Degree Of Obstructive Sleep Apnea Research Articles

A case of sleep apnoea

This case report represents a comprehensive overview of the assessment, diagnosis, and subsequent management of a 60 year old patient who sought medical attention due to debilitating fatigue. Despite displaying atypical symptoms and an absence of characteristic signs, polysomnography revealed significant degree of obstructive sleep apnea. This case highlights the importance of considering sleep-related disorders in the differential diagnosis of fatigue and the remarkable efficacy of continuous positive airway pressure (CPAP) therapy in improving the patient’s quality of life. Keywords: obstructive sleep apnea, fatigue, continuous positive airway pressure, case report

Metabolic bariatric surgery and combined multilevel surgery as a treatment for obstructive sleep apnea patient with obesity


 
 
 Body mass index (BMI) and the degree of obstructive sleep apnea (OSA) are strongly correlated. Managing obesity is an important strategy for preventing and treating OSA. Bariatric surgery can lead to significant weight loss and improvements in metabolic function, which can have beneficial effects on OSA symptoms within obese population. There is a relative lack of data directly comparing the different types of bariatric surgery and multilevel upper airway surgery for the treatment of obstructive sleep apnea (OSA). While there is some evidence to suggest that bariatric surgery can improve OSA symptoms in obese individuals, and multilevel upper airway surgery can improve OSA symptoms in some cases of anatomical obstruction, there is limited research directly comparing these treatment options. Therefore, this review provides an update on the relationship between OSA, MBS and MLS for demonstrating the significance of multidisciplinary surgery approach for obese patients with OSA.
 
 

Relationship between obstructive sleep apnea and coronary artery stenosis, myocardial injury and cardiac structure and function in coronary heart disease patients

Objective: To further investigate the relationship between sleep apnea and coronary heart disease. Obstructive sleep apnea (OSA) is associated with various cardiovascular diseases including coronary heart disease. Moderate to severe OSA patients are prone to more severe coronary stenosis. We combined the serological indicators, echocardiography and coronary angiography all together to further investigate the relationship between sleep apnea and coronary heart disease. Methods: A total of 110 coronary heart disease patients who underwent coronary angiography and overnight polysomnography during hospitalization were enrolled, including 97 males and 13 females aged 27-85 years. Data of baseline characteristics, biochemical measurements, echocardiography, coronary angiography and polysomnography were collected. The differences in cardiovascular indicators of different degrees of OSA were compared by t-test and nonparametric test. Logistic regression was used to analyze the risk factors for OSA and coronary stenosis. Results: The median age of the enrolled 110 patients was 56 years. Totally, 88.2% patients were male and 84.5% suffered from OSA. Patients with moderate to severe OSA had a greater degree of heart rate variation during sleep, a wider proximal ascending aorta, and were more prone to abnormal right heart structure, however, no significant difference was found in myocardial injury. Patients with more severe coronary stenosis were more likely to have OSA, and they often had higher apnea-hypopnea index (AHI) and more central sleep apnea. Hypertension was independently associated with coronary stenosis and moderate to severe OSA after adjustment (OR=3.88, P=0.035; OR=2.95, P=0.046). Conclusions: Patients with more severe coronary stenosis had higher prevalence of OSA and more central sleep apnea affairs. Coronary heart disease patients with moderate to severe sleep apnea were more likely to develop aortic widening and abnormal right heart structure. Hypertension was an independent risk factor for severe coronary stenosis and moderate to severe OSA, respectively.

Sex-specific differences in diagnostic approaches of inpatient sleep testing for obstructive sleep apnea

BackgroundFew studies have investigated sex-specific disparities in inpatient sleep testing. We postulate that women are more likely to have a milder degree of obstructive sleep apnea (OSA) and lower extent of hypoxia on Type III sleep studies versus polysomnography (PSG). Patients and methodsThe Cleveland Clinic Sleep laboratory registry was leveraged to identify all adult inpatient sleep studies performed for OSA. Demographics, comorbidities, and sleep study measures were collected and compared by sex and sleep study type. Logistic regression was used to examine sleep study type predictive of OSA (apnea hypopnea index [AHI; ≥5, ≥15 and ≥ 30]) and hypoxia, (median percentage of sleep time spent at <90% SaO2 [TST<90%,≥ 11%,] adjusted for covariates. ResultsThe sample 778 patients had a mean age of 56.1 ± 16.1 years; 44.5% were female and 72.2% Caucasian. At an AHI≥5, women showed an increase odds of OSA (adjusted, OR = 2.04,95%; CI:1.24–3.35, p = 0.005) with Type III sleep study vs PSG compared to men. At an AHI≥15, men had less odds of OSA (adjusted OR = 0.60,95%CI:0.39–0.90,p = 0.015) with Type III sleep study vs PSG compared to women (OR = 1.15,95%CI:0.72–1.85,p = 0.56), with an interaction p-value of 0.040. These results were attenuated when the analysis was restricted using the 3% hypopnea scoring rule. Men and women had higher odds of TST <90 ≥ 11% (OR:2.60,95%CI:1.60–4.21,p=<0.001; OR:3.46,95%CI:1.97–6.05,p < 0.001) with Type III sleep study versus PSG, albeit no sex-interaction was observed. ConclusionsThese results suggest that sex-specific differences in diagnostic performance of sleep testing type in the inpatient setting should be considered according to level of OSA severity, which are influenced by hypopnea-related desaturation extent.

Study on Relationship Between Carotid Intima-Media Thickness and Inflammatory Factors in Obstructive Sleep Apnea.

The purpose of this study was to explore the change of carotid intima-media thickness (IMT) and its correlation with inflammatory markers in patients with different degrees of obstructive sleep apnea (OSA). One hundred hospitalized patients were selected and were divided into the normal control group (21 cases), the mild-moderate group (39 cases) and the severe group (40 cases) according to their apnea hypopnea index (AHI). Carotid IMT of all registered patients was studied with ultrasound, and serum levels of high-sensitivity C-reactive protein (hs-CRP), Lipoprotein-associated phospholipaseA2 (Lp-PLA2) and tumor necrosis factor-α (TNF-α) were measured. Pearson correlation analysis and multiple stepwise regression analysis were used to analyze the correlation between carotid IMT and inflammatory factors. Patients with mild, moderate and severe OSA Carotid IMT had significantly higher levels of serum hs-CRP, Lp-PLA2 and TNF-α compared with the normal control group (P < 0.001). The levels of carotid IMT, serum protein hs-CRP, Lp-PLA2 and TNF-α in the severe OSA group were significantly higher than those of the mild-moderate OSA group, with P values being less than 0.001. Carotid artery IMT was positively correlated with serum hs-CRP (r = 0.83, P < 0.001), Lp-PLA2 (r =0.58, P < 0.001), and TNF-α (r =0.69, P < 0.001). hs-CRP, TNF-α and AHI were independent factors affecting carotid artery IMT. In addition, AHI was an independent indicator of carotid atherosclerosis (P = 0.0012). Increased inflammatory factors in OSA patients might cause the progression of atherosclerosis, which might increase the risk of cardiovascular and cerebrovascular diseases in OSA patients.

Symptoms Underestimate the Presence of Obstructive Sleep Apnea in Patients with Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone.

To determine the severity of symptoms and degree of obstructive sleep apnea (OSA) in patients with spontaneous cerebrospinal fluid (sCSF) leaks of the temporal bone given the known association between sCSF leaks and OSA. Retrospective case review. Ambulatory clinics in tertiary referral centers. Polysomnogram testing in 34 consecutive patients who had been diagnosed with sCSF leaks of the temporal bone was examined. Diagnosis of sCSF leak was defined as biochemically confirmed CSF from middle ear fluid with no other obvious source. Diagnostic. Patient characteristics (age, sex, body mass index, Epworth Sleepiness Scale score, presence of hypoxia, overnight change in blood pressure, and apnea hypopnea index [AHI]) were recorded. Diagnosis of OSA was defined as mild when AHI ≥5 and <15/h, moderate when AHI ≥15 and <30/h, and severe when AHI ≥30/h. Of the 34 patients, 28 (82%) had a confirmed diagnosis of OSA. There was a male predisposition in those with OSA, and 17 of 28 (61%) were male. A majority were overweight, and the mean body mass index was 30.1 (SD, 4.8; range, 23.2-40) kg/m2. The mean severity of OSA was moderate, and the mean AHI was 28.7 (SD, 21.9; range, 5.4-92.8). Of the 28 patients, 13 with OSA (46%) had Epworth Sleepiness Scale scores higher than 8, suggesting that many were asymptomatic for excessive daytime sleepiness at the time of presentation. OSA is highly prevalent among patients with sCSF leaks of the temporal bone. Patients with sCSF leaks irrespective of symptoms of OSA should undergo formal polysomnogram testing.

Incidence of nasal and nasopharyngeal obstruction by nasal examination and nasal endoscopy in patients with abnormal polysomnography: A prospective study

To assess the incidence of nasal and nasopharyngeal obstruction in patients with abnormal polysomnography. To correlate the levels of nasal and nasopharyngeal obstruction with degree of obstructive sleep apnoea (OSA). Polysomnography by RMS Quest 32 polysomnography machine. Anterior and posterior rhinoscopy using Thudicum’s nasal speculum and posterior rhinoscopy mirror respectively. Nasal endoscopy to visualise nasal and nasopharyngeal airway for obstruction using 0 Hopkin’s rod endoscope under topical anaesthesia using 4% Xylocaine. 31 patients had deviated nasal septum (DNS), 19 had hypertrophied turbinates, 4 had Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP). 21 patients had posterior DNS, 7 had postnasal drip. By Nasal Endoscopy 42 patients had DNS among which 20 had anterior, 15 had posterior deviation. 7 patients had both anterior and posterior DNS. 4 patients had CRSwNP, 7 CRSsNP (Chronic Rhinosinusitis sans Nasal Polyposis), 3 had concha bullosa. Retropalatal obstruction was classified according to Mullers grade, where we found 10% patients had grade I, 28.75% grade II, 28.75% grade III and 32.5% grade IV obstruction. P value of DNS was 0.60 whereas that of other types of nasal obstruction was 0.85. Correlation of Retropalatal obstruction was significantly high with severity of OSA with P value &amp;#60;0.0001. 1-year incidence of Nasal and Nasopharyngeal obstruction in patients with OSA is 0.67 per 1000 population. Degree of OSA has poor correlation with levels of nasal obstruction and strong correlation with grades of retropalatal obstruction.

Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome.

In this study, the authors aimed to 1) retrospectively analyze the early functional outcomes in a cohort of very young children with craniofacial dysostoses who underwent robot-assisted frontofacial advancement (RAFFA) or robot-assisted midface distraction (RAMD), and 2) analyze the utility of robotic assistance in improving the accuracy and safety of performing transfacial pin insertion for RAFFA or RAMD. A retrospective analysis of a cohort of 18 children (age range 1-42 months at presentation), who underwent RAFFA or RAMD from February 2015 to February 2021 in the craniofacial unit at Amrita Institute of Medical Sciences and Research Centre in Kochi, India, was performed. Inclusion criteria were patients who had undergone RAFFA in a single stage or RAMD where the cranial vault had been addressed earlier, had been addressed on follow-up, or had not been addressed and had follow-up of at least 6 months. Overall, 18 children with syndromic craniosynostosis underwent LeFort level III midface distraction, with or without RAFFA, from February 2015 to February 2021 at a single center in India. The patients' ages ranged from 6 to 47 months at the time of the procedure. All patients had significant obstructive sleep apnea (OSA), significant ocular issues, and disturbed sleep as determined by the authors' preoperative protocol. Clinically significant intracranial pressure issues were present in 17 patients. None of the patients had injury due to the transfacial pin trajectory such as globe injury, damage to the tooth buds, or the loss of purchase during the active distraction phase. The mean distraction achieved was 23 mm (range 18-30 mm) (n = 16/18). Of the 18 patients, 10 (56%) had an excellent outcome and 6 (33%) had a satisfactory outcome. In all cases, the degree of OSA had significantly reduced after surgery. Eye closure improved in all patients, and complete closure was seen in 11 patients. On follow-up, the functional gain remained in 14 of 16 patients at the final follow-up visit. The distraction results were stable during the follow-up period (mean 36 months [range 6-72 months]). The early RAFFA and RAMD protocols investigated in this study gave a significant functional advantage in very young patients with craniofacial dysostoses. The results have demonstrated the accuracy and safety of robotic assistance in performing transfacial pin insertion for RAFFA or RAMD.

Obstructive sleep Apnea in spectrum of cognitive disorders on the Island of Guam

Emerging evidences suggest an association between Obstructive Sleep Apnea (OSA) and various cognitive disorders, including dementia. The degree of OSA has been directly correlated with the severity of cognitive impairment. Vascular disorders are significant comorbidities in these patients. We report the occurrence of OSA in patients with cognitive disorders on the island of Guam and correlate the severity of OSA with the results of the neuropsychological testing (NPT) and neuroimaging studies.

Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective cross-sectional study.

Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severity is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity–based on hospital or intensive care unit (ICU) admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days–were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. Only LSAT was found to be significantly associated with the COVID-19 severity (p<0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA–based on AHI, ODI, and RDI–and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days.

Can the negative pressures found in obstructive sleep apnea and Eustachian tube dysfunction be related?

ObjectiveThe association between obstructive sleep apnea (OSA) and Eustachian tube dysfunction (ETD) is well known. When both exist in a single pediatric patient, one of the expected culprits is adenoid enlargement. We hypothesize, in contrast, that the negative pharyngeal pressure found in OSA may be transmitted to the middle ear as negative middle ear pressure (MEP), which subsequently results in pathology. The objective of this study was to determine whether the degree of OSA and MEP are associated while using MEP as a quantifiable measurement of ETD. Study designRetrospective chart review. SettingTertiary academic center (Jan 2000–Jan 2018). Subjects and methodsThe relationship between apnea-hypopnea index (AHI) and MEP was examined. A non-anatomic model was utilized to support causality. ResultsThirty-four pediatric patients and twenty-three adult patients were included in the analysis. REM AHI showed a moderate negative correlation with MEP in children (r = -0.265), and a weak positive correlation with MEP in adults (r = 0.171). Children with an AHI in the severe OSA category had a more negative mean MEP than those in the mild category (p = 0.36). Adults with an AHI in the severe OSA category had a more positive mean MEP than those in the mild category (p = 0.11). ConclusionIn children, increasing severity of OSA is associated with a negative MEP, suggesting that negative pressure associated with OSA may be transmitted to the middle ear. In adults, increasing severity of OSA is associated with a more positive MEP.

Does nocturnal use of a complete denture interfere with the degree of obstructive sleep apnea? A systematic review and meta-analysis

The impact of a complete denture on obstructive sleep apnea is not well understood. Therefore, this study aimed to evaluate the relationship between nighttime use of complete dentures and obstructive sleep apnea and determine if wearing a complete denture during sleep changes the degree of obstructive sleep apnea. This systematic review followed the notification items for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) andwas recorded in the International Prospective Registry of Systematic Reviews (PROSPERO) under number CRD42020183167. An electronic search in the PubMed/MEDLINE, Scopus, and Cochrane Library databases for articles published until September 2020 was conducted. The search strategy used the terms (complete denture OR denture OR edentulous OR edentulism) AND (quality of sleep OR sleep OR apnea OR obstructive sleep apnea). Only prospective, retrospective, controlled, and randomized clinical studies of patients wearing complete dentures, studies comparing sleep with and without the prosthesis, and studies in which patients were diagnosed with obstructive sleep apnea by polysomnography were included in the review. In total, four articles were selected for the qualitative and quantitative analyses. A total of 144 patients, with an average age of 60years, were studied. The meta-analysis showed that there was no statistical difference in the apnea-hypopnea index between using and not using the prosthesis during sleep. The use of complete dentures during sleep does not influence the degree of obstructive sleep apnea.

0912 Central Sleep Apnea Patterns On Pediatric Polysomnograms

Abstract Introduction Central sleep apneas (CA) are frequently seen on pediatric polysomnograms (PPSG) independently or in conjunction with obstructive sleep apnea (OSA). In the pediatric population, the AASM defines CA as the absence of chest and/or abdominal movement associated with a cessation of airflow of more than 20s or longer than 2 baseline respiratory cycles if associated with an arousal, an awakening or oxygen desaturation ≥ 3%. Scoring CAs on PPSG based on AASM definition can cause confusion among providers as CAs are generally associated with central nervous disorders causing reduced or absent respiratory drive. Methods Retrospective review of 71 consecutive diagnostic PPSGs to analyze patterns of CAs scored per AASM definition was performed. None of the children had a disorder causing reduced respiratory drive. Data on age, obstructive AHI (Apnea Hypopnea Index), CO2, Oxygen saturation, Central AHI and diagnosis were collected. Results 68 of 71 children had varying degree of OSA and CAs. Three main patterns of CAs were observed: occurring in NREM, following sigh breaths or arousals and CAs seen in REM sleep. CO2 and oxygen saturation were in the normal range. Conclusion In our study, CAs were more often seen in young children related to reduced functional residual capacity and immaturity of chest wall. CAs in REM sleep was seen more often in children with lung disorders and gastroesophageal reflux. CAs associated with arousals/awakenings were seen in conjunction with OSA or periodic limb movement disorder (PLMD). Though a finding of CAs &amp;gt;5/hour is considered significant, the minimum number of events required to cause a specific disorder or syndrome remains elusive and may be different in different patient populations. As such, there is no threshold of the number of central apneas associated with disease. CAs associated with disorders causing reduced or absent respiratory drive are mostly seen in NREM sleep and associated with abnormal gas exchange. The context in which the CAs are seen on PPSGs should be clearly described to avoid confusion among ordering providers. In CAs associated with arousals/awakenings, it is important to target the cause of arousals such as OSA or PLMD. Support None

Obstructive sleep apnea in children with down syndrome - Prevalence and evaluation of surgical treatment

IntroductionThe prevalence of obstructive sleep apnea (OSA) in the pediatric population with Down syndrome (DS) is reported to be 45–76%. The criterion “gold” standard for diagnosing OSA is polysomnography (PSG). First-hand surgical treatment is adenotonsillectomy (ATE), and another option is adenopharyngoplasty (APP). The aims of this study were to determine the OSA prevalence among children with DS who had undergone PSG and to evaluate and compare the efficiency and results of ATE and APP treatments. Methods and materialsChildren <18 years old with DS who underwent PSG at Karolinska University Hospital were included in this retrospective cohort study. Medical records were examined for patient age, sex, medical comorbidity diagnoses, and OSA treatment, and the results from PSG and the quality of life questionnaire OSA-18 were registered. The prevalence and degree of OSA were calculated. Results from a nonsystematic subgroup that underwent postoperative PSG and the OSA-18 were compiled to evaluate surgical efficiency. Pre- and postoperative results from APP and ATE patients were compared. ResultsIn the study, 138 DS children were included. The OSA prevalence was 82.6%, and 39.9% had severe OSA, with a median (range) apnea hypopnea index (AHI) of 7.6 (0–104). Other comorbidity diagnoses were found for ear disease in 60%, circulatory disease in 51% and endocrine disease in 39% of patients. A nonsystematic subgroup of 33 patients underwent postoperative PSG, with a residual prevalence of moderate or severe OSA of 63.6%. Among the ATE and APP patients with pre- and postoperative PSG (n = 20), no difference between the groups was shown, but the values were significantly improved as a whole: the median AHI changed from 21.1 to 12.4 and the median OSA-18 rating changed from 54.0 to 35.0. ConclusionsIn this population of children with DS, the OSA prevalence was over 80%, wherefore continued screening and treatment are strongly supported. Uncertain surgical efficiency was indicated, and no significant difference in the results for ATE and APP was shown. When interpreting the results, it should be taken into consideration that the frequency of postoperative PSG was low and nonsystematic and that the groups were unequal and small.

The Screening Value Of ESS, SACS, BQ, And SBQ On Obstructive Sleep Apnea In Patients With Chronic Obstructive Pulmonary Disease.

ObjectiveTo compare the performance of Epworth sleepiness scale (ESS), sleep apnea clinical score (SACS), Berlin questionnaire (BQ), and STOP-BANG questionnaire (SBQ) in screening for obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD).MethodsA total of 431 patients were analyzed. All subjects completed lung function test, ESS, SACS, BQ, and SBQ survey and overnight polysomnography (PSG). According to lung function and PSG results, participants were divided into COPD with OSA group (OVS, AHI ≥5) and without OSA group (AHI <5). The value of ESS, SACS, BQ, and SBQ was compared in predicting OSA in patients with COPD by receiver-operating characteristic (ROC) curve statistics.ResultsOf the 431 subjects, there were 96 cases in COPD without OSA group, and 335 cases in OVS group including 183, 96, and 56 cases of COPD combined with mild, moderate or severe OSA. In predicting different degrees of severity of OSA in patients with COPD, the value of ESS was poor with all the values of area under the curve (AUC) < 0.7. SACS and BQ had moderate predictive value in screening for severe OSA with the value of AUC of 0.750, 0.735 respectively. However, the SBQ performed best in predicting various degrees of OSA. For screening mild OSA (AHI ≥5), the ROC statistics recommended the cut-off score of SBQ >2 was considered high risk of OSA; the sensitivity, specificity, and AUC were 92.8%, 40.6%, and 0.723 respectively, the odds ratio (OR) was 2.161. When AHI ≥15, AUC for SBQ was 0.737. In predicting severe OSA (AHI ≥30), the ROC curve showed cut-off point, sensitivity, specificity, and AUC for SBQ was >4, 66.1%, 82.1%, and 0.824 respectively; the positive and negative likelihood ratio was 3.70, 0.41 separately, the OR was 2.977.ConclusionSBQ performed better than ESS, SACS, and BQ in predicting OSA in patients with COPD.

Preliminary study on the relationship between OSA and renal function

Objective:To explore the relationship between obstructive sleep apnea(OSA) and renal function. Method:We collected the clinical data of 487 patients who underwent sleep monitoring in our hospital from January 2013 to December 2017 and excluded history of chronic heart disease, acute and chronic glomerulonephritis, and pyelonephritis. Among the 487 patients, 54 were in nonOSA control group and 433 were in OSA group, including 64 patients with mild OSA, 77 patients with moderate OSA, 108 patients with severe OSA, and 188 patients with extremly severe OSA. The eGFR was calculated using an equation combined serum creatinine and cystatin C. Then propensity score matching(PSM) was used to reduce differences in confounders among groups. The differences of creatinine, cystatin and eGFR between the control group and different degrees of OSA were compared, and the relationship between OSA severity and renal dysfunction was analyzed.Result:There was no statistically significant difference in creatinine between the OSA group and the control group. Serum cystatin C levels in the moderate OSA group and the extremly severe OSA group were higher compared with the control group(0.90±0.18)mg/L, (0.82±0.21) mg/L,P=0.026;(0.92±0.22) mg/L,(0.82±0.21) mg/L,P=0.006,there was no statistically significant difference in cystatin C level of mild OSA group or severe OSA group compared with the control group.The eGFR levels in the moderate OSA group and extremly severe OSA group were lower than that in the control group, 100.64±16.09, 108.57±19.31,P=0.012; 102.03±18.39, 108.57±19.31, P=0.024.After matching with the PSM, the serum cystatin C levels in the moderate OSA group and in the extremely severe OSA group were higher compared with the control group, (0.91±0.19) mg/L,P=0.028;(0.91±0.23) mg/L,P=0.031;(0.82±0.21) mg/L, but only in moderate OSA group, eGFR was lower than the control group,100.86±17.31,108.57±19.31,P<0.05. Conclusion: The renal function of OSA patients has different degrees of impairment. Renal function impairment and the severity of OSA do not show a single linear relationship.

The prevalence of sleep breathing disorders in patients with atrial fibrillation undergoing catheter treatment

Aim. To study the prevalence of obstructive sleep apnea (OSA) among patients with atrial fibrillation (AF) who have undergone catheter treatment for this arrhythmia, as well as to study the possible interrelationships of these sleep breathing disorders with comorbid diseases and the received therapy in this cohort.Material and methods. 231 patients from a random sample were examined (men – 118 [51.1%], mean age 57.8±9.3 years) in the range of 1-6 months after catheter therapy for AF. All patients underwent cardiorespiratory sleep monitoring for one night. The criterion for OSA severity was apnea/hypopnea index (AHI) for hour (the norm is less than 5 events/h). Depending on the results obtained, all patients were divided into groups without apnea and with apnea of varying severity – a mild degree with an AHI value of 5 to 15 events/h, moderate severity with an AHI value of 16 to 30 events/h, and severe degree when the value of AHI more than 30 events/h. The study was performed without abolishing the basic therapy.Results. According to the results of cardiorespiratory sleep monitoring 127 patients (56.7%) with OSA criteria, were registered. Among them, a mild degree of OSA was found in 35.4% (n=45), a moderate degree – in 40.9% (n=52), and severe one – in 23.7% (n=30) of all patients with apnea. Among patients with obstructive sleep apnea 51.1% were males. Arterial hypertension was significantly more frequent in patients with OSA of pronounced degrees of severity compared with patients without apnea (p=0.047). Weight and body mass index of patients with OSA were significantly higher than in patients without apnea (p=0.001 and p=0.001, respectively). The left atrium (LA) size in patients with severe OSA was significantly larger than in patients without apnea (p=0.0005), which may indicate a possible contribution of severe obstructive apnea to the arrhythmia generating. OSA was the strongest independent factor among others related to the LA size (odds ratio was 1.6; 95% confidence interval 1.2-2.1; p&lt;0.0003).Conclusion. Obstructive sleep apnea is very widespread among a cohort of patients with AF who have undergone a catheter procedure to isolate the pulmonary veins. Sleep breathing disorder is the strongest and most independent risk factor for AF associated with increased LA, among other risk factors such as age, hypertension, and obesity.

Comparison of nasal geometry among adults with obstructive sleep apnea: a preliminary study

ABSTRACT Purpose: to compare nasal geometry between two groups of patients with different degrees of obstructive sleep apnea and to correlate apnea-hypopnea index, apnea severity and degree of daytime sleepiness with nasal areas and volume. Methods: a total of 20 adults (15 women and 5 men, mean age of 52.0±11.4 years old) without nasal obstruction were submitted to polysomnography. The subjects were divided into two groups: a) 10 individuals without apnea or with mild-grade apnea; b) 10 with moderate or severe apnea. Nasal geometry was evaluated by acoustic rhinometry. The volume, comprising the distance from the nasal valve to the posterior part of the middle nasal turbinate, and the three sectional areas corresponding to nasal valve, anterior part of the inferior nasal turbinate and posterior part of the inferior nasal turbinate, were considered. The Shapiro-Wilk, Mann-Whitney, Student’s t tests for independent samples and Spearman’s correlation coefficient were used for the analysis, with a significance level lower than 5%. Results: group 2 presented lower values in the area corresponding to the nasal valve (on the right), and higher values in the nasal turbinate areas. There was no correlation between the drowsiness scale and nasal areas and volumes. Conclusion: the area of the nasal valve was unilaterally smaller in the group with moderate and severe apnea. There was no correlation between volumes and nasal areas and excessive daytime sleepiness.

Nocturnal blood pressure decrease in patients with chronic kidney disease and in healthy controls - significance of obstructive sleep apnea and renal function.

BackgroundChronic kidney disease (CKD) is often associated with a blunted nocturnal BP decrease and OSA. However, it is not fully clear whether a relationship exists between reduction in renal function and obstructive sleep apnea (OSA) on the one hand and relative nocturnal BP decrease in CKD patients on the other. The aim of this study was to investigate the association between nocturnal BP decrease and renal function, the degree of OSA, vasoactive hormones, and renal sodium handling in CKD3-4 patients and healthy age-matched controls.MethodsWe performed brachial and central 24-hour ambulatory BP measurement and CRM in 70 CKD3-4 patients and 56 controls. In plasma, we measured renin, AngII, aldosterone, and vasopressin. In urine, 24-hour excretion of sodium, protein fractions from the epithelial sodium channel (u-ENaCγ), and the AQP2 water channels (u-AQP2) were measured.ResultsCKD patients had lower relative nocturnal BP decrease than controls: brachial (10% vs 17%, P=0.001) and central (6% vs 10%, P=0.001). Moderate-to-severe OSA was more frequent in patients (15 vs 1%, P<0.0001). Neither the presence of OSA nor eGFR were predictors of either brachial or central nocturnal BP decrease. CKD3-4 nondippers were more obese, had higher HbA1c level, and more often a history of acute myocardial infarction than CKD3-4 dippers (P<0.05).ConclusionCKD3-4 patients had lower brachial and central nocturnal BP decrease than healthy controls. OSA and eGFR were not associated with nondipping in CKD patients or healthy controls. Nondipping in CKD3-4 was associated with obesity, diabetes, and cardiovascular disease.ClinicalTrials.gov IDNCT01951196.

Complete concentric collapse at the soft palate in sleep endoscopy: what change is possible after UPPP in patients with CPAP failure?

The aim of this work was to assess whether uvulopalatopharyngoplasty in patients with failure for positive airway pressure not only reduces the degree of obstructive sleep apnea but also to determine as well if it changes the collapse pattern of the soft palate and thereby fulfills the qualifications for implementing upper airway stimulation (UAS) as an adjunctive solution. Fifteen patients with intolerance for positive airway pressure were included in this retrospective cohort study. Polygraphy and drug-induced sleep endoscopy were used in order to evaluate the reduction of the apnea-hypopnea index (AHI), as well as the change of collapse pattern at the soft palate level before and about 3months after uvulopalatopharyngoplasty and tonsillectomy (TE-UPPP). In 93% of the patients, a postoperative change of the initially complete concentric palatal collapse pattern could be found during drug-induced sleep endoscopy. In one patient, no obstruction at all was seen at the soft palatal level. Only one patient still presented with a complete concentric collapse at velum level. AHI decreased from mean 34.7 events per hour to 20.2/h and oxygen desaturation index from 25.3 events per hour to 16.1/h. Patients seeking for positive airway pressure alternatives could not only benefit from reduction of AHI by TE-UPPP postoperatively; additionally, by changing the collapse pattern at the soft palate, they might also fulfill criteria for upper airway stimulation (UAS) in case of persistent OSA of at least moderate degree.