Adult Obstructive Sleep Apnea Patients Research Articles

The role of large muscle movements on excessive daytime sleepiness in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a heterogeneous disorder requiring personalized diagnostic approaches. Restless sleep and excessive daytime sleepiness (EDS) frequently accompany OSA, and are mainly linked to sleep fragmentation secondary to apneas and/or hypopneas. In this study, we aimed to analyze the characteristics of LMMs in OSA and to evaluate interrelationship between LMMs and EDS. Untreated-naïve adult OSA patients, with vs. without EDS were prospectively enrolled. Patients with comorbid neurological/psychiatric diagnosis, usage of drugs/substances known to affect sleep and positive airway pressure therapy were excluded. Routine evaluation of video-polysomnography was followed by LMM scoring. LMMs were compared between OSA with vs. without EDS, and correlations of LMMs with ESS scores and macrostructural sleep parameters were analyzed. Sixty patients were included (median age 43.5 [37.0] years, %78.3 men); 17 had EDS with Epworth Sleepiness Scale (ESS) ≥ 10 (28.3%). Total LMM index in total sleep time (TST) was 7.9 [20.6]. Total LMM index in TST (p = 0.048) and N1 (p = 0.020), and arousal-related LMM index in TST (p = 0.050) and N1 (p = 0.026) were higher in OSA with EDS than those without EDS. ESS scores were positively correlated with total (r = 0.332,p = 0.028) and arousal-related (r = 0.338,p = 0.025) LMM indexes in N1, and abnormal respiratory event-related LMM indexes in N1 (r = 0.440,p = 0.003) and N3 (r = 0.293,p = 0.050) after correction for age, sex, body-mass-index and apnea-hypopnea index. Our study demonstrated that LMMs were more frequent in OSA with EDS than those without EDS. This may have broad implications for the mechanisms of motor restlessness and residual sleepiness in OSA and warrants larger-scale, long-term follow-up studies. No clinical trial registration due to the observational design of the study.

Follow-up clarifications concerning the authors' reply to the 'look at the elephant!' comment on 'prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study'.

OSAS and TMDs represent multifactorial nosologic entities, whose central, functional and psycho-social aspects are gaining growing attention within the scientific community. In our previous commentary, we wanted to point out that structural aspects should not be forgotten in a clinical and research context. The inherent complexity of the matter could make it difficult to quantify the exact contribution of every single factor. The multifaceted nature of OSAS and TMDs pathophysiology could sustain several phenotypes in both conditions, and the anatomic parameters may assume different weights according to each phenotype, possibly justifying literature discrepancies. Thus, a patient with a co-existing OSAS and TMD (umbrella terms per se, each of them including different pathophysiological and clinical characteristics) represents an even greater challenge to researchers and practitioners. The scientific and therapeutic community should keep on looking for evidence to offer the best possible answers to such daring questions, in the most collaborative and fruitful way.

A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients.

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.

Craniofacial features of adult obese obstructive sleep apnoea patients in relation to the obesity onset - A pilot study.

Obesity and craniofacial structures are aetiologies of obstructive sleep apnoea (OSA). The effect of obesity onset on the craniofacial development and growth of obese OSA subjects has been suggested, but supporting data were lacking. This study aimed to assess the craniofacial features of adult obese OSA patients in relation to their obesity onset. A total of 62 adult OSA patients were included in the study, consisting of 12 early-onset (i.e. before puberty), 21 late-onset (i.e. after puberty) and 29 non-obese. All participants underwent a sleep study and cephalometric radiograph. Cephalometric analysis was conducted to measure the craniofacial features among the groups. The early obesity onset group (n = 12) showed a more prognathic mandible, longer lower facial height, protrusive incisors, a more caudal position of the hyoid bone and a wider lower airway. The late-onset group (n = 21) had more proclined and protrusive upper incisors, a shallower overbite, a more inferiorly positioned hyoid bone and an obtuse craniocervical angle. The overall obese group showed a combination of the findings above, plus a shorter soft palate and shorter airway length. There was no significant difference between early and late obesity onset groups. However, the early group showed a tendency for a shallower or decreased mandibular plane angle and deeper overbite. The current pilot study had many limitations but holds important information as a hypothesis generator. Craniofacial features of OSA patients with different obesity onset showed discrepancies and were distinguished from non-obese controls. Adult OSA patients with an early obesity onset showed a tendency for a more hypodivergent growth pattern than those with a late obesity onset.

The relationship between aerodynamic characteristics of the upper airway and severity of obstructive sleep apnea in adults

ABSTRACT Objective To investigate the relationship between aerodynamic characteristics of theupper airway and severity of obstructive sleep apnea (OSA)in adults. Methods Ninety-seven adult OSA patients underwent polysomnography and cone beam computedtomography (CBCT). The anatomical and aerodynamic characteristics were measuredbased on CBCT images and computational fluid dynamics modelling of the upper airway. Results Aftercontrolling for patients’ gender, age, and body mass index (BMI), the maximumvelocity during inspiration (In-Vmax) led to the largest increase in theexplanatory power of apnea-hypopnea index (AHI) variation. The In-Vmax was closely correlated with theminimum axial area, and their relationship was represented by an inverselyproportional fitted curve. Conclusions TheIn-Vmax was the most relevant to OSA severity, and it could be used to assistin recognizing severe OSA patients and as a primary variable to evaluate treatmentoutcomes of OSA. The In-Vmax was closely related to the most constricted areaof the upper airway.

Video-Based Decision Aids Improve Sleep Surgery Decision-Making: A Randomized Controlled Trial.

Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre-consultation video decision aids on patient DC and decision readiness. Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]-100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high-conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. Twenty-five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post-visit improvements in DC scores (post-consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision-making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High-conflict patients (n = 5) who reviewed pre-visit videos (intervention sub-group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high-conflict control patients. Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision-making process. 2 Laryngoscope, 134:2958-2963, 2024.

Multi-Omics Analysis of Circulating Exosomes in Adherent Long-Term Treated OSA Patients.

Obstructive sleep apnea (OSA) is a highly prevalent chronic disease affecting nearly a billion people globally and increasing the risk of multi-organ morbidity and overall mortality. However, the mechanisms underlying such adverse outcomes remain incompletely delineated. Extracellular vesicles (exosomes) are secreted by most cells, are involved in both proximal and long-distance intercellular communication, and contribute toward homeostasis under physiological conditions. A multi-omics integrative assessment of plasma-derived exosomes from adult OSA patients prior to and after 1-year adherent CPAP treatment is lacking. We conducted multi-omic integrative assessments of plasma-derived exosomes from adult OSA patients prior to and following 1-year adherent CPAP treatment to identify potential specific disease candidates. Fasting morning plasma exosomes isolated from 12 adult patients with polysomnographically-diagnosed OSA were analyzed before and after 12 months of adherent CPAP therapy (mean ≥ 6 h/night) (OSAT). Exosomes were characterized by flow cytometry, transmission electron microscopy, and nanoparticle tracking analysis. Endothelial cell barrier integrity, wound healing, and tube formation were also performed. Multi-omics analysis for exosome cargos was integrated. Exosomes derived from OSAT improved endothelial permeability and dysfunction as well as significant improvement in tube formation compared with OSA. Multi-omic approaches for OSA circulating exosomes included lipidomic, proteomic, and small RNA (miRNAs) assessments. We found 30 differentially expressed proteins (DEPs), 72 lipids (DELs), and 13 miRNAs (DEMs). We found that the cholesterol metabolism (has04979) pathway is associated with lipid classes in OSA patients. Among the 12 subjects of OSA and OSAT, seven subjects had complete comprehensive exosome cargo information including lipids, proteins, and miRNAs. Multi-omic approaches identify potential signature biomarkers in plasma exosomes that are responsive to adherent OSA treatment. These differentially expressed molecules may also play a mechanistic role in OSA-induced morbidities and their reversibility. Our data suggest that a multi-omic integrative approach might be useful in understanding how exosomes function, their origin, and their potential clinical relevance, all of which merit future exploration in the context of relevant phenotypic variance. Developing an integrated molecular classification should lead to improved diagnostic classification, risk stratification, and patient management of OSA by assigning molecular disease-specific therapies.

Oral Health Status and Treatment Needs Among Obstructive Sleep Apnea Patients in Jodhpur, Rajasthan.

Obstructive sleep apnea (OSA) is a sleep disorder characterized by periodic and repetitive partial or complete collapse of the upper airway during sleep, resulting in reduced ventilation (hypopnea) or absent ventilation (apnea). The present study was conducted on 100 adult OSA patients attending hospitals of Jodhpur and the dental clinic in Vyas Dental College and Hospital in Jodhpur city. The sample consisted of 65.0% males and 35.0% females, belonging to 18 years ≥60 years of age with a mean age of 47.61 ± 8.53. In our study, we have used AHI for the assessment of OSA, the major significant association (P = 0.001) was seen between AHI and periodontitis. The finding suggest that the prevalence of periodontitis is greater among patient with OSA with almost 39 patients with AHI value between 11to15 having loss of attachment between 4 mm ≥8 mm. Obstructive sleep apnea is acting as a significant risk factor for major Dental diseases. The study concludes that there was a significant association found between oral health status and OSA patients.

Sex-specific associations between daytime sleepiness, chronic diseases and mortality in obstructive sleep apnea.

Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA. Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness (N = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality. In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality. The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.

0530 Efficacy of obstructive sleep apnea treatment by a unique oral appliance and effect of concurrent myofunctional and CPAP therapy

Abstract Introduction Current treatment options for obstructive sleep apnea (OSA) include positive airway pressure, oral appliances, and upper airway surgery. The Day and Night Appliance (DNA) is a component of a dentist-guided system (Complete Airway Repositioning and Expansion [CARE], Vivos Therapeutics) that leads to gradual increases in upper airway volume. This study examines the effects of DNA treatment on OSA in patients before and after use of the device; we also examined how DNA treatment was impacted by concurrent myofunctional and CPAP therapy. Methods Data from a prospectively-collected clinical database (Vivos Airway Intelligence Service [AIS]) were reviewed, and 94 adult OSA patients who met DNA use criteria and had pre- and post-treatment sleep studies without the device in place were included. We compared the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) pre- and post-treatment using a paired t-test and fit linear regression models with change in AHI and ODI as dependent variables. Results Mean patient age was 47.8±14.7 years and 44.7% were men. Pre- and post-treatment sleep studies were conducted 15.2±7.0 months apart. 24.5% of patients were treated with DNA and myofunctional therapy (14.1% exclusively myofunctional, 10.4% myofunctional plus another treatment, e.g., tonsillectomy, frenectomy). 17.0% of patients were treated with CPAP (12.8% exclusively CPAP, 4.2% CPAP plus another treatment). For both pre-treatment and post-treatment, mean AHIs were 22.3±19.4 and 12.7±11.2 respectively (p< 0.0001) and mean ODIs were 11.6±13.7 and 7.8±9.1 respectively (p< 0.0001). Excluding patients who had undergone myofunctional therapy and another treatment modality and adjusting for patient age, BMI, and gender, we found myofunctional therapy was associated with a -10.4 change in AHI (p=0.038). However, myofunctional therapy was not associated with a significant change in ODI (p=0.905). Concurrent CPAP use did not have a significant association with change in either AHI (p=0.47) or ODI (p=0.61). Conclusion This study shows that DNA use significantly improved post-treatment OSA severity, and that concurrent myofunctional but not CPAP therapy may result in further OSA improvement. An oral appliance system that provides palatal expansion with consequent improvement in OSA severity but does not require permanent nightly use has advantages over conventional oral appliances; however, further investigation is warranted. Support (if any)

0533 Healthcare Utilization by Patients with Obstructive Sleep Apnea and Excessive Daytime Sleepiness After Airway Therapy in the UK

Abstract Introduction Obstructive Sleep Apnea (OSA) is a chronic condition characterized by repetitive episodes of upper airway collapse during sleep. Despite standard treatment with continuous positive airway pressure (CPAP), some patients continue to experience residual excessive daytime sleepiness (rEDS). Pharmacotherapy use for rEDS is low in Europe and some wake-promoting agents are no longer allowed as treatments by the European Medicines Agency. The objective of this study was to characterize the patient demographics, comorbidities, medications, and healthcare resource utilization (HCRU) in a population of OSA patients with and without rEDS after CPAP initiation. Methods The retrospective observational cohort study used the Clinical Practice Research Datalink (CPRD) AURUM, a primary care database, linked at the patient level to the Hospital Episode Statistics (HES) database, which covers secondary care for all of England. The population included 10,746 adult OSA patients with a first record of CPAP treatment during the eligibility period (Jan 1, 2009-Mar 21, 2018). rEDS patients were identified 6 months after initiating CPAP treatment. Results Among all eligible OSA patients in the AURUM database, 596 (5.6%) had rEDS; 80.5% of rEDS patients were identified using recorded diagnosis code of daytime fatigue, and 21.7% using ESS score ≥11 (13 patients had both measures). A greater percentage of patients had a history of psychiatric (21.5%; p< 0.0001), gastrointestinal (7.7%; p< 0.0001), and neurodegenerative (13.6%; p=0.003) disorders in the rEDS group, compared with the non-rEDS group, while the prevalence of obesity, cardiovascular, and sleep disorders did not significantly differ between groups. Across all patients, rates of prescription for stimulants or modafinil were low during the 12 months prior to CPAP initiation. Patients with rEDS had significantly higher HCRU compared to non-rEDS patients in the first and second years after CPAP initiation. Conclusion Despite low rates of rEDS identified in this study, the clinical needs of patients with rEDS are significant, as evidenced by the volume of HCRU, low use of pharmacotherapy, and high comorbidity rates, highlighting the need to improve patient care in rEDS. Support (if any) Axsome Therapeutics and Jazz Pharmaceuticals

Look at the elephant! Commentary on "Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study".

The relationship between obstructive sleep apnoea (OSA) and temporomandibular disorders (TMDs) is complex. Research has shown controversial evidence. The recent study by Bartolucci et al. titled "Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study" reported no clear associations between the 2 conditions. However, it does not take into account the occlusal and mandibular features of the patients, which may justify the hypothetical coexistence of OSA and TMD in a subset of cases. In this letter, we discuss these aspects and possible biases that could have impaired the results.

Prevalence of Temporomandibular Disorders in Adult Obstructive Sleep Apnea Patients: a cross-sectional controlled study.

Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airways during sleep and it has been associated with temporomandibular disorders (TMDs) on the basis of several pathophysiological hypotheses. to assess the prevalence of TMDs in a population of patients affected by OSA compared to a control group of subjects not affected by OSA. a cross-sectional controlled study was conducted on a group subjects studied by polygraphy (PG) at the snoring section of the ENT department, Sant'Orsola-Malpighi Hospital - University of Bologna. Patients who received a diagnosis of OSA were included in the study group and subjects with a negative PG diagnosis for Sleep Disordered Breathing and PG respiratory pattern that did not suggest the occurrence of sleep disorders were enrolled in the control group. Both the subjects included in the study group and the control group underwent an examination following the Diagnostic Criteria for Temporomandibular Disorders Axis I and II. 43 OSA patients (29M, 16F, mean age 52.26±11.40) and 43 healthy controls (25M, 18F, mean age 49.95±7.59) were included in the study. No significant differences were found between groups in demographic data. TMD prevalence and Axis II results did not differ between groups. this paper does not highlight a higher prevalence of TMDs in adults with OSA compared to healthy controls. Further high quality studies are needed to confirm the results and to give possible pathophysiological explanations, providing reliable evidence.

A panoramic view of a cohort of obstructive sleep apnea patients on positive airway pressure therapy using cloud based telemonitoring devices.

Positive airway pressure therapy is mainstay of treatment of obstructive sleep apnea (OSA). But long-term compliance with is poor with such therapy. A proactive and vigilant management may improve the PAP therapy usage. Cloud-based telemonitoring PAP devices offer an opportunity for proactive monitoring and prompt interventions related to PAP troubleshooting. This technology is also used in India for adult OSA patients. But we lack our own data on behavior of Indian patients as a cohort on PAP therapy. The present study is an attempt to look at the behavior a cohort of PAP users in OSA. This study was planned as a retrospective analysis of data of OSA patients who were using a cloud-based PAP devices. First 100 patients were chosen for data retrieval that who was on this therapy. The data was obtained for those patients who were on PAP for at least 7 days and maximum follow-up was available up to 390 days. Descriptive statistical analysis has been carried out in the present study. The number of male and female patients was 75 and 25, respectively. Overall good compliance was present in 66% of patients. 34% of patients were not compliant with PAP during follow-up. The compliance was statistically same in both the sexes (P = 0.8088). Incomplete data recovery was present in 17 patients and 11 (64.70%) were non-compliant among them. In the initial, 60 days non-compliant patients were more than compliant patients. The difference was lost in 60 to 90 days of use. The air leak was present more in the compliant group than non-compliant group (P = 0.0239). 75.75% of compliant patients had achieved AHI control, whereas 35.29% of non-compliant patients also achieved AHI control. But overall, AHI control was poor in non-compliant patients and 61.76% of non-compliant patients had an AHI uncontrolled. We conclude that 3/4th of the compliant patients achieve AHI control while 1/4th didn't. This 1/4th population needs further exploration to determine the causes of poor AHI control. Cloud-based PAP devices give an easy opportunity to monitor patients of OSA. It gives an instant panoramic view of behavior of OSA patients on PAP therapy. The compliant patients can be tracked, and non-compliant patients can be segregated quickly.

Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population.

Positive airway pressure (PAP) is the first-line therapy for obstructive sleep apnea (OSA). Overnight PAP titration for determining optimal PAP requirements is expensive and often inconvenient. Prediction of optimal PAP requirements from diagnostic polysomnography via mathematical equations is possible but variable across populations. We aimed to (1) determine the optimal PAP requirement, (2) determine differences in optimal PAP requirements across OSA severity groups, (3) determine the relationship between optimal PAP requirement and diagnostic polysomnography measurements of OSA severity, and (4) develop a pilot equation to predict the optimal PAP requirement from diagnostic polysomnography in a sample from the Saudi population. We analyzed records pertaining to adult OSA patients (n = 215; 63% of males) who underwent standardized diagnostic and titration polysomnography in our sleep laboratory between 2015 and 2019. Demographic, anthropometric, and clinical information were also collected for the analysis. Inferential statistics were performed for comparisons between diagnostic and titration studies and between OSA severity groups. Regression analyses were also performed to determine the potential predictors of optimal PAP requirements. Data were presented as the mean (± standard deviation) or median (25th-75th quartiles) according to normality. The median optimal PAP requirement was 13 (9-17) cmH2O. The optimal PAP requirement was significantly greater for male versus female participants (14 [10-17] vs. 12 [8-16] cmH2O) and for participants with severe OSA (16 [12-20] cmH2O, n = 119) versus those with moderate (11 [8-14] cmH2O, n = 63) or mild (9 [7-12] cmH2O, n = 33) OSA. When combined, nadir oxygen saturation, oxygen desaturation index, and arousal index could be used to predict the optimal PAP requirement (R 2= 0.39, F = 34.0, P < 0.001). The optimal PAP requirement in the Saudi population is relatively high and directly correlated with OSA severity. Diagnostic polysomnography measurements of OSA severity predicted the optimal PAP requirement in this sample. Prospective validation is warranted.

Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? Case Report and Systematic Review.

Ankyloglossia (tongue-tie) is a condition of the oral cavity in which an abnormally short lingual frenulum affects the tongue's mobility. Literature on the correlation between ankyloglossia and obstructive sleep apnea (OSA) is scarce. The main objective of this study was to report our preliminary experience in adult OSA patients before and after ankyloglossia treatment, using drug-induced sleep endoscopy (DISE) to evaluate the upper airway modifications resulting after treatment, and to present a systematic review of the impact of ankyloglossia and its treatment on OSA adults. We found that, after frenotomy, regarding the DISE findings, and according to the VOTE classification, two of the three patients showed an improvement in tongue level, from 2A-P (complete anteroposterior collapse) to 1ap (partial anteroposterior collapse). The third patient showed no changes in his UA after frenotomy, neither worsening nor showing improvement. Thus, the results of this study suggest that frenotomy in OSA patients with ankyloglossia could reduce tongue collapse, probably by allowing the tongue to take into the physiological position in the oral cavity. These patients should undergo speech therapy and oropharyngeal exercises prior to any surgical procedure, in order to avoid glossoptosis and to improve the quality of life and sleep apnea results.

Quality of Life and Adverse Side Effects of Continuous Positive Airway Pressure Therapy in Thai Patients with Obstructive Sleep Apnea

Objective: To evaluate the quality of life (QOL) and adverse side effects of continuous positive airway pressure (CPAP) therapy in Thai patients with obstructive sleep apnea (OSA). Material and Methods: The present study was conducted at Siriraj Hospital by reviewing medical records, symptoms questionnaire, functional outcomes of sleep questionnaire (FOSQ), and Epworth sleepiness scales (ESS) of adult OSA patients who were treated with CPAP between November 2010 and June 2017. Patients who failed to follow-up or had incomplete questionnaires were excluded. Results: Data of 135 OSA patients, which included 99 males and 36 females with a mean age of 50.2±11.1, apnea-hypopnea index of 48.8±30.2 events per hour, and follow-up time of 50.6 months with a range of 13 to 79 months, were recruited. There were 57 patients or 42.2% using fixedpressure CPAP and 78 patients or 57.8% using auto-adjusting CPAP. A statistically significant improvement in scores of all FOSQ subscales, global FOSQ, and ESS were found after CPAP therapy (p&lt;0.05). Good treatment adherence through self-reported data was found in 123 patients or 91.1% at approximately three months and 97 patients or 71.9% after more than one year follow-up. The most common reported side effects of CPAP were mask discomfort at 60%, nose congestion at 47.4%, and dry mouth at 40%. However, these side effects were mostly mild to moderate and tolerable. Conclusion: CPAP therapy can significantly improve QOL of Thai patients with OSA who continuously use it in both the short-term and long-term. However, side effects are common especially mask discomfort and nasal congestion in short-term. Keywords: Obstructive sleep apnea; Quality of life; Continuous positive airway pressure; CPAP; Side effects; Thai

Abstract 13798: Obstructive Sleep Apnea Severity and Abnormal Right Ventricular Flow Reserve in Adult OSA Patients Who Received Rubidium-82 Cardiac PET Perfusion Imaging

Background: Obstructive sleep apnea (OSA) is associated with right ventricular (RV) remodeling, RV dysfunction and pulmonary hypertension. Myocardial flow reserve (MFR), the ratio of stress-to-rest myocardial blood flow (MBF), is an index of coronary microvascular health. Recent evidence suggests that severe OSA is associated with abnormal left ventricular MFR (LVFR). However, little is known about MFR in the RV of patients with OSA. In this study we examined the relationship between measures of OSA severity and RV MFR (RVFR) in humans. Methods: We conducted RV MBF assessment in 47 persons with OSA who had a cardiac positron emission tomographic (PET) perfusion scan. All participants had in-laboratory polysomnography. RVFR &lt;2.0 was chosen as threshold for abnormal RVFR to coincide with the 25 th percentile of RVFR in our sample. Abnormal LVFR was also defined as &lt;2.0 based on thresholds from previously determined studies. We compared the mean apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and time spent with &lt;90% oxygen saturation (T90%). Results: The mean age of the participants was 58 years and 63% were female. There was a strong correlation between RVFR and LVFR (Spearman Rho = 0.63, P&lt;0.001). The mean AHI was greater among persons with RVFR &lt;2 compared to those with RVFR≥2 [mean (SE) AHI: 63 (20) v. 32 (5), P=0.042]. This trend was observed with the ODI although it was not statistically significant. Given the RVFR and LVFR were strongly correlated, we created a ratio of RVFR to LVFR to account for the LV MBF. The mean AHI and ODI among persons with RVFR/LVFR &lt;1 was greater than those with ≥1; p = 0.025 and p=0.031 respectively. See the figure for more details. Conclusion In patients with OSA, patients with reduced RVFR had higher AHI and ODI indicating greater severity of OSA. The exact mechanism behind this phenomenon is not known. Future studies should further characterize the relationship between RV myocardial blood flow and OSA.

Saliva Analysis of pH and Antioxidant Capacity in Adult Obstructive Sleep Apnea Patients.

Background: Obstructive sleep apnea syndrome (OSAS) may be associated with and activates the stress response system, and variation in the physiological antioxidant capacity of body fluids. Our aim was to evaluate the variation of pH and antioxidant capacity on the saliva of obstructive sleep apnea subjects (OG) compared to a control group (CG). Method: Fifty subjects with moderate/severe OSAS were recruited in Tor Vergata Hospital and compared with 20 healthy subjects CG. The buffer and the antioxidant capacity of the samples were quantified measuring the pH and the percentage of total salivary antioxidant capacity (%TAC), which refers to the reduced glutathione salivary concentration (GSH). Moreover, the protein concentration and the gelatinolytic activity of metalloproteinases were quantified. Results: The data showed that the pH value is slightly more alkaline in OSAS subjects; however, it is not directly related to the severity of OSAS. The %TAC was found to be significantly reduced by 86.2% in the OG. Proteins of saliva from the OG were found 1.5 times more concentrated than in the healthy sample. The gelatinolytic activity of metalloproteinases of healthy and OSA did not show statistically significant changes. Conclusions: The salivary samples from OSAS compared to CG show an alteration of the oxidative state, the pH buffering power, and protein concentrations, inducing conditions that can easily evolve chronic gingivitis. Further investigations are necessary to evaluate the feasibility of using salivary fluid for the early diagnosis of oral or systemic problems in OSAS subjects.

Transoral Tongue Suspension for Obstructive Sleep Apnea-A Preliminary Study.

Objectives: To evaluate the safety and efficacy of a novel technique for transoral tongue suspension (TOTS) in obstructive sleep apnea (OSA) patients. Material and Methods: The retrospective study enrolled 24 consecutive OSA patients (21 males; average age, 43 years; average apnea–hypopnea index (AHI), 42.2 event/h; average body mass index (BMI), 25.7 kg/m2) with tongue obstruction confirmed by drug-induced sleep endoscopy. All patients received TOTS as the main procedure in conjunction with uvulopalatopharyngoplasty (UPPP). Key procedures of TOTS included a transoral sublabial approach, drilling two holes on the mandible, passing the polypropylene through the hole to the tongue base using a suture passer and returning the polypropylene through loop traction, and tying the polypropylene to the mandible. Lingual tonsil ablation (n = 8) was also implemented in hypertrophic lingual tonsils (grades III and IV). Results: The operation time for TOTS was around 30 min. No wound bleeding or airway compromise occurred throughout the postoperative period. Minor complications were temporary and included swelling of the tongue, numbness of the lower incisor, and sublabial wound dehiscence (n = 2). The quality of life improved significantly in the patients’ subjective daytime sleepiness according to the Epworth Sleepiness Scale (11.4 ± 3.2 vs. 5.7 ± 1.6, p < 0.001). The objective parameters of OSA also improved significantly in the apnea/hypopnea index (42.2 ± 21.8 vs. 19.5 ± 16.2, p < 0.001), minimal oxygen saturation (77.1 ± 12.2 vs. 81.7 ± 8.1, p = 0.026), and snoring index (207 ± 141 vs. 101 ± 91, p = 0.03). Conclusions: The demonstrated TOTS showed its advantage in low morbidity with a scarless exterior and easy performance with free availability in treating adult OSA patients with tongue obstruction. TOTS combined with UPPP significantly improved AHI and daytime sleepiness. TOTS can be implemented with lingual tonsillectomy to achieve both stabilization of the tongue and widening of hypopharyngeal airway.