Mild Obstructive Sleep Apnea-hypopnea Research Articles

Abnormal interaction between cortical regions of obstructive sleep apnea hypopnea syndrome children.

Obstructive sleep apnea hypopnea syndrome negatively affects the cognitive function of children. This study aims to find potential biomarkers for obstructive sleep apnea hypopnea syndrome in children by investigating the patterns of sleep electroencephalography networks. The participants included 16 mild obstructive sleep apnea hypopnea syndrome children, 12 severe obstructive sleep apnea hypopnea syndrome children, and 13 healthy controls. Effective brain networks were constructed using symbolic transfer entropy to assess cortical information interaction. The information flow pattern in the participants was evaluated using the parameters cross-within variation and the ratio of posterior-anterior information flow. Obstructive sleep apnea hypopnea syndrome children had a considerably higher symbolic transfer entropy in the full frequency band of N1, N2, and rapid eye movement (REM) stages (P < 0.05), and a significantly lower symbolic transfer entropy in full frequency band of N3 stage (P < 0.005), in comparison with the healthy controls. In addition, the cross-within variation of the β frequency band across all sleep stages were significantly lower in the obstructive sleep apnea hypopnea syndrome group than in the healthy controls (P < 0.05). What is more, the posterior-anterior information flowin the β frequency band of REM stage was significantly higher in mild obstructive sleep apnea hypopnea syndrome children than in the healthy controls (P < 0.05). These findings may serve as potential biomarkers for obstructive sleep apnea hypopnea syndrome in children and provide new insights into the pathophysiological mechanisms.

Serum hepcidin and paraoxonase levels in patients with severe, moderate, and mild obstructive sleep apnea hypopnea syndrome (OSAS): A comparison between OSAS patients and simple snoring patients

ABSTRACT Objective To investigate the importance of hepcidin and paraoxonase in obstructive sleep apnea syndrome (OSAS). Methods Eighty-eight patients with sleep disorders were included and divided into four groups: simple snoring (SS), mild, moderate, and severe OSAS. All patients underwent polysomnography. The hepcidin and paraoxonase levels were examined and compared between the groups. Results There were significant differences between the four groups in terms of paraoxonase levels. In the SS group, the paraoxonase value was significantly higher than in the other three groups. In the analysis, Apnea Hypopnea Index (AHI) was negatively correlated with paraoxonase levels. Conclusion A significant difference was found between the OSAS groups with respect to paraoxonase enzyme, and a negative correlation with AHI was observed. Paraoxonase level could be used as a biomarker in OSAS. No significant data was found for hepcidin levels; therefore, hepcidin cannot be used as a biomarker in OSAS.

Pediatric polygraphy: A 6-year experience

The early diagnosis of Sleep Disordered Breathing (SDB) may allow proper intervention. Currently, polygraphy (PG) is a reliable and accessible alternative. To describe and analyze the PG of children > 1 year old with suspicion of SDB. PG of children > 1 year old and adolescents from Concepcion, Chile, with suspected SDB were included, from December 2011 to Au gust 2017. Demographic, clinical and polygraphic variables were collected. It was used descriptive sta tistics, expressing results in median and range. The association between apnea-hypopnea index (AHI) and oxygen saturation was determined by Spearman's Rho, considering significance of p < 0.05. Re sults: 190 studies were analyzed. Age 7.9 years old (1.0-20.6), 61% males. neuromuscular disease (NMD) (24.2%), chronic lung damage (21.1%), upper airway obstruction (UAO) (19.5%), neurological damage (11%), Down syndrome (8.9%), upper airway malformations (7.4%), central hypoventilation (3.7%), obesity (2.6%), and others (1.6%). 55.3% were altered PG, with 53.3% of mild Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), 30.5% moderate, and 16.2% severe. There were no significant differences in AHI between groups of pathologies (p = 0.032), highlighting a higher AHI in obese patients 9 (0.41-51), and those with NMD 23.9 (0.4-36.6). It was found asso ciation between AHI and oxygen saturation parameters: mean saturation (rho = -0.425; p = 0.001), minimum (rho = -0.654; p = 0.001), and oxygen saturation below 90% (rho = 0.323; p = 0.001) in the whole sample. There was a high percentage of OSAHS in at-risk pediatric patients, especially in those with NMD and obesity. PG is an accessible and implementable tool in a public hospital, a situation that can potentially be extrapolated to other healthcare centers.

КЛИНИЧЕСКАЯ ХАРАКТЕРИСТИКА ПАЦИЕНТОВ С НЕКЛАПАННОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ И СИНДРОМОМ ОБСТРУКТИВНОГО АПНОЭ/ГИПОПНОЭ СНА

Background. In recent years growing evidence has suggested the potential role of obstructive sleep apnoeahypopnoea (OSAH) in the genesis of atrial fibrillation (AF), but the precise mechanisms linking these two conditions are currently unknown. The aim. To assess the prevalence of OSAH in a sample of non-valvular AF patients and evaluate the clinical profile of non-valvular AF patients depending on the severity of sleep-disordered breathing. Material and methods. We enrolled into the study 172 patients with non-valvular AF (mean age 55.54±8.43 years; 68.02% males). The study subjects were divided into 4 groups according to the results of clinical laboratory evaluation (typical complaints, clinical markers, the Epworth scale scores and cardiorespiratory monitoring). Results. OSAH patients had higher body mass index, greater waist and neck circumference than non-OSAH patients (p<0.01); they more often had cardiac comorbidities (arterial hypertension, chronic heart failure) (p<0.01) and diabetes mellitus, and their parameters of blood oxygen saturation as well as apnea-hypopnea index (AHI) were significantly worse. Mild OSAH patients were less likely than moderate/severe OSAH patients to have permanent AF (p<0.01). Conclusion. OSAH appears to be highly prevalent in non-valvular AF patients and has been estimated to be present in approximately 78.49% in the study sample (it affects predominantly men with abdominal type of obesity). With the increase in OSAH severity and the level of AHI the prevalence of permanent AF and the risk of thromboembolic disorders by the CHA2DS2-VASc scale significantly rise.

Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure.

Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1. All MADs improved disease-specific QoL. Compliance was lower for SP1, which was unpopular at trial exit. At 4 weeks, all devices were cost-effective at £20,000/quality-adjusted life-year (QALY), with SP2 the best value below £39,800/QALY. A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH patients comparing MAD with conservative management (CM), MADs with CPAP or CPAP with CM. MADs and CPAP significantly improved AHI [MAD -9.3/hour (p < 0.001); CPAP -25.4/hour (p < 0.001)]. Effect difference between CPAP and MADs was 7.0/hour (p < 0.001), favouring CPAP. No trials compared CPAP with MADs in mild OSAH. MAD and CPAP reduced the ESS score similarly [MAD 1.6 (p < 0.001); CPAP 1.6 (p < 0.001)]. An existing model assessed lifetime cost-utility of MAD and CPAP in mild to moderate OSAH, using the revised meta-analysis to update input values. The TOMADO provided utility estimates, mapping ESS score to European Quality of Life-5 Dimensions three-level version for device cost-utility. Using SP2 as the standard device, MADs produced higher mean costs and mean QALYs than CM [incremental cost-effectiveness ratio (ICER) £6687/QALY]. From a willingness to pay (WTP) of £15,367/QALY, CPAP is cost-effective, although the likelihood of MADs (p = 0.48) and CPAP (p = 0.49) being cost-effective is very similar. Both were better than CM, but there was much uncertainty in the choice between CPAP and MAD (at a WTP £20,000/QALY, the probability of being the most cost-effective was 47% for MAD and 52% for CPAP). When SP2 lifespan increased to 18 months, the ICER for CPAP compared with MAD became £44,066. The ICER for SP1 compared with CM was £1552, and for bMAD compared with CM the ICER was £13,836. The ICER for CPAP compared with SP1 was £89,182, but CPAP produced lower mean costs and higher mean QALYs than bMAD. Differential compliance rates for CPAP reduces cost-effectiveness so MADs become less costly and more clinically effective with CPAP compliance 90% of SP2. Mandibular advancement devices are clinically effective and cost-effective in mild to moderate OSAH. A semi-bespoke MAD is the appropriate first choice in most patients in the short term. Future work should explore whether or not adjustable MADs give additional clinical and cost benefits. Further data on longer-term cardiovascular risk and its risk factors would reduce uncertainty in the health economic model and improve precision of effectiveness estimates. This trial is registered as ISRCTN02309506. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 67. See the NIHR Journals Library website for further project information.

Effects of CPAP on systemic hypertension in OSAH: A monocentric, observational, cohort study

Obstructive sleep apnea-hypopnea (OSAH) is a risk factor for development of systemic arterial hypertension (SAH) and can worse the control of established SAH. We investigated the effects of long-term continuous positive airway pressure (CPAP) treatment in controlling and preventing SAH in a large cohort of subjects referred for sleep study for suspected OSAH. In 495 subjects of whom 422 with OSAH and 73 without OSAH, the clinical history was obtained, arterial blood pressure was measured and the current anti-hypertensive drugs was recorded at diagnosis and/or at CPAP start. Subjects were interviewed after a follow-up period of (mean ± SD) 3.4 ± 2.2 yr (range 1-8 yr) and divided in patients with moderate-to-severe OSAH (n = 125) who referred to use CPAP regularly for at least 4 h every night (group 1), with moderate-to-severe OSAH (n = 70) who refused or abandoned the CPAP treatment after few weeks (group 2), with mild OSAH (n = 227) with no CPAP indication (group 3) and simple snorers or normals (n = 73) (group 4). For each group clinical status, BMI, and changes in SAH therapy and occurrence of SAH were assessed at the follow-up. At the follow-up, a higher risk of increasing treatment for SAH was found for group 2 and group 3 versus group 1 (OR = 5, 95%CI 1-20, p < 0.01 and OR = 3, 95%CI 1-10, p < 0.05), respectively. The occurrence of SAH was lower (p < 0.001) in the group 1 (1.9%), vs group 2 (35.9%), 3 (21.1%) and 4 (18.6%). In moderate-to-severe OSAH patients, long-term CPAP treatment significantly reduces the development of SAH and, in those with SAH at baseline, the need of anti-hypertensive drugs.

Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea

Sleep and sleep position have a significant impact on physical, cardiac and mental health, and have been evaluated in numerous studies particularly in terms of lateral sleeping positions and their association with diseases. We retrospectively examined the relationship between the sleeping position and position-specific apnea-hypopnea index (AHI) in obstructive sleep apnea-hypopnea (OSA) patients. We assessed the sleeping body position and the body position-specific AHI score in patients who were referred for suspected OSA and underwent diagnostic nocturnal polysomnography. In order to eliminate inter-individual differences, only those who had a similar percentage of time spent in the LSSP and RSSP for each patient were enrolled. To provide this validity, only subjects that had a similar percentage of left and right lateral sleep time (±10%) were included in the analysis. A total of 864 patients had nocturnal diagnostic PSG. Of them, 131 patients met the inclusion criteria. The percent rate spent in the supine sleeping position (SSP) was 31.3 ± 18.7%, in the LSSP was 31.8 ± 10% and in the RSSP was 32.6 ± 10.8%. Whereas the SSP-specific AHI score was the highest with 60.4 ± 36.2/h among all the sleeping position-specific AHI scores (p < 0.001), the LSSP-specific AHI score was statistically higher than that for RSSP (30.2 ± 32.6/h vs. 23.6 ± 30.1/h; p < 0.001). When comparing individuals sub-grouped based on OSA severity, there was a statistically significant difference between the LSSP-specific AHI score and RSSP-specific AHI score in patients with severe (p = 0.002) and moderate (p = 0.026), but not mild (p = 0.130) OSA. We found that the sleeping position had a significant influence on apneic events and RSSP decreased the frequency of obstructive respiratory events in patients with moderate and severe disease.

Treatment of Obstructive Sleep Apnea and Hypopnea—We Are Not There Yet!

Recently available data from a number of studies provide convincing evidence that obstructive sleep apnea hypopnea (OSAH) is an independent risk factor for the development of cardiovascular disease (CVD) and for increased mortality.1–3 Even if the prevalence of OSAH is assumed to be 2% to 4% in the general population, an arguably conservative estimate, OSAH is a significant public health concern. Initial consideration of these findings would suggest that we as Sleep Medicine practitioners should be as diligent in identifying and prescribing treatment for OSAH as internists and family practitioners are for treatment of elevated lipids and hypertension. As much as this strategy is attractive from a scientific perspective, there are some important gaps in our knowledge with respect to the impact of OSAH on all segments of the population as well as practical barriers that preclude implementation. Although recent prospective observational studies have demonstrated that OSAH appears to be an independent risk factor for CVD and increased mortality,2,3 it is not clear that the impact is uniform across all segments of the population. Data presented last year by the Sleep Heart Health Study indicate that the impact of OSAH on mortality and incident CVD is primarily found in men less than 70 years of age, with little effect in women and older men.4 The absence of an adverse impact on older men is consistent with a previous study in a large clinical cohort.1 Furthermore, longitudinal studies of clinical populations demonstrating an adverse impact of OSAH on CVD and mortality have been performed in cohorts comprised predominantly or entirely of men.1,5,6 Thus, it can be argued that the adverse impact on mortality and incident CVD, if any, of OSAH on women, and perhaps older men remains to be determined. Perhaps an equally vexing issue for Sleep Medicine practitioners is the question of who to treat. Review of the data from several longitudinal studies suggest that the mortality and CVD risks for persons with an AHI < 15 may be very low or absent. For example, in the frequently cited study by Marin et al, increased risk of incident CVD and mortality appeared to be present only in those with an AHI ≥ 30.5 Moreover, in the Busselton study, an increase in all-cause mortality was associated only with a RDI ≥ 15.2 Many individuals with OSAH are not sleepy or feel unrested7 and present for medical attention for other reasons. Can we justify treatment of mild OSAH in those with the absence of these symptoms given the lack of definitive evidence of an adverse CVD or mortality impact in this group? In particular, should older persons and women with mild OSAH be treated? The question of who to treat would be less of an issue if available treatment modalities were plentiful and highly effective. Unfortunately, neither is the case. There are 4 commonly employed therapeutic modalities for OSAH: weight loss, upper airway surgery, oral appliances, and positive airway pressure (PAP). Excluding surgical procedures for weight loss, diet programs have not been highly effective. Upper airway surgery is only modestly efficacious at best, and even less effective.8 Oral appliances and PAP therapy are highly efficacious, but their clinical effectiveness rates are less than desirable.9,10 Long-term use of PAP therapy in some studies is reported to be only ∼60%.10 This latter observation is now reflected in Medicare regulations, which require documentation of both treatment compliance and improvement in symptoms for continued reimbursement for PAP therapy. The aforementioned realities present significant challenges to the field of Sleep Medicine. One of our most important disease conditions is highly prevalent in the general population, but it is unclear whether all persons should be treated. Moreover, available treatment modalities are limited and are not highly effective. Recently published studies have provided important information concerning the health impact of OSA, but we are not there yet' Many unresolved issues remain. Additional research and development will be required from both the scientific community and industry to effectively treat the epidemic of OSA.