Apnea Group Research Articles

Pediatric sleep apnea and depressive disorders risk: A population-based 15-year retrospective cohort study.

BackgroundStudies have shown a higher risk of depressive disorders in children with sleep apnea than in those without sleep apnea. However, the association between sleep apnea and subsequent depressive disorders in the pediatric population remains undetermined. Thus, this study investigated the risk of depressive disorders among pediatric patients with sleep apnea.MethodsIn this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients who had first been diagnosed with sleep apnea between 1999 and 2013. Patients with sleep apnea who were younger than 18 years were included in the sleep apnea group. Controls (those without sleep apnea) were matched to patients with sleep apnea at a 1:10 ratio by age, sex, and index year. Patients who had baseline or inherited depressive disorders before the enrollment date were excluded. The two groups were followed up until December 31, 2013. The primary endpoint was the occurrence of one or more depressive disorders.ResultsAt the end of this study, 6,237 children had been enrolled, comprising 567 children with sleep apnea and 5,670 children without sleep apnea. During the mean follow-up period of 5.87 years, a total of 77 children (1.23%) developed one or more depressive disorders; 14 (2.46%) from the sleep apnea group and 63 (1.11%) from the control group. Kaplan–Meier analysis showed that children with sleep apnea had a significantly higher risk of depressive disorders (log-rank test, p = 0.002). After adjusting for covariates, the risk of subsequent depressive disorders among children with sleep apnea was still significantly higher (hazard ratio [HR] = 2.25; 95% confidence interval [CI] = 1.25–4.05; p = 0.006). Moreover, boys with sleep apnea had a significantly higher risk than those without sleep apnea (adjusted HR = 3.77; 95% CI, 1.82–7.54; p < 0.001). Furthermore, in sleep apnea group, children older than 12 years of age had more risk to depression (hazard ratio (HR) = 7.1833, 95% confidence interval (CI), 2.3734 to 21.7411; p = 0.0004).ConclusionsThis study found a significantly higher subsequent risk of depressive disorders in children with sleep apnea, particularly boys and those older than 12 years of age. The study findings strongly suggest that clinicians should provide psychological evaluation and supportive care for children with sleep apnea, in addition to medical treatment.

Evaluation of the association between sleep apnea and polyunsaturated fatty acids profiles in patients after percutaneous coronary intervention.

The long-term outcome is poor in patients with sleep apnea and cardiovascular disease. Polyunsaturated fatty acid (PUFA) is also known as an independent predictor for adverse clinical events. However, the profile of PUFA in sleep apnea patients with coronary artery disease (CAD) is still unclear. This study aimed to clarify the association between sleep apnea and PUFA profiles in patients with CAD. Two hundred seventy-four consecutive patients undergoing percutaneous coronary intervention (PCI) were screened for sleep apnea using nocturnal oximetry. Oxygen desaturation index down to 4% (4%ODI) ≥5 was used as an indicator of sleep apnea. Baseline characteristics, including PUFA profiles, were compared between patients with and without sleep apnea. Among 243 enrolled patients, 134 (55%) had sleep apnea. The sleep apnea group included a significantly higher rate of patients with obesity, insulin-requiring diabetes, peripheral artery disease (PAD), and a higher C-reactive protein level than the non-sleep apnea group. The sleep apnea group had a significantly lower eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio than the non-sleep apnea group (0.33 vs. 0.44, respectively, p=0.024). Additionally, EPA value and EPA/AA ratio were significantly correlated with 4%ODI (r=-0.15, p=0.028; r=-0.16, p=0.019, respectively). Results of logistic regression analysis indicated that the comorbidities of obesity, PAD, heart failure and EPA/AA ratio had a significant association with sleep apnea. Our results suggested that patients with sleep apnea who underwent PCI had a lower EPA/AA ratio than those without sleep apnea, and EPA value and EPA/AA ratio were significantly correlated with 4%ODI.

Influence of Obstructive Sleep Apnea Syndrome and Sleep Variables on Cognitive Performance and Psychological Distress in Severely Obese Patients

&lt;p&gt;&lt;em&gt;We examined the presence of the Obstructive Sleep Apnea Syndrome (OSAS) and explored associations/correlations between sleep variables, anthropometric measures, cognitive performance, and psychological distress in severely obese patients. We also sought to verify the relationship between the Cognitive Reserve (CR) and the OSAS.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;Sixty-one patients who required treatment for severe obesity performed a neuropsychological evaluation and an overnight polysomnography.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;Most of the patients were female in the age group of 50 years. The incidence of the OSAS defined by Apnea-Hypopnea Index (AHI) was 65.6%. The Severe Apnea group was the biggest, with a statistically significant number of males, significantly higher anthropometric measures,&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;and with a higher percentage of patients with low CR than the other groups&lt;/em&gt;&lt;em&gt;. Cognitive performance was significantly affected by sleep parameters, sleep efficiency and REM sleep duration. Great daytime sleepiness and cognitive complaints were correlated with distress symptoms. The female gender, advanced age, the highest weight, daytime sleepiness, hypertension, and oxygen saturation significantly contributed to the onset of the OSAS.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;The incidence of the OSAS is higher in severely obese patients. Anthropometric measures, cognitive performance, and psychological distress symptoms are influenced by sleep parameters and sleep efficiency. There is a&lt;/em&gt;&lt;em&gt; high percentage of patients with Severe Apnea and low CR.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;em&gt;&lt;/em&gt;&lt;em&gt;&lt;/em&gt;

0042 PERFORMANCE OF ADHESIVE WIRELESS PATCH SENSOR FOR SCREENING OF SLEEP ARCHITECTURE IN NORMAL AND APNEA

Sleep is a renowned marker of health. One in three adults endure sleep disorders with out diagnosis due to lack of effective sleep screening technology. The study presents clinical validation of VitalPatch®, a wireless adhesive medical device for screening of sleep architecture in normal and apnea compared to the Polysomnography (PSG). 45 volunteers (male/female: 24/21; 42 ± 13 years) were recruited for an overnight PSG study, and attached to 22-channel PSG and a VitalPatch sensor on chest. Simultaneous PSG and patch data were acquired wirelessly during overnight. PSG recordings were scored to obtain 5-stage sleep architecture and apnea-hypopnea index (AHI) per AASM guidelines. Based on PSG’s AHI values, the study population was grouped into normal (28), mild apnea (10) and moderate apnea (7). The statistical differences in sleep patterns among 3 groups were assessed using PSG sleep metrics. 3-class hypnograms with wake, non-rapid eye movement (NREM) and REM stages were further derived using VitalPatch recordings and calculated their respective sleep metrics. Performance analyses of VitalPatch’s sleep assessment were carried out compared to the PSG. PSG revealed significant decrease in total REM time (P=0.032) and increase in latency to REM (P=0.005) in apnea than normal. Latency to NREM and wake after sleep onset (WASO) were increased in apnea (P=0.063 and P=0.072, respectively). The accuracy and Cohen’s kappa of sleep stage prediction using VitalPatch compared to the PSG were (82.4 ± 8.2, 79.2 ± 4.3 and 72.2 ± 10.0 in %) and (0.57 ± 0.16, 0.54 ± 0.09 and 0.39 ± 0.25), respectively in normal, mild apnea and moderate apnea groups. VitalPatch’s total sleep time, total NREM time and total REM time had highest correlation (R) of 0.93, 0.86 and 0.72 with PSG respectively in normal and relatively lower in apnea groups. WASO was highly correlated to PSG in moderate apnea (0.67) compared to normal (0.47), as the number awakenings and wake duration after sleep onset were higher in apnea than normal. The study validates good performance of adhesive wireless VitalPatch sensor for sleep staging in normal and apnea compared to the PSG. The unobtrusive disposable patch sensor can be valuable for widespread clinical screening of sleep architecture. None.

Atrial electrophysiological and molecular remodelling induced by obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) affects 9–24% of the adult population. OSA is associated with atrial disease, including atrial enlargement, fibrosis and arrhythmias. Despite the link between OSA and cardiac disease, the molecular changes in the heart which occur with OSA remain elusive. To study OSA‐induced cardiac changes, we utilized a recently developed rat model which closely recapitulates the characteristics of OSA. Male Sprague Dawley rats, aged 50–70 days, received surgically implanted tracheal balloons which were inflated to cause transient airway obstructions. Rats were given 60 apnoeas per hour of either 13 sec. (moderate apnoea) or 23 sec. (severe apnoea), 8 hrs per day for 2 weeks. Controls received implants, but no inflations were made. Pulse oximetry measurements were taken at regular intervals, and post‐apnoea ECGs were recorded. Rats had longer P wave durations and increased T wave amplitudes following chronic OSA. Proteomic analysis of the atrial tissue homogenates revealed that three of the nine enzymes in glycolysis, and two proteins related to oxidative phosphorylation, were down regulated in the severe apnoea group. Several sarcomeric and pro‐hypertrophic proteins were also up regulated with OSA. Chronic OSA causes proteins changes in the atria which suggest impairment of energy metabolism and enhancement of hypertrophy.

The effect of fluid overload on sleep apnoea severity in haemodialysis patients.

As in heart failure, obstructive and central sleep apnoea (OSA and CSA, respectively) are common in end-stage renal disease. Fluid overload characterises end-stage renal disease and heart failure, and in heart failure plays a role in the pathogenesis of OSA and CSA. We postulated that in end-stage renal disease patients, those with sleep apnoea would have greater fluid volume overload than those without.End-stage renal disease patients on thrice-weekly haemodialysis underwent overnight polysomnography on a nondialysis day to determine their apnoea-hypopnoea index (AHI). Extracellular fluid volume of the total body, neck, thorax and right leg were measured using bioelectrical impedance.28 patients had an AHI ≥15 (sleep apnoea group; OSA:CSA 21:7) and 12 had an AHI <15 (no sleep apnoea group). Total body extracellular fluid volume was 2.6 L greater in the sleep apnoea group than in the no sleep apnoea group (p=0.006). Neck, thorax, and leg fluid volumes were also greater in the sleep apnoea than the no sleep apnoea group (p<0.05), despite no difference in body mass index (p=0.165).These findings support a role for fluid overload in the pathogenesis of both OSA and CSA in end-stage renal disease.

Prevalence of M75 Streptococcus pyogenes Strains Harboring slaA Gene in Patients Affected by Pediatric Obstructive Sleep Apnea Syndrome in Central Italy.

Recently we reported an association between pediatric obstructive sleep apnea syndrome (OSAS) and Group A streptococcus (GAS) sub-acute chronic tonsil colonization. We showed that GAS may contribute to tonsil hyperplasia via a streptolysin O (SLO)-dependent cysteinyl leukotrienes (CysLTs) production, which can trigger T and B cell proliferation. In the present study, we characterized the GAS strains isolated from pediatric OSAS patients in comparison with a panel of age and sex matched GAS strains unrelated to OSAS, but isolated in the same area and during the same period ranging from 2009 to 2013. We found that slaA gene, previously reported to be associated to CysLTs production pathway, was significantly associated to GAS OSAS strains. Moreover, the most numerous group (32%) of the GAS OSAS strains belonged to M75 type, and 6 out of 7 of these strains harbored the slaA gene. Multilocus Sequence Typing (MLST) experiments demonstrated that the clone emm75/ST49/ smeZ, slaA was associated to OSAS cases. In conclusion, we found an association between slaA gene and the GAS OSAS strains, and we showed that the clone emm75/ST49 harboring genes smeZ and slaA was exclusively isolated from patients affected by OSAS, thus suggesting that this genotype might be associated to the pathogenesis of OSAS, although further studies are needed to elucidate the possible role of SlaA in tonsil hypertrophy development.

Effects of Breathing and Apnoea during Sustained Inflations in Resuscitation of Preterm Infants

Background: A sustained inflation (SI) at birth in preterm babies may be ineffective unless the infants breathe. Gain in lung volume is associated with breathing during delivery room non-invasive management. Objective: To describe the breathing patterns of preterm infants during an SI and correlate to a calculated gain in lung volume. Methods: Retrospective observational study. Data collected from a respiratory function monitor during SI (25 cmH₂O for 15 s then PEEP at 5 cmH₂O) through a face mask in preterm infants (gestational age [GA] ≤31 weeks). Spontaneous breaths, inspiratory time (TI), inspiratory/expiratory tidal volume (Vti/Vte), and gain in lung volume were determined. Results: 30 SIs in 20 infants (mean GA 27 weeks; birth weight 825 g) were analysed and stratified in 2 groups according to spontaneous breathing: SIs without spontaneous breaths (apnoea: n = 11) and SIs with spontaneous breaths (breathing: n = 19). Mean GA was lower in the apnoea group versus the breathing group (25 vs. 27⁺⁵ weeks; p = 0.01). Mean birth weight was lower in the apnoea group versus the breathing group (683 vs. 860 g; p = ns). In the breathing group, the mean number of spontaneous breaths was 4 with a mean TI of 0.52 min, the mean Vti/kg was 5.9 mL/kg, and the mean Vt_e was 2.7 mL/kg. The calculated mean gain in lung volume was 7.5 mL/kg in the apnoea group and 17.8 mL/kg in the breathing group (p = 0.039). Conclusions: Actively breathing infants during an SI at birth showed a gain in lung volume higher than apnoeic infants. Spontaneous breathing during SI seems to be related to GA.

The deterioration of driving performance over time in drivers with untreated sleep apnea

Sleep apnea increases risk of driving crashes when left untreated. This study examined the driving performance decrements of untreated, undiagnosed sleep apnea drivers compared with healthy controls in a monotonous highway driving simulator task. It was hypothesized that the sleep apnea group would perform worse during a driving simulator test compared with the control group. A significant group by time interaction occurred indicating that sleep apnea participants’ performance degraded more quickly over the course of the drive. In contrast with previous studies, this sleep apnea group did not include sleep disorder center patients, but rather community volunteers whose screening indicated a significant apnea/hypopnea index of 15 or greater. There may be inherent differences between patients and nonpatients with sleep apnea, as patients may have a more significant impact on their quality of life, causing them to seek treatment. Still, the results are clear that although the sleep apnea group drove similarly to the control group at the start of the drive, they are sensitive to time on task effects. These results support the need to diagnose and treat sleep apnea.

Evaluation of the Role of Palatal Tonsil Hypertrophy in Sleep Apnea Patients: Cephalometric Analysis

The purpose of this research was to elucidate the relationship between tonsillar hypertrophy and Obstructive Sleep Apnea Syndrome (OSAS) in terms of cephalometric analysis, as well as to determine factors that affect OSAS severity. 25 patients were enrolled in this study. Lateral cephalograms of the subjects were taken. Disease severity was evaluated by the Apnea Hypopnea Index (AHI). Cephalometric measurements (angle between line S-N and line N-A (SNA), angle between line S-N and line N-B (SNB), distance between the Mandibular Plane and the Hyoid (MPH), posterior airway space, the width of the airway behind the base of tongue along the B-Go line (PAS), upper airway space, the distance parallel to long axis of the airway, between a horizontal plane tangent to the superior aspect of the hyoid and a horizontal plane tangent to the posterior palate (UAL), multiplication of PAS and UAL (PAS × UAL)) were analyzed and compared between the groups with and without tonsillar hypertrophy. PAS and PAS × UAL were lower in the no hypertrophy group. SNB was significantly lower in the severe apnea group than mild to moderate group in no hypertrophy group (p = 0.035). In conclusion, patients with tonsillar hypertrophy had severe obstruction, but they had a relatively larger pharyngeal space on cephalometric analysis. After exclusion of the tonsillar hypertrophy group, cephalometric analysis could be more effective for analyzing OSAS severity.

Systemic prostacyclin and thromboxane production in obstructive sleep apnea

PurposeObstructive sleep apnea increases the risk of cardiovascular diseases. Alternations in prostacyclin and thromboxane concentrations and balance could constitute one of mechanisms linking sleep apnea and cardiovascular events. Thus we aimed to assess the concentrations of 6-keto-prostaglandin F1α (6-keto-PGF1α) (metabolite of prostacyclin) and thromboxane B2 (TXB2) (metabolite of thromboxane A2) in urine and blood of obstructive sleep apnea patients and controls (snoring subjects with otherwise normal polysomnogram). Material and methodsOvernight urine and morning blood samples were taken from subjects and controls at baseline and in sleep apnea group during continuous positive airway pressure (CPAP) treatment. Samples were analyzed using mass chromatography/gas spectrometry. ResultsWe analyzed data from 26 obstructive sleep apnea subjects (mean apnea–hypopnea index 45.4±17.3) and 22 well-matched controls. At baseline sleep apnea patients, when compared to controls, have higher 6-keto-PGF1α in urine (0.89±0.15 vs 0.34±0.06, p=0.01) and blood (24.49±1.54 vs 19.70±1.77, p=0.04). TXB2 levels in urine and blood were not different across groups. CPAP treatment significantly decreased 6-keto-PGF1α in urine (0.92±0.17 vs 0.22±0.10, p=0.04), but not in blood. TXB2 levels during CPAP treatment did not change significantly. ConclusionsThese results suggest augmented systemic prostacyclin production in obstructive sleep apnea patients, which potentially could constitute a protective mechanism against detrimental effects of sleep apnea.

Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting

PurposeNew-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) remains a prevalent problem. We investigated the relationship between sleep apnea and new-onset post-CABG AF during inhospital stay. Materials and methodsWe prospectively recruited 171 patients listed for an elective CABG for an overnight sleep study. Sleep apnea was defined as apnea-hypopnea index greater than or equal to 5. ResultsAmong the 160 patients who completed the study, those in the sleep apnea group (n = 128; 80%) had larger left atrial diameter (40.4 ± 5.4 vs 38.4 ± 6.0 mm; P = .03) and left ventricular end-diastolic dimension (52.6 ± 7.9 vs 49.2 ± 6.8 mm; P = .03) than those in the non–sleep apnea group. The incidence of new-onset post-CABG AF was higher for the sleep apnea than non–sleep apnea groups (24.8% vs 9.7%; P = .07). There was 1 inhospital death and 2 patients with acute renal failure requiring dialysis after CABG in the sleep apnea group. None of the patients developed inhospital stroke. Multiple logistic regression analysis showed that sleep apnea was an independent predictor of post-CABG AF (odds ratio, 4.4; 95% confidence interval, 1.1-18.1; P = .04). ConclusionSleep apnea is prevalent in patients undergoing CABG. It increases the susceptibility to new-onset AF after CABG, probably related to atrial and ventricular remodeling.

Choking during sleep: can it be expression of arousal disorder?

BackgroundChoking during sleep may be caused by various respiratory and non-respiratory problems. ObjectiveWe aimed at documenting a new, rare cause of hallucinatory choking. MethodsWe documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea. ResultsThe 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. The patients consistently reported a frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, or gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious. ConclusionAlthough insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be a rare, specialized variant of the arousal disorders in some cases.

Effect of obstructive sleep apnoea on severity and short-term prognosis of acute coronary syndrome.

The goal of this study was to evaluate the influence of obstructive sleep apnoea on the severity and short-term prognosis of patients admitted for acute coronary syndrome. Obstructive sleep apnoea was defined as an apnoea-hypopnoea index (AHI) >15 h(-1). We evaluated the acute coronary syndrome severity (ejection fraction, Killip class, number of diseased vessels, and plasma peak troponin) and short-term prognosis (length of hospitalisation, complications and mortality). We included 213 patients with obstructive sleep apnoea (mean±sd AHI 30±14 h(-1), 61±10 years, 80% males) and 218 controls (AHI 6±4 h(-1), 57±12 years, 82% males). Patients with obstructive sleep apnoea exhibited a higher prevalence of systemic hypertension (55% versus 37%, p<0.001), higher body mass index (29±4 kg·m(-2) versus 26±4 kg·m(-2), p<0.001), and lower percentage of smokers (61% versus 71%, p=0.04). After adjusting for smoking, age, body mass index and hypertension, the plasma peak troponin levels were significantly elevated in the obstructive sleep apnoea group (831±908 ng·L(-1) versus 987±884 ng·L(-1), p=0.03) and higher AHI severity was associated with an increased number of diseased vessels (p=0.04). The mean length of stay in the coronary care unit was higher in the obstructive sleep apnoea group (p=0.03). This study indicates that obstructive sleep apnoea is related to an increase in the peak plasma troponin levels, number of diseased vessels, and length of stay in the coronary care unit.

Induced apnea enhances image quality and visualization of cardiopulmonary anatomic during contrastenhanced cardiac computerized tomographic angiography in children.

Objective:The purpose of our study was to determine the effect of induced apnea on quality of cardiopulmonary structures during computerized tomographic (CT) angiography images in children with congenital heart diseases.Methods:Pediatric patients with congenital heart defects undergoing cardiac CT angiography at our facility in the past 3 years participated in this study. The earlier patients underwent cardiac CT angiography without induced apnea and while, later, apnea was induced in patients, which was followed by electrocardiogram gated cardiac CT angiography. General anesthesia was induced using sleep dose of intravenous propofol. After the initial check CT, on request by the radiologist, apnea was induced by the anesthesiologist by administering 1 mg/kg of intravenous suxamethonium. Soon after apnea ensued, the contrast was injected, and CT angiogram carried out. CT images in the “apnea group” were compared with those in “nonapnea group.” After the completion of the procedure, the patients were mask ventilated with 100% oxygen till the spontaneous ventilation was restored.Results:We studied 46 patients, of whom 36 with apnea and yet another 10 without. The quality of the image, visualization of structures such as cardiac wall, outflow tracts, lung field, aortopulmonary shunts, and coronary arteries were analyzed and subjected to statistical analysis (Mann–Whitney U, Fischer's exact test and Pearson's Chi-square test). In the induced apnea group, overall image quality was considered excellent in 89% (n = 33) of the studies, while in the “no apnea group,” only 30% of studies were excellent. Absent or minimal motion artifacts were seen in a majority of the studies in apnea group (94%). In the nonapnea group, the respiratory and body motion artifacts were severe in 50%, moderate in 30%, and minimal in 20%, but they were significantly lesser in the apnea group. All the studied parameters were statistically significant in the apnea group in contrast to nonapnea group (P < 0.000).Conclusion:The image quality of cardiac CT angiography greatly improves, and motion artifact significantly decreases with the use of induced apnea in pediatrics patients being evaluated for congenital heart disease. This technique poses no additional morbidity of significance.

Electrocardiographic characteristics of children with obstructive sleep apnea in a tertiary health center in Kano

Background: Obstructive sleep apnea in children may be associated with cardiovascular complications and these may be identifiable on the electrocardiogram. Some of those changes seen in adults include ventricular hypertrophy and arrhythmias; however the exact prevalence of these in children is not known. Therefore, this study seeks to characterize the electrocardiographic features in children with obstructive sleep apnea. Materials and Methods: This study reviewed 43 electrocardiograms (ECGs) of children clinically diagnosed with obstructive sleep apnea (OSAS) aged 4-14 years; their ECG parameters were compared with 43 apparently healthy controls matched for age and sex. Results: There were 21 males and 22 females with male to female ratio of 1:1. The PR interval and QRS duration were higher in the obstructive sleep apnea group in the 4-9-year age group except for the QRS and P-wave axes. While in the 10-14-year-old age group lower values in the QRS axis, PR interval, QRS duration, and T-wave axis were recorded in those with obstructive sleep apnea; however, these were not statistically significant. The mean R- and S-waves amplitude in V 4 R, V 2 , V 5 and V 6 though higher in the obstructive sleep apnea group, but were not statistically significant. Premature ventricular complex was identified in only one of the subjects, phasic sinus arrhythmia in three of the subjects, and two ECGs had premature junctional complexes. T-wave inversion involving precordial leads V 4 R to V 3 was most predominant in all the age groups Conclusion: The ECG characteristics of children with OSAS in this study were comparable to previous report in children and the prevalence of arrhythmia was also low.

Obstructive Sleep Apnea during Pregnancy and the Morbidity Outcome

Obstructive Sleep Apnea during Pregnancy and the Morbidity Outcome Background: There is an increasing concern that obstructive sleep apnea is a risk factor of a poor pregnancy outcome. Our research design used polysomnography, which gives an objective measurement in defining obstructive sleep apnea in non-high risk pregnancy. This study was carried out to measure the prevalence of obstructive sleep apnea in pregnancy and show whether obstructive sleep apnea is a risk factor of poor pregnancy outcome. Methods: A prospective cohort study had been carried out at Chiang Mai University Hospital. 50 pregnancy women who received antenatal care at Chiang-Mai University hospital were included in the study. All subjects were assessed by physical examination and polysomnography at GA 28th-32nd weeks and were followed until the end of the pregnancy to see the difference in poor pregnancy outcomes in the obstructive sleep apnea and non-obstructive sleep apnea group. Results: The prevalence of obstructive sleep apnea in pregnancy was 12%. Obstructive sleep apnea related to overall more poor pregnancy outcomes (RR=7.33(2.45-21.86), p=0.004), more preterm labor (RR=22.0(2.70-178.99), p-0.004), more preeclampsia (p=0.012). Conclusions: Obstructive sleep apnea was a high risk in pregnancy and should be screened for with multidisciplinary team cooperation, to establish the diagnosis and treatment to enhance maternal and child health

P292 Validation Of The Stop-bang Questionnaire As A Screening Tool For Sleep Apnoea In Patients Undergoing Ablation For Paroxysmal Atrial Fibrillation

Background Patients with treated obstructive sleep apnoea have a greater chance of treatment success compared to those untreated, when undergoing ablation for atrial fibrillation (AF) (Patel et al 2010). The STOP-BANG questionnaire has previously been validated as a screening tool for detecting sleep apnoea in surgical patients (Chung et al 2008), but has not been validated for use in AF patients. We present the results from a study investigating its predictive value in AF patients. Methods Patients with paroxysmal AF undergoing ablation were approached. Those with previously diagnosed sleep apnoea were excluded. Participants completed the STOP-BANG questionnaire and underwent overnight oximetry. Of 228 patients approached, 101 participated. Sleep apnoea was defined as a 4% desaturation index of >5 per hour, and participants were reviewed by an experienced sleep physician to determine if treatment with continuous positive airway pressure (CPAP) was necessary. Results Of the 101 patients screened, 36 had sleep apnoea, and 13 were offered treatment with CPAP. The STOP-BANG questionnaire (with a cut off of 3 or more out of 8 questions answered positively considered ‘high risk’) had a sensitivity of 97.2% and a specificity of 43.1% for detecting sleep apnoea in this group. The STOP questions alone (with a cut off of 2 or more out of 4 considered ‘high risk’) had a sensitivity of 75.0% and a specificity of 63.1%, however the sensitivity was 100% and specificity 56.8% for predicting the need for CPAP. Conclusion There is a high prevalence of undiagnosed sleep apnoea in this patient group. The STOP-BANG questionnaire has a high sensitivity for detecting sleep apnoea in AF patients. The STOP questions alone have a high sensitivity for detecting sleep apnoea requiring treatment. References Patel D, Mohanty P, Di Biase L, et al . Circ Arrhythm Electrophysiol. 2010 Oct;3(5):445-51 Chung F, Yegneswaran B, Liao P, et al . Anesthesiology. 2008 May;108(5):812-21

Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome

BackgroundSleep disorders are a group of disorders characterized by abnormalities of respiration during sleep. OSA (Obstructive Sleep Apnea) is characterized by the repetitive episodes of complete or partial collapse of the upper airway during sleep, causing a cessation or a significant reduction of airflow. MethodThe study population consisted of 30 control patients (AHI ≤ 5) events per hour, 74 patients with OSAS, including 34 Obese (BMI ≥ 27) and 40 non-obese (BMI ≤ 27). Polysomnography and measurements of 21 cephalometric variables were carried out for all patients with OSAS. ResultsObese patient with OSAS showed significant difference in following cephalometric parameters: (1) PAS (2) MPT (3) MPH (4) PNS-P (5) SAS. In addition, obese patient had longer tongue (TGL), more anteriorly displaced hyoid bones (H-VL) and more anterior displacement of mandible (G-VL) when compared with control groups. The findings of non-obese patients when compared to controls showed all the findings of obese patients and in addition to that narrow bony oropharynx were significant. Step wise regression analysis showed the significant predictors for all patients were MPH, PNS-P, bony nasopharynx (PNSBa), MPT, and palatal length (ANS-PNS) for AHI. The significant predictors for obese OSA (obstructive sleep apnea) group were MAS while for non-obese OSA group ANS-PNS was significant predictor for AHI (apnea-hypopnea index). ConclusionCraniofacial landmarks such as increase in hyoid distance, longer tongue and soft palate with increased thickness and narrowing of superior pharyngeal, oropharyngeal and hypopharyngeal airway space may be important risk factors for development of OSAS.

Automated prediction of the apnea-hypopnea index using a wireless patch sensor.

Polysomnography (PSG) is the gold standard that manually quantifies the apnea-hypopnea index (AHI) to assess the severity of sleep apnea syndrome (SAS). This study presents an algorithm that automatically estimates the AHI value using a disposable HealthPatch(TM) sensor. Volunteers (n=53, AHI: 0.1-85.8) participated in an overnight PSG study with patch sensors attached to their chest at three specified locations and data were wirelessly acquired. Features were computed for 150-second epochs of patch sensor data using analyses of heart rate variability, respiratory signals, posture and movements. Linear Support Vector Machine classifier was trained to detect the presence/absence of apnea/hypopnea events for each epoch. The number of epochs identified with events was subsequently mapped to AHI values using quadratic regression analysis. The classifier and regression models were optimized to minimize the mean-square error of AHI based on leave-one-out cross-validation. Comparison of predicted and reference AHI values resulted in linear correlation coefficients of 0.87, 0.88 and 0.92 for the three locations, respectively. The predicted AHI values were subsequently used to classify the control-to-mild apnea group (AHI<;15) and moderate-to-severe apnea (AHI≥15) with an accuracy (95% confidence intervals) of 89.4% (77.4-95.4%), 85.0% (70.9-92.9%), and 82.9% (67.3-91.9%) for the three locations, respectively. Overnight physiological monitoring using a wireless patch sensor provides an accurate estimate of AHI.