Median Apnea-hypopnea Index Research Articles

Randomised, controlled crossover trial of intermittent and continuous transcutaneous electrical stimulation of the genioglossus muscle for obstructive sleep apnoea

PurposeContinuous transcutaneous electrical stimulation (CTES) of the genioglossus muscle may benefit patients with obstructive sleep apnoea (OSA). However, the therapeutic value of intermittent transcutaneous electrical stimulation (ITES) for OSA is...

Long-term outcomes regarding arterial stiffness and carotid artery atherosclerosis in female patients with rapid eye movement obstructive sleep apnea.

ObjectiveRapid eye movement (REM) obstructive sleep apnea (OSA) is associated with the risk of cardiovascular events. Arterial stiffness and carotid artery intima-media thickness (IMT) predict these events, but few relevant studies have been conducted. We compared long-term changes in arterial stiffness and IMT between patients with REM OSA and non-REM (NREM) OSA receiving continuous positive airway pressure (CPAP) or oral appliance (OA) therapy.MethodsNewly diagnosed female patients with OSA received CPAP (n = 6) or OA (n = 7). Pulse wave velocity (PWV) and carotid artery ultrasound were performed before and 60 months after treatment.ResultsThere were no differences in baseline characteristics (mean age: 56.0 vs. 61.3 years; mean body mass index: 22.6 vs. 21.7 kg/m2) between the REM OSA and non-REM OSA groups. The median apnea-hypopnea index was lower in the REM OSA group than in the non-REM OSA group. Increased PWV (12.92 ± 1.64 to 14.56 ± 2.73 m/s) and deteriorated glucose metabolism were observed in the REM OSA group after treatment. PWV, IMT, and cardiovascular risk factors were unaffected in the non-REM OSA group.ConclusionArterial stiffness and glucose metabolism are deteriorated in patients with REM OSA compared with these parameters in patients with non-REM OSA after CPAP or OA treatment.

An interim oral appliance as a screening tool during drug-induced sleep endoscopy to predict treatment success with a mandibular advancement device for obstructive sleep apnea.

PurposePrevious studies have shown a wide range of efficacy (29 to 71%) of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). Currently, the ability to preselect suitable patients for MAD therapy based on individual characteristics related to upper airway collapsibility is limited. We investigated if the use of non-custom interim MAD during drug-induced sleep endoscopy (DISE) could be a valuable screening tool to predict MAD treatment outcome.MethodsIn a single-center prospective study including a consecutive series of patients with OSA, we compared DISE outcomes with a MAD in situ with polysomnography results after 3 months of using the same MAD that was used during DISE.ResultsOf 41 patients who completed the study, the median apnea–hypopnea index (AHI) was 16.0 events/h [IQR 7.4–23.4]. Respiratory outcomes on polysomnography, including apnea index (AI), total AHI, AHI in supine position, and oxygen desaturation index, all significantly improved after 3 months of MAD treatment. With complete improvement of the upper airway obstruction with the MAD in situ during DISE in supine position, patients were 6.3 times more likely to be a responder to MAD treatment compared to patients with a persisting complete obstruction, although not statistically significant (OR 6.3; 95%CI 0.9–42.7; p = 0.060).ConclusionThe potential predictive value with regard to MAD therapy outcomes of the use of an interim MAD during DISE would be an important finding, since the prediction of MAD therapy outcome is of great clinical and scientific interest. A study with a larger cohort should be performed to further investigate our findings.

Comparison of obstructive sleep apnoea prevalence and severity across WHO pulmonary hypertension groups

IntroductionPulmonary hypertension is classified into five groups in the WHO classification system. Patients with pulmonary hypertension often have comorbid obstructive sleep apnoea (OSA), yet the prevalence and severity of OSA...

Upper Airway Stimulation in Patients with Obstructive Sleep Apnea: Long-Term Surgical Success, Respiratory Outcomes, and Patient Experience.

Introduction Upper airway stimulation (UAS) with electric activation of the hypoglossal nerve has emerged as a promising treatment for patients with moderate-to-severe obstructive sleep apnea. Objective To retrospectively analyze objective and subjective outcome measures after long-term follow-up in obstructive sleep apnea patients receiving upper airway stimulation. Methods An observational retrospective single-center cohort study including a consecutive series of patients diagnosed with obstructive sleep apnea receiving upper airway stimulation. Results Twenty-five patients were included. The total median apnea-hypopnea index (AHI) significantly decreased from 37.4 to 8.7 events per hour at the 12-month follow-up ( p < 0.001). The surgical success rate was 96%. Adverse events were reported by 28% of the patients. Conclusion Upper airway stimulation is an effective and safe treatment for obstructive sleep apnea in patients with continuous positive airway pressure (CPAP) failure or intolerance. However, it is possible that the existing in and exclusion criteria for UAS therapy in the Netherlands have positively influenced our results.

Use of the Complete Airway Repositioning and Expansion (CARE) approach in 220 patients with Obstructive Sleep Apnea (OSA): A retrospective cohort study

Objective/BackgroundObstructive sleep apnea (OSA) is a prevalent disease with significant health repercussions. While many effective OSA treatment modalities exist, Complete Airway Repositioning and Expansion (CARE) represents an emerging approach that leverages gradual airway expansion, with or without mandibular advancement. We conducted a retrospective study of patients who underwent CARE with a dental provider and examined how their sleep study data changed, with a focus on apnea hypopnea index (AHI). Patients/MethodsA retrospective database of 220 adult patients was examined. Demographic data and radiographic and sleep study data were compared in patients before and following at least 6 months of treatment with one of two possible dental devices. ResultsThe median age of patients in this cohort was 50 years, and evenly split by gender. The median decrease in AHI was 49.0%, with a median pre-treatment AHI of 17.3 and median post-treatment AHI of 9.6 (p<0.001). Most participants (63.6%) demonstrated an improvement in their OSA severity class. Fifty-seven (25.9%) participants had complete resolution of their OSA. Post-treatment, 151 (68.6%) of patients had OSA severities of none or mild. Thirty-four (15.5%) of patients had in increase in AHI and 13 (6.0%) of these patients demonstrated an increase in OSA classification. One patient experienced an adverse event in the form of a loose molar tooth requiring repair. Overall findings were limited by missingness of BMI and clinical co-morbidity data, as well as quality of life measures. ConclusionsIn this large, but data limited retrospective series, CARE seems to be an effective and safe approach to OSA management that may be a useful alternative to current mainstays of OSA management. Further investigation is warranted.

0567 When Loud Sleep Aids a Silent Killer: A Prevalence Study on Obstructive Sleep Apnoea in Type-2 Diabetics from a Tertiary Care Hospital in Western India

Abstract Introduction Type-2 diabetes mellitus is a highly prevalent multisystemic disorder having bidirectional association with Obstructive sleep apnoea. These disorders, when present as co-morbidities, can lead to life-threatening cardiovascular complications. The current prevalence of Obstructive sleep apnoea in Type-2 diabetics is largely unknown, especially in developing nations like India. This study was aimed at determining its prevalence and other risk factors in Type-2 diabetics visiting a tertiary-care hospital in Western India. Methods Adult patients with Type 2 diabetes mellitus visiting the Departments of Pulmonary medicine and Non-communicable diseases on an out-patient basis at a tertiary-care hospital were recruited for the study. Those with unstable medical illnesses or other forms of diabetes were excluded. Participants were interviewed and examined based on a case-study form, including Epworth Sleepiness Scale, STOP-BANG and OSA-50 questionnaires, followed by a Home Sleep Apnoea Test. Apnoea-Hypopnoea Index(AHI) was used to evaluate for Obstructive sleep apnoea. Results A sample of 62 diabetics (median age: 61(16) years; 34 males; 28 females) was analysed. Obstructive sleep apnoea(Apnea-Hypopnea Index [AHI] ≥ 5.0/h) was diagnosed in 55 subjects(88.7%, median AHI – 20.95/h). 62.9% had moderate-to severe Obstructive sleep apnoea(OSA)(AHI ≥ 15/h), 21% had positional OSA and 48.4% had OSA syndrome(OSAS). AHI had significant positive correlation with waist circumference(rho- 0.318, p- 0.012), neck circumference(rho-0.363, p-0.004), Modified Mallampati score(rho-0.372, p-0.003) and Epworth Sleepiness Scale(rho-0.403, p-0.001). No significant association of glycaemic control, duration of Type-2 diabetes and Random Blood Sugar level with AHI was identified. Sensitivity and specificity of STOP-BANG questionnaire for diagnosing OSA was 69.1% and 71.4% and that of OSA-50 questionnaire was 94.5% and 14.3%, respectively. Conclusion Obstructive sleep apnoea(OSA) is more prevalent in adult population with Type-2 diabetes mellitus(T2DM) than in the general population. A high index of suspicion for OSA in patients with T2DM is warranted, because they may not have overt daytime sleepiness or presence of high-risk predictors. Waist and neck circumferences are better predictors of OSA syndrome than body mass index(BMI). Home Sleep Apnoea Test is a more reliable test for OSA detection compared to screening questionnaires and hence can be a useful tool for diagnosis and management planning of OSA in high-burden, low-resource settings. Support (If Any)

0702 Real World Characteristics of Central Sleep Apnea: Experience at One Academic Medical Center

Abstract Introduction Despite growing recognition of sleep disordered breathing, the prevalence and clinical characteristics of central sleep apnea (CSA) in real-world sleep referral populations remain poorly understood. We used historical data from the University of Pittsburgh Medical Center (UPMC) to assess the differences in patients with CSA compared to obstructive sleep apnea (OSA). Methods We retrospectively reviewed the medical records of 29,803 patients who underwent in-lab diagnostic polysomnography at six UPMC sleep labs between 2004 and 2018. Baseline clinical characteristics and polysomnography results including apnea hypopnea index (AHI), central apnea index (CAI), and obstructive apnea index (OAI) were extracted from the electronic health record. Among those with AHI≥5, patients were categorized as CSA if CAI≥5 and CAI&amp;gt;OAI or OSA if OAI≥5 and OAI&amp;gt;CAI. Results CSA and OSA were identified in 2% (583/29,803) and 34% (10,090/29,803) of patients, respectively, while 32% had AHI≥5 but didn’t meet either CSA or OSA criteria (CAI and OAI&amp;lt;5 or CAI=OAI) and the remaining 32% had AHI&amp;lt;5. Median AHI was 41 events/hr for CSA vs. 36 events/hr for OSA (p&amp;lt;0.01). The median percentage of apneas being central was 78% for CSA vs. 0% for OSA (p&amp;lt;0.01). Compared to patients with OSA, those with CSA were more likely to be male (78% vs. 66%), older (58 vs. 54 yrs), have lower body mass index (32 vs. 35 kg/m2), have heart failure (23% vs. 13%), atrial fibrillation (19% vs. 8%), stroke (5% vs. 2%), myocardial infarction (7% vs. 2%), diabetes (27% vs. 22%) and have received a prescription for methadone (1.5% vs. 0.3%) [all p&amp;lt;0.01]. In multivariable logistic regression, all factors except stroke remained independently associated with CSA. The strongest predictors of CSA (compared to OSA) were methadone prescription (adjusted odds ratio=4.9, 95% CI [2.3-10.6]) and myocardial infarction (1.9, [1.3-2.8]). In contrast, the prevalence of CSA and OSA were similar across races. Conclusion CSA was identified in 2% of patients undergoing polysomnography in everyday clinical practice and independently associated with a variety of clinical characteristics. Recognition of characteristics associated with CSA can lead to more targeted screening and treatment in a broader population beyond just heart failure patients. Support (If Any) ZOLL Respicardia, Inc.

0765 Enhanced Response to Targeted Hypoglossal Nerve Stimulation in Patients with Normal Sleep Efficiency: A THN3 Post-Hoc Analysis

Abstract Introduction THN3 was the first reported parallel-arm, randomized controlled trial of hypoglossal nerve stimulation (HGNS), wherein targeted HGNS (THN) was shown to be safe and efficacious at ameliorating sleep disordered breathing in selected patients with moderate to severe OSA and BMI≤35kg/m2 without screening with drug-induced sleep endoscopy. A secondary THN3 objective was to identify baseline characteristics which enhance therapeutic response. Methods Predictors of long-term (Month 12/15) apnea-hypopnea index (AHI) response (reduction ≥50% to ≤20/hr) were identified in stages. Baseline characteristics, including polysomnography parameters, were screened one at a time using univariate logistic regression. Variables significant at α=0.25 were further selected using stepwise multivariate logistic regression. Candidate predictors were then optimized by manual, incremental threshold adjustment to maximize AHI response rate (RR). Optimized predictors were ranked according to the AHI RR and size of the corresponding subpopulation, with a goal of capturing at least 40% of the overall THN3 cohort. Results Baseline sleep efficiency (SE) in the normal range (&amp;gt;85%) achieved the highest AHI RR while retaining 42% (58/138) of the THN3 cohort. Similar to the overall study population, subgroup subjects were predominantly middle-aged (age 54±7 years), male (83%), Caucasian (86%) and overweight/obese (BMI 30±3 kg/m2). Short-term (Month 4) AHI RRs in the Treatment and Control groups were 59.5% and 20.0%, respectively, with long-term AHI RR at 50.9%. Median AHI was reduced from 35.1 to 16.0, as compared to 29.3 to 9.0 in the STAR trial of distal HGNS. ODI RRs (reduction ≥25%) for Treatment and Control were respectively 73.0% and 30.0% at Month 4 and 64.9% at Month12/15. Enhanced response carried through to larger point estimates for improvement in secondary variables, including the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire, exceeding minimum clinically important differences thresholds of 2-3 and 1.7-2.0, respectively. Conclusion Normal SE at Baseline was associated with enhanced AHI and ODI RR as well as patient-reported outcome measures for patients receiving THN therapy, providing results similar to those obtained with distal HGNS. Future studies, including the ongoing OSPREY trial, will be needed to prospectively validate these findings. Support (If Any) LivaNova

0716 Risk for Heart Failure with preserved Ejection Fraction in patients with or without Obstructive Sleep Apnea

Abstract Introduction Approximately two out of three patients with Heart Failure with preserved Ejection Fraction (HFpEF) have co-morbid sleep apnea, but the risk of HFpEF in patients who test positive for obstructive sleep apnea (OSA) is unknown. Methods Referred subjects (n=228) over the age of 18 underwent a diagnostic in-lab polysomnogram at the University of Michigan Sleep Laboratories between 1/8/2019-3/11/2020 and an echocardiogram within 12 months of their sleep study. Individuals with a known history of HFpEF were excluded (n=44). OSA was defined as an apnea-hypopnea-index (AHI) ≥ 5/hour. Clinical and echocardiogram variables were abstracted from the electronic medical record and used to determine H2FPEF scores (ordinal scale, range 0-9). The H2FPEF score is a validated predictor of HFpEF risk in patients with dyspnea. In the presence of dyspnea, a H2FPEF score ≥ 3 indicates a &amp;gt;50% risk of HFpEF, though dyspnea was not assessed in this study. HFpEF probability (continuous variable) was determined using the corresponding online calculator. Linear regression was used to predict HFpEF probability based on AHI. Results The 184 subjects without a known diagnosis of HFpEF had a median age of 65 years (interquartile range (IQR) 51, 71). Seventy subjects (38%) were male, 150 (82%) had OSA, and the median AHI was 15 (7, 35). The median H2FPEF score was 3 (2, 5). Among 34 participants without OSA, 10 (29%) had an H2FPEF score ≥ 3, whereas among 150 participants with OSA, 59 (39%) had an H2FPEF score ≥ 3. Linear regression indicated that higher AHI is associated with a higher probability of HFpEF (β = 0.39, p=0.0001). Conclusion Many patients referred for polysomnography may be at high risk for HFpEF. Sleep-study-referred subjects without clinically-indicated echocardiograms were not assessed, but patients at sleep disorders centers who test positive for OSA may have a particularly high rate of undiagnosed HFpEF. Sleep physicians should consider a cardiology referral in appropriately screened patients. Support (If Any)

Sex-Specific Difference in the Effect of Altitude on Sleep and Nocturnal Breathing in Young Healthy Volunteers.

Importance: To date, there is no established evidence of sex-specific differences in altitude-induced sleep-disordered breathing (SDB) during polysomnography-confirmed sleep. Objective: The aim of this study was to investigate whether differences in sex play a pivotal role in incidences of SDB and acute mountain sickness (AMS) when staying overnight at high altitude. Design: This was a prospective cohort study. Setting: Participants underwent overnight polysomnography (PSG) and clinical assessment in a sleep laboratory at 500 m and two consecutive days at 3270 m. Participants: The participants comprised 28 (18 women) healthy, young, low-altitude residents with a median (interquartile range) age of 26.0 (25.0, 28.0) years. Exposures: Altitude exposure. Main outcomes and Measures: The primary outcome was altitude-induced change in the PSG-confirmed apnea–hypopnea index (AHI) at 3270 m compared to 500 m between men and women. Secondary outcomes included sex differences in other parameters related to SDB, sleep structure, AMS, psychomotor vigilance test reaction time and parameters from arterial and venous blood analyses. Results: The median (interquartile range) AHIs at 500 m and 3270 m on night 1 and on night 2 were 6.5/h (3.6, 9.1), 23.7/h (16.2, 42.5) and 15.2/h (11.8, 20.9) in men, respectively, and 2.2/h (1.0, 5.5), 8.0/h (5.3, 17.0) and 7.1/h (4.9, 11.5) in women, respectively (p < 0.05 nights 1 and 2 at 3270 m vs. 500 m in men and women). The median difference (95% CI) of altitude-induced change in AHI (3270 m night 1 compared to 500 m) between men and women was 11.2/h (1.9 to 19.6) (p < 0.05). Over the time course of 2 days at 3270 m, 9 out of 18 (50%) women and 1 out of 10 (10%) men developed AMS (p < 0.05 women versus men). Conclusions and Relevance: This prospective cohort study showed that men were more susceptible to altitude-induced SDB but that they had a lower AMS incidence when staying for 2 days at 3270 m than women. These findings indicate that sex-related prevention and intervention strategies against SDB and AMS are highly warranted. Trial Registration: This trial was registered at the Chinese Clinical Trial Registry; No. ChiCTR1800020155.

Feasibility of split night polysomnography in children to diagnose and treat sleep related breathing disorders

Study objectivesThe gold standard test for diagnosis of sleep related breathing disorders (SRBD) in children is diagnostic polysomnography (PSG). This is often followed by a titration PSG to identify optimal non-invasive ventilation (NIV) pressures. Access to pediatric PSG is limited, resulting in delays to diagnosis and initiation of treatment. Split-night PSGs (snPSG) combine a diagnostic and titration PSG into a single night study. Although described in adults, the pediatric literature on this topic is sparse. The objective of this study was to describe a large cohort of children who utilized snPSG to diagnose SRBD and initiate NIV. MethodsThis multi-center study analyzed clinical and PSG data from children with SRBD who had initiated NIV following a snPSG. Data from diagnostic and titration portions of the snPSG were analyzed separately. ResultsThe study included 165 children who initiated NIV following a snPSG. The majority of children (61.8%) were initiated on NIV for upper airway obstruction. The population included children with medical complexity, including those with central nervous system disorders (17.0%), musculoskeletal/neuromuscular disorders (12.1%), and cardiac disorders (1.2%). Moderate to severe SRBD was present in 87.2% of children with a median apnea-hypopnea index (AHI) of 16.6 events/hour (IQR: 8.2, 38.2). The median AHI was reduced on treatment to 7.6 events/hour (IQR: 3.3, 17.1), with fewer subjects meeting criteria for severe SRBD. ConclusionssnPSG is technically feasible in children, facilitating the diagnosis of SRBD and initiation of NIV, even in those with high medical complexity.

Equal effect of a noncustom vs a custom mandibular advancement device in treatment of obstructive sleep apnea.

Numerous types of mandibular advancement devices (MADs) are available to treat patients with obstructive sleep apnea, varying from noncustom to custom devices. Only a limited number of studies have been performed to determine whether a noncustom MAD could be used to predict treatment success of a custom MAD. In this study, we investigated the potential of a new-generation noncustom MAD, by comparing its effectiveness with a custom MAD. We hypothesized that the effectiveness of the devices is similar with regard to both objective (polysomnography) and self-reported (questionnaires, adherence, and patient satisfaction) outcomes. This was a single-center prospective randomized crossover study including a consecutive series of patients with obstructive sleep apnea. Patients were randomized to start either with the noncustom or custom MAD. Both MADs were applied for 12 weeks, followed by polysomnography with MAD in situ and questionnaires. After the first 12 weeks of follow-up, a washout period of 1 week was applied. Equal effectiveness was defined as no significant differences in both objective and self-reported outcomes between both devices. Fifty-eight patients were included; 40 completed the full follow-up. The median apnea-hypopnea index significantly decreased from 16.3 (7.7, 24.8) events/h to 10.7 (5.6, 16.6) events/h with the custom MAD (P = .010) and to 7.8 (2.9, 16.1) events/h with the noncustom MAD (P < .001). Self-reported outcomes significantly improved in both groups. No significant differences were found between both devices. The effectiveness of a noncustom and custom MAD is comparable, which suggests that a noncustom MAD can be used as a selection tool for MAD treatment eligibility to improve MAD treatment outcome. Registry: Netherlands Trial Register; Name: The Use of a Boil and Bite Mandibular Advancement Device vs a Custom Mandibular Advancement Device in Obstructive Sleep Apnea Management; URL: https://www.trialregister.nl/trial/7249; Identifier: NL64738.100.18. Bosschieter PFN, Uniken Venema JAM, Vonk PE, etal. Equal effect of a noncustom vs a custom mandibular advancement device in treatment of obstructive sleep apnea. J Clin Sleep Med. 2022;18(9):2155-2165.

Comparison of clinical, biochemical, and polysomnographic parameters between obese and nonobese obstructive sleep apnea.

Background:Obstructive sleep apnea (OSA) occurs in both obese and nonobese individuals. This study was designed to compare clinical, metabolic profile, and polysomnographic parameters among obese and nonobese OSA patients.Material and Methods:This cross-sectional retro-prospective study involved 148 OSA patients. OSA patients were classified as nonobese (body mass index [BMI] <27.5 kg/m2) and obese (BMI ≥27.5 kg/m2) to determine the influence of BMI on its risks, clinical, metabolic, and polysomnographic parameters. For statistical comparisons, continuous variables were analyzed by Student’s t-test and categorical variables by Chi-square.Results:Of 148 patients, 106 patients were of a retrospective group and 42 in the prospective group. 116 patients were obese and 32 were nonobese with a mean BMI of 33.66 ± 5.3 versus. 25.17 ± 2.2 kg/m2 respectively. Female sex (70.7% vs. 43.4%), larger neck circumference (37.99 ± 3.93 vs. 33.67 ± 5.5 cm), loud snoring (94.8% vs. 81.3%), excessive daytime sleepiness (53.4% vs. 9.4%), fatigability (94.8% vs. 75%), high Epworth Sleepiness Scale score (16% vs. 8%), and hypertension (77.6% vs. 46.9%) were significantly (P < 0.05) more common among obese OSA patients while as smoking and sedative use was more prevalent among nonobese OSA group. However, no significant difference in median apnea-hypopnea index and severity of OSA between obese and nonobese group was observed. At the same time, the median oxygen desaturation index was significantly higher in obese patients (26.1 vs. 12.7, P = 0.005).Conclusion:Nonobese OSA patients depicted less severe disease symptoms and thus require high index of suspicion for early identification due to associated cardiovascular risk.

Preoperative Assessment of Obstructive Sleep Apnea in Bariatric Patients Using Polysomnography or Polygraphy.

Preoperative assessment of obstructive sleep apnea (OSA) in patients scheduled for bariatric surgery can be performed by in-laboratory polysomnography (PSG) or by portable polygraphy (PP) at home. We aimed to evaluate the association between PSG/PP, OSA diagnosis, and implementation of continuous positive airway pressure (CPAP) therapy. All patients who underwent bariatric surgery from 2015 to 2017 were retrospectively reviewed. Patients underwent preoperative PSG or PP, based on prevailing protocols or at the physician's discretion. Logistic regression analyses were performed to determine predictors of CPAP implementation. OSA-related postoperative complications were analyzed in both groups. During the study period, 1464 patients were included. OSA was diagnosed in 79% of 271 patients undergoing PSG, compared to 64% of 1193 patients undergoing PP (p < 0.001), with median apnea-hypopnea index (AHI) of 15.8 and 7.7, respectively. CPAP treatment was initiated in 52% and 27% of patients, respectively, p < 0.001. Predictors (with adjusted odds ratio) in multivariate regression analysis for CPAP implementation were as follows: male gender (5.15), BMI ≥ 50 (3.85), PSG test (2.74), hypertension (2.38), and age ≥ 50 (1.87). OSA-related complications did not differ between groups (p = 0.277). Both PSG and PP are feasible options for preoperative OSA assessment in bariatric patients. When PP is performed, some underdiagnosis may occur as cases of mild OSA may be missed. However, clinically relevant OSA is detected by both diagnostic tools. No difference in OSA-related complications was found. PP is a safe, less invasive option and can be considered as a suitable measure for OSA assessment in this population.

Impact of undiagnosed obstructive sleep apnea on atrial fibrillation recurrence following catheter ablation (OSA-AF study).

BackgroundSleep-disordered breathing (SDB) may hamper the outcome of catheter ablation of atrial fibrillation (AF). However, SDB is underdiagnosed in clinical practice and the relevancy of undiagnosed SDB on the outcome of catheter ablation is unclear.ObjectiveTo evaluate if undiagnosed SDB has an impact on AF recurrence after catheter ablation.MethodsIn this single-center cohort study we enrolled patients who had a catheter ablation of AF 12 to 18 months prior to enrolment. Patients with diagnosed SDB at the time of catheter ablation were excluded. Enrolled patients underwent screening using WatchPAT (WP). SDB was defined as an apnea-hypopnea index (AHI) ≥ 15.ResultsA total of 164 patients were screened for eligibility. After exclusion of patients with previously diagnosed SDB (n = 30), 104 of 134 eligible patients were enrolled and underwent SDB screening. The median AHI was 11.5 (interquartile range 6.8–21.9) and 39 patients (38%) had SDB which was undiagnosed during the first year after ablation. AF recurrence in the first year after catheter ablation occurred in 40 patients (38%). The risk of AF recurrence was higher in the group with undiagnosed SDB in comparison to those without SDB (51% versus 31%, P = 0.04). Interestingly, the prevalence of AF recurrence was similar between patients with previously diagnosed and undiagnosed SDB (51% versus 50%, P = 0.92).ConclusionA significant proportion of patients undergoing catheter ablation of AF have undiagnosed SDB which is associated with a twofold higher risk of AF recurrence. SDB screening may improve patient counselling regarding the efficacy of catheter ablation.

Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea.

Rationale: Mouth breathing increases upper airway collapsibility, leading to decreased efficacy of obstructive sleep apnea (OSA) treatments. We hypothesized that the use of mandibular advancement devices (MAD) increases mouth breathing, and thus, using an adhesive mouthpiece (AMT) to prevent mouth breathing in combination with MAD can improve the treatment efficacy. Objectives: To evaluate the efficacy of MAD + AMT in comparison with MAD alone. Methods: A prospective crossover pilot study was designed to test this hypothesis. Briefly, adult participants with an apnea-hypopnea index (AHI) between 10 and 50 events/h at the screening visit were randomized to no treatment (baseline), MAD treatment, AMT treatment, and MAD + AMT treatment. As a primary analysis, absolute AHI was compared between MAD and MAD + AMT arms. Secondary analyses included quantifying the percent change in AHI, percentage of complete (AHI < 5 events/h) and incomplete (5-10 events/h) responders, and the efficacy of AMT alone in comparison with other treatment arms. Results: A total of 21 participants were included (baseline AHI = 24.3 ± 9.9 events/h). The median AHI (interquartile range) in the MAD and MAD + AMT arms were 10.5 (5.4-19.6) events/h and 5.6 (2.2-11.7) events/h (P = 0.02), respectively. A total of 76% of individuals achieved an AHI of <10 events/h in the MAD + AMT arm versus 43% in the MAD arm (P < 0.01). Finally, the observed effect was similar in moderate to severe OSA (AHI ⩾ 15 events/h) in terms of absolute reduction and treatment responders, and AMT alone did not significantly reduce the AHI compared with baseline. Conclusions: A combination of an adhesive mouthpiece and MAD is a more effective therapy than MAD alone. These findings may help improve clinical decision making in sleep apnea.

The effects of lateral pharyngoplasty on carotid intima-media thickness in patients with obstructive sleep apnoea.

IntroductionObstructive sleep apnea (OSA) is a known risk factor for development of carotid atherosclerosis. The treatment of OSA, through positive pressure devices or surgical procedures, may reduce the signs of subclinical atherosclerosis in apneic patients.ObjectiveThe decrease of carotid intima-media thickness (CIMT) after treatment of OSA remains a highly controversial issue. Our purpose is to compare CIMT, which represents an early sign of atherosclerosis, before and at least 6 months after lateral pharyngoplasty in patients with OSA.Material and MethodsA total of 17 patients with OSA who underwent lateral pharyngoplasty were submitted to common carotid Doppler ultrasonography, 24-hour ambulatory blood pressure monitoring and type-1 polysomnography before and at least 6 months after surgery.ResultsThe median apnoea-hypopnoea index decreased from 22.6 to 5.9 (p<0.001). There were significant improvements in the arousal index, minimum oxyhaemoglobin saturation, Epworth sleepiness scale and reported snoring intensity. The surgical success rate (Shers criteria) obtained with the procedure was 76.4%. There was no significant variation in the mean CIMT after surgeries (right carotid artery, mean, 0.67 and 0.72 mm; left carotid artery, mean, 0.69 and 0.70 mm, pre- and postoperative, respectively, both p>0.05). Blood pressure measurements also did not significantly change.ConclusionNotwithstanding a significant improvement in OSA after lateral pharyngoplasty, there was no significant reduction in CIMT in a follow-up of 6 months.

Association between sleep-disordered breathing and prostate cancer

BackgroundSleep-disordered breathing (SDB) has been associated with a greater aggressiveness of melanoma tumors, but the association with other cancers is unknown. This study investigates the relationship between the severity of SDB and the aggressiveness of prostate cancer (PC). Methods165 patients under 66 years consecutively diagnosed with PC in three University Hospitals underwent a home respiratory polygraphy. SDB severity was assessed by means of the apnea-hypopnea index (AHI) as well as several oximetric parameters. The primary marker of the aggressiveness of PC was the Gleason score, while secondary markers included the tumor stage and metastatic spreading. ResultsThe patients had a median (P 25–75) age of 60 (56–63) years, AHI of 13.3 (5.7–25.8), and 4% oxygen desaturation index of 8.7 (2.9–17.8). The prevalence of an AHI≥5 and AHI≥15 was 78.2% and 46.7%, respectively.The median AHI was similar in patients with Gleason 6 and > 6 [13.7 (5.6–28.7) vs 12.2 (5.7–23.2), p = 0.44], tumor stage I-II and III-IV [13.5 (5.3–26.5) vs 11.7 (7.8–21.1), p = 0.67], and presence or absence of metastasis [14.2 (9.6–31.8) vs 13.3 (5.2–24.6), p = 0.46].The prevalence of an AHI≥5 and AHI≥15 was similar in patients with Gleason 6 and > 6 (79.2% vs 77.2%; p = 0.85, and 49.3% vs 44.33%; p = 0.53, respectively). These results did not change when different oximetric variables were analyzed instead of the AHI. ConclusionsDespite the high prevalence of SDB in patients with PC, our results do not support any association between the severity of SDB and PC aggressiveness.

Impulse Configuration in Hypoglossal Nerve Stimulation in Obstructive Sleep Apnea: The Effect of Modifying Pulse Width and Frequency

ObjectivesHypoglossal nerve stimulation is an effective treatment option for obstructive sleep apnea (OSA) in positive airway pressure therapy failure. Nonetheless, data regarding the functional effect of modifying stimulation parameters within each electrode configuration are limited. Materials and MethodsIn a retrospective study of 76 patients with 12 months or more follow-up, functional tongue protrusion thresholds were compared for pulse width and frequency configurations of 90 μsec 33 Hz vs 120 μsec 40 Hz. The number of tolerated voltage amplitude steps between sensation, functional, and subdiscomfort thresholds were assessed for both settings as well as impedances. ResultsThe overall cohort showed improvement in OSA metrics: median apnea–hypopnea index from 30.0/hour to 18.6/hour and Epworth Sleepiness Scale from 13.5 to 7.6. For both bipolar and unipolar electrode configurations, the stimulation amplitude required for functional tongue protrusion was significantly reduced when the pulse width and frequency were converted from 90 μsec 33 Hz to 120 μsec 40 Hz (p < 0.001). Nevertheless, the number of voltage amplitude steps from sensation, functional, to subdiscomfort thresholds did not differ between the two settings. The ratio of automatically derived impedances between bipolar and unipolar electrode configurations was relevantly correlated with the ratio of functional thresholds at these parameters. ConclusionChanging the stimulation parameters may lower the voltage requirements while maintaining the same effect on tongue protrusion. Changing these stimulation parameters does not affect the range of tolerated impulse steps between functional and subdiscomfort thresholds. Future technical appliances could help estimate functional thresholds at different electrode configurations for each patient by automatically measuring impedances.