Evidence Of Obstructive Sleep Apnea Research Articles

A Comprehensive Analysis of Clinical, Biochemical, and Polysomnographic Characteristics in Patients With Type 2 Diabetes Mellitus With and Without Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) has been a significant contributor tomortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on,but the indicators of its early detection are still elusive. The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. Atotal of 110 patientsunderwent a sleep study, of which68 (61.8%)had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09vs 0.930, p = 0.001). HbA1c >7%was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. OSAfrequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalenceof OSAin persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.

Sickle Cell Disease Phenotypes and Obstructive Sleep Apnea; Are They Related?

This study aims to compare the polysomnographic features between Arab-Indian and Benin phenotypes of sickle cell disease (SCD). This prospective cross-sectional study was conducted in the Children's Hospital at King Fahad MedicalCity, in Riyadhwhere childrenwere recruited fromthe pediatric hematology clinic and pediatric sleepmedicine. All families were approached and patients who met the inclusion criteria and agreed to participate were included in the study. Eighty four children (37 of whom were females) with SCD were included in the study. Their median (interquartile) age was 9 (6.65, 11) years and their body mass index z score was -1.45 (-2.195, -1.45). The evidence of obstructive sleep apnea (OSA) was more prominent in the Benin phenotype (66.7%) in comparison to those of the Arab-Indian (35.2%) phenotype ( p = 0.006). Additionally, 56.7% of Benin had moderate to severe OSA whereas Arab-Indian had 18% with a ( p = 0.0003). Controlling for other factors, the odds ratio (confidence interval) of having OSA in Benin phenotype was 4.68 (1.42-15.38) times higher as compared to Arab-Indian phenotype. The risk of having OSA as well as the severity of OSA is higher in Benin phenotype as compared to Arab-Indian phenotype which indicates the presence of potential OSA risk factors other than the SCD itself.

0989 Hello From the Other Side: A Grandmother’s Eternal Love

Abstract Introduction Sleep-related hallucinations (SRH) may arise at sleep onset or on awakening from sleep and represent sleep-state dissociation with the abnormal intrusion or persistence of dreams into wakefulness. These multisensory experiences are usually visual but may be tactile and colored by emotions such as grief. We describe a patient who presented with episodes of visual and tactile hallucinations of being comforted by his late grandmother at sleep onset shortly after her death. Report of case(s) A 20-y/o male with a history of autism spectrum disorder (ASD) presented with sleep onset insomnia related to disturbing multisensory hallucination temporally associated with the passing of his grandmother two years earlier. He sleeps for 5 hours nightly and experiences more frequent spells when sleep-deprived. The spells manifest within an hour of sleep onset and consist of the patient experiencing quasi-visual and tactile sensations of his grandmother wrapping her hands through his hair and hugging him. The episodes are associated with longing and sadness as this was customary for his grandmother as she comforted him to sleep when she was alive. The patient’s interpretation was that the episodes might represent his grandmother's attempt to communicate with him and keep him safe. Polysomnography depicted REM sleep latency of 107 minutes without evidence of REM sleep without atonia. There was no evidence of obstructive sleep apnea. Conclusion Sensory and quasi-sensory experiences of the deceased (SED) is an inclusive and neutral term used to describe multisensory experiences of the presence of the deceased. Phenomenologically, post-bereavement hallucinations are more closely aligned with the ICD-3 classification of SRH. The patient’s spells of SED were likely facilitated by sleep deprivation. Emerging data also supports the presence of unusual somatosensory experiences leading to supernatural attribution to these experiences in ASD. With the passing of his grandmother, the combination of grief and sleep deprivation along with altered central sensory processing likely contributed to the SED. SED and SRH represent a spectrum of abnormal hallucinations following bereavement and are facilitated by sleep deprivation. In ASD, the episodes might emerge in response to altered central limbic sensory processing and represent an important mechanism of impaired REM sleep in Autism spectrum. Support (if any)

Acoustic Screening for Obstructive Sleep Apnea in Home Environments Based on Deep Neural Networks

Obstructive sleep apnea (OSA) is a chronic and prevalent condition with well-established comorbidities. However, many severe cases remain undiagnosed due to poor access to polysomnography (PSG), the gold standard for Obstructive sleep apnea (OSA) diagnosis. Accurate home-based methods to screen for OSA are needed, which can be applied inexpensively to high-risk subjects to identify those that require PSG to fully assess their condition. A number of methods that analyse speech or breathing sounds to screen for OSA have been previously investigated. However, these methods have constraints that limit their use in home environments (e.g., they require specialised equipment, are not robust to background noise, are obtrusive or depend on tightly controlled conditions). This paper proposes a novel method to screen for OSA, which analyses sleep breathing sounds recorded with a smartphone at home. Audio recordings made over a whole night are divided into segments, each of which is classified for the presence or absence of OSA by a deep neural network. The apnea-hypopnea index estimated from the segments predicted as containing evidence of OSA is then used to screen for the condition. Audio recordings made during home sleep apnea testing from 103 participants for 1 or 2 nights were used to develop and evaluate the proposed system. When screening for moderate OSA the acoustics based system achieved a sensitivity of 0.79 and a specificity of 0.80. The sensitivity and specificity when screening for severe OSA were 0.78 and 0.93, respectively. The system is suitable for implementation on consumer smartphones.

Impact of Syndromes on Sleep-Disordered Breathing in Children After Cleft Palate Repair.

Prior research suggests that children with cleft palate (CP) are at increased risk of obstructive sleep-disordered breathing (SDB). However, few studies differentiate the effects of CP repair on SDB based on syndrome status. The goal of this study was to evaluate differences in SDB after palatoplasty among children with nonsyndromic CP, syndromic CP, and isolated Robin sequence (RS). Retrospective chart review. Tertiary academic children's hospital. A total of 145 children who underwent primary CP repair from 2014 to 2021. Post-palatoplasty SDB is defined as parent-reported symptoms and/or evidence of obstructive sleep apnea (OSA). Median age at palatoplasty was 11.1 [IQR 10.2-13.6] months. Most patients (61.4%) had nonsyndromic CP, 26.9% had a syndrome, and 11.7% had RS. Children with syndromic CP and RS had more post-palatoplasty SDB symptoms (56.4% vs 58.8% vs 30.3%, P = .006) and higher rates of OSA (25.6% vs 29.4% vs 5.6%, P = .001) compared to children with nonsyndromic CP after palatoplasty. Children with syndromic CP and RS had nearly 3 to 4 higher odds of post-palatoplasty SDB than children with nonsyndromic CP (adjusted odds ratio [aOR] 2.88, 95% CI 1.29-6.47, P = .010; aOR 3.73, 95% CI 1.19-11.70, P = .024). This study showed that children with CP experience higher rates of SDB after palatoplasty than the general pediatric population. Within the cohort, children with syndromic CP and isolated RS were more likely to have obstructive sleep disorders than nonsyndromic children after palatoplasty. Clinicians should counsel caregivers accordingly and closely monitor these groups for SDB after palate repair.

Rationalising requests for preoperative sleep studies and postoperative HDU beds: a quality improvement project in paediatric ENT patients undergoing elective surgery

BackgroundSleep disordered breathing represents a spectrum of upper airway obstruction including snoring, increased respiratory effort and obstructive sleep apnoea. An increasing demand for paediatric preoperative sleep studies and postoperative high...

The Efficacy of Diode Laser Palatoplasty on Patients with Troublesome Snoring.

Introduction:Simple Snoring is low frequency sound without obstructive sleep apnea, produced mainly from vibration of the upper airway wall in the soft palate; it can be bothersome and may causes social problems. So the aim of this study is an attempt for relieving simple snoring though, stiffening the soft palate via transoral diode laser palatoplasty. Materials and Methods:Forty six adult patients with socially troublesome snoring were recruited in this stuy. Adequately history was taken to rule out witnessed evidence of obstructive sleep apnea. Then full otolaryngological examination, with soft palate vibration grading assessment by Muller maneuver were followed, consequently the eligible patients were underwent transoral 810 nm diode laser palatoplasty under local anesthesia and followed-up 6 months post-operatively. Results:The loudness of subjective snoring assessed by visual analogue score (VAS) was relieved from 6.6 to 2.4 and by Muller maneuver was improved from 2.7 to 1.9, and for the frequency from 2.1 Hz to 0.3 Hz, and from 2.4 Hz to 0.55 Hz for the duration pre to post-operative with P value of 0.75 to 0.023 respectively, So the overall frequencies of improvement of snoring loudness results had revealed a total improvement (no snoring) were detected in 4 patients, and moderate improvement had been found in 30 patients, while mild improvement of snoring had been seen in 10 patients, however about 2 patents got no benefit from the surgery. Conclusion:Stiffening of the soft palate by diode laser had shown to be significantly beneficial in relieving the snoring intensity as it had a positive impact on its subjective loudness, frequency and duration.

PREVALENCE OF POST-BARIATRIC SURGERY SLEEP-RELATED COMPLICATIONS IN A TERTIARY HOSPITAL IN SAUDI ARABIA

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Over the past decade, bariatric surgeries have been on the rise worldwide as an effective way of weight loss. Most patients going for these surgeries are known to have Obstructive Sleep Apnea (OSA) or diagnosed with it while being screened for OSA as part of their pre-operative assessment. Our study aims to detect specific respiratory complications of bariatric surgeries, their relation to the severity of OSA, and how we might anticipate them pre-operatively. METHODS: we did a chart review on patients who underwent bariatric surgeries between the year 2017 to 2019. Our main outcome was respiratory failure and unplanned intubation. secondary outcomes include post-operative Oxygen saturation and oxygen need, unplanned non-invasive ventilation need, and ICU stay. We compared those outcomes to patient's BMI, baseline SpO2, and pre-operative Polysomnography findings. RESULTS: 67 patients underwent bariatric surgery who also had polysomnography prior to surgery. There were 34 males (50.7%) and 33 females (49.3%) with an average age of 37 +/- 12 in this cohort. Their mean Body Mass Index was 50 +/- 10 and baseline O2 was 96%. 67 patients had pre-operative sleep evaluation. 47% of them had severe OSA (AHI >30), 21% had moderate OSA while 14% had no evidence of OSA. 58% had low O2 nadir (o2 saturation <88%) and Oxygen Desaturation Index >10 was observed in 14 patients (20%) The Majority of patients underwent laparoscopic sleeve surgery (77%). Post-operatively, 3 patients had unplanned ICU admission secondary to hypoxic/hypercapnic respiratory failure. One of them had intubation while the other two received Non-Invasive Ventilation. All these patients had severe OSA with an average AHI 80 events/hour. 13 patients (19.4%) needed oxygen for post-operative hypoxia and 13 patients needed unplanned Positive Airway Pressure device (PAP). There was a correlation between the severity of OSA and the unplanned PAP use postoperatively (Pearson chi2 = 9.2394, P-value = 0.026) and correlation with post-operative hypoxia that required O2 therapy which didn’t reach statistical significance (Pearson chi2 = 6.5301 P = 0.088). There was no correlation between postoperative respiratory complications and other variables in polysomnography such as Oxygen Desaturation Index or Oxygen nadir. CONCLUSIONS: There were few major post-operative respiratory complications in this study given its small cohort size. There was a correlation between the severity of sleep apnea and minor respiratory complications such as post-operative mild-moderate hypoxia. CLINICAL IMPLICATIONS: It is suggested to screen patients for OSA prior to bariatric surgeries as this will help in detecting high-risk patients for post-operative complications. Further and larger studies are needed to evaluate the effect of different PSG parameters on post-bariatric surgery respiratory complications. DISCLOSURES: No relevant relationships by MUHAMMAD ABUKHATER, source=Web Response No relevant relationships by Riyad Al-Lehebi, source=Web Response no disclosure on file for Abdullah AlJasser; no disclosure on file for Nasser Aljohani; no disclosure on file for Rana AlTurki

Intensive Continuous Positive Airway Pressure Adherence Program During Stroke Rehabilitation.

Background and Purpose- Continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea may improve stroke recovery, but adherence is poor. We assessed the effectiveness of an intensive CPAP adherence program during and after inpatient stroke rehabilitation on 3-month adherence and stroke recovery. Methods- In a single-arm study, 90 stroke rehabilitation patients were enrolled into an intensive CPAP adherence program. CPAP was continued after a run-in among qualifying patients with evidence of obstructive sleep apnea. The primary outcome was CPAP adherence, defined as ≥4 hours of use on ≥70% of days, over 3 months. Results- A total of 62 patients qualified for continued CPAP and 52 of these were willing to continue CPAP after discharge from rehabilitation. At 3 months, the average daily CPAP use was 4.7 hours (SD 2.6), and 32/52 (62%) patients were adherent. Factors significantly associated with adherence included more severe stroke, aphasia, and white race. Compared with nonadherent patients, adherent patients experienced greater improvements in the cognitive component of the Functional Independence Measure ( P=0.02) and in the National Institutes of Health Stroke Scale ( P=0.03). Conclusions- This intensive CPAP adherence program initiated during stroke rehabilitation can lead to CPAP adherence in the majority of patients with evidence of obstructive sleep apnea, including those with more severe stroke and aphasia, and may promote recovery. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02809430.

A pilot study of sleep-related breathing disorders and hypersomnia in adult survivors of childhood Hodgkin lymphoma treated with thoracic radiation.

e21527 Background: Survivors of childhood Hodgkin lymphoma (HL) often report fatigue and daytime sleepiness. The presence of sleep disorders, such as obstructive sleep apnea (OSA), could further increase cardiovascular and cerebrovascular morbidity and mortality in these patients. The purpose of this pilot study was to assess for the presence of sleep-related breathing disorders and hypersomnia in adult survivors of childhood HL treated with thoracic radiation. Methods: Survivors, ≥18 years of age and ≥10 years from diagnosis, were randomly selected from the St. Jude Lifetime Cohort (SJLIFE) study and assessed with nocturnal polysomnography (PSG) and the multiple sleep latency test (MSLT). Enrollment was stratified by body mass index (BMI) to include an equal number of normal weight and overweight/obese survivors. Survivors with a history of neurotoxicity related to cancer therapies, and neurological, genetic, or neurodevelopmental conditions associated with neurocognitive impairment were excluded. Results: Thirty adult survivors of childhood HL (60% male; 73% white; mean age 35.8 years [range,19.9-52.8]; BMI 28.6 [range, 18.2-43.5]) enrolled, and 14 (47%) met PSG criteria for mild or moderate OSA (OSA; apnea-hypopnea index 5-30). Of those with OSA, 11 had concurrent hypersomnia using the MSLT criteria and 3 of these 11 met diagnostic criteria for narcolepsy. Twelve (40%) had hypersomnia without OSA and 3 of these 12 met diagnostic criteria for narcolepsy. Within the cohort, 86% had objective evidence of OSA and/or hypersomnia/narcolepsy. Conclusions: Findings suggest adult survivors of childhood HL may be at increased risk for OSA, which when concurrent with treatment-related cardiopulmonary and cerebrovascular risk may further increase morbidity and mortality. Future studies are warranted to compare the prevalence of OSA in this population with a matched community control group and examine whether and how the mechanism for OSA might differ from that in the general population.

Abstract TMP45: An Intensive Multidisciplinary Protocol for Improving Adherence to CPAP Therapy During Inpatient Rehabilitation May Improve Recovery in Stroke Patients

Introduction: Obstructive sleep apnea (OSA) is associated with worse outcome after stroke. Treatment with continuous positive airway pressure (CPAP) may improve recovery after stroke but has been limited by poor adherence. Methods: In a single-arm ongoing study, adults with stroke underwent an intensive CPAP adherence protocol during inpatient rehabilitation, including motivational interviewing and help with CPAP by nurses and respiratory therapists. A 3-night run-in period of auto-titrating CPAP was used to test for tolerance and to diagnose OSA, based upon the apnea-hypopnea index and flow resistance. Qualifying patients were asked to continue CPAP for 3 months. The outcomes included CPAP adherence, defined as ≥ 4 hours of use on ≥ 70% of nights, and stroke recovery, measured by change in NIH Stroke scale (NIHSS) and Functional Independence Measure (FIM) over 3 months. Results: During the run-in, 39 of 60 (65%) patients had presumed OSA, 5 (8%) had no evidence of OSA, 4 (7%) had evidence of central sleep apnea, and 12 (20%) were intolerant of CPAP. Among the 34 of 39 patients who chose to continue CPAP after the run-in, the median use per night was 5.3 hours (IQR 4.1, 6.0) with 56% (n=19) adherent during rehabilitation. The median CPAP use per night for the 22 who completed the study was 5.1 hours (IQR 2.5, 6.4) with 54% (n=12) adherent over the 3-month period. Unadjusted for baseline factors, there was a significant change in the NIHSS in adherent patients (n=10) vs. non-adherent patients (n=10) [5 (SD 3) vs. 2 (SD 2), p =0.02]. Comparing adherent (n=7) to non-adherent patients (n=5), the change for total FIM trended towards significant [42 (SD 18) vs. 30 (SD 11), p =0.20] and the change for cognitive component of the FIM was significant [10 (SD 7) vs. 2 (SD 3), p =0.05]. Conclusion: After an intensive adherence intervention, over half of stroke patients with presumed OSA and CPAP tolerance were adherent over 3 months. CPAP adherent patients had greater improvement in NIHSS and the cognitive component of the FIM, although the associations may be confounded by patients’ characteristics influencing both adherence and outcomes. Future studies are needed to evaluate in a randomized trial if the intensive intervention will lead to long-term CPAP adherence and improved stroke recovery.

Pediatric sickle cell disease and obstructive sleep apnea: A cross-sectional study in a tertiary pediatric center in Saudi Arabia.

OBJECTIVE:The aim of the study was to evaluate snoring and obstructive sleep apnea (OSA) in Saudi children with sickle cell disease (SCD).MATERIALS AND METHODS:This cross-sectional study was conducted among children with SCD attending a hematology clinic were recruited. Demographics, clinical data, and sleep questionnaires were collected and overnight polysomnographies performed.RESULTS:Seventy children (31 of whom were females) with SCD were included in the study. Their median (interquartile) age was 9 (6.5, 11) years and their body mass index z-score was −1.2 (−2.0, −0.4). Seventy-four percent of SCD patients snored and 32 (46%) had evidence of OSA (obstructive apnea-hypopnea index [OAHI] ≥2 events per hour of sleep), 13 of whom had moderate OSA (OAHI ≥5 and <10 events per hour of sleep) and 10 had severe OSA (OAHI ≥10 events per hour of sleep).CONCLUSION:Snoring and the proportion of OSA were high in children with SCD. This underlines the importance of screening for OSA in all children with SCD.

Do I Have to be Worried About Cancer if I Have Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a common sleep breathing disorder, characterized by recurrent upper airway obstruction triggered by complete or partial upper airway collapse during sleep. It is a major public health issue, and it has been strongly associated with cardiovascular and metabolic morbidity and mortality, as well as behavioral and cognitive dysfunction. Recently, OSA has been associated with an increased solid tumor prevalence and poorer outcome, suggesting these patients are at higher risk to develop solid tumor malignancies or to die from oncological complications. The underlying mechanisms are not completely understood, but intermittent hypoxia is considered to be a major factor of OSA for promoting tumor invasion and metastasis. We discuss in the present review the current evidence of obstructive sleep apnea and cancer relationship.

Restless Leg Syndrome is Prevalent in Military Veterans with Post- Traumatic Stress Disorder and Sleep Disturbances

Introduction: While Restless leg syndrome (RLS) is a common sleep related movement disorder with a negative impact on sleep, quality of life and health, it may remain underdiagnosed for years. This study aims to evaluate RLS in military veterans with post-traumatic stress disorder (PTSD) suffering from sleep disturbances. Material and methods: Thirty-One Iranian male military veterans diagnosed with PTSD entered this study. None of them had diabetes, Parkinson’s disease and renal failure or were taking medications affecting RLS. Daytime sleepiness, anxiety and depression, RLS severity and the risk of obstructive sleep apnea (OSA) were assessed by standard questionnaires. Results: The mean age was 51.6 ± 6.1 years. The most common complaint was difficulty falling asleep. Eight individuals (25.5% of participants) had RLS. All of them had evidence of OSA based on the STOP-BANG questionnaire. The severity of RLS was not associate with sleepiness, depressive symptoms and body mass index (BMI), but with anxiety symptoms. Conclusion: RLS should be taken into consideration in veterans with PTSD, particularly in those with sleep disturbances including insomnia, sleep related movements and sleep apnea.

Treatment of primary aldosteronism is associated with a reduction in the severity of obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is known to commonly co-exist with primary aldosteronism (PA), but it is unknown if treatment of PA improves sleep apnoea parameters in these patients. We therefore aimed to determine whether specific medical or surgical treatment of PA improves OSA, as measured by the apnoea-hypopnoea index (AHI). We recruited patients undergoing diagnostic workup for PA if they had symptoms suggestive of OSA. Patients with confirmed PA underwent polysomnography (PSG) at baseline and again at least 3 months after specific treatment for PA. Of 34 patients with PA, 7 (21%) had no evidence of OSA (AHI <5), 9 (26%) had mild (AHI ⩾5 and <15), 8 (24%) moderate (AHI ⩾15 and <30) and 10 (29%) severe OSA (AHI ⩾30). Body mass index tertile, neck circumference and 24 h urinary sodium correlated with the AHI. Twenty patients had repeat PSG performed after treatment for PA (mineralocorticoid receptor antagonists in 13 with bilateral PA and adrenalectomy in 7 with unilateral PA). In this group the median (s.d.) AHI reduced from 22.5 (14.7) to 12.3 (12.1) (P=0.02). Neck circumference reduced with PA treatment (41.6 vs 41.2 cm, P=0.012). OSA is common in patients with primary aldosteronism and may improve with specific therapy for this disease. Aldosterone and sodium-mediated fluid retention in the upper airways and neck region may be a potential mechanism for this relationship.

Diagnostic accuracy of carotid intima media thickness in predicting coronary plaque burden on coronary computed tomography angiography in patients with obstructive sleep apnoea

AimTo assess the diagnostic accuracy of common carotid artery intima media thickness (CIMT) for coronary artery disease (CAD) detection in patients with obstructive sleep apnoea (OSA). Materials & methodsPatients with clinically suspected OSA prospectively underwent polysomnography (PSG), ultrasound CIMT measurement and coronary computed tomography angiography (CTA). An average CIMT of ≥0.9 mm in either common carotid artery designated as a positive test. Coronary CTA was the reference standard for the presence of CAD. Coronary plaque presence, volume, density and type were correlated with CIMT findings. Results35 consecutive male patients were enrolled from sleep clinic. Two patients had no evidence of OSA on PSG (apnoea-hypopnea index [AHI]<5/hr), and were excluded. Of the remaining 33, 18 (54%) had mild-moderate OSA (AHI 5–30/hr) and 15 (46%) had severe OSA (AHI >30/hr). Eight (24%) patients had CAD on coronary CTA. Coronary plaques were predominantly non- or partly calcified, and located in proximal coronary artery segments. Sensitivity, specificity, positive and negative predictive and likelihood ratios for a positive CIMT (≥0.9 mm) in diagnosing CAD were 0.5 (95% confidence interval: 0.76–0.12), 0.96 (1–0.89), 80, 85.7, 12.5 and 0.52 respectively. The adjusted odds ratio was 40.8. ConclusionIn patients with OSA, CIMT is a highly specific but poorly sensitive test for detecting CAD.

Longitudinal evaluation of sleep disordered breathing in infants with Prader-Willi syndrome

ObjectiveTo evaluate the course of sleep disordered breathing (SDB) in infants with Prader-Willi syndrome (PWS).DesignRetrospective longitudinal observational study.SettingSleep laboratory at The Hospital for Sick Children, Toronto, Canada.PatientsInfants with PWS.Main outcome...

Apert syndrome: Surgical outcomes and perspectives.

Apert syndrome is a rare congenital malformation with severe craniofacial anomalies. The aim of this study was to review the outcomes of craniofacial and neurosurgical interventions in Apert syndrome patients treated at a single institution. A retrospective review of all patient records with a diagnosis of Apert syndrome assessed and managed in the Australian Craniofacial Unit (ACFU) from 1985 to 2013 was conducted. A total of 94 patients were identified, and 130 transcranial procedures were performed. Of the patients, 83 underwent a fronto-orbital advancement (FOA) as their primary procedure, and 18 patients also underwent a posterior vault procedure. Twenty patients underwent a fronto-facial monobloc advancement. Overall, 70% of patients underwent at least 2 transcranial procedures. Shunts were inserted in 2 patients preoperatively and in 5 patients postoperatively for cerebrospinal fluid (CSF) leaks or acute hydrocephalus. Re-do FOAs were performed in 8 patients. Patients who underwent an FOA at the age of more than 18 months had no recurrence of raised intracranial pressure (ICP). Of 18 patients who also underwent a posterior vault procedure, 1 patient had recurrence of raised ICP. Midfacial surgery was performed early if there was evidence of obstructive sleep apnoea (OSA), but delayed midfacial surgery was preferred. Complications were reported in 18% of procedures. The most common complications were CSF leaks and acute hydrocephalus. Shunting is rarely required in Apert syndrome patients, confirming a predominantly nonprogressive ventriculomegaly. FOA appears to be a more stable procedure when performed at an age of more than 18 months. Undergoing a posterior vault procedure may reduce the risk of recurrent raised ICP and lead to fewer transcranial procedures needed in childhood. Midfacial surgery should be delayed until adolescence where there is no evidence of OSA, psychological disturbance, or complications of exorbitism. Complications are rare when these patients are treated by an experienced craniofacial team.

Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children.

PurposeThis study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children.MethodsStudy subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals.ResultsSleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux.ConclusionThe data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.

Objectively measured sleep characteristics and prevalence of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis Sleep study

BackgroundWe tested whether objectively measured indices of obstructive sleep apnoea (OSA) and sleep quality are associated with coronary artery calcification (CAC) prevalence independent of obesity, a classic confounder.Methods1465 Multi-Ethnic Study...