Adult Sleep Apnea Patients Research Articles

Asociación entre el perfil anatómico y la severidad del Apnea Obstructiva del Sueño en una muestra de pacientes peruanos

Introduction: Obstructive Sleep Apnea (OSA) is the total or partial limitation of the passage of air through the upper respiratory tract during sleep, it has two forms of presentation: central and obstructive (related to anatomical profile). Objective: To determine the relationship between the anatomical profile and severity of Obstructive Sleep Apnea in adult patients of a Private Clinic in Lima Norte, Lima, 2020-2022. Methods: Cross-sectional analytical study. We used medical records of patients diagnosed with OSA during the period 2020-2022 in a private clinic in Lima, Peru. Our variable was the severity of OSA, in addition to apnea-hypopnea per hour (AHI), in addition we also took oxygen desaturation index (ODI), Epworth Scale, CT90%, body mass index (BMI), minimum saturation and snoring and of the newborn reported in the clinical history. The response variable was OSA . Results: a total of 120 clinical histories were studied. The predominant OSA was mild (29.2%), followed by very severe (26.7%). In very severe OSA, patients with retrognathia had 3.0 higher frequency, those with long face had 30.0 lower frequency and those with short face had 4.0 higher frequency, compared to patients with normal face (40 vs 7 vs 41 vs 37; p<0.01). Conclusions: OSA is associated with the anatomical profile. The ANGLE scale was the one most associated with OSA compared to the Friedman Score. OSA was associated with BMI, IDO, minimum saturation, and maximum heart rate.

Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests.

The clinical performance of home sleep apnea tests (HSATs) can be described by their (diagnostic) accuracy, defined as the percentage agreement with the obstructive sleep apnea severity category (normal, mild, moderate, and severe) based on polysomnography. Rather than reporting on accuracy, there has been a strong reliance in the literature to report correlation coefficients between the apnea-hypopnea index of HSATs and polysomnography to support claims of diagnostic performance. This is surprising, as it has been well described that correlation coefficients are inadequate to evaluate equivalence between 2 parameters. The aim of this study was to systematically investigate the magnitude of the discrepancies between correlation coefficients and diagnostic accuracy reported in or retrievable from HSAT validation studies. We compared the discrepancy between accuracy and apnea-hypopnea index correlation coefficients of all validation papers that met the inclusion criteria. A total of 20 papers were retained, representing a participant pool of 1,652. The weighted average apnea-hypopnea index correlation across all 20 papers was 0.82 and the weighted average accuracy was 0.61, highlighting a discrepancy of 0.21 and an overall misdiagnosis rate of 39%. The results of our study confirm the need for increased scientific rigor in selecting primary performance endpoints to support clinical performance claims of HSATs. Massie F, Van Pee B, Bergmann J. Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med. 2022;18(3):871-876.

Modeling the upper airway: A precursor to personalized surgical interventions for the treatment of sleep apnea.

An accurate benchtop model was developed to mimic the different forms of human upper airway collapse in adult sleep apnea patients. This was done via modeling the airway through digital imaging. Airway representative models were then produced in two steps via a customized pneumatic extrusion 3D printing system. This allowed the pressure of collapse and planes of collapse to be manipulated to accurately represent those seen in sleep apnea patients. The pressure flow relationships of the collapsible airways were then studied by inserting the collapsible airways into a module that allowed the chamber pressure (Pc ) around the airways to be increased in order to cause collapse. Airways collapsed at physiologically relevant pressures (5.32-9.58 cmH2 O). Nickel and iron magnetic polymers were then printed into the airway in order to investigate the altering of the airway collapse. The introduction of the nickel and iron magnetic polymers increased the pressure of collapse substantially (7.38-17.51 cmH2 O). Finally, the force produced by the interaction of the magnetic polymer and the magnetic module was studied by measuring a sample of the magnetic airways. The peak force in (48.59-163.34 cN) and the distance over which the forces initially registered (6.8-9.7 mm) were measured using a force transducer. This data set may be used to inform future treatment of sleep apnea, specifically the production of an implantable polymer for surgical intervention.

MT3 OUTCOMES AND HOSPITAL UTILIZATION OF SLEEP APNEA PATIENTS TREATED WITH POSITIVE AIRWAY PRESSURE DURING AND AFTER ONSET OF HEART FAILURE

As a few recent studies failed to show beneficial effect of Positive Airway Pressure (PAP) on the sleep apnea patients with cardiovascular comorbidities, we aimed to use large administrative database to investigate the association of PAP usage and the health economics outcomes of the sleep apnea patients with a new onset of heart failure (HF). Adult sleep apnea patients with a new onset of HF were selected in the 5% Medicare data during June 2013-December 2014. The remaining patients were further divided by whether they had used PAP within 6 months prior to the HF onset. One-year clinical outcomes and medical utilization were compared between the groups. Propensity-score matching by patient/hospital characteristics and comorbidities were performed to adjust baseline differences. T-test or Chi-square test was used to determine statistical significance and COX Survival analysis was used to determine the hazard ratio (HR) of the mortality. Our study identified 15,511 sleep apnea patients with a new onset of heart failure, of whom, a total of 4,376 (28.2%) were identified as PAP users. After propensity-score matching, the patients who had used PAP prior to the heart failure had less hospital charge (56,250 USD vs. 60,515 USD, p=0.02), shorter hospital length of stay (5.45 vs. 5.89 days, p=0.0005), shorter ICU length of stay (4.64 vs. 5.07 days, p=0.03) during the index visit. Further, PAP users had significantly decreased 30-day readmission (18.5% vs. 20.4%, p=0.04) and lower mortality with the hazard ratio of 0.85 compared to non-PAP users (p<0.0001) during the one-year follow-up. We have found a significant association of the PAP usage with higher one-year survival and lower hospital charge among sleep apnea patients with a new onset of heart failure (HF). Therefore, effective PAP treatment for sleep apnea among high-risk heart failure patients is strongly recommended.

Effects of Medical Therapy on Mild Obstructive Sleep Apnea in Adult Patients.

Patients with obstructive sleep apnea (OSA) have been shown to have high levels of inflammatory markers. Anti-inflammatory treatment with montelukast and intranasal steroids have demonstrated efficacy for mild OSA in children; this has not been fully evaluated in adults. This study investigated the response of mild OSA in adults to anti-inflammatory medical therapy. Adults aged ≥ 21 years with an apnea-hypopnea index (AHI) ≤ 15 events/h on polysomnography (PSG) were recruited to a prospective double-blind, randomized control trial. Patients were treated for 12 weeks with montelukast and fluticasone or placebo. All underwent a pretreatment and posttreatment PSG. Epworth Sleepiness Scale (ESS) score was obtained pretreatment and at 6 and 12 weeks posttreatment. A total of 26 patients completed the study with 13 in each group. Mean age in the treatment and placebo groups were 58.3 ± 10.3 and 54.8 ± 14 years, respectively. There was no significant difference between groups reporting nasal congestion (P = .186), rhinitis (P = .666), or snoring (P = .177). There was no difference in the pretreatment ESS score (P = .077), body mass index (P = .173), or AHI (P = .535). The posttreatment PSG in the treatment group demonstrated a significant increase in total sleep time (P = .02) and percent of stage R sleep (P = .05). Neither group showed significant change in AHI. In patients in the treatment group, the 6- and 12-week follow-up ESS scores were not significantly different from pretreatment scores (P = .37-.46). Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA. Registry: ClinicalTrials.gov; Title: Montelukast and Nasa ICS for Treatment of Mild Obstructive Sleep Apnea in Adults; Identifier: NCT01089647; URL: https://clinicaltrials.gov/ct2/show/record/NCT01089647.

Prevalence and risk factors of sleep apnea in adult patients with congenital heart disease.

Although sleep apnea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with congenital heart disease are limited. In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnea using a type-3 portable overnight polygraph in adult patients with congenital heart disease were evaluated. There were 104 patients [median age: 36 (interquartile range: 28-48) years] who were admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37%, 16%, and 10% for mild (5≤ respiratory disturbance index &lt;15), moderate (15≤ respiratory disturbance index &lt;30), and severe (respiratory disturbance index ≥30) sleep apnea, respectively. A large majority of the sleep apnea cases were categorised as obstructive sleep apnea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnea (respiratory disturbance index &lt;5). Multivariable analysis showed that New York Heart Association class ≥II (OR, 4.36; 95% CI, 1.09-20.87) and body mass index ≥25 (OR, 4.29; 95% CI, 1.32-15.23) were independent risk factors for a respiratory disturbance index ≥15. Our results showed a high prevalence of sleep apnea in adult patients with congenital heart disease. Its unique haemodynamics may be associated with a high prevalence of sleep apnea. Congestive heart failure and being overweight are important risk factors for sleep apnea. Management of heart failure and general lifestyle improvements will be important for controlling sleep apnea symptoms in these patients.

Prevalence of Sleep Bruxism and Its Association with Obstructive Sleep Apnea in Adult Patients: A Retrospective Polysomnographic Investigation.

To determine the prevalence of sleep bruxism (SB) in adult obstructive sleep apnea (OSA) patients, to assess the association between SB and OSA in terms of sleep macrostructure and respiratory parameters, and to determine possible OSA risk factors for SB. Type I polysomnographic data of 147 adult OSA patients (mean age 44.6 ± 12.8 years) were evaluated for SB. SB episodes were scored when masseter rhythmic masticatory muscle activity (RMMA) was twice the background electromyography amplitude, and SB was established when patients had more than four SB episodes per hour of sleep. Demographic characteristics, sleep macrostructure, and respiratory parameters, including respiratory-related arousal index (RAI), spontaneous arousal index (SAI), oxygen desaturation index (ODI), and Apnea-Hypopnea Index (AHI), were analyzed for differences between patients with and without SB using independent samples t test and Mann-Whitney U test. Multivariate logistic regression analysis was performed to determine the odds of OSA risk factors for SB. Approximately one-third (33.3%) of the adult OSA patients had concomitant SB. Most of the RMMA observed in OSA-SB patients was phasic in nature. OSA patients with SB demonstrated significantly greater RAI (P = .001) and ODI (P = .005). RAI (odds ratio = 1.05, 95% confidence interval = 1.00 to 1.10) and SAI (odds ratio = 0.89, 95% confidence interval = 0.80 to 0.96) demonstrated marginal effects on the odds of experiencing SB. About one-third of adult OSA patients had SB, and these patients demonstrated significantly more respiratory-related arousals and oxygen desaturations. These findings suggest that a phenotypic subtype of OSA patients with predominantly phasic SB exists and allude to a possible protective role of RMMA in respiratory-related arousals.

Overnight Pulse Oximetry Unwoven.

Overnight Pulse Oximetry Unwoven.

The Future of the Sleep Lab: It's Complicated.

The Future of the Sleep Lab: It's Complicated.

The prevalence of obstructive sleep apnea in adult patients with sickle cell disease

Purpose: Although few previous studies suggested an increased prevalence of obstructive sleep apnea (OSA) among children with sickle cell disease (SCD) compared to others, there are little data regarding this association in adults. In this study, we aimed to investigate the prevalence of OSA among the patients with SCD and its risk factors. Materials And Methods: This cross-sectional, observational study was conducted at a specialty hematology clinic. From December 2013 to July 2014, all the patients with SCD and chronic anemia were approached. Data were collected on the risk of OSA using the Berlin questionnaire, and the data on daytime sleepiness were collected using the Epworth sleepiness scale (ESS); medical history of the patients was also obtained. The objective diagnosis of OSA using polysomnography was performed in a subsample of the study population. Results: The study included 106 patients, 44.3% with SCD and 55.7% with other types of anemia being used as a comparison group. Among the patients with SCD, 14.9% were at a high risk of OSA, and 23% were confirmed to have OSA, whereas 10.1% and 16.7% of those in the comparison group did, respectively. However, there were no statistically significant differences between the two groups. Mean scores of risk factors for OSA among the patients with SCD with OSA were 28 years for age, 22.1 kg/m2for body mass index, 14.5 inches for neck circumference, 122 mmHg for systolic blood pressure, and 6.67 for ESS score. Conclusion: Although not different from chronic anemia, the OSA is a common, coexisting disease in the patients with SCD. Furthermore, it is suspected that the traditional screening tools may miss potential cases of OSA in the SCD population.

The prevalence of obstructive sleep apnea in adult patients with sickle cell disease

The prevalence of obstructive sleep apnea in adult patients with sickle cell disease

A systematic review of central sleep apnea in adult patients with chronic kidney disease.

Obstructive sleep apnea has been widely studied in patients with chronic renal insufficiency; however only a limited number of studies have reviewed the association between central sleep apnea (CSA) and chronic kidney disease (CKD). The objectives of this systematic review were to assess the prevalence of CSA in and its association with CKD in adult patients and to determine if inclusion of the central hypopnea index affected the reported rates for the prevalence of CSA in CKD. Medline, Web of Science, Google Scholar, Scopus, and Cochrane Library were searched through October 2015 without any language limitations. Of 188 articles searched, 8 articles met our study inclusion criteria. Of a cumulative total of 313 patients with CKD undergoing sleep study, a total of 30 patients were diagnosed with central sleep apnea. Three studies had patients with coexistent congestive heart failure, six studies included some patients on dialysis and at least 3 studies included central hypopneas while calculating central sleep apnea index. The aggregate point prevalence of CSA in CKD is 9.6%, although the estimated range is highly variable between 0 and 75%. Limited evidence suggested that even after adjustment for cardiovascular comorbidities, CKD is independently associated with CSA. It is unknown if patients on dialysis are at increased risk compared to patients without end-stage renal disease. Standardization of polysomnographic criteria used to define CSA and sleep disordered breathing (SDB) as well as inclusion of central hypopneas in the overall CSA index will limit the heterogeneity and allow better estimation of the prevalence of CSA in patients with CKD.

Risk of Obstructive Sleep Apnea in Adult Patients with Asthma: A Population-Based Cohort Study in Taiwan.

BackgroundThere are several publications reported that obstructive sleep apnea (OSA) was associated with asthma. However, large-scaled, population-based cohort study has been limited. We aimed to examine the risk of OSA among adult patients with asthma in an Asian population.MethodsWe conducted a retrospective cohort study using data from the National Health Insurance (NHI) of Taiwan. The asthma cohort included 38,840 newly diagnosed patients between 2000 and 2010. The date of diagnosis was defined as the index date. Each patient was randomly matched with four people without asthma according to gender, age, and the index year as the comparison cohort. The occurrence of OSA was followed up until the end of 2011. The risk of OSA was estimated using the Cox proportional hazard model after adjusting for gender, age, and comorbidities.ResultsThe overall incidence of OSA was 2.51-fold greater in the asthma cohort than in the comparison cohort (12.1 versus 4.84 per 1000 person-years). Compared to non-asthma subjects, the adjusted hazard ratio (aHR) of OSA increased to 1.78 for asthma patients with one or less annual emergency room (ER) visit, and 23.8 for those who visited ER more than once per year. In addition, aHR in patients with inhaled steroid treatment compared to those without steroid treatment was 1.33 (95% CI = 1.01–1.76).ConclusionPatients with asthma have a significantly higher risk of developing OSA than the general population. The results suggest that the risk of OSA is proportional to asthma control and patients with inhaled steroid treatment have a higher risk for OSA than those without steroid treatment.

Obstructive sleep apnea in adult patients: considerations for anesthesia and acute pain management.

Obstructive sleep apnea (OSA) represents a challenge in the perioperative period for both physicians and the health care system alike. A number of studies have associated OSA with increased risk for postoperative complications. This is of particular concern in the face of this disease remaining vastly underdiagnosed. In this context, current guidelines and established concepts such as the use of continuous positive airway pressure or the level of postoperative monitoring, lack strong scientific evidence. Other interventions such as the use neuraxial/regional anesthesia may however offer added benefit. This review aims to address considerations for physicians in charge of OSA patients in the perioperative setting and to give an outlook for current and future research on this topic.

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Obstructive sleep apnea (OSA) is a sleep disorder which has been gradually accepted as an important cause of increased morbidity and mortality. The treatment of moderate-severe OSA has improved dramatically since the introduction of continuous positive airway pressure (CPAP) devices; however, the adherence of patients to CPAP treatment is relatively low. Adherence appears to be even worse in patients with mild or asymptomatic OSA. The failure to identify and treat mildly symptomatic or asymptomatic OSA patients may be costly, as such patients comprise about 20% of the general adult population. OSA patients could be divided into positional and non-positional patients. Positional patients show most of their breathing abnormalities while sleeping in the supine position. Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas. On the contrary, non-positional patients suffer from breathing abnormalities in the supine and lateral postures, and as a consequence those are the most severe OSA patients for whom CPAP is the treatment of choice. In this paper we intend to argue that positional therapy, i.e., avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild-moderate OSA. Considering the fact that the vast majority of mild-moderate OSA patients are positional patients (between 65 and 87%), positional therapy may be a simple, cheap and effective solution for them. High-quality research regarding this issue is needed to evaluate the real effectiveness of this mode of therapy.

Changing the Direction of Sleep Medicine: Business can Boom, but it is Not as Usual

Changing the Direction of Sleep Medicine: Business can Boom, but it is Not as Usual

Targeted Case Finding for OSA within the Primary Care Setting

The aim was to determine the feasibility of using an unattended 2-channel device to screen for obstructive sleep apnea in a population of high-risk patients using a targeted, case-finding strategy. The case finding was based on the presence of risk factors not symptoms in the studied population. The study took place from June 2007 to May 2008 in rural and metropolitan Queensland and New South Wales. Family doctors were asked to identify patients with any of the following: BMI > 30, type 2 diabetes, treated hypertension, ischemic heart disease. Participants applied the ApneaLink+O2 at home for a single night. The device recorded nasal flow and pulse oximetry. Data were analyzed by proprietary software, then checked and reported by either of two sleep physicians. 1,157 patients were recruited; mean age 53 ± 14.6, M/F% = 62/38, mean BMI = 31.8, obesity = 35%, diabetes = 16%, hypertension = 39%, IHD = 5%, Mean Epworth Sleepiness Scale score (ESS) = 8.3. The prevalence of unrecognized OSA was very high: 71% had an AHI > 5/h, 33% had an AHI > 15/h, and 16% had an AHI > 30/h. The ApneaLink+O2 device yielded technically adequate studies in 93% of cases. The study shows that a "real world" simple low cost case finding and management program, based on unattended home monitoring for OSA, can work well in a population with risk factors and comorbidities associated with OSA, independent of the presence of symptoms. The prevalence of unrecognized OSA was very high.

Neurophysiological Two-Channel Polysomnographic Device in the Diagnosis of Sleep Apnea

Our objective was to evaluate a portable device (Somté, Compumedics, Australia), which incorporates 2 neurophysiological channels (electroencephalography and electrooculography) with cardiorespiratory monitoring for the diagnosis of obstructive sleep apnea (OSA). Full polysomnography (PSG) and Somté recordings were simultaneously performed in 68 patients with suspected OSA. Data were analyzed blindly by 2 scorers. A good agreement between methods in sleep efficiency was observed (68.8% [18.4] with PSG vs 68% [19.1] with Somté [p: n.s.] for scorer 1, and 67.5% [19.1] vs 68.4% [18.5; p: n.s.] for scorer 2). The apnea-hypopnea index (AHI) obtained with Somté was lower than with PSG: 19 (17.8) vs 21.7 (19) (p < 0.001) for scorer 1, and 16.6 (16.7) vs 20 (18.8) (p < 0.001) for scorer 2. The sensitivity of Somté for a PSG-AHI > 5 was 91% for scorer 1 and 90% for scorer 2, while specificity was 77% and 90%, respectively. The areas under the receiver operating curve for different PSG-AHI cutoff points (≥ 5, ≥ 15, and ≥ 30) were 0.81, 0.90, and 0.86, respectively, for scorer 1, and 0.90, 0.88, and 0.83 for scorer 2. These data suggest that Somté is an effective device to identify sleep and respiratory variables in patients with suspected OSA.

Drug Trials for Obstructive Sleep Apnea

Drug Trials for Obstructive Sleep Apnea

Obstructive sleep apnea in patients with inflammatory myopathies

The purpose of this study was to determine the frequency of obstructive sleep apnea in patients with inflammatory myopathy. An observational and prospective study was performed on a cohort of adult patients with inflammatory myopathy followed at a specialized outpatient clinic. Sixteen consecutive adult patients were evaluated by the Epworth Sleepiness Scale (ESS) and by complete polysomnography study. Disease activity and severity were assessed using the Myositis Disease Activity Assessment Tool (MDAAT) and Myositis Damage Index (MDI), respectively. Associations between sleep parameters and other factors were calculated using the chi-square test, Fisher's exact test, Mann-Whitney U-test, and Wilcoxon's test. A serum autoantibody profile was determined for all patients. The mean apnea-hypopnea index was 28.7 (23.8), and 14 patients (87%) had an apnea-hypopnea index >5. The mean frequency of respiratory arousals was 20.1 (12.5). Eleven (68%) patients reported frequently-always snoring, and 3 (19%) had excessive daytime sleepiness (ESS >10). Seven patients were offered continuous positive airway pressure (CPAP) therapy; 4 tolerated the procedure well and reported a clear improvement in daytime sleepiness and/or sleep quality. No significant association was observed between the apnea-hypopnea index and clinical or immunological groups. Dysphagia, disease activity, and disease severity were not significantly associated with any sleep parameters. The frequency of obstructive sleep apnea in adult patients with inflammatory myopathy is high. The possibility that these alterations play a role in persistent fatigue in these patients cannot be ruled out.