either extrathoracic airway obstruction (ratio of expiratory flow to inspiratory flow at 50 percent of forced vital capacity [FEF50/FIF50] exceeding 1) or upper airway fluttering (indicated by a sawtooth aspect on the mid-half of the inspiratory part of the curve) or both. In our study, 57 patients referred for a suspected sleep apnea syndrome (SAS) underwent conventional spirometry, assessment of flow-volume curves, ENT examination, and polysomnography. Thirty patients had an obstructive SAS, four patients a central SAS, and 23 patients no SAS. Signs of upper airway fluttering (the sawtooth sign) were present in 61 percent of the patients with obstructive SAS and in 46 percent of the patients without obstructive SAS (central SAS or no SAS). Signs of extrathoracic upper airway obstruction (FEF50/FIF50 greater than 1) were present in 67 percent of the patients with obstructive SAS and in 71 percent of the patients without obstructive SAS. These results suggest that upper airway abnormalities, as reflected by abnormal flow volume curves, are not always associated with obstructive SAS; they favor the hypothesis of a central component in the mechanism of upper airway occlusion during sleep.
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Five patients with severe obstructive sleep apnoea were treated with continuous positive airway pressure (CPAP) applied via a comfortable nose mask through the nares. Low levels of pressure (range 4.5-10 cm H2O) completely prevented upper airway occlusion during sleep in each patient and allowed an entire night of uninterrupted sleep. Continuous positive airway pressure applied in this manner provides a pneumatic splint for the nasopharyngeal airway and is a safe, simple treatment for the obstructive sleep apnoea syndrome.
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We evaluated the effect of posture on the sensitivity and specificity of abnormalities in the flow-volume loop in 30 patients with suspected obstructive sleep apnoea. Flow-volume loops were judged as abnormal if the FEF50/FIF50 ratio was greater than 1 or if the sawtooth sign was judged to be present by at least two of three chest physicians. Detailed nocturnal recordings confirmed the presence of obstructive sleep apnoea in 17 of the 30 patients. Our results showed that both the sensitivity and the specificity of each of the flow-volume criteria for the diagnosis of obstructive sleep apnoea were higher when the loops were recorded in the supine than when they were recorded in the sitting position. The sensitivities were low, however, even with the supine posture--sawtoothing 41% and FEF50/FIF50 ratio greater than 1 47%. The highest sensitivity (71%) was obtained by considering a positive result as being the presence of either of the abnormalities in either the sitting or the supine posture. This sensitivity of the flow-volume loop was too low to recommend it as a routine screening test for the diagnosis of obstructive sleep apnoea but the presence of the sawtooth sign had a high specificity (92%) for the diagnosis of obstructive sleep apnoea. Furthermore, there was a greater fall in oxygen saturation in patients with apnoea who had sawtoothing than in those without sawtoothing. The presence of the sawtooth sign should increase the suspicion of sleep apnoea and suggest the need for further investigation. The effect of posture on the occurrence of abnormalities in the flow-volume loop suggests that position alters the configuration of the upper airway.
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Questionnaire data from patients presenting at three sleep disorders centers were used to develop and assess a screening tool for sleep apnea based on the reporting of the frequency of various symptoms of sleep apnea and other sleep disorders plus age, body mass index (BMI) and gender. Patients were not specifically referred for suspicion of sleep apnea. Separate factor analyses of survey responses from 658, 193 and 77 respondents from the first, second and third sites, respectively, each yielded four orthogonal factors, one of which accounted for all the questions concerned with the frequency of disordered breathing during sleep. The survey was shown to be reliable in a subset of patients from one of the sites (test-retest correlation = 0.92). Survey data were then compared to a clinical measure of sleep apnea (respiratory disturbance index) obtained from polysomnography. A multivariable apnea risk index including survey responses, age, gender and BMI was estimated using multiple logistic regression in a total sample of 427 respondents from two of the sites. Predictive ability was assessed using receiver operating characteristic (ROC) curves. The area under the ROC curve was 0.79 (p < 0.0001). For BMI alone, it was 0.73, and for an index measuring the self-report of the frequency of apnea symptoms, it was 0.70. The multivariable apnea risk index has potential utility in clinical settings.
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Conventional polysomnography (CPS) is a complex, costly procedure that is not widely available, meaning that it is difficult to apply it in patients suspected of having obstructive sleep apnea syndrome (OSAS). Various procedures have therefore been proposed for screening candidates for CPS. We studied the usefulness of visual analysis of nocturnal oximetry in 96 patients suspected of having OSAS. The OSAS diagnosis was confirmed by CPS in 67 (69.8%). Oximetry was positive in 70 cases. Sixty-one patients were positive by both oximetry and CPS, while 9 and positive oximetry results and a negative CPS. We conclude that nocturnal oximetry has a 91% sensitivity and 69% specificity for OSAS, with a positive predictive value of 87% and a negative predictive value of 77%. We believe that nocturnal oximetry may be a useful way of screening for OSAS, in order to decrease the number of CPS performed on patients without the disease.
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Many laboratories have large numbers of patients with suspected obstructive sleep apnea (OSA) waiting to be tested. We assessed the use of simple clinical data to detect those patients with an apnea index <20 (low AI) who could be studied less emergently. Using questionnaires completed by patients prior to evaluation, we collected data on 354 consecutive patients (281 males, 73 females; mean age 48.6 years) referred for OSA and assessed with polysomnography (PSG). The questionnaires included the Epworth sleepiness scale (ESS), height, weight, age, and a history of observed apnea. Analysis of receiver operating characteristics curves revealed that both body mass index (BMI) [area under curve = 0.7258, standard error (SE) = 0.03, p < 0.01] and ESS (area under curve = 0.5581, SE = 0.03, p = 0.03) were significantly better than chance alone in detecting people with AI < 20. ESS ≤ 12 was found in 37.9% of the subjects but 39.6% of those expected to have a low AI using ESS had an AI ≥20. À BMI ≤ 28 was found in 24.9% of the subjects; 14.8% of those expected to have a low AI using BMI had an AI ≥20. Combining these variables improved accuracy but resulted in smaller groups; a cut-off of ESS ≤12 and BMI ≤28 resulted in a group of 33 (9.3% of subjects), only two (6%) of whom were falsely called low AI. Adding to this the fact that apnea had not been observed resulted in a group of nine patients (2.5% of subjects), none of whom had an AI ≥20. Thus there is a tradeoff; the more variables used, the greater the accuracy but the smaller the percent of cases selected to have low AI. However, in laboratories with hundreds of patients waiting to be tested, any procedure better than chance to help prioritize patients seems worthwhile.
Article
Many studies have documented significant craniomandibular abnormalities in obstructive sleep apnea syndrome (OSAS) patients. Recent literature clearly describes the cephalometric abnormalities commonly associated with OSAS. Studies have not evaluated specific cephalometric abnormalities that may contribute to OSAS by various ethnic groups. Data were collected on 48 patients (20 Caucasian, 15 Black and 13 Hispanic) with completed cephalometric analysis and polysomnography. Cephalometric landmarks, angles and measurements [angle measured from sella to nasion to subspinale point (SNA), angle measured from sella to nasion to supramentale point (SNB), difference between SNA and SNB (ANB), perpendicular distance from gonion to gnathion to hyoid (MP-H), distance from posterior nasal spine to tip of soft palate (PNS-P) and posterior airway space (PAS)] commonly used in the evaluation of OSAS patients were recorded. Measurements were normalized by dividing the observed value by the mean value for the ethnic group. Statistically significant differences in normalized SNA and SNB appeared in the Black and Hispanic groups when compared to the Caucasian group. For both SNA and SNB, Blacks averaged approximately 3.5% above their ethnic mean, whereas Hispanics averaged 1.8–2.8% below their ethnic mean. There was a statistically significant correlation between respiratory distress index (RDI) and MP-H. These baseline cephalometric differences in the ethnic groups studied suggest that surgical intervention might be approached differently in various ethnic groups. Further studies that evaluate the surgical success achieved by various procedures among different ethnic groups may help define surgical protocol in various ethnic groups for OSAS.
Article
BACKGROUND There is considerable debate regarding the relationship between obstructive sleep apnoea (OSA) and hypertension. It is unclear whether OSA is an independent vascular risk factor as studies attempting to assess this association have produced conflicting results because of confounding variables such as upper body obesity, alcohol, and smoking. A case-control study of 24 hour ambulatory blood pressure was undertaken in patients with OSA and matched controls to assess whether OSA is an independent correlate of diurnal hypertension. METHODS Forty five patients with moderate to severe OSA and excessive daytime sleepiness were matched with 45 controls without OSA in a sleep study. Matched variables included age, body mass index (BMI), alcohol, cigarette usage, treated hypertension, and ischaemic heart disease. Upper body obesity was compared by waist:hip and waist:height ratios; 24 hour ambulatory blood pressure recordings were performed (before treatment for OSA) in all subjects. RESULTS Patients with OSA had significantly increased mean (SD) diastolic blood pressure (mm Hg) during both daytime (87.4 (10.2) versus 82.8 (9.1); p=0.03, mean difference 4.6 (95% CI 0.7 to 8.6) and night time (78.6 (9.3) versus 71.4 (8.0); p<0.001, mean difference 7.2 (95% CI 3.7 to 10.6)), and higher systolic blood pressure at night (119.4 (20.7) versus 110.2 (13.9); p=0.01, mean difference 9.2 (95% CI 2.3 to 16.1)). The nocturnal reduction in blood pressure (“dipping”) was smaller in patients with OSA than in control subjects. CONCLUSIONS Compared with closely matched control subjects, patients with OSA have increased ambulatory diastolic blood pressure during both day and night, and increased systolic blood pressure at night. The magnitude of these differences is sufficient to carry an increased risk of cardiovascular morbidity. The slight excess of upper body fat deposition in the controls may make these results conservative.
Article
Verschiedene Faktoren sind dafür verantwortlich, dass die Diagnose des obstruktiven Schlafapnoe-Hypopnoe-Syndroms (OSAHS) bei Frauen seltener als bei Männern gestellt wird: neben einer unterschiedlichen Prävalenz des OSAHS zeigen sich insbesondere geschlechtsspezifische Unterschiede der Anatomie und Funktion der oberen Atemwege, der Körperfettverteilung sowie der respiratorischen Kontrollmechanismen. Diese Unterschiede prädisponieren Männer für die Entwicklung des OSAHS. Ein wesentlicher Grund für die im Vergleich zu Männern spätere Diagnosestellung des OSAHS bei Frauen ist die geschlechtsspezifische Anamnese bei Frauen, die eher für eine Insomnie spricht. Das OSAHS betrifft nicht nur postmenopausale Frauen, sondern es erlangt eine zunehmende Bedeutung bei Frauen mit Übergewicht und kraniofazialen Dysmorphien. Several factors are responsible for the underdiagnosis of obstructive sleep-apnea-hypopnea-syndrome (OSAHS) in women. Apart from different prevalences there are profound gender-specific differences as far as anatomy and function of the upper airways, body fat distribution, and respiratory control mechanisms are concerned. These differences predispose men rather than women to develop OSAHS. An important reason for a delayed diagnosis of OSAHS in women is the gender-specific anamnesis which is more typical of insomnia in women. OSAHS does not only affect postmenopausal women, but it plays an increasing role especially in women with obesitas or craniofacial malformation.
Article
A positive diagnosis of obstructive sleep apnoea (OSA) is based on a combination of characteristic symptoms and polysomnographic findings. The present study evaluated the specificity and sensitivity of several risk factors, signs and symptoms in predicting an Apnoea Index in 86 patients referred to the sleep laboratory with suspected OSA. All 86 subjects completed a detailed questionnaire, were interviewed, underwent a brief physical examination, and then a whole-night polysomnographic study. Stepwise multiple regression analysis revealed that self reporting on apnoeas, neck circumference index (NCI), age, and a tendency to fall asleep unintentionally, were all significant positive predictors of apnoea index (AI), explaining 41.8% of the variability. The sensitivity of the model for predicting OSA (taking OSA as AI > 10) was 92.2%, specificity was 18.2% and the positive predictive value was 76.6%. Raising the cut-off AI values resulted in decreased sensitivity and increased specificity. Applying the predicting equation of AI to another group of 50 patients referred to the sleep laboratory with suspected OSA revealed similar results. However, running the equation on 105 offspring of OSA patients who did not complain of OSA-associated symptoms resulted in 32% sensitivity and 94% specificity in predicting OSA. It is concluded that questionnaires, interviews and physical examination, can only vaguely predict AI, and cannot replace polysomnographic recordings. However, the low rates of false negative in predicting AI > 10, and the low rates of false positive in predicting AI > 50, can be used for specific purposes.
Article
Polysomnography is used increasingly to investigate patients with possible sleep apnoea/hypopnoea syndrome (SAHS), but it has not been assessed critically. We thus examined prospectively the value of electrophysiological and respiratory monitoring in 200 consecutive adults (163 men, 37 women; mean [SD] age 50 [13] years) having polysomnography. At polysomnography, 91 patients had SAHS (greater than 15 apnoeas + hypopnoeas [A + H] per h asleep) and 11 had periodic limb-movement disorder. Recording sleep electrophysiologically was of no diagnostic value and SAHS could be as accurately defined by A + H per time in bed as by A + H per time asleep. 66% of patients with SAHS could be diagnosed with oximetry alone, but many of the undiagnosed patients had moderately severe SAHS and benefited from treatment. Neurophysiological sleep recording is unnecessary and oximetry alone is of limited value in the overnight investigation of patients suspected of having SAHS.
We hypothesized that sleep-disordered breathing (SDB), defined by the apnea index (AI), the apnea + hypopnea index (A + H/I), or the desaturation event frequency (number of desaturations greater than 5%/h slept) (DEF), could be diagnosed after less than full-night polysomnography (PSG). Forty-eight consecutive full-night PSG sessions were evaluated by separately analyzing the first half (PSG-1/2) and the total (PSG-T) sleep time: 134.42 +/- 35.7 and 277.15 +/- 56.5 min (mean +/- SD), respectively. PSG-1/2 and PSG-T were not different with respect to AI. The DEF was statistically but not clinically higher during PSG-1/2 (41.72 +/- 41 versus 37.95 +/- 35.8, p = 0.04). Sensitivities, specificities, and predictive values of each PSG-1/2 parameter were determined by comparing the values with those measured during PSG-T, using cutoff frequencies of both 5 and 10 events/h slept to define SDB. At a cutoff frequency of 10, sensitivities and positive predictive values were high for all PSG-1/2 parameters (range, 94.6 to 96.9%). The specificities of the DEF and AI during PSG-1/2 were also high (93.75 and 95%, respectively), but the negative predictive value of the DEF was substantially better (93.75 versus 83.3%). With SDB defined by 5 events/h slept, there also were high sensitivities (87.9 to 93%), positive predictive values (93.6 to 100%), and specificities (86.7 to 100%) for all parameters. Negative predictive values, however, were substantially reduced (62.5 to 76.5%). We conclude that PSG during 2 h of sleep is an appropriate method for evaluating SDB.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The role of single night studies and the determinants of effective nasal continuous positive airway (CPAP) pressures were determined in 412 consecutive patients between 1984 and 1989. Patients chosen for analysis had an apnea index (AI) of greater than or equal to 20 hr-1 prior to CPAP. The AI was 67 +/- 30 hr-1, the body mass index (BMI) was 36 +/- 9 kg/m2, the age was 51 +/- 13 yr and the lowest oxygen saturation was 72 +/- 14%. Effective CPAP (9 +/- 3 cm H2O) was documented in 320 patients on single night studies and resulted in a 99% reduction in the frequency of obstructive events and improvement in the lowest O2 saturation to 94 +/- 5%. Only 18% of the variability in effective CPAP could be explained by AI and BMI. Single night studies are sufficient to establish effective CPAP in 78% of patients and offer considerable conservation of resources compared to routine multiple night studies. Effective CPAP pressures are variable and must be determined by incremental CPAP trials.
Article
To determine whether presenting clinical history, pharyngeal examination, and the overall subjective impression of the clinician could serve as a sensitive screening test for sleep apnea. Blinded comparison of history and physical examination with results of nocturnal polysomnography. Sleep clinic of a tertiary referral center. A total of 410 patients referred for suspected sleep apnea syndrome. Most patients reported snoring. All patients were asked standard questions and given an examination relevant to the diagnosis of the sleep apnea syndrome, and all had full nocturnal polysomnography. Patients with more than ten episodes of apnea or hypopnea per hour of sleep were classified as having sleep apnea. Stepwise linear logistic regression was used to develop two predictive models of sleep apnea: one based on the presence of characteristic clinical features, age, sex, and body mass index; and one based on subjective clinical impression. The prevalence of sleep apnea in our patients was 46%. Only age, body mass index, male sex, and snoring were found to be predictors of sleep apnea. The logistic rule discriminated between patients with and without sleep apnea (receiver operating characteristic [ROC] area, 0.77 [95% Cl, 0.73 to 0.82]). For patients with a predicted probability of apnea of less than 20%, the clinical model had 94% sensitivity and 28% specificity. Subjective impression alone identified correctly only 52% of patients with sleep apnea and had a specificity of 70%. In patients with a high predicted probability of the sleep apnea syndrome, subjective impression alone or any combination of clinical features cannot serve as a reliable screening test. However, in patients with a low predicted probability of sleep apnea, the model based on clinical data was sufficiently sensitive to permit about a 30% reduction in the number of unnecessary sleep studies.
Article
To examine the hypothesis that sleep apnoea is a risk factor for ischaemic heart disease, overnight polysomnography was performed in 101 unselected male survivors of acute myocardial infarction (MI) aged less than 66 yr and in 53 male subjects of similar age without evidence of ischaemic heart disease. The apnoea index (AI, number of apnoea episodes per hour of sleep) was 6.9 (SEM 1.2) in the MI patients versus 1.4 (0.3) in the control subjects. After adjustment for age, body mass index, hypertension, smoking, and cholesterol level, multiple logistic regression analysis identified the top quartile of AI (greater than 5.3) as an independent predictor of MI patients. The relative risk for myocardial infarction between the highest and lowest quartiles of AI was 23.3 (95% confidence interval 3.9-139.9).
Article
An autopsy was performed in 460 consecutive cases of sudden death among 35- to 76-year-old men. The closest cohabiting individual known to each decreased subject was interviewed. Snoring history was obtained in 321 of the 371 interviews. In 86 cases there was a history of 'habitual' (almost always or always) snoring, and 88 men snored 'often'. The mean age of subjects was 55.4 years. The mean body mass index (BMI) was 26.3 kg m-2. Among the obese snorers (n = 82), apnoeas had been observed 'occasionally', 'often', or 'habitually' in 49 cases. Death was classified as cardiovascular in 186 (40.4%) cases. Cardiovascular cause of death was more common among those who snored habitually or often than among those who snored occasionally or never (P less than 0.05). 'Habitual' snorers died more often while sleeping (P less than 0.05). Habitual snoring was found to be a risk factor for morning death (P less than 0.01). The possibility of obstructive sleep apnoea as a cause of sudden death should at least be considered if the decreased is known to have been a habitual snorer.
Article
The diagnostic value of flow-volume curves for sleep apnea was studied in 32 patients with obstructive sleep apnea, 40 simple snorers, and 30 healthy nonsnorers. A sawtooth appearance of the flow-volume curve was seen in 22 of the sleep apnea patients (69%), 14 of the simple snorers (35%), and 10 of the nonsnorers (33%). The ratio of midexpiratory flow (FEF 50) to midinspiratory flow (FIF 50) was greater than 1 in 6 of the sleep apnea patients (19%), 3 of the simple snorers (8%), and 2 of the nonsnorers (7%). Thus, only the sawtooth sign was more frequently found in sleep apnea patients than in controls (p less than 0.01). Sleep apnea patients with a sawtooth appearance of the flow-volume curve had a higher apnea index (38.7 +/- 22 vs. 21.5 +/- 12.1; p less than 0.01) and lower nocturnal minimum oxygen saturation (68.1% +/- 16.8 vs. 81.3% +/- 9.97; p less than 0.01) than those without. In symptomatic snorers, sensitivity of the sawtooth sign for sleep apnea was 72% and specificity 61%, for a FEF50/FIF50 ratio above 1 sensitivity was 17% and specificity 83%. In asymptomatic patients, sensitivity of either sign was extremely poor (33%) and specificity was 67% for the sawtooth sign and 85% for FEF50/FIF50 greater than 1. We conclude that abnormal flow-volume curves are of limited value for predicting sleep apnea.
Article
Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.
We have investigated the ability of a statistical model developed from clinical data and questionnaire responses to predict disturbance of breathing during sleep. Data from 100 consecutive patients referred for sleep study for suspected sleep apnea were used to develop the model using logistic regression analysis. For each subject, the model predicted the probability of having an apnea-hypopnea index (AHI) greater than 15; this probability was compared with the AHI measured from sleep study. A probability cutoff point (= 0.15) was decided on that minimized the number of subjects with false-negative predictions. Four terms--apneas observed by bed partner, hypertension, body mass index, and age--were found to contribute significantly to the model with observed apneas being by far the most predictive term of the four (adjusted odds ratio 19.7). When the model was tested to estimate the probability of an AHI greater than 15 for 105 patients from a second group of consecutive patients referred for sleep study, the model correctly classified 33 of 36 patients with a measured AHI greater than 15 (sensitivity = 92%) and 35 of 69 patients with a measured AHI less than or equal to 15(specificity = 51%). This study shows that analysis of clinical features of patients presenting with suspected sleep apnea may reduce the need for sleep studies by about one-third yet still lead to the identification of the great majority of patients with abnormal breathing during sleep.
Article
We have studied the predictive importance of neck circumference, obesity, and several radiographic pharyngeal dimensions for obstructive sleep apnoea (OSA), in 66 patients. OSA was quantified as the mean hourly number of greater than 4% dips in arterial oxygen saturation during sleep. Neck circumference (correlation coefficient (r) = 0.63, 95% confidence interval (C.I.) 0.46-0.76), obesity index (r = 0.54, 95% C.I. 0.39-0.69), hyoid position (r = 0.40, 95% C.I. 0.17-0.59), soft palate length (r = 0.31, 95% C.I. 0.08-0.51), and hard palate-to-spine angle (r = 0.29, 95% C.I. 0.04-0.49), correlated significantly with saturation dips in single regression analysis. In stepwise multiple linear regression analysis (saturation dip rate as the dependent variable), only neck size and retroglossal space were significant independent correlates (total r2 = 0.42, 95% C.I. 0.22-0.61, p less than 0.0001). We conclude that the relationships between general obesity, hyoid position, soft palate length, and OSA are probably secondary to variation in neck circumference.
To examine the usefulness of flow-volume curves as a screening test for the diagnosis of obstructive sleep apnea (OSA), we studied 405 consecutive patients referred for evaluation of possible OSA. All patients had full pulmonary function studies, which included measurements of maximal inspiratory and expiratory flow-volume curves, and nocturnal polysomnography, including continuous monitoring of snoring sounds. When the results were analyzed, of the 405 patients studied, 207 had OSA (apnea/hypopnea index [AHI] greater than 10) and 198 did not. Flow-volume curves were examined for the presence of upper airway obstruction defined as midvital capacity flow ratio (MVCFR = ratio of the maximal expiratory flow at 50% of vital capacity to maximal inspiratory flow at 50% of vital capacity) greater than 1.0. We found no significant difference in the values of MVCFR between the two groups: MVCFR was equal to 0.69 +/- 0.31 for nonapneic snorers, and 0.68 +/- 0.29 for the apneic snorers. Furthermore, we redefined the apneic and nonapneic groups using different cutoff values of AHI: 20, 30, 40, and 50. Independently of the AHI cutoff used, we found no significant difference in the MVCFR between the two groups. Linear regression analysis for the entire group of 405 patients revealed no significant correlation between MVCFR and the AHI or the snoring indices. We calculated the sensitivity, specificity, and predictive values of MVCFR for the diagnosis of OSA. We found that this test had 12% sensitivity, 86% specificity, 47% positive predictive value, and 46% negative predictive value.(ABSTRACT TRUNCATED AT 250 WORDS)
We have observed patients who clinically have the obstructive sleep apnea syndrome but have no apneas, instead having recurrent nocturnal hypoventilation. There is disagreement about the definition and significance of such sleep-related hypopneas. We have thus analyzed breathing patterns, oxygenation and sleep records of 50 consecutive patients referred with the clinical features of the sleep apnea syndrome and found to have abnormal breathing during sleep to determine: (1) the best definition of hypopnea, and (2) how frequently patients have the clinical features of the sleep apnea syndrome without recurrent apneas. Hypopnea definitions based on decreases in thoracoabdominal movement yielded hypopnea frequencies that were significantly closer to desaturation and arousal frequencies than hypopnea definitions based on flow reduction. The best hypopnea definition was that of a 50% reduction in thoracoabdominal movement lasting for 10 s. This was validated in 33 normal subjects, all of whom had fewer than 11 hypopneas/h, and fewer than 14 apneas plus hypopneas/h of sleep. Thirty-two of the 50 patients had 10 or more apneas/h, the remaining 18 having 9 to 98 hypopneas/h such that all patients had more than 16 apneas plus hypopneas/h. Patients with recurrent hypopneas were clinically indistinguishable from and had a similar frequency of 4% desaturations (zero to 104/h) and arousals (7 to 98/h) to the patients with frequent apneas. This study confirms that hypopneas are clinically important and that the "sleep apnea syndrome" may occur in the absence of recurrent apneas.
Article
The prevalence of the sleep apnea syndrome (SAS) among Swedish men 30-69 years old was estimated by a two-stage procedure. In the first stage, 4064 questionnaires were mailed to a random sample of a defined population in the municipality of Uppsala. The response rate was almost 80%; 15.6% of the responders were habitual snorers and 5.8% complained of daytime sleepiness. From these, a group of 166 men highly suspected of having SAS was selected. Eventually, 61 of these came for all-night polysomnographic studies, and 15 of these were found to have SAS. On this basis the lower limit of the prevalence of SAS was estimated to be as high as 1.3%. The majority of subjects with the syndrome were in the age group 50-59 years.
Article
A new clinical syndrome, sleep apnea associated with insomnia, has been characterized. Repeated episodes of apnea occur during sleep. Onset of respiration is associated with general arousal and often complete awakening, with a resultant loss of sleep. An important clinical implication is that patients complaining only of insomnia may be suffering from this syndrome.
The consistency of apneas from night to night was examined in 2 groups of patients. The first group had more than 100 apneas per night (frequent apnea) and the second group had less than 100 apneas per night (infrequent apnea). All patients underwent clinical polysomnography for 2 nights, with no significant weight change or treatment occurring between recordings. The frequent apnea group showed a consistent number of apneas on the 2 nights (r = 0.92, p less than 0.01), whereas the infrequent apnea group showed a highly variable number of apneas (r = 0.35, p greater than 0.10). The correlations on apnea index (apneas per hours of sleep) showed a similar result. Apnea duration and type were consistent in both groups of patients.
Article
In order to investigate the impact on breathing, during sleep, of alcohol ingestion and of sleep deprivation, two series of experiments were performed on male subjects with documented obstructive sleep apnea syndrome who had little complaint of excessive daytime somnolence. Four subjects were submitted to one night's sleep deprivation; four others ingested alcohol shortly before normal bedtime hours. In both studies, the apneic index of the patients was increased compared to baseline. There was a general trend toward longer apneic events during sleep and a lowering of blood oxygen saturation secondary to apneic events; both alcohol ingestion and sleep deprivation impair the arousal response normally induced by apneic events, thus increasing the duration of the episodes and the severity of their effect. As alcohol ingestion and moderate sleep deprivation are not uncommon in today's life-styles, the immediate impact of these on the ventilatory response to hypoxia during sleep deserves attention.
Article
The interaction between craniofacial structure assessed by lateral cephalometry, and tongue, soft palate, and upper airway size determined from computed tomography (CT) scans was examined in 25 control subjects and 80 patients with obstructive sleep apnea (OSA). On the basis of the cephalometric analyses, the patients with OSA had retruded mandibles with larger ANB angle differences, elongated maxillary and mandibular incisors and mandibular molars, and high total upper and lower face heights The computed tomographic evaluations revealed that patients with OSA also had larger tongue, soft palate, and upper airway volumes. Men with OSA and skeletal Class I malocclusions had significantly larger soft palates than comparable controls. Both tongue and soft palate volumes were positively correlated with body mass index. A principal component analysis reduced the database, and one significant correlation was identified. Subjects with high total, upper and lower face heights, elongated maxillary and mandibular teeth, and proclined lower incisors were observed to have large tongue, soft palate, and upper airway volumes, to have a higher apnea index and to be obese. Linear regression analysis indicated that a high apnea index was seen in association with large tongue and soft palate volumes, a retrognathic mandible, an anteroposterior discrepancy between the maxilla and mandible, an open bite tendency between the incisors, and obesity.
Article
Nocturnal polysomnography, the standard diagnostic test for sleep apnea, is an expensive and limited resource. In order to help identify the urgency of need for treatment, we determined which clinical features were most useful for establishing an accurate estimate of the probability that a patient had sleep apnea. Of 263 physician-referred patients, 200 were eligible for the study and 180 (90%) completed it. All patients had their histories recorded with a standard questionnaire, and underwent anthropomorphic measurements and nocturnal polysomnography. Sleep apnea was defined as more than 10 episodes of apnea or hypopnea per hour of sleep. Multiple linear and logistic regression models predictive of sleep apnea were compared with physicians' subjective impressions and previously reported models. Likelihood ratios were calculated for several levels of a sleep apnea clinical score produced by one of the linear models. Predictors of sleep apnea in the final model (R2 = 0.34) included neck circumference, hypertension, habitual snoring, and bed partner reports of nocturnal gasping/choking respirations. This model was superior to physician impression, slightly inferior to more detailed linear and logistic models, and comparable to previously reported models. A sleep apnea clinical score of less than 5 had a likelihood ratio of 0.25 (95% CI: 0.15 to 0.42) and a corresponding posttest probability of 17%, while a score of greater than 15 had a likelihood ratio of 5.17 (95% CI: 2.54 to 10.51) and posttest probability of 81%. These likelihood ratios can simply and accurately determined the probability of whether a patient has sleep apnea.