Minimum Oxygen Saturation Research Articles

Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a retrospective cohort study.

A multivariable model found evidence that lower average oxygen saturation while asleep was associated with PRAEs requiring intervention in children with Down syndrome. This study highlights the difficulty in predicting complications in this population. •Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy. •However, children with Down syndrome are at increased risk for perioperative respiratory adverse events (PRAEs) following adenoidectomy and/or tonsillectomy. •We found that a lower average oxygen saturation asleep is associated with increased odds of PRAEs, adjusting for age, total apnea-hypopnea index, cardiac comorbidity, and minimum oxygen saturation. •This study highlights the difficulty in predicting complications in this population.

Prediabetes Is Associated with Increased Prevalence of Sleep-Disordered Breathing.

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea–hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events.

Oxygen desaturation index as alternative parameter in screening patients with severe obstructive sleep apnea.

ObjectivesAssess reliability of oxygen desaturation index (ODI) as an alternative parameter to apnea hypopnea index (AHI) in screening patients with severe obstructive sleep apnea (OSA).Material and MethodsRetrospectively two-year data on demography, anthropometric features, polysomnography (PSG) parameters [AHI, ODI, minimum oxygen saturation (SpO2), mean SpO2], and Epworth sleepiness score (ESS) were collected and analyzed.ResultsStudy showed significant correlation of ESS with AHI, ODI, apnea-hypopnea percentage of sleep period time (AH%SPT), mean SpO2 and minimum SpO2 with highest correlation being with AHI. A Cohen’s weighted Kappa analysis showed good concordance of 87.32% between AHI and ODI in classifying severity of OSA, with a significant R2 correlation of 0.84 on linear regression. An ODI>20 has a sensitivity of 96.6% and specificity of 69.6% in diagnosing severe OSA.ConclusionGood concordance between AHI and ODI makes nocturnal oximetry a less expensive tool to confdently screen patients with severe OSA.

When adherence to CPAP fails, how do we treat workers with obstructive sleep apnea?

AimsA cross-sectional study was designed to evaluate the effectiveness of a mandibular advancement device (MAD) with respect to respiratory and sleep parameters among miners with obstructive sleep apnea syndrome (OSAS) and primary snore.MethodsThe target sample was composed by 102 Brazilian miners with a history of non-adherence to continuous positive airway pressure. All patients were treated with a MAD and underwent pre and post-treatment full-night polysomnography. Ethical approval and consents were obtained. Bivariate and logistic regression analyses were conducted. The level of statistical significance was set at 5%.ResultsAfter the treatment with MAD, 71.8% of patients presented a decrease ≥ 50% in the basal apnea-hypopnea index (AHI), 51.2% presented an AHI < 5 events/h and 83.3% reached an AHI<10/h, whereas 22.5% did not show any changes and 7.5% of the sample presented an increase in the AHI (p<0.05). There was an increase in the mean SpO2 nadir (p<0.001) and in the baseline duration of the REM sleep stage (p<0.05). The MAD significantly decreased snore events (p<0.05). Multivariate analysis did not identify predictive factors related to therapy success (decrease ≥ 50% of AHI). However, basal AHI was a significant predictor related to the secondary endpoint (AHI<10/h) (OR= 1.06, IC 95%1.00-1.13, p=0.007).ConclusionsThe MAD therapy showed significant improvements in AHI, minimum oxygen saturation, REM sleep and snoring.

A new design of mandibular advancement device (IMYS) in the treatment of obstructive sleep apnea

ABSTRACT Objective The mandibular advancement device (MAD) is currently suggested in patients with mild to moderate obstructive sleep apnea (OSA). This study investigated the effects of a new fully customizable MAD-type device called, “It Makes You Sleep” (IMYS), in patients with mild to moderate OSA. Methods Sixteen patients (14 men and 2 women; mean age 62; SD ± 11 years) were retrospectively enrolled. Each patient received home sleep apnea testing (HSAT) at baseline (T0) and after three months (T1) of IMYS treatment. The Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the Minimum Oxygen Saturation (minSO2) and the Medium Oxygen Saturation (medSO2) were analyzed. Results From T0 to T1, the IMYS treatment showed a significant reduction of AHI and ODI and a significant increase of minSO2 and medSO2. Conclusion The IMYS appliance is an effective device for treating mild or moderate OSA.

Prevalence and Characteristics of Erectile Dysfunction in Obstructive Sleep Apnea Patients.

BackgroundObstructive sleep apnea (OSA) is a common and severe social problem. Erectile dysfunction (ED) is an important health concern. The prevalence of OSA with ED is increasing, which significantly affects the quality of life and work efficiency of patients. However, the mechanism underlying the comorbidity of these two diseases remains unclear.Objectives(1) Investigate the prevalence of OSA with ED; (2) analyze the correlation between OSA and ED; and (3) explore the treatment response to and possible mechanism of uvulapalatopharyngoplasty (UPPP) in patients with OSA and ED. This study aims to provide a theoretical basis for the clinical diagnosis and comprehensive treatment of OSA with ED and improve prevention and treatment strategies.Materials and MethodsIn total, 135 subjects were enrolled in the study. Clinical data, polysomnography, the ESS score, Beck anxiety score, Beck depression score, IIEF-5 score and ASEX score were recorded before UPPP and 6 months after UPPP. Sex hormones were measured for all subjects using a Roche electrochemiluminescence analyzer.ResultThe prevalence of OSA with ED was 64.52%, and the prevalence of severe OSA with ED was 73.02%. The prevalence of OSA with ED increased with age, BMI and apnea-hypopnea index (AHI) value. Among polysomnography indicators, minimum oxygen saturation and average oxygen saturation may predict the occurrence of OSA with ED. Improving the patient’s anxiety and depression is very important for treating OSA with ED. Sex hormone levels were not significantly correlated with the occurrence of OSA with ED.ConclusionED is a common symptom of OSA patients. This study showed that sex hormone levels in OSA patients with ED were not significantly correlated with the condition, but further investigation of this relationship is worthwhile. It is recommended that the free and combined types of sex hormones be further distinguished during testing because the free type is the active form. UPPP surgical treatment is effective for OSA with ED, and its possible mechanism is protection of the peripheral nerves of the sex organs by improving nighttime hypoxia and arousal.

HP05: Diagnostic and prognostic assessment in respiratory and hemodynamic changes related to prone position in COVID-19 patients

Objective: One of the most relevant findings of COVID-19 is the respiratory damage that leads to an impairment in tissue oxygenation during the course of the disease. To study this disease's physiopathology, we have analyzed the respiratory patterns and the hemodynamic variations related to postural changes in inpatients with COVID-19.Methods: We performed a prospective study including 11 polygraph and hemodynamic studies from inpatients admitted for COVID-19 who benefited from positional changes. To assess the respiratory parameters, we conducted polygraph studies. To evaluate the hemodynamic variables, we used a thoracic electrical bioimpedance.Results: We observed a minimum oxygen saturation median of 85.00% (IQR: 7.00) in the supine position vs 91.00% (IQR: 8.00) in the prone position (p=0.173). The airflow restriction in the supine position was 2.70% (IQR: 6.55) vs 1.55% (IQR: 2.80) in the prone position (p=0.383). We observed a slight tendency to decrease in all parameters in the prone position concerning the hemodynamic variables, although they were no statistically significant. We show a decrease in vascular resistance mean in the prone position, being 18.2% vs 36.4% in the supine position (p=0.871).Conclusion: Our report shows an improvement in oxygen saturation and airflow restriction related to the placement of the patient in the prone position. Also, we observed a mild enhancement in hemodynamic variables. The data shown is relevant because early identification of the more severe cases could help anticipate the clinical progression using the therapeutic oxygen measures necessary to avoid the disease's fatal progression.

Skeletal and upper airway stability following modified maxillomandibular advancement for treatment of obstructive sleep apnea in skeletal class I or II deformity.

Maxillomandibular advancement (MMA) is an effective short-term treatment for obstructive sleep apnea (OSA). This study aimed to evaluate the long-term stability of the facial skeleton, upper airway, and its surrounding structures, as well as improvement in OSA following MMA. Thirty-one adults with moderate-to-severe OSA underwent surgery-first modified MMA as primary surgery. Polysomnography and cone-beam computed tomography were obtained pre-surgery, early post-surgery, and at follow-up (i.e., ≥ 2 years post-surgery). Image analysis software assessed the facial skeleton, upper airway, and its surrounding structures. Early post-surgery, apnea-hypopnea index (AHI) had decreased significantly (p < 0.001) and the minimum oxygen saturation (MSAT) increased (p = 0.001), indicating significant improvement in OSA. At follow-up, the AHI and MSAT remained stable. However, the anterior maxilla, soft palate, and tongue moved backward while the hyoid moved downward. There was also a significant decrease in the minimal cross-sectional area of the oropharynx. The reduction in AHI was significantly related to the anterior movement of the anterior maxilla and tongue, inferior movement of the posterior maxilla, and superior movement of the soft palate tip. The improvement of OSA after modified MMA remained stable for at least 2 years following treatment, despite the relapse of the facial skeleton, upper airway, and its surrounding structures. The reduction of AHI was not related to changes in the caliber of the upper airway but to the movement of the maxilla, soft palate, and tongue. Clinical relevance Modified MMA is clinically effective for long-term treatment of patients with moderate-to-severe OSA.

Apneic Technique in Laryngotracheal Surgery.

BackgroundApneic oxygenation can be applied to select laryngotracheal procedures to improve operative visualization and avoid potential complications associated with intubation and jet ventilation. Aims/objectivesThe authors sought to determine if apneic oxygenation using a high-flow nasal cannula could be used as a safe alternative airway management strategy for the duration of select laryngotracheal procedures.MethodsSingle institution, multi-site retrospective review of 38 adult (>18 years old) patients undergoing apneic oxygenation in the setting of various laryngotracheal procedures from January 2017 through January 2018. Humidified oxygen was delivered via a high-flow nasal cannula. The data was collected and analyzed using SAS version 9.4 (SAS Institute, Cary, NC).ResultsTwenty-four women and 14 men, mean age 60.0 years (SD 16.1; 36-89) and 70.1 years (SD 7.2; 56-81), respectively, underwent a mean total apneic time of 23.9 minutes (13-40). A statistically significant correlation existed between apneic time and minimum oxygen saturation (Pearson correlation coefficient 0.38; p=0.018). Twenty-one patients resumed spontaneous ventilation without the need for jet ventilation, mask ventilation, or placement of a definitive airway during the procedure. Conclusions and significanceApneic oxygenation allows for extended periods of operating without the need for the placement of an endotracheal tube in patients undergoing general anesthesia for select laryngotracheal procedures.

Pre-operative prostaglandin-E is not required for d-transposition of the great arteries

BackgroundProstaglandin E-1 (PGE) is frequently utilized preoperatively for patients with d-transposition of the great arteries (dTGA) but may not be necessary for all patients. ObjectiveWe sought to define the impact of PGE at the time of the arterial switch operation (ASO) on perioperative clinical outcomes as well as patient characteristics that allowed for PGE discontinuation prior to surgical intervention. MethodsSingle center, retrospective review of patients with dTGA who underwent ASO from 2013 to 2019. Patients with concurrent cardiac lesions requiring surgical intervention, genetic syndromes, gestation age < 37 weeks, and birth weight < 2 kg were excluded. Demographics, laboratory data, and postoperative course were obtained. Data were expressed as median (Q1, Q3) for continuous variables or N (%) for categorical variables. All comparisons utilized a p value of 0.05 for significance. Results40 patients were identified. At the time of the surgery, 27 patients were receiving PGE while 13 patients were not. Of the 28 patients trialed off PGE, 17 (61%) required re-initiation. There were no patient characteristics identified that predicted successful PGE discontinuation. Patients who were able to remain off PGE prior to ASO required less respiratory support than those who required PGE (4 (36%) vs 1 (6%), p = 0.003), had lower maximum oxygen saturation than those who required PGE (92% (87, 94) vs 95% (92, 98), p = 0.044), and lower minimum oxygen saturation than those who required PGE (63%, (60, 71) vs 75% (69, 79) p = 0.044) in the 24 h prior to the ASO. ConclusionsPreoperative exposure to PGE had no significant benefit on operative outcomes. No patient characteristics that predicted successful discontinuation of PGE were identified. Thus, a trial off PGE should be considered in patients with dTGA prior to the ASO to minimize side effects, particularly patients requiring less respiratory support.

Integrating multimodal data through interpretable heterogeneous ensembles.

MotivationIntegrating multimodal data represents an effective approach to predicting biomedical characteristics, such as protein functions and disease outcomes. However, existing data integration approaches do not sufficiently address the heterogeneous semantics of multimodal data. In particular, early and intermediate approaches that rely on a uniform integrated representation reinforce the consensus among the modalities but may lose exclusive local information. The alternative late integration approach that can address this challenge has not been systematically studied for biomedical problems.ResultsWe propose Ensemble Integration (EI) as a novel systematic implementation of the late integration approach. EI infers local predictive models from the individual data modalities using appropriate algorithms and uses heterogeneous ensemble algorithms to integrate these local models into a global predictive model. We also propose a novel interpretation method for EI models. We tested EI on the problems of predicting protein function from multimodal STRING data and mortality due to coronavirus disease 2019 (COVID-19) from multimodal data in electronic health records. We found that EI accomplished its goal of producing significantly more accurate predictions than each individual modality. It also performed better than several established early integration methods for each of these problems. The interpretation of a representative EI model for COVID-19 mortality prediction identified several disease-relevant features, such as laboratory test (blood urea nitrogen and calcium) and vital sign measurements (minimum oxygen saturation) and demographics (age). These results demonstrated the effectiveness of the EI framework for biomedical data integration and predictive modeling.Availability and implementationCode and data are available at https://github.com/GauravPandeyLab/ensemble_integration.Supplementary information Supplementary data are available at Bioinformatics Advances online.

Light and moderate intensity physical activity are associated with better ambulation, quality of life, and vascular measurements in patients with claudication

ObjectiveWe sought to determine whether patients with claudication who reported performing either light intensity physical activity (LPA) or moderate-to-vigorous intensity physical activity (MVPA) would have higher levels of objectively determined physical activity and better physical function, health-related quality of life (HRQoL), and vascular measures, consisting of exercise time to minimum calf muscle oxygen saturation (StO2) and high-sensitivity C-reactive protein, than patients who reported being physically sedentary. MethodsA total of 269 patients were assessed using the Johnson Space Center physical activity scale. The patients were grouped according to whether they performed no physical activities (n = 75), LPAs (n = 140), or MVPAs (n = 54). The primary measurements were the total daily steps obtained from a step activity monitor worn for 1 week, peak walking time obtained from a treadmill test, physical function score on the Medical Outcomes Study short-form 36-item survey to assess HRQoL, and high-sensitivity C-reactive protein. ResultsThe total daily steps was significantly different among the groups. Both the LPA group (mean ± standard deviation, 7878 ± 2808 steps/d) and the MVPA group (mean, 8551 ± 3365 steps/d) had taken more daily steps (P < .01) than had the sedentary group (mean, 3323 ± 986 steps/d). The treadmill peak walking time was significantly different among the three groups. Both the LPA group (433 ± 296 seconds) and the MVPA group (548 ± 300 seconds) had had a greater peak walking time (P < .01) than that of the sedentary group (302 ± 210 seconds). The physical function score was also significantly different among the groups. The LPA group (44% ± 20%) and MVPA group (58% ± 19%) both had had higher scores (P < .01) than the sedentary group (36% ± 20%). In addition, the exercise time to the minimum calf muscle StO2 was significantly different among the groups. Both the LPA group (215 ± 238 seconds) and the MVPA group (377 ± 351 seconds) had had greater values (P < .05 and P < .01, respectively) than the sedentary group (147 ± 172 seconds). Finally, the high-sensitivity C-reactive protein level was significantly different among the groups. Both the LPA group (4.8 ± 5.5 mg/L) and the MVPA group (3.5 ± 3.6 mg/L) had had lower values (P < .01) than the sedentary group (8.6 ± 8.4 mg/L). ConclusionsPatients with claudication who reported performing LPA had greater amounts of objectively determined physical activity levels and better physical function, HRQoL, and vascular measures than those who reported being physically sedentary. Furthermore, these favorable results associated with LPA were even more pronounced for the patients who performed MVPA compared with those who were sedentary. The clinical significance is that our results have shown that engaging in any physical activity, even at relatively light intensity, is associated with favorable health and vascular measures for patients with claudication.

Comparison of the innovative endoscopic oropharyngeal airway and the conventional mouthpiece in elderly outpatients undergoing esophagogastroduodenoscopy under sedation: a prospective and randomized study

BackgroundUndesirable outcomes may appear for elderly patients undergoing esophagogastroduodenoscopy (EGD) under sedation, such as hypoxia and hypotension. The aim of our study was to investigate the ability of the innovative endoscopic oropharyngeal airway to reduce the frequency of hypoxia during EGD under sedation in elderly patients.MethodsIn this trial, aged patients undergoing EGD were randomized into airway group and mouthpiece group. The primary outcome was the incidence of the minimum pulse oxygen saturation < 90% and minimum pulse oxygen saturation. In addition, sedation dose, recovery time, emergency management and adverse reactions were recorded.Results360 patients completed the study (180 in each groups). The minimum pulse oxygen saturation during EGD was significantly higher in airway group (97.66 ± 2.96%) than in mouthpiece group (95.52 ± 3.84%, P < 0.001). The incidence of pulse oxygen saturation of 85–89% of airway group (5.0%, 9/180) was lower than mouthpiece group (10.6%, 19/180, P = 0.049). The endoscopy entry time in airway group was 3 (2, 4) seconds and in mouthpiece group was 5 (4, 6) (P < 0.001). Propofol total dose and awakening time were significantly lower in the airway group than in the mouthpiece group (P = 0.020 and P = 0.012, respectively). Furthermore, the incidence rate of hypotension was significantly higher in mouthpiece group (12.2%) than in airway group (5.0%) (P = 0.015). By comparison with the mouthpiece group, the satisfaction of endoscopists was higher in airway group (P = 0.012).ConclusionElderly patients undergoing EGD, Endoscopy Protector was associated with a significantly lower incidence of hypoxia, shortened endoscopy entry time and more stable hemodynamics.Trial registration: ChiCTR, ChiCTR2000031998, 17/04/2020. http://www.chictr.org.cn/index.aspx

Serum Transferrin Level Is Associated with the Severity of Obstructive Sleep Apnea Independently of Obesity: A Propensity Score-Match Observational Study

Introduction: Dysregulation of iron metabolism is closely associated with the development of obesity and obstructive sleep apnea (OSA), but little is known about the relationship between serum transferrin (TF) level and OSA severity. We aimed to verify this relationship and fit into account for obesity-related confounders among bariatric candidates. Methods: We compared data retrospectively collected in 270 bariatric candidates. A propensity score-matched (PSM) analysis was used to determine the impact of iron metabolism on OSA severity independently of obesity. Univariate analysis was used to evaluate the relationship between serum TF level and the severity of OSA reflected by hypoxia and night awakenings parameters. Serum TF level to predict the severity of OSA was assessed by using univariate and multiple logistic regression model. Results: The preliminary analysis showed that serum ferritin (113 ng/mL [50–203] vs. 79 ng/mL [40–130], p = 0.009) and TF (2.72 g/L [2.46–3.09] vs. 2.65 g/L [2.34–2.93], p = 0.039) level was significantly higher in the moderate/severe OSA group than the no/mild OSA group. After PSM analysis, there were 75 patients in each group and only serum TF level remained significant (p = 0.014). The proportion of patients with combined T2D and hyperlipidemia also remained higher in moderate/severe OSA groups. Univariate analysis showed that the group with higher degree of hypoxia had higher serum TF levels no matter the severity of OSA was grouped by oxygen desaturation index (ODI; 2.79 g/L [2.56–3.06] vs. 2.55 g/L [2.22–2.84], p < 0.001) or minimum oxygen saturation (SpO₂nadir; 2.75 g/L [2.50–3.03] vs. 2.56 g/L [2.24–2.92], p = 0.009). Univariate and multiple logistic regression analysis further showed that serum TF level emerged as a significant and independent factor associated with OSA severity especially grouped by ODI (odds ratio: 2.91, 95% CI: 1.36–6.23, p = 0.006). Conclusion: The existence of OSA exacerbates obesity comorbidities, particularly type 2 diabetes and hyperlipidemia. Serum TF level is associated with the severity of OSA independently of obesity and might be a potential identification and therapeutic targets.

Appendix A

BACKGROUND: High-G acceleration experienced during launch and re-entry of suborbital spaceflights may present challenges for older or medically susceptible participants. A detailed understanding of the associated physiological responses would support the development of an evidence-based medical approach to commercial suborbital spaceflight.METHODS: There were 24 healthy subjects recruited into ‘younger’ (18-44 yr), ‘intermediate’ (45-64 yr) and ‘older’ (65-80 yr) age groups. Cardiovascular and respiratory variables were measured continuously during dynamic combinations of +Gx (chest-to-back) and +Gz (head-to-foot) acceleration that simulated suborbital G profiles for spaceplane and rocket/capsule platforms. Measurements were conducted breathing air and breathing 15% oxygen to simulate a cabin pressure altitude of 8000 ft.RESULTS: Suborbital G profiles generated highly dynamic changes in heart rate, blood pressure, and cardiac output. G-induced hypoxemia was observed, with minimum arterial oxygen saturation &lt; 80% in a quarter of subjects. Increased age was associated with greater hypoxemia and reduced cardiac output responses but did not have detrimental cardiovascular effects. ECG changes included recurrent G-induced trigeminy in one individual. Respiratory and visual symptoms were common, with 88% of subjects reporting greyout and 29% reporting blackout. There was one episode of G-induced loss of consciousness (G-LOC).DISCUSSION: Suborbital acceleration profiles are generally well tolerated but are not physiologically inconsequential. Marked hemodynamic effects and transient respiratory compromise could interact with predisposing factors to precipitate adverse cardiopulmonary effects in a minority of participants. Medically susceptible individuals may benefit from expanded preflight centrifuge familiarization that includes targeted physiological evaluation in the form of a ‘G challenge test’.Smith TG, Pollock RD, Britton JK, Green NDC, Hodkinson PD, Mitchell SJ, Stevenson AT. Physiological effects of centrifuge-simulated suborbital spaceflight. Aerosp Med Hum Perform. 2022; 93(12):830–839.

Clinical and anatomical characteristics associated with obstructive sleep apnea severity in children

PurposeTo determine the clinical and anatomical characteristics associated with obstructive sleep apnea severity in children with adenotonsillar hypertrophy. MethodsThe authors conducted a cross-sectional multidisciplinary survey and selected 58 Brazilian children (4‒9 years old) with adenotonsillar hypertrophy, parental complaints of snoring, mouth-breathing, and witnessed apnea episodes. The authors excluded children with known genetic, craniofacial, neurological, or psychiatric conditions. Children with a parafunctional habit or early dental loss and those receiving orthodontic treatment were not selected. All children underwent polysomnography, and three were excluded because they showed an apnea-hypopnea index lower than one or minimal oxygen saturation higher than 92%. The sample consisted of 55 children classified into mild (33 children) and moderate/severe (22 children) obstructive sleep apnea groups. Detailed clinical and anatomical evaluations were performed, and anthropometric, otorhinolaryngological, and orthodontic variables were analyzed. Sleep disorder symptoms were assessed using the Sleep Disturbance Scale for Children questionnaire. All children also underwent teleradiography exams and Rickett's and Jarabak's cephalometric analyses. ResultsThe mild and moderate/severe obstructive sleep apnea groups showed no significant differences in clinical criteria. Facial depth angle, based on Ricketts cephalometric analysis, was significantly different between the groups (p = 0.010), but this measurement by itself does not express the child's growth pattern, as it is established by the arithmetic mean of the differences between the obtained angles and the normal values of five cephalometric measurements. ConclusionsThe clinical criteria and craniofacial characteristics evaluated did not influence the disease severity.

Differences in Polysomnography Parameters of Women in the Post and Transitional Phases of Menopause.

ObjectivesTo investigate the relationship between the changes in the main components of sleep during the menopausal transition and the postmenopausal period.MethodsA total of 162 patients were included in the study, including 62 patients in the menopausal transition period and 100 patients in the postmenopausal period. The Epworth sleepiness scale (ESS) was applied to the patients before polysomnography (PSG). In PSG recordings, the total sleep time, sleep efficiency, rapid eye movement (REM) sleep (%), non-REM (NREM) sleep (%), apnea-hypopnea index (AHI), REM-AHI, NREM-AHI, minimum and mean oxygen saturation, oxygen desaturation time, and oxygen desaturation index (ODI) were recorded.ResultsTotal sleep time (256.4±89.9 vs. 302.8±73.8, p<.03) and sleep efficiency (63.8±16.3 vs 75.6±16.0, p<.005) were significantly decreased in the postmenopausal patient group compared to the menopausal transition group. ODI, desaturation time, and desaturation percentages were significantly higher and minimum oxygen saturation was significantly lower in the postmenopausal group than in the transitional group. While mild obstructive sleep apnea syndrome (OSAS) rates in the menopausal transition group were significantly higher than in the menopausal group, moderate and severe OSAS rates were significantly higher in the menopausal group.ConclusionChanges in PSG measurements during the menopausal transition and postmenopausal period showed a significant effect of hormonal changes on sleep in women.

Abstract 10101: Obstructive Sleep Apnea Syndrome Attenuates HDL Functions

Background: High density lipoprotein (HDL) exerts anti-atherogenic functions including cholesterol efflux capacity and anti-oxidative activities. Obstructive sleep apnea (OSA) is associated with increased risk for cardiovascular disease via inflammation and oxidative stress. However, HDL functions in patients with OSA remains to be elucidated. We therefore investigated cholesterol efflux capacity and anti-oxidative activity in order to assess whether OSA would affect HDL functions. Methods and Results: A total of 116 OSA patients who underwent polysomnography tests from April 2017 to April 2019 were enrolled in this cross-sectional study. Blood samples were obtained at the next day of polysomnography test. We measured cholesterol efflux capacity in OSA patients and found that CEC was significantly lower in SAS groups (apnea hypoxia index (AHI)≧5) compared with non-SAS groups.(AHI&lt;5)(1.06±0.15 vs 0.96±0.14 p=0.01) Among OSA parameters, minimal pulse oxygen saturation(minSpO2), a highly correlated parameter with AHI (r=-0.76 p&lt;0.001), was found to be positively correlated with CEC (r=0.19 p=0.034) In multiple regression analysis , CEC was associated with minSpO2 independently of several clinical parameters including BMI, age, PON1, smoking, hypertension, dyslipidemia, diabetes mellitus, TC, logTG, HDL-C.(β=0.25 p=0.02) Further, CEC was inversely correlated with log hsCRP adjusted with the same model.(β=-0.25 p=0.01).With regard to anti-oxidative function, assessed by AAPH and PON1 activity, AHI or min SpO2 did not correlate with anti-oxidaitive activity by AAPH or PON1 activity. Conclusion: Obstructive sleep apnea syndrome attenuated cholesterol efflux capacity. Min SpO2 may be a good predictor of HDL dysfunction in OSA.

Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices.

Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).

An Exploratory Study on the Treatment of Obstructive Apnea-Hypopnea Syndrome by Nasal Cavity Expansion.

Background Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently occurring disease, which seriously influences the health of the affected population. The pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is numerous. With the continuous research on OSAHS disease, it has been found that one of its main pathogeneses is caused by the anatomical characteristics of upper airway obstruction induced during sleep. The narrowing and collapse of any plane can affect the ventilation of the upper respiratory tract. In recent years, with the deepening of research, the importance of the upper respiratory tract obstruction as a source of the disease has attracted increasing attention. Nasal stenosis can cause increased nasal resistance, increased pharyngeal inhalation negative pressure, soft palate collapse, and narrow pharyngeal cavity, resulting in open mouth breathing, which can be the initiating factor of the upper airway obstruction. With the development and popularization of nasal endoscopy technology, domestic and foreign scholars have reported more on the treatment of rhinogenic OSAHS with nasal cavity expansion, but they are different. There is still more controversy; the main controversy centered on the effective rate of surgical treatment and the improvement of objective indicators. Therefore, this study performed individualized nasal cavity expansion for patients with OSAHS who are mainly rhinogenic, from subjective symptoms, objective indicators, and effective rate of surgery. Methods and Patients. Conduct research and analysis to provide references for the clinical treatment of such patients. For patients with the obstructive apnea-hypopnea syndrome with nasal congestion, individualized nasal cavity expansion was performed to study the clinical effect of nasal cavity expansion in the treatment of OSAHS. This article mainly screens cases through big data and selects a large hospital in China to perform individualized nasal cavity expansion surgery to treat 43 adult OSAHS patients with nasal congestion. Results There are uploaded sleep monitoring, nasal reflex, nasal resistance, and nasal symptoms before and after surgery. Conclusion Spirometer examination records, along with apnea-hypopnea index and minimum arterial blood oxygen saturation, the minimum cross-sectional area of the nasal cavity, nasal cavity volume, nasal airway resistance, total nasal respiratory volume, and other information. Also we fill in the nasal obstruction symptom assessment scale, sleepiness scale, and study and analyze the surgical effect of nasal cavity expansion.