Apnea-hypopnea Index Scores Research Articles

Can the complete blood count be used as a reliable screening tool for obstructive sleep apnea?

Since hypoxia increases erythropoietin production and inflammation, the complete blood count (CBC) has been proposed as an inexpensive alternative for obstructive sleep apnea (OSA) screening. The objective of this study was to determine whetheror not intermittent hypoxia and OSA severity, as measured by the mean oxygen saturation (SpO2) and apnea-hypopnea index (AHI), affect parameters measured by the CBC. This retrospective study included a total of 941 surgical patients who had a pre-operative home sleep study. The pre-operative CBC was extracted from the electronic patient records. Patients were stratified according to their AHI scores, into mild (AHI ≥ 5- < 15), moderate (AHI ≥ 15- < 30), and severe (AHI ≥ 30) OSA groups. There were 244 patients without OSA, 294 with mild, 223 with moderate, and 180 with severe OSA. Our analysis showed that hemoglobin (P = 0.010), hematocrit (P = 0.027), and basophils (P = 0.006) showed significant changes among the different severities of OSA. For mean SpO2, there were negative associations with body mass index (r = - 0.287; P < 0.001), age (r = - 0.077; P = 0.021), hemoglobin (r = - 0.208; P < 0.001), hematocrit (r = - 0.220; P < 0.001), red blood cells (r = - 0.107; P = 0.001), mean corpuscular volume (MCV) (r = - 0.159; P < 0.001), mean corpuscular hemoglobin (r = - 0.142; P < 0.001), and basophils (r = - 0.091; P = 0.007). All analyzed parameters remained within normal clinical range. Multivariable regression identified hemoglobin, MCV, and basophils to be independent predictors of mean SpO2 and AHI. Hemoglobin, MCV, and basophils were independently associated with intermittent hypoxia defined by mean SpO2 and AHI. Adding CBC parameters to other screening tools for OSA may have additional value due to its association with changes in mean SpO2.

Association of Pediatric Obstructive Sleep Apnea With Elevated Blood Pressure and Orthostatic Hypertension in Adolescence

Although pediatric guidelines have delineated updated thresholds for elevated blood pressure (eBP) in youth and adult guidelines have recognized obstructive sleep apnea (OSA) as an established risk factor for eBP, the relative association of pediatric OSA with adolescent eBP remains unexplored. To assess the association of pediatric OSA with eBP and its orthostatic reactivity in adolescence. At baseline of this population-based cohort study (Penn State Child Cohort) in 2000-2005, a random sample of 700 children aged 5 to 12 years from the general population was studied. A total of 421 participants (60.1%) were followed up in 2010-2013 after 7.4 years as adolescents (ages, 12-23 years). Data analyses were conducted from July 6 to October 29, 2020. Outcomes were the apnea-hypopnea index (AHI) score, ascertained via polysomnography conducted in a laboratory; eBP measured in the seated position identified using guideline-recommended pediatric criteria; orthostatic hyperreactivity identified with BP assessed in the supine and standing positions; and visceral adipose tissue assessed via dual-energy x-ray absorptiometry. Among the 421 participants (mean [SD] age at follow-up, 16.5 [2.3] years), 227 (53.9%) were male and 92 (21.9%) were racial/ethnic minorities. A persistent AHI of 2 or more since childhood was longitudinally associated with adolescent eBP (odds ratio [OR], 2.9; 95% CI 1.1-7.5), while a remitted AHI of 2 or more was not (OR, 0.9; 95% CI 0.3-2.6). Adolescent OSA was associated with eBP in a dose-response manner; however, the association of an AHI of 2 to less than 5 among adolescents was nonsignificant (OR, 1.5; 95% CI, 0.9-2.6) and that of an AHI of 5 or more was approximately 2-fold (OR, 2.3; 95% CI, 1.1-4.9) after adjusting for visceral adipose tissue. An AHI of 5 or more (OR, 3.1; 95% CI, 1.2-8.5), but not between 2 and less than 5 (OR, 1.3; 95% CI, 0.6-3.0), was associated with orthostatic hyperreactivity among adolescents even after adjusting for visceral adipose tissue. Childhood OSA was not associated with adolescent eBP in female participants, while the risk of OSA and eBP was greater in male participants. The results of this cohort study suggest that childhood OSA is associated with adolescent hypertension only if it persists during this developmental period. Visceral adiposity explains a large extent of, but not all, the risk of hypertension associated with adolescent OSA, which is greater in male individuals.

Sleep duration as an independent factor associated with vitamin D levels in the EPISONO cohort.

Obstructive sleep apnea and short sleep duration have been separately associated with inadequate serum 25-hydroxyvitamin D [25(OH)D] levels. However, whether these 2 factors may concurrently influence 25(OH)D in the general population is unknown. We hypothesized that both obstructive sleep apnea and short sleep duration would be independently associated with lower concentrations of 25(OH)D in a sex-dependent manner. In this cross-sectional study, 712 individuals, part of the prospective EPISONO cohort (Brazil), underwent polysomnography, answered sleep questionnaires, and had their blood collected for serum 25(OH)D quantification. Individuals with a sleep duration of < 6 hours had 2-fold increased odds of 25(OH)D < 20 ng/mL compared with those who reported 6 or more hours of sleep, even after adjusting for confounding factors. Subset sex analysis revealed that men with a sleep duration of < 6 hours had 4-fold increased odds of 25(OH)D < 20 ng/mL. In women, short sleep duration was not associated with lower 25(OH)D levels. The presence of obstructive sleep apnea (as classified according to the individual's apnea-hypopnea index) was not independently related to 25(OH)D concentrations in men or women. Sleep parameters, including sleep latency and sleep efficiency, had no association with 25(OH)D < 20 ng/mL. Short sleep, but not apnea-hypopnea index, was an independent factor associated with low 25(OH)D serum levels in men, but not in women. Apnea-hypopnea index scores were not associated with 25(OH)D levels in either sex. These results raise the possibility of investigating sex-specific characteristics, such as gonadal hormone regulation, and re-evaluating obstructive events by classifying them in mild, moderate, and severe obstructive sleep apnea. de Oliveira DL, Dokkedal-Silva V, Fernandes GL, Kim LJ, Tufik S, Andersen ML. Sleep duration as an independent factor associated with vitamin D levels in the EPISONO cohort. J Clin Sleep Med. 2021;17(12):2439-2449.

Do complete blood count parameters predict diagnosis and disease severity in obstructive sleep apnea syndrome?

Inflammation and platelet activation play a role in the pathogenesis of obstructive sleep apnea syndrome (OSAS). In this study, it was aimed to investigate the effectiveness of the systemic inflammation markers, the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and WMR (white blood cell count (WBC) to mean platelet volume (MPV) ratio), in determining the severity of OSAS. The study included 207 patients who visited the pulmonology polyclinic between 1 and 31 January 2020 with complaints of snoring, apnea periods during sleep and sleepiness and were assessed with polysomnography (PSG) with the indication of hospitalization. The patients were grouped based on their apnea-hypopnea index (AHI) scores as 54 patients with AHI<5 as the control group, 41 patients with AHI=5-15 as the mild, 54 patients with AHI=15-30 as the moderate and 58 patients with AHI>30 as the severe OSAS groups. From the complete blood counts of the patients, NLR, PLR and WMR were calculated. The demographic characteristics of the patient and control groups were assessed by comparing PSG and blood parameters. The mean age of the 207 patients included in the study was 54.56±10.24 years. Among the patients, 58.5% were male, and 41.5% were female. Between the control and OSAS groups, there were significant differences in terms of the WBC and lymphocyte counts (p=0.004 and p=0.035). In terms of the NLR and PLR values, there was no significant difference among the OSAS groups (p=0.723 and p=0.309). WMR had a significant difference in the OSAS groups (p=0.001). It was determined that WMR was valuable especially in distinguishing severe OSAS from the other groups. In our study, where OSAS severity and complete blood count parameters assessed as inflammatory markers were examined, it was identified that the NLR and PLR levels were not very determinant in predicting either OSAS or its severity, and among these parameters, WMR was more significant, and it was determinant in distinguishing severe OSAS. Therefore, we believe it is needed to plan new studies without losing time over these markers in the diagnosis of OSAS, determination of its severity and its monitoring.

Effects of nocturnal wearing of dentures on the quality of sleep and oral-health-related quality in edentate elders with untreated sleep apnea: a randomized cross-over trial.

Study ObjectivesThis study aims to assess whether the nocturnal wear of dentures has an effect on the quality of sleep and oral-health-related quality of life of the edentulous elderly with untreated sleep apnea.MethodsA single-blind randomized cross-over design with two sequences and two periods was used. Participants (n = 77) were randomly assigned either to sequence 1 (nocturnal wear followed by nocturnal nonwear of the denture for 30–30 days) or sequence 2 (nocturnal nonwear followed by nocturnal wear of denture for 30–30 days). The primary sleep outcome was the quality of sleep, assessed through sleep fragmentation measured as Apnea–Hypopnea Index (AHI) and respiratory arousal from portable polysomnography. Secondary outcomes were daytime sleepiness, sleep quality (Pittsburgh Sleep Quality Index, PSQI) and oral-health-related quality of life measured by validated questionnaires.ResultsThe mean paired difference in AHI scores for the period of wearing versus not wearing dentures at night was small 1.0 event per hour (p = 0.50; 95% confidence interval (CI) = −2.0 to 4.1). The mean respiratory arousal index was higher when wearing dentures at night than when not wearing dentures at night, with a mean paired difference of 2.3 events per hour (p = 0.05; 95% CI = 0.0 to 4.6). No difference in sleepiness and PSQI were noted. Wearing dentures at night resulted in a statistically significantly higher mean score of psychological discomfort when compared to not wearing dentures at night.ConclusionsThe results provide some support to usual practice guidelines to remove dentures at night in edentulous elders suffering from sleep apnea.Clinical trial registrationNCT01868295.

Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores.

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X2-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

Effect of healthcare benefits on short-term adherence of positive airway pressure therapy.

The objective of this study was to assess the impact of healthcare benefits on adherence to positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients. Medical records of OSA patients at the Veterans Health Service Medical Center were retrospectively reviewed. OSA patients were assigned to two groups as the date of prescribing PAP: after (=Group A) and before (=Group B) July 1, 2018 when PAP therapy starts to be included in healthcare insurance coverage for OSA patients in South Korea. PAP adherence was compared over a 3-month period between the two groups; subjective improvement after therapy was evaluated using the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index scores. In addition, we evaluated a number of OSA patients who chose to start PAP therapy without healthcare benefit (from July 2018 to December 2018). Each of the 50 patients in the Group A and B exhibited PAP adherence rates of 82% and 26%, respectively (P<.001). Age did not affect PAP adherence in the Group A. The mean apnea-hypopnea index (from 36.7 to 1.34, P<.001) and ESS (from 7.6 to 5.6, P=.004) scores of patients in the Group A had significantly improved within the first three months. Twenty-three (23 out of 334, 6.9%) OSA patients did not have any healthcare insurance, but they medically needed PAP therapy. However, only one of the 23 patients began PAP treatment. Short-term PAP adherence significantly improved after PAP therapy was included in healthcare insurance coverage.

Olfactory function in patients with obstructive sleep apnea and the effect of positive airway pressure treatment: a systematic review and meta-analysis.

ObjectivesTo investigate olfactory function (OF) in patients with obstructive sleep apnea (OSA) and evaluate whether or not the use of positive airway pressure (PAP) treatment has an impact on olfactory performance.MethodsAll studies published in English that gave satisfactory data regarding the assessment of OF in patients with OSA were included in this review. First, a baseline assessment of OF in patients with OSA who had not received any treatment was examined. Second, the effect of PAP therapy on OF was assessed to be able to make before and after comparisons. The primary outcome of this study was the threshold-discrimination identification (TDI) scores, obtained from the Sniffin’ Sticks test.ResultsThe database search identified 552 articles. According to the exclusion criteria, 11 studies involving 557 patients diagnosed with OSA were included in this meta-analysis. The general rate of olfactory dysfunction was 73% (95% CI: 56.481–87.057) among the patients with OSA. The patients with OSA had lower TDI scores compared to the control group and the difference was statistically significant (p < 0.001). PAP treatment significantly improved the TDI scores in patients with OSA (p < 0.001). There was a significant negative correlation between the severity of apnea-hypopnea index and TDI scores (p = 0.001, z = −3.377, r = −0.438) and between age and TDI scores (p = 0.007, z = −2.695, r = −0.236).ConclusionThis meta-analysis demonstrates that OSA impairs OF, while PAP treatment can reverse the olfactory performance of patients with OSA.

Nonalcoholic Fatty Liver Disease and Fibrosis Risk in Patients With Obstructive Sleep Apnea: A Retrospective Analysis.

ObjectivesObstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD) are prevalent and commonly associated conditions. We aimed to estimate the prevalence of NAFLD and identify liver fibrosis risk using noninvasive scoring methods in a cohort of patients with OSA.MethodologyIn this retrospective study of patients with confirmed OSA, patients who underwent abdominal ultrasonography were recruited. The primary outcome was the prevalence of suspected NAFLD (steatosis on ultrasound and/or elevated alanine transaminase [ALT]). The secondary outcomes included the prevalence and predictors of liver fibrosis risk as assessed by the NAFLD fibrosis score (NFS) and fibrosis-4 (FIB-4) score.ResultsA total of 133 patients fulfilled the study inclusion criteria. The average age was 49.8±15.1 years, and 57.1% were females. The average BMI was 37.3±14.5. According to the apnea-hypopnea index (AHI) scores, 37.9%, 29.6%, and 32.6% of participants had mild (5-14), moderate (15-29), and severe (>=30) OSA, respectively. Radiologically defined NAFLD was detected in 44.4% of the participants, and elevated liver enzymes were detected in 63.9% of the patients. High NFS and FIB-4 scores were recorded in 9% and 3.8% of the patients, respectively. According to logistic regression analysis, age and BMI significantly predicted high NFS scores.ConclusionNAFLD appears to be common among OSA patients. Age and obesity, but not OSA severity, predicted high liver fibrosis risk as assessed by noninvasive scoring systems.

Obstructive sleep apnea and sudden unexpected death in epilepsy in unselected patients with epilepsy: are they associated?

We aimed to determine (1) the frequency of high-risk sudden unexpected death in epilepsy (SUDEP) in patients with epilepsy who have had obstructive sleep apnea (OSA) in different stages of sleep using the revised SUDEP risk inventory (rSUDEP-7) score instrument and (2) the factors associated with high risk SUDEP in patients with epilepsy who have had OSA. We conducted a cross-sectional study of consecutive subjects who are more than 15 years old without known sleep disorders, recruited from a single epilepsy clinic in a tertiary care facility. Participants underwent polysomnography. Scoring was performed by two blinded board-certified sleep physicians. The relationships between rSUDEP-7 scores and OSA measures were evaluated using Wilcoxon rank-sum test, chi-squared test, and quantile regression. Our study population consisted of 95 participants. Overall median (IQR) apnea-hypopnea index (AHI) of our populations was 2.3 (0.7,7.5) events rate per hour; 12 (75%) patients had moderate OSA and 4 (25%) patients had severe OSA. Nine patients had a rSUDEP-7 score of 5 to 7. There was no significant difference between total rSUDEP-7 score or rSUDEP-7 score of > 5 or < 5 and total AHI, supine AHI, non-supine AHI, NREM AHI, or REM AHI; similarly, (2) there was no significant difference in total rSUDEP-7 score between AHI of < 15 or > 15. Our study reveals no association between AHI score, OSA, and total rSUDEP-7 score or rSUDEP-7 score of > 5. The pathophysiology underlying SUDEP appears complex. We need further studies on SUDEP to help elucidate the cardiorespiratory mechanisms and predisposing factors.

Polysomnography findings and risk factors for sleep-disordered breathing in patients with systemic sclerosis.

Objectives This study aims to evaluate polysomnography findings and risk factors for sleep-disordered breathing in patients with systemic sclerosis (SSc).Patients and methods Thirty-nine patients (2 males, 37 females; mean age: 51.1±12.5 years; range, 21 to 76 years) who attended to the Rheumatology Clinic of Trakya University Medical Faculty between March 2014 and May 2014 were included in the study. Thoracic computed tomography, pulmonary function tests, carbon monoxide diffusion tests, echocardiography, and all-night polysomnography in a sleep laboratory were performed in all patients. Demographic and clinical characteristics of the patients were recorded. The Apnea-Hypopnea Index (AHI) scores were calculated. Disease activity was examined using the Medsger Disease Severity Scale (MDSS). Possible risk factors for sleep-disordered breathing were evaluated.Results Using the AHI of ≥5 for obstructive sleep apnea (OSA), 21 (53.8%) of the patients were classified as having OSA. There were no significant differences between the groups with and without OSA in terms of steroid use (p=0.4), CT involvement (p=0.3), and Warrick (p=0.6) and MDSS scores (p=0.5). Age, body mass index (BMI), and mean oxygen desaturation index were found to be significant in the univariate analysis (p<0.1); however, the multivariate analysis revealed only BMI as significant risk factor of OSA (p=0.028). In the multivariate analysis, the mean saturation was found to be significant risk factor for high pulmonary artery pressure (p<0.001).Conclusion Although OSA is common in SSc, only increased BMI is a significant risk factor of OSA, but not lung involvement, Warrick scores, or MDSS scores.

Obstructive sleep apnea and early weight loss among adolescents undergoing bariatric surgery.

Little is known regarding obstructive sleep apnea's (OSA's) prevalence or the factors related to OSA remission post-metabolic bariatric surgery (MBS) in adolescents. To identify the baseline OSA prevalence in adolescents with severe obesity and examine factors associated with post-MBS OSA remission. Tertiary-care children's hospital. We conducted a retrospective chart review of 81 patients pre-MBS with OSA assessments done between June 2017 to September 2020 to collect demographic characteristics; co-morbidities; polysomnography (PSG) results, if indicated; and weight data. Chi-square or Mann-Whitney tests compared baseline characteristics and surgical outcomes by pre-MBS OSA status. McNemar's test or t tests assessed differences in baseline characteristics, stratified by remission versus no remission of OSA. The patients were 71% female, had an average age of 16.9 ± 2.0 years, and had a mean body mass index (BMI) of 47.9 ± 7.3 kg/m2. Half (50%) of the patients were Hispanic and 20% had type 2 diabetes. The OSA prevalence, defined as an Obstructive Apnea Hypopnea Index (OAHI) score ≥5, was 54% pre-MBS (n = 44), with 43% having severe OSA (OAHI > 30). Those with OSA were older (17.3 versus 16.4 yr, respectively; P = .05), more likely to be male (79% versus 42%, respectively; P = .022), and had higher baseline weights (142.0 versus 126.4 kg, respectively; P = .001) than those without OSA. Of the 23 patients with a post-MBS PSG result (average 5 mo post MBS), 15 (66%) had remission of OSA. Patients with OSA remission had a lower average pre-MBS BMI (46.0 versus 57.7 kg/m2, respectively; P < .001) and weight (132.9 versus 172.6 kg, respectively; P = .002) but no significant differences in percentage weight loss through 12 months post MBS versus those with continued OSA. The OSA prevalence in an adolescent MBS population was higher than that in the general adolescent population with severe obesity. Remission of OSA was correlated with lower pre-MBS BMIand weight, but not weight loss within the first year post-MBS.

Effect of adenotonsillectomy in children with obstructive sleep apnea and major psychiatric disorders on obstructive apnea-hypopnea index and Epworth Sleepiness Scale scores.

This study evaluates the effectiveness of adenotonsillectomy in the treatment of obstructive sleep apnea in children with major psychiatric disorders as measured by polysomnography and the Epworth Sleepiness Scale (ESS) at a tertiary children's hospital. Adults with major psychiatric disorders often have higher rates of obstructive sleep apnea and decreased response to treatment. The goal was to determine if children with serious mental illness had outcomes similar to their adult counterparts. A retrospective chart review was undertaken to identify children with obstructive sleep apnea and major psychiatric disorders who underwent adenotonsillectomy as part of their treatment for obstructive sleep apnea and had undergone preoperative and postoperative polysomnography as well as ESS. A multivariable model was run for each of the postoperative outcomes (ESS, obstructive apnea-hypopnea index, or body mass index percentile), adjusting for their respective preoperative value, age, and group. There were 34 patients who qualified for this study and who were matched with 66 controls. There was no significant difference between the 2 groups in terms of change in ESS, obstructive apnea-hypopnea index, or body mass index percentile, both before and after adjusting for age. The only significant findings were that preoperative ESS and body mass index percentile were predictive of postoperative ESS and body mass index percentile for both groups. Children with psychiatric disorders in our institution respond to surgical management of obstructive sleep apnea similar to pediatric controls without mental illness despite comorbidities and central-acting medications that may alter sleep.

Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis.

Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O₂ peak) or maximum rate of oxygen uptake (V̇O2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O₂ peak, V̇O₂ max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for V̇O₂ peak, 2 studies for V̇O₂ max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O₂ peak between pre- and post-CPAP of 2.69 mL·kg-1·min-1, P = .02, favoring treatment with CPAP. There was no difference in V̇O₂ max or AT with CPAP treatment (mean net difference 0.66 mL·kg-1·min-1 [P = .78] and -144.98 mL·min-1 [P = .20] respectively). There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O₂ peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O₂ max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome.

To evaluate the risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). Patients aged over 18years who had been diagnosed with OSAS using polysomnography (PSG) from January to December 2019 were evaluated. The number of nocturia episodes had been assessed in a 3-day bladder diary. We analysed the age, sex, body mass index (BMI) score, apnea-hypopn ea index (AHI) score and severity, hypertension, diabetes mellitus, smoking and heart diseases in all patients. A total of 124 patients with a mean age of 49.9±11.6years (range: 25-81years) were included in the study. Ninety-two (75.8%) patients had nocturia. The mean number of nocturia episodes of patients with nocturia was 2.4±1.3. To determine factors affecting the risk of nocturia, the logistic regression analysis was performed. Patient age and BMI scores were found as the most effective risk factors determining nocturia (P<.05). The odds of patient age were 1.06 (odds ratio: 1.12; 95% confidence interval: 1.01-1.11; P=.010) times higher for patients with nocturia. Every 1-unit increase in the BMI score increased the risk of nocturia 1.12 times. In the study period, 48 patients with nocturia had undergone the continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean number of nocturia episodes of these patients was 2.3±1.4 before treatment and 1.7±2.2 after treatment, showing a significant decrease (P=.032). Although the total daily urine volume increased significantly with the treatment, the total night-time urine volume decreased significantly at night (P=.016 and P=.024, respectively). The age and BMI score were the risk factors associated with nocturia in patients with OSAS.

Assessment of Screening for Nasal Obstruction among Sleep Dentistry Outpatients with Obstructive Sleep Apnea.

Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea–hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.

The role of antioxidant vitamins and selenium in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a disorder characterized by recurrent episodes of obstruction ofthe upper respiratory tract during sleepoften accompanied by oxygen desaturations. Antioxidant defense mechanisms are important to prevent OSA-associated diseases and decrease mortality. We aimed to determine the levels ofselenium and vitamins A, C, and E in patients withOSA butwithout any comorbidities and compare the results with a control group, theorizing that the findings may be helpful to understand the antioxidant mechanisms in the pathogenesis ofOSA and associated diseases. We designed a case-control study with 146 subjects. Subjects were categorized into four groups by apnea-hypopneaindex (AHI) scores: control (n = 32; AHI < 5), mild OSA (n = 32; 5 ≤ AHI < 15), moderate OSA (n = 34; 15 ≤ AHI < 30), and severe OSA (n = 48; AHI ≥ 30) groups. Serum levels of selenium were measured by atomic absorption spectrometer. Vitamin A, C, and E levels were measured by high-performance liquid chromatography and ultraviolet (HPLC-UV) detector. After adjusting for age, BMI, and gender, serum selenium and vitamin A levels were found to behigher in patients withOSA compared with controls (ANCOVA, p < 0.008, and p = 0.014 respectively), and levels of these markers increased with the severity of the disease. AHI was positively correlated with selenium (r = 0.289; p < 0.001), and vitamin A levels (r = 0.276; p < 0.001). These results demonstrated that antioxidant response with increased vitamin A, and selenium concentrations, may be important defense mechanisms in patients withOSA patientswho do not have other comorbidities. Antioxidant nutrients or supplements may be implemented as a complementary treatment of OSA to support antioxidant defense.

Plasma expression of HIF-1α as novel biomarker for the diagnosis of obstructive sleep apnea-hypopnea syndrome.

BackgroundObstructive sleep apnea‐hypopnea syndrome (OSAHS) is a common breathing disorder during sleep with potential lethality and multi‐complications. Polysomnography (PSG) is now the golden standard for the diagnosis obstructive sleep apnea‐hypopnea syndrome. However, PSG is expensive and time‐consuming. Therefore, it is important to find inexpensive and convenient biomarkers for the diagnosis of OSAHS.ObjectiveThe present study aimed to explore the potential diagnostic value of HIF‐1α for OSAHS and its clinical significance.MethodsThis study consisted of 368 patients admitted to the sleep laboratory. The patients were classified according to their apnea‐hypopnea index (AHI) scores as OSA negative (AHI < 5), mild‐moderate (AHI:5‐30), and severe OSA (AHI > 30), and severe OSA treated with continuous positive airway pressure (CPAP). qRT‐PCR was used to detect mRNA levels in the plasma; Pearson's correlation analysis was performed to analyze the correlation of HIF‐1α mRNA level and the clinicopathological factors of OSAHS; ROC curve was constructed to evaluate the diagnostic value of HIF‐1α mRNA.ResultsHIF‐1α mRNA was significantly up‐regulated in the plasma of OSAHS patients, especially patients with severe OSAHS. HIF‐1α mRNA was positively correlated with the AHI and ODI but negatively correlated with the mean oxygen saturation in patients with OSAHS. Results of ROC curve showed that HIF‐1α is a sensitive biomarker for the diagnosis of OSAHS, especially severe OSAHS.ConclusionsHIF‐1α mRNA might be used as s a convenient and inexpensive method for triaging OSAHS patients PSG assessment in the hospital and evaluate the curative effect.

Impaired intestinal barrier in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is often associated with multisystem damage. The gut is a pivotal organ that initiates the pathophysiological processes of multisystem diseases. Intermittent hypoxia resulting from OSA may impair the intestinal barrier prior to the induction of systemic inflammation. We hypothesize that the intestinal barrier markers D-lactic acid (D-LA) and intestinal fatty acid-binding protein (I-FABP) levels would be higher in patients with OSA. Consecutive snoring and nonsnoring adults were included in this study and were grouped based on their apnea-hypopnea index (AHI) scores: the control group (AHI < 5) and the OSA group (AHI ≥ 5). Plasma D-LA and I-FABP levels were measured using colorimetry and ELISA, respectively. Other parameters, such as fasting levels of lipids, routine blood tests, and glucose were also assessed. Of 76 participants, patients in the OSA group accounted for 73% (55/76). Plasma D-LA and I-FABP levels were significantly higher in patients with OSA [7.90 (7.42) (IQR) vs. 0.88 (2.79) (IQR) mmol/L, p < 0.001 and 1851.99 ± 754.23 (SD) vs. 1131.98 ± 383.38 pg/mL, p < 0.001, respectively]. Increased glucose, triglycerides(TGs), leukocytes, neutrophils, and monocytes but decreased high density lipoprotein (HDL) were also found inpatients with OSA. It was also observed that the increase in D-LA and I-FABP exhibited the strongest positive association with AHI (r = 0.443, p < 0.001; r = 0.645, p < 0.001), followed by the lowest SaO2 (p ≤ 0.001), BMI (p ≤ 0.017), glucose (p ≤ 0.011), and TGs (p ≤ 0.025). Moreover, multivariate regression analysis showed that D-LA (B = 0.823, p < 0.001) and I-FABP (B = 0.002, p = 0.017) were independently associated with OSA. The systemic expression of D-LA and I-FABP is dramatically higher in OSA patients, suggesting that hypoxia resulting from OSA might have the capacity to impair the intestinal barrier prior to the induction of multisystem dysfunction.

THE CONNECTION BETWEEN POLYSOMNOGRAPHY RESULTS, EPWORTH SCORES AND DRUG-INDUCED SLEEP ENDOSCOPY FINDINGS IN PATIENTS WITH OSAS

Objective: To determine the usefulness of drug-induced sleep endoscopy (DISE) and evaluate correlations between DISE findings, polysomnography and Epworth sleepiness scale values. Material and Method: Included in this study are patients with major OSAS symptoms and apnea-hypopnea index (AHI) values between 5 and 30 who were scheduled for soft palate surgery. The patients were sedated with propofol (0.25 cc/kg) in the operating room for examination of obstructive regions. Anatomical structures affected by obstruction were observed with flexible endoscopy. The images from this examination were analyzed with Ulead video study. Patients with soft palate pathologies were operated and the endoscopic examination repeated postoperatively. Changes in pre- and post-operative obstruction areas were compared with changes in pre- and post-op PSG and Epworth sleepiness scale values. Results: Changes in retropalatal area values were correlated with changes in AHI values. The most important factor affecting this correlation was the formation of base of tongue pathology, despite being absent preoperatively. We also determined the correlation between patients’ Epworth scores, AHI and retropalatal area. Changes in the retropalatal area following OSAS surgery were correlated with changes in AHI and Epworth scores. Conclusion: DISE is an effective diagnostic technique in OSAS with advantages such as a low radiation risk, cost effectiveness and precise findings.