AHI Severity Research Articles

Is obstructive sleep apnea syndrome a risk factor for floppy eyelid syndrome? A multicenter study

ABSTRACT Objective Evaluate the relationship between OSAS and floppy eyelid syndrome [FES], along with possible confounding factors such as gender, age, and BMI. Methods This was a multicenter, cross-sectional prospective study. Patients referred to the sleep clinic suspected of OSAS were included in the study. Polysomnography, ophthalmological examination, and standard sleep questionnaires were applied for all patients. Results A total of 617 patients, 68.4% of whom were men, with a mean age of 50.66 [±12.43] years were included. While FES was 70.2% in the group with OSAS for ≥5/h, OSAS was detected in 93.6% of the individuals with FES. In addition, a positive correlation was found between AHI and FES. Age and the male gender were independent risk factors for FES. Conclusion A direct relationship was found between FES and the severity of AHI and OSAS. However, there was no evidence that OSAS is an independent risk factor for FES.

78 The Effects of Hypertension and Obstructive Sleep Apnea on Auditory Learning and Memory in Veterans with PTSD Symptomology

Objective:Obstructive sleep apnea (OSA) has been associated with cognitive deficits as evidenced by neuropsychological testing in the domains of attention/working memory, verbal memory, processing speed, and executive function. OSA is often comorbid with hypertension and has been considered a risk factor for hypertension (Kareem et al., 2018; Tietjens et al., 2019). Both hypertension and OSA have been shown to be independent predictors of memory (Kinoshita et al., 2012). OSA and posttraumatic stress disorder (PTSD) are also frequently co-occurring, especially among veterans. In a group of veterans with a history of PTSD, we seek to explore the effects of sleep apnea and hypertension on cognitive functioning, particularly auditory learning/memory.Participants and Methods:One hundred and three male and female participants with comorbid OSA and PTSD symptomology were screened as part of a larger VA Palo Alto Health Care System study. Participants (age: x=56.3, a=13.8, 24-81 years; education: x=14.6, a=2.3, 8-20 years; 9.6% female, 89.6% male) completed a neuropsychological battery, including the CVLT-II and WMS-IV Logical Memory. Presence or absence of hypertension was dichotomously coded and AHI severity was categorically coded. An auditory learning/memory composite variable was created using the z-score transformation method (Dodge et al., 2020). Variables and covariates were entered into a hierarchical regression.Results:The initial regression model revealed hypertension and OSA severity to be independent predictors of performance on auditory learning/memory (hypertension: ß= -0.71, p<0.01; OSA: ß= -0.42, p<0.01), where presence of hypertension or increased severity of OSA resulted in worse performance on the auditory learning/memory composite.Conclusions:Results suggest that hypertension and OSA may independently and negatively affect performance on measures of auditory learning/memory in veterans with PTSD symptomology and OSA. Such findings underscore the importance of assessing and treating both hypertension and OSA among veterans with PTSD to improve not only physical health, but also cognitive health. Further research demonstrating similar findings is recommended along with studies investigating whether or not the treatment of hypertension and OSA can improve auditory learning/memory.

Comparing the diagnostic value of the positional obstructive sleep apnea definitions

Several definitions were proposed to diagnose Positional Obstructive Sleep Apnea (pOSA). However, the comparison between these definitions according to their diagnostic value is scarce in the literature. Thus, we decided to conduct this study to compare between the four criteria according to their diagnostic value. Between 2016 and 2022, 1092 sleep studies were performed at the sleep lab at the Jordan University Hospital. Patients who had an AHI <5 were excluded. pOSA was described according to the four definitions; Amsterdam Positional OSA Classification (APOC), supine AHI twice the non-supine AHI (Cartwright), Cartwright plus the non-supine AHI <5 (Mador), and overall AHI severity at least 1.4 times the non-supine severity (Overall/NS-AHI). Furthermore, 1033 polysomnographic sleep studies were retrospectively analyzed. The prevalence of pOSA according to the reference rule was 49.9% among our sample. The Overall/Non-Supine definition had the highest sensitivity, specificity, positive predictive value, and negative predictive value, which were 83.5%, 99.81%, 99.77%, and 85.88% respectively. The Overall/Non-Supine definition also had the highest accuracy among the four definitions (91.68%). Our study showed that all the criteria had a diagnostic accuracy above 50%, indicating that they were accurate in forming the diagnosis of pOSA. The Overall/Non-Supine criteria had the highest sensitivity, specificity, diagnostic odds ratio, and positive likelihood ratio as well as the lowest negative likelihood ratio, indicating the superiority of this criterion over the other definitions. Choosing the right criteria for diagnosing pOSA would result in fewer patients being assigned to CPAP and more being assigned to positional therapy methods.

Efficacy of obstructive sleep apnea treatment by antileukotriene receptor and surgery therapy in children with adenotonsillar hypertrophy: A descriptive and cohort study

BackgroundPrevalence of obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy is high and related to the occlusion of the upper airway. The main treatments of OSA in these children is adenotonsillectomy. However, this intervention is an invasive method with a various success rate. Thus, the indications of tonsillectomy remain debatable and non-invasive treatment is still a potential choice in these patients.MethodsIt was a cross-sectional and interventional study. This study included children aged from 2 to 12 years-old who were diagnosed with OSA by respiratory polygraphy and had tonsillar hypertrophy with/without adenoid hypertrophy. All main data including age, gender, height, weight, body mass index (BMI), clinical symptoms, and medical history were recorded for analysis. Physical examination and endoscopy were done to evaluate the size of tonsillar and adenoid hypertrophy by using Brodsky and Likert classifications, respectively. The severity of OSA was done by using the classification of AHI severity for children.ResultsThere were 114 patients (2–12 years old) with a mean age of 5.5 ± 2.1 years included in the present study. The main reasons for consultations were snoring (96.7%), a pause of breathing (57.1%), an effort to breathe (36.8%), unrefreshing sleep (32%), doziness (28.2%), and hyperactivity (26.3%). There were 36% of subjects with tonsillar hypertrophy grade 1–2, 48.2% with grade 3, and 15.8% with grade 4 (Brodsky classification); among them, there were 46.5% of subjects with grades 1–2 of adenoid hypertrophy, 45.6% with grade 3, and 7.0% with grade 4 (Likert classification). The mean AHI was 12.6 ± 11.2 event/h. There was a significant correlation between the mean AHI and the level of tonsillar and adenoid hypertrophy severity (r = 0.7601 and r = 0.7903; p < 0.05 and p < 0.05, respectively). The improvement of clinical symptoms of study subjects was found in both groups treated with ALR (antileukotriene receptor) or ST (surgery therapy). The symptoms related to OSA at night including snoring, struggle to breathe, sleeping with the mouth open, and stopping breathing during sleep were significantly improved after treatment with ATR and with ST (p < 0.001 and p = 0.001, respectively). The mean AHI was significantly reduced in comparison with before treatment in study subjects treated with ALR (0.9 ± 1.0 vs. 3.9 ± 2.7 events/h; p = 0.001) or with ST (3.5 ± 1.4 vs. 23.4 ± 13.1 events/h; p < 0.001).ConclusionThe treatment of OSA due to adeno-tonsillar hypertrophy with ALR for moderate OSA or surgery for severe OSA might reduce the symptoms related to OSA at night and during the day.

Association of Hypertriglyceridemic Waist Phenotype with Obstructive Sleep Apnea: A Cross-Sectional Study.

ObjectiveHypertriglyceridemic waist (HTGW) phenotype is an independent risk factor for metabolic disorders. Although obstructive sleep apnea (OSA) is associated with metabolic disorders, it is unclear whether there is an association between HTGW phenotype and OSA.MethodsWe enrolled consecutive participants presenting to a sleep center in Shanghai, China. Full-night polysomnography was performed, and serum triglyceride (TG) levels and waist circumference (WC) were calculated. HTGW phenotype was defined as increased WC (men > 90 cm, women > 80 cm) and elevated TG levels (> 1.7 mmol/L). Participants were classified into four groups: normal TG with normal WC (NTNW); normal TG with increased WC (NTGW); elevated TG with normal WC (HTNW); and elevated TG with enlarged WC, namely HTGW. The relationships between HTGW phenotypes and OSA were assessed using binary (apnea hypopnea index, [AHI]≥5/hr) and multinomial logistic regression analyses (clinical AHI severity categories).ResultsWe included 3190 participants in this cross-sectional study. Compared to the NTNW phenotype, participants with NTGW and HTGW phenotypes had the significantly higher risk of OSA (AHI ≥5/hr, odds ratio [OR] = 2.51, 95% confidence interval [CI] = 1.91–3.31; OR = 3.76, 95% CI = 2.67–5.31, respectively), after adjustment for confounders. In subgroup analyses categorised by age, sex, and BMI, the aforementioned associations remained significant. The association between the NTGW, HTGW phenotype and OSA risk remained significant across the OSA severity groups. Multinomial logistic regression also revealed that the mild (OR = 1.63, 95% CI = 1.07–2.50), moderate (OR = 1.875, 95% CI = 1.22–2.88), and severe OSA (OR = 3.18, 95% CI = 2.14–4.73) were associated with HTGW phenotype.ConclusionBoth NTGW and HTGW phenotype were positively associated with OSA risk in all subgroups. Further longitudinal follow-up studies are needed to determine the causal link and prognostic role of these metabolic factors.

Clinical Factors Associated with Very Severe Obstructive Sleep Apnea in Mongolian Patients: A Case-Control Study

Objectives: To determine risk factors and clinical characteristics of obstructive sleep apnea patients (OSA) according to the severity of the value of AHI ≥ 60 (Apnea-Hypopnea Index). Methods: A hospital-based, case-control study, December 2018 - 2020. Patients were grouped by severity of AHI as moderate, severe, and very severe. Results: Of 103 male cases, 52 were very severe obstructive sleep apnea (vsOSA). The control group consisted of 16 moderate OSA (mOSA) and 35 severe OSA (sOSA) patients. The case group consisted of 52 vsOSA patients. The average age was 48.7 ± 12.6. There was statistically significant increased body mass index (p &lt; 0.003), systolic blood pressure, and abdominal circumference (p &lt; 0.006) in the vsOSA group. Moreover, on polysomnography there was less deep sleep (p &lt; 0.004), a greater arousal index (p &lt; 0.000), higher apnea-hypopnea index (p &lt; 0.000), and higher night systole pressure (p &lt; 0.010). According to a bivariate analysis, abdominal circumferences were the variable with the closest association to the vsOSA group (crude OR: 9.14, p &gt; 0.004), followed by decreased maximum saturation of O2 (crude OR: 6.6, p &gt; 0.451). Conclusion: Of male OSA patients, 50.1% have vsOSA (AHI &gt; 60) and most of them were obese and suffered from high blood pressure. Lower levels of O2 saturation and increased abdominal and neck circumferences were significant risk factors for the very severe obstructive sleep apnea group.

Long-term All-Cause Mortality Risk in Obstructive Sleep Apnea Using Hypopneas Defined by a ≥3 Percent Oxygen Desaturation or Arousal.

Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3% O2 desaturation or arousal (AHI3%A). Data from 5591 Sleep Heart Health Study participants without prevalent cardiovascular disease at baseline who underwent polysomnography were analyzed regarding OSA diagnosed using the AHI3%A criteria and all-cause mortality over a mean follow up period of 10.9±3.2 years. There were 1050 deaths in this group during the follow-up period. A Kaplan-Meir plot of survival revealed a reduction in survival with increasing AHI severity. Cox proportional hazards regression models revealed significantly increased all-cause mortality risk with increasing AHI, hazard ratio (HR, 95% CI) 1.13 (1.04-1.23), after adjusting for age, sex, race, BMI, cholesterol, HDL, self-reported hypertension and/or diabetes and smoking status. In categorical models, the mortality risk was significantly higher with severe OSA [adjusted HR 1.38 (1.09-1.76)]. When stratified by gender or age, severe OSA was associated with increased risk of death in men [adjusted HR 1.14 (1.01-1.28)] and in those <70 years of age [adjusted HR 1.51 (1.02-2.26)]. In contrast, AHI severity was not associated with increased mortality in women or those ≥70 years of age in fully adjusted models. Severe AHI3%A OSA is associated with significantly increased mortality risk, especially in men and those <70 years of age.

Sleep disordered breathing from preschool to early adult age and its neurocognitive complications: A preliminary report.

ObjectiveThe onset and development of sleep disordered breathing (SDB) remains unclear in an age - dependent manner. Despite treatment, persistent symptoms such as snoring and excessive daytime sleepiness, as well as cognitive impairment may be present. The aim of the research was to determine the prevalence of residual symptoms of SDB in adolescence and early adulthood, the predisposing factors and its neurocognitive complications.MethodsIn the present pilot study-cohort, a questionnaire was utilized to 154 people (average age: 17.9 ± 3), who as children (mean age: 5.3 ± 1.4) had AHI ≥2.5 episodes/h. They were divided into two groups based on AHI = 5 episodes/h. Depending on the results, they were invited to undergo a repeated polysomnography (PSG) and complete the Montreal Cognitive Assessment (MoCA) test. Statistical analysis was made with IBM SPSS software.ResultsOut of the total, 35.7% claimed to still snore. AHI was negatively correlated to the severity of residual symptoms (Mann-Witney U test, p <0.005). According to repeated PSGs, 9/17 met the criteria for OSAS, while high BMI was associated with the severity of new AHI (chi squared test, p<0.005). Additionally, 7/16 scored below the MoCA baseline (<26/30). The characteristics of cognitive declines were mapped, with most prominent having been visuospatial, short - term memory and naming/language deficits.DiscussionA significant percentage of children with sleep breathing disorder present with residual symptoms during their transition to early adulthood, as well as undiagnosed neurocognitive complications. Clinicians suspicion for the underlying neurocognitive complications is required, even in young adults, while guidelines on monitoring pediatric OSAS patients after treatment should be addressed.

681 Sleep Apnea Severity and COVID-19 Hospitalization Outcomes: Interim Analysis

IntroductionMillions worldwide have been infected with COVID-19. Risk factors for poor outcomes include older age, obesity, cardiovascular disease, diabetes, COPD, and minority ethnicity. The impact of sleep apnea (OSA) on COVID-19 illness remains a topic of ongoing research. The association seems plausible as OSA shares common risk factors with COVID-19 comorbidities. The aim of our study is to investigate if the severity of OSA correlates with COVID-19 hospitalization outcomes.MethodsThe study is an observational retrospective electronic medical chart review of patients admitted to the Yale Health system for COVID-19 illness, who have an ICD medical history diagnosis of sleep apnea. Subjects with an available sleep study were grouped based on AHI severity. Composite outcome was determined by mortality or critical illness (ICU admission, mechanical ventilation, High-Flow nasal cannula or noninvasive ventilation). Interim analysis was conducted with data from 256 patients. Logistic regression was performed to calculate OR associated with the primary outcome comparing mild versus moderate-severe OSA groups.ResultsThe sample of 256 patients included 50% females, with a median age of 64 (IQR,55–73) and BMI of 36 (IQR,30–41). Race distribution composed of 45% Whites and 40% African-Americans with 18% identifying as Hispanic. Overall mortality rate was 16%. Median length of stay (LOS) was 9 days (IQR,5 -15). 155 patients had a recorded AHI with a median of 26/hour (IQR,11–51) grouped into mild (34%), moderate (20%) and severe (45%) disease. Severe sleep apnea had the highest mortality rate of 19% and median LOS of 10 days (IQR,5- 16) compared to moderate (6% mortality,9 days (IQR,6–14)) and mild (17% mortality,6 days (IQR,4–11)) disease; differences were not statistically significant. Univariate logistic regression analysis demonstrated no significant difference in the composite outcome for mild versus moderate-severe OSA groups (OR=1.2; 95% CI:0.58–2.32).ConclusionSevere OSA appeared to have a trend towards an association with higher mortality versus moderate but not mild disease. Comparing moderate-severe disease to a reference group of mild disease did not demonstrate a significant difference in our composite outcome of death or critical illness. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.Support (if any)N/A

OBSTRUCTIVE SLEEP APNEA IS AN INDEPENDENT PREDICTOR OF ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS

Objective: Studies have suggested an association between obstructive sleep apnea (OSA) and arterial stiffness. We aimed to further assess this relationship in hypertensive patients. Design and method: In all, 199 patients with hypertension (mean age 57 ± 11 years, 73 females, body mass index 27.9 ± 4.4 kg/m2, office blood pressure (BP) 147 ± 19/89 ± 11 mm Hg) referred for 24-h ambulatory blood pressure monitoring (ABPM, recordings every 20 min throughout) underwent simultaneous over-night polygraphic sleep recording (nasal airflow and finger pulse-oximetry). The number of apneas and hypopneas during sleep per hour were measured (apnea hypopnea index, AHI) as well as the burden of desaturation (oxygen desaturation index, ODI). From ABPM the ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of diastolic on systolic BP. Patients were divided into three groups according to their AHI; AHI &lt;5 (no OSA, n = 75), AHI 5&lt;15 (mild OSA, n = 69) and AHI &gt;15 (moderate/severe OSA, n = 44/11). Also 24-h pulse pressure (PP) was assessed as an indirect marker of arterial stiffness. Results: AASI increased with AHI severity: 0.39 ± 0.14, 0.44 ± 0.13, and 0.46 ± 0.13 in AHI&lt;5, 5&lt;15, and AHI &gt;15, respectively (p = 0.011, by ANOVA). In a multivariate regression model including age, sex, triglycerides (TG), AHI, 24-h systolic BP, 24-h mean heart rate (HR) and diabetes, all but sex, HR and diabetes remained independent predictors for AASI (age p &lt; 0.001, sex p = 0.086, TG p = 0.029, AHI p = 0.015, 24-h systolic BP p = 0.003, 24-h mean HR p = 0.064, diabetes p = 0.070 with R = 0.52, p &lt; 0.001 for full model). Using ODI instead of AHI yielded similar results, though HR was significant (p = 0.022), not TG (p = 0.057). In a similar regression model for describing 24-h PP (replacing 24-h systolic BP with 24-h mean arterial BP), neither AHI, nor ODI, remained independent predictors for 24-h PP. Conclusions: AASI, but not 24-h PP, is independently associated with both AHI and ODI in hypertensive patients together with 24-h systolic BP and age. TG also seems to be of importance in predicting AASI, probably through its association to glucose control. Ongoing work aims to further reveal the potential influence of OSA on arterial function in hypertensive patients.

Automatic Assessment of Pediatric Sleep Apnea Severity Using Overnight Oximetry and Convolutional Neural Networks.

In this study, we use the overnight blood oxygen saturation (SpO2) signal along with convolutional neural networks (CNN) for the automatic estimation of pediatric sleep apnea-hypopnea syndrome (SAHS) severity. The few preceding studies have focused on the application of conventional feature extraction methods to obtain information from the SpO2 signal, which may omit relevant data related to the illness. In contrast, deep learning techniques are able to automatically learn features from raw input signal. Thus, we propose to assess whether CNN, a deep learning algorithm, could automatically estimate the apnea-hypopnea index (AHÍ) from nocturnal oximetry to help establish pediatric SAHS presence and severity. A database of 746 SpO2 recordings is involved in the study. CNN was trained using 20-min segments from the SpO2 signal in the training set (400 subjects). Hyperparameters of the CNN architecture were tuned using a validation set (100 subjects). This model was applied to a test set (246 subjects), in which the final AHI of each patient was obtained as the average of the output of the CNN for all the segments of the corresponding SpO2 signal. The AHI estimated by the CNN showed a promising diagnostic performance, with 74.8%, 90.7%, and 95.1% accuracies for the common AHI severity thresholds of 1, 5, and 10 events per hour (e/h), respectively. Furthermore, this model reached 28.6, 32.9, and 120.0 positive likelihood ratios for the above-mentioned AHI thresholds. This suggests that the information extracted from the oximetry signal by deep learning techniques may be useful to both establish pediatric SAHS and its severity.

Obstructive sleep apnea and pulmonary hypertension: a bidirectional relationship.

Citation:Mesarwi O, Malhotra A. Obstructive sleep apnea and pulmonary hypertension: a bidirectional relationship. J Clin Sleep Med. 2020;16(8):1223–1224.

0695 Sleepwell24, A Smartphone Application To Promote PAP Therapy Adherence: Feasibility And Acceptability

Abstract Introduction We aimed to test the feasibility and acceptability of SleepWell24, a multicomponent, smartphone-delivered intervention to increase positive airway pressure (PAP) adherence among newly diagnosed OSA patients. Methods SleepWell24 targets PAP adherence along with other health behaviors through education, trouble-shooting, goal-setting, and near real-time biofeedback of PAP machine use, and sleep and physical activity levels (via Fitbit integration), and other chronic disease self-management components. Patients with a first-time diagnosis of OSA (AHI≥5) and prescribed PAP therapy were enrolled from the Centers for Sleep Medicine at Mayo Clinic in Rochester, MN and Phoenix, AZ. Patients were randomized to SleepWell24 or usual care (UC) and assessed for PAP use over 60 consecutive nights. UC patients received a Fitbit monitor to control for non-specific intervention effects related to the introduction of a new personal technology. Feasibility was assessed with recruitment and retention rates and acceptability was assessed post-intervention with the validated, 8-item Treatment Evaluation Questionnaire (TEQ; range:0-4). ANCOVA models, adjusting for age, sex, and AHI severity, compared intervention arms on acceptability ratings. Results OSA patients were consented and randomized (N=111). Before the intervention began 4 participants withdrew, 12 were lost to follow-up, and 5 could not start the trial due to durable medical equipment (DME) vendor barriers. Ninety OSA patients (n=41 SleepWell24, n=49 UC; age M±SD=57.2±12.2; 44.4% female, 61.1% AHI≥15) started the intervention, with 2 participants withdrawing, 1 becoming deceased (unrelated to treatment) and 7 with missing PAP data due to DME vendor barriers. There was no significant between-groups differences on post-treatment acceptability (SleepWell24 M±SD=2.7±1.1 vs. UC M±SD=3.1±0.9, F[1,73]=2.3, p=0.11), and 77% of SleepWell24 participants found the app to be moderately to totally acceptable. Conclusion Overall, SleepWell24 was found to be feasible for delivery in two large clinical sleep medicine centers, and patients found the app to be acceptable. A number of challenges in trial delivery were encountered that have implications for scaled-up efficacy testing: (a) partnerships with DME vendors for near real-time PAP data integration; (b) alignment with clinical practice (i.e., referral, medical record integration); and (c) patient engagement. Support National Institute of Nursing Research / National Institutes of Health: R21NR016046

0658 The Effect of Text Message Reminders on Positive Airway Pressure Adherence in Veterans With Obstructive Sleep Apnea

Abstract Introduction Adherence to positive airway pressure (PAP) therapy continues to be a challenge. The main objective of this study was to determine whether mobile text-message reminders increased PAP adherence in veterans with obstructive sleep apnea. Methods This is a retrospective study of 25 patients with poor adherence to PAP therapy who used the Veterans Affairs ANNIE app to receive nightly mobile text message reminders. PAP adherence was measured at baseline, 1,and 3 months. A one-way repeated measures ANOVA was used to compare the effect of time on PAP adherence, specifically the percentage of overall days used and percentage use &amp;gt;4 hours. A two-way repeated measures ANOVA without replication was used to determine the effects of AHI severity and time on PAP adherence. Results Our sample demographics included a mean age of 59 ±12 years, mean BMI of 33.5% ±5.4, and mean AHI of 26.3 ±25.4. The mean PAP overall percentage use and mean use &amp;gt;4 hours respectively were 32% ± 27 and 18% ± 19 at baseline, 66% ± 27 and 45% ± 30 at 1 month, and 54% ±32 and 37% ± 30 at 3 months. After three months of receiving nightly text-message reminders, there was a statistically significant effect of time on percentage overall PAP use, F (2, 48)=21.54, p=2.10E-07, as well as in the percentage PAP use &amp;gt;4 hours, F (2, 48)=22.05, p=1.61E-07. A two-way repeated measures ANOVA without replication yielded a main effect of the interaction of time with PAP adherence, F (2, 48)=22, p=&amp;lt;0.0001. AHI severity was not a significant factor. Conclusion Nightly text message reminders significantly improved PAP adherence from baseline to 3 months. Though PAP adherence was not optimal, it doubled initially in our sample. Further studies are warranted to determine how text-messages can be used long term to improve adherence. Support Nil

Long-term compliance to continuous positive airway pressure therapy in patients with severe sleep apnea syndrome

Background and Aim: Compliance is the adherence of the patient to continuous positive airway pressure (CPAP) therapy after his/her decision to start treatment. The aim of this study is to evaluate the compliance to CPAP therapy in a large patient population and the results were presented after 5 years of follow-up period in order to emphasize long-term compliance with CPAP treatment in the light of the literature. Materials and Methods: Patients who could not afford CPAP device or attend regular controls were excluded from the study and the remaining 174 patients were included in the study. At the end of 5 years, the patients were called back. A total of 110 patients met the eligibility criteria for the study110 patients (79 males, 31 females) whose charts were reviewed. Results: Fifty of 110 study participants (45.5%) regularly used CPAP device for ≥4 hours and the remaining 60 (54.5%) patients did not use CPAP device regularly. At the end of 5 years, we found that 36.4% of the patients used the device 4 hours a night. AHI severity does not affect adherence to the device and compliance rates (2=2.743; p=0.254). Conclusion: The patients compliance rates with CPAP device was found concord with the literature. This study conveys greater importance than other relevant studies in the literature in that it encompasses a larger patient population followed up for a longer period.

Outcomes in children with down syndrome and mild obstructive sleep apnea treated non-surgically.

Nasal steroids, oral anti-leukotrienes and supplemental oxygen are effective in the treatment of mild obstructive sleep apnea (OSA) in otherwise healthy children. However, their efficacy is unknown in children with Down syndrome (DS). Here we examine the effect of single medication therapy versus observation versus oxygen on polysomnographic outcomes in these children. We reviewed children (<18 years) diagnosed with DS and mild OSA (obstructive apnea-hypopnea index [oAHI] ≥1 to <5 events/hour) treated non-surgically (with supplemental oxygen, one medication, or observation) between 2012 and 2017. Demographic data, comorbid diagnoses, and pre- and posttreatment polysomnograms were analyzed. We assessed pre- and posttreatment oAHI, oxyhemoglobin saturation nadir, percent total sleep time (%TST) in rapid eye movement (REM), and end-tidal carbon dioxide (ETCO2 ) >50 mmHg. Twenty-four children met inclusion criteria; 10 treated with medication, one with oxygen, and 13 with observation (baseline oAHI was 3.5, 3.3, and 2.9 events/hour, respectively). There was no significant change in oAHI, oxyhemoglobin saturation nadir, ETCO2 , or percent TST in REM after treatment for any treatment group (P = .21-.94). There was no association between reported symptoms and AHI severity or change in AHI. OSA resolved in one patient treated with observation and two treated with medication, but worsened in two each in the medication and observation groups. Resolution of OSA occurred in 20% treated with medication, 7.7% with observation, and 0% with oxygen (P = .82). In our cohort, resolution of mild OSA was low. This suggests that consideration should be given to multimodality treatments in children with DS and mild OSA. Prospective studies will help establish effectiveness in this cohort. 4 Laryngoscope, 130:1828-1835, 2020.

Correlation of BMI and Neck circumference with severity of AHI in patients with Obstructive Sleep Apnea

Correlation of BMI and Neck circumference with severity of AHI in patients with Obstructive Sleep Apnea

WHEN OPEN GETS CLOSED: PHENOTYPIC CHARACTERISTICS OF SLEEP APNEA IN PATIENTS WITH NORMAL UPPER AIRWAY SIZE

SESSION TITLE: Original Research in OSA SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 07:30 AM - 08:30 AM PURPOSE: Obstructive sleep apnea is characterized by recurrent episodes of upper airway closure and has been typically associated with compromised upper airway space. However some adults with normal upper airway morphology also develop sleep apnea and this phenotype has not yet been adequately characterized. The aim of this study was to examine peculiarity of sleep apnea in a cohort of patients with normal upper airway morphology and size METHODS: This was a retrospective review from patients who underwent overnight diagnostic polysomnography. OSA was defined as AHI >5. Upper airway morphology was assessed by trained techs using Modified Friedman categorization and their classification was validated in an initial subset. Epworth scale ESS and other anthropometric variables such as neck circumference NC and BMI were also recorded. Respirattory arousal threshold ArTH was calculated from AHI, fraction of hypopneas and O2 nadir RESULTS: A total of 589 patients were included in the study 201 F and 388 M. 243 patients (41%) had a normal UA as defined as MF of 1 or 2. No age difference was seen between Normal UA and Small UA groups 55 +/- 13 vs 54 +/- 14. Gender and ethnicity distribution was not different– 45% of F and 39% of M had a normal UA (p >0.1) as did 43% of Hispanics & 38% of Caucasian. BMI was lower in the normal UA group 35 +/- 8 vs 37 +/- 7 p = 0.2 but NC was not different 16.9 +/- 4 vs 17.2 +/- 2; p= 0.2. ESS was not different between the two groups 10.4 +/- 6 vs 11.1 +/- 6. Sleep study showed lower AHI in normal UA group AHI 33 +/- 25 vs 39 +/- 28 in small UA group. REM AHI was the same in both groups 35 +/- 25 vs 35 +/- 26 & supine AHI was also lower in the normal UA group – 34 +/- 26 vs 40 +/- 29; p < 0..001. The normal UA group had less severe hypoxemia with O2 nadir 77 +/- 9 vs 75 +/- 11 and minutes spent below a sat 90% 37 +/- 47 vs 52 +/- 61 both being significantly lower p < 0.001. Patients with normal UA size had increased % of patients with low ArTH (ArTh >2) 47% vs 37%; p< 0.05. CPAP requirements were not different between normal UA and small UA 10.5 +/- 4 vs 11.2 +/- 4 CONCLUSIONS: Patients with OSA and normal upper airway size as assessed by MF scale have lower BMI, but similar neck size. There is no gender or ethnic bias. They have less severe sleep apnea with less supine AHI and less hypoxemia. They are more likely to have a low ArTH. Despite differences in airway size and AHI severity there was no difference in CPAP requirements in patient with normal UA size CLINICAL IMPLICATIONS: There is a significant percentage of patients with OSA who have normal upper airway assessment - identifying characteristics that place these patients at high risk for OSA will be useful in screening them appropriately. The significance of a low ArTH in this group is interesting and its physiologic basis needs to be explored as it may pave the way for more precision based therapeutic approaches in this group. DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response Speaker/Speaker's Bureau relationship with astra zeneca Please note: $5001 - $20000 Added 11/02/2017 by Shyamsunder Subramanian, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with boehringer ingelheim Please note: $5001 - $20000 Added 11/02/2017 by Shyamsunder Subramanian, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with genentech Please note: $5001 - $20000 Added 11/02/2017 by Shyamsunder Subramanian, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with teva Please note: $5001 - $20000 Added 03/02/2018 by Shyamsunder Subramanian, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with sunovion Please note: $1001 - $5000 Added 03/02/2018 by Shyamsunder Subramanian, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Sunovian Please note: $5001 - $20000 Added 11/20/2017 by Salim Surani, source=Web Response, value=Honoraria Advisory Committee Member relationship with Astra Zeneca Please note: $5001 - $20000 Added 11/20/2017 by Salim Surani, source=Web Response, value=Consulting fee No relevant relationships by Zoya Surani, source=Web Response No relevant relationships by Joseph Varon, source=Web Response

Relationship between upper airway volume and polysomnography parameters of patients with obstructive sleep apnea hypopnea syndrome

Objective:To study the relationship among upper airway volume of naso-pharyngeal, yelo-pharyngeal,glosso-pharyngeal, hypo-pharyngeal area which measured by spiral computed tomography three-dimensional reconstruction technique, apnea hypopnea indexes, and the lowest oxygen saturation in patients with OSAHS.Method:①fifty-one patients with OSAHS were received polysomnography, and then were divided into groups by the AHI,LSaO₂ values. ②To measure upper airway volume at normal breath and Müller maneuver state using spiral computed tomography three-dimensional reconstruction technique of CT measurement, and to calculate volume change rate and observe the upper airway compliance. ③To analyses the relationship between upper airway volume and AHI,LSaO₂ values.Result:The smallest upper airway volume of OSAHS was at the velo-pharyngeal level; the volume of velo-pharyngeal level were negatively correlated with AHI during normal respiration and Müller's maneuver state and were positively correlated with LSaO₂; the volume of hypo-pharyngeal were negatively correlated with AHI during normal respiration; the volume of glosso-pharyngeal were positively correlated with LSaO₂ during Müller's maneuver state.Conclusion:①The volume of velo-pharyngeal level with OSAHS patients can reflect the severity of AHI,LSaO₂. ②The measurement of upper airway volume using spiral computed tomography three-dimensional reconstruction technique is good method to evaluate the upper airway compliance of OSAHS patients.

A systematic comparison of factors that could impact treatment recommendations for patients with Positional Obstructive Sleep Apnea (POSA)

Objective/BackgroundSystematically compare four criteria for Positional Obstructive Sleep Apnea (POSA) based on AASM 2007 and 2012 hypopnea scoring definitions. Patients/Methods142 records acquired by in-home polysomnography (Sleep Profiler PSG2™) were retrospectively analyzed using AHI based on the American Academy Sleep Medicine 2007 and 2012 criteria (AHI2007 and AHI2012). Positional obstructive sleep apnea (POSA) was characterized using four criteria: Amsterdam Positional OSA Classification (APOC), supine AHI twice the non-supine AHI (Cartwright), Cartwright plus the non-supine AHI < 5 (Mador), and the overall AHI severity at least 1.4 times the non-supine severity (Overall/NS-AHI). ResultsCorrelations between the Cartwright and Overall/NS-AHI criteria increased with the inclusion of a more relaxed definition of hypopneas (AHI2007 = 0.79 and AHI2012 = 0.86, P < 0.00001). The prevalence of POSA based on the Cartwright and Overall/NS-AHI criteria was approximately 60% in those with at least mild OSA by AHI2007and AHI2012. A 16% reduction in POSA prevalence for AHI2012 vs. AHI2007 was attributed to the increased incident of mild OSA. For identification of those expected to have 25% or 35% reductions in SDB severity with positional therapy, Cartwright and Overall/NS-AHI exhibited the strongest sensitivity and Overall/NS-AHI and Mador the best specificity. ConclusionsThe four criteria used to identify POSA have similarities and differences. While there were similarities between the Cartwright and Overall/NS-AHI criteria in the detection of POSA prevalence across both scoring criteria, the Overall/NS-AHI provided the most consistent detection of those most likely to demonstrate important reductions in sleep disordered breathing severity if supine sleep is avoided.