Cessation Of Breathing Research Articles

A case of behavioural hyperventilation associated with severe central sleep apnoea and follow-up management

YL (Junior Doctor): A 36-year-old man was observed by his wife to have irregular breathing with sighs followed by recurrent episodes of prolonged breathing cessation while falling asleep. The longest...

Apnea–hypopnea index estimation using quantitative analysis of sleep macrostructure

Obstructive sleep apnea, characterized by recurrent cessation or substantial reduction in breathing during sleep, is a prevalent and serious medical condition. Although a significant relationship between obstructive sleep apnea and sleep macrostructure has been revealed in several studies, useful applications of this relationship have been limited. The aim of this study was to suggest a novel approach using quantitative analysis of sleep macrostructure to estimate the apnea–hypopnea index, which is commonly used to assess obstructive sleep apnea. Without being bound by conventional sleep macrostructure parameters, various new sleep macrostructure parameters were extracted from the polysomnographic recordings of 132 subjects. These recordings were split into training and validation sets, each with 66 recordings including 48 recordings with an apnea–hypopnea index greater than 5 events h−1. The nonlinear regression analysis, performed using the percentage transition probability from non-rapid eye movement sleep stage 2 to stage 1, was most effective in estimating the apnea–hypopnea index. Between the apnea–hypopnea index estimates and the reference values reported from polysomnography, a root mean square error of 7.30 events h−1 was obtained in the validation set. At an apnea–hypopnea index cut-off of ⩾30 events h−1, the obstructive sleep apnea diagnostic performance was provided with a sensitivity of 90.0%, a specificity of 93.5%, and an accuracy of 92.4% by our method. The developed apnea–hypopnea index estimation model has the potential to be utilized in circumstances in which it is not possible to acquire or analyze respiration signal but it is possible to obtain information on sleep macrostructure.

Comparative Study of HRV Indexes Between Severe and Non-Severe Obstructive Sleep Apnea Patients

Background: The temporary cessation of breathing, or obstructive sleep apnea, is a known risk factor for cardiovascular disease. The autonomic cardiac measurement via the heart rate variability (HRV) is a known identification method for heart conditions during sleep, which identifies their relationship with the apnea-hypopnea index (AHI), and can help to detect disease severity. Additionally, it helps to estimate the risk of heart problems and begin treatment of the disease (according to the HRV), and in mild cases, the AHI can help reduce the risk of cardiovascular problems in patients. Objectives: This study was conducted to compare the HRV in patients with severe and non-severe obstructive sleep apnea. Patients and Methods: This cross-sectional study contained 36 patients suffering from obstructive sleep apnea who were referred to the sleep clinic of the Imam Khomeini hospital in Tehran, Iran, in 2015. Apnea syndrome in these patients was confirmed by polysomnography, and the participants were divided into two groups, severe (AHI ≥ 30) and non-severe (AHI = 5 - 29). The age, BMI, resting heart rate, and obtained HRV indexes via a sleep test (polysomnography) were recorded for each patient. The statistical analysis was done by SPSS version 19. Results: The statistical analysis did not show any significant differences in the age and BMI between the two groups. Moreover, the results showed that only the SDNNi index (P value = 0.026) and ODI index (P value = 0.001) were significantly different between the two groups. The AHI had the greatest correlation with the HRV-triangular index (P = 0.022, rp = 0.371), between the HRV indexes, and with the oxygen desaturation index (ODI) (P = 0.001, rp = 0.63), among all of the parameters. Conclusions: According to the results of this study, the majority of the HRV indexes did not significantly differ between the two groups, with only the ODI index differing significantly. Therefore, it seems that a clinical judgment cannot be made based on the index data in all societies.

Is polysomnographic examination necessary for subjects with diaphragm pathologies?

OBJECTIVES:While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated.METHODS:This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014–2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared.RESULTS:Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement.CONCLUSION:All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented.

THE ROLE OF CORTISOL IN NEUROCOGNITIVE PERFORMANCE IN OBSTRUCTIVE SLEEP APNEA PATIENTS.

Obstructive sleep apnea consists in recurrent episodes of partial obstruction of the upper airways which can determine cessation of breathing during sleep causing intermittent hypoxia. The obstructive sleep disorders are encountered predominantly in obese patients with or without metabolic syndrome, that can affect the quality of life and life expectancy by increasing the cardiovascular risk of coronary artery disease, conductance disturbances, malignant arrhythmias, promoting atherogenic processes, determining sudden death and impairing several domains of cognitive function.

Dimensional and volumetric analysis of the oropharyngeal region in obstructive sleep apnea patients: A cone beam computed tomography study.

Obstructive Sleep Apnea (OSA) is a potentially life-threatening condition in which there is a periodic cessation of breathing (for 10 sec or longer) that occurs during sleep in the presence of inspiratory effort. The aim of the study was to assess volumetric and dimensional differences between OSA patients and normal individuals in the upright posture. The present study was conducted on CBCT scans of 32 patients who were divided into two groups -Group I (control group) and Group II (OSA subjects). Group I consisted of 16 patients with normal airway with ESS score from 2 to 10, STOP BANG Questionnaire score of <3 and who had undergone CBCT for various diagnostic reasons. Group II had patients with ESS score >10, STOP BANG Questionnaire score of > 3, AHI index >5. Linear and angular parameters, volume and minimum cross-section area (MCA) of oropharyngeal airway, anteroposterior length and lateral width at MCA was compared amongst the groups. The oropharyngeal volume, MCA, and the anteroposterior and lateral width of the airway at MCA of the OSA subjects was significantly lesser than that of normal subjects. The length of both soft palate and tongue was significantly more in Group II. The angle between the nasopharyngeal airway and the oropharyngeal airway was significantly more obtuse in Group II. The reduction in oropharyngeal volume in OSA patients could be attributed to different anatomical and pathophysiological factors that were corroborated with the findings of the present study.

Critical Analysis and Alternative Explanations for Effects of Apnea on the Timing of Motor Representations

This commentary is designed to provide an analysis of issues pertinent to the investigation of the effects of the temporary cessation of breathing (apnea), particularly during water immersion or diving, and its effects on time estimation in general and the timing of motor representation in particular. In addition, this analysis provides alternative explanations of certain unexpected findings reported by Di Rienzo et al. (2014) pertaining to apnea and interval timing. The perspective and guidance that this commentary provides on the relationship between apnea and time estimation is especially relevant considering the scarcity of experimental and clinical studies examining these variables.

Difference in nasolabial features between awake and asleep infants with unilateral cleft lip: Anthropometric measurements using three-dimensional stereophotogrammetry.

Cleft lip repair is performed in the supine position, tilting the head back under general anesthesia. However, postoperative results are evaluated in the upright position while patients are awake. The purpose of this study was to anthropometrically assess whether nasolabial features of infants with unilateral cleft lip are influenced by posture and anesthesia. Three-dimensional facial images in a preoperative upright position and operating supine position under general anesthesia were captured from 51 consecutive infants with unilateral cleft lip. Twenty-four indirect anthropometric measurements (11 for the nose and 13 for the lip elements) were considered on each infant. In the supine position under general anesthesia, alar surface distance was significantly shorter (p<0.001). Regarding lip measurements, medial lip height of the cleft side and philtrum height were significantly smaller (p<0.05 and p<0.05, respectively), whereas vermilion height was greater (p<0.01). In addition, the cleft width and lip width were significantly broader (p<0.001 and p<0.001, respectively) after general anesthesia. Several nasolabial alteration patterns are found after general anesthesia that are presumably attributable to cessation of nasal breathing and the action of muscle relaxation. Surgeons should take these nasolabial changes into account during preoperative planning and postoperative assessment.

She's Not the Same Mother I Loved

She's Not the Same Mother I Loved

Self-reported obstructive sleep apnea, simple snoring, and various markers of sleep-disordered breathing as predictors of cardiovascular risk.

Our objective was to investigate whether self-reported obstructive sleep apnea (OSA), simple snoring, and various markers of sleep-disordered breathing (SDB) are associated with cardiovascular risk. We examined a representative nationwide cohort of 5177 Finnish adults aged ≥30years. The participants underwent measurement of traditional cardiovascular risk factors and answered SDB-related questions derived from the Basic Nordic Sleep Questionnaire, which were used to operationalize self-reported OSA. The primary end point was incidence of a cardiovascular event (cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, or coronary interventions). During a median follow-up of 11.2years and 52,910 person-years of follow-up, 634 participants suffered a cardiovascular event. In multivariable-adjusted Cox models, self-reported OSA (hazard ratio [HR] 1.34; 95% confidence interval [CI] 1.04-1.73; p = 0.03) was an independent predictor of cardiovascular events. Self-reported simple snoring by itself was not associated with future cardiovascular events (HR 0.88 versus non-snorers, 95% CI 0.75-1.04, p = 0.15). However, among snorers (n = 3152), frequent breathing cessations (HR 2.19, 95% CI 1.26-3.81, p = 0.006) and very loud and irregular snoring (HR 1.82, 95% CI 1.31-2.54, p < 0.001) were associated with cardiovascular risk. Self-reported OSA and SDB-related snoring variables are associated with cardiovascular risk, whereas simple snoring is not. In clinical practice and in surveys, questions concerning only habitual snoring should be amended with questions focusing on respiratory pauses and snoring stertorousness, which can be used to estimate the risk of OSA and cardiovascular events.

Cardiology Patient Page. Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common sleep disorder that affects 2% to 7% of the population. It is a serious medical condition that has many effects on health, happiness, and survival, beyond simple snoring and poor sleep. OSA often goes undiagnosed, and many patients with risk factors for OSA should be evaluated for the disease. OSA is initiated by inappropriate closure of the upper airway during sleep, leading to a cessation in breathing that is often terminated by a gasp and awakening (see Figure). Patients with OSA are prone to airway closure for a number of reasons. First, they have a smaller airway opening than those without OSA. They also have changes in the muscles surrounding the airway that make it more collapsible than normal. People who are obese or have a large neck circumference are at particular risk of airway closure because of the excess tissue that may compress the airway opening further. When awake, patients with OSA are able to keep the collapsible airway open, but when they are asleep, the airway muscles relax, putting the patient at risk of airway closure. Figure. Pathophysiological mechanisms of OSA. This is a schematic of the mechanism responsible for OSA. (1) The patient begins awake, and as he/she falls asleep, the upper airway tissues relax and start to close. (2) Once asleep, the airway closes completely. As a result, breathing stops. (3) When the patient’s oxygen levels fall and carbon dioxide levels rise, he/she is stimulated to breath. This stimulation results in awakening, in addition to gasping and rapid …

Obstructive sleep apnoea syndrome and its management.

Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment. Nasal CPAP (nCPAP) is highly effective in controlling symptoms, improving quality of life and reducing the clinical sequelae of sleep apnoea. Other positive airway pressure modalities are available for patients intolerant to CPAP or requiring high levels of positive pressure. Mandibular advancement devices, particularly if custom made, are effective in mild to moderate OSA and provide a viable alternative for patients intolerant to CPAP therapy. The role of surgery remains controversial. Uvulopalatopharyngoplasty is a well established procedure and can be considered when treatment with CPAP has failed, whereas maxillar-mandibular surgery can be suggested to patients with a craniofacial malformation. A number of minimally invasive procedures to treat snoring are currently under evaluation. Weight loss improves symptoms and morbidity in all patients with obesity and bariatric surgery is an option in severe obesity. A multidisciplinary approach is necessary for an accurate management of the disease.

Abstract P072: Short Sleep Duration is Associated with Elevated Homocysteine Levels

Introduction: Short and long sleep durations are associated with heightened risk for cardiovascular disease and vascular risk factors. Elevated homocysteine is also associated with greater risk for cardiovascular disease; however, studies have yet to investigate the relationship between sleep duration and homocysteine. Hypothesis: We hypothesized that short and long sleep duration would be associated with clinical levels of homocysteine. Methods: Adults (n=2,469; ≥20y) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were assessed for habitual sleep duration (coded as &lt;5, 5, 6, 7, 8, 9, and ≥10hrs) and fasting plasma homocysteine levels (&lt;10 [normative], 10 to &lt;15 [pre-clinical] and ≥15 [clinical] μmol/L). Participants were excluded if pregnant, lactating, missing data on the primary variables, or if they had a history of cardiovascular disease, cancer, diabetes, kidney disease, or diagnosed sleep disorder. Population weighted, multinomial logistic regression analyses assessed the relationship between sleep duration and homocysteine after adjustment for age, sex, race/ethnicity, marital and menopausal status, shift work, dietary folate, alcohol intake, cotinine levels, reported physical activity, hypertension, and reported frequency of cessation of breathing at night. Results: Pre-clinical and clinical levels of homocysteine were present in 13.7% and 2.5% of the sample, respectively. The mean sleep duration was 6.9 ± 1.4 hours. In adjusted analyses, sleep duration was significantly related to homocysteine ( p &lt; 0.001). See Table. Very short sleepers (&lt;5hrs) were more likely to have clinical levels of homocysteine (OR: 3.01, 95%CI: 1.38, 6.57) compared to 7-hr sleepers. Conclusions: In a U.S. representative sample of adults without cardiovascular disease or other major conditions, short sleepers were at greater odds for clinical levels of homocysteine Findings suggest that homocysteine may be one mechanism linking short sleep duration to cardiovascular disease.

Effect of different oxygen desaturation threshold levels on hypopnea scoring and classification of severity of sleep apnea.

Recently, there has been a debate about the rules used to score hypopnea events. The purpose of this study was to examine the effect of different oxygen desaturation threshold (ODT) levels on the apnea-hypopnea index (AHI) and on a recently introduced parameter, adjusted AHI. Adjusted AHI incorporates the severity of individual breathing cessation events. We also aimed to clarify the impact of the different ODT levels on the current classification of obstructive sleep apnea (OSA) severity. Ambulatory polygraphic recordings of 68 patients (19 F/49 M, median age 53.2 years, AHI ≥5) were analyzed retrospectively. Hypopneas were defined as ≥30% drop in airflow for ≥10 s associated with ≥2% oxygen desaturation (ODT2%), and after that, using stricter ODT criteria (ODT3%-ODT8%). Compared to ODT4%, the ODT3% resulted in 5.6 events/h higher median conventional AHI, but only 1.5 events/h higher median adjusted AHI. A significant rearrangement of patients between the clinical severity categories took place when using different ODTs. When assessing with ODT3% instead of ODT4%, the portion of the patients with moderate or severe OSA (AHI ≥15) raised from 29.4 to 73.5% using conventional AHI, but only marginally, i.e., from 73.5 to 77.9%, using the adjusted AHI. The conventional AHI was found to be susceptible even to minor changes in ODT level which may lead to substantial variability in AHI-based classification of disease severity. Since the adjusted AHI comprises information on severity of individual breathing cessations, it reduces the variability related to ODT levels used in hypopnea scoring and can increase the accuracy of estimation of OSA severity.

Importance of cephalographs in diagnosis of patients with sleep apnea.

Introduction:Obstructive sleep apnea (OSA) is considered to be a potentially life threatening disorder, which is characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The cephalometric method despite being a static, two-dimensional evaluation of dynamic three-dimensional structures of the head and neck is useful in diagnosing patients with OSA, as they have shown that significant differences exist between asymptomatic controls and patients with OSA.Aims and Objectives:This study is designed to compare and validate the craniofacial morphology in patients with OSA using lateral cephalometry in both upright and supine position.Materials and Methods:Sixty subjects participated in the study of which 30 were patients with OSA diagnosed by questionnaire and 30 were healthy control group with age range of 25–45 years.Results:The study group demonstrated an increased ANB, mandibular plane angles (GoGn-SN), lower anterior facial height which are statistically significant with a significant P < 0.05. Significant decrease in posterior airway space, increased soft palate length, tongue length, and thickness suggesting reduced airway space in supine posture.Conclusion:Evaluation of craniofacial morphology in OSA patients using lateral cephalometry helps in recognizing the morphological changes induced by altered sleep pattern and for appropriate treatment planning.

Features of REM-related Sleep Disordered Breathing in the Japanese Population.

Rapid eye movement (REM)-related sleep disordered breathing (SDB) is an entity in which the cessation or reduction of breathing occurs primarily during the REM period. Most studies have shown that REM-related SDB more frequently affects women, younger people and patients with mild or moderate SDB. The aim of this study was to prospectively investigate the prevalence and features of REM-related SDB in Japanese subjects compared with the findings of previous reports. A total of 468 patients were evaluated in this study. The diagnosis of SDB was established using polysomnographic monitoring. The patient variables included age, gender, body characteristics, comorbidities, etc. REM-related SDB was more prevalent in women than non-REM-related SDB (male ratio; 66.3% vs. 79.5%, p=0.03). Moreover, the patients with REM-related SDB had lower body mass indexes (25.9 ± 6.9 vs. 28.5 ± 7.7; p=0.003), arousal indexes (31.8 ± 10.7 vs. 61.0 ± 29.1; p<0.001), apnea hypopnea indexes (15.0 ± 8.0 vs. 54.9 ± 35.9) and glycosylated hemoglobin (HbA1c) levels (5.5 ± 0.9 vs. 5.9 ± 2.6; p=0.02) than the patients with non-REM-related SDB. However, the overall and female gender prevalence of REM-related SDB among the Japanese subjects was lower than that shown in previous reports. The finding that REM-related SDB was not prevalent in younger individuals or severely obese patients was not consistent with the results of previous studies. The present findings suggest that REM-related SDB may have different clinical characteristics in the Japanese population than that observed in previous reports.

Is Two Better Than One? Anticipation of a Favorable Hemodynamic Profile by Combining the Hypnotic Drugs for Induction of Anesthesia.

Is Two Better Than One? Anticipation of a Favorable Hemodynamic Profile by Combining the Hypnotic Drugs for Induction of Anesthesia.

Obstructive Sleep Apnea, Prevalence, Etiology &amp;amp; Role of Dentist &amp;amp; Oral Appliances in Treatment: Review Article

Objective: The aim of this article is to provide a detailed description for obstructive sleep apnea regarding its signs and symptoms, the way it is diagnosed, the risk factors, management, the role of dentists and oral appliances in treatment and consequences of untreated condition. Material and Method: Electronic searching was done in PubMed, Medline, EMBASE and CENTRAL databases. Inclusion criteria were: dental, oral and maxillofacial oriented articles. Exclusion criteria: cardiac, obesity and non dental oriented articles were excluded. Result: 59 articles meet the criteria. Conclusion: Obstructive sleep apnea (OSA) is a potentially life threatening disorder characterized by repeated collapse of the upper airway during sleep, with periodic cessation of breathing for more than ten seconds. The frequency of obstructive sleep apnea has been found to increase with age; ranging from two percent among children to two and half percent - six percent among adolescents. Overnight polysomnographic test at specialized sleep clinics remains the gold standard for diagnosing obstructive sleep apnea disorder. Management of this condition can be performed via surgical and non surgical methods. Continuous positive airway pressure represents the first line of treatment for most patients with obstructive sleep apnea.

198-POS

Objectives Sleep disordered breathing (SDB) is common in women and reported at 14–45% in pregnancy. SDB is identified by snoring and repetitive cessation of breathing during sleep accompanied by repetitive hypoxia, and has been found to be associated with hypertension, stroke, and heart attack. There is no depth of knowledge examining the association between SDB and pregnancy outcomes. The aim of the current study was to examine the prevalence of self-reported snoring in pregnancy and the potential association between self-reported snoring and the development of hypertensive disorders of pregnancy (HDP) within a larger cohort from a prevalence of SDB in pregnancy study. Methods Questionnaires were administered to women attending an outpatient’s antenatal clinic. Objective measurements were undertaken. The self-reported snoring is a component of the Epworth scale. Overnight recordings of sleep were attained using SonoMat™ (Home Sleep Testing). Pregnancy progression and outcome data were collected on all participants and analysed by IBM SPSS v.20™ utilizing chi-square analysis, student T test and logistic regression analysis. HDP diagnoses were in alignment with the SOMANZ (2009) criteria. Results Questionnaires were administered and outcomes collected on 2309 pregnancies. Snoring was reported in 45.5% of women. Objective measures were attended on 202 women, snoring was recorded at 61%. HDP affected 10.1% of the cohort, 3.3% of whom had preeclampsia. Of the pregnancies affected by self-reported snoring, HDP occurred in 13.4% in comparison to 7.6% of those who do not report snoring (p Conclusions This indicates an association between self-reported snoring and HDP. Further analysis will be undertaken to model the effect of other potential cofounders such as maternal age, parity, pre-pregnancy BMI and other co-morbidities. Disclosures A.J. Robertson: None. P. Johnson: None. C.E. Sullivan: c. Other(specify)*; Commercial Interest(s):; developed Sonomat. A. Hennessy: None.

Absence of Typical Symptoms and Comorbidities in Patients with Central Sleep Apnea.

Sleep apnea is characterized by pauses in breathing during sleep. There are three forms: central, obstructive, and complex, or mixed sleep apnea. Central sleep apnea, a manifestation of respiratory instability in many clinical conditions and with a variety of causes, is the result of a temporary cessation of breathing in which the inhibitory influences favoring the instability predominate over excitatory influences favoring stable breathing. In contrast to central sleep apnea, according to the published data from previous studies, an association exists between obstructive sleep apnea and various comorbidities, especially chronic obstructive pulmonary disease. This article examines retrospectively the possible association of central sleep apnea with special sleep-related symptoms and various co-morbidities. Data of all patients with different types of central sleep apnea were collected from our hospital charts within the Department of Pneumology, HELIOS Clinic, University of Witten/Herdecke, Wuppertal, Germany, within the study period of January 1, 2011 to September 19, 2014. After clinical examination, all patients underwent polysomnography in our sleep laboratory. We identified a total of 60 (3.5 %) patients with central sleep apnea from 1722 patients with assumed sleep disordered breathing of the mean age of 68.2 ± 13.7 years (44 males - 73.3 %, 95 % CI 0.6-0.9 and 16 females - 26.7 %, 95 % CI 0.2-0.4). Typical symptoms of sleep-disordered breathing were not observed. A relation to co-morbidities was not found. Central sleep apnea was often diagnosed in the elderly. A direct association between central sleep apnea and symptoms of sleep-disordered breathing and various co-morbidities was not detected. This is in direct contrast to the obstructive sleep apnea syndrome.