Diagnosis Of Obstructive Sleep Apnea Research Articles

Influencia del grado de incomodidad durante lapolisomnografía en el resultado de la prueba

Objective: To relate the degree of discomfort caused by polysomnography (PSG) with the test result. Methods: Cross-sectional analytical observational study based on PSG performed in adult patients. After performing the PSG, patients completed a standardized form with questions about the degree of discomfort during the exam. This information was divided into two groups according to the presence or absence of obstructive sleep apnea (OSA), evidenced according to the PSG result by measuring the Apnea and Hypopnea Index (AHI). The analysis was univariate, and the chi-square test was used as an association measure for qualitative variables and, for non-parametric variables, the Mann-Whitney test, with a 95% confidence interval (95%CI) and p-value significant less than 0.05. Results: We included 594 polysomnography patients, with 279 (46.97%) men and 315 (53.03%) women. The 30 to 44.9 years old group had the highest number of patients (43.43%) and the most with obesity (65.16%). The factor that most bothered patients was the presence of wires during the examination. The variables on sleep latency (p = 0.55*), number of awakenings (p = 0.46*), total hours slept (p = 0.98*), and sleep score (p = 0.36 *) showed no significant relationship with the diagnosis of OSA. The degree of discomfort did not present a significant relationship with the PSG result (p = 0.565**). Conclusion: Despite the discomfort during PSG, this factor does not interfere with the test result regarding the presence or absence of OSA.

Lipid Profile and Ankle Brachial Index in Obese Male Subjects with Obstructive Sleep Apnea: Cross sectional analytical study

Background & Objective: Obstructive sleep apnea (OSA) and dyslipidemia are common medical disorders that independently increase vascular morbidity and mortality. Currently, there is no conclusive data indicating that Obstructive Sleep Apnea serves as a risk factor for disrupted lipid profiles and subclinical atherosclerosis, as assessed by ankle-brachial index (ABI). The objective of this cross-sectional study was to assess lipid profiles, blood sugar levels, and ankle brachial index in obese male participants with OSA and to compare them with obese individuals lacking OSA. Methods: In the present study, 64 obese males with BMI > 25kg/m2 were included between ages 20 - 45 years. Subjects having acute or chronic inflammatory conditions were excluded. Obstructive sleep apnea (OSA) diagnosis involved two subjective assessment tools, the Berlin and STOP BANG questionnaires, followed by overnight portable pulse oximetry. The study participants were partitioned into two distinct groups, 32 with OSA and 32 without OSA. Following an overnight fast lasting between 10 to 12 hours, blood samples were collected. Fasting blood glucose and lipid profiles were then analyzed using a spectrophotometer. ABI was measured by using a Doppler ultrasound device. The data was collected and then entered SPSS version 22 and analyzed. The study utilized both Independent Samples t-test as well as Mann-Whitney U test to analyze and compare the quantitative variables across the two groups. Results Comparison of ABI between the study groups showed a non-significant difference p-value= 0.435. Fasting blood sugar levels showed insignificant difference (p-value 0.778) among the study groups. Comparison between the groups showed a nonsignificant difference in triglyceride levels (p= 0.413) cholesterol (p-value 0.523), HDL (p-value 0.190), and LDL (p-value 0.888). Conclusion Normal lipid profile and normal ABI indicate the absence of detectable atherosclerosis in young apparently healthy OSA subjects without known comorbidities.

Sleep Bruxism and Obstructive Sleep Apnea Are Not Risk Factors for Tension-Type Headache (TTH): A Polysomnographic Study.

Background: Tension-type headache (TTH) is the most common primary headache. Obstructive sleep apnea (OSA) and sleep bruxism (SB) are two of the most common sleep disorders; however, the relationship between TTH, OSA, and SB has not been conclusively proved in the literature. The objective of our study was to estimate potential associations with OSA and SB in TTH subjects. Methods: 108 adult individuals who underwent polysomnography (vPSG) were included, and the group was divided into two subgroups: TTH (n = 34) and control (n = 74). The International Classification of Headache Disorders (ICHD-3) guidelines were used to diagnose TTH. OSA and SB diagnoses were based on vPSG examination with electromyographic (EMG) recordings and the American Academy of Sleep Medicine (AASM) criteria. The results were analyzed, where p < 0.05 was considered to be statistically significant. Results: In the TTH group, the incidence of SB was more than two times lower than the control (OR = 0.41, 95% CI: 0.17-0.96, p < 0.05). However, the incidence of severe SB (BEI > 4) was similar in the TTH and control groups (OR = 0.54, 95% CI: 0.21-1.35, p > 0.05). Additionally, phasic and tonic SB episodes were less frequent in the TTH group compared to the controls (p < 0.05). The mean apnea-hypopnea index (AHI) was not significantly different between the TTH and control groups (p > 0.05). The sleep architecture and respiratory disturbances did not differ between the examined groups (p > 0.05). Conclusions: SB is not a risk factor for TTH. Moreover, severe SB is not connected with TTH. OSA is not a risk factor for TTH. Sleep quality did not differ between both groups during PSG; therefore, TTH may not change sleep structure. The mechanism of these findings is still unclear, and further studies should explain in detail the association between TTH and OSA.

Connecting the dots: analysing the relationship between AHI and ODI in obstructive sleep apnea

BackgroundIn the lab type-1 Polysomnography (PSG) is the gold standard for the diagnosis of Obstructive sleep apnea (OSA). But in view, the increasing prevalence, highly expensive, and the presence of a pandemic state make it sometimes impractical to perform PSG in all patients suspected of OSA. The objective of our study was to compare the correlation between the gold standard Autoscored Apnea Hypopnea Index (AHI) and Oxygen desaturation index (ODI) based classification of the severity of OSA.MethodologyIt was a single-centered hospital-based cross-sectional study in which a total of 176 Subjects suspected of OSA were recruited and underwent overnight 7 channels of in-lab polysomnography at AIIMS Patna. Demographic details, comorbidities, and lab data were collected for all enrolled patients. BMI, STOP-BANG score, and Epworth sleepiness score (ESS) were also calculated for all subjects. They were categorized into mild, moderate, and severe OSA based on AHI and ODI values of 5–14.9, 15–29.9, and ≥ 30 events per hour, respectively.Recordings of polysomnography (PSG) were presented with descriptive statistics. Data is presented as the “mean ± standard deviations” for continuous variables and percentage frequencies for categorical variables. The Chi-square test was used to compare the discrete variables. Statistical significance was set at an alpha level of 0.05 with P < 0.05, with a two-tailed probability. Spearman's rank correlation analysis was used to test the strength and direction of the association between OSA severity (using AHI classification) and the Oxygen Desaturation Index.ResultsThe Mean (SD) age of patients enrolled in our study was 47.42(12.60) years with 57.95% males. Among comorbidities, 31.8% (n = 56) were known cases or incidentally diagnosed with Diabetes Mellitus Type 2, 43.18% (n = 76) were hypertensive and 31.8% (n = 56) had hypothyroidism. The mean HbA1c level among Diabetic patients was 6.05 (1.27) and the mean TSH level among Hypothyroidism patients was 12.24 (27.34). There was a positive correlation between AHI and ODI in our study (Pearson’s correlation coefficient = 0.897).ConclusionGood concordance between AHI and ODI makes nocturnal oximetry a less expensive tool to confidently screen patients with severe OSA. This may be applicable in smaller centers where facilities and expertise for a full night PSG may not be easily available.

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

Patient experience of the use of continuous positive airway pressure for the treatment of obstructive sleep apnea with or without telemedicine during COVID-19: a qualitative approach.

Continuous positive airway pressure (CPAP) is considered effective treatment for moderate-severe obstructive sleep apnea (OSA). Clinicians measure compliance to treatment by the number of hours CPAP is used per 24 hours. There have been very few studies examining the patients' lived experience of CPAP and the barriers to use. This study examined the patients' experience of OSA, CPAP use and treatment during COVID-19. This CPAP patient experience qualitative study was part of a larger project. The overarching study was a three-armed nonblinded randomized controlled trial of patients on CPAP for treatment of OSA using standard care or one of two telemedicine interventions. Patients who had completed the RCT study were invited to be interviewed via telephone, about their OSA diagnosis, CPAP experiences, their experience of using telemedicine and the impact of SARS-CoV-2 (COVID-19). Fifteen patients (five from each arm of the trial) took part in a semi-structured interview. Thematic analysis identified three themes: day to day living, standard hospital care versus telemedicine management and living though COVID-19 with CPAP. All participants described significant symptoms caused by their OSA before diagnosis. While CPAP treatment was often described as challenging, patients discussed the improvement in their symptoms with treatment. There were differing opinions on virtual appointments, however the consensus was the use of telemedicine to support CPAP treatment was well received. COVID-19 appeared to have little effect on the patient experience.

Machine learning based severity classification of obstructive sleep apnea patients using awake EEG

Obstructive sleep apnea (OSA) is one of the most widespread breathing-based sleep disorders. Previous studies reported daytime sleepiness, mental fatigue, and cognitive decline in patients with OSA. The diagnosis of OSA is done with laborious overnight polysomnography (PSG) recording. This study aims to classify the severity of OSA patients according to the Apnea-Hypopnea Index (AHI) into mild and moderate to-serve groups (AHI ≥ 15) without using recorded signals during sleep, non-PSG signals and investigate the relevant features. For this purpose, 25 OSA patients participated in 3-minute eyes closed resting state EEG session on the following morning of overnight PSG recording. Time, spectral domain, and nonlinear features were extracted from the delta, theta, and alpha subbands’ of EEG signals. Several machine learning algorithms were used to classify patients’ severity. To investigate optimal feature combinations features were grouped according to their types (Time domain/spectral domain and nonlinear), their electrodes (frontal/central/parietal/occipital), and their subbands (delta/theta/alpha). Also, the Relief method was applied to select the most relevant features. A 5-fold cross validation method was used to generalize the model behaviour. Optimal feature combinations were selected according to classifiers' performances that were evaluated by accuracy, sensitivity, specificity, and area under curve (AUC) parameters when feature sets were used as input. The 15 selected features by the Relief method showed the best performances in the K-Nearest Neighbours (K = 5) classifier [accuracy: 93.33 % ± 5.27 %; sensitivity: 92.30 % ± 4.97 %; specificity: 94.14 % ± 4.24 %; AUC:0.98]. The findings establish that awake resting state EEG records might be used as a faster tool to use OSA severity level.

Community-based intervention for obstructive sleep apnea in the general population: a randomized controlled trial.

To investigate the engagement and health outcomes of community-based intervention for obstructive sleep apnea (OSA) in the general population. We conducted a 3-month randomized controlled trial in two communities in southern China. We initially screened the general population for high-risk OSA and further diagnosis using home sleep testing. Eligible participants were randomly (1:1) assigned to either a control or continuous positive airway pressure-based integrated intervention group. The primary outcomes were multimodal indicators reflecting health outcomes, including health-related quality of life (Short Form-36 [SF-36]), sleep-related symptoms, and cardiometabolic risk. Of the 2484 participants screened, 1423 identified as having high-risk OSA were considered for telephone invitations to participate in the trial. Of these, 401 participants responded positively (28.2%), 279 were diagnosed with OSA, and 212 were randomized. The intervention significantly improved several domains of SF-36, including physical functioning (intergroup difference, 2.8; p = .003), vitality (2.3; p = .031), and reported health transition (6.8; p = .005). Sleep-related symptoms, including Epworth Sleepiness Scale (-0.7; p = .017), Fatigue Severity Scale (-3.0; p = .022), Insomnia Severity Index (-1.8; p < .001), and Pittsburgh Sleep Quality Index (-0.7; p = .032), also showed significant improvements. Although the intervention did not significantly alter glycolipid metabolism, ventricular function, or cardiac structural remodeling, it achieved a significant reduction in systolic (-4.5 mmHg; p = .004) and diastolic blood pressure (BP; -3.7 mmHg; p < .001). Community-based intervention for previously undiagnosed OSA in the general population yielded improvements in health-related quality of life, sleep-related symptoms, and BP. However, engagement in the intervention program was low. "Community Intervention Trial for OSA";URL: https://www.chictr.org.cn/showprojEN.html?proj=144927;Trial identification number: ChiCTR2100054800.

Validation of Tracheal Sound-Based Respiratory Effort Monitoring for Obstructive Sleep Apnoea Diagnosis.

Background: Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient's natural sleep. This study examines the reliability of an unobtrusive tracheal sound-based approach to monitor respiratory effort in the context of OSA, using manually marked respiratory inductance plethysmography (RIP) signals as a gold standard for validation. Methods: In total, 150 patients were trained on the use of type III cardiorespiratory polygraphy, which they took to use at home, alongside a neck-worn AcuPebble system. The respiratory effort channels obtained from the tracheal sound recordings were compared to the effort measured by the RIP bands during automatic and manual marking experiments. A total of 133 central apnoeas, 218 obstructive apnoeas, 263 obstructive hypopneas, and 270 normal breathing randomly selected segments were shuffled and blindly marked by a Registered Polysomnographic Technologist (RPSGT) in both types of channels. The RIP signals had previously also been independently marked by another expert clinician in the context of diagnosing those patients, and without access to the effort channel of AcuPebble. The classification achieved with the acoustically obtained effort was assessed with statistical metrics and the average amplitude distributions per respiratory event type for each of the different channels were also studied to assess the overlap between event types. Results: The performance of the acoustic effort channel was evaluated for the events where both scorers were in agreement in the marking of the gold standard reference channel, showing an average sensitivity of 90.5%, a specificity of 98.6%, and an accuracy of 96.8% against the reference standard with blind expert marking. In addition, a comparison using the Embla Remlogic 4.0 automatic software of the reference standard for classification, as opposed to the expert marking, showed that the acoustic channels outperformed the RIP channels (acoustic sensitivity: 71.9%; acoustic specificity: 97.2%; RIP sensitivity: 70.1%; RIP specificity: 76.1%). The amplitude trends across different event types also showed that the acoustic channels exhibited a better differentiation between the amplitude distributions of different event types, which can help when doing manual interpretation. Conclusions: The results prove that the acoustically obtained effort channel extracted using AcuPebble is an accurate, reliable, and more patient-friendly alternative to RIP in the context of OSA.

Disparities in polysomnography referral in a high-risk cardiac population.

Obstructive sleep apnea (OSA) is associated with metabolic, cardiovascular, and cerebrovascular comorbidities. Appropriate diagnosis and treatment of OSA might mitigate these comorbidities. This retrospective review sought to assess the impact of sex, age, race, ethnicity, and insurance status on polysomnography (PSG) referral rates. An institutional STOP-Bang database of 299,320 patients was filtered for patients admitted to the hospital with an acute cardiac diagnosis between 2015-2020. A cohort of 4,735 patients were risk stratified by STOP-Bang (SB) score and correlations were made between PSG referrals and demographic and clinical variables (sex, age, race, ethnicity, and insurance status). Of the 25.3% of the cohort with high SB scores (5-8) only 21.3% were referred for PSG. Age and female sex were negatively associated with sleep study referrals (p < 0.001). No correlation was found between sleep study referral rates and race or ethnicity. No correlation was found between sleep study referrals and insurance provider. Admitting cardiac diagnosis significantly influenced sleep study referrals with diagnoses of arrhythmias and myocardial infarction being associated with an increased rate of PSG referrals compared to heart failure patients (p < 0.002). Our study found no significant correlation between PSG referral rates and race, ethnicity, or insurance provider. However, we found low overall rates of PSG referral, with negative correlations between older age and female sex and a high-risk cardiac population. This represents a substantial missed opportunity to identify patients at risk for OSA, obtain a diagnosis, and provider adequate treatment.

Role of the oral health professional in obstructive sleep apnea

American Academy of Sleep Medicine (AASM) describes obstructive sleep apnea (OSA) as a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. This causes multiple episodes of hyperarousal or wakefulness from sleep, which leads to a decrease in the quality of sleep, leading to daytime sleepiness, increased affinity to accidents, and cardiovascular diseases such as myocardial infarction, congestive heart failure, and stroke. It is measured using the apnea-hypopnea index, that is, the number of sleep arousals in a given night. Possible risk factors for the disease include obesity (body mass index of ≥30), older age, Down’s syndrome, family history of OSA, and abnormal craniofacial features. Treatment options include continuous positive airway pressure, weight loss, oral devices, surgeries of the soft palate and/or genioglossus muscle, and maxilla-mandibular advancements. This review aims to address the oral diagnosis and dental treatment of OSA.

Association between obstructive sleep apnea (OSA) and COVID-19 severity.

Obstructive sleep apnea and sleep-related hypoxia have been associated with higher rates of hospitalization and mortality among patients with Coronavirus disease 2019 (COVID-19). We further explored the association between obstructive sleep apnea, COVID-19 severity and related mortality. In addition, we examined the effects of clinical and demographic parameters on COVID-19. In this retrospective study, we included adult patients who were diagnosed with COVID-19 prior to the Omicron variant identification. We compared the severity of COVID-19 and mortality with the diagnosis of obstructive sleep apnea. The study population included 44,275 patients who tested positive for COVID-19. Of these, 97% had mild or asymptomatic disease, 1.2% had moderate disease, and 1.8% had severe disease. Obstructive sleep apnea was diagnosed in 980 (2.2%) patients. In a multivariate analysis, obstructive sleep apnea diagnosis increased the risk of severe COVID-19 by 1.6 (95% confidence interval: 1.1-2.4) compared with mild disease. However, no increase in mortality was associated with obstructive sleep apnea. Interestingly, patients with moderate and high socioeconomic status had a 1.6 times higher risk for severe COVID-19 than patients from the low socioeconomic status group (95% confidence interval: 1.2-2.1 and 95% confidence interval: 1.1-2.3, respectively). The risk of dying due to COVID-19 was 1.6 (95% confidence interval: 1.1-2.5) and 3.1 (95% confidence interval: 1.8-5.3) times higher in patients with medium and high socioeconomic status, respectively, compared with patients with low socioeconomic status. Diagnosis of obstructive sleep apnea was found to be an independent risk factor for severe COVID-19. The higher the socioeconomic status, the higher the risk of severe COVID-19 morbidity and mortality.

Expert consensus on the diagnosis and treatment of obstructive sleep apnea in women

Expert consensus on the diagnosis and treatment of obstructive sleep apnea in women

PREVALENCE OF OBSTRUCTIVE SLEEP APNEA IN CASES OF METABOLIC SYNDROME: A CROSS-SECTIONAL STUDY

Objectives: The study aimed to find out the prevalence of obstructive sleep apnea (OSA) in individuals with metabolic syndrome (MS). Methods: This was a cross-sectional study conducted in the department of respiratory medicine of a tertiary care medical institute. Eighty patients infected with MS diagnosed on the basis of national cholesterol education program adult treatment panel III criteria were included in this study on the basis of predefined inclusion and exclusion criteria. Demographic details such as age, gender, and socioeconomic status of all the patients were noted. A thorough general and clinical examination was conducted, including the assessment of vital signs. Polysomnography was done in all cases and the diagnosis of OSA was based on polysomnography results. SSPS 21.0 was used for statistical analysis and p&lt;0.05 was taken as statistically significant. Results: Out of 80 patients, there were 58 (72.50%) males and 22 (27.50%) females with a M: F ratio of 1: 0.37. The overall mean age of the studied cases was found to be 44.60±12.92. Mild (apnea-hypopnea index [AHI] 5–14), moderate (AHI=15–30), and severe OSA (AHI &gt;30) was seen in 33 (41.25%), 17 (21.25%) and 9 (11.25%) patients, respectively. Overall prevalence of OSA in cases of MS was found to be 73.75% as the severity of OSA increased there was decreased in mean sleep time and the difference was found to be statistically significant (p&lt;0.05). The most common presenting complaint was loud snoring, observed in 55 patients (93.22%). This was followed by daytime sleepiness in 47 patients (79.66%), waking up tired in 37 patients (62.71%), and disturbed sleep in 36 patients (61.02%). Conclusion: The prevalence of OSA is notably high among individuals with MS. Consequently, routine assessment for OSA should be an integral component of the management strategy for patients with MS.

A Comparison of a Wrist-Worn Portable Device (WatchPAT 200)™ with In-Lab Polysomnography for the Diagnosis of Obstructive Sleep Apnea

A Comparison of a Wrist-Worn Portable Device (WatchPAT 200)™ with In-Lab Polysomnography for the Diagnosis of Obstructive Sleep Apnea

Knowledge and attitude regarding obstructive sleep apnoea among medical and dental practitioners working in North-Eastern Peninsular Malaysia: A comparative cross-sectional study.

Obstructive Sleep Apnea (OSA) is a temporary airflow obstruction during periods of sleep. Patients with OSA often suffer from poor work performance, compromised sleep quality, and low quality of life which may lead to a life-threatening event. Adequate knowledge and a positive attitude toward OSA among medical and dental practitioners are crucial to the initial diagnosis and treatment. This study aimed to identify the differences in knowledge and attitude toward OSA between medical and dental practitioners working in North-Eastern Peninsular Malaysia. A comparative cross-sectional study was performed from February 2020 to February 2021. A total of fifty-two medical practitioners and fifty-two dental practitioners working at university-based outpatient clinics, government health clinics, and oral health clinics located in Kelantan State of Malaysia participated in the study, and data were collected by the structured questionnaire including sociodemographic inquiry and OSAKA questionnaire by non-probability stratified random sampling. The Mann-Whitney U test was used to compare knowledge and attitude scores between the two groups. The mean age of the respondents was 34.6 years. The current study shows that 92.3% of medical doctors and 96.1% of dental doctors were able to correctly answer the question "Most of the patients with OSA snore" a significant finding in our study. Only 1% of medical professionals could answer seventeen questions correctly with a median score of 11, and only 1% of dental professionals could answer sixteen questions correctly with a median score of 9. None of them could provide an accurate answer to all the knowledge questions. Medical and dental practitioners exhibited different knowledge levels on OSA (z- statistics=-4.39, U = 827.00 with p < 0.05, and effect size, r = 0.61). However, no significant differences were found in total knowledge score by gender (p-value>0.05), ethnicity (p-value>0.05), total service years (p-value>0.05), and training attended. In addition, significant differences in attitude levels between medical and dental practitioners have been observed (z-statistics=-3.42, U = 725.00 with p < 0.05, and effect size, r = 0.47). Nevertheless, no significant differences have been seen in total attitude score by ethnicity (p-value > 0.05), total service years (p-value > 0.05), attending training on OSA (p-value > 0.05), and professional status (p-value > 0.05) except gender (p-value < 0.05). A Significant difference is evident concerning knowledge and attitude toward OSA diagnosis and management between medical and dental practitioners working in North-Eastern Peninsular Malaysia. Medical practitioners in this study recorded a higher knowledge and attitude score compared to dental practitioners.

Management of obstructive sleep apnoea in primary care.

Obstructive sleep apnoea (OSA) is common in the community and is increasing in prevalence. Primary care plays a pivotal role in the diagnosis and management of OSA. This article focuses on the management options for a patient with an established diagnosis of OSA and provides a guide for driving licensing requirements. Indications for continuous positive airway pressure (CPAP) are discussed and tips provided toconsider when conducting a review appointment, including trouble shooting. There are several treatment options available for patients with an established diagnosis of OSA. Selecting the optimal therapy involves aligning the symptoms and severity of OSA with the presence of comorbidities. CPAP is a highly effective therapy for symptomatic adults with moderate-to-severe OSA and for some symptomatic patients with mild OSA. Early trouble shooting of side effects and using supportive interventions increases the probability of long-term adherence, which is key to symptomatic improvement.

Diagnosis of obstructive sleep apnoea in primary care.

Obstructive sleep apnoea (OSA) is a highly prevalent condition associated with significant adverse health consequences affecting multiple organ systems. As the first point of contact for most patients with OSA, general practitioners (GPs) have an important role in the diagnosis of this common sleep disorder. The aim of this paper is to improve awareness of common risk factors for andclinical presentation of OSA in primary care to improve patient health outcomes. We seek to understand how screening tools, such as the OSA50 questionnaire and the Epworth Sleepiness Scale, can help GPs identify patients who are at high risk for OSA with significant daytime sleepiness. Patients at high risk of symptomatic moderate-severe OSA should proceed to further investigation with sleep study testing. Referral to a sleep physician should be considered for patients with complex presentations or other suspected sleep disorders, commercial drivers, and those who fail to comply with or respond to initial OSA treatments.

Differences and Risk Factors of Peripheral Blood Immune Cells in Patients with Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a respiratory disorder characterized by chronic intermittent hypoxia and fragmented sleep, leading to inflammatory response and oxidative stress. However, the differences in immune inflammatory response in OSA patients with different severity remain unclear. This study aims to examine the differences in peripheral blood immune cells and their risk factors in OSA patients. A total of 277 snoring patients from the Sleep Respiratory Disorder Monitoring Center of Zhongnan Hospital of Wuhan University were recruited in this study. According to the diagnosis and severity criteria of OSA, the included patients were further divided into simple snoring, mild, moderate, and severe groups. Peripheral blood immune cell counts including white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood cells, platelets, and polysomnography indicators were collected from the patients. Compared with simple snoring patients, the OSA patients had increased circular monocyte and basophil count levels. In addition, correlation analysis results indicated that monocyte count was positively associated with chronic obstructive pulmonary disease (COPD), smoking, apnea-hypopnea index (AHI), the longest apnea duration, and Oxygen desaturation index (ODI), and negatively correlated with average SpO2 in snoring patients. Finally, multiple linear regression analysis revealed that AHI, COPD, smoking, and maximum heart rate were independent predictors of monocyte count. OSA patients had a significant increase in their peripheral blood monocyte count. AHI, COPD, smoking, and maximum heart rate were risk factors for increased peripheral blood monocyte count in OSA patients. These findings suggest that peripheral blood monocytes can be considered an inflammatory biomarker of OSA.

Prevalence, Severity, and Treatment of Obstructive Sleep Apnea in Children with Down Syndrome in Qatar.

Patients with Down syndrome (DS) are at risk for sleep disorder breathing (SDB) due to their abnormal craniofacial anatomy, hypotonia, and propensity for obesity. The prevalence and severity of SDB in this population vary between different cohorts due to the multifactorial nature of these patients and the different diagnostic criteria used. We aim to report the prevalence and severity of SDB in the DS population in Qatar. This study is a retrospective review of all patients with genetically confirmed DS who completed a diagnostic polysomnography (PSG) study at Sidra Medicine in Doha, Qatar, which is the only pediatric sleep center in the country, between September 2019 and July 2022. Clinical and PSG data were collected from the patients' electronic medical records. Central and obstructive events were scored according to the American Academy of Sleep Medicine (AASM) criteria. Obstructive sleep apnea (OSA) diagnosis was made based on apnea-hypopnea index (AHI) and defined as AHI>1.5 events/hour.OSA was considered mild if AHI was ≥ 1.5 but < 5, moderate if AHI was ≥ 5 but < 10, and severe if AHI was ≥ 10 events/hour. Diagnosis with central apnea was considered if the central apnea index was > 5 events/hour. Hypoventilation was considered present if end-tidal/transcutaneous carbon dioxide gas was more than 50 mmHg for more than 25% of total sleep time.Multiple regression analysis was performed to evaluate predictors of high AHI and rapid eye movement (REM)-AHI. A total of 80 patients (49 males and 31 females) were included. Median (range) age was 7.3 years (0.9, 21). The mean (range) BMI z-score was 1.7 (-1.3, 4.3). Sixty-five patients were diagnosed with OSA, with a prevalence rate of 81%. OSA was mild in 25 (38.5%) patients, moderate in 15 (23.1%) patients, and severe in 25 (38.5%) patients. Only one patient was diagnosed with central apnea and five patients (6.9%) with alveolar hypoventilation. Multiple regression analysis showed BMI (P = 0.007) and snoring/apnea symptoms (P=0.023) to be predictive of high AHI. No correlation was found between the same variables and REM-AHI. Treatments used for OSA included anti-inflammatory medications in 37 (46%) patients, tonsillectomy/adenoidectomy in 13 (16.5%) patients, and positive airway pressure support in 10 (15%) patients. Our patient population with DS had a high prevalence of OSA comparable to other reported cohorts. High BMI and symptoms of snoring are predictive of OSA.