Clinical Diagnosis Of Obstructive Sleep Apnea Research Articles

Prevalence and regional distribution of obstructive sleep apnea in Canada: Analysis from the Canadian Longitudinal Study on Aging.

Obstructive sleep apnea (OSA) is a common chronic condition that is often undiagnosed or diagnosed after many years of symptoms and has an impact on quality of life and several health factors. We estimated the Canadian national prevalence of OSA using a validated questionnaire and physical measurements in participants in the Canadian Longitudinal Study on Aging (CLSA). The method used individual risk estimation based upon the validated STOP-BANG scale developed for OSA. This stratified population sample spans Canada to provide regional estimates. In this sample of adults aged 45 to 85years old, the overall prevalence in 2015 of combined moderate and severe OSA in the 51,337 participants was 28.1% (95% confidence intervals, 27.8‒28.4). The regional prevalence varied statistically between Atlantic Canada and Western Canada (p < 0.001), although clinically the variations were limited. The provincial prevalence for moderate and severe OSA ranged from 27.5% (New Brunswick and British Columbia) to 29.1% (Manitoba). Body mass index (BMI) was the dominant determinant of the variance between provinces (β = 0.33, p < 0.001). Only 1.2% of participants had a clinical diagnosis of OSA. The great majority (92.9%) of the participants at high risk of OSA were unrecognized and had no clinical diagnosis of OSA.

A Review of Current Tools Used for Evaluating the Severity of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common and heterogeneous disease characterized by episodic collapse within the upper airways, which leads to reduced ventilation and adverse consequences, including hypoxia, hypercapnia, sleep fragmentation, and long-term effects such as cardiovascular comorbidities. The clinical diagnosis of OSA and its severity classification are often determined based on the apnea–hypopnea index (AHI), defining the number of apneic and hypopnea events per hour of sleep. However, the limitations of the AHI to assess disease severity have necessitated the exploration of other metrics for additional information to reflect the complexity of OSA. Novel parameters such as the hypoxic burden have the potential to better capture the main features of OSA by maximizing the information available from the polysomnogram. These emerging measures have described multidimensional qualities of sleep-disordered breathing events and breathing irregularity and will ultimately result in better management of OSA.

Obstructive sleep apnea severity and subsequent risk for cancer incidence.

In vitro and animal models suggest that obstructive sleep apnea (OSA) increases cancer risk. However, the impact of OSA severity on cancer risk is poorly understood.We conducted a case-cohort study (a variant of the case-control study design), nested in a cohort of patients with a clinical diagnosis of OSA. OSA patients diagnosed between 2005 and 2013 were linked to a population-based cancer registry to identify cancers diagnosed subsequent to OSA between 2005 and 2015. Medical records were reviewed for a representative sample of 1162 OSA patients from this cohort (including 24 with subsequent cancer), and for an additional 304 OSA patients diagnosed with cancer; information regarding OSA severity indicators, including apnea-hypopnea index (AHI) was abstracted from these records. Adjusted Cox proportional hazards regression were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for associations of OSA severity indicators on cancer incidence.Compared with individuals in the lowest AHI category (5–14.9), indicating mild OSA, the adjusted HR (95% CI) for cancer incidence associated with having moderate (15–29.9) or severe (30+) OSA were 0.72 (0.40–1.29) and 0.87 (0.52–1.45) respectively. Associations with other severity indicators were not significantly associated with cancer. However, the proportion of patients with severe OSA (AHI ≥30) was consistently higher across numerous cancer sites relative to the subcohort, suggesting increased cancer risk relative to patients with less severe OSA.The absence of significant associations with OSA severity measures suggest that the underlying mechanisms deserve further investigation.

Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA).

Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .

Proportion of Surgical Patients With Undiagnosed Obstructive Sleep Apnoea

Editor's key points † Obstructive sleep apnoea (OSA) is associated with perioperative morbidity but is under-diagnosed in the community. † In this study of Canadian surgical patients, both anaesthetists and surgeons often failed to diagnose OSA. † Preoperative diagnosis Background. Obstructive sleep apnoea (OSA) affects � 9-24% of the general population, and 90% remain undiagnosed. Those patients with undiagnosed moderate-to-severe OSA may be associated with an increased risk of perioperative complications. Our objective was to evaluate the proportion of surgical patients with undiagnosed moderate-to-severe OSA. Methods. After research ethics board approval, patients visiting preoperative clinics were recruited over 4 yr and screened with the STOP-BANG questionnaire. The 1085 patients, who consented, subsequently underwent polysomnography (PSG) (laboratory or portable) before operation. Chart review was conducted in this historical cohort to ascertain the clinical diagnosis of OSA by surgeons and anaesthetists, blinded to the PSG results. The PSG study-identified OSA patients were further classified based on severity using the apnoea- hypopnoea index (AHI) cut-offs. Results. Of 819 patients, 111 patients had pre-existing OSA and 58% (64/111) were not diagnosed by the surgeons and 15% (17/111) were not diagnosed by the anaesthetists. Among the 708 study patients, PSG showed that 233 (31%) had no OSA, 218 (31%) patients had mild OSA (AHI: 5- 15); 148 (21%) had moderate OSA (AHI: 15 -30), and 119 (17%) had severe OSA (AHI.30). Before operation, of the 267 patients with moderate- to-severe OSA, 92% (n¼245) and 60% (n¼159) were not diagnosed by the surgeons and the anaesthetists, respectively. Conclusions. We found that anaesthetists and surgeons failed to identify a significant number of patients with pre-existing OSA and symptomatic undiagnosed OSA, before operation. This study may provide an impetus for more diligent case finding of OSA before operation.

Testing the system non-linearity in snoring sound via neural networks

Obstructive sleep apnea (OSA) is a serious disease caused by the collapse of upper airways during sleep. OSA is almost always accompanied by snoring. While snoring is not currently used in the clinical diagnosis of OSA, there have been intense efforts recently to model snoring for that purpose. Conventional approach is to treat snores as the outcome of a linear process and apply techniques such as linear prediction coding (LPC). However, the snores are likely to have diagnostically relevant non-linearities that cannot be captured by linear techniques. In this paper, we investigate the non-linearity of snores and develop a novel measure, as a possible characterisation index. The method is based on artificial neural networks (NN). The developed method was tested on a database of 27 subjects (5568 snoring episodes), categorised into two groups based on their respiratory disturbance index (RDI).

Tonsillectomy and Adenoidectomy in Children with Sleep-Related Breathing Disorders: Consensus Statement of a UK Multidisciplinary Working Party

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a 'concise, accurate and helpful document'. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal.

Tonsillectomy and adenoidectomy in children with sleep related breathing disorders: consensus statement of a UK multidisciplinary working party

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not avail able, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominat ed expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limit ed evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decisionmaking at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endors ing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a ‘concise, accurate and helpful document’. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal. This consensus statement is also being published by all the working party host organisations and will appear in the RCoA Bulletin, Clinical Otolaryngology and on the RCPCH website

Why CMS Approved Home Sleep Testing for CPAP Coverage

On December 14, 2007 the Centers for Medicare & Medicaid Services (CMS) released its proposed decision for modification of National Coverage Determination (NCD) policy 240.41 pertaining to coverage of continuous positive airway pressure therapy (CPAP) for adult obstructive sleep apnea (OSA). The proposed modification allows for an initial 12 week period of CPAP coverage when OSA is diagnosed using both a clinical evaluation and polysomnography performed in the sleep laboratory (PSG) or a clinical evaluation and unattended home sleep testing (HST) using a Type II, III or IV device. CPAP would be subsequently covered for those diagnosed with OSA who benefit from CPAP during the 12-week trial. CMS further intends to modify the criteria for a positive sleep study by removing the requirement for a minimum two hours of continuous recorded sleep (the 2-hour rule) and remove the current requirements that an individual have moderate to severe OSA and that surgery is a likely alternative to CPAP. Finally, CMS will expand Medicare coverage for CPAP for beneficiaries with a clinical diagnosis of OSA without either PSG or HST only when provided in the context of a clinical study that meets specific standards. A clinical study seeking Medicare coverage for CPAP pursuant to Coverage with Evidence Development must necessarily address specific questions as stipulated in the NCD.

Associations Between the Use of Common Medications and Sleep Architecture in Patients With Untreated Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is often associated with other disorders, which are usually treated with medications. Little is known about the extent to which medications are used in the OSA population or the effects of common prescription medications on the sleep architecture of patients with OSA. The aim of this study was to describe the frequency of use of medications by patients with untreated OSA and to examine the potential associations between specific, frequently used medication types and indexes of sleep architecture assessed through laboratory-based polysomnography. This study used a retrospective design with analyses of archival clinical data. Tertiary public sleep disorders center in Brisbane, Australia. Consecutive patients with a clinical diagnosis of OSA (N = 1779). None. Of the patients with OSA, 77.1% were taking at least 1 medication; 12.4% were taking beta-adrenergic receptor-blocking agents and 20.8% were taking antidepressant or anxiolytic medications. Analyses of covariance demonstrated reliable effects of medication use on sleep architecture, after accounting for age, sex, and body mass index variables. Both tricyclic and selective serotonin reuptake inhibitor antidepressant or anxiolytic medications were associated with a lower percentage of rapid eye movement sleep and lower sleep-efficiency values in patients with OSA, compared with those not taking any medications. The use of beta-adrenergic receptor-blocking agents and aspirin had no consistent associations with the indexes of sleep architecture. Medication use was high within this sample of patients with OSA. Some common medications may be associated with differences in objective sleep quality in a large proportion of patients with OSA. The potential effects of classes of common medication on both the presentation and treatment of OSA need to be further assessed.