non-OSA Group Research Articles

The role of dry mouth in screening sleep apnea

Purpose of the studyEffective screening questionnaires are essential for early detection of obstructive sleep apnea (OSA). The STOP-Bang questionnaire has high sensitivity but low specificity. Dry mouth is a typical...

Children who underwent tonsillectomy due to OSAS have significantly bigger tonsils than those with hypertrophic tonsils without OSAS

Introduction. Tonsillectomy is one of the most commonly performed procedures in otolaryngology departments. Main indications include tonsil hypertrophy with or without obstructive sleep apnea and recurrent throat infections. The size of tonsils in the group of children qualified for tonsillectomy with obstructive sleep apnea may differ from the size of tonsils in the group without obstructive sleep apnea. Aim. Comparison of morphological features of tonsils in children with and without OSAS undergoing tonsillectomy. Material and methods. Retrospective study conducted from 2011 until 2020, including patients under 18 years old who underwent a total or partial tonsillectomy at the Department of Otorhinolaryngology at the University Medical Center in Ljubljana. Results. Among 824 patients included in the analysis, 96 underwent tonsillectomy due to OSAS and 728 due to tonsil hypertrophy without OSAS. Both groups were comparable in terms of mean age and sex distribution. Tonsil size statistically differed in both groups (p = 0.01), with the prevalence of big tonsils (grade 3 of 4) in the non-OSAS group (in 47% of patients) and large tonsils (grade 4 of 4) in the OSAS group (in 53% of patients). Conclusions. In age and sex-matched groups of children who underwent total or partial tonsillectomy, patients who underwent the procedure due to OSAS had bigger tonsils than those with hypertrophy without OSAS.

Perception of sleep duration in adult patients with suspected obstructive sleep apnea.

Discrepancies between subjective and objective measures of total sleep time (TST) are frequent among insomnia patients, but this issue remains scarcely investigated in obstructive sleep apnea (OSA). We aimed to evaluate if sleep perception is affected by the severity of OSA. We performed a 3-month cross-sectional study of Brazilian adults undergoing overnight polysomnography (PSG). TST was objectively assessed from PSG and by a self-reported questionnaire (subjective measurement). Sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5.0/h, being its severity classified according to AHI thresholds: 5.0-14.9/h (mild OSA), 15.0-29.9/h (moderate OSA), and ≥ 30.0/h (severe OSA). Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups (p = 0.014). Mean SPI values significantly decreased as the OSA severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036. Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028). However, insomnia was not considered as an independent variable for the presence of any OSA, moderate/severe OSA, and severe OSA (all p-values > 0.05). In a clinical referral cohort, SPI significantly decreases with increasing OSA severity, but is not modified by the presence of insomnia symptoms.

Risk factors associated with the severity of obstructive sleep apnea syndrome among adults

Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that causes significant physiologic disturbance with various clinical impacts. The aim of the study was to determine the risk factors associated with the severity of OSAS. 303 patients with OSAS and 199 patients without OSAS enrolled in the sleep disorder center from 2017 to 2019 were included in the study. All patients completed physical examination, Epworth sleepiness scale, and polysomnography. By apnea–hypopnea index (AHI), patients were separated into four subsets: AHI < 5 as non-OSAS group, AHI ≧ 5 and < 15 as mild group, AHI ≧ 15 and < 30 as moderate group and AHI ≧ 30 as severe group. AVONA analyses, chi-square test, univariate and multivariate linear regression analyses were conducted to assess the correlation between specific factors and AHI. Our study demonstrated that patients with severe OSAS were associated with higher body mass index, higher systolic blood pressure awake in the morning, lengthened latent period of slow wave sleep, lower level of average oxygen saturation and minimum oxygen saturation (P < 0.05). Our findings provide evidence regarding several potentially useful factors for recognizing OSAS in adults, and physicians should promote the early recognition, diagnosis and intervention of OSAS.

The utility of proinflammatory markers in patients with obstructive sleep apnea.

To evaluate the association of recently diagnosed obstructive sleep apnea (OSA) with TNF-α and IL-6 and to measure the effect of short-term continuous positive airway pressure (CPAP) therapy on these markers. A prospective, open-label, controlled trial was conducted among patients referred for diagnostic polysomnography (PSG). After PSG, patients were divided into 3 groups: OSA intervention group (N = 21), OSA control untreated group (N = 19), and non-OSA control group (N = 24). IL-6 and TNF-α levels were measured at baseline and 1 month after intervention. Repeated measures (RM) ANOVA and ANCOVA were used to compare the three groups regarding changes in TNF-α and IL-6 levels by analyzing between-subject and within-subject effects as a function of time and adjusting for significant covariates. At baseline, IL-6 (p = 0.05) and TNF-α (p = 0.04) were significantly higher in the OSA patients than in the non-OSA controls. There was no effect of time either on the TNF-α (p = 0.069) or IL-6 (p = 0.717) after 1 month of CPAP. No interaction effect between group and time was found for either TNF-α (p = 0.240) or IL-6 (p = 0.552) after 1 month of CPAP. There was neither a group effect nor an interaction effect between group and time for either IL-6 or TNF α after adjusting for age, BMI, neck circumference, and AHI. This study showed increases in proinflammatory state as illustrated by plasma TNF-α and IL-6 levels among recently diagnosed OSA patients, but there were no changes in these inflammatory markers following 1-month CPAP therapy.

Obstructive sleep apnoea and cognitive decline in mild-to-moderate Alzheimer's disease.

We evaluated the influence of untreated obstructive sleep apnoea (OSA) on the magnitude of cognitive decline and on several cognitive subdomains in patients with mild-to-moderate Alzheimer's disease.In this single-centre study, 144 patients were recruited prospectively from a cognitive impairment unit and underwent overnight polysomnography.The mean±sd change in the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) score at 12 months was 3.19±5.61 in the non-OSA group and 0.08±5.62 in the OSA group, with an intergroup difference of -3.36 (95% CI 0.19-0.16; p=0.002). We did not observe a significant difference in any cognitive subdomains at 12 months. Regarding Mini-Mental State Examination scores at 36 months, the mean change was 1.69 (95% CI -1.26-4.64; p=0.445). No significant differences were found among different OSA severity groups.We observed that ADAS-cog scores were better in the OSA group than in the non-OSA group by a statistically but not clinically significant margin. We did not find differences in the different cognitive subdomains after 1 year or in global cognition after 3 years of follow-up.

1014 Relationship Between Lung Function and Obstructive Sleep Apnea in Cystic Fibrosis

Abstract Introduction The frequency of obstructive sleep apnea (OSA) may be high among patients with cystic fibrosis (CF), a life-shortening, genetic respiratory disease that affects approximately 30,000 Americans. Yet, the potential relationship between OSA and lung function has not been thoroughly explored. Methods Single-center retrospective review of polysomnography (PSG) results from 2009-2017 in referred patients with CF and available pulmonary function data (PFTs) obtained at time of PSG and at 3, 6, 9, and 12-months prior. Results Mean ages were 11.1±3.9 (sd) and 37.1±14.1 years, among 18 children and 16 adults, respectively. Mean body mass index (BMI) was normal in both groups (62.5±26.6% in children; 25.1±6.4 kg/m2 in adults). Twenty-six subjects (76%) had OSA (apnea-hypopnea index &amp;gt;1 in children, ≥5 in adults). Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was higher among subjects with vs. without OSA at PSG and at each time-point in the year prior, independent of age and BMI at PSG (longitudinal mixed effects model, β=19.0, SE=8.1, p=0.028). While FEV1 PPD remained unchanged in the non-OSA group, FEV1 PPD at PSG was lower, in comparison to the year prior in subjects with OSA, with the greatest difference observed at 9-months prior to PSG (2-sample t-test, difference of -6.6% vs 0.6% in OSA vs. non-OSA groups respectively, p=0.078). Conclusion The PFTs, as daytime markers of CF lung disease severity, do not seem to reliably predict risk for OSA. In our sample, CF patients with vs. without OSA had better PFTs at baseline but they also showed a greater tendency for decline in PFTs over the year prior to OSA diagnosis. Larger sample size and longer duration of assessment may help, going forward, to assess any potential adverse impact of OSA on lung function decline. Support NIH Training Grant (T32NS007222, F32HL145915)

0882 Local Deformation Analysis of Lateral Cephalogram for Childhood OSA Classification

Abstract Introduction Craniofacial profile is one of the anatomical causes of obstructive sleep apnea (OSA). Cephalometry provides information on patients’ skeletal structures and soft tissues. Traditional cephalometric analysis focuses on linear distances, angles, ratios and area of specific variables. Its classification power is often disappointed. In this study, a novel approach to cephalometric analysis using local deformation information was carried out to assess its efficacy in OSA classification. Methods This study was a retrospective analysis based on 60 case-control pairs who were Chinese children recruited for sleep studies in the Prince of Wales Hospital, with accessible lateral cephalometry and polysomnography (PSG) data. Local deformation technique was adopted to derive 1215 deformations from 15 manual landmarking on each cephalogram. In addition, three linear distances (hyoid bone to mandibular plane, hyoid bone to posterior pharyngeal wall, and minimal distance between tongue base and posterior pharyngeal wall) were measured from each cephalogram. A total of 1218 information features were obtained per subject. Classification models were built with an equal ratio between OSA and non-OSA groups (defined by OAHI≥1 and OAHI&amp;lt;1 respectively). Forty pairs were used as training data and twenty pairs were used as testing data. Results Three model settings which used all 1218 cephalometric features, 800 features, and 500 features were tested. The accuracy for the three settings were 67.5% (sensitivity: 70%, specificity: 65%), 87.5% (sensitivity: 90%, specificity: 85%), and 92.5% (sensitivity: 95%, specificity: 90%) respectively. Apart from the three distances, the 500 topmost discriminative features were predominantly landmarks around the nasal cavity. Conclusion A new approach to cephalometric analysis using local deformation information can provide additional details on each cephalogram, hence, achieving better classification. The classification models using 500 features yielded the highest accuracy among the three settings. This setting could benefit most from the comprehensive comparison while avoiding overfitting. Support -

The value of improved Mallampati grading combined with NoSAS in OSA screening

Objective:To evaluate the value of improved Mallampati grading combined with NoSAS questionnaire in screening for obstructive sleep apnea （OSA）. Method:A total of 344 patients admitted to our hospital for sleep disorders were studied. All patients were measured for their height, weight, neck circumference and other parameters. NoSAS scores, improved Mallampati grading and polysomnography （PSG） were performed in these patients. According to AHI in PSG monitoring results, patients were divided into non-osa group （AHI<5） 93 cases and OSA group 251 cases. The OSA group were divided into mild （AHI 5-15）, moderate（AHI 16-30） and severe OSA group（AHI>30） according to the PSG result. The ROC curve was plotted to evaluate the screening value of NoSAS and improved Mallampati grading combined with NoSAS for OSA. Result:With the NoSAS score of 8 or 9 as cutoffs for analysis, the sensitivity for OSA was 0.733 and 0.701; the specificity for OSA was 0.538 and 0.624, respectively. The sensitivity and specificity of NoSAS combined with improved Mallampati grading for screening OSA were 0.813 and 0.710, respectively. Conclusion:As a new screening tool, NoSAS questionnaire is simple and convenient, and has certain screening value to OSA. The improved Mallampati grading combined with NoSAS questionnaire can obviously improve the screening sensitivity and specificity of Osa, and has higher application value.

Association of epicardial adipose tissues with obstructive sleep apnea and its severity: A meta-analysis study

Background and aimsObstructive sleep apnea (OSA) is a global disease that is a manifestation of metabolic syndrome. Epicardial adipose tissue (EAT), a special type of visceral adipose tissue, has been proposed to be an independent predictor of visceral adiposity. Both OSA and EAT have a close association with diabetes and coronary artery disease. Whether EAT thickness is associated with OSA is controversial. Methods and resultsSeveral databases were searched from their inception to October 13, 2019. We estimated the summarized weighted mean difference (WMD) with 95% confidence intervals (CIs) for EAT thickness in the OSA and non-OSA groups. Then, we conducted a meta-analysis to evaluate the association between EAT thickness and OSA. The relationship between EAT thickness and OSA severity was also assessed. Nine studies with a total of 1178 participants were included. Globally, patients with OSA had a higher EAT thickness than patients without OSA (WMD = 0.95, 95% CI: 0.73–1.16, P < 0.001). Compared to the non-OSA patients, those with mild, moderate, and severe OSA had a progressively higher EAT thickness (WMD = 0.62, 95% CI: 0.41–0.83; WMD = 0.83, 95% CI: 0.50–1.15; and WMD = 1.06, 95% CI: 0.70–1.43, respectively; all P < 0.001). ConclusionEAT thickness was shown to be higher in patients with OSA than in patients with non-OSA measured by echocardiography. The increase in the EAT thickness was associated with OSA severity.

Hypoglossal nerve stimulation therapy does not alter tongue protrusion strength and fatigability in obstructive sleep apnea.

Hypoglossal nerve stimulation (HNS) is an effective surgical alternative for patients with obstructive sleep apnea (OSA). HNS therapy relies on the stimulation of the hypoglossal nerve to open the upper airways. This stimulation could lead to alterations in tongue strength and fatigability, which could alter treatment outcome over time. The aim of the study was to investigate whether HNS alters tongue strength and fatigability. Tongue protrusion strength (peak pressure in kPa) and fatigability (time to task failure during 50% of peak pressure contraction) were measured with a pressure transducer at least 2 months after HNS implantation (n = 30). These results were compared to a group of patients with OSA (n = 38) and a non-OSA control group (n = 35). Median tongue protrusion strength was lower (54.7 [43.8, 63.0] versus 60.7 [53.7, 66.0] kPa, P = .013) and fatigue occurred more quickly (21.3 [17.4, 26.3] versus 26.0 [19.3, 31.3] seconds, P = .017) in the patients with OSA compared to the non-OSA control group. In multiple regression analysis, age was a significant factor for tongue strength and diagnosis of OSA for tongue fatigability. Tongue strength and fatigability did not differ between patients with OSA with conservative therapy or observation versus after HNS implantation (51.8 [41.3, 63.4] versus 56.3 [45.0, 62.3] kPa, P = .502; 20.8 [16.3, 26.2] versus 21.8 [18.3, 26.8] seconds, P = .418). Tongue strength decreases with age. Tongue fatigability is more pronounced in people with OSA. However, approximately 1.5 years of HNS therapy on average does not alter tongue strength or fatigability compared to an OSA control group. Registry: ClinicalTrials.gov; Title: Change in Tongue Strength and Fatigue After Upper Airway Stimulation Therapy; Identifier: NCT03980158.

Exploring the STOP-BANG questionnaire for obstructive sleep apnea screening in seniors.

The accuracy of obstructive sleep apnea (OSA) screening instruments in seniors may change as the predictive role of sex, age, and body mass index (BMI) changes with aging. We investigated the diagnostic performance of the STOP-BANG questionnaire in older individuals with aging-adapted scores and thresholds. Independent community-dwelling adults aged 65 years or older were screened for OSA. The STOP-BANG questionnaire was tested with different configurations and compared to the apnea-hypopnea index (AHI) obtained from home sleep apnea testing (HSAT). Epworth Sleepiness Scale (ESS) and Athens Insomnia Scale (AIS) were tested as possible supplementary screening criteria. We recruited 458 individuals with a mean age of 71 ± 5 years, 41% men, BMI of 28.5 ± 4.6 kg/m². Mild, moderate, and severe OSA were present in, respectively, 34%, 30%, and 19% of the sample. The STOP questions had an area under the curve (AUC) of the receiver operating characteristic curve significantly lower than the STOP-BANG and the STOP+BMI > 28 kg/m² (STOP-B28). Both STOP-BANG and STOP-B28 had high sensitivity and low specificity in all OSA levels with similar AUC to predict AHI ≥ 5 events/h, 0.64. ESS and AIS were nonsignificant as adjunctive instruments. Novel modifications of a standard instrument created the STOP-B28, a simpler-to-obtain and similarly performing variation of the STOP-BANG using fewer inputs, and useful to exclude OSA. Screening seniors via questionnaires to detect OSA is problematic. Considering the 83% OSA prevalence in this age group, it may be a sensible option to indicate objective tests, oximetry, HSAT, or even polysomnography, as a first step in OSA investigation.

Association of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis

BackgroundResearch evidence suggests a close relationship between overweight and obesity with obstructive sleep apnoea (OSA); however, the extent of this relationship among different population groups is relatively unknown. The aim of this paper was to conduct a systematic review and meta-analysis to determine the magnitude of association of overweight and obesity with OSA in different population groups. MethodsWe searched five electronic databases (Medline, Embase, Cochrane Library, CBM and CNKI) from inception to December 2017 for comparative epidemiological studies assessing the relation between overweight and obesity with OSA. Studies were included if they reported OSA by polysomnography and overweight/obesity by body mass index. Two authors independently screened titles and abstracts, selected studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was examined using Cochrane's Q statistic and I2 test and explored using subgroup analyses for adults and children, adjusting for potential confounders. Publication bias was assessed using a funnel plot. ResultsTwelve case-control studies encompassing a total of 3214 participants (Obese group n = 773, Non-Obese group n = 315; OSA group n = 1742, Non-OSA group n = 384) were analyzed. Results showed that increased body mass index was associated with higher risk of OSA in the adult group. The Obese group was associated with increased risk of apnoea-hypopnoea index (AHI) compared to the Non-Obese group and the differences were statistically significant in both children (Mean Difference = 12.29; 95% CI 8.46–16.11; P < 0.00001) and adults (Mean Difference = 12.11; 95% CI 4.35–19.85; P = 0.002). ConclusionsThese findings suggest that overweight and obesity are important risk factors for OSA in both adults and children. Future studies are required to determine the effects of weight loss interventions in the development of obesity-related OSA.

Validation of NoSAS Score and Obstructive Sleep Apnea Hypopnea Syndrome Screening Model for Female Snorers in Females with Obstructive Sleep Apnea

Objective To evaluate the NoSAS score and the obstructive sleep apnea hypopnea syndrome(OSAHS)screening model for female snorers with obstructive sleep apnea(OSA)in females and compare the performance of these two tools. Methods A total of 425 females with suspected OSA who underwent overnight polysomnography(PSG)were consecutively recruited into this study.The above two questionnaires were completed.Based on the severity of OSA which was determined by apnea-hypopnea index(AHI),the patients were classified into four groups:non-OSA group(AHI<5 events/h),OSA group(AHI≥5 events/h),moderate-to-severe OSA group(AHI>15 events/h),and severe OSA group(AHI>30 events/h).The sensitivity,specificity,positive predictive values,negative predictive values,and the area under the receiver operating characteristics(ROC)curve of two questionnaires were calculated. Results The sensitivity of NoSAS score for OSA,moderate-to-severe OSA,and severe OSA groups were 57.3%,64.9%,and 69.5%,and its specificity was 83.5%,76.6%,and 70.9%,respectively.The sensitivity of the OSAHS screening model of female snorers was 62.7%,74.8%,and 75.8%,and its specificity was 92.5%,84.3%,and 74.5%,respectively.Both of these two screening tools had high specificity and performed well in ruling out non-OSA females.For patients with their AHI≥5 events/h,the results of NoSAS score and OSAHS screening model were in moderate to high consistency with those diagnosed by PSG,with a Kappa value of 0.401 and 0.541,respectively.The area under curve of these two tools was 0.792(95% CI=0.750-0.829)and 0.866(95% CI=0.830-0.897),respectively,showing moderate screening value.The area under curve of the OSAHS screening model of female snorers was significantly larger than that of NoSAS score(P =0.002,P =0.003,P =0.019). Conclusions Both the NoSAS score and the OSAHS screening model for female snorers have a moderate performance in diagnosing OSA in females,although the OSAHS screening model for female snorers has better performance.However,the sensitivity of the OSAHS screening model needs to be further improved.

High-resolution Peripheral Quantitative Computed Tomography for the Assessment of Bone Strength and Structure in Obstructive Sleep Apnea Patients

Objective To evaluate the bone strength and structure of patients with obstructive sleep apnea(OSA)by the high-resolution peripheral quantitative computed tomography(HR-pQCT)and to explore the relationship between OSA and osteoporosis. Methods Male patients who visited the Sleep Respiratory Center of our hospital from August 2017 to January 2019 were consecutively recruited.Clinical data including the results of Epworth sleep scale(ESS)scoring and overnight polysomnography were collected.HR-pQCT was used to compare the differences in bone geometry,density,and microstructure between OSA patients and non-OSA people;also,the radius and tibia on the non-dominant side were measured to explore the relationship between OSA and osteoporosis. Results A total of 83 subjects were enrolled in the study.The number of patients in the mild,moderate,and severe OSA groups and non-OSA group were 21,18,34,and 10,respectively.There was no significant difference in age,blood pressure,ESS score,sleep stage,and sleep efficiency among these four groups(P>0.05).Body mass index(BMI)and neck circumference were significantly different among these groups(F=4.234,P=0.008;F=3.100,P=0.031).There was no significant difference in the radius indicators(P>0.05).For tibia,there were significant differences among the four groups in the cortical area(Ct.Ar)(F=3.937,P=0.011).There were also significant differences in the bone microstructural indicators including trabecular thickness(Tb.Th)and cortical thickness(Ct.Th)(F=6.247,P=0.001;F=3.746,P=0.014),which were significantly lower in the three OSA groups than in the control group.Pairwise comparisons showed that the Ct.Ar in the severe OSA group was significantly higher than that in the mild OSA group(P=0.019)and Tb.Th in the control group was significantly higher than those in the mild and moderate OSA groups(P=0.006,P=0.001).Correlation analysis showed that,within a certain range,total volumetric bone mineral density(Tt.vBMD)and Tb.Th of radius and tibia were negatively correlated with age(r=-0.312,P=0.004;r=-0.328,P=0.002;r=-0.265,P=0.015;r=-0.280,P=0.010)and positively correlated with BMI(r=0.240,P=0.029;r=0.369,P=0.004;r=0.299,P=0.006;r=0.416,P=0.010).Stepwise multiple regression analysis showed that Tb.Th of radius and tibia were mostly correlated with BMI(β=0.262,P=0.008,R 2=0.243,F=6.270,P=0.000;β=0.494,P=0.000,R 2=0.186,F=7.243,P=0.000)and age(β=-0.216,P=0.030,R 2=0.243,F=6.270,P=0.000;β=-0.306,P=0.003,R 2=0.186,F=7.243,P=0.000).Tt.vBMD of radius had a certain correlation with sleep efficiency and with the decreasing nocturnal mean oxygen saturation caused by OSA(β=0.312,P=0.002, β=-0.249,P=0.012,R 2=0.327,F=7.482,P=0.000). Conclusions In non-elderly male populations,OSA mainly causes a decrease in Tb.Th and Ct.Th of the tibia.The changes in bone strength and structure are mainly related with age and body size and also have certain correlations with sleep efficiency and with the decreasing nocturnal mean oxygen saturation caused by OSA.

Implications of Obstructive Sleep Apnea on the Cognitive Evolution of Alzheimer's Disease Patients

Background: Sleep-disordered breathing encompasses a group of diseases, of which obstructive sleep apnea (OSA) is most frequent. Alzheimer's disease (AD) is the most prevalent neurodegenerative disease; it is manifested as an initial deficit of episodic memory that evolves into global cognitive and psychosocial dysfunction, and its prevalence is increasing around the world. OSA has been described as a risk factor for AD, and its prevalence is higher in AD patients. However, little is known about the influence of OSA on cognition in the AD population.The aim of this study was to evaluate the impact of nontreated OSA on the cognitive evolution of patients with mild-moderate AD, to investigate whether the magnitude of the cognitive decline is associated with the severity of OSA and to evaluate the influence of OSA on several cognitive subdomains in AD patients. Methods: In this single-center study, patients with mild-moderate AD were recruited prospectively from a cognitive impairment unit and underwent overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) >15/h. AD severity was assessed using the Mini-Mental State Examination (MMSE). The primary outcome was to measure the change in cognitive score on the Alzheimer’s Disease Assessment Scale-cognitive scale (ADAS-cog) from baseline to 12 months in patients with mild AD with and without OSA. An extensive battery of neuropsychological tests, including the Epworth Sleepiness Scale (ESS), were performed and APOE status was measured. Findings: The cohort included 144 patients with a mean (SD) age of 75.19 (5.30) years; 72 (57.6%) were women, and the mean MMSE score was 23.5 (2.24) points at baseline. The mean (SD) change in the ADAS-cog score at 12 months was 3.19 (5.61) in the non-OSA group and 0.08 (5.62) in the OSA group, with a difference between the groups of -3.36 (95%CI 0.19 to 0.16; p=0.002). Regarding the changes in the ADAS-cog subitems at 12 months, ideational praxis, remembering test instructions and commands showed a significant difference between the groups (p<0.05). We did not observe significant differences in cognitive subdomains, such as memory or executive functioning, or for caregiver overload, on the extensive battery of neuropsychological assessments at 12 months. No significant differences were found according to OSA severity group by ADAS-cog or MMSE at 12 months neither at 36 months by MMSE.According to the MMSE score at 36 months, the mean change was similar between the groups, with a difference of 1.69 (95%CI -1.26 to 4.64; p = 0.445). Interpretation: In this large cohort of patients with AD, we demonstrated that that OSA did not worsen cognitive evolution after 1 year of follow-up, either in global cognition or in the different cognitive subdomains, or global cognition after 3 years of follow-up. Based on these findings, OSA does not modify the cognitive evolution of patients in mild or moderate stages of Alzheimer’s disease. Trial Registration: This study was registered with ClinicalTrials.gov (number NCT02814045). Funding Statement: This work was supported by “Fundacio La Marato TV3” (Gerard Pinol), the Spanish Respiratory Society (SEPAR), PERIS SLT008/18/00050, the Health Department of Generalitat de Catalunya and ALLER. This work was supported by the IRBLleida Biobank (B.0000682) and PLATAFORMA BIOBANCOS PT17/0015/0027/. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was conducted in accordance with the Declaration of Helsinki, and it was approved by the care ethics committee of Hospital Arnau de Vilanova de Lleida (CE-1218). All patients signed informed consent.

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of...

Study on the application effect of the female OSAHS screening model

Objective To evaluate the screening effect of the female obstructive sleep apnea (OSAHS/OSA) screening model and test its ability to examine OSA. Methods From March 2018 to January 2019, 245 women who met the inclusion criteria for polysomnography monitoring in two ClassⅢ Grade A hospitals were selected as the research objects. The researcher asked the objectives one by one and filled in the questionnaire. Subjects were grouped according to Apnea Hypopnea Index (AHI) to calculate the sensitivity and specificity, positive predictive value and negative predictive value of the OSAHS screening model of female snorers. The screening effect of the female OSAHS screening model was determined according to the Youden Index, coincidence rate, Kappa value, ROC curve and its area. Results Among 245 women, 108 were non-OSA and 137were OSA. The scores of female OSAHS screening model was positively correlated with AHI (r=0.654, P<0.01) , positively correlated with BMI, MMP grading and snoring years, and negatively correlated with night mean oxygen saturation (P<0.01) . The differences of screening model items between OSA group and non-OSA group were statistically significant (P<0.01) . The area under ROC curve of the female OSAHS screening model was 0.845 (95%CI: 0.797-0.893) , which indicated that the female OSAHS screening model had moderate ability ofpredicting OSA. The coincidence rate of model screening OSA was 74.7% divided by 7 points when AHI was no less than 5 events/h, and the female OSAHS screening model has moderate consistency in predicting OSA. When the cut-off values were set to be 6 points, the Youden index was the highest, and the sensitivity was 86.1%, 93.6%, 96.9%, the specificity was 63.9%, 59.6% and 47.8% respectively. Conclusions The female OSAHS screening model has moderate predictive value and good screening effect for female OSA. It should be further validated and promoted. Key words: Female; Obstructive sleep apnea-hypopnea sydrome; Screen; Model

Prevalence of Obstructive Sleep Apnoea Syndrome (OSAS) and Its Association with Hypertension in Jatinangor West Java

Background: Hypertension is a global health problem, with the prevalence increasing by 30% from 2013 to 2018 in Indonesia. Furthermore, obesity, a major risk factor for hypertension, has also escalated by 50%. Hence, the incidence of Obstructive Sleep Apnoea Syndrome (OSAS), which is strongly associated with hypertension and obesity, is expected to increase. OSAS is part of the complex sleep disorder breathing syndrome, but there is a lack of data regarding its prevalence and association with hypertension. Objective: To investigate the prevalence of OSAS and its association with hypertension in Jatinangor, West Java, Indonesia. Methods: A cross-sectional study was conducted from September to October 2018 of subjects from two villages in Indonesia selected by purposive sampling. Fifteen neighbourhoods were chosen by the cluster random sampling method, with a total of 1,308 respondents included in this study. Inclusion criteria were age &gt; 17 years old and resident in the village for more than one year. OSAS was determined by a 4-variable screening tool questionnaire (4-V) and hypertension was measured by a standardised method (average of three measurements in each session with a one-minute break using a digital device); both measurements were performed by trained health cadres. All results were statistically analysed using chi-square and logistic regression. Results: Of the total of 1308 respondents included in this study, 33 (2.5%) had OSAS and 299 respondents (22.8%) had hypertension. In the population with OSAS, 18 respondents (54.5%) had hypertension, significantly higher (p&lt;0.001) compared to the non-OSAS group (22%). After adjustment for age, gender, and Body Mass Index (BMI), OSAS was still an independent predictor of hypertension (OR = 4.3, p = 0.000). Conclusion: The prevalence of OSAS in the Jatinangor district of Indonesia is 2.5% and it is significantly associated with hypertension.

Oropharyngeal Microbiome in Obstructive Sleep Apnea: Decreased Diversity and Abundance.

To explore and analyze diversity and abundance of oropharyngeal microbiota in patients with obstructive sleep apnea (OSA). This was a cross-sectional study. Middle-aged men, suspected to have OSA, referred to full-night polysomnography, and willing to provide oropharyngeal swab samples, were consecutively enrolled. OSA severity was assessed by apnea-hypopnea index (AHI) as non-OSA (AHI < 5 events/h) and OSA (AHI ≥ 15 events/h). Bacterial DNA of oropharyngeal samples was extracted and quality test performed. Oropharyngeal microbiota was analyzed using 16S ribosomal DNA (rDNA) sequencing, and bioinformatic analysis carried out after sequencing. Samples from 51 men (25 in the non-OSA group and 26 in the OSA group) were sent for examination. Of these, 40 samples were found to have sufficient concentration of DNA and were analyzed for bioinformatics. In alpha diversity analysis, the OSA group exhibited significantly lower sobs (198.33 ± 21.71 versus 216.57 ± 26.21, P = .022), chao (221.30 ± 26.62 versus 243.86 ± 26.20, P = .014), ace (222.17 ± 27.15 versus 242.42 ± 25.81, P = .028) and shannon index (3.14 ± 0.23 versus 3.31 ± 0.26, P = .035), suggesting a reduction in microbial species diversity. We further divided participants into non-OSA, moderate OSA, and severe OSA groups and observed a significant decrease in the bacterial biodiversity of OSA groups compared with the non-OSA group, with the most significant decrease occurring in the moderate OSA group. Principal coordinate analysis showed two extremely different oropharyngeal microbial communities in non-OSA and OSA groups. More interestingly, proportion of Neisseria was slightly higher in the severe OSA group (20.64%), followed by the moderate OSA and non-OSA groups (12.57% and 9.69%, respectively). Glaciecola was not detected in the OSA groups compared to the non-OSA group (0 versus 0.772 ± 0.4754, P < .001). Middle-aged men with OSA showed less oropharyngeal species diversity and altered abundance, on which further confirmation is warranted.