Factors In Obstructive Sleep Apnea Research Articles

Obstructive sleep apnea in obese minipigs.

Objective:Obesity has reached epidemic proportions and is a strong risk factor for obstructive sleep apnea (OSA). However, the underlying mechanisms are poorly understood and current treatment strategies for OSA and obesity have critical limitations. Thus, establishment of an obesity-related large animal model with spontaneous OSA is imperative.Materials and methods:Natural and sedated sleep were monitored and characterized in 4 obese (body mass index - BMI>48) and 3 non-obese (BMI<40) minipigs. These minipigs were instrumented with the BioRadio system under sedation for the wireless recording of respiratory airflow, snoring, abdominal and chest respiratory movements, electroencephalogram, electrooclulogram, electromyogram, and oxygen saturation. After instrumentation, the minipigs were placed in a dark room with a remote night-vision camera for monitoring all behaviors. Wakefulness and different sleep stages were classified, and episodes of apneas and/or hypopneas were identified during natural and/or sedated sleep.Results:No hypopnea episodes were observed in two of the non-obese minipigs, but one non-obese minipig had 5 hypopnea events. Heavy snoring and 27-58 apnea and/or hypopnea episodes were identified in all 4 obese minipigs. Most of these episodes occurred in the rapid eye movement stage during natural sleep and/or sedated sleep in Yucatan minipigs.Conclusions:Obese minipigs can experience naturally occurring OSA, thus are an ideal large animal model for obese-related OSA studies.

Risk factors for obstructive sleep apnea in socio-demographic groups of the population of Chuvashia

To study risk factors (RF) of obstructive sleep apnea syndrome (OSAS) in the socio-demographic groups of the population of Chuvashia. An anonymous survey included 2161 residents of Chuvashia (1007 men, 1154 women), aged from 18 to 70 years, average 36.5±13.8 years). Of all included people, 1547 (71.6%) lived in urban settlements, 614 (28.4%) in rural settlements. Exclusion criteria were those under the age of 18 and over 70. Body mass index (BMI) of more than 35 kg/m2, neck circumference of more than 43 cm for men or more than 37 cm for women, snoring, fatigue/drowsiness during the day, respiratory arrest in sleep and high blood pressure (BP) were considered as SOAS RF. The likelihood of OSAS was determined by the Lausanne NoSAS (Neck circumference, Obesity, Snoring, Age, Sex) test. RF OSAS were present in 63.4% of respondents. 2.4% of respondents had a BMI of more than 35 kg/m2, 162% had a large neck circumference. Snoring was detected in 24.4%, fatigue/drowsiness during the day in 42.2%, respiratory arrest in sleep in 8.1%, increased BP in 19.7%. In men, compared with women, the number of respondents with a high BMI, snoring, and respiratory failure in a dream was significantly larger; women with a large neck size and complaints of fatigue/drowsiness prevailed. The rural residents had more RF OSAS, including higher BMI, large neck circumference and snoring. The probability of OSAS according to the NoSAS score was 13.65%, including 21.35% of men and 6.93% of women, 11.38% of urban- and 19.38% of rural residents. Multivariate regression analysis showed that the OSAS prediction model included gender, age, BMI, the RF sum of four questions from the questionnaire, neck circumference and level of education with a probability of 99.99%. RF OSAS are widespread in the population of Chuvashia, which requires intensification of preventive measures to minimize them and the development of somnological service in the Republic.

Structural risk factors for obstructive sleep apnea at different levels of obesity

Structural risk factors for obstructive sleep apnea at different levels of obesity

Clinical risk factors for obstructive sleep apnea in a Korean sleep clinic

Clinical risk factors for obstructive sleep apnea in a Korean sleep clinic

Position of Hyoid Bone Between Snorers with Obstructive Sleep Apnea and Snorers without Obstructive Sleep Apnea―A Cephalometric Study

Obstructive sleep apnea is brought about by intermittent upper aviation route deterrent during sleep and it presents as loud snoring, blood vessel oxygen desaturation, sleep fragmentation, and over the top daytime sleepiness. The lateral cephalogram is a routine diagnostic aid in orthodontics. It has been used extensively in the fields of orthodontics and anthropology to record craniofacial form. Recently, it has also suggested that cephalometry could be an adjunctive procedure for assessing craniofacial patterns associated with obstructive sleep apnea. This study was attempted to look at the craniofacial structures of Obstructive sleep apnea patients with those of basic snorers utilizing parallel cephalometric radiographs and to decide the hazard factors for Obstructive sleep apnea in a Dravidian population.

GCH1 (rs841) polymorphism in the nitric oxide-forming pathway has protective effects on obstructive sleep apnea

Several studies have recently investigated the contribution of genetic factors in obstructive sleep apnea (OSA). Patients with OSA suffer from a reduction in nitric oxide (NO) serum level. This study investigated rs841, A930G p22phox, and rs1799983 polymorphisms in three critical genes involved in NO formation. A total of 94 patients with OSA and 100 healthy controls were enrolled into the study. Results showed there was no association between rs841, A930G p22phox and rs1799983 polymorphism and the risk of OSA (P = 0.51, P = 0.4 and P = 0.33, respectively). Moreover, rs841 GA genotype had a reverse relationship with the severity of OSA (P = 0.005). On the other hand, rs841 GA and A930G p22phox AA genotypes had a protective effect on daytime sleepiness in OSA patients (P = 0.01and P = 0.02, respectively). Additionally, the combination of rs841 and A930G p22phox (AG/AG and AG/AA) genotypes was significantly associated with a reduction in daytime sleepiness in OSA patients (P = 0.03 and P = 0.03, respectively). According to the results of our study, GA genotype of rs841 and GA/AA genotypes of A930G p22phox polymorphisms significantly reduced the severity of the problem and daytime sleepiness in OSA patients.

Obesity is not an independent risk factors of obstructive sleep apnea in asian hypertensive patients

Obesity is not an independent risk factors of obstructive sleep apnea in asian hypertensive patients

Prevalence and related risk factors of obstructive sleep apnea in postmenopausal women

Prevalence and related risk factors of obstructive sleep apnea in postmenopausal women

Risk Factors of Obstructive Sleep Apnea among Individuals with Moderate to Severe Traumatic Brain Injury

Risk Factors of Obstructive Sleep Apnea among Individuals with Moderate to Severe Traumatic Brain Injury

Evolution and Predictive Factors of Improvement of Obstructive Sleep Apnea in an Obese Population After Bariatric Surgery.

Our objectives were to determine in an obese population (body mass index > 35 kg/m²) the number of patients, after gastric bypass (GBP), who no longer met French Ministry of Health criteria for utilizing positive airway pressure (PAP), and the predictive factors of obstructive sleep apnea (OSA) improvement. Between June 2012 and August 2014 we diagnosed OSA in 129 incident patients requiring PAP therapy before GBP. A postoperative sleep recording was undertaken for 44 of these patients after a weight loss of at least 10%. Most of the patients showed severe OSA with a mean [standard deviation] apnea-hypopnea index (AHI) of 52.8 [23.8] events/h. The body mass index was 46.1 [5.1] kg/m². All the patients were treated via PAP and most of them via auto-titrating PAP with a range of 4-16 cmH₂O. Following the GBP, in 31 patients (70.5%) OSA was improved, allowing PAP to be stopped (AHI < 15 events/h). The Epworth Sleepiness Scale score, the modified Medical Research Council dyspnea scale, the loudness of snoring, and sleep structure were improved. AHI was decreased by a mean of 40.9 [22.4] events/h (P < .001). In a multivariate logistic regression model, age (P = .018) and sleep oxygen desaturation index (P = .049) appeared to predict improvement of OSA. After GBP, 70.5% of the patients no longer met French Ministry of Health criteria for utilizing PAP, allowing discontinuation of this treatment. At diagnosis, a younger age and a less severe sleep oxygen desaturation were predictive factors of this improvement.

The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study

IntroductionObstructive sleep apnea is the most common type of sleep apnea, which is caused by complete or partial obstructions of the upper airway. Nasal obstruction is also considered as one of the independent risk factors of obstructive sleep apnea. ObjectivePatients with obstructive sleep apnea. MethodsWe enrolled patients with obstructive sleep apnea from June to December 2015 and treated them with intranasal corticosteroid spray for four weeks. Several parameters were obtained before and after the treatment, including Nasal Obstruction Symptom Evaluation scores, Pittsburgh Sleep Quality Index questionnaire and Epworth Sleepiness Scale questionnaire. ResultsFifty patients completed questionnaires prior to and following the intranasal fluticasone treatments. The average age was 39.7 ± 15.6 y, with a male to female ratio of 3:2. The post-treatment Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Nasal Obstruction Symptom Evaluation scores all indicated a decrease compared to pre-treatment scores, from 10.4 to 8.74, 7.86 to 6.66 and 9.08 to 6.48, respectively. A significant decrease was observed in the Nasal Obstruction Symptom Evaluation ≥10 group in all three categories, but not in the Nasal Obstruction Symptom Evaluation <10 group. ConclusionsIntranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction.

The Effect of Acupressure Therapy in Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a respiratory disorder during sleep with characteristics of temporary breathing cessation and upper airway obstruction that recurred partially or completely. Obesity has been recorded as one important risk factor in OSA. The purpose of this research was to assess the effect of acupressure therapy in OSA. This is a quasi-experimental study with pre-test and post-test one group design. Respondents were 18 high school students with BMI &gt; 25 kg/m2. OSA was assesed using Epworth Sleepiness Scale. Acupressure therapy was done at 10 acupoints for 10 consecutive days. Data was analyzed using dependent t test. The results showed Epworth Sleepiness Scale score decreased significantly after acupressure therapy procedure (6.78 vs 5.28; p value 0.004). Conclusion, acupressure therapy can reduce the severity of OSA.&#x0D; &#x0D; Keywords: acupressure, obesity, obstructive sleep apnea

Clinical Features and Contributing Factors of Excessive Daytime Sleepiness in Chinese Obstructive Sleep Apnea Patients: The Role of Comorbid Symptoms and Polysomnographic Variables.

Background The occurrence and severity of excessive daytime sleepiness (EDS) vary considerably among obstructive sleep apnea (OSA) patients. This study was designed to investigate the characteristics of EDS and identify its contributing factors in OSA patients. Methods This was a cross-sectional study from a tertiary medical center in China. A total of 874 consecutive patients with newly diagnosed OSA were included. Subjective daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The subjects were assigned to the non-EDS group (582 patients), mild to moderate EDS group (227 patients), and severe EDS group (65 patients) according to the ESS scores. The clinical features and polysomnographic parameters were acquired and analyzed to identify the differences between groups and the determinants of EDS. Results The age of patients with severe EDS (49.5 ± 11.3) was slightly greater than that of patients with mild to moderate EDS (44.5 ± 10.2) (p < 0.05) and non-EDS patients (45.2 ± 12.0) (p < 0.05). Body mass index (BMI) was highest in the severe EDS group (29.1 ± 3.6 kg/m2) (p < 0.0001), intermediate in the mild to moderate EDS group (27.9 ± 3.3 kg/m2), and lower in the non-EDS group (26.8 ± 3.3 kg/m2). Logistic regression analysis showed waist circumference, memory loss, work/commute disturbances, and sleep efficiency were independently associated with mild to moderate EDS, and the microarousal index, apnea-hypopnea index (AHI), and saturation impair time below 90% were independent contributing factors of mild to moderate EDS. Meanwhile, age, neck circumference, gasping/choking, memory loss, work/commute disturbances, and sleep latency were independently associated with severe EDS, and the AHI and mean SpO2 were independent contributing factors of severe EDS. Conclusions OSA patients with various severities of EDS are more obese and have more comorbid symptoms compared to patients without EDS. Sleep fragmentation, respiratory events, and nocturnal hypoxia may be predictors of EDS. Comprehensive consideration of demographic, clinical, and polysomnographic factors is required when evaluating OSA patients.

Accuracy of global and/or regional anthropometric measurements of adiposity in screening sleep apnea: the ELSA-Brasil cohort

ObjectiveAdiposity is a well-established risk factor for obstructive sleep apnea (OSA) but the existence of a preferable anthropometric measurement is not established or whether the combination of measurements may improve the accuracy to detect OSA. This study aimed to compare the accuracies of body mass index (BMI), several surrogate markers of body fat (in isolation or combined) and validated questionnaires for screening OSA. MethodsA total of 2059 participants from the ELSA-Brasil study given anthropometric measurements using standard procedures and a home sleep study. OSA was defined by an apnea-hypopnea index ≥15 events/hour. ResultsThe frequency of OSA was 32.3%. Compared with the non-OSA group, all anthropometric measurements were higher in the OSA group. Age and gender-adjusted BMI afforded the highest accuracy to detect OSA [AUC = 0.760 (0.739–0.781)], followed by waist [AUC = 0.753 (0.732–0.775)] and neck [AUC = 0.733 (0.711–0.755)] circumferences, waist-to-hip ratio [AUC = 0.722 (0.699–0.745)] and body shape index [AUC = 0.680 (0.656–0.704)]. The combination of two or more anthropometric measurements did not improve the accuracy of BMI in predicting OSA. The adjusted BMI had similar predictive performance to the NoSAS score [AUC = 0.748 (0.727–0.770)] but a better accuracy than the Berlin Questionnaire [AUC = 0.676 (0.653–0.699)]. ConclusionsDespite one's intuition, surrogate markers of regional adiposity are not better than BMI in screening OSA. Combining measurements of global and/or regional adiposity did not have additional value in detecting OSA. The merely fair accuracy range of BMI and sleep questionnaires underscore the need for additional tools to improve OSA underdiagnosis.

P48-S Obstructive sleep apnea in Myasthenia gravis patients

Background Myasthenia gravis (MG) is autoimmune diseases that manifest clinical symptoms including diurnal fatigability, ptosis, diplopia, dysarthria and rarely respiratory failure. Few studies have demonstrated a high prevalence of obstructive sleep apnea (OSA) in MG. The aim of this study was to elucidate the clinical and polysomnographic difference between clinically stable Korean MG patients with and without OSA. Objectives and methods Total of eighteen stable MG patients were enrolled. The clinical parameters including sex, age, duration of the disease, prescribed medication status, thymectomy status and antibody status were obtained. The overnight polysomnography (PSG) was performed in all patients. Results We compared MG patients with and without OSA in relation to the baseline characteristics and overnight PSG parameters. Among the clinical parameters, male sex and body mass index showed a statistically significant difference between the two groups. The PSG showed eleven times higher apnea-hyponea index (AHI) in MG with OSA. AHI was further analyzed with supine and non-supine position and 70% of the MG with OSA manifested supine OSA. Conclusions This study demonstrated male sex and body mass index as significant clinical risk factors of OSA in MG and PSG data showed a high prevalence of supine dominant OSA.

Impact of obstructive sleep apnea on cerebral blood flow

Aim: Obstructive sleep apnea (OSA) is a common disorder with growing incidence. Major risk factors for OSA are obesity, aging, gender and menopause. As life expectancy lengthens and the obesity epidemic is ongoing, we can assume that OSA will affect an increasing part of the population. Pathological consequences of this disease include an increased risk of arterial hypertension, coronary artery disease, arrhythmia, heart failure as well as cerebrovascular diseases, such as stroke, transient ischemic attack and cognitive dysfunction. The cerebrovascular system differs significantly from other vessels in the body. Brain oxygen demands constitute about 20% of the total oxygen consumed by the body. Conclusions: OSA significantly affects the cerebral blood flow both during sleep and daily activities. This can have serious health consequences and makes the brain more vulnerable to ischemia. In this review we describe the impact of OSA on cerebral circulation during both sleep and wakefulness and we also outline the pathophysiology of these changes. Results: In patients with other risk factors for cerebral ischemia, early screening and treatment for OSA should be introduced.

Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts.

Central obesity is the main risk factor for obstructive sleep apnea (OSA). Whether there exists a central-obesity anthropometric that better explains apnea-hypopnea index (AHI) variability in the general population and in sleep cohorts is unknown, and this is even less explored among increasing grades of obesity. The objective of the study is to investigate whether there is an anthropometric that better explains AHI variability in a sample of morbidly obese women awaiting bariatric surgery (BS). A prospective multicentre cross-sectional study was conducted in consecutive women before BS. Demographic and anthropometric characteristics included age, body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR). OSA was diagnosed by polysomnography. The capacity of anthropometrics to explain AHI variance was investigated using regression linear models. A total of 115 women were evaluated: age, 44±10years; BMI, 46±5kg/m2 ; AHI, 35±26 events/hr. AHI was associated with all anthropometrics except weight, height and HC. The best univariate predictor was WHR, which accounted for 15% of AHI variance. The simplest model (age+BMI) accounted for 9%, which increased to 20% when applying more complex measurements (age+BMI+NC+WC+HC). The explanatory capacity did not change significantly when applying a simpler model (age+WHR+NC, 19%). In this female morbidly obese cohort, anthropometrics explained one-fifth of AHI variability. WHR is the best univariate parameter and models including waist and neck data provide more information than BMI when explaining AHI variability. Thus, even in young women with extreme obesity, OSA seems to be linked to a specific central-obesity phenotype rather than to a whole-obesity pattern.

Obstructive sleep apnea phenotypes in men based on characteristics of respiratory events during polysomnography.

The upper airway (UA) anatomical collapsibility, UA muscle responsiveness, breathing control, and/or arousability are important contributing factors for obstructive sleep apnea (OSA). Differences in clinical manifestations of OSA are believed to reflect interactions among these factors. We aimed to classify OSA patients into subgroups based on polysomnographic (PSG) variables using cluster analysis and assess each subgroup's characteristics. Men with moderate or severe OSA and without any concomitant heart or psychosomatic disease were recruited. A hierarchical cluster analysis was performed using variables including fraction of apnea, respiratory event duration, minimum oxygen saturation, arousal rate before termination, and frequency of respiratory events in the supine position. The impact of sleep stages or body position on PSG variables was also evaluated in each cluster. A total of 210 men (mean age, 50.0years, mean body mass index, 27.4kg/m2) were studied. The three subgroups that emerged from the analysis were defined as follows: cluster 1 (high fraction of apnea and severe desaturation (20%)), cluster 2 (high fraction of apnea and long event duration (31%)), and cluster 3 (low fraction of apnea (49%)). There were differences in the body mass index and apnea type between the three clusters. Sleep stages and/or body position affected PSG variables in each cluster. Patients with OSA could be divided into three distinct subgroups based on PSG variables. This clustering may be used for assessing the pathophysiology of OSA to tailor individual treatment other than continuous positive airway pressure therapy.

Evaluation of obstructive sleep apnea in metabolic syndrome.

Background:Metabolic syndrome has become one of the most important public health problems with a growing prevalence in both developed and developing countries. Obesity is a major risk factor for obstructive sleep apnea (OSA), which is associated with significant cardiorespiratory morbidity.Aims:The aims of this study were to find out the prevalence of OSA in patients with metabolic syndrome and to highlight the importance of assessment of OSA in these patients.Methods:This cross-sectional analytical study was conducted on 100 subjects aged 30–60 years, comprising 50 cases of metabolic syndrome and 50 controls without metabolic syndrome. Overnight polysomnography was done in all the subjects. Prevalence and severity of OSA were assessed and compared between the two groups.Results:Prevalence of OSA was significantly higher (66%) in patients with metabolic syndrome than in subjects without metabolic syndrome (12%). Out of 33 (66%) OSA patients with metabolic syndrome, 8 (16%) had mild OSA, 11 (22%) had moderate OSA, and 14 (28%) had severe OSA. Increasing severity of OSA was associated with higher mean levels of all the metabolic syndrome parameters except serum high density lipoprotein (HDL).Conclusions:OSA is highly prevalent in patients with metabolic syndrome. Also, the increasing severity of OSA is associated with poorer control of diabetes, hypertension, and dyslipidemia, which are all components of metabolic syndrome. Therefore, effective treatment of metabolic syndrome can prevent and control OSA in these patients. Similarly, reducing the severity of OSA (by early diagnosis and treatment) in patients with metabolic syndrome might help to optimize control of blood sugar, blood pressure, and serum lipids, thereby reducing the risk of cardiovascular disease. Therefore, the need for screening metabolic syndrome patients for OSA has been reinforced by this study.

Effect of weight reduction and exercise program on patients with obstructive sleep apnea

Background Obesity is the most important risk factor for obstructive sleep apnea (OSA). Aim The aim of the study was to evaluate the effectiveness of weight reduction and exercise program on patients with OSA at a university hospitals in Egypt. Subjects and methods Research design: A quasi experimental one group pre/post test design was utilized to achieve the aim of the study. Subjects A purposive sample included 30 patients with a confirmed diagnosis of OSA were recruited in this study. The program implemented through 10 months. Tools of data collection Five tools of data collection were used: (1) A structured interview questionnaire. (2) Berlin questionnaire. (3) Epworth sleepiness scale. (4) Questionnaire of sleep apnea, and (5) Questionnaire to assess sleep disturbance symptoms associated with obesity Results There was a significant reduction in weight through decreasing in BMI, neck circumference, and waist circumference with mean±SD 103.87±21.11, 35.27±7.66, 36.67±4.85, 112.83±16.51 respectively after intervention of program that reflected then on decreasing sleep disturbance symptoms associated with obesity. The sleep efficiency increased after intervention of program with mean±SD 88.32±8.50 through increasing in Base SPO2% (oxygen saturation during daytime) and mini SPO2% and reduction in sum of desaturation (difference between sleep and awake), snoring index, AHI (apnea-hypopnea index). In addition, there was a reduction in daytime and nocturnal symptoms of sleep disorder breathing after intervention of program. Conclusion Hence, it can be concluded that the application of a balanced and low calorie dietary intake and regular exercise training for upper airway was effective on improving severity of OSA.