Diagnosis Of Apnea Research Articles

0522 Level II Home Sleep Apnea Testing Compared to In-Lab Polysomnography for the Evaluation of Obstructive Sleep Apnea in Youth with Down Syndrome

Abstract Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families. Methods Prospective comparative effectiveness study. Youth <18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater than 5 events per hour on either test. Results Thirty-five (17 female) youth aged [median (IQR)] 10.0 (6.1, 16.9) years completed testing. Total sleep time for HSAT was 7.9 (6.9, 8.9) hours versus 6.8 (5.9, 7.0) hours for PSG (p=0.002). PSG OAHI was 12.7/hr (5.3, 21.5). Twenty-six (74.3%) participants had OSA by PSG, 20 of whom were correctly identified by HSAT; one participant with OSA diagnosed by HSAT (OAHI=6.2/hr) was not identified by PSG (OAHI=3.9/hr). Accuracy of HSAT for identifying OSA was 80.0%, sensitivity 76.9%, and specificity 88.9% compared to PSG. Signal quality was good except for pulse oximetry, with median (IQR) adequate signal for 79.5% (57.5%, 86.3%) of the study. Compared to PSG, 83.3% of parents reported that youth had a more normal night’s sleep with HSAT, 70.0% of parents found HSAT easier, and 90.0% of youth preferred HSAT. Conclusion In youth with DS, HSAT has good accuracy for detecting moderate-severe OSA. Limitations may include night-to-night variability, differences in environment, or loss of oximetry signal. Youth slept more during HSAT than in-lab PSG and the majority of families preferred level II HSAT. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with DS. Support (If Any) NIH R21HD101003 (Tapia/Kelly)

0589 REM Sleep Behavior Disorder is Associated with Poor Outcomes in Pulmonary Embolism Hospitlizations

Abstract Introduction REM Sleep Behavior Disorder (RBD), is a rare sleep behavior disorder, characterized by loss of skeletal muscle atonia during REM sleep, resulting in prominent motor activity with exhibited behavior mirroring the image of the dreams during sleep. Other sleep disorders were studied before in patients with Pulmonary Embolism (PE). Although, REM sleep behavior disorder association with pulmonary embolism has never been described. In this study we aim to study the prevalence of RBD in patients admitted with PE, and to assess the association between RBD and PE. Methods Adults with principal diagnosis of Pulmonary Embolism (PE) on discharge were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis. We queried the 2019 National Inpatient Sample for secondary diagnosis of RBD, Obstructive Sleep Apnea (OSA) and other secondary diagnoses (hyperlipidemia,history of old myocardial infarction, atrial fibrillation, Chronic obstructive pulmonary disease, hypertension, heart failure, smoking, chronic kidney disease , electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses. Results In a total of 188,355 hospitalizations with PE primary diagnosis on discharge were included from the 2019 national inpatient sample, 25 hospitalizations had concomitant secondary diagnosis with RBD. The overall in-hospital mortality for PE was 3.2%. On weighted analysis, Patients with RBD had statistically significant higher odds for mortality compared to patients without [adjusted odds ratio (OR): 17.15; 95% confidence interval (CI): 2.75-106.8, p= 0.002], 20% mortality rate in patients with RBD compared to 0.03% in patients without RBD (p= 0.03). OSA did not show significant result for mortality when compared to without OSA [adjusted odds ratio (OR): 0.83; 95% confidence interval (CI): 0.67-1.04, p= 0.114]. Conclusion Our analysis showed a low number of patients with secondary diagnosis of RBD in hospitalizations with primary diagnosis of PE on discharge. However significant association between RBD and mortality in patients with PE primary diagnosis on discharge. The identification of patients with RBD in patients admitted with PE may help decrease mortality rate. Furthermore, our analysis showed that OSA is an independant variable for mortality in PE hospitalization. Support (If Any)

Diagnosis and management of cardiopulmonary events in very low birth weight infants close to discharge: a quality improvement initiative.

Cardiopulmonary events (CPE) have a central, obstructive, or mixed etiology. Lack of standardized diagnosis and management of CPE may prolong the length of stay (LOS). To increase the accuracy of CPE diagnosis and decrease LOS by 10% for preterm infants over a 12-month period. Develop an evidence-based algorithm to identify type of CPE, determine management approach, and evaluate cardio-respiratory monitors output. Apply model for improvement and statistical process control charts to determine special cause variation. Identification of central apnea increased from 15 to 39% (p < 0.01). LOS decreased 26% from 52.6 days to 39.2 days, with an estimated cost savings of $13,119 per each of the 225 infants in the initiative. After implementing an evidence-based algorithm for management of neonatal CPE, a significant increase in the accuracy of the diagnosis of central apnea and cost savings associated with a decrease in LOS were observed.

Problems and considerations in the diagnosis of obstructive sleep apnea

阻塞性睡眠呼吸暂停（OSA）的诊断标准需要考虑不同临床特征和不同病理生理表型，以及相关的靶器官损害；严重程度的评估需要考虑是否修改目前单一指标呼吸暂停低通气指数（AHI）；治疗决策应该考虑病理生理亚型和疾病的靶器官损害，而不只是依赖于AHI的病情评估标准。.

Designing an Intelligent System for Diagnosing Type of Sleep Apnea and Determining Its Severity

Introduction: Sleep apnea syndrome can be considered as one of the most serious risk factors of sleep disorder. Due to the lack of information about this disease, many causes of unexpected deaths have been identified. With increasing the number of patients with this disease around the world, many patients suffer apnea complications. Most of them are not treated because of the complex and costly and time-consuming polysomnography (PSG) diagnostic procedure.Material and Methods: This descriptive-analytical study was performed on 50 patients referred to sleep clinic of Imam Khomeini Hospital in Tehran, Attempts to design, and develop a system for detection of sleep apnea and its severity using ECG signals, RR intervals and airflow. The random forest algorithm and MATLAB2016 were used in the design of the system that the algorithm inputs are extracted 8 features nonlinear in time-frequency domain from airflow and ECG signals and 10 nonlinear features of RR intervals.Results: The accuracy for normal, obstructive, central and mixed apnea was obtained at 95.3%, 97.92%, 99.60%, and 97.29%, respectively, and the accuracy For detection of normal, mild, moderate and severe apnea was obtained 96%, 94%, 94%, 96% respectively. According to the results, the proposed system can correctly classify the types of sleep apnea and its severity.Conclusion: The proposed system, which has high performance capability in addition to increasing the physician speed and accuracy in the diagnosis of apnea can be used in home systems and the areas where healthcare facilities are not sufficient.

Prolonged apnea after ECT in organophosphorus poisoning \u2013 the need to redefine norms

BackgroundPoisoning and deaths by organo-phosphorous (OP) compounds are one of the major causes of death in developing and poor countries, and a common admission in the emergency ward and the ICU. OP compounds act by irreversibly binding to pseudocholinesterase enzyme and hence prolong the apnea in patients being given suxamethonium. We present a unusual case of OP poisoning (OPP) in which prolonged apnea ensued in a patient of severe depression following MECT (modified electroconvulsive therapy) in which suxamethonium was used as muscle relaxant, in whom we were cautious of the side-effect of prior organophosphorus poisoning. Since the cases of OPP are very high worldwide, a thorough knowledge of the interaction of the action of the drug and the receptors on which it acts takes pride of place. This article highlights the nuances in the field of psychiatry and anaesthesia in diagnosis and management of prolonged apnea after ECT.Case presentationA 53/F patient consumed OP 38 days prior to MECT. Since existing literature recommend a delay of 4 weeks and a subminimal dose of suxamethonium to prevent prolonged apnea, both these points were taken into consideration. Despite 38 days post exposure to OP, and a dose of succinylcholine of < 0.3 mg/kg, the patient remained apneic for 3 h. Suxamethionum apnea was managed with elective ventilation. After recovery, patient had no residual effect. Subsequently her pseudocholinesterase levels were done which were found to be very low.ConclusionThis case is being presented to emphasize that behaviour of post synaptic receptors cannot be relied upon after OP poisoning and pseudocholinesterase levels needs to be mandatorily checked, irrespective of duration post-exposure. In strong suspects dibucaine number and fluoride number also needs to be estimated.

Obstructive Sleep Apnea: Diagnosis and Management

As part 2 of three chapters on sleep disordered breathing, this chapter reviews obstructive sleep apnea (OSA) diagnosis and management. OSA should be considered in all patients who have loud habitual snoring, excessive daytime sleepiness, and witnessed apneas. On physical examination, craniofacial abnormalities that can lead to sleep apnea include retrognathia, micrognathia, a narrow hard palate, nasal obstruction, an overjet, and an overbite. Enlargement of the upper airway soft tissue structures (the tongue, soft palate, lateral walls, and parapharyngeal fat pads) also increases the risk of OSA. The gold standard for making the diagnosis of OSA is overnight polysomnography, but home sleep apnea tests (HSAT) are rapidly gaining acceptance, especially in patients with a high probability of OSA. The first line of therapy for OSA remains positive airway pressure (PAP), with the second line of therapy being oral appliances. Another alternative to PAP therapy is hypoglossal nerve stimulation, which has been shown to decrease the Apnea-Hypopnea index by 67.4%. This review contains 6 figures, 3 tables, and 52 references. Key Words: craniofacial abnormalities, Epworth Sleepiness Scale, home sleep apnea test, hypoglossal nerve stimulation, obstructive sleep apnea, oral appliances, oral pharyngeal crowding, polysomnography, positive airway pressure, STOP-BANG

0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea

Abstract Introduction The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs. Methods A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented. Results 429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA. Conclusion Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP. Support N/A

Sleep Thermography for Diagnosis of Obstructive Sleep Apnea (TERMOAPNEA)

Sleep Thermography for Diagnosis of Obstructive Sleep Apnea (TERMOAPNEA)

Attach importance to diagnosis and treatment of obstructive sleep apnea

Attach importance to diagnosis and treatment of obstructive sleep apnea

Epidemiological trends among preterm infants with apnea. A twelve-year database review

ObjectivesThis study sought to characterize trends in the diagnosis of apnea, associated comorbidities and complications, and 30-day readmission rates in preterm singleton infants. Subjects and methodsThe study design was a retrospective, longitudinal, observational study. 2003–2014 New York State Statewide Planning and Research Cooperative System and New York City Vital Statistics databases were merged identifying preterm live singleton births. Hospitalizations of preterm newborns with and without apnea were compared; multivariable logistic regression and log-linear Poisson regression models applied. ResultsOf 1,384,013 singleton births, 7.5% were identified as preterm. While relative risk of preterm birth rates declined (RR = 0.987, 95% CI = 0.982–0.991), the diagnosis of apnea increased significantly (RR = 1.069, 95% CI = 1.049–1.089). Multivariable analysis identified two apnea predictors, gastric reflux (OR = 3.19, 95% CI = 2.80–3.63) and early gestational age (OR = 0.83 for 1 week GA increase, 95% CI = 0.82–0.84). Preterm newborns with apnea were more likely to be readmitted within the first 30 days and total charges were 5.4 times higher. ConclusionsWhile the preterm birth rate has declined the rate of diagnosis of apnea with associated comorbidities and complications has increased. Given the additional findings of higher 30-day readmission rates and charges, more multidisciplinary research appears warranted to identify ways to optimize the quality of high risk newborn care.

Diagnosis and treatment of idiopathic apnea in the aspect of cardiac diseases

Diagnosis and treatment of idiopathic apnea in the aspect of cardiac diseases

Obstrüktif Uyku Apnesi Tanısında Epworth Uykululuk Ölçeğinin Ortak Değişkene Göre Düzeltilmiş İşlem Karakteristik Eğrisi ile Değerlendirilmesi

Obstrüktif Uyku Apnesi Tanısında Epworth Uykululuk Ölçeğinin Ortak Değişkene Göre Düzeltilmiş İşlem Karakteristik Eğrisi ile Değerlendirilmesi

&lt;b&gt;A Odontologia na sindrome da apneia obstrutiva do sono&lt;/b&gt;: diagnóstico e tratamento

O presente trabalho objetiva realizar uma revisão na literatura sobre os aspectos da Síndrome da Apneia Obstrutiva do Sono (SAOS), diagnóstico e tratamento, com foco nos dispositivos intrabucais. A SAOS é um distúrbio respiratório crônico, caracterizado por um colapso das vias aéreas superiores durante o sono, ocasionando diminuição ou ausência do fluxo de ar para os pulmões. A etiologia é multifatorial. O diagnóstico inclui exame clínico e exames complementares como a polissonografia do sono. Dentre as opções de tratamento estão os dispositivos intrabucais que, quando bem indicados e confeccionados, permitem a supressão parcial ou total do ronco e da apneia obstrutiva. Pode-se concluir que a Odontologia exerce papel fundamental no cenário da SAOS.&#x0D; &#x0D; DOI: 10.18363/rbo.v72i1/2.588

Higher Levels of Plasma interleukin-6 Are Associated with Lower BOLD Responses to Working Memory Load in Older Adults

Author(s): Dev, Sheena I; Moore, Raeanne; Jones, Savannah R; Soontornniyomkij, Benchawanna; Achim, Cristian L; Jeste, Dilip V; Eyler, Lisa T

Effects of interactions between different clinical presentations of coronary heart disease and timing of polysomnography on diagnosis of obstructive sleep apnea

Introduction Obstructive sleep apnea (OSA) is a novel risk factor for coronary heart disease and screening polysomnography is recommended. Yet, optimal time to perform polysomnography is unknown. We sought to determine if the diagnosis of OSA is influenced by the timing of polysomnography and its interaction with different presentations of coronary heart disease. Materials and methods We prospectively recruited 160 patients admitted with acute myocardial infarction (AMI) or stable coronary artery disease (CAD) for either in-hospital ( n =80) or post-discharge ( n =80) polysomnography. Results The median time from admission to polysomnography for in-hospital and post-discharge groups was 1day and 17days, respectively ( p ⩾ 15). In patients presenting with AMI ( n =80), the average AHI was higher in the in-hospital than post-discharge group (55.0 vs. 27.5, p =0.022). In patients presenting with stable CAD ( n =80), no significant differences were observed (27.5 vs. 37.5, p =0.474). OSA patients were more likely to have the polysomnography done during the in- hospital than post-discharge period (55.9% vs. 46.5%, p =0.037). Logistic regression analysis revealed a significant interaction between clinical presentation and effect of polysomnography timing on diagnosis of OSA ( p =0.003). The timing of polysomnography predicted the risk of OSA in patients presenting with AMI (adjusted OR 3.84%, 95% CI 1.42–10.41, p =0.008), but not those presenting with stable CAD. Other independent predictors included body mass index, diabetes mellitus and hyperlipidemia. Conclusion The timing of polysomnography influences the diagnosis of OSA in patients presenting with AMI, but not in those presenting with stable CAD. There is a higher chance of diagnosing OSA in AMI patients when polysomnography is done in-hospital compared to post-discharge. The role of AMI-induced myocardial is stunning in the diagnosis of OSA and deserves further study.

AAP Clinical Practice Guideline on Diagnosis and Management of Childhood Obstructive Sleep Apnea

The American Academy of Pediatrics (AAP) revised the guideline for primary care clinicians on diagnosis and management of obstructive sleep apnea (OSA)

Diagnosis and treatment of central sleep apnea

中枢性睡眠呼吸暂停(CSA)是由于呼吸中枢驱动消失所引起的呼吸停顿,在常规睡眠多导图上表现为口鼻气流停止和无胸腹运动,持续时间＞10 s.当呼吸气流幅度较基础水平降低≥30％持续10 s以上,同时伴有血氧饱和度下降≥4％或微觉醒时,则这一事件定义为低通气[1].低通气由呼吸中枢驱动下降所致者为中枢性,由上气道部分阻塞所致者为阻塞性.呼吸暂停和低通气事件常同时存在,二者对机体的损害及导致的病理生理变化相似,临床上常通称为呼吸暂停低通气,并把平均每小时发生的呼吸暂停和低通气次数称为呼吸暂停低通气指数(AHI).许多情况下,阻塞性睡眠呼吸暂停(OSA)低通气与CSA低通气事件同时存在,如果50％以上事件是中枢性的,则诊断为CSA低通气综合征。

Sleep Medicine: The Shot Heard Around the World

background There has recently been concern about the future of sleep medicine in response to the “disruptive technology” of home sleep testing (HST) and its embrace by the medical insurance industry in the USA. 1,2 A reader might surmise that the ficontract by an insurance carrier in Massachusetts to mandate HST as a fistep in apnea diagnosis was the shot heard around the world that would change sleep medicine forever. The original shot heard around the world referred to the fiskirmish of the American Revolution (incidentally only about 30 miles from the headquarters of the insurance carrier in Massachusetts) was simply a step in a process that had its genesis long before. Similarly, the genesis of this shot affecting sleep medicine was long ago, and the reader must recognize that this is a shot heard around America, not the around the World. There have been many “disruptive” technologies and treatments in medicine, and in general they have improved patient outcomes. We can now prevent poliomyelitis and many childhood viral diseases; we can cure most bacterial, mycobacterial, and fungal infections; we seldom require surgery to treat diseases caused by gastric acid hypersecretion; we use “noninvasive” surgery using laparoscopic and thoracoscopic techniques to treat many patients who a generation ago would have required large incisions, dissections and excisions, and prolonged hospital admissions. We can now determine the presence of cancer in many cases using PET/MRI imaging. disruptions in Sleep medicine Sleep medicine is a young fiand there have already been several disruptions. In the fi eld of sleep apnea some of the disruptions have been technical, while others were based on new knowledge. There have already been several shots heard around the world of sleep. Some of the shots have been quiet, while some have very loud. Such shots might include the following: the description of CPAP 3 ; the fi rst description of data acquisition for respiratory variables during sleep by a microcomputer 4 ; the notion that respiratory sleep data can be obtained outside the laboratory 5 ; the publication of data suggesting that apnea patients have more automobile accidents 6 and increased mortality 7 ; the implementation of an integrated home sleep testing system 8 ; the monitoring of CPAP compliance 9 ; and the realization that sleep apnea is a very common problem. 10

Validation de l’oxymétrie continue dans le diagnostic du syndrome d’apnées obstructives du sommeil

Validation de l’oxymétrie continue dans le diagnostic du syndrome d’apnées obstructives du sommeil