Apnea-hypopnea Index Research Articles

Effects of sleep on the glymphatic functioning and multimodal human brain network affecting memory in older adults.

Understanding how sleep affects the glymphatic system and human brain networks is crucial for elucidating the neurophysiological mechanism underpinning aging-related memory declines. We analyzed a multimodal dataset collected through magnetic resonance imaging (MRI) and polysomnographic recording from 72 older adults. A proxy of the glymphatic functioning was obtained from the Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index. Structural and functional brain networks were constructed based on MRI data, and coupling between the two networks (SC-FC coupling) was also calculated. Correlation analyses revealed that DTI-ALPS was negatively correlated with sleep quality measures [e.g., Pittsburgh Sleep Quality Index (PSQI) and apnea-hypopnea index]. Regarding human brain networks, DTI-ALPS was associated with the strength of both functional connectivity (FC) and structural connectivity (SC) involving regions such asthe middle temporal gyrus and parahippocampal gyrus, as well as with the SC-FC coupling ofrich-club connections. Furthermore, we found that DTI-ALPS positively mediated the association between sleep quality and rich-club SC-FC coupling. The rich-club SC-FC coupling further mediated the association between DTI-ALPS and memory function in good sleepers but not in poor sleepers. The results suggest a disrupted glymphatic-brain relationship in poor sleepers, which underlies memory decline. Our findings add important evidence that sleep quality affects cognitive health through the underlying neural relationships and the interplay between the glymphatic system and multimodal brain networks.

Prognostic implications of obstructive sleep apnea in patients with unstable angina stratified by remnant cholesterol and triglyceride: a prospective cohort study

BackgroundThe prognostic significance of obstructive sleep apnea (OSA) in patients with unstable angina (UA) based on remnant cholesterol (RC) or triglyceride (TG) levels remains unclear. This study aims to evaluate the effects of the interaction between RC, TG, and OSA on cardiovascular outcomes in UA patients.MethodsIn this prospective cohort study, OSA was diagnosed when apnea-hypopnea index of ≥ 15 events/h. Patients with high RC (HRC, n = 370) or high TG (HTG, n = 362) included RC or TG in the highest tertile, and those in the middle and lowest tertiles were defined as normal RC (NRC, n = 736) or normal TG (NTG, n = 744). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, ischemia stroke, ischemia-driven revascularization, or hospitalization for UA.ResultsA total of 1,106 eligible UA patients were enrolled, among which 560 (50.6%) had OSA. RC and TG levels were increased in OSA patients, but there was no difference in the prevalence of OSA between the NRC and HRC or NTG and HTG groups. During a median follow-up of 1.9 (1.1, 3.0) years, OSA was associated with an increased risk of MACCE occurrence compared to non-OSA in UA patients with HRC (adjusted HR 2.06; 95% CI 1.20–3.51, P = 0.008), but not in those with NRC (adjusted HR 1.21; 95% CI 0.84–1.75, P = 0.297). The incremental risk in HRC was attributable to higher rates of hospitalization for UA and ischemia-driven revascularization. Results for HTG and NTG were similar.ConclusionOSA was associated with a worse prognosis in UA patients with HRC or HTG, emphasizing the necessity of identifying OSA presence in this population.Trial registrationClinicaltrials.gov; No: NCT03362385.

A Novel Screening Tool for Severe Obstructive Sleep Apnea.

Purpose: Obstructive sleep apnea (OSA) is a prevalent condition with long waiting lists for the gold standard polysomnography (PSG) test. Screening tests are essential to identify and prioritize patients with severe OSA. Current questionnaires do not accurately detect severe cases. This study aims to develop an alternative screening tool based on anthropometric and morphological characteristics to determine the severity of OSA. Methods: The study included 149 patients with sleep apnea symptoms who did not have additional diseases. The obstructive sleep apnea morphologic scale (OSAMS) was created using 5 parameters: 3 internal parameters related to the upper respiratory tract (tonsil size, oropharyngeal passage, and hypopharyngeal-laryngeal examination) and 2 external parameters (neck circumference and body mass index). Each parameter was scored, and the total scores were correlated with the apnea-hypopnea index (AHI) of PSG to determine the severity of OSA. Results: A statistically significant moderate positive correlation was found between AHI and OSAMS scores (rho = .491; P < .001). A grand total score >4 provided 80.3% sensitivity and 53.9% specificity to identify patients with severe OSA. OSAMS demonstrated superior results compared to existing questionnaires for OSA screening in our study group. Conclusions: OSAMS is a potential alternative to existing questionnaires to screen patients with severe OSA, offering a practical approach based on morphology during physical examinations.

The value of amide proton transfer imaging in assessing brain damage in patients with obstructive sleep apnea

ObjectiveTo investigate the application value of amide proton transfer (APT) magnetic resonance imaging in evaluating brain damage in patients with obstructive sleep apnea (OSA). Materials and methods49 OSA patients and 25 healthy individuals matched for age and sex were included as case and control groups. All study participants underwent conventional 3D T1WI and APT imaging of the head. The APT values were measured in each of the brain regions of interest (ROI). To compare the differences in APT values of each brain region between the case and control groups, to compare the differences in the efficacy of APT values of each brain region in diagnosing OSA, and to investigate the correlation between APT values of each brain region and Apnea Hypopnea Index (AHI) and minimum blood oxygen saturation. ResultsCompared to the control group, patients with OSA had elevated APT values in several brain regions (P < 0.05), and the diagnostic efficacy of the combined diagnosis of OSA by multiple brain regions is better than that by each brain region alone.Left frontal APT values were positively correlated with AHI in the case group (r = 0.33, P = 0.020).In the case group, the APT values of bilateral frontal lobe, parietal lobe, occipital lobe, left temporal lobe, right thalamus, left internal capsule, left lenticular nucleus, right cerebellar hemisphere and splenium of corpus callosum were negatively correlated with the minimum blood oxygen saturation, and the APT values for each of the above ROIs were positively correlated. ConclusionAPT imaging has a certain value in evaluating brain damage in OSA patients, which may provide a new objective imaging basis for the clinical diagnosis of OSA.

Polysomnographic and clinical characteristics of sleep apnea headache patients.

Sleep apnea headache can be defined as a persistent, widespread, throbbing headache that occurs recurrently, is not accompanied by any additional symptoms after waking up, and usually resolves within four hours. Diagnosis of the condition requires confirmation through polysomnography with an apnea-hypopnea index of at least 5, indicating the presence of obstructive sleep apnea syndrome (OSAS). While sleep apnea headaches are common in 10-15% of individuals with OSAS, morning headaches are experienced by 5% of this population. The aim of this study is to examine both polysomnographic and clinical features associated with sleep apnea headache in individuals confirmed to have OSAS by polysomnography. The study was conducted in the sleep center of University of Health Science, Erenköy Mental and Nervous Disease Training and Research Hospital. We have examined the clinical and polysomnographic data of the patients with sleep apnea headache (SAH) diagnosed according to IHS-3 criteria retrospectively and grouped the patients as mild, moderate and severe OSAS. Patients with morning headache except sleep apnea headache and under PAP titration treatment were excluded. The differences between the sleep macro structures of patients with (WSAH) and without sleep apnea headache (WOSAH) were examined. The WSAH group consisted of 384 participants and the control group (WOSAH) consisted of 294 participants The mean age was 46.29 ± 12.18 and 45.08 ± 12.62 years, respectively. Patients in the WSAH group had significantly higher scores on the Epworth Sleepiness Scale (ESS) (p = 0.004) and higher periodic limb movement index (PLMI) (p = 0.014) compared to the WOSAH group. WSAH patients exhibited shorter wake times after sleep onset (WASO) and lower scores on the sleep quality index, in contrast to WOSAH patients. Additionally, within the WSAH group, there was a negative correlation between age and several sleep parameters, including total sleep parameters. A positive correlation was observed between sleep duration (p = 0.009), waking up after sleep (p = 0.043), sleep efficiency (p = 0.001) and apnea-hypopnea index (AHI) (p = 0.018). Additionally, ESS scores were positively correlated with AHI and total awake time (p = 0.000 and p = 0.008, respectively), while negatively correlated with stage N3 sleep percentage and mean minimum oxygen level (p = 0.001 and p = 0.020, respectively) in the WSAH group. The causes and possible mechanisms of sleep apnea headache are not fully clarified and the underlying processes are not fully understood. Sleep apnea headaches appear to be related to disturbances in nocturnal sleep. Dysregulation in regions that modulate sleep and nociception may be one possible mechanism.

Comparison of Awake Respiratory Control Versus Sleep Obstructive Sleep Apnea Endotypes.

Most approaches to advance simplified physiology-based precision medicine strategies for obstructive sleep apnea (OSA) focus on sleep parameters (i.e., OSA endotypes). However, wakefulness physiology measures can also provide prediction insight for certain OSA therapies yet their relationship with sleep parameters has not been extensively investigated. This study aimed to investigate potential relationships between awake ventilatory control parameters and sleep OSA endotypes and their potential to predict changes in OSA severity with morphine. Data were acquired from a randomised, cross-over trial that investigated effects of morphine versus placebo on OSA severity and underlying mechanisms. Here, awake ventilatory chemoreflex testing prior to overnight polysomnography was compared with direct measures of sleep respiratory control (e.g., hypercapnic ventilatory responses and loop gain) and OSA endotypes during a separate overnight physiology study (pharyngeal critical closure pressure-Pcrit, muscle responsiveness via genioglossus intramuscular electromyography and arousal threshold via epiglottic pressure catheter to transient continuous positive airway pressure reductions). Twenty-one men with OSA completed both study arms. During placebo, 1) awake chemosensitivity correlated with Pcrit (r=0.726, p=0.001), 2) arousal threshold correlated with awake CO2 ventilatory response threshold (r=-0.467, p=0.047) and basal ventilation (r=-0.500, p=0.029). Awake chemosensitivity and Pcrit also correlated with the apnea-hypopnea index (p<0.001) during placebo. Awake chemosensitivity was predictive of changes in OSA severity with morphine(r=-0.535, p=0.013). In conclusion, awake measures of respiratory control are related to physiological endotypes such as airway collapsibility and arousal threshold during sleep and OSA severity. Awake ventilatory chemosensitivity has the best potential to predict changes in OSA severity with morphine.

Prevalence and assessment of sleep-disordered breathing in head and neck cancer patients: a systematic review.

Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population. A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects. The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent. There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required.

Ansa Cervicalis Stimulation Effects on Upper Airway Patency: A Structure-Based Analysis.

Ansa cervicalis stimulation (ACS) of the infrahyoid muscles has been proposed as a neurostimulation therapy for obstructive sleep apnea (OSA). ACS stabilizes the pharynx by pulling it caudally, but its specific effects on flow limitation caused by palatal, oropharyngeal lateral wall, tongue base, or epiglottis collapse remains unclear. To quantify the effect of ACS on collapsibility of different pharyngeal flow-limiting structures. Participants with OSA underwent bilateral ACS during drug-induced sleep endoscopy. Maximum inspiratory airflow was assessed over a range of positive airway pressures while ACS was applied. The flow-limiting structure for each breath was classified based on manometric and endoscopic findings and a linear mixed-effects model characterized their response to ACS. The influence of patient characteristics was explored with univariate models. Forty-one participants yielded 1761 breaths for analysis. On average, bilateral ACS decreased the observed pharyngeal critical closing (PCRIT) and opening (POPEN) pressures by -3.0 [95% confidence interval: [-3.6, -2.3] and -3.7 [-4.4, -3.0] cmH2O, respectively (p<0.001). During tongue base obstruction, modeled ACS effects for PCRIT and POPEN were -2.0 [-2.7, -1.4] and -3.1 [-3.8, -2.4] cmH2O, respectively (p<0.001). Greater reductions were generally observed for other flow-limiting structures. A lower apnea-hypopnea index was associated with a greater decrease in POPEN (p<0.01). Other patient characteristics, including body mass index, did not influence PCRIT or POPEN (p>0.05). Bilateral ACS decreased collapsibility of all airway flow-limiting structures. ACS generally had greater effects on palatal, oropharyngeal lateral wall, and epiglottic collapse than the tongue base.

Validation of the European Obstructive Sleep Apnea Screening (EUROSAS) in Professional Male Drivers.

(1) Background: The European Union Driver License Committee recently developed a questionnaire as a screening tool for obstructive sleep apnea (OSA), named the European Obstructive Sleep Apnea Screening (EUROSAS) questionnaire for drivers. The aim of the current study was to investigate the diagnostic performance of the EUROSAS to predict risk of OSA in professional male drivers. (2) Methods: Fifty-eight drivers were included in the current study. All participants were asked to fill out the EUROSAS before an overnight polysomnography (PSG) in the hospital. OSA was defined as an apnea-hypopnea index (AHI) 5 events/hour on the PSG. (3) Results: Out of 58 participants, the EUROSAS correctly identified 39 (67.2%) cases as having high-risk OSA and one patient as having low-risk OSA, using AHI ≥ 5 events/h. The results indicated that the EUROSAS has a sensitivity of 67.2%, a specificity of 33.3%, a positive predictive value of 94.8%, and a negative predictive value of 5.2%. Similar results were obtained using AHI cut-offs of 15 and 30 events/h. (4) Conclusions: The EUROSAS provides a moderate level of accuracy for the screening of OSA in the professional male drivers. It seems that the diagnostic performance of the EUROSAS is not promising as an alternative questionnaire to identify professional drivers with OSA, probably due to participant response bias. Despite its limited evidence, the EUROSAS might have potential as a clinical screening tool in the general population.

Pitolisant 40 mg for excessive daytime sleepiness in obstructive sleep apnea patients treated or not by CPAP: Randomised phase 3 study.

Obstructive sleep apnea (OSA) syndrome commonly leads to excessive daytime sleepiness (EDS). Pitolisant, a selective histamine-3 receptor antagonist, is efficacious at doses up to 20 mg once daily in OSA treated or not with continuous positive airway pressure (CPAP). We assessed the efficacy and safety of pitolisant at doses up to 40 mg once daily in patients with moderate to severe OSA treated or not with CPAP therapy. In this phase 3, multicentre, randomised, double-blind, placebo-controlled clinical trial, patients with OSA were assigned 2:1 to receive pitolisant (according to an individual up-titration scheme, 10, 20 or 40 mg once daily) or placebo for 12 weeks. The primary endpoint was a change in the Epworth Sleepiness Scale (ESS) score from baseline to week 12. Secondary endpoints included a change in reaction time using the Oxford Sleep Resistance test (OSleR), Clinical Global Impression of Change (CGI-C), and Patient's Global Opinion of the Effect (PGOE) of study treatment. Overall, 361 patients (mean age 52.4 years, 77.3% male; mean apnea-hypopnea index [AHI] 27.0 events/h) were randomised to receive pitolisant (n = 242; 50% received CPAP) or placebo (n = 119; 48.7% CPAP). After the dose-adjustment phase (week 3), 88.8% of patients received pitolisant 40 mg. Compared with placebo, pitolisant produced a significant reduction in the ESS score at week 12 (least square mean difference -2.6 (95% CI: -3.4; -1.8; p < 0.001)) irrespective of CPAP use; and improved the reaction time on OSleR, CGI-C, and PGOE at week 12. Pitolisant was well tolerated; no new safety signals were identified. In conclusion, pitolisant up to 40 mg once daily was an effective treatment for EDS in patients with moderate to severe OSA irrespective of CPAP use.

Circadian clock dysregulation: a potential mechanism of depression in obstructive sleep apnea patients

Obstructive sleep apnea (OSA) is characterized by co-occurrence with affective disorders. Our study aims to investigate the association of circadian clock gene expressions, and the presence and severity of depressive symptoms in OSA patients. The study included 184 individuals, who underwent polysomnography (PSG) and had their peripheral blood collected in the evening before and the morning after the PSG. Patients were divided into two groups: the OSA (apnea-hypopnea index (AHI) > 5) and the control group (AHI < 5). RNA was extracted from peripheral blood leukocytes. Expression levels of the selected genes (BMAL1, CLOCK, PER1, CRY1, NPAS2, and NR1D1) were assessed by qRT-PCR. Questionnaire data was collected in the morning (including the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Chronotype Questionnaire (CQ), and Montgomery–Åsberg Depression Rating Scale (MADRS)). The expression of all examined circadian clock genes in OSA patients was upregulated in the morning compared to the evening (except NPAS2). No differences were observed between OSA and control groups at either time point. Additionally, there was a positive correlation between the severity of depressive symptoms (assessed with MADRS) and morning expression of circadian genes in the group of OSA patients. Finally, in multivariable linear regression, ISI score (B = 0.750, p < 0.001), AM score of CQ (B = 0.416, p = 0.007), and morning PER1 gene expression (B = 4.310, p = 0.042) were found to be predictive factors for greater severity of depression symptoms in OSA patients. Dysregulated circadian clock gene expression in OSA patients is linked to depressive symptom severity, suggesting circadian disruption may underlie affective symptoms in OSA.

Polysomnographic insights into the attention-deficit/hyperactivity disorder and obstructive sleep apnea connection in children

IntroductionThere is a high prevalence of sleep disturbances and disorders such as obstructive sleep apnea (OSA) in children with attention-deficit hyperactivity disorder (ADHD), though this relationship remains poorly characterized by objective measures. Polysomnographic studies (PSGs) on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated vs. non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA.MethodsMedical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019 to 2022. ADHD diagnosis was determined by ICD code F90, and OSA was defined by apnea-hypopnea indices (AHI) ≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA alone, children with ADHD alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest.Results4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA alone (29.8%), 333 with ADHD alone (8.3%), and 111 with ADHD and OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD alone. However, they exhibited significantly better sleep efficiency (SE), than children with OSA alone, and SE did not significantly differ from the other groups. No significant difference in periodic limb movements (PLMs) was found across all groups. The above results held true even after correcting for stimulant prescription.ConclusionThe increased frequency of clinical insomnia diagnoses in children with ADHD is not associated with any traditional parameters on polysomnogram. Innovative subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with both ADHD and OSA, PSG results do not reveal any distinctive sleep disturbances which cannot be better explained by OSA alone. These findings underscore the importance of screening for OSA in patients with ADHD and clinically assessing for other sleep concerns.

Sex Differences in Obstructive Patterns on Drug-Induced Sleep Endoscopy.

To identify and characterize sex differences in collapse patterns on drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA). Retrospective cohort analysis. An outpatient tertiary care academic medical center. A retrospective cohort study at a single tertiary care institution was performed from 2020 to 2023. All adult patients who underwent a DISE were included in this study. Univariate and multivariate analyses were used to compare differences between males and females on DISE. 117 patients who underwent DISE were included in this study, including 30% females (n = 35). The average age was 54.7 years (SD 15.2), mean BMI was 28.6 kg/m2 (SD 4.1), and mean apnea-hypopnea index (AHI) was 32.3 events per hour (SD 21.3). Most patients had severe OSA (48.7%). There was no difference in palatine or lingual tonsil size between sexes. On DISE, a significantly lower proportion of females demonstrated complete oropharyngeal lateral wall collapse (25.7% females vs 51.2% males, P = .008). Multivariate analysis revealed that male sex was independently associated with the presence of complete collapse at the oropharynx (odds ratio [OR] 2.55, 95% confidence interval [CI] [0.005-1.868], P = .048) but not at other levels. Additionally, higher BMI was associated with any collapse (partial or complete) at the oropharynx (OR 1.30, 95% CI [0.131-0.392], P < .001). This study demonstrates that a lower proportion of females have complete oropharyngeal lateral wall collapse even when controlling for BMI and AHI. Additional studies are needed to better understand the differences in OSA physiology between the sexes.

8688 Pseudopheochromocytoma Due To Severe Obstructive Sleep Apnea

Abstract Disclosure: L.M. José: None. M. Ataide: None. F. Aratani: None. S. Beeby: None. G.F. Fagundes: None. F. Coelho: None. F. Ledesma: None. A. Latronico: None. B.B. Mendonca: None. M.C. Fragoso: None. M.Q. Almeida: None. Background: Obstructive sleep apnea (OSA) represents an independent risk factor for cardiovascular disease, and it is associated with a wide range of conditions, such as resistant hypertension and primary aldosteronism (PA). Patients with sleep apnea have a higher sympathetic activity during wakefulness due to chronic hypoxia. We present the case of pseudopheochromocytoma caused by severe OSA in an obese patient with RH and PA.Clinical Case: A 58-year-old female Brazilian patient was referred to an endocrinologist to investigate a 1.8 cm right adrenal nodule at computed tomography (CT) performed to investigate abdominal pain. Her medical history includes resistant hypertension diagnosed at 27 years of age, type 2 diabetes, dyslipidemia, Class II obesity, a previous acute myocardial infarction, and severe OSA (apnea-hypopnea index 61.6/hour). She has used irregularly the continuous positive airway pressure (CPAP) therapy at night. She is currently using carvedilol 50 mg bid, chlorthalidone 25 mg, olmesartan 40 mg, amlodipine 10 mg, spironolactone 50 mg, clonidine 0.2 mg tid, hydralazine 50 mg every 6 hours, acetylsalicylic acid 100 mg, atorvastatin 80 mg, and metformin XR 1000 mg. At physical examination, she had BMI 37 kg/m2, BP 150 x 90 mmHg, HR 64 bpm, and no signs of Cushing syndrome. Abdominal CT revealed a right adrenal nodule measuring 1.8 cm with 18 Hounsfield unit (HU) in the pre-contrast phase, reaching a density of 117 HU at the arterial phase and showing an absolute washout of 65% and a relative washout of 56%. A nodular thickening of 1.4 cm (-4 HU) at the left adrenal gland was also displayed at CT scan. Hormone evaluation showed basal cortisol 7 µg/dL, ACTH 15.7 pg/mL, DHEAS 1152 ng/mL (189-2050 ng/mL), 1 mg overnight dexamethasone suppression test 2.3 ug/dL, aldosterone 9.9 ng/dL, direct renin concentration 36.8 uIU/mL, plasma metanephrines 0.3 nmol/L (&amp;lt;0.5 nmol/L) and plasma normetanephrines 1.3 nmol/L (&amp;lt;0.9 nmol/L). It was not possible to change anti-hypertensive medications to investigate PA. A 0.3 mg clonidine suppression test did not suppress normetanephrine levels, confirming the biochemical diagnosis of pheochromocytoma. Then, alpha-blockade with doxazosin 4 mg was started and the patient underwent right adrenalectomy. Pathological examination revealed an adenoma with immunohistochemistry positive for CYP11B2. BP control was achieved with only two medications and aldosterone decreased to 3 ng/dL confirming PA. Plasma normetanephrine levels remained elevated post-surgery and only normalized after the CPAP regular use.Clinical lessons: Chronic activation of sympathetic autonomic drive in OSA can increase norepinephrine and normetanephrine levels. OSA is a very prevalent disease and it is frequently associated with RH. Therefore, OSA should be considered a possible cause of pseudopheochromocytoma in hypertensive patients. Presentation: 6/3/2024

Cone beam computed tomography changes upon oral appliance therapy for adult patients with obstructive sleep apnea: A non-randomized clinical trial.

Obstructive sleep apnea (OSA) is caused by narrowing or obstruction of the airway lumen at single or multiple levels of the airway, starting from the nasal cavity up to the larynx. Oral appliance therapy for the management of OSA is prescribed as an alternative treatment option for patients with mild to moderate OSA who fail to adhere to Continuous Positive Airway Pressure (CPAP) therapy. Treatment with oral appliances addresses the craniofacial deficiencies that cause OSA by providing means to mandibular advancement and palatal expansion, thus opening the airways and potentially preventing airway collapse during sleep. Imaging the upper airway is employed to investigate the narrowing or the obstruction in the airway. Three-dimensional imaging modalities such as cone beam computed tomography (CBCT) allow for detecting obstructions before commencing treatment and for evaluating changes in the upper airway dimensions after treatment. To evaluate the effect of the biomimetic oral appliance therapy (BOAT) device on the airway measurements taken from a CBCT before and after treatment in correlation with the changes in the AHI. A non-randomized clinical trial. About 17 patients with mild-moderate OSA (9 males, 8 females; age, mean [SD]: 45.76 [10.31]) underwent BOAT therapy. Subjects had 2 months of follow-up visits, including examinations for progress and adjustment of the appliances. The mean apnea-hypopnea index (AHI) with no appliance in the mouth before BOAT and after treatment was recorded. The midpalate screw mechanism of the appliance was advanced once per week. The subjects were asked to wear the appliance for 10 to 12 h/d and night. Pre and Post CBCT were taken. Paired T-test was used to analyze the results. The treatment duration was 15.4 ± 6.3 months. Before treatment, at the diagnosis stage, the mean AHI of the sample (n = 17) was 24.0. After treatment, the mean AHI fell by 5% to 22.8% (P = .019), indicating enhanced upper airway functions. Airway measurements from the CBCT were not statistically significant despite improvement in the polysomnographic parameters. CBCT is a valuable tool for airway assessment and the determination of upper airway anatomic risk factors for OSA.

Clinical characteristics of obstructive sleep apnea patients with residual sleepiness

ObjectiveThis meta-analysis examines the clinical characteristics of CPAP-treated obstructive sleep apnea (OSA) patients with residual excessive sleepiness (RES).MethodWe conducted a search for articles published from inception to March 16, 2024, in PubMed, Embase, Cochrane Library, and Web of Science. Seven studies were included in this meta-analysis.ResultsThe meta-analysis revealed that continuous positive airway pressure (CPAP)-treated OSA patients with RES were characterized by higher Epworth Sleepiness Scale and Depression Scale scores, lower body mass index (BMI) and apnea-hypopnea index (AHI) before CPAP treatment. RES patients also exhibit poorer CPAP adherence. Being female was also associated with RES.ConclusionBeing female, having lower BMI and AHI, and more severe daytime sleepiness and depressive symptoms before CPAP treatment, and lower CPAP adherence were characteristics of OSA patients with RES. These factors may prove helpful in identifying CPAP-treated OSA patients who may need additional treatment to minimize RES.

Posterior fossa decompression in patients with Chiari malformation type 1: effect on sleep apnea and follow-up outcomes.

Sleep apnea, posing significant health risks, is frequently associated with Chiari malformation (CM), characterized by cerebellar tonsil herniation through the foramen magnum. Central sleep apnea (CSA) in CM results from impaired brain-to-muscle signaling and requires treatment. Conversely, obstructive sleep apnea (OSA), arising from throat muscle relaxation, typically unrelated to CM, often coexists. This study evaluates the effectiveness of posterior fossa decompression (PFD) on sleep apnea. A retrospective chart review was conducted of pediatric patients with CM-1 and sleep apnea who underwent PFD between April 1, 2004, and September 30, 2022. Data collected included demographics, clinical characteristics, adenotonsillectomy status, PFD details, and sleep study parameters like the apnea-hypopnea index and respiratory disturbance index. Statistical analysis assessed the surgery's impact on sleep apnea severity. The study included eleven patients, predominantly male (63.6%). All had OSA (100%), with 63.6% also having CSA. Preoperative sleep studies classified OSA severity as 36.4% mild, 18.2% moderate, and 45.5% severe, with no change post-surgery. CSA severity initially included seven mild cases, which became three mild, one moderate, and three resolved cases post-surgery. Among seven patients who had adenotonsillectomy before decompression, five showed no improvement in OSA severity post-surgery. This study elucidates the complex relationship between CM-1, sleep apnea, and PFD. The findings show the persistence of sleep apnea in some patients and highlight the need for continuous monitoring of these patients in order to optimize their care after surgery.

Impact of frenectomy on the oral exercise in patients with ankyloglossia and obstructive sleep apnea: double-blind randomized controlled clinical trials.

This study compares the efficacy of oral exercise alone to oral exercise with frenectomy in improving obstructive sleep apnea (OSA) symptoms and quality of life (QOL) in patients with ankyloglossia. A prospective, controlled, double-blind clinical study enrolled fifteen adults (20-60 years) newly diagnosed with mild to moderate OSA and ankyloglossia. Participants were randomly assigned to either oral exercise alone (control group; n = 8) or oral exercise with frenectomy (intervention group; n = 7). Outcomes were assessed after a 3-month therapy period using polysomnography, the Epworth Sleepiness Scale (ESS), tongue strength (measured in kPa), and QOL questionnaires. Both control (-2.88 ± 1.73; p = 0.02) and intervention (-4.00 ± 3.65; p = 0.03) groups showed a significant reduction in ESS scores, indicating both improved sleepiness. Although the apnea-hypopnea index (AHI) increased in both groups after treatment, these changes were not statistically significant (control 4.73 ± 15.55; p = 0.48, intervention 10.42 ± 14.66; p = 0.12). Tongue strength significantly increased in both groups: control group (p = 0.04) and intervention group (p = 0.03). Satisfaction rates with the overall treatment process were 100% in the control group and 57.1% in the intervention group. Furthermore, 75.0% and 57.1% of participants in the respective groups reported an improvement in QOL. Frenectomy improved tongue mobility and the ability to perform oral exercises in individuals with OSA and ankyloglossia. However, these exercises did not significantly improve OSA-related symptoms or QOL. While frenectomy enhances tongue mobility, thereby enabling better engagement in oral exercises. These exercises alone did not significantly improve OSA-related symptoms or QOL. This suggests that oral exercises focusing solely on tongue mobility may not be sufficient for managing OSA. The Thai Clinical Trials Registry was TCTR20220429002.

The association between endothelial dysfunction and subclinical myocardial injury in male OSA patients

BackgroundEndothelial dysfunction was shown to contribute significantly to the elevated cardiovascular risk observed in the general population. However, the relationship between endothelial dysfunction and subclinical myocardial injury in obstructive sleep apnea (OSA) patients remains unclear.MethodsThis cross-sectional study recruited 165 consecutive male patients diagnosed with OSA. All participants underwent overnight polysomnography to confirm the diagnosis and assess the severity of OSA. Subclinical myocardial injury was evaluated using high-sensitivity cardiac troponin I (hs-cTnI) measurements, while endothelial dysfunction was assessed through the peripheral arterial tonometry.ResultsEndothelial dysfunction was present in 80 (48.5%) of the subjects. Hs-cTnI was detectable in 147 (89.1%) of the participants. When compared to OSA patients without endothelial dysfunction, those with endothelial dysfunction exhibited significantly lower percentages of hypertension (23.8%versus43.5%, p=0.007) and abdominal obesity (76.3%versus88.2%, p=0.043). Patients with endothelial dysfunction frequently manifest a lower apnea-hypopnea index and oxygen desaturation index. Despite comparable median hs-cTnI levels, a higher proportion of subjects with detectable hs-cTnI levels was observed among those with endothelial dysfunction (95%versus83.5%, p=0.018). Logistic regression analysis indicated that endothelial dysfunction was significantly associated with a detectable level of hs-cTnI after adjustment for multiple confounders.ConclusionsIn male OSA patients, endothelial dysfunction appears to be potentially correlated with an increased risk of subclinical myocardial injury, as evidenced by the higher prevalence of detectable hs-cTnI levels. Further investigations are warranted to elucidate the role of endothelial dysfunction in predicting future cardiovascular mortality in this population.

Implementation of home OSAHS screening device based on sleep sounds

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common chronic sleeping respiratory condition. Screening for OSAHS approaches based on sleep breathing sounds has received much attention since it can provide fully noncontact monitoring at home. Deploying a diagnostic sound-based OSAHS system on a smartphone not only interferes with regular phone use but may also pose privacy problems, as well as suffer from decreasing accuracy owing to device variances. This work describes a local OSAHS monitoring system implementation designed for a dedicated device to estimate the apnea-hypopnea index and screening for OSAHS while doing away with concerns about the abovementioned issue. The OSAHS screening system is deployed on a Kendryte K510 (Canaan Inc.), a low-power RISC-V 64-bit CPU that has 2.5 TFLOPS, to analyze sleep breath sounds in a 9-s window. The design results are relatively low-cost and efficient for screening severe OSAHS. The equipment can be further used as a platform to evaluate the performance of the OSAHS diagnosis model.